IMPORTANCE It is estimated that more than half of those with serious mental illness smoke tobacco regularly. Standard courses of pharmacotherapeutic cessation aids improve short-term abstinence, but most who attain abstinence relapse rapidly after discontinuation of pharmacotherapy.OBJECTIVE To determine whether smokers diagnosed with schizophrenia and bipolar disease have higher rates of prolonged tobacco abstinence with maintenance pharmacotherapy than with standard treatment. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled, parallel-group, relapse-prevention clinical trial conducted in 10 community mental-health centers. Of 247 smokers with schizophrenia or bipolar disease recruited from March 2008-April 2012, 203 received 12-weeks' open-label varenicline and cognitive behavioral therapy and 87 met abstinence criteria to enter the relapse prevention intervention.INTERVENTIONS Participants who had 2 weeks or more of continuous abstinence at week 12 of open treatment were randomly assigned to receive cognitive behavioral therapy and double-blind varenicline (1 mg, 2 per day) or placebo from weeks 12 to 52. Participants then discontinued study treatment and were followed up to week 76. MAIN OUTCOMES AND MEASURESSeven-day rate of continuous abstinence at study week 52, the end of the relapse-prevention phase, confirmed by exhaled carbon monoxide. Secondary outcomes were continuous abstinence rates for weeks 12 through 64 based on biochemically verified abstinence and weeks 12 through 76, based on self-reported smoking behavior.RESULTS Sixty-one participants completed the relapse-prevention phase; 26 discontinued participation (7 varenicline, 19 placebo) and were considered to have relapsed for the analyses; 18 of these had relapsed prior to dropout. At week 52, point-prevalence abstinence rates were 60% in the varenicline group (24 of 40) vs 19% (9 of 47) in the placebo group (odds ratio [OR], 6.2; 95% CI, 2.2-19.2; P < .001). From weeks 12 through 64, 45% (18 of 40) among those in the varenicline group vs 15% (7 of 47) in the placebo group were continuously abstinent (OR, 4.6; 95% CI, 1.5-15.7; P = .004), and from weeks 12 through 76, 30% (12 of 40) in the varenicline group vs 11% (5 of 47) in the placebo group were continuously abstinent (OR, 3.4; 95% CI, 1.02-13.6; P = .03). There were no significant treatment effects on psychiatric symptom ratings or psychiatric adverse events.CONCLUSIONS AND RELEVANCE Among smokers with serious mental illness who attained initial abstinence with standard treatment, maintenance pharmacotherapy with varenicline and cognitive behavioral therapy improved prolonged tobacco abstinence rates compared with cognitive behavioral therapy alone after 1 year of treatment and at 6 months after treatment discontinuation.

As Earth's atmosphere accumulates carbon dioxide (CO 2 ) and other greenhouse gases, Earth's climate is expected to warm and precipitation patterns will likely change. The manner in which terrestrial ecosystems respond to climatic changes will in turn affect the rate of climate change. Here we describe responses of an old-field herbaceous community to a factorial combination of four levels of warming (up to 4°C) and three precipitation regimes (drought, ambient and rain addition) over 2 years. Warming suppressed total production, shoot production, and species richness, but only in the drought treatment. Root production did not respond to warming, but drought stimulated the growth of deeper (> 10 cm) roots by 121% in 1 year. Warming and precipitation treatments both affected functional group composition, with C 4 grasses and other annual and biennial species entering the C 3 perennial-dominated community in ambient rainfall and rain addition treatments as well as in warmed treatments. Our results suggest that, in this mesic system, expected changes in temperature or large changes in precipitation alone can alter functional composition, but they have little effect on total herbaceous plant growth. However, drought limits the capacity of the entire system to withstand warming. The relative insensitivity of our study system to climate suggests that the herbaceous component of old-field communities will not dramatically increase production in response to warming or precipitation change, and so it is unlikely to provide either substantial increases in forage production or a meaningful negative feedback to climate change later this century.

IntroductionCurrent evidence has demonstrated the usefulness of mobile technology in supporting smoking cessation. 1 The most recent Cochrane review, based on 20 studies and a total sample size of 9100 smokers, indicated significant benefit of mobile phone-based smoking cessation interventions on long-term outcomes, with a relative risk estimate of 1.71, compared to no intervention or less intensive intervention via mobile.1 These effects were achieved with fully-automated, highly cost-effective programs of unprecedented reach. They were also achieved with a relatively low level of technological sophistication, as up to this point, mobile technology approaches to smoking cessation have largely used text messaging. AbstractIntroduction: Smartphone technology is ideally suited to provide tailored smoking cessation support, yet it is unclear to what extent currently existing smartphone "apps" use tailoring, and if tailoring is related to app popularity and user-rated quality. Methods: We conducted a content analysis of Android smoking cessation apps (n = 225), downloaded between October 1, 2013 to May 31, 2014. We recorded app popularity (>10 000 downloads) and user-rated quality (number of stars) from Google Play, and coded the existence of tailoring features in the apps within the context of using the 5As ("ask, " "advise, " "assess, " "assist, " and "arrange follow-up"), as recommended by national clinical practice guidelines. Results: Apps largely provided simplistic tools (eg, calculators, trackers), and used tailoring sparingly: on average, apps addressed 2.1 ± 0.9 of the 5As and used tailoring for 0.7 ± 0.9 of the 5As. Tailoring was positively related to app popularity and user-rated quality: apps that used two-way interactions (odds ratio ), proactive alerts .38]), responsiveness to quit status ), addressed more of the 5As (OR = 1.53 [1.10-2.14]), used tailoring for more As (OR = 1.67 [1.21-2.30]), and/or used more ways of tailoring 5As content (OR = 1.35 [1.13-1.62]) were more likely to be frequently downloaded. Higher star ratings were associated with a higher number of 5As addressed (b = 0.16 [0.03-0.30]), a higher number of 5As with any level of tailoring (b = 0.14 [0.01-0.27]), and a higher number of ways of tailoring 5As content (b = 0.08 [0.002-0.15]). Conclusions: Publically available smartphone smoking cessation apps are not particularly "smart": they commonly fall short of providing tailored feedback, despite users' preference for these features.