***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To assess the process variables involved in a weight loss program for African-American adolescent girls . Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children , including program adherence , self-efficacy , and social support . The current study sought to broaden the underst and ing of these process variables as they pertain to an intervention program that is presented using the Internet . It was hypothesized that variables such as program adherence , dietary self-efficacy , psychological factors , and family environment factors would mediate the effect of the experimental condition on weight loss . RESEARCH METHODS AND PROCEDURES Participants were 57 adolescent African-American girls who joined the program with one obese parent ; family pairs were r and omized to either a behavioral or control condition in an Internet-based weight loss program .  Outcome data ( weight loss ) are reported for the first 6 months of the intervention . RESULTS Results partially supported the hypotheses . For weight loss among adolescents , parent variables pertaining to life and family satisfaction were the strongest mediating variables . For parental weight loss , changes in dietary practice s over the course of 6 months were the strongest mediators . DISCUSSION The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group . The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs Smoking  cessation interventions are needed for young adults . Innovative approaches to behavior change for this population should be tested . Formative research and process evaluation of those approaches would result in more effective programs . This paper presents the development process and process evaluation of a web-based  smoking cessation program . A description of the stages of development is presented with formative research , development of the web-based intervention , formative evaluation , and process evaluation . The smokers reported high usage of the intervention and satisfaction with the intervention in that it helped to raise their consciousness about quitting , encouraged them to set behavioral goals , provided stages of change feedback , and offered interactivity in presenting information and strategies about quitting . The Internet may be a promising tool for patient education according to the process results Objective : Alcohol consumption has been a growing concern at U.S. colleges , particularly among first-year students , who are at increased risk for problems . This study tested the efficacy of the “ electronic Check-Up to Go ” ( e-CHUG ) , a commercially-available internet program , at reducing drinking among a group of at-risk college freshman . Method : The design was a r and omized controlled trial : 106 freshmen students who reported heavy episodic drinking were r and omly assigned to receive feedback or to assessment only . Assessment measures were completed at baseline , 8 weeks , and 16 weeks . Results : At 8 weeks , the feedback group showed a significant decrease in drinks per week and peak BAC over control . By 16 weeks , the control group also declined to a point where there were no differences between groups . Changes in normative drinking estimates mediated the effect of the intervention . An additional 245 abstainers and light drinkers who were also r and omized to condition did not show any intervention effect . Conclusions : This study provides preliminary support for the efficacy of this intervention at reducing short-term drinking among at-risk students AIMS To test the feasibility of online alcohol screening and brief intervention ( BI ) by comparing ( i ) two approaches to inviting all students to be screened , and ( ii ) a minimal versus a more extensive BI . METHODS Freshmen students at one university were r and omized to receive one of two types of email invitations to an online anonymous : ( i ) general health assessment , or ( ii ) alcohol-specific assessment . All were linked to the same alcohol screening survey . Those with unhealthy alcohol use ( AUDIT > or=8 ) were r and omly assigned to minimal or more extensive online alcohol BI . RESULTS In both invitation groups ( 4008 students ) , 55 % of students completed the online screening .  Overall , 37 % of men and 26 % of women had unhealthy alcohol use .  Compared to minimal BI , more extensive BI was associated with intention to seek help among men and with a greater increase in readiness to change among women . One month after BI , 75 % of students completed another assessment , 33 % of women and 15 % of men with unhealthy alcohol use at baseline no longer had unhealthy alcohol use . There were no significant differences on drinking measures by BI r and omization group . CONCLUSIONS Over half of an entire freshman class of college students were reached by email and completed alcohol screening and brief intervention . Even an alcohol-specific invitation did not deter students . Although brief interventions that differed had some gender specific effects on readiness to change and intention , in general , unhealthy alcohol use decreased after brief intervention . Web screening and brief intervention show promise for addressing unhealthy alcohol use by college students OBJECTIVES This study aim ed to develop an Internet-assisted smoking cessation program accompanied with auricular acupressure , and compare the quit rate and self-efficacy of youth smokers receiving auricular acupressure with and without the Internet-assisted smoking cessation program . DESIGN A Website was constructed on IBM Websphere 5.0 and DB2 data base using HTML , Javascript , and JSP . A quasiexperimental research design was adopted . Subjects were assigned nonr and omly to two groups . Group 1 received auricular acupressure plus the Internet-assisted smoking cessation program , whereas group 2 received auricular acupressure only . MEASUREMENTS The data of demographic factors , serum cotinine , quitting rate , nicotine dependence , and self-efficacy of subjects were collected before and after a 4-week intervention . RESULTS After intervention , the quit rate was 15.78 % in group 1 and 2.56 % in group 2 . Nicotine dependence was significantly lowered in group 1 , but remained unchanged in group 2 . The improvement of self-efficacy between groups 1 and 2 was significantly different . CONCLUSIONS The combination of auricular acupressure and Internet-assisted smoking cessation program was more efficacious than auricular acupressure alone in terms of quit rate PURPOSE The Internet offers a potential medium for delivering smoking cessation treatment to adolescents . However , few Internet-based cessation programs for adolescents have been evaluated . We describe adolescent use of a  home-based Internet intervention to stop smoking ( Stomp Out Smokes [ SOS ] ) and explore baseline characteristics associated with SOS use . METHODS Participants were 70 adolescent smokers aged 12 - 18 years ( 50 % female , 90 % Caucasian ) r and omized to receive the SOS intervention for 24 weeks as part of a larger clinical trial . SOS comprised 40 components , of which eight were primarily interactive ( e.g. , discussion support group , ask an expert , quit plan ) and 32 were primarily informational ( e.g. , managing withdrawal , medications to stop smoking ) . SOS use data were captured electronically , including total logins to the site , and type of SOS components used defined by page hits on the interactive and information components . RESULTS A total of 7,708 SOS website pages ( 6825 interactive and 883 informational ) were accessed over the 24 weeks . The highest proportion of page hits was for the discussion support group ( 35 % ) and quit plan ( 30 % ) . Interactive pages were significantly more likely to be used than informational pages ( median 65 vs. 6 , p < .001 ) . Males accessed fewer interactive pages compared with females ( p = .04 ) . No other baseline characteristics were univariately associated with total logins or use of informational or interactive pages . CONCLUSIONS Adolescent smokers most often used a discussion support group and other interactive Internet-based cessation components . Future studies design ed to increase adolescent use , and efficacy of , Internet-based cessation programs are warranted The authors investigated the efficacy of an interactive Web site , MyStudentBody.com : Alcohol ( MSB : Alcohol ) that offers a brief , tailored intervention to help heavy drinking college students reduce their alcohol use . They conducted a r and omized , controlled clinical trial to compare the intervention with an alcohol education Web site at baseline , postintervention , and 3-month follow-up . Students were assessed on various drinking measures and their readiness to change their drinking habits . The intervention was especially effective for women and persistent binge drinkers . Compared with women who used the control Web site , women who used the intervention significantly reduced their peak and total consumption during special occasions and also reported significantly fewer negative consequences related to drinking . In addition , persistent heavy binge drinkers in the experimental group experienced a more rapid decrease in average consumption and peak consumption compared with those in the control group . The authors judged MSB : Alcohol a useful intervention for reaching important subgroups of college binge drinkers OBJECTIVE A r and omized controlled trial tested the efficacy of an internet-based lifestyle behavior modification program for African-American girls over a 2-year period of intervention . RESEARCH METHODS AND PROCEDURES Fifty-seven overweight ( mean BMI percentile , 98.3 ) African-American girls ( mean age , 13.2 years ) were r and omly assigned to an interactive behavioral internet program or an internet health education program , the control condition .  Overweight parents were also participants in the study . Forty adolescent-parent dyads ( 70 % ) completed the 2-year trial . Outcome data including BMI , body weight , body composition , and weight loss behaviors were collected at baseline and at 6-month intervals . A computer server tracked use of the web sites . RESULTS An intention-to-treat statistical approach was used , with the last observation carried forward . In comparison with the control condition , adolescents in the behavioral program lost more mean body fat ( BF ) ( -1.12 + /- 0.47 % vs. 0.43 + /- 0.47 % BF , p < 0.05 ) , and parents in the behavioral program lost significantly more mean body weight ( -2.43 + /- 0.66 vs. -0.35 + /- 0.64 kg , p < 0.05 ) during the first 6 months . This weight loss was regained over the next 18 months . After 2 years , differences in fat for adolescents ( -0.08 + /- 0.71 % vs. 0.84 + /- 0.72 % BF ) and weight for parents ( -1.1 + /- 0.91 vs. -0.60 + /- 0.89 kg ) did not differ between the behavioral and control programs . DISCUSSION An internet-based weight management program for African-American adolescent girls and their parents result ed in weight loss during the first 6 months but did not yield long-term loss due to reduced use of the web site over time The goal of this longitudinal study was to test an innovative approach to smoking cessation that might be particularly attractive to adolescent smokers . The study was a participatory research effort between academic and school partners . The intervention used an Internet-based , virtual reality world combined with motivational interviewing conducted in real-time by a smoking cessation counselor .  Participants were 136 adolescent smokers recruited from high schools r and omized to the intervention or a measurement-only control condition . Those who participated in the program were significantly more likely than controls to report at the immediate post-intervention assessment that they had abstained from smoking during the past week ( p < or=.01 ) , smoked fewer days in the past week ( p < or=.001 ) , smoked fewer cigarettes in the past week ( p < or=.01 ) , and considered themselves a former smoke ( p < or=.05 ) . Only the number of times quit was statistically significant at a one-year follow-up assessment ( p < or=.05 ) . The lack of longer-term results is discussed , as are method ological challenges in conducting a cluster-r and omized smoking cessation study Background Published research on the use of Web-based behavior change programs is growing rapidly . One of the observations characterized as problematic in these studies is that participants often make relatively few website visits and spend only a brief time accessing the program . Properly structured websites permit the unobtrusive measurement of the ways in which participants access ( are exposed to ) program content . Research on participant exposure to Web-based programs is not merely of interest to technologists , but represents an important opportunity to better underst and the broader theme of program engagement and to guide the development of more effective interventions . Objectives The current paper seeks to provide working definitions and describe initial patterns of various measures of participant exposure to ChewFree.com , a large r and omized controlled trial of a Web-based program for smokeless tobacco cessation . Methods We examined measures of participant exposure to either an Enhanced condition Web-based program ( interactive , tailored , and rich-media program ) or a Basic condition control website ( static , text-based material ) . Specific measures focused on email prompting , participant visits ( number , duration , and pattern of use over time ) , and Web page viewing ( number of views , types of pages viewed , and Web forum postings ) . Results Participants in the ChewFree.com Enhanced condition made more visits and spent more time accessing their assigned website than did participants assigned to the Basic condition website . In addition , exposure data demonstrated that Basic condition users thoroughly accessed program content , indicating that the condition provided a meaningful , face-valid control to the Enhanced condition . Conclusions We recommend that research ers conducting evaluations of Web-based interventions consider the collection and analysis of exposure measures in the broader context of program engagement in order to assess whether participants obtain sufficient exposure to relevant program content Pilot studies revealed promising results regarding crushing virtual cigarettes to reduce  tobacco addiction . In this study , 91 regular smokers were r and omly assigned to two treatment conditions that differ only by the action performed in the virtual environment : crushing virtual cigarettes or grasping virtual balls . All participants also received minimal psychosocial support from nurses during each of 12 visits to the clinic . An affordable virtual reality system was used ( eMagin H 
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Patterns of effective strategies could be observed , such as the combination of tailored communication and the use of reminders and incentives .