***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: In India , 57 % of men between 15 and 54 years and 10.8 % of women between 15 and 49 years use tobacco . A wide variety of tobacco gets used and the poor and the underprivileged are the dominant victims of tobacco and its adverse consequences . Project MYTRI ( Mobilizing Youth for Tobacco-Related Initiatives in India ) was a  tobacco prevention intervention program , a cluster-r and omized trial in 32 Indian schools which aim ed to decrease susceptibility to tobacco use among sixth- to ninth- grade students in urban setting s in India . This culture-specific intervention , which addressed both smokeless and smoked forms of tobacco , was Indian in content and communication . We qualitatively developed indicators which would help accurately measure the dose of the intervention given , received and reached . A multi-staged process evaluation was done through both subjective and objective measures . Training the teachers critically contributed toward a rigorous implementation and also correlated with the outcomes , as did a higher proportion of students participating in the classroom discussion s and better peer-leader-student communication . A sizeable proportion of subjective responses were ' socially desirable ' , making objective assessment a preferred methodology even for ' dose received ' . The peer-led health activism was successful . Teachers ' manuals need to be concise There are a number of impulses towards public participation in health care decision making including instrumentalist , communitarian , educative and expressive impulses and the desire for increased accountability . There has , however , been little research looking systematic ally at the public 's preferences for being involved in particular types of rationing decisions , nor indeed , has there been a critical examination of the degree of involvement desired by the public . The research reported here uses findings from focus groups and in-depth interviews to explore these questions . Eight focus groups were conducted with a total of 57 informants , four amongst r and omly selected members of the public and four with informants from health and non-health related organisations . Nineteen interviews were conducted to allow the elaboration of focus group comments , to probe views more deeply and to pursue emerging themes . The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with r and omly selected citizens and pre-existing organisations . There was a strong desire in all the groups for the public to be involved both at the system and programme levels , with much less willingness to be involved at the individual level . At the system and programme levels informants generally favoured consultation , without responsibility for decisions , but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained . At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment . The public has much to contribute , particularly at the system and programme levels , to supplement the inputs of health care professionals The RIPPLE study is a r and omized controlled trial of peer-led sex education in English secondary schools . In 1997 , 27 schools were recruited and r and omly allocated to a programme of peer-led sex education or to act as control schools . In experimental schools peer educators in Year 12 ( aged 16/17 years ) were recruited in two successive cohorts and , having received a st and ardized training programme , delivered classroom-based sex education sessions to Year 9 students ( aged 13/14 years ) . This paper is the first of two focusing on data gathered from these peer educators . Through analysis of pre-(n = 505 ) and post- ( n = 331 ) programme question naire data , the paper describes the profile of peer educators and examines the impact on them of their involvement . Compared to the students receiving the peer-led sex education , more peer educators were female , white , high academic achievers and less socially disadvantaged . Peer educators reported positive changes in sexual knowledge and changes towards more liberal attitudes , and believed the programme would have a positive impact on their confidence in relationships and on their sexual behaviour . There was an increase in confidence about communication and interaction in groups . The paper discusses the method ological difficulties of assessing how involvement in such a programme impacts on peer educators This article describes perceptions of adolescents involved in peer-led school-based nutrition promotions  encouraging lower-fat food purchases and assesses the differences by level of student involvement . Surveys were administered at schools . Data were collected from 397 high school students from 10 Minnesota schools r and omized to the intervention condition of the Trying Alternative Cafeteria Options in Schools study . Students were categorized as highly involved ( n=54 ) or less involved ( n=343 ) based on their level of involvement in promotional activity implementation . Chi 2 tests were conducted to measure the differences between highly-involved and less-involved students in perceptions and attitudes about lower-fat foods . Highly-involved students were significantly more likely than less-involved students to report more healthful eating behaviors and positive attitudes toward lower-fat foods . Student involvement in nutrition interventions should be integrated into programs aim ed at increasing healthful food choices among adolescents Multicomponent interventions are recommended for health behavior change among adolescents . However , it is difficult to disentangle the effects of multiple intervention components . This article reports outcomes associated with varying levels of exposure to a school-based nutrition intervention .  Teens Eating for Energy and Nutrition at School ( TEENS ) . Four incremental exposures were possible : ( 1 ) control group , ( 2 ) school environment interventions only , ( 3 ) classroom plus environment interventions , and ( 4 ) peer leaders plus classroom plus environment interventions . Pattems suggesting dose response were observed , with peer leaders reporting the largest increases in fruit , vegetable , and lower fat food consumption .  Students exposed to  classroom plus environment interventions also improved , whereas students exposed only to school environment interventions showed trends toward choosing lower fat foods and declining fruit intake and no change in vegetable intake . Control students ' choices remained stable . Future studies may investigate mechanisms for peer leaders ' changes , maximizing curriculum effectiveness , and improving environmental interventions Two versions of a school-based alcohol prevention programme for 7th grade students were evaluated against a non-treated comparison condition . Both programme versions were based on a social-cognitive theory approach to alcohol prevention , and differed in the level of role-specifications for participating teachers and peer leaders . Twelve schools with 955 students in Bergen , Norway , participated in the study . Four schools were r and omly assigned to each of the three conditions , and the programme was implemented during 10 class periods over 2 months in Spring , 1992 . Pre- and post-test surveys were conducted , assessing alcohol use , as well as cognitive variables related to alcohol use in a specific context ( intentions , attitudes , norms and self-efficacy expectations ) . Results showed that the highly role-specified ( HRS ) version had a higher degree of student involvement than the less role-specified ( LRS ) version , indicating that the HRS programme was more successful in engaging students in alcohol prevention activities . A significant difference in programme effectiveness was found , as measured by an overall programme effect across all dependent variables . This effect was explained by significantly more positive outcomes in the HRS version compared to both the LRS and the non-treated conditions , while the LRS version did not differ significantly from the non-treated condition 
    Output:
    
We identified evidence for positive effects , especially for the students themselves , the school as organization , and interactions and social relations at school .
Almost all included studies showed personal effects on students referring to an increased satisfaction , motivation and ownership , an increase in skills , competencies and knowledge , personal development , health-related effects and influence on student perspective .