***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 : The goal of this study was to assess the efficacy of an after-school , peer-led , healthy living program on adiposity , self-efficacy , and knowledge of healthy living behaviors in children living in a remote isolated First Nation . METHODS : A quasi-experimental trial with a parallel nonequivalent control arm was performed with 151 children in Garden Hill First Nation during the 2010–2011 and 2011–2012 school years . Fourth grade students were offered a 5-month , peer-led intervention facilitated by high school mentors between January and May of each school year ; students in the control arm received st and ard curriculum . The main outcome measures were waist circumference ( WC ) and BMI z score . Secondary outcome measures included healthy living knowledge and self-efficacy . RESULTS : Fifty-one children ( mean ± SD age : 9.7 ± 0.4 years ; BMI z score : 1.46 ± 0.84 ) received the intervention , and 100 children were in the control arm . At baseline , WC ( 79.8 vs 83.9 cm ) , BMI z score ( 1.46 vs 1.48 ) , and rates of overweight/obesity ( 75 % vs 72 % ) did not differ between arms . After the intervention , the change in WC ( adjusted treatment effect : –2.5 cm [ 95 % confidence interval ( CI ) : –4.1 to –0.90 ] ; P = .002 ) and BMI z score ( adjusted treatment effect : –0.09 [ 95 % CI : –0.16 to –0.03 ] ; P = .007 ) were significantly lower in the intervention arm compared to the control arm . The intervention arm also experienced improvements in knowledge of healthy dietary choices ( 2.25 % [ 95 % CI : –0.01 to 6.25 ] ; P = .02 ) . Self-efficacy was associated with the change in WC after the intervention ( β = –7.9 , P = .03 ) . CONCLUSIONS : An after-school , peer-led , healthy living program attenuated weight gain and improved healthy living knowledge in children living in a remote isolated First Nation The Solihull Approach is a psychotherapeutic and behavioural model for health visitors and other professionals working with children and families to address sleeping , toileting , feeding and behavioural difficulties in young children . This pilot study used quantitative methods to assess the effectiveness of the Solihull Approach compared to st and ard health visitor practice . At assessment , the parent completed the short form Parenting Stress Index and a visual analogue scale rating how severe the problem was . The health visitor also completed a visual analogue scale rating their perception of the severity of the problem . This process was repeated at the end of the intervention and again at three months follow-up . Results showed statistically significant better outcome on five out of six measures for the experimental group . Results are discussed in context of a small sample size We conducted a school-based parallel cluster r and omized controlled trial with 36-month follow-up of children aged 7 to 8 years . Primary schools were r and omly assigned to 2 groups : 3 applications of fluoride varnish ( 22,600 ppm ) each year or no intervention . The primary outcome was DFS increment in the first permanent molars , with the hypothesis that 9 applications of varnish over 3 years would result in a lower increment in the test group . Follow-up measurements were recorded by examiners blind to the allocation . Ninety-five schools were r and omized to the test and 95 to the reference groups ; 1473 ( test ) and 1494 ( reference ) children participated in the trial . An intention-to-treat analysis was carried out with r and om effects models . The DFS increment was 0.65 ( SD 2.15 ) in the test and 0.67 ( SD 2.10 ) in the reference groups , respectively . There was no statistically significant difference between the groups . We were unable to demonstrate an effect for fluoride varnish when it was used as a public health intervention to prevent caries in the first permanent molar teeth ( Inter-national St and ard R and omized Controlled Trial Registration : IS RCT N : # 72589426 IMPORTANCE Schools are considered an attractive setting to promote healthy living behaviors in children , but previous school-based interventions aim ed at preventing weight gain in children have yielded mixed results . Novel school-based approaches are needed to modify healthy living behaviors and attenuate weight gain in children . OBJECTIVE To assess the effectiveness of a peer-led healthy living program called Healthy Buddies on weight gain  and its determinants when disseminated at the provincial level to elementary school students . DESIGN , SETTING , AND PARTICIPANTS Cluster-r and omized effectiveness trial performed during the 2009 - 2010 school year . Baseline and follow-up measurements were made in October 2009 and May 2010 , respectively . The study was performed in 19 elementary schools in Manitoba , Canada , and included 647 elementary school students aged 6 to 12 years ( 48 % girls ) .  INTERVENTION Schools were r and omized to receive regular curriculum or Healthy Buddies lesson plans . Lesson plans were delivered by older ( 9- to 12-year-old ) elementary school students to the younger ( 6- to 8-year-old ) peers and targeted 3 components of health : physical activity , healthy eating , and self-esteem and body image . MAIN OUTCOMES AND MEASURES The primary outcome measures were the change in waist circumference and body mass index z score . Secondary outcomes included physical activity ( steps per day ) , cardiorespiratory fitness , self-efficacy , healthy living knowledge , and self-reported dietary intake . RESULTS At baseline , 36 % of children were overweight or obese and 11 % achieved the recommended 13,500 steps per day . Intention-to-treat analyses showed that waist circumference declined significantly in the intervention group relative to controls : -1.42 cm ( -2.68 to -0.17 ; P = .03 ) . Reductions in waist circumference were particularly significant for children who were younger , overweight or obese , or attending First Nations schools . No difference in body mass index z score was observed between groups . Self-efficacy , healthy living knowledge , and dietary intake significantly improved in younger peers who received the intervention compared with students from control schools . No differences were observed in daily step counts or cardiorespiratory fitness between the groups . CONCLUSIONS AND RELEVANCE The implementation of Healthy Buddies lesson plans delivered by older peers within an elementary school setting is an effective method for attenuating increases in central adiposity and improving knowledge of healthy living behaviors among elementary school students . Improvements were achieved with parallel improvements in diet quality , self-efficacy , and knowledge of healthy living . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01979978 A peer-managed self-control program to teach responsible drinking was tested with 30 American Indian teenagers at high risk for problem drinking . Students were r and omly assigned to three groups incorporating combinations of self-monitoring , peer-assisted self-control training , and alcohol education . Significant decreases were observed in quantity and frequency of drinking and in peak blood alcohol levels . These improvements were maintained at follow-ups of 4 , 9 , and 12 months posttreatment . Self-report data were corroborated by breath tests and official records . No group differences were found , indicating that minimal and full program interventions had comparable effects 
    Output:
    
Study outcomes included improved knowledge , attitude , and behaviors .