***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 : In the United States , 15- to 24-year-olds represent ∼14 % of HIV cases diagnosed in 2006 and almost 50 % of the 19 million sexually transmitted infections ( STIs ) reported annually . This survey assessed pediatricians ' practice s regarding preventive health care screening , provision of reproductive health services including HIV and STI screening and counseling , and barriers to providing these services . METHODS : A r and om- sample mailed survey of 1626 US members of the American Academy of Pediatrics in 2005.A total of 752 completed question naires were returned ( 46 % response rate ) . Analysis was limited to the 468 pediatricians who provided health supervision visits to patients who were older than 11 years . RESULTS : Most pediatricians discussed sexual activity at preventive care visits ; similar numbers discuss abstinence ( 62 % ) , condoms ( 61 % ) , and STIs ( 61 % ) with slightly fewer discussing HIV ( 54 % ) . Pediatricians occasionally or rarely/never discussed homosexuality/sexual identity ( 82 % ) . Most ( 71 % ) identified adolescents with high-risk behaviors by clinical interviews . Approximately 30 % prescribed condoms , 22 % distributed condoms , and 19 % provided condom demonstrations . Whereas 46 % of pediatricians recommended STI tests for all sexually active teens , only 28 % recommended HIV testing for this population . Hospital/clinic-based and inner-city practitioners were more likely to prescribe , provide , and demonstrate condoms and recommend HIV/STI tests for sexually active teens . The most frequently identified barrier to HIV and STI prevention counseling was lack of time . CONCLUSIONS : Pediatricians believed it is important to deliver reproductive health services , and most addressed adolescent sexual activity at preventive care visits but did not routinely address homosexuality/sexual identity . Counseling and testing practice s varied by physician characteristics BACKGROUND Primary care is a key step in young people 's pathway to mental health care . Despite the high prevalence of mental disorder in this age group , little is known about the factors that determine the identification of young people 's mental disorder in primary care . AIM To provide a detailed description of the factors associated with both ' correct ' and ' excessive ' identification of youth mental disorder in primary care . DESIGN OF THE STUDY Cross-sectional study . SETTING Twenty-six r and omly selected general practice s in Victoria , Australia . METHOD Consecutive young people ( 16 - 24 years ) were interviewed before their consultation , using a semi-structured interview . They completed  Kessler 's scale of emotional distress ( K10 ) . GPs completed a  question  naire after the consultation . Multinomial logistic regression was used to examine the factors associated with GP identification of mental disorder in those with high and low probability of disorder on the K10 . RESULTS Altogether , 450/501 ( 90 % ) of approached young people participated ; 36.1 % ( 95 % confidence interval [ CI ] = 32.3 to 40.2 % ) had high probability of mental disorder on the K10 . Young people 's perception that they had a mental illness was highly associated with GP identification ( odds ratio [ OR ] = 62.6 , 95 % CI = 22.8 to 172.0 ) . Other significantly associated factors were : patient fears ( OR = 2.4 , 95 % CI = 1.1 to 5.1 ) , frequent consultations ( OR = 3.0 , 95 % CI = 1.0 to 8.4 ) , days out of role ( OR = 2.7 , 95 % CI = 1.2 to 5.7 ) , and continuity of care ( OR = 3.4 , 95 % CI = 1.6 to 6.9 ) . The latter two were also associated with ' over- identification ' of young people who had low probability of mental disorder . GP characteristics were not associated with identification . CONCLUSION These findings provide guidance for GPs in their clinical work and training . They should also inform the further development of mental health literacy programmes in the community Objective To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors , on clinicians ’ detection of health risks and patients ’ risk taking behaviour , compared to a didactic seminar on young people ’s health . Design Pragmatic cluster r and omised trial where volunteer general practice s were stratified by postcode advantage or disadvantage score and billing type ( private , free national health , community health centre ) , then r and omised into either intervention or comparison arms using a computer generated r and om sequence . Three months post-intervention , patients were recruited from all practice s post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later . Research ers recruiting , consenting and interviewing patients and patients themselves were masked to allocation status ; clinicians were not . Setting General practice s in metropolitan and rural Victoria , Australia Participants General practice s with at least one interested clinician ( general practitioner or nurse ) and their 14–24 year old patients . Intervention This complex intervention was design ed using evidence based practice in learning and change in clinician behaviour and general practice systems , and included best practice approaches to motivating change in adolescent risk taking behaviours . The intervention involved training clinicians ( nine hours ) in health risk screening , use of a screening tool and motivational interviewing ; training all practice staff ( receptionists and clinicians ) in engaging youth ; provision of feedback to clinicians of patients ’ risk data ; and two practice visits to support new screening and referral re sources . Comparison clinicians received one didactic educational seminar ( three hours ) on engaging youth and health risk screening . Outcome Measures Primary outcomes were patient report of ( 1 ) clinician detection of at least one of six health risk behaviours ( tobacco , alcohol and illicit drug use , risks for sexually transmitted infection , STI , unplanned pregnancy , and road risks ) ; and ( 2 ) change in one or more of the six health risk behaviours , at three months or at 12 months . Secondary outcomes were likelihood of future visits , trust in the clinician after exit interview , clinician detection of emotional distress and fear and abuse in relationships , and emotional distress at three and 12 months . Patient acceptability of the screening tool was also described for the intervention arm . Analyses were adjusted for practice location and billing type , patients ’ sex , age , and recruitment method , and past health risks , where appropriate . An intention to treat analysis approach was used , which included multilevel multiple imputation for missing outcome data . Results 42 practice s were r and omly allocated to intervention or comparison arms . Two intervention practice s withdrew post allocation , prior to training , leaving 19 intervention ( 53 clinicians , 377 patients ) and 21 comparison ( 79 clinicians , 524 patients ) practice s. 69 % of patients in both intervention ( 260 ) and comparison ( 360 ) arms completed the 12 month follow-up . Intervention clinicians  discussed more health risks per patient ( 59.7 % ) than comparison clinicians ( 52.7 % ) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours ( 38.4 % vs 26.7 % , risk difference [ RD ] 11.6 % , Confidence Interval [ CI ] 2.93 % to 20.3 % ; adjusted odds ratio [ OR ] 1.7 , CI 1.1 to 2.5 ) . Patients reported less illicit drug use ( RD -6.0 , CI -11 to -1.2 ; OR 0·52 , CI 0·28 to 0·96 ) , and less risk for STI ( RD -5.4 , CI -11 to 0.2 ; OR 0·66 , CI 0·46 to 0·96 ) at three months in the intervention relative to the comparison arm , and for unplanned pregnancy at 12 months ( RD -4.4 ; CI -8.7 to -0.1 ; OR 0·40 , CI 0·20 to 0·80 ) . No differences were detected between arms on other health risks . There were no differences on secondary outcomes , apart from a greater detection of abuse ( OR 13.8 , CI 1.71 to 111 ) . There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool . Conclusions A complex intervention , compared to a simple educational seminar for practice s , improved detection of health risk behaviours in young people . Impact on health outcomes was inconclusive . Technology enabling more efficient , systematic health-risk screening may allow providers to target counselling toward higher risk individuals . Further trials require more power to confirm health benefits . Trial Registration IS RCT N.com IS RCT N16059206 Abstract Objectives : To evaluate the effectiveness of inviting teenagers to  general practice consultations to discuss health behaviour concerns and appropriate follow up care . Design : R and omised controlled trial , with participants r and omised to a consultation ( intervention ) or usual care ( control ) . Question naires completed at baseline , 3 months , and 12 months . Setting : Eight general practice s in Hertfordshire , Engl and . Participants : 1516 teenagers aged 14 - 15 years . Intervention : Consultations with practice nurses to discuss health concerns and develop plans for healthier lifestyles . Main outcome measures : Mental and physical health , “ stage of change ” for health related behaviour , and use of health services . Results : At baseline 970 teenagers completed question naires ; 23 % smoked , 35 % had been drunk in the previous three months , 64 % considered they ate unhealthily , 39 % took little exercise , and 36 % had possible depression . 41 % ( 304 ) of teenagers invited attended for a consultation ; over one third ( 112 ) were offered follow up care . More intervention group teenagers reported positive movement in stage of change for diet and exercise and in at least one of four behaviours ( diet , exercise , smoking , drinking alcohol ) at 3 months ( 41 % v 31 % , P<0.01 ) , but this did not persist at 12 months . There was marginally more positive change in actual behaviour by intervention teenagers at 3 months ( 16 % v 12 % , P=0.06 ) . Recognition of possible depression result ed in improved mental health outcomes at 3 and 12 months . 97 % of attenders said they would recommend the intervention to a friend . Conclusions : Change in behaviour was slight but encouraging , and the intervention was well received and relatively cheap PURPOSE This study examined the effects of brief image-based interventions , including a multiple behavior health contract , a one-on-one tailored consultation , and a combined consultation plus contract intervention , for impacting multiple health behaviors of students in a university health clinic . METHODS A total of 155 college students attending a major southern university were recruited to participate in a study evaluating a health promotion program titled Project Fitness during the fall 2005 and spring 2006 . Participants were r and omly assigned to one of three treatments as they presented at the clinic : 1 ) a multiple behavior health contract , 2 ) a one-on-one tailored consultation , or 3 ) a combined consultation plus contract intervention . Baseline and 1-month post-intervention data were collected using computer-assisted question naires in a quiet office within the student health clinic . RESULTS Omnibus repeated- measures analyses of variance were significant for drinking driving behaviors , F(2,136 ) = 4.43 , p = .01 , exercise behaviors , F(5,140 ) = 6.12 , p = .00 , nutrition habits , F(3,143 ) = 5.37 , p = .00 , sleep habits , F(2,144 ) = 5.03 , p = .01 , and health quality of life , F(5,140 ) = 3.09 , p = .01 , with improvements on each behavior across time . Analysis of group-by-time interaction effects showed an increase in the use of techniques to manage stress , F(2,144 ) = 5.48 , p = .01 , and the number of health behavior goals set in the last 30 days , F(2,143 ) = 5.35 , p = .01 , but only among adolescents receiving the consultation , or consultation plus contract .  Effect sizes were consistently larger across health behaviors , and medium in size , when both consult and contract were used together . CONCLUSIONS Brief interventions using a positive goal image of fitness , and addressing a number of health habits using a contract and consultation strategy alone , or in combination , have the potential to influence positive changes in multiple health behaviors of college students attending a university primary health care clinic OBJECTIVE To prevent early adolescent health risk behaviors and to maintain or improve safety behaviors , we compared the effects of 2 interventions , delivered through pediatric primary care practice s. The interventions , based on an office systems ' approach , sought to prevent early drinking and smoking or to influence bicycle helmet use , gun storage , and seatbelt safety for children who were followed from fifth/sixth grade s through eighth/ninth grade s. DESIGN Setting s and Participants . Twelve pediatric practice s in New Engl and were paired according to practice size and assigned r and omly within pairs to deliver the multicomponent interventions , which built on pediatric primary care clinicians performing as counselors and role models during health supervision visits and other office encounters . INTERVENTION One intervention arm focused on alcohol and tobacco use . The other intervention arm focused on gun safety , bicycle helmet , and seatbelt use . Office systems provided infrastructure that supported the clinician 's role . Clinician messages encouraged family communication 
    Output:
    
Conclusions There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical setting s improves health outcomes .