***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: Adolescent females in Zimbabwe are at high risk for  HIV acquisition . Shaping the Health of Adolescents in Zimbabwe ( SHAZ ! ) was a r and omized controlled trial of a combined intervention package including life-skills and health education , vocational training , micro-grants and social supports compared to life-skills and health education alone . SHAZ ! was originally envisioned as a larger effectiveness trial , however , the intervention was scaled back due to context ual and economic conditions in the country at the time . SHAZ ! enrolled 315 participants r and omly assigned to study arm within blocks of 50 participants ( 158 intervention and 157 control ) . The intervention arm participants showed statistically significant differences from the control arm participants for several outcomes during the two years of follow up including ; reduced food insecurity [ IOR = 0.83 vs. COR = 0.68 , p-0.02 ] , and having their own income [ IOR = 2.05 vs. COR = 1.67 , p = 0.02 ] . Additionally , within the Intervention arm there was a lower risk of transactional sex [ IOR = 0.64 , 95 % CI ( 0.50 , 0.83 ) ] , and a higher likelihood of using a condom with their current partner [ IOR = 1.79 , 95 % CI ( 1.23 , 2.62 ) ] over time compared to baseline . There was also evidence of fewer unintended pregnancies among intervention participants [ HR = 0.61 , 95 % CI ( 0.37 , 1.01 ) ] , although this relationship achieved only marginal statistical significance . Several important challenges in this study included the coordination with vocational training programs , the political and economic instability of the area at the time of the study , and the difficulty in creating a true st and ard of care control arm . Overall the results of the SHAZ ! study suggest important potential for HIV prevention intervention packages that include vocational training and micro-grants , and lessons for further economic livelihoods interventions with adolescent females . Further work is needed to refine the intervention model , and test the impact of the intervention at scale on biological outcomes . Trial Registration Clinical Trials.gov There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on  adolescent transitions to adulthood in re source poor setting s , however existing research is typically from small scale programs in diverse geographic and cultural setting s. We provide estimates of the impact of a national unconditional cash transfer program , the Kenya Cash Transfer for Orphans and Vulnerable Children  , on pregnancy and early marriage among females aged 12 to 24 , four years after program initiation . The evaluation was design ed as a clustered r and omized controlled trial and ran from 2007 to 2011 , capitalizing on the existence of a control group , which was delayed entry to the program due to budget constraints . Findings indicate that , among 1549 females included in the study , while the program reduced the likelihood of pregnancy by five percentage points , there was no significant impact on likelihood of early marriage . Program impacts on pregnancy appear to work through increasing the enrollment of young women in school , financial stability of the household and delayed age at first sex . The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa , suggesting a degree of generalizability of the results reported here . Although the objective of the program is primarily poverty alleviation , it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood We r and omly assigned the Shifting Boundaries interventions to 30 public middle schools in New York City , enrolling 117 sixth and seventh grade classes ( over 2,500 students ) to receive a classroom , a building , a combined , or neither intervention . The classroom intervention included a six-session curriculum emphasizing the laws and consequences for perpetrators of dating violence and sexual harassment ( DV/H ) , the social construction of gender roles , and healthy relationships . The building-based intervention included the use of building-based restraining orders , higher levels of faculty/security presence in safe/unsafe “ hot spots ” mapped by students , and posters to increase DV/H awareness and reporting . Student surveys  were implemented at baseline , immediately after the intervention , and 6-months post-intervention . As hypothesized , behaviors improved as a result of the interventions . The building-only and the combined interventions were effective in reducing sexual violence victimization involving either peers or dating partners at 6-months post-intervention . This was mirrored by reductions in sexual violence perpetration by peers in the building-only intervention . While the preponderance of results indicates that the interventions were effective , an anomalous result ( increase in sexual harassment victimization reports that was contradicted by lower frequency estimates ) did emerge . However , after analysis these anomalous results were deemed to be most likely spurious . The success of the building-only intervention alone is important because it can be implemented with very few extra costs to schools In this experiment , 123 sixth and seventh grade classrooms from Clevel and area schools were r and omly assigned to one of two five-session curricula addressing gender violence/sexual harassment ( GV/SH ) or to a no-treatment control . Three-student surveys were administered . Students in the law and justice curricula , compared to the control group , had significantly improved outcomes in awareness of their abusive behaviors , attitudes toward GV/SH and personal space , and knowledge . Students in the interaction curricula experienced lower rates of victimization , increased awareness of abusive behaviors , and improved attitudes toward personal space . Neither curricula affected perpetration or victimization of sexual harassment . While the intervention appeared to reduce peer violence victimization and perpetration , a conflicting finding emerged — the intervention may have increased dating violence perpetration ( or at least the reporting of it ) but not dating violence victimization OBJECTIVE To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships , sexual health , and substance use reduces physical dating violence ( PDV ) . DESIGN Cluster r and omized trial with 2.5-year follow-up ; prespecified subgroup analyses by sex . SETTING Grade 9 health classes . PARTICIPANTS A total of 1722 students aged 14 - 15 from 20 public schools ( 52.8 % girls ) . Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships . Dating violence prevention was integrated with core lessons about healthy relationships , sexual health , and substance use prevention using interactive exercises . Relationship skills to promote safer decision making with peers and dating partners were emphasized . Control schools targeted similar objectives without training or material s. MAIN OUTCOME MEASURES The primary outcome at 2.5 years was self-reported PDV during the previous year . Secondary outcomes were physical peer violence , substance use , and condom use . Analysis was by intention-to-treat . RESULTS The PDV was greater in control vs intervention students ( 9.8 % vs 7.4 % ; adjusted odds ratio , 2.42 ; 95 % confidence interval , 1.00 - 6.02 ; P = .05 ) . A significant group x sex interaction effect indicated that the intervention effect was greater in boys ( PDV : 7.1 % in controls vs 2.7 % in intervention students ) than in girls ( 12.1 % vs 11.9 % ) . Main effects for secondary outcomes were not statistically significant ; however , sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention ( 114 of 168 ; 67.9 % ) vs controls ( 65 of 111 [ 58.6 % ] ) ( P < .01 ) . The cost of training and material s averaged CA$16 per student . CONCLUSION The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost Background An emerging model for sexuality education is the rights-based approach , which unifies discussion s of sexuality , gender norms , and sexual rights to promote the healthy sexual development of adolescents . A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published . This paper evaluates the immediate effects of the Sexuality Education Initiative ( SEI ) on hypothesized psychosocial determinants of sexual behavior . Methods A cluster-r and omized trial was conducted with ninth- grade students at 10 high schools in Los Angeles . Classrooms at each school were r and omized to receive either a rights-based curriculum or basic sex education ( control ) curriculum . Surveys were completed by 1,750 students ( N = 934  intervention , N = 816 control )  at pretest and immediate posttest . Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes , which were hypothesized to be mediators of students ’ sexual behaviors . Results Compared with students who received the control curriculum , students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services , more positive attitudes about sexual relationship rights , greater communication about sex and relationships with parents , and greater self-efficacy to manage risky situations at immediate posttest . There were no significant differences between the two groups for two outcomes , communication with sexual partners and intentions to use condoms . Conclusions Participation in the rights-based classroom curriculum result ed in positive , statistically significant effects on seven of nine psychosocial outcomes , relative to a basic sex education curriculum . Longer-term effects on students ’ sexual behaviors will be tested in subsequent analyses . Trial registration Clinical Trials.gov NCT02009046 Objective To assess the impact of Stepping Stones , a HIV prevention programme , on incidence of HIV and herpes simplex type 2 ( HSV-2 ) and sexual behaviour . Design Cluster r and omised controlled trial . Setting 70 villages ( clusters ) in the Eastern Cape province of South Africa . Participants 1360 men and 1416 women aged 15 - 26 years , who were mostly attending schools . Intervention Stepping Stones , a 50 hour programme , aims to improve sexual health by using participatory learning approaches to build knowledge , risk awareness , and communication skills and to stimulate critical reflection . Villages were r and omised to receive either this or a three hour intervention on HIV and safer sex . Interviewers administered question naires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2 . Main outcome measures Primary outcome measure : incidence of HIV . Other outcomes : incidence of HSV-2 , unwanted pregnancy , reported sexual practice s , depression , and substance misuse . Results There was no evidence that Stepping Stones lowered the incidence of HIV ( adjusted incidence rate ratio 0.95 , 95 % confidence interval 0.67 to 1.35 ) . The programme was associated with a reduction of about 33 % in the incidence of HSV-2 ( 0.67 , 0.46 to 0.97 ; P=0.036)—that is , Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 ( 1.6 to 68.2 ) per 1000 people exposed . Stepping Stones significantly improved a number of reported risk behaviours in men , with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months . In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months . Conclusion Stepping Stones did not reduce incidence of HIV but had an impact on several risk factors for HIV — notably , HSV-2 and perpetration of intimate partner violence . Trial Registration Clinical Trials NCT00332878 With an increase in sexual activity among young adults in Vietnam and associated risks , there is a need for evidence -based sexual health interventions . This evaluation of three sexual health programs based on the Protection Motivation Theory ( PMT ) was conducted in 12 communes in Ha Noi , Nha Trang City , and Ninh Hoa District . Inclusion criteria included unmarried youth 15–20 years residing in selected communes . Communes were r and omly allocated to an intervention , and participants were r and omly selected within each commune . The intervention programs included Vietnamese Focus on Kids ( VFOK ) , the gender-based program Exploring the World of Adolescents ( EWA ) , and EWA plus parental and health provider education ( EWA+ ) . Programs were delivered over a ten-week period in the communities by locally trained facilitators . The gender-based EWA program with parental involvement ( EWA+ ) compared to VFOK showed significantly greater increase in knowledge . EWA+ in comparison to VFOK also showed significant decrease at immediate postintervention for intention to have sex . Sustained changes are observed in all three interventions for self-efficacy condom use , self-efficacy abstinence , response efficacy for condoms , extrinsic rewards , and perceived vulnerability for HIV . These findings suggest that theory-based community programs contribute to sustained changes in knowledge and attitudes regarding sexual risk among Vietnamese adolescents Men and women living in r and omly selected 1st-year dormitories participated in tailored single-sex sexual assault prevention or risk-reduction programs , respectively . An evaluation of the men ’s project is presented ( N = 635 ) . The program incorporated social norms and byst and er intervention education and had an impact on self-reported sexual aggression and an effect on men ’s perceptions that their peers would intervene when they encountered inappropriate behavior in others . Relative to the control group , participants also reported less reinforcement for engaging in sexually aggressive behavior , reported fewer associations with sexually aggressive peers , and indicated less exposure to sexually explicit media Adolescent relationship abuse ( ARA ) is a significant public health problem . 
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INTERPRETATION This review can accelerate efforts to improve global health by leading to more strategic investment in programmes that promote gender e quality and target restrictive gender norms among young people .
Such programmes can lead to a lifetime of improved health and wellbeing by challenging not only attitudes and behaviours related to gender at an early age , but also the gendered systems that surround them .