***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: Underserved minority population s in the US Affiliated Pacific Isl and s ( USAPI ) , Hawaii , and Alaska display disproportionate rates of childhood obesity . The region ’s unique circumstance should be taken into account when design ing obesity prevention interventions . The purpose of this paper is to ( a ) , describe the community engagement process ( CEP ) used by the Children ’s Healthy Living ( CHL ) Program  for remote underserved minority population s in the USAPI , Hawaii , and Alaska ( b ) report community-identified priorities for an environmental intervention addressing early childhood ( ages 2–8 years ) obesity , and ( c ) share lessons learned in the CEP . Four communities in each of five CHL jurisdictions ( Alaska , American Samoa , Commonwealth of the Northern Mariana Isl and s , Guam , Hawai‘i ) were selected to participate in the community-r and omized matched-pair trial . Over 900 community members including parents , teachers , and community leaders participated in the CEP over a 14 month period . The CEP was used to identify environmental intervention priorities to address six behavioral outcomes : increasing fruit/vegetable consumption , water intake , physical activity and sleep ; and decreasing screen time and intake of sugar sweetened beverages . Community members were engaged through Local Advisory Committees , key informant interviews and participatory community meetings . Community-identified priorities centered on policy development ; role modeling ; enhancing access to healthy food , clean water , and physical activity venues ; and healthy living education . Through the CEP , CHL identified culturally appropriate priorities for intervention that were also consistent with the literature on effective obesity prevention practice s. Results of the CEP will guide the CHL intervention design and implementation . The CHL CEP may serve as a model for other underserved minority isl and population Background We report the main results , among adults , of a cluster-r and omised-trial of Well London , a community-engagement programme  promoting healthy eating , physical activity and mental well-being in deprived neighbourhoods . The hypothesis was that benefits would be neighbourhood-wide , and not restricted to intervention participants . The trial was part of a multicomponent process/ outcome evaluation which included non-experimental components ( self-reported behaviour change amongst participants , case studies and evaluations of individual projects ) which suggested health , well-being and social benefits to participants . Methods Twenty matched pairs of neighbourhoods in London were r and omised to intervention/control condition . Primary outcomes ( five portions fruit/vegetables/day ; 5 × 30 m of moderate intensity physical activity/week , abnormal General Health Question naire (GHQ)-12 score and Warwick – Edinburgh Mental Well-being Scale ( WEMWBS ) score ) were measured by postintervention question naire survey , among 3986 adults in a r and om sample of households across neighbourhoods . Results There was no evidence of impact on primary outcomes : healthy eating ( relative risk [ RR ] 1.04 , 95 % CI 0.93 to 1.17 ) ; physical activity ( RR:1.01 , 95 % CI 0.88 to 1.16 ) ; abnormal GHQ12 ( RR:1.15 , 95 % CI 0.84 to 1.61 ) ; WEMWBS ( mean difference [ MD ] : −1.52 , 95 % CI −3.93 to 0.88 ) . There was evidence of impact on some secondary outcomes : reducing unhealthy eating-score ( MD : −0.14 , 95 % CI −0.02 to 0.27 ) and increased perception that people in the neighbourhood pulled together ( RR : 1.92 , 95 % CI 1.12 to 3.29 ) . Conclusions The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours , well-being and social outcomes . Low participation rates and population churn likely compromised any impact of the intervention . Imprecise estimation of outcomes and sampling bias may also have influenced findings . There is a need for greater investment in refining such programmes before implementation ; new methods to underst and , longitudinally different pathways residents take through such interventions and their outcomes , and new theories of change that apply to each pathway Objective : To evaluate the effectiveness of a lay delivered intervention to reduce Latino children ’s exposure to environmental tobacco smoke ( ETS ) . The a priori hypothesis was that children living in households that were in the intervention group would have lower exposure over time than measurement only controls . Design : A two group , r and omised control trial was conducted . Setting : Areas of San Diego county with a large Latino population . Participants : 143 Latino parent – child pairs . Intervention : Trained bicultural and bilingual Latina lay community health advisors , or promotoras , conducted problem solving aim ed at lowering the target child ’s exposure to ETS in the household . Six home and telephone sessions were delivered by the promotoras over a four month period . Main outcome measures : Outcome measures were collected at baseline , immediately post-intervention , three months post-intervention , and 12 months post-intervention . Four outcomes were considered : ( 1 ) parent ’s paper- and -pencil reports of the child ’s past month exposure ; ( 2 ) hair sample s from the child analysed for past month nicotine ; ( 3 ) hair sample s from the child analysed for past month cotinine ; and ( 4 ) per cent confirmed reducers . Results : There were no significant condition-by-time interactions , the term indicative of a differential intervention effect . Significant or near significant time main effects were seen for children ’s hair cotinine , per cent confirmed reducers , and , in particular , parent reports of exposure . Conclusions : Applying a lay promotora model to deliver the behavioural problem solving intervention unfortunately was not effective . A likely explanation relates to the difficulty of delivering a relatively complex intervention by lay women untrained in behaviour change theory and research methods Background Cardiovascular disease remains the leading killer of women in most developed areas of the world . Rates of physical inactivity and poor nutrition , which are two of the most important modifiable risk factors for cardiovascular disease in women , are substantial . This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women 's physical activity in a r and omized trial guided by community-based participatory research ( CBPR ) methods . Methods A total of 335 healthy , 25–64 years old women who had been selected by a multiple-stage stratified cluster r and om sampling method in Bushehr Port/I.R. Iran , were r and omized into control and intervention groups . The intervention group completed an 8-week lifestyle modification program for increasing their physical activity , based on a revised form of Choose to Move program ; an American Heart Association Physical Activity Program for Women . Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations . Results Among the participants , the percentage who reported being active ( at lease 30 minutes of moderate intensity physical activity for at least 5 days a week , or at least 20 minutes of vigorous physical activity for at least three days a week ) increased from 3 % and 2.7 % at baseline to 13.4 % and 3 % ( p < 0.0001 ) at the ending of the program in the intervention and control groups , respectively . The participants in the intervention group reported more minutes of physical activity per week ( mean = 139.81 , SE = 23.35 ) than women in the control group ( mean = 40.14 , SE = 12.65 ) at week 8 ( p < 0.0001 ) . The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure ( -10.0 mmHg ) than the control group women ( + 2.0 . mmHg ) . The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77 , respectively ( P < 0.0001 ) . Conclusion An intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women . The development of participatory process to support the adequate delivery of lifestyle-modification programs is feasible and an effective healthcare delivery strategy for cardiovascular community health promotion . Trial Registration This study tested the effects of an exercise and diet modification training program for weight loss  among Latinas . Forty four obese women were assigned to an experimental training group ( n = 22 ) or a control ( n = 22 ) , at r and om . One session per week for eight weeks included instruction for diet modification and walking for exercise , and all women were led in 20 min of walking during each session . Instruction was provided by a bi-cultural Spanish-speaking physician . Statistically significant ( P < 0.05 ) decreases , relative to controls , were obtained for Body Mass Index , waist to hip ratio , and serum cholesterol . Significant increases were obtained for fitness , exercise rate and frequency , and diet/exercise knowledge . Results suggest that the training was effective for decreasing obesity and increasing fitness among Low SES , Mexican-American women . Implication s for weight control and disease prevention among under-served population s are discussed Introduction The high prevalence of cardiovascular disease ( CVD ) in the Hispanic population of the United States , together with low rates of health insurance coverage , suggest a potential cardiovascular health crisis . The objective of Project HEART ( Health Education Awareness Research Team ) was to promote behavior changes to decrease CVD risk factors in a high-risk Hispanic border population . Methods Project HEART took place from 2005 through 2008 as a r and omized community trial with a community-based participatory research framework using promotores de salud ( community health workers ) . A total of 328 participants with at least 1 CVD risk factor were selected by r and omizing 10 US Census tracts in El Paso , Texas , to either the experimental or the control group . The experimental group ( n = 192 ) was assigned to a series of 8 health classes using the Su Corazón , Su Vida curriculum . After 2 months of educational sessions , the group was followed for 2 months . The control group ( n = 136 ) was given basic educational material s at baseline , and no other intervention was used . Main outcomes of interest included changes in health behaviors and clinical measures . Results Participants in the experimental group showed more awareness of CVD risk factors , more confidence in the control of these factors , and improved dietary habits ( ie , lower salt and cholesterol intake , better weight-control practice s ) compared with the control group . Total cholesterol was 3 % lower in the experimental than in the control participants , and non – high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were both 5 % lower . Conclusion The HEART trial suggests that community health education using promotores de salud is a viable strategy for CVD risk reduction in a Hispanic border community BACKGROUND Community mobilisation through participatory women 's groups might improve birth outcomes in poor rural communities . We therefore assessed this approach in a largely tribal and rural population in three districts in eastern India . METHODS From 36 clusters in Jharkh and and Orissa , with an estimated population of 228 186 , we assigned 18 clusters to intervention or control using stratified r and omisation . Women were eligible to participate if they were aged 15 - 49 years , residing in the project area , and had given birth during the study . In intervention clusters , a facilitator convened 13 groups every month to support participatory action and learning for women , and facilitated the development and implementation of strategies to address maternal and newborn health problems . The primary outcomes were reductions in neonatal mortality rate ( NMR ) and maternal depression scores . Analysis was by intention to treat . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N21817853 . FINDINGS After baseline surveillance of 4692 births , we monitored outcomes for 19 030 births during 3 years ( 2005 - 08 ) . NMRs per 1000 were 55.6 , 37.1 , and 36.3 during the first , second , and third years , respectively , in intervention clusters , and 53.4 , 59.6 , and 64.3 , respectively , in control clusters . NMR was 32 % lower in intervention clusters adjusted for clustering , stratification , and baseline differences ( odds ratio 0.68 , 95 % CI 0.59 - 0.78 ) during the 3 years , and 45 % lower in years 2 and 3 ( 0.55 , 0.46 - 0.66 ) . Although we did not note a significant effect on maternal depression overall , reduction in moderate depression was 57 % in year 3 ( 0.43 , 0.23 - 0.80 ) . INTERPRETATION This intervention could be used with or as a potential alternative to health-worker-led interventions , and presents new opportunities for policy makers to improve maternal and newborn health outcomes in poor population s. FUNDING Health Foundation , UK Department for International Development , Wellcome Trust , and the Big Lottery Fund ( UK ) ABSTRACT BACKGROUND Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care . Quality improvement ( QI ) programs for depression in primary care improve outcomes relative to usual care , but health , social and other community-based service sectors also support clients in under-re source d communities . Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors . OBJECTIVE To compare the effectiveness of Community Engagement and Planning ( CEP ) and Re sources for Services ( RS ) to implement depression QI on clients ’ mental health-related quality of life ( HRQL ) and services use . DESIGN Matched programs from health , social and other service sectors were r and omized to community engagement and planning ( promoting inter-agency collaboration ) or re sources for services ( individual program technical 
    Output:
    
Conclusions The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged population s if design ed properly and implemented through effective community consultation and participation .