***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: BACKGROUND African Americans suffer disproportionately from diabetes complications , but little research has focused on how to improve diabetic control in this population . There are also few or no data on a combined primary care and community-based intervention approach . METHODS We r and omly assigned 186 urban African Americans with type 2 diabetes ( 76 % female , mean A SD age 59 A 9 years ) to 1 of 4 parallel arms : ( 1 ) usual care only ; ( 2 ) usual care + nurse case manager ( NCM ) ; ( 3 ) usual care + community health worker ( CHW ) ; ( 4 ) usual care + nurse case manager/community health worker team . Using the framework of the Precede-Proceed behavioral model , interventions included patient counseling regarding self-care practice s and physician reminders . RESULTS The 2-year follow-up visit was completed by 149 individuals ( 84 % ) . Compared to the Usual care group , the NCM group and the CHW group had modest declines in HbA(1c ) over 2 years ( 0.3 and 0.3 % , respectively ) , and the combined NCM/CHW group had a greater decline in HbA(1c ) ( 0.8 % . P = 0.137 ) . After adjustment for baseline differences and /or follow-up time , the combined NCM/CHW group showed improvements in triglycerides ( -35.5 mg/dl ; P = 0.041 ) and diastolic blood pressure , compared to the usual care group ( -5.6 mmHg ; P = 0.042 ) . CONCLUSIONS Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes . Although results were clinical ly important , they did not reach statistical significance . This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans BACKGROUND The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk , low-income black women attending a prenatal clinic in Clevel and . METHODS Based on previous research , risk was defined by clinic registration between the 17th and 28th weeks of gestation , low family functioning score , and experience of at least one stressful life event prior to registration . Optional factors included being a smoker , a low maternal weight-height ratio , being age 27 or older , and a previous premature birth . A 21-item family function screen previously vali date d in a similar population was the primary determinant of psychosocial risk . Low birth weight was defined as weight less than 2,500 g regardless of gestational age . RESULTS There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking , drug and nutrition education , support , and links with community services , compared to women who received no visits . The number of prenatal visits was significantly higher in the intervention group , but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight . Despite previous research , the family function screen was not an effective predictor of low birth weight in our study . A revised equation involving a history of previous premature birth , smoking , and a low maternal weight-height ratio did predict low birth weight . CONCLUSIONS These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic population s. The family function screen was not cross vali date d. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum OBJECTIVES To evaluate the costs of implementing a church-based , telephone-counseling program for increasing mammography use , and to identify the components of costs and the likely cost-effectiveness in hypothetical communities with varying characteristics . DATA SOURCES / STUDY SETTING An ethnically and socioeconomically diverse sample of 1,443 women recruited from 45 churches participating in the Los Angeles Mammography Promotion ( LAMP ) program were followed from 1995 to 1997 . STUDY DESIGN Churches were stratified into blocks and r and omized into three intervention arms-telephone counseling , mail counseling , and control . We surveyed participants before and after the intervention to collect data on mammography use and demographic characteristics . DATA COLLECTION / EXTRACTION METHODS We used call records , activity reports , and interviews to collect data on the time and material s needed to organize and carry out the intervention . We constructed a st and ard model of costs and cost-effectiveness based on these data and the Year One results of the LAMP program . PRINCIPAL FINDINGS The cost in material s and overhead to the church site was $ 10.89 per participant and $ 188 per additional screening . However , when the estimated cost for church volunteers ' time was included , the cost of the intervention increased substantially . CONCLUSIONS A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and re sources Purpose Large-scale effectiveness trials design ed to translate evidence -based diabetes care to community setting s are few . Studies describing these methods among high-risk minority population s are particularly limited . Methods The authors describe Project Sugar , a r and omized controlled trial conducted in 2 phases : Project Sugar 1 ( 1994 - 1999 ) , which piloted a 4-arm clinic and homebased intervention using nurse case management and community health workers in 186 urban African Americans with type 2 diabetes , and Project Sugar 2 ( 2000 - 2005 ) , which examined effectiveness of this intervention among 542 diabetic , urban African Americans . Results and Conclusions Project Sugar had success with regard to recruitment and retention , both in phase 1 ( 80 % rate at 24 months ) and phase 2 ( > 90 % at 24 months ) . Using the RE- AIM framework , planning and research design for Project Sugar 2 is described in detail for elements that contributed to the reach , effectiveness , adoption , implementation , and maintenance of this study within a minority community setting . In addition to successful strategies , challenges to conducting effectiveness trials in an inner-city African American community are identified PURPOSE The purpose of this r and omized controlled trial is to determine the effectiveness of an intervention led by promotoras ( community lay workers ) on the glycemic control , diabetes knowledge , and diabetes health beliefs of Mexican Americans with type 2 diabetes living in a major city on the Texas-Mexico border . METHODS One hundred fifty Mexican American participants were recruited at a Catholic faith-based clinic and r and omized into 2 groups . Personal characteristics , acculturation , baseline A1C level , diabetes knowledge , and diabetes health beliefs were measured . The intervention was culturally specific and consisted of participative group education , telephone contact , and follow-up using inspirational faith-based health behavior change postcards . The A1C levels , diabetes knowledge , and diabetes health beliefs were measured 3 and 6 months postbaseline , and the mean change between the groups was analyzed . RESULTS The 80 % female sample , with a mean age of 58 years , demonstrated low acculturation , income , education , health insurance coverage , and strong Catholicism . No significant changes were noted at the 3-month assessment , but the mean change of the A1C levels , F(1 , 148 ) = 10.28 , P < .001 , and the diabetes knowledge scores , F(1 , 148 ) = 9.0 , P < .002 , of the intervention group improved significantly at 6 months , adjusting for health insurance coverage . The health belief scores decreased in both groups . CONCLUSIONS The intervention result ed in decreased A1C levels and increased diabetes knowledge , suggesting that using promotoras as part of an interdisciplinary team can result in positive outcomes for Mexican Americans who have type 2 diabetes . Clinical implication s and recommendations for future research are suggested OBJECTIVES A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program , a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older . METHODS A stratified r and om sample of 801 African American women completed baseline ( 1993 - 1994 ) and follow-up ( 1996 - 1997 ) surveys . The primary outcome was self-reported mammography use in the previous 2 years . RESULTS The intervention was associated with an overall 6 percentage point increase ( 95 % confidence interval [ CI ] = -1 , 14 ) in community-wide mammography use .  Low-income women in intervention counties showed an 11 percentage point increase ( 95 % CI = 2 , 21 ) in use above that exhibited by low-income women in comparison counties . Adjustment for potentially confounding characteristics did not change the results . CONCLUSIONS A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income , rural population 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 OBJECTIVES This study examined differences between  nurses and paraprofessionals  in implementation of a home visiting program for low-income , first-time parents during pregnancy and the first 2 years of the child 's life . METHODS Mothers were r and omly assigned to either a nurse-visited ( n = 236 ) or a paraprofessional-visited ( n = 244 ) condition .  Nurse- and paraprofessional-visited families were compared on number and length of visits , topics covered , number of program dropouts , and relationship with home visitor . RESULTS On average , nurses completed more visits than paraprofessionals ( 28 vs 23 ; P < .001 ) and spent a greater proportion of time on physical health issues during pregnancy ( 38 % vs 27 % ; P < .001 ) and on parenting issues during infancy ( 46 % vs 32 % ; P < .001 ) . Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues ( 15 % vs 7 % pregnancy ; 15 % vs 8 % infancy ; P < .001 ) . While home visitors were viewed equally positively by mothers , nurses had fewer dropouts than did paraprofessionals ( 38 % vs 48 % ; P = .04 ) . More paraprofessional-visited families than nurse-visited families experienced staff turnover . CONCLUSIONS Nurses and paraprofessionals , even when using the same model , provide home visiting services in different ways OBJECTIVE To assess the effectiveness of a volunteer-driven outreach program on immunization rates in children younger than 2 years . DESIGN R and omized controlled trial . SETTING Pediatric ambulatory clinics in New York , NY . PATIENTS A total of 163 children were r and omly assigned to receive services from the volunteer-driven outreach program  or to serve as control subjects . All children were ( 1 ) younger than 2 years , ( 2 ) no-shows for a scheduled appointment in the pediatric clinic , and ( 3 ) due or overdue for a vaccine . INTERVENTION Immunization outreach , tracking , and follow-up were provided by community volunteers throughout follow-up ( mean , 6.5 months ) . Control children were notified of immunization status at enrollment but received no further contact until the conclusion of follow-up ( mean , 6.4 months ) . MAIN OUTCOME MEASURE Immunization status 6 months 
    Output:
    
Conclusions : CHWs can improve outcomes for underserved population s for some health conditions .