***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: Acquired immunodeficiency syndrome ( AIDS ) continues to be a significant concern for adolescents , especially in minority population s. There is a scarcity of knowledge of the cultural context of sexual behavior in this age group and the influences that lead to early initiation of sex and unsafe sex . Few efforts targeting young adolescents have been community based , although there has been an increased awareness of the need for such research and intervention programs . Four key processes have been defined in gaining community participation in health education programs : ( a ) defining the community and reaching the community ; ( b ) recognizing tensions among service , research , and community participation ; ( c ) involving community residents ; and ( d ) considering cultural differences in a community . These processes are used to describe the " Focus on Kids " project , a human immunodeficiency virus ( HIV ) risk reduction intervention that result ed in significant increases in condom use demonstrated by a r and omized controlled trial OBJECTIVES This study examines the impact of an intervention to promote dual- method contraceptive use among HIV concordant and discordant couples already using condoms for HIV prevention . METHODS A three-armed r and omized , controlled trial was conducted at a voluntary HIV testing and counseling clinic in Lusaka , Zambia ; 251 couples were r and omized . Control couples received family planning education and referral to an outside clinic for nonbarrier contraceptives , intervention 1 couples received education and offer of contraceptives at the research clinic , and intervention 2 couples received intervention 1 plus a presentation design ed to reduce outside pressures to conceive . RESULTS There was a 3-fold higher contraceptive initiation rate in both intervention arms compared with the control arm . The interventions had no impact on incident pregnancy , largely due to high levels of contraceptive discontinuation and user failure .  HIV-positive women who initially selected injectable contraception were less likely to ab and on the method and significantly less likely to conceive than other study participants . CONCLUSIONS Improving access to nonbarrier contraceptives among couples already using condoms for HIV prevention increased dual- method use . Selection of longer-acting injectable contraception was associated with lower pregnancy rates among HIV-positive women . Further research is needed to identify ways to help couples in this population continue to correctly use nonbarrier contraceptives OBJECTIVE To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos , Mexico , whose aim was to impact adolescents ' sexual behavior , knowledge and access to contraception . MATERIAL AND METHODS Quasi-experimental prospect i ve study with eleven control and eleven intervention schools  using self-administered question naires for parents and adolescents pre- and post-intervention . Parent-child dyads in the control and intervention schools were matched according to parents ' propensity score ; the average treatment effect ( ATE ) was estimated for adolescent 's outcome variables . RESULTS At follow-up , we found significant differences for adolescents in the intervention schools : 6.8 % delayed initiation of sexual intercourse , 14.4 % had correct knowledge about emergency contraception ( EC ) , and 164 % reported having received condoms from their parents , when comparing with students in control schools . CONCLUSIONS Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health This pilot study used a r and omized controlled trial to test the efficacy of an HIV risk-reduction intervention for university students in Eastern Cape Province , South Africa . R and omly selected second-year students were r and omized to one of two interventions based on social cognitive theory and qualitative research : HIV risk-reduction , targeting sexual-risk behaviors ; health-promotion control , targeting health behaviors unrelated to sexual risks . Participants completed behavioral assessment s via audio computer-assisted self-interviewing pre-intervention , 6 , and 12 months post intervention , with 97.2 % retained at 12-month follow-up . Averaged over the 2 follow-ups , HIV risk-reduction intervention participants reported less unprotected vaginal intercourse and more frequent condom use than control participants , with greater efficacy in non-South Africans than South Africans . Positive changes were also observed on theoretical mediators of condom use that the intervention targeted . Interventions based on social cognitive theory integrated with qualitative information from the population may reduce sexual risk behaviors among university students in sub-Saharan Africa . ResumenEste estudio piloto se utilizó una prueba controlada aleatoria para probar la eficacia de la intervención para reducir el riesgo de VIH entre estudiantes universitarios en la Provincia Oriental del Cabo , Sudáfrica . Estudiantes de segundo año seleccionados al azar fueron asignados a una de dos intervenciones basadas en teoría cognoscitiva social e investigación cualitativa : reducción de riesgo para VIH con atención a conductas de riesgo sexual ; promoción de la salud con atención a conductas no relacionas a riesgos sexuales . Los participantes completaron encuestas por medio del uso de computadoras con audio , pre-intervención y 6 y 12 meses post-intervención , con un 97.2 % de retención al darse seguimiento 12 meses después . Promediada sobre los 2 seguimientos , participantes de intervención de reducción del riesgo de VIH reportó menos relaciones sexuales sin protección y uso de preservativos más frecuentemente que los participantes de control , con una mayor efectos en aquellos que no eran sudafricano en comparación con los sudafricanos . Cambios positivos fueron también observados en mediadores teóricos del uso del condón . Las intervenciones basadas en la teoría cognitiva social integrada con información cualitativa de la población pueden reducir los comportamientos sexuales de riesgo entre los estudiantes universitarios en el África subsahariana Objective To assess the impact of a theoretically based sex education programme ( SHARE ) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS . Design Follow-up of cluster r and omised trial 4.5 years after intervention . Setting NHS records of women who had attended 25 secondary schools in east Scotl and . Participants 4196 women ( 99.5 % of those eligible ) .  Intervention SHARE programme ( intervention group ) v existing sex education ( control group ) . Main outcome measure NHS recorded conceptions and terminations for the achieved sample linked at age 20 . Results In an “ intention to treat ” analysis there were no significant differences between the groups in registered conceptions per 1000 pupils ( 300 SHARE v 274 control ; difference 26 , 95 % confidence interval −33 to 86 ) and terminations per 1000 pupils ( 127 v 112 ; difference 15 , −13 to 42 ) between ages 16 and 20 . Conclusions This specially design ed sex education programme did not reduce conceptions or terminations by age 20 compared with conventional provision . The lack of effect was not due to quality of delivery . Enhancing teacher led school sex education beyond conventional provision in eastern Scotl and is unlikely to reduce terminations in teenagers . Trial registration IS RCT N48719575 OBJECTIVE To evaluate the success of efforts to educate youth not only to use prescription contraceptives to avoid pregnancy , but also to use condoms to avoid sexually transmitted diseases , including infection with the human immunodeficiency virus . METHODS Longitudinal study of 383 African-American youth aged 9 to 15 years enrolled in a r and omized , controlled trial of an acquired immunodeficiency syndrome ( AIDS ) risk reduction intervention .  Data about contraceptive practice s were obtained at baseline and 6 , 12 , and 18 months later using a culturally and developmentally appropriate risk assessment tool administered with " talking " computers ( Macintosh , Apple Computer Inc , Cupertino , Calif ) . RESULTS Approximately three fourths of sexually active youth used some form of contraception  in each 6-month round , with almost half of the youth using combinations of contraceptives . Among all youth at baseline and among control youth throughout the study , more than half used condoms and more than two thirds who used oral contraceptives also used condoms . Receipt of an AIDS education intervention was associated with use of more effective contraceptive practice s ( eg ,  condoms  and another prescription or nonprescription method of birth control )  . After receiving the intervention , more than 80 % of the youth who used oral contraceptives also used condoms . Contraceptive practice s showed considerable stability . Knowledge about AIDS was positively associated with use of more effective contraceptive methods . CONCLUSIONS Many youth are using condoms and prescription birth control simultaneously , and these use rates can be increased through AIDS education interventions IMPORTANCE Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches . Prime Time , a youth development intervention , aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy . OBJECTIVE To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey , 6 months after the conclusion of the Prime Time intervention . DESIGN R and omized controlled trial . SETTING Community and school-based primary care clinics . PARTICIPANTS Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria , 236 ( 93.3 % ) completed the 24-month follow-up survey . INTERVENTION Offered during an 18-month period , Prime Time includes case management and youth leadership programs . MAIN OUTCOME MEASURES Self-reported consistency of condom , hormonal , and dual- method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months . RESULTS At 24-month follow-up , the intervention group reported significantly more consistent use of condoms , hormonal contraception , and dual- method contraception than the control group . Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex , and reductions in the perceived importance of having sex . No between-group differences were found in the number of recent male sex partners . CONCLUSIONS AND RELEVANCE This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic setting s , where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk . Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth PURPOSE Prime Time , a youth development intervention , aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy . This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention . METHODS This study was a r and omized controlled trial with 253 girls aged 13 - 17 years meeting specified risk criteria . Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months , control participants received usual clinic services . The intervention used a combination of case management and peer leadership programs . Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment . Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time . RESULTS At the 12-month interim , the intervention group reported more consistent use of condoms , hormonal contraception , and dual contraceptive methods with their most recent partner as compared with the control group . The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family . No between-group differences were noted in psychosocial measures specific to sex and contraceptive use . CONCLUSION Preventing early pregnancy among high-risk adolescents requires multifaceted , sustained approaches . An important research focus involves testing youth development interventions offered through clinic setting s , where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk . Findings suggest that youth development interventions through clinic setting s hold promise in reducing pregnancy risk among high-risk youth Abstract Objective : To determine whether a theoretically based sex education programme for adolescents ( SHARE ) delivered by teachers reduced unsafe sexual intercourse compared with current practice . Design : Cluster r and omised trial with follow up two years after baseline ( six months after intervention ) . A process evaluation investigated the delivery of sex education and broader features of each school . Setting : Twenty five secondary schools in east Scotl and . Participants : 8430 pupils aged 13 - 15 years ; 7616 completed the baseline question naire and 5854 completed the two year follow up question naire . Intervention : SHARE programme ( intervention group ) versus existing sex education ( control programme ) . Main outcome measures : Self reported exposure to sexually transmitted disease , use of condoms and contraceptives at first and most recent sexual intercourse , and unwanted pregnancies . Results : When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years . However , those in the intervention group reported less regret of first sexual intercourse with most recent partner ( young men 9.9 % difference , 95 % confidence interval −18.7 to −1.0 ; young women 7.7 % difference , −16.6 to 1.2 ) . Pupils evaluated the intervention programme more positively , and their knowledge of sexual health improved . Lack of behavioural effect could not be linked to differential quality of delivery of intervention . Conclusions : Compared with conventional sex education this specially design ed intervention did not reduce sexual risk taking in adolescents CONTEXT Adolescent females often have questions or concerns about their contraceptive methods , and they may discontinue use if these questions are not answered . Little evidence exists on whether follow-up phone calls to address young women 's concerns can help sustain contraceptive use . METHODS Between 2005 and 2007 , a total of 805 females aged 14 - 18 attending a reproductive health clinic 
    Output:
    
The latter study , which addressed multiple risks , showed an effect on contraceptive use .
We found few behavioral interventions for improving dual- method contraceptive use and little evidence of effectiveness .
A multifaceted program showed some effect but only had self-reported outcomes .