***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: Context Cost-effective , scalable programs are urgently needed in countries deeply affected by HIV . Methods This parallel-group RCT was conducted in four secondary schools in Mbarara , Ug and a. Participants were 12 years and older , reported past-year computer or Internet use , and provided informed caregiver permission and youth assent . The intervention , CyberSenga , was a five-hour online healthy sexuality program . Half of the intervention group was further r and omized to receive a booster at four-months post-intervention . The control arm received ‘ treatment as usual ’ ( i.e. , school-delivered sexuality programming ) . The main outcome measures were : 1 ) condom use and 2 ) abstinence in the past three months at six-months ' post-intervention . Secondary outcomes were : 1 ) condom use and 2 ) abstinence at three-month 's post-intervention ; and 6-month outcomes by booster exposure . Analyses were intention to treat . Results All 416 eligible youth were invited to participate , 88 % ( n = 366 ) of whom enrolled . Participants were r and omized to the  intervention ( n = 183 ) or  control ( n = 183 ) arm ; 91 intervention participants were further r and omized to the booster . No statistically significant results were noted among the main outcomes . Among the secondary outcomes : At three-month follow-up , trends suggested that intervention participants ( 81 % ) were more likely to be abstinent than control participants ( 74 % ; p = 0.08 ) , and this was particularly true among youth who were abstinent at baseline ( 88 % vs. 77 % ; p = 0.02 ) . At six-month follow-up , those in the booster group ( 80 % ) reported higher rates of abstinence than youth in the intervention , no booster ( 57 % ) and control ( 55 % ) groups ( p = 0.15 ) ; they also reported lower rates of unprotected sex ( 5 % ) compared to youth in the intervention , no booster ( 24 % ) and control ( 21 % ) groups ( p = 0.21 ) among youth sexually active at baseline . Conclusions The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and , with the booster , may also promote HIV preventive behavior among sexually active youth in the longer term . Trial Registration NCT00906178 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 PURPOSE An earlier r and omized controlled trial found that two middle school sexual education programs-a risk avoidance ( RA ) program and a risk reduction ( RR ) program-delayed  initiation of sexual intercourse ( oral , vaginal , or anal sex ) and reduced other sexual risk behaviors in ninth grade . We examined whether these effects extended into 10th grade . METHODS Fifteen middle schools were r and omly assigned to RA , RR , or control conditions . Follow-up surveys were conducted with participating students in 10th grade ( n = 1,187 ; 29.2 % attrition ) . RESULTS Participants were 60 % female , 50 % Hispanic , and 39 % black ; seventh grade mean age was 12.6 years . In 10th grade , compared with the control condition , both programs significantly delayed anal sex initiation in the total sample ( RA : adjusted odds ratio [ AOR ] , .64 , 95 % confidence interval [ CI ] , .42-.99 ; RR : AOR , .65 , 95 % CI , .50-.84 ) and among Hispanics ( RA : AOR , .53 , 95 % CI , .31-.91 ; RR : AOR , .82 , 95 % CI , .74-.93 ) . Risk avoidance students were less likely to report unprotected vaginal sex , either by using a condom or by abstaining from sex ( AOR : .61 , 95 % CI , .45-.85 ) ; RR students were less likely to report recent unprotected anal sex ( AOR : .34 , 95 % CI , .20-.56 ) . Both programs sustained positive impact on some psychosocial outcomes . CONCLUSIONS Although both programs delayed anal sex initiation into 10th grade , effects on the delayed initiation of oral and vaginal sex were not sustained . Additional high school sexual education may help to further delay sexual initiation and reduce other sexual risk behaviors in later high school years Background To promote well-being and health behaviors among adolescents , 2 interventions were implemented at 12 secondary schools . Adolescents in the E-health4Uth  group received Web-based tailored messages focused on their health behaviors and well-being . Adolescents in the  E-health4Uth and consultation group received the same tailored messages , but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems . Objective This study evaluated the effect of E-health4Uth and E-health4Uth and consultation on well-being ( ie , mental health status and health-related quality of life ) and health behaviors ( ie , alcohol and drug use , smoking , safe sex ) . Methods A cluster r and omized controlled trial was conducted among third- and fourth-year secondary school students ( mean age 15.9 , SD 0.69 ) . School classes ( clusters ) were r and omly assigned to ( 1 ) E-health4Uth group , ( 2 ) E-health4Uth and consultation group , or ( 3 ) control group ( ie , care as usual ) . Adolescents completed a question naire at baseline and at 4-month follow-up assessing alcohol consumption , smoking , drug use , condom use , mental health via the Strengths and Difficulties Question naire ( SDQ ) and the Youth Self Report ( YSR ; only measured at follow-up ) , and health-related quality of life . Multilevel logistic , ordinal , and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up . Subsequently , it was explored whether demographics moderated the effects . Results Data from 1256 adolescents were analyzed . Compared to the control intervention , the E-health4Uth intervention , as a st and alone intervention , showed minor positive results in health-related quality of life ( B=2.79 , 95 % CI 0.72 - 4.87 ) and condom use during intercourse among adolescents of Dutch ethnicity ( OR 3.59 , 95 % CI 1.71 - 7.55 ) not replicated in the E-health4Uth and consultation group . The E-health4Uth and consultation intervention showed minor positive results in the mental health status of adolescents ( SDQ : B=−0.60 , 95 % CI −1.17 to −0.04 ) , but a negative effect on drug use among boys ( OR 0.36 , 95 % CI 0.13 - 0.96 ) . In the subgroup of adolescents who were at risk of mental health problems at baseline ( and referred for a consultation with the nurse ) , the E-health4Uth and consultation group showed minor to moderate positive results in mental health status ( SDQ : B=−1.79 , 95 % CI −3.35 to −0.22 ; YSR : B=−9.11 , 95 % CI −17.52 to −0.71 ) and health-related quality of life ( B=7.81 , 95 % CI 2.41 - 13.21 ) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline . Conclusions Findings from this study support the use of the E-health4Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems . Future research is needed to further evaluate the effects of the consultation as a st and alone intervention , and the dual approach of further tailored eHealth messages and a consultation . Trial Registration Nederl and s Trial Register : NTR 3596 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3596 ( Archived by WebCite at http://www.webcitation.org/6PmgrPOuv ) 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 BACKGROUND Students attending ' alternative ' high schools form relatively small , highly mobile high-risk population s , presenting challenges for the design and implementation of HIV- , other STI- , and pregnancy-prevention interventions . This paper describes the rationale , study design , and baseline results for the Safer Choices 2 program . STUDY DESIGN Modified group-r and omized intervention trial with cross-over of schools but not of students . The study cohort was defined a priori as those who completed the baseline measures and were still enrolled at the time of first follow-up . DESIGN RESULTS : Of 940 students initially enrolled in the study , 711 ( 76 % ) formed the study cohort . There were significant demographic differences between those included and those excluded from the study cohort in sex , age , sexual experience , experience with pregnancy , drug use , and some psychosocial measures . There were no significant differences between the intervention and control groups within the study cohort . The only significant difference between those students excluded from the intervention group and those excluded from the control group was reported age at first intercourse . BASELINE DATA RESULTS : Students ( n=940 ) enrolled were predominately African-American ( 29.7 % ) and Hispanic ( 61.3 % ) ; 57.3 % were female ; 66 % had ever had sex ; and reported drug use in the previous 30 days ran from 4.3 % ( cocaine ) to 26.9 % ( marijuana ) . Of the 627 sexually experienced , 41.8 % reported their age at first intercourse as 13 years or younger ; 28.5 % reported ever being or having gotten someone pregnant ; 74 % reported sex in the past 3 months . Of the 464 sexually active in the last 3 months , 55.4 % reported unprotected intercourse and 31.3 % reported using drugs beforeh and . CONCLUSION The cross-over design will provide a rigorous test of the intervention ; however , loss to follow-up of this population can result in some selection bias . Students attending dropout prevention and recovery schools are at high risk for HIV , STIs , and pregnancy , and are in need of interventions The effectiveness of an intervention based upon the theories of Ajzen and Tri and is was evaluated among 698 junior and 306 senior high school students . The intervention to juniors was offered by  senior students who were trained during a course integrated into the school curriculum . Respondents in the control and experimental groups completed a question naire at baseline and 9 months after the program . Compared to junior respondents in the control group , those in the experimental group positively modified their attitude , perceived behavioral control , personal normative beliefs , perceived role beliefs , anticipated regret and intention with respect to postponing sexual intercourse and with respect to condom use , as well as perceived self-efficacy to negotiate both behaviors . Comp 
    Output:
    
Since most trials addressed preventing STI/HIV and pregnancy , they emphasized condom use .