***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: OBJECTIVE To examine the long-term effects of an intervention combining teacher training , parent education , and social competence training for children during the elementary grade s on adolescent health-risk behaviors at age 18 years . DESIGN Nonr and omized controlled trial with follow-up 6 years after intervention . SETTING Public elementary schools serving high-crime areas in Seattle , Wash. PARTICIPANTS Of the fifth- grade students enrolled in participating schools , 643 ( 76 % ) were given written parental consent for the longitudinal study and 598 ( 93 % ) were followed up and interviewed at age 18 years . INTERVENTIONS A full intervention provided in grade s 1 through 6 of 5 days of in-service training for teachers each intervention year , developmentally appropriate parenting classes offered to parents when children were in grade s 1 through 3 and 5 through 6 , and developmentally adjusted social competence training for children in grade s 1 and 6 . A late intervention , provided in grade s 5 and 6 only , paralleled the full intervention at these grade s. MAIN OUTCOME MEASURES Self-reported violent and nonviolent crime , substance use , sexual activity , pregnancy , bonding to school , school achievement , grade repetition and school dropout , suspension and /or expulsion , and school misbehavior ; delinquency charges from court records ; grade point average ; California Achievement Test scores : and disciplinary action reports from school records . RESULTS Fewer students receiving full intervention than control students reported violent delinquent acts ( 48.3 % vs 59.7 % ; P=.04 ) , heavy drinking ( 15.4 % vs 25.6 % ; P=.04 ) , sexual intercourse ( 72.1 % vs 83.0 % ; P=.02 ) , having multiple sex partners ( 49.7 % vs 61.5 % ; P=.04 ) , and pregnancy or causing pregnancy ( 17.1 % vs 26.4 % ; P=.06 ) by age 18 years . The full intervention student group reported more commitment ( P=.03 ) and attachment ( P=.006 ) to school , better academic achievement ( P=.01 ) , and less school misbehavior ( P=.02 ) than control students . Late intervention in grade s 5 and 6 only did not significantly affect health-risk behaviors in adolescence . CONCLUSIONS A package of interventions with teachers , parents , and children provided throughout the elementary grade s can have enduring effects in reducing violent behavior , heavy drinking , and sexual intercourse by age 18 years among multiethnic urban children . Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods OBJECTIVE To test the efficacy of 2 programs design ed to reduce high-risk behaviors among inner-city African American youth . DESIGN Cluster r and omized trial . SETTING Twelve metropolitan Chicago , Ill , schools and the communities they serve , 1994 through 1998 . PARTICIPANTS Students in grade s 5 through 8 and their parents and teachers . INTERVENTIONS The social development curriculum ( SDC ) consisted of 16 to 21 lessons per year focusing on social competence skills necessary to manage situations in which high-risk behaviors occur . The school/community intervention ( SCI ) consisted of SDC and school-wide climate and parent and community components . The control group received an attention-placebo health enhancement curriculum ( HEC ) of equal intensity to the SDC focusing on nutrition , physical activity , and general health care . MAIN OUTCOME MEASURES Student self-reports of violence , provocative behavior , school delinquency , substance use , and sexual behaviors ( intercourse and condom use ) . RESULTS For boys , the SDC and SCI significantly reduced the rate of increase in violent behavior ( by 35 % and 47 % compared with HEC , respectively ) , provoking behavior ( 41 % and 59 % ) , school delinquency ( 31 % and 66 % ) , drug use ( 32 % and 34 % ) , and recent sexual intercourse ( 44 % and 65 % ) , and improved the rate of increase in condom use ( 95 % and 165 % ) . The SCI was significantly more effective than the SDC for a combined behavioral measure ( 79 % improvement vs 51 % ) . There were no significant effects for girls . CONCLUSIONS Theoretically derived social-emotional programs that are culturally sensitive , developmentally appropriate , and offered in multiple grade s can reduce multiple risk behaviors for inner-city African American boys in grade s 5 through 8 . The lack of effects for girls deserves further research CONTEXT Despite the recent declines in rates of teenage pregnancy , relatively little is known about the few programs that have been successful in reducing adolescent pregnancy . METHODS Six agencies in New York City each r and omly assigned 100 disadvantaged 13 - 15-year-olds to their usual youth program or to the intervention being tested -- the Children 's Aid Society-Carrera program  , a year-round afterschool program with a comprehensive youth development orientation . Both program and control youth were followed for three years . Multivariate regression analyses assessed the effects of program participation on the odds of current sexual activity , use of a condom along with a hormonal contraceptive , pregnancy and access to good health care . RESULTS Seventy-nine percent of participants remained in the program for three full years . Female program participants had significantly lower odds than controls of being sexually active ( odds ratio , 0.5 ) and of having experienced a pregnancy ( 0.3 ) . They had significantly elevated odds of having used a condom and a hormonal method at last coitus ( 2.4 ) . However , participation in the program created no significant impact on males ' sexual and reproductive behavior outcomes . Nonetheless , program participants of both genders had elevated odds of having received good primary health care ( 2.0 - 2.1 ) . CONCLUSIONS This program is one of only four whose evaluation has successfully documented declines in teenage pregnancy using a r and om-assignment design . Better outcomes among males may be achieved if programs reach them even earlier than their teenage years OBJECTIVE To examine the long-term effects of the full  Seattle Social Development Project intervention on sexual behavior and associated outcomes assessed at age 21 years . DESIGN Nonr and omized controlled trial with long-term follow-up . SETTING Public elementary schools serving children from high-crime areas in Seattle , Wash. PARTICIPANTS Ninety-three percent of the fifth- grade students enrolled in either the full-intervention or control group were successfully interviewed at age 21 years ( n = 144 [ full intervention ] and n = 205 [ control ] ) . INTERVENTIONS In-service teacher training , parenting classes , and social competence training for children . MAIN OUTCOME MEASURES Self-report measures of all outcomes . RESULTS The full-intervention group reported significantly fewer sexual partners and experienced a marginally reduced risk for initiating intercourse by age 21 years as compared with the control group . Among females , treatment group status was associated with a significantly reduced likelihood of both becoming pregnant and experiencing a birth by age 21 years . Among single individuals , a significantly increased probability of condom use during last intercourse was predicted by full-intervention group membership ; a significant ethnic group x intervention group interaction indicated that after controlling for socioeconomic status , single African Americans were especially responsive to the intervention in terms of this outcome . Finally , a significant treatment x ethnic group interaction indicated that among African Americans , being in the full-intervention group predicted a reduced probability of contracting a sexually transmitted disease by age 21 years . CONCLUSION A theory-based social development program that promotes academic success , social competence , and bonding to school during the elementary grade s can prevent risky sexual practice s and adverse health consequences in early adulthood Sexual risk behavior outcome data from the Healthy for Life ( HFL ) project is presented . Using a social influences model , the intervention was design ed to positively affect the health behaviors of middle school students in five related areas : alcohol use , tobacco use , marijuana use , nutrition , and sexuality . The in-school program was supplemented by parent , community and peer components . The research used self-report data on an initial sample of 2,483 middle school students followed from Grade 6 to Grade 10 . Twenty-one schools were assigned to three conditions -- age appropriate ( program taught in Grade s 6 , 7 , and 8) , intensive ( program taught in Grade 7 ) and control -- using blocked r and omization . Attrition was 20 % ( by Year 4 ) and 33 % ( by Year 5 ) . By ninth grade the lifetime intercourse rate among both groups of HFL subjects was significantly higher than for controls ( controlling for baseline substance use risk and involvement with the opposite sex ) , but reported past month intercourse rates and condom use did not differ . At the tenth grade follow-up , the age appropriate subjects reported higher adjusted rates of lifetime and past month intercourse than did the controls . Intensive subjects perceived significantly lower normative rates of intercourse than controls at ninth grade follow-up , but age appropriate subjects perceived significantly higher norms at tenth grade . Our expectation that this approach would be effective in reducing adolescent sexual risk behavior has not been supported . The influence of social and community norms and context ual factors has a far greater influence on the behavior of students ( even 6 years later ) than this school-based social influences program targeting only one grade cohort PURPOSE This study was undertaken to determine whether the Adult Identity Mentoring ( AIM ) project successfully promotes abstinence , delays initiation of sex , and decreases intention to engage in sex . METHODS Twenty middle school classes of African-American seventh grade rs were r and omly assigned to receive either the AIM intervention or a st and ard health education control curriculum . The AIM is a 10-session curriculum based on the theory of possible selves . Class exercises encourage students to articulate a possible future self-identity and to develop self-promotion skills . Surveys about sexual activity were conducted before the intervention , 19 weeks after baseline , and again at 1 year after the intervention . RESULTS Hierarchical logistic regression analyses showed significant effects for the intervention on sexual intentions , abstinence , and a trend toward fewer virgins initiating intercourse for the first time , 19 weeks after baseline . Specifically , students who received the intervention showed decreased intention to engage in sex and increased abstinence compared with students not receiving the intervention . Effects for 1-year follow-up , with smaller sample size , showed only that AIM male participants maintained the significant abstinence effect . CONCLUSIONS A new intervention , AIM was evaluated among African-American seventh grade rs . This program , by focusing students on positive future selves , effectively modified sexual risk without directly providing instruction on sexually explicit topics PURPOSE To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade . METHODS During the fall of seventh grade and again in eighth grade , students were r and omly assigned by classroom to participate either in community youth service ( CYS ) or not ( controls ) . Service learning is an educational strategy that couples meaningful service in the community with classroom instruction . Students in both intervention and control conditions received classroom health lessons . Surveys were conducted at seventh grade baseline and at the end of 10th grade , approximately 2 years after intervention . Self-reported sexual behaviors  of youths who had participated in CYS  were compared with those of controls receiving classroom curriculum alone ( n = 195 ) . RESULTS CYS participants were significantly less likely than controls to report sexual initiation ( 2 years CYS , odds ratio [ OR ] = 0.32 ; 1 year , OR = 0.49 ) as well as recent sex ( 2 years CYS , OR = 0.39 ; 1 year CYS , OR = 0.48 ) . Among those who were virgins at seventh grade , 80 % of males in the curriculum-only condition had initiated sex , compared with 61.5 % who received 1 year of CYS , and 50 % who received 2 years . Among females , the figures were 65.2 % , 48.3 % , and 39.6 % , respectively . CONCLUSION A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents OBJECTIVES This study evaluated the effectiveness of a community youth service ( CYS ) program in reducing sexual risk behaviors among African American and Latino urban young adolescents . METHODS A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up . Students at one school were r and omly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only . Students at the other school served as controls . RESULTS At follow-up . CYS participants reported significantly less recent sexual activity ( P < .05 ) and scored lower on a sexual activity index than those in the control condition ( P < .03 ) . The greatest effect was among eighth grade rs , who received the most intensive service program ( P < .03 ) . The benefit of the curriculum-only intervention appeared greatest among students in special education classes . CONCLUSIONS Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV , sexually transmitted diseases , and unintended pregnancy . This study also suggests the importance of including students in special education classes in health education programs OBJECTIVES We sought to test the efficacy of an intervention that was design ed to promote social inclusion and commitment to education , in reducing among students health risk behaviors and improving emotional well-being . METHODS The design was a cluster-r and omized trial in 25 secondary schools in Victoria , Australia . The subjects were 8th- grade students ( aged 13 to 14 y ) in 1997 ( n=2545 ) and subsequent 8th- grade 
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Effective programs were significantly more likely than those that did not have an impact to strengthen the school context and to deliver activities in a supportive atmosphere .
Effective programs were also more likely to build skills , enhance bonding , strengthen the family , engage youth in real roles and activities , empower youth , communicate expectations , and be stable and relatively long-lasting , although these differences between effective and ineffective programs were not statistically significant .