***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: Reported are results of an independent effectiveness study of the  Project ALERT drug prevention program  implemented in eight Pennsylvania middle schools by outside program leaders employed by Cooperative Extension . In this r and omized , 2-cohort longitudinal evaluation , 1,649 seventh- grade students completed a pretest and four waves of posttests over the 2-year program and 1-year follow-up . Project ALERT 's effectiveness was tested through a 3-level hierarchical linear model . Analyses failed to yield any positive effects for substance use or mediators for use in the adult or teen-assisted delivery of the curriculum . An extensive set of additional analyses detected no differential program effects by student risk level , gender , school , or level of implementation quality . Potential explanations for outcomes relative to Project ALERT 's original effectiveness trial are discussed , as well as implication s for future research , including the need to conduct independent effectiveness studies of previously vali date d programs in a variety of context 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 BACKGROUND Adolescents ' alcohol consumption is a public health concern in Sweden as well as in many other countries . Underage drinking is associated with increased risks of alcohol-related injuries , risky sexual behaviours and dependence later in life . Different strategies have been used in the effort to prevent this behaviour , and to postpone the onset of alcohol . The Strengthening Families Programme 10 - 14 ( SFP 10 - 14 ) from the USA has been highlighted as one of the more effective prevention programmes . The aim of the present article was to evaluate the effectiveness of a culturally adapted Swedish version of the SFP 10 - 14 . METHODS This was a cluster r and omized controlled trial including 587 sixth- grade students ( age 12 ) and their parents in 19 elementary schools in Stockholm . Schools were r and omly assigned to either control ( 9 schools , 216 students ) or to the family skills training intervention ( 10 schools , 371 students ) . The SFP Swedish version consisted of two parts with seven and five sessions , respectively , held separately for youths and parents except two joint family sessions . Measures of students ' self-reported episodes of drunkenness , smoking , illicit drug use and other norm-breaking behaviours were collected at baseline ( March 2003 ) and at three subsequent yearly surveys . Data were analysed using multilevel models with an intention-to-treat approach . RESULTS No preventive effects were found for smoking , alcohol and illicit drug use and other norm-breaking behaviours , nor did moderators affect the outcome . CONCLUSION The Swedish version of the SFP 10 - 14 was not effective in preventing youths ' substance use in a Swedish context OBJECTIVES We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities . METHODS Fifty-five South Dakota middle schools were r and omly assigned to program or control conditions . Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade . Program effects for 4276 8th- grade rs were assessed 18 months after baseline . RESULTS The revised Project ALERT curriculum curbed cigarette and marijuana use initiation , current and regular cigarette use , and alcohol misuse . Reductions ranged from 19 % to 39 % . Program effects were not significant for initial and current drinking or for current and regular marijuana use . CONCLUSIONS School-based drug prevention programs can prevent occasional and more serious drug use , help low- to high-risk adolescents , and be effective in diverse school environments AIM To analyze data from a r and omized clinical trial to determine the cost-effectiveness of using contingency management ( CM ) and motivational/skills building therapy ( motivational enhancement therapy/cognitive-behavioral therapy : MET/CBT ) to treat young adults with marijuana dependence . PARTICIPANTS , DESIGN AND MEASUREMENTS : A total of 136 marijuana-dependent young adults , all referred by the criminal justice system , were r and omized to one of four treatment conditions : MET/CBT with CM , MET/CBT without CM , drug counseling ( DC ) with CM and DC without CM . Patient outcome measures include the longest duration of confirmed marijuana abstinence ( LDA ) during treatment and the total number of marijuana-free urine specimens provided during treatment . Costs were collected retrospectively from the provider and include the costs of therapy , patient drug testing , and those associated with the incentives component ( value of vouchers , time to administer the voucher system ) . SETTING Out-patient substance abuse clinic in New Haven , Connecticut , USA . FINDINGS Which treatment is the most cost-effective depends on the threshold values of an additional week of LDA or an additional marijuana-free urine specimen . For example , the most effective treatment , MET/CBT with CM , was also the most cost-effective treatment at the highest threshold values , while the least effective treatment , DC , was the most cost-effective at the lowest values . Because consensus threshold values for these patient outcomes do not exist , results are presented showing the ranges of values over which each treatment would be considered cost-effective compared to the others . Acceptability curves are presented to show the decision uncertainty associated with these ranges . The results are shown to be robust to ( i ) sensitivity analyses on several key cost parameters and ( ii ) patient outcomes measured during the 6-month follow-up period . CONCLUSIONS This study uses incremental cost-effectiveness ratios and acceptability curves to shed light on the relative cost-effectiveness of four interventions for treating young adults with marijuana dependence . Given the relatively small and specialized nature of our study sample , and the fact that we examined a CM procedure with a single reinforcement schedule , additional studies are warranted to determine the reliability and generalizability of our results both to alternative marijuana-using population s and to CM procedures with alternative incentive parameters . Nevertheless , the relative durability of effects of MET/CBT compared to DC through the 6-month follow-up , and its cost-effectiveness over a comparatively wide range of threshold values , underscores the promise of this approach This exploratory study sought to determine if a popular school-based drug prevention program  might be effective in schools that are making adequate yearly progress ( AYP ) . Thirty-four schools with grade s 6 through 8 in 11 states were r and omly assigned either to receive Project ALERT ( n = 17 ) or to a control group ( n = 17 ) ; of these , 10 intervention and nine control schools failed to make AYP . Students completed three self-report surveys . For lifetime cigarette use and 30-day alcohol use ,  Project ALERT was more effective in schools that made AYP . However , in these schools , Project ALERT negatively affected students ' lifetime marijuana use . This study provided some preliminary evidence that prevention programming may not work as well in poorer performing schools ; however , further exploration is needed BACKGROUND A younger age at onset of use of a specific substance is a well-documented risk-factor for a substance use disorder ( SUD ) related to that specific substance . However , the cross-substance relationship between a younger age at onset of alcohol use ( AU ) and nicotine use ( NU ) and the risk of cannabis use disorders ( CUD ) in adolescence and early adulthood remains unclear . AIMS To identify the sequence of and latency between initial AU/NU and initial cannabis use ( CU ) . To investigate whether younger age at AU- and NU-onset is associated with any and earlier CU-onset and a higher risk of transition from first CU to CUD , taking into account externalizing disorders ( ED ) and parental substance use disorders as putative influential factors . METHODS Prospect ive-longitudinal community study with N=3021 subjects ( baseline age 14 - 24 ) and up to four assessment waves over up to ten years with additional direct parental and family history information .  Substance use and CUD were assessed with the DSM-IV/M-CIDI . RESULTS Most subjects with CU reported AU ( 99 % ) and NU ( 94 % ) . Among users of both substances , 93 % reported AU prior to CU ( 87 % for NU ) . After adjustment for ED and parental substance use disorders younger age at AU-onset was associated with any CU . Younger age at NU-onset was associated with earlier CU initiation . Younger age at AU- and NU-onset was not associated with a higher risk of CUD . CONCLUSIONS The cross-substance relevance of younger age at first AU and NU for the risk of CUD is limited to early CU involvement 
    Output:
    
ConclusionS chool-based prevention such as Project ALERT has the potential to be cost effective and to be cost saving if implemented in deprived areas .