***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: Theories and empirical studies of adolescent sexual behavior have identified the contributions of personal attributes and social experiences ; however , it is rare that models have clarified developmental pathways to adolescent sexual behavior that include ( 1 ) factors assessed prior to and early in adolescence and ( 2 ) dyadic experiences in adolescence that provide the opportunity for sexual behavior ( i.e. , dating ) . Using data from a prospect i ve study , structural equation modeling was used to test a model predicting  adolescent sexual behavior at age 19 , denoted by the number of lifetime sexual partners . Predictors examined were sociability and impulsivity assessed at 30 months of age , physical characteristics and experiences with peers measured at age 12–13 , the age  of first romantic relationship  , and frequency of alcohol use at age 16 . The pathway to greater sexual involvement was marked by some desired personal attributes ( e.g. , sociability ) and peer experiences ( e.g. , higher quality friendships ) . These associations were mediated , however , by earlier initiation of romantic relationships and more frequent use of alcohol in middle adolescence . Earlier initiation of romantic relationships and more frequent alcohol use were predicted by greater sociability and less impulsivity in childhood , higher quality friendships and greater peer acceptance in early adolescence , and a more mature appearance and physical attractiveness ( among females ) at age 13 . The findings imply a complex pathway that leads to a greater accumulation of sexual partners by age 19 . This pathway begins in childhood and includes individual qualities , peer acceptance , romantic relationships , and alcohol use 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 Background Spanish-dominant Latino youth represent a growing yet underserved segment of the U.S. population , especially in terms of protection from sexually transmitted HIV infection . There is evidence to suggest that this subgroup engages in both risk and protective behaviors that may be different from the behaviors of English-dominant Latino youth . Objective To examine theoretical predictors ( attitude , subjective norm , behavioral beliefs , normative beliefs , control beliefs ) of sexual intercourse and condom use with a sample of Spanish-dominant Latino youth . Methods Participants in this study were part of a larger r and omized controlled intervention design ed to reduce the risk of sexually transmitted HIV among Latino youth . This article is based on preintervention data from 141 Spanish-speaking Latino adolescents ( 77 girls and 64 boys ) who completed a Spanish version of the question naire . Results Multiple regression analyses showed significant effects of attitudes , perceived partner approval , self-pride , and parental pride on intentions to engage in sexual intercourse . Attitudes , intentions to engage in sex in the next 3 months , self-pride , parental pride , goals , and partner approval predicted sexual intercourse in the preceding 3 months . Attitudes , subjective norms , self-efficacy , partner and parental approval , and impulse control beliefs were significant predictors of intentions to use condoms . Conclusions This study represents initial efforts to address the needs of Spanish-dominant Latino youth . The identification of salient beliefs that may predict sexual risk and protective behavior are relevant to the design of culturally and linguistically effective interventions OBJECTIVE African-American adolescents living in high-risk inner-city environments have been disproportionately affected by the epidemics of human immunodeficiency virus ( HIV ) and other sexually transmitted diseases . Underst and ing the factors that influence the use of condoms by adolescents is critical for developing effective behavioral interventions . The present study examined the demographic , psychosocial , and behavioral correlates of condom use among African-American adolescents residing in public housing developments in an HIV epicenter ( San Francisco ) and prospect ively evaluated the stability of these significant cross-sectional variables to predict consistent condom use . DESIGN A prospect i ve study . SETTING Two public housing developments in San Francisco . PARTICIPANTS African-American adolescents and young adults between 12 and 21 years of age were recruited though street outreach  and completed a theoretically derived research interview assessing HIV-related knowledge , attitudes , and behaviors . After a 6-month period , adolescents completed a follow-up interview similar to the baseline measure . Among adolescents reporting sexual activity in the 6 months before completing the baseline interview ( n = 116 ) , logistic regression analysis evaluated the influence of demographic , psychosocial , and behavioral factors on consistent condom use . RESULTS Adolescents who had high assertive self-efficacy to dem and condom use ( adjusted odds ratio [ OR ] , 11 ) , perceived peer norms as supporting condom use ( OR , 4.2 ) , had greater impulse control ( OR , 3.7 ) , were male ( OR , 4.7 ) , and were younger ( OR , 2.9 ) were more likely to report consistent condom use . Frequency of sexual intercourse was inversely related to condom use ; adolescents with higher numbers of sexual episodes were less likely to use condoms consistently . Prospect i ve analyses identified the baseline level of condom use as the best predictor of condom use at the 6-month follow-up . Adolescents who were consistent condom users at baseline were 7.4 times as likely to be consistent condom users during the follow-up period . Of those adolescents changing their frequency of condom use during the follow-up interval , significantly more engaged in risky behavior ; 33.3 % changed from consistent to inconsistent condom use , whereas 20.6 % changed from inconsistent to consistent use ( OR , 1.6 ) . CONCLUSIONS The findings suggest that HIV prevention programs need to be implemented early , before high-risk behaviors are established and may be more difficult to modify To estimate trends and determinants of sexual initiation and contraceptive use among adolescent women in Northeast Brazil , multivariate logistic hazard models are used that draw on data from three Demographic and Health Surveys conducted there between 1986 and 1996 . Educational attainment is among the variables found to be associated most consistently with differential risk of engaging in first intercourse during adolescence , including premarital intercourse , and of contraceptive use during sexual initiation . Greater frequency of attending religious services and greater exposure to television are also associated with lower rates of sexual initiation and higher use of contraceptives . Seemingly diminishing returns of education on delayed sexual activity may help explain , in part , observed increases in the absolute level of adolescent sexual experience across survey periods , however . Multilevel modeling techniques pointing to the existence of cluster-level r and om variances underline the need for further research into community influences on individual sexual activity This study assessed the impact of school-based social competence training on skills , social adjustment , and self-reported substance use of 282 sixth and seventh grade rs . Training emphasized broad-based competence promotion in conjunction with domain-specific application to substance abuse prevention . The 20-session program comprised six units : stress management , self-esteem , problem solving , substances and health information , assertiveness , and social networks . Findings indicated positive training effects on Ss ' skills in h and ling interpersonal problems and coping with anxiety . Teacher ratings revealed improvements in Ss ' constructive conflict resolution with peers , impulse control , and popularity . Self-report ratings indicated gains in problem-solving efficacy . Results suggest some preventive impact on self-reported substance use intentions and excessive alcohol use . In general , the program was found to be beneficial for both inner-city and suburban students 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 students in 1999 ( n=2586 ) and 2001 ( n=2463 ) . The main outcomes were recent substance use , antisocial behavior , initiation of sexual intercourse , and depressive symptoms . RESULTS At 4-year follow-up , the prevalence of marked health risk behaviors was approximately 20 % in schools in the comparison group and 15 % in schools in the intervention group , an overall reduction of 25 % . In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models ( odds ratio [OR]= 0.69 ; 95 % confidence interval [CI]= 0.50 , 0.95 ) and adjusted models ( OR= 0.71 ; CI = 0.52 , 0.97 ) for potential confounders . There was no evidence of a reduction in depressive symptoms . CONCLUSION The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments Condom promotion strategies for adolescents typically include provision of STD/HIV-associated knowledge , fostering favorable attitudes toward condom use , promoting positive peer norms regarding condom use , improving condom-related communication skills and self-efficacy , and overcoming barriers to condom use . The purpose of this study was to identify which of these constructs were prospect ively associated with condom use among a high-risk sample of African American adolescent females reporting sexual activity with a steady male partner . Adolescents , 14–18 years old , were recruited from schools and health clinics . Adolescents completed an in-depth survey and interview at baseline and again 6 months later . Analyses were limited to adolescents with steady partners who reported sexual activity between the baseline and 6-month follow-up assessment periods ( N = 179 ) . At baseline , five-scale measures and a single-item measure were used to assess predictive constructs . At follow-up , adolescents were asked about their frequency of condom use over various periods of recall . Multivariate models were created to control for the confounding influence of pregnancy status . The findings were remarkably distinct . The evidence strongly supported the predictive role of perceived barriers toward condom use and peer norms . The measure of sexual communication achieved significance for two of the six assessed outcomes . Alternatively , measures of attitudes toward condom use , condom negotiation self-efficacy , and knowledge about STD/HIV-prevention were consistently nonsignificant . The findings suggest that to improve effectiveness of individual-level STD/HIV prevention programs , design ed for this population , program emphasis should be on reducing barriers to condom use , teaching partner communication skills , and fostering positive peer norms relevant to condom use Predictive effects of school experiences were studied over a 7-year interval in a r and om community sample of 452 adolescents , 12 through 18 years of age . Outcomes examined included dropping out of school , adolescent pregnancy , engaging in criminal activities , criminal conviction , antisocial personality disorder , and alcohol abuse . Logistic regression showed academic achievement , academic aspirations , and leaming-focused school 
    Output:
    
There was insufficient evidence to draw conclusions about emotional and moral competence and ASRH .
Helping adolescents to achieve cognitive , social , and behavioral competence may reduce the likelihood of sexual activity and teen pregnancy , and increase contraceptive use .