***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: The objective of this study was to determine the prevalence of , and factors associated with , sexual violence in childhood , adolescence and adulthood , among injection drug using men and women . The Vancouver Injection Drug User Study is a prospect i ve cohort of injection drug users ( IDU ) begun in 1996 . The analysis included all individuals who completed the baseline question naire who responded to a question about sexual assault . Multivariate modeling was used to determine and to what extent a history of sexual violence at different ages is predictive of HIV risk and other health risk behaviors . HIV prevalence was calculated as the total current number of HIV-positive individuals in the cohort . Of the 1437 eligible individuals , 36 % reported a lifetime history of sexual violence ; 68 % of women , and 19 % of men ( p<0.001 ) . After adjusting for fixed sociodemographics , these individuals were more likely to have ever been in the sex trade , to knowingly share needles/rigs with HIV-positive people , to have attempted suicide , to have ever accidentally overdosed , to binge on alcohol , and to have been diagnosed with a mental disorder/disability . The prevalence of child sexual abuse in this cohort is 21 % ; 33 % for women , and 13 % for men . The data show a dose-response relationship between age at first sexual violence and most risk behaviors examined . These relationships are further mediated by gender . The prevalence of HIV among individuals who ever experienced sexual violence was 25 % , compared to 19 % among those who never experienced sexual violence ( p=0.006 ) . Sexual violence , and especially child sexual abuse , is highly prevalent among this cohort , particularly among women . Child sexual abuse has worse consequences for both genders than sexual violence later in life . Nevertheless , women and men are affected differently by sexual violence at different ages , and this has significant implication s for health promotion programs , and specifically HIV prevention Homeless young adults ages 18 - 25 exhibit high rates of alcohol and other drug ( AOD ) use , and  sexual risk behaviors such as unprotected sex . Yet few programs exist for this population that are both effective and can be easily incorporated into setting s serving this population . This pilot cluster cross-over r and omized controlled trial evaluates AWARE , a voluntary four session group-based motivational interviewing ( MI ) intervention to reduce AOD use and sexual risk behavior . We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County ( mean age=21.8years ; 73 % male ; 79 % heterosexual ; 31 % non-Hispanic White , 25 % African American , 24 % Hispanic , 21 % multiracial/other ) . Surveys were completed at baseline and three months after program completion . Retention in the AWARE program was excellent ( 79 % attended multiple sessions ) and participants reported high levels of satisfaction with the program . AWARE participants self-reported positive change in their past 3month and past 30day alcohol use ( ps≤0.05 ) , motivation to change drug use ( ps<0.05 ) , and condom use self-efficacy ( p=0.05 ) compared to the control group . Among those with multiple sex partners , AWARE participants showed a decrease in unprotected sexual events ( p<0.05 ) , whereas the control group did not . Results from this pilot evaluation are promising , suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use . Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions PURPOSE We evaluate the efficacy of a short family intervention in reducing sexual risk behavior , drug use , and delinquent behaviors among homeless youth . METHODS A r and omized controlled trial of 151 families with a homeless adolescent aged 12 to 17 years . Between March 2006 and June 2009 , adolescents were recruited from diverse sites in Southern California and were assessed at recruitment ( baseline ) , and at 3 , 6 , and 12 months later . Families were r and omly assigned to an intervention condition with five weekly home-based intervention sessions or a control condition ( st and ard care ) . Main outcome measures reflect self-reported sexual risk behavior , substance use , and delinquent behaviors over the past 90 days . RESULTS Sexual risk behavior ( e.g. , mean number of partners ; p < .001 ) , alcohol use ( p = .003 ) , hard drug use ( p < .001 ) , and delinquent behaviors ( p = .001 ) decreased significantly more during 12 months in the intervention condition compared with the control condition . Marijuana use , however , significantly increased in the intervention condition compared with the control condition ( p < .001 ) . CONCLUSIONS An intervention to reengage families of homeless youth has significant benefits in reducing risk over 12 months BACKGROUND Although numerous interventions have been demonstrated to reduce targeted adolescent risk behaviors for brief periods , sustained behavior changes covering multiple risk behaviors have been elusive . OBJECTIVE To determine whether a parental monitoring intervention ( Informed Parents and Children Together [ ImPACT ] ) with and without boosters can further reduce adolescent truancy , substance abuse , and sexual risk behaviors and can alter related perceptions 24 months after intervention among youth who have all received an adolescent risk-reduction intervention ,  Focus on Kids ( FOK ) . DESIGN R and omized , controlled , 3-celled longitudinal trial . SETTING Thirty-five low-income , urban community sites . PARTICIPANTS Eight hundred seventeen African American youth aged 13 to 16 at baseline . Intervention All youth participated in FOK , an 8-session , theory-based , small group , face-to-face risk-reduction intervention , 496 youth and parents received the  1-session ImPACT intervention ( a videotape and discussion ) , 238 of the ImPACT youth also received four 90-minute FOK boosters delivered in small groups . MAIN OUTCOME MEASURES Responses at baseline and 24 months after intervention to a question naire assessing risk and protective behaviors and perceptions . Analyses used General Linear Modeling , intraclass correlation coefficient , analysis of covariance , and multiple comparisons with least significant difference test adjustment . RESULTS After adjusting for the intraclass correlation coefficient , 6 of 16 risk behaviors were significantly reduced ( P < or = .05 ) among youth receiving ImPACT compared with youth who only received FOK ( respectively , mean number of days suspended , 0.65 vs 1.17 ; carry a bat as a weapon , 4.1 % vs 9.6 % ; smoked cigarettes , 12.5 % vs 22.7 % ; used marijuana , 18.3 % vs 26.8 % ; used other illicit drugs , 1.4 % vs 5.6 % ; and , asked sexual partner if condom always used , 77.9 % vs 64.9 % ) . Four of the 7 theory-based subscales reflected significant protective changes among youth who received ImPACT . ImPACT did not produce any significant adverse effects on behaviors or perceptions . CONCLUSION A parent monitoring intervention can significantly broaden and sustain protection beyond that conferred through an adolescent risk-reduction intervention Outreach and service linkage are key for engaging marginalized population s , such as homeless youth , in services . Research to date has focused primarily on engaging individuals already receiving some services through emergency shelters , clinics , or other programs . Less is known about those who are not connected to services and , thus , likely the most vulnerable and in need of assistance . The current study sought to engage non-service-connected homeless youth ( N = 79 ) into a strengths-based outreach and advocacy intervention . Youth were r and omly assigned to receive 6 months of advocacy that focused on linking youth to a drop-in center ( n = 40 ) or to a crisis shelter ( n = 39 ) . All youth were assessed at baseline and 3 , 6 , and 9 months post-baseline . Findings indicated that youth prefer drop-in center services to the shelter . Also , the drop-in center linkage condition was associated with more service linkage overall ( B = 0.34 , SE = 0.04 , p < 0.01 ) and better alcohol-l [ B = −0.39 , SE = 0.09 , t(75 ) = −4.48 , p < 0.001 ] and HIV-related outcomes [ B = 0.62 , SE = 0.10 , t(78 ) = 6.34 , p < 0.001 ] compared to the shelter linkage condition . Findings highlight the importance of outreach and service linkage for reconnecting service-marginalized youth , and drop-in centers as a primary service option for homeless youth BACKGROUND AND OBJECTIVES : " Housing First " has been shown to improve housing stability in homeless individuals with mental illness , but had not been empirically tested in homeless youth . We aim ed to evaluate the effect of " Housing First " on housing stability in homeless youth aged 18 to 24 years participating in At Home/Chez Soi , a 24-month r and omized trial of " Housing First " in 5 Canadian cities . METHODS : Homeless individuals with mental illness were r and omized to receive " Housing First " ( combined with assertive community treatment or intensive case management depending on their level of need ) or treatment as usual . We defined our primary outcome , housing stability , as the percent of days stably housed as a proportion of days for which residence data were available . RESULTS : Of 2148 participants who completed baseline interviews and were r and omized , 7 % ( n = 156 ) were youth aged 18 to 24 years ; 87 received " Housing First " and 69 received treatment as usual . In an adjusted analysis , youth in " Housing First " were stably housed a mean of 437 of 645 ( 65 % ) days for which data were available compared with youth in treatment as usual , who were stably housed a mean of 189 of 582 ( 31 % ) days for which data were available , result ing in an adjusted mean difference of 34 % ( 95 % confidence interval , 24%–45 % ; P < .001 ) . CONCLUSIONS : " Housing First " was associated with improved housing stability in homeless youth with mental illness . Future research should explore whether adaptations of the model for youth yield additional improvements in housing stability and other outcomes While research on homeless adolescents and young adults evidencing substance use disorder is increasing , there is a dearth of information regarding effective interventions , and more research 
    Output:
    
Housing first , a structural intervention , led to improvements in housing stability .
Many interventions showed inconsistent results compared to services as usual or other interventions , but often led to improvements over time in both the intervention and comparison group .
The equity analysis showed that equity variables were inconsistently measured , but there was data to suggest differential outcomes based upon gender and ethnicity .
This review identified a variety of interventions for youth experiencing homelessness .
Promising interventions include  cognitive behavioural therapy  for addressing depression ,  family-based therapy for substance use outcomes , and housing programs for housing stability .