***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: This study investigated preschoolers ' perceptions of authority in sexual and benign situations and how these might influence acquisition of concepts presented in a sexual abuse prevention program . Participants were 117 children , ages 36 - 84 months , at four day-care centers . Children were r and omly assigned to either an experimental or delayed treatment control group . Measures of authority and prevention skills were administered prior to and following the first administration of the curriculum . Preschoolers reasoned at a higher level of authority in sexually abusive encounters as compared to benign ones . For experimental children , this capability increased after participating in the prevention program . At pretest , sexual abuse authority scores predicted scores on one of two prevention skills ; pretest authority scores did not predict either posttest prevention skill . Results are discussed in relation to children 's underst and ing of moral versus social-conventional rules , and future directions for research are indicated CONTEXT Home-visitation services have been promoted as a means of improving maternal and child health and functioning . However , long-term effects have not been examined . OBJECTIVE To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women 's life course and child abuse and neglect . DESIGN R and omized trial . SETTING Semirural community in New York . PARTICIPANTS Of 400 consecutive pregnant women with no previous live births enrolled , 324 participated in a follow-up study when their children were 15 years old . INTERVENTION Families received a mean of 9 home visits during pregnancy and 23 home visits from the child 's birth through the second birthday . DATA SOURCES AND MEASURES : Women 's use of welfare and number of subsequent children were based on self-report ; their arrests and convictions were based on self-report and archived data from New York State . Verified reports of child abuse and neglect were abstract ed from state records . MAIN RESULTS During the 15-year period after the birth of their first child , in contrast to women in the comparison group , women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports ( P<.001 ) . Among women who were unmarried and from households of low socioeconomic status at initial enrollment , in contrast to those in the comparison group , nurse-visited women had 1.3 vs 1.6 subsequent births ( P=.02 ) , 65 vs 37 months between the birth of the first and a second child ( P=.001 ) , 60 vs 90 months ' receiving Aid to Families With Dependent Children ( P=.005 ) , 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs ( P=.03 ) , 0.18 vs 0.58 arrests by self-report ( P<.001 ) , and 0.16 vs 0.90 arrests disclosed by New York State records ( P<.001 ) . CONCLUSIONS This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies , the use of welfare , child abuse and neglect , and criminal behavior on the part of low-income , unmarried mothers for up to 15 years after the birth of the first child OBJECTIVE The research evaluated a sexual abuse prevention program for elementary school-aged children . Although other evaluations of similar programs have demonstrated significant improvements in knowledge and skills , a number of key questions with respect to their efficacy remain . METHOD 231 children were r and omly assigned ( matched by age ) to participate in the program ( N = 117 ) or in a wait-list control condition ( N = 114 ) . Knowledge of abuse prevention concepts were tested using the 33-item Children 's Knowledge of Abuse Question naire-Revised ( CKAQ-R ) , a st and ardized measure with strong psychometric properties ( Tutty , 1995 ) , with a new subscale on Appropriate Touch . RESULTS An analysis of covariance showed that children who received the program increased their knowledge levels of both Inappropriate Touch ( p = .000 ) and Appropriate Touch ( p = .012 ) to a significantly greater degree than children in the control group . Age also significantly differentiated the knowledge levels regarding Inappropriate Touch , with younger children knowing fewer concepts both at pretest and posttest ( p = .000 ) . Parallel results apply to the Appropriate Touch subscale ( p = .04 ) . CONCLUSIONS The results are consistent with other evaluations of child sexual abuse prevention programs , however the statistically significant though small gains suggest that the programs need to be presented in a more powerful manner This paper presents results from a third grade sexual abuse prevention program . A 24-item question naire was administered as a pretest and post-test to an  experimental group ( n = 236 ) and a control group ( n = 195 ) of third grade students . Those receiving the sexual abuse prevention program significantly increased their sexual abuse knowledge scores from pretest to post-test . In addition , differences in knowledge were significantly higher in the experimental compared to the control group . Students who received the sexual abuse curriculum  significantly improved from pretest to post-test on their behavioral intention scores . Results from this evaluation indicated a modest improvement can be obtained through use of this two-hour sexual abuse prevention curriculum OBJECTIVE --To see whether non-professional volunteer community mothers  could deliver a child development programme to disadvantaged first time mothers for children aged up to 1 year . DESIGN --R and omised controlled trial . SETTING --A regional health authority in Dublin . SUBJECTS--262 first time mothers who were delivered during six months in 1989 and who lived in a deprived area of Dublin ; 30 experienced mothers from the same community recruited as community mothers . INTERVENTIONS --All the first time mothers received st and ard support from the public health nurse . In addition , those in the intervention group received the services of a community mother , who was scheduled to visit monthly during the first year of the child 's life . RESULTS --232 ( 89 % ) first time mothers completed the study --127 in the intervention group , 105 controls . At the end of the study children in the intervention group were more likely to have received all of their primary immunisations , to be read to , and to be read to daily , played more cognitive games ; and were exposed to more nursery rhymes . They were less likely to begin cows ' milk before 26 weeks and to receive an inappropriate energy intake and inappropriate amounts of animal protein , non-animal protein , wholefoods , vegetables , fruit , and milk . Mothers in the intervention group also had a better diet than controls . At the end of the study they were less likely to be tired , feel miserable , and want to stay indoors ; had more positive feelings ; and were less likely to display negative feelings . CONCLUSION --Non-professionals can deliver a health promotion programme on child development effectively . Whether they can do so as effectively as professionals requires further study Evaluation of high-risk cases treated via a tri-agency , interdisciplinary , early-intervention program suggests that a better outcome was achieved in the treatment program than in a control group of similar high-risk families receiving st and ard care . The number of treated cases requiring child protection services decreased during treatment , and confirmed episodes of child abuse were fewer in the treated group than in the control group A r and omized trial tested the psychosocial efficacy of a home visitation model for women at risk of out-of-home placement of their newborns . After an average of ten months of exposure , the experimental group reported significantly increased social support , greater access to services , and decreased psychological distress . Implication s of the findings for interventions with at-risk families are discussed OBJECTIVE To identify demographic , family , parent , and child factors prospect ively associated with risk for child abuse and neglect among families in the community , using data on child maltreatment obtained from both official records and youth self-reports . METHOD Surveys assessing demographic variables , family relationships , parental behavior , and characteristics of parents and children  were administered to a representative sample of 644 families in upstate New York on four occasions between 1975 and 1992 . Data on child abuse and neglect were obtained from New York State records and retrospective self-report instruments administered when youths were > or = 18 years old . RESULTS Logistic regression analyses indicated that different patterns of risk factors predicted the occurrence of physical abuse , sexual abuse , and neglect , although maternal youth and maternal sociopathy predicted the occurrence of all three forms of child maltreatment . In addition , the prevalence of child abuse or neglect increased from 3 % when no risk factors were present to 24 % when > or = 4 risk factors were present . State records and self-reports of child maltreatment did not correspond in most cases when maltreatment was reported through at least one data source , underlining the importance of obtaining data from both official records and self-reports . CONCLUSIONS Assessment of a number of risk factors may permit health professionals to identify parents and children who are at high risk for child maltreatment , facilitating appropriate implementation of prevention and treatment interventions OBJECTIVE To examine , during the 3rd and 4th years of life , the health , development , rates of child maltreatment , and living conditions of children who had been enrolled in a r and omized trial of nurse home visitation during pregnancy and first 2 years of their lives . DESIGN Prospect i ve follow-up of families who had been r and omly assigned to nurse-visited and comparison conditions .  SETTING Study conducted in semirural community in upstate New York . Families dispersed among 14 other states during 2-year period after children 's second birthdays . PARTICIPANTS Four hundred women were recruited through a health department antepartum clinic and offices of private obstetricians and were registered before 30th week of pregnancy . All women had no previous live births and 85 % were either teenaged ( < 18 years at registration ) , unmarried , or from Hollingshead social classes IV or V. Analysis focused on whites , who comprised 89 % of sample . INTERVENTION Nurse home visitation from pregnancy through second year of the child 's life . MAIN RESULTS There were no treatment differences in the rates of child abuse and neglect or children 's intellectual functioning from 25 to 48 months of age . Nurse-visited children , nevertheless , lived in homes with fewer hazards for children ; they had 40 % fewer injuries and ingestions and 45 % fewer behavioral and parental coping problems noted in the physician record ; and they made 35 % fewer visits to the emergency department than did children in the comparison group . Nurse-visited mothers were observed to be more involved with and to punish their children to a greater extent than were mothers in the comparison group . The functional meaning of punishment differed between the nurse-visited and comparison families . CONCLUSIONS The program does have enduring effects on certain aspects of parental caregiving , safety of the home , and children 's use of the health care system , but it may be necessary to extend the length of the program for families at highest risk to produce lasting reductions in child abuse and neglect This study employed a Posttest-Only Control Group Design to assess the effects of a victimization prevention program , Project TRUST , on elementary school students ' knowledge of general prevention concepts , knowledge of difficult-to-acquire prevention concepts , anxiety , and reporting of abuse . A selected subgroup of experimental subjects was also assessed for retention of acquired concepts over time . Students exposed to Project TRUST  demonstrated significantly greater knowledge of maltreatment prevention information , as well as difficult-to-acquire concepts , than control group students . A 3-month delayed re assessment of the experimental subgroup showed no loss in acquired prevention information . No differences in anxiety scores existed between experimental and control groups . First-time student abuse disclosures were greater in the experimental than in the control group . These findings support the effectiveness of Project TRUST as a strategy to increase prevention knowledge and generate abuse disclosures without creating student anxiety CONTEXT Although child maltreatment is considered common , few community surveys have examined the prevalence of more than 1 type of maltreatment among both males and females . OBJECTIVE To determine the prevalence of a history of physical and sexual abuse during childhood among the general population . DESIGN General population survey . SETTING Household dwellings in the province of Ontario , Canada . PARTICIPANTS A r and om sample ( N=9953 ) of residents aged 15 years and older participated in the Ontario Health Supplement . MAIN OUTCOME MEASURE Self-administered question naire about a history of physical and sexual abuse in childhood . RESULTS A history of child physical abuse was reported more often by males ( 31.2 % ) than females ( 21.1 % ) , while sexual abuse during childhood was more commonly reported by females ( 12.8 % ) than males ( 4.3 % ) . Severe physical abuse was reported by similar proportions of males ( 10.7 % ) and females ( 9.2 % ) . A greater percentage of females reported a history of severe sexual abuse ( 11.1 % ) compared with males ( 3.9 % ) . Age of the respondent was not significantly associated with childhood abuse within any category for males . However , for females , the reported prevalence in childhood of sexual abuse , co-occurrence of physical and sexual abuse , and both categories of severe abuse decreased with increasing age of the respondent . CONCLUSIONS A history of childhood maltreatment among Ontario residents is common . Child abuse may be more prevalent in younger women compared with older women , or there may be a greater willingness among younger women to report abuse This study sought ( 1 ) to retest an approach to the prediction of risk of child maltreatment and ( 2 ) to test the effect of a comprehensive prenatal and pediatric health services program on the rate of maltreatment . Of 2585 women screened at their first prenatal visit , 1154 qualified for the study . Risk assignment was determined by a structured interview . High-risk women ( n = 314 ) were assigned to receive st and ard ( 
    Output:
    
Evidence remains inconclusive on the effectiveness of a comprehensive health care program , a parent education and support program , or a combination of services in preventing child maltreatment .
Education programs design ed to teach children prevention strategies to avoid sexual abuse show increased knowledge and skills but not necessarily reduced abuse .
There is good evidence to continue recommending a program of home visitation for disadvantaged families during the perinatal period extending through infancy to prevent child abuse and neglect ( grade A recommendation ) .
The strongest evidence is for an intensive program of home visitation delivered by nurses beginning prenatally and extending until the child 's second birthday .
There is insufficient evidence to recommend a comprehensive health care program ( grade C recommendation ) , a parent education and support program ( grade C recommendation ) or a combination of home-based services ( grade C recommendation ) as a strategy for preventing child maltreatment , but these interventions may be recommended for other reasons .