***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 assess the impact of a school-based nutrition education intervention aim ed at increasing the consumption of fruits and vegetables . DESIGN The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing material s , newsletters for children and parents , and teacher information . Curriculum material s at age 6 - 7 and 10 - 11 years were also developed and utilised . Evaluation was undertaken with groups of younger ( aged 6 - 7 years ) and older ( aged 10 - 11 years ) children . Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline , with follow-up at 9 months , in intervention and control schools . SETTING The work was undertaken in primary schools in Dundee , Scotl and . SUBJECTS Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls . RESULTS Children ( n=64 ) in the intervention schools had an average increase in fruit intake ( 133+/-1.9 to 183+/-17.0 g day(-1 ) ) that was significantly ( P<0.05 ) greater than the increase ( 100+/-11.7 to 107+/-14.2 g day(-1 ) ) estimated in children ( n=65 ) in control schools . No other changes in food or nutrient intake were detected . Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group , although taste preferences for fruits and vegetables were unchanged . CONCLUSIONS It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake OBJECTIVE To evaluate the impact of a school-based health behavior intervention known as Planet Health on obesity among boys and girls in grade s 6 to 8 . DESIGN R and omized , controlled field trial with 5 intervention and 5 control schools . Outcomes were assessed using preintervention ( fall 1995 ) and follow-up measures ( spring 1997 ) , including prevalence , incidence , and remission of obesity . PARTICIPANTS A group of 1295 ethnically diverse grade 6 and 7 students from public schools in 4 Massachusetts communities . INTERVENTION Students participated in a school-based interdisciplinary intervention over 2 school years . Planet Health sessions were included within existing curricula using classroom teachers in 4 major subjects and physical education . Sessions focused on decreasing television viewing , decreasing consumption of high-fat foods , increasing fruit and vegetable intake , and increasing moderate and vigorous physical activity . MAIN OUTCOME MEASURES Obesity was defined as a composite indicator based on both a body mass index and a triceps skinfold value greater than or equal to age- and sex-specific 85th percentiles . Because schools were r and omized , rather than students , the generalized estimating equation method was used to adjust for individual-level covariates under cluster r and omization . RESULTS The prevalence of obesity among girls in intervention schools was reduced compared with controls , controlling for baseline obesity ( odds ratio , 0.47 ; 95 % confidence interval , 0.24 - 0.93 ; P = .03 ) , with no differences found among boys . There was greater remission of obesity among intervention girls vs. control girls ( odds ratio , 2.16 ; 95 % confidence interval , 1.07 - 4.35 ; P = .04 ) . The intervention reduced television hours among both girls and boys , and increased fruit and vegetable consumption and result ed in a smaller increment in total energy intake among girls . Reductions in television viewing predicted obesity change and mediated the intervention effect . Among girls , each hour of reduction in television viewing predicted reduced obesity prevalence ( odds ratio , 0.85 ; 95 % confidence interval , 0.75 - 0.97 ; P = .02 ) . CONCLUSION Planet Health decreased obesity among female students , indicating a promising school-based approach to reducing obesity among youth BACKGROUND This study evaluated the effects of a school-based dietary intervention program to increase fruit and vegetable consumption among fourth- grade rs . METHODS Twenty-eight elementary schools were r and omized to an immediate intervention condition or to a delayed intervention control condition . Measures of diet and psychosocial variables were collected at base line and 1 and 2 years post-baseline . The intervention included classroom , parent , and cafeteria components . RESULTS Mean daily consumption of fruit and vegetables was higher for the intervention children compared with controls at Follow-up 1 ( X(t ) = 3.96 , X(c ) = 2.28 ) and at Follow-up 2 ( X(t ) = 3.20 , X(c ) = 2.21 ) . Macro- and micronutrient changes favoring the intervention children were also observed at both Follow-up 1 and Follow-up 2 . Mean daily consumption of fruit and vegetables was higher for intervention parents compared with controls at Follow-up 1 ( X(t ) = 4.23,X(c ) = 3.94 ) but not at Follow-up 2 . CONCLUSIONS Strong effects were found for the High 5 intervention on fruit and vegetable consumption , on macro- and micro-nutrients , and on psychosocial variables . Future work is needed to enhance the intervention effects on parents ' consumption and to test the effectiveness of the intervention when delivered by classroom teachers OBJECTIVE To determine the uptake of a free fruit provision to low-decile primary -school children by quantitatively assessing changes in fruit intake . DESIGN A r and omised controlled trial using a paired , cluster r and omisation . SETTING Twenty low-decile primary schools ( schools attended by the most deprived children ) in Auckl and , New Zeal and . SUBJECTS In total 2032 children , aged 7 - 11 years , provided data on at least one occasion . INTERVENTION Ten pairs of low-decile primary schools matched by roll size and location were r and omly allocated to control ( no free fruit ) or intervention ( free fruit ) for a school term . Dietary assessment s using the 24 h recall methodology were made at baseline , on the last week of the intervention and 6 weeks post-intervention . RESULTS Fruit intakes in this cohort were lower than the national average with over 40 % reporting no fruit intake at baseline and did not differ between groups . After the free fruit period the intervention group increased school fruit intakes by 0.39 pieces/school d from baseline ( P < or = 0.001 ) and the proportion of children consuming no fruit reduced to 22 % . This increase , however , was not sustained and fruit intakes fell below baseline levels at 6 weeks post-intervention . Control subjects did not significantly alter their fruit intakes throughout the study . CONCLUSIONS Improving exposure and accessibility to fruits at school increases fruit intakes of low socio-economic group children , particularly those who do not normally eat fruit . The present pilot study demonstrates some possible negative effects of short-term free fruit interventions , but is informative for developing and evaluating sustained fruit intervention programmes OBJECTIVE Children 's fruit/vegetable intake is still below recommended levels . This study applied Internet-tailored advice for schoolchildren  and Internet-supported brief dietary counselling ( with child and parent ) within preventive health care to promote fruit/vegetable intake . SETTING /SUBJECTS The study involved 30 seventh- grade classes ( 16 in the intervention group and 14 in the control group ) with a total of 675 children aged 9 - 12 years , of whom 495 were allowed to participate . DESIGN A cluster-r and omised baseline-post-test experimental design was applied . During school hours , all children completed Internet-administered question naires on fruit/vegetable intake and related determinants . Children in the intervention group received immediate online individually tailored nutrition feedback . For each child in the intervention group , a nurse received information concerning the assessment of fruit/vegetable intake via the Internet to support a 5 min counselling protocol to promote fruit/vegetable intake . Children completed a similar post-test question naire 3 months after the first assessment . Intention-to-treat analyses were conducted using multilevel regression analyses . RESULTS A total of 486 children ( 98 % of 495 ) participated ( 263 in the intervention group , 223 in the control group ) ; 240 child-parent couples in the intervention group attended the counselling . Awareness of inadequate fruit intake ( odds ratio ( OR ) = 3.0 ; 95 % confidence interval ( CI ) = 1.8 - 5.3 ) and knowledge of recommended vegetable intake levels ( OR = 2.7 ; 95 % CI = 1.8 - 4.1 ) were significantly more likely at post-test in the intervention group than in the control group . No significant effects were found on intake or other determinants . CONCLUSIONS A compact , integrated two-component intervention can induce positive changes in knowledge and awareness of intake levels of fruit/vegetables among schoolchildren . To induce changes in intake levels , more comprehensive interventions may be needed This study describes the development and usage of a Web-based component of a nutrition and physical activity behavioral intervention to promote bone health  among preadolescent girls . Thirty Girl Scout troops were r and omized to either an intervention or control group for a 2-year period . Girls in the intervention troops ( aged 10 to 12 years , N=194 ) were exposed to grade -specific Web sites that were developed to reinforce the content of the broader , face-to-face intervention . In 5th grade , 82 % of the girls logged on once and 48 % logged on more than once , compared to 56 % and 23 % of 6th grade rs , respectively . Results suggest that although Web-site usage decreased over time , a Web-site program may be useful as a component of a face-to-face , multicomponent intervention . More research is needed to determine ways to enhance and maintain Web-site use over time among youth in health-behavior intervention programs OBJECTIVE The Girls health Enrichment Multisite Studies ( GEMS ) Fun , Food , and Fitness Project ( FFFP ) was design ed to prevent obesity among 8-year-old African-American girls . DESIGN Twelve-week , two-arm parallel group r and omized controlled pilot study . SETTING Summer day camp and homes in Houston , Texas . PARTICIPANTS Thirty-five girls and their parents or caregivers were r and omly assigned to treatment ( N=19 ) or control groups ( N=16 ) . INTERVENTION Girls in the intervention group attended a special 4-week summer day camp , followed by a special 8-week home Internet intervention for the girls and their parents . Control group girls attended a different 4-week summer day camp , followed by a monthly home Internet intervention , neither of which components included the GEMS-FFFP enhancements . MAIN OUTCOME MEASURES Body mass index ( BMI ) , consumption of fruit , 100 % fruit juice , and vegetables ( FJV ) , physical activity . RESULTS After adjusting for baseline BMI , there were no significant differences in BMI between treatment and control group girls , either at the end of the 4-week summer day camp , or after the full 12-week intervention . By the end of the summer camp , the subgroup of treatment group girls heavier at baseline exhibited a trend ( P<.08 ) toward lower BMI , compared to their heavier counterparts in the control group . Overall results at the end of the 12-week program demonstrated substantial , although not significant , differences between treatment and control groups in the hypothesized directions . On average , less than half the treatment sample logged onto the Website , which limited intervention dose . CONCLUSIONS Summer day camp appears to offer promise for initiating health behavior change . Effective methods must be developed and tested to enhance log-on rates among healthy children and their parents before Internet programs can achieve their potential The goal was to have children and adolescents identify and rank the major perceived benefits of and barriers to healthful eating and physical activity and to suggest strategies for overcoming barriers . Semistructured , in-depth focus groups were undertaken using st and ardized questions and prompts . Students in grade s 2 through 11(ages 7 through 17 ; N=213 ) from 34 r and omly selected schools participated in 38 focus groups . Major benefits of healthful eating included improvements to cognitive and physical performance , fitness , endurance , psychological benefits , physical sensation ( feeling good physically ) , and production of energy . Barriers included convenience , taste , and social factors . Benefits of physical activity included social benefits , enhancement of psychological status , physical sensation , and sports performance . Barriers included a preference for indoor activities , lack of energy and motivation , time constraints , and social factors . Suggested strategies for overcoming barriers included support from parents and school staff , better planning , time management , self-motivation , education , restructuring the physical environment , and greater variety of physical activities PURPOSE To test the effects of a classroom and World Wide Web ( WWW ) educational intervention on self-efficacy ( SE ) for healthy eating ( HE ) and to examine the relationship of the theoretical concepts in a hypothesized model of eating behavior in adolescents . DESIGN A quasiexperimental pretest , posttest design was used in a r and om sample of students in two junior high schools . METHODS The intervention consisted of a combination of 5 hours of Web-based instruction and 10 hours of classroom curriculum , compared to nutrition education embedded in the st and ard school curriculum during a 1-month period . Participants completed six question naires . Data were analyzed using descriptive statistics , t tests , and Pearson 's r correlation coefficient . FINDINGS AND CONCLUSIONS The intervention group had significantly higher scores for SE for fruits and vegetables , SE for lower fat , usual food choices , and dietary knowledge of fat compared to the control group . No difference was found between groups in food consumption . Self-efficacy was significantly associated with 
    Output:
    
Most of these programs were effective in achieving the objectives established .
Some of the main advantages the Internet provides are : the opportunity to put the children in contact with education and health professionals ; children can keep a record of the food consumed ; and it is a more attractive and interesting way for children to learn NE , compared to traditional methods