***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 report experimental impacts of a universal , integrated school-based intervention in social-emotional learning and literacy development on change over 1 school year in 3rd- grade children 's social-emotional , behavioral , and academic outcomes . METHOD This study employed a school-r and omized , experimental design and included 942 3rd- grade children ( 49 % boys ; 45.6 % Hispanic/Latino , 41.1 % Black/African American , 4.7 % non-Hispanic White , and 8.6 % other racial/ethnic groups , including Asian , Pacific Isl and er , Native American ) in 18 New York City public elementary schools . Data on children 's social-cognitive processes ( e.g. , hostile attribution biases ) , behavioral symptomatology ( e.g. , conduct problems ) , and literacy skills and academic achievement ( e.g. , reading achievement ) were collected in the fall and spring of 1 school year . RESULTS There were main effects of the 4Rs Program after 1 year on only 2 of the 13 outcomes examined . These include children 's self-reports of hostile attributional biases ( Cohen 's d = 0.20 ) and depression ( d = 0.24 ) . As expected based on program and developmental theory , there were impacts of the intervention for those children identified by teachers at baseline with the highest levels of aggression ( d = 0.32 - 0.59 ) on 4 other outcomes : children 's self-reports of aggressive fantasies , teacher reports of academic skills , reading achievement scaled scores , and children 's attendance . CONCLUSIONS This report of effects of the 4Rs intervention on individual children across domains of functioning after 1 school year represents an important first step in establishing a better underst and ing of what is achievable by a schoolwide intervention such as the 4Rs in its earliest stages of unfolding . The first-year impacts , combined with our knowledge of sustained and exp and ed effects after a second year , provide evidence that this intervention may be initiating positive developmental cascades both in the general population of students and among those at highest behavioral risk . ( PsycINFO Data base Record ( c ) 2010 APA , all rights reserved ) The Media Ready Program was design ed as a middle school , media literacy education , preventive intervention program to improve adolescents '  media literacy skills and reduce their intention to use alcohol or tobacco products . In a short-term efficacy trial , schools in North Carolina were r and omly assigned to conditions ( Media Ready : n = 214 ; control : n = 198 ) . Boys in the Media Ready group reported significantly less intention to use alcohol in the future than did boys in the control group . Also , students in the Media Ready group who had used tobacco in the past reported significantly less intention to use tobacco in the future than did students in the control group who had previously used tobacco . Multilevel multiple mediation analyses suggest that the set of logical analysis Message Interpretation Processing variables mediated the program 's effect on students ' intentions to use alcohol or tobacco in the future 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 We examined the differential impact of a well-established human immunodeficiency virus (HIV)/sexually transmitted infections ( STIs ) curriculum , Be Proud ! Be Responsible ! , when taught by school nurses and health education classroom teachers within a high school curricula . METHODS Group-r and omized intervention study of 1357 ninth and tenth grade students in 10 schools . Twenty-seven facilitators ( 6 nurses , 21 teachers ) provided programming ; nurse-led classrooms were r and omly assigned . RESULTS Students taught by teachers were more likely to report their instructor to be prepared , comfortable with the material , and challenged them to think about their health than students taught by a school nurse . Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention , compared to controls . Yet , those taught by school nurses reported significant and sustained changes ( up to 12 months after intervention ) in attitudes , beliefs , and efficacy , whereas those taught by health education teachers reported far fewer changes , with sustained improvement in condom knowledge only . CONCLUSIONS Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students ; however , teaching the technical ( eg , condom use ) and interpersonal ( eg , negotiation ) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have 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 Summary of Etiological Analyses . T his analysis confirm ed the i m portance of school bonding to child devel-opm ent . V arious techniques w ere used to exam ine the rela-tionship betw een school bonding and positive and problembehavior , and these relationships w ere found during child-h o o d and ad o lescen ce . S chool b o n d in g in elem en taryschool w as related to initiation of drinking , sm oking , and alcohol abuse and dependence at age 2 1 . It also related tolow er likelihood of becom ing serious offenders in m iddleschool and joining a gang in adolescence . E lem entary and m iddle school bonding had a negative effect on violence inm iddle school through age 2 1 . It also reduced the chance ofschool m isbehavior , grade repetition , and dropout .  S choolbonding also affected positive developm ent . S chool bond-ing  w as associated w ith increases in academ ic achievem ent and social skills .  S chool bonding effects extended to high -risk groups including aggressive boys , children w ith parent sw ho m odeled problem behaviors , and children from low -incom e fam ilies .  S chool bonding in m iddle school w asrelated to desistance of serious delinquent behavior . T herelationship w as m aintained through age 2 1 , w ith studentsreporting greater school bonding in sevent h grade m orelikely to desist rather than escalate the seriousness of theiroffending . S chool bonding in m iddle school and the patternof bonding throughout m iddle and high school also relatedto reduced levels of substance use in 12th grade . T h u s , school bonding during elem entary and m iddle school w asconsistently related negatively to problem behaviors in thislongitudinal study .S everal com peting factors that m ight explain the rela-tionship betw een school bonding  and problem behaviorsw ere controlle d in the analyses , lending credibilit y to thepotential causal effect of school bonding . H ow ever , w hilenonexperim ental , longitudinal studies establish tim e order , they do not establish cause . A stronger criterion for estab-lishing the causal effect of school bonding com es fromintervention studies aim ed at changing the levels of schoolbonding and exam ining the effects on positive and problembehavior . S tatistically significant results of the preventionexperim ent em bedded w ithin S S D P are described below This study contributes to ongoing scholarship at the nexus of translational research , education reform , and the developmental and prevention sciences . It reports 2-year experimental impacts of a universal , integrated school-based intervention in social-emotional learning and literacy development on children 's social-emotional , behavioral , and academic functioning . The study employed a school-r and omized , experimental design with 1,184 children in 18 elementary schools . Children in the intervention schools showed improvements across several domains : self-reports of hostile attributional bias , aggressive interpersonal negotiation strategies , and depression , and teacher reports of attention skills , and aggressive and socially competent behavior . In addition , there were effects of the intervention on children 's math and reading achievement for those identified by teachers at baseline at highest behavioral risk . These findings are interpreted in light of developmental cascades theory and lend support to the value of universal , integrated interventions in the elementary school period for promoting children 's social-emotional and academic skills 
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All this is driven by the salience of international metrics of attainment as used , for example , by the Program for International Student Assessment .10,11 The decline of PSHE is of particular concern because there is strong evidence from systematic review s that school curriculum-based health education is one key element in strategies to reduce outcomes such as alcohol consumption,12 smoking,13 drug