***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: OBJECTIVES The purpose of this study was to test the effects of an  education program in Tanzania  design ed to reduce children 's risk of human immunodeficiency virus ( HIV ) infection and to improve their tolerance of and care for people with acquired immunodeficiency syndrome ( AIDS ) . METHODS A r and omized controlled community trial including baseline and 12-month follow-up surveys was employed . Public primary schools in the Arusha and Kilimanjaro regions of Tanzania were stratified according to location and r and omly assigned to intervention ( n = 6 ) or comparison ( n = 12 ) conditions . Of the 1063 sixth- grade students ( average age : 13.6 years ) who participated at baseline , 814 participated in the follow-up survey . RESULTS At follow-up , statistically significant effects favoring the intervention group were observed for exposure to AIDS information and communication , AIDS knowledge , attitudes toward people with AIDS , and subjective norms and behavioral intentions toward having sexual intercourse . A consistent positive but nonsignificant trend was seen for attitudes toward having sexual intercourse and for initiation of sexual intercourse during the previous year ( 7 % vs 17 % ) . CONCLUSIONS It is feasible and effective to train local teachers and health workers to provide HIV/AIDS education to Tanzanian primary school children Abstract Objective : To determine whether a theoretically based sex education programme for adolescents ( SHARE ) delivered by teachers reduced unsafe sexual intercourse compared with current practice . Design : Cluster r and omised trial with follow up two years after baseline ( six months after intervention ) . A process evaluation investigated the delivery of sex education and broader features of each school . Setting : Twenty five secondary schools in east Scotl and . Participants : 8430 pupils aged 13 - 15 years ; 7616 completed the baseline question naire and 5854 completed the two year follow up question naire . Intervention : SHARE programme ( intervention group ) versus existing sex education ( control programme ) . Main outcome measures : Self reported exposure to sexually transmitted disease , use of condoms and contraceptives at first and most recent sexual intercourse , and unwanted pregnancies . Results : When the intervention group was compared with the conventional sex education group in an intention to treat analysis there were no differences in sexual activity or sexual risk taking by the age of 16 years . However , those in the intervention group reported less regret of first sexual intercourse with most recent partner ( young men 9.9 % difference , 95 % confidence interval −18.7 to −1.0 ; young women 7.7 % difference , −16.6 to 1.2 ) . Pupils evaluated the intervention programme more positively , and their knowledge of sexual health improved . Lack of behavioural effect could not be linked to differential quality of delivery of intervention . Conclusions : Compared with conventional sex education this specially design ed intervention did not reduce sexual risk taking in adolescents Objective : To evaluate an  HIV risk-reduction intervention among Namibian adolescents . Methods : A r and omized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sexual practice s conducted among 515 youths ( median age 17 years and median grade 11 ) attending 10 secondary schools located in two districts in Namibia . Youths were r and omly assigned to the intervention or control condition at the level of the individual . HIV risk behaviours , intentions and perceptions were assessed at baseline , immediately post-intervention and at 6 and 12 months post-intervention . Results : Among all 515 youths who enrolled in the programme , rates of either abstinence or sex with a condom were not different between control and intervention youths at baseline or in the follow-up period . However , analyses conducted among the subset of youths who were sexually inexperienced at baseline ( n = 255 ) revealed that a higher percentage of intervention youths ( 17 % ) than control youths ( 9 % , P < 0.05 ) remained sexually inexperienced one year later . Moreover , in the immediate post-intervention period , among baseline virgins who subsequently initiated sex , intervention youths were more likely than control youths to use a condom ( 18 versus 10 % , P < 0.05 ) . Additional HIV-related risk behaviours ( failure to discuss previous HIV risk exposure with one 's sexual partner and alcohol use ) , intentions to use condoms , and perceptions of the ability to use condoms were positively affected by the intervention . Conclusions : There is evidence that the ‘ My Future is My Choice ’ ( MFMC ) intervention is reducing HIV risk behaviours among sexually inexperienced participants aged 15–18 . Related risk behaviours and perceptions are also positively impacted by the intervention PURPOSE To evaluate the effectiveness of peer education when compared to teacher-led curricula in AIDS prevention programs conducted in schools in Rome , Italy . METHODS Eighteen high schools were r and omly assigned to one of two prevention programs : one led by teachers and the other by peer leaders . A sample of students attending the last 2 years ( n = 1295 ) completed pre and post-intervention question naires . Changes in sexual behaviors , knowledge , prevention skills , risk perception and attitudes were first evaluated within each intervention group . Afterwards , changes in knowledge , prevention skills , risk perception , and attitudes total scale scores ( post-test scores minus pre-test scores ) were compared between the two groups , through linear regression models , in order to control for confounders , taking into account the within-school correlation in score changes . As for sexual behaviors , number of sexual partners and frequency of condom use in the 3 months before post-test were compared by intervention group through ordinal regression models , also taking into account behaviors reported before pre-test . RESULTS For both groups , we observed significant improvements in skills , knowledge , attitudes and risk perception . The peer-led group showed a 6.7 % ( 95 % C.I. 1.9 - 11.5 ) scores greater improvement in knowledge , compared to the teacher-led group . In neither group were improvements observed in condom use or number of sexual partners . CONCLUSIONS The only apparent benefit of the peer-led intervention , compared to that led by teachers , was a greater improvement in knowledge of HIV . Neither of the interventions induced changes in sexual behavior . However , the role of possible biases and method ological problems must be considered when interpreting these results PURPOSE To assess the effectiveness of a relatively unaltered version of a sexual risk reduction intervention previously shown to be effective among urban youth , " Original Focus on Kids " ( OFOK ) , compared with a version modified for West Virginia ( WVFOK ) and a control condition ( training in environmental conservation ) , in altering protective sexual behaviors and perceptions among rural , Appalachian youth . SUBJECTS Nine hundred ninety-nine youth aged 12 to 16 years from 12 rural counties in West Virginia . METHOD R and omized , controlled , longitudinal trial of a theory-based prevention intervention . Outcomes were self-reported sexual behaviors and perceptions assessed at baseline , 3 , 6 , and 9 months postintervention . RESULTS Both WVFOK and OFOK positively affected perceptions of abstinence but not behaviors . OFOK significantly enhanced some perceptions of condom use compared with both control youth and WVFOK youth , but again , not behaviors . CONCLUSIONS Overall , neither version was as effective as FOK had been in the original urban setting . The less altered version ( OFOK ) was more effective , especially with regard to condom-use perceptions , in this new population and cultural setting than the more culturally altered version ( WVFOK ) . In several of the implementation setting s , neither version was delivered as intended by the research ers because of logistic issues . Although many of these changes were seemingly minor , such deviations may have significant impact on intervention effect BACKGROUND Improvement of sex education in schools is a key part of the UK government 's strategy to reduce  teenage pregnancy in Engl and . We examined the effectiveness of one form of peer-led sex education in a school-based r and omised trial of over 8000 pupils . METHODS 29 schools were r and omised to either peer-led sex education ( intervention ) or to continue their usual teacher-led sex education ( control ) . In intervention schools , peer educators aged 16 - 17 years delivered three sessions of sex education to 13 - 14 year-old pupils from the same schools . Primary outcome was unprotected ( without condom ) first heterosexual intercourse by age 16 years . Analysis was by intention to treat . FINDINGS By age 16 years , significantly fewer girls reported intercourse in the peer-led arm than in the control arm , but proportions were similar for boys . The proportions of pupils reporting unprotected first sex did not differ for girls ( 8.4 % intervention vs 8.3 % control ) or for boys ( 6.2 % vs 4.7 % ) . Stratified estimates of the difference between arms were -0.4 % ( 95 % CI -3.7 % to 2.8 % , p=0.79 ) for girls and -1.4 % ( -4.4 % to 1.6 % , p=0.36 ) for boys . At follow-up ( mean age 16.0 years [ SD 0.32 ] ) , girls in the intervention arm reported fewer unintended pregnancies , although the difference was borderline ( 2.3 % vs 3.3 % , p=0.07 ) . Girls and boys were more satisfied with peer-led than teacher-led sex education , but 57 % of girls and 32 % of boys wanted sex education in single-sex groups . INTERPRETATION Peer-led sex education was effective in some ways , but broader strategies are needed to improve young people 's  sexual health . The role of single-sex sessions should be investigated further A computer- and Internet-based intervention was design ed to influence several variables related to the prevention of pregnancy , sexually transmitted diseases ( STDs ) , and human immunodeficiency virus ( HIV ) in rural adolescents . The intervention was guided by the extended parallel process model and was evaluated using a pretest – post-test control group design with r and om assignment at the school level . Three hundred and twenty-six tenth- grade males and females enrolled in two rural Appalachian public high schools completed the survey at both points in time . Results indicate the vast majority ( 88.5 % ) of students in the experimental school completed at least one activity ( M = 3.46 for those doing at least one activity ) . Further , both the overall program and all but one of the activities were rated positively by participants . Regarding the effects of the intervention , results indicate that students in the experimental school were less likely to initiate sexual activity and had greater general knowledge , greater condom negotiation self-efficacy , more favorable attitudes toward waiting to have sex , and greater situational self-efficacy than in the control school . In t and em , the results suggest that the computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy , STDs , and HIV This project assessed the impact of a school-based AIDS prevention program on student participation in sexual risk and protective behaviors such as use of condoms and use of condoms with foam and intention to participate in such behaviors . The paper focuses on students who became sexually active for the first time between the seventh and eighth grade ( " changers , " n = 312 ) . The school-based intervention was developed using social cognitive theory and the social influences model of behavior change . Using an experimental , longitudinal design , 15 high-risk school districts were divided r and omly into two treatment ( 10 districts ) and one control ( five districts ) conditions . Students in both treatment conditions received a 10-lesson classroom program in the seventh grade with a five-lesson booster in the eighth grade , while control students received basic AIDS education ( current practice in their districts ) in compliance with state m and ates . Results indicated classroom programs had an impact on certain protective behaviors and on frequency of sexual activity the past month . Post-intervention measures also indicated the program affected students ' intentions to perform specific protective behaviors This r and omized controlled trial tested the effects of a theory-based culture-sensitive HIV risk-reduction intervention among 496 inner-city African American adolescents ( mean age = 13 years ) and examined the generality of its effects as a function of the facilitator 's race and gender and the gender composition of the intervention group . Adolescents who received the HIV risk-reduction intervention expressed more favorable behavioral beliefs about condoms , greater self-efficacy , and stronger condom-use intentions postintervention than did those who received a control intervention on other health issues . Six-month follow-up data collected on 93 % of the adolescents revealed that those who received the HIV risk-reduction intervention reported less HIV risk-associated sexual behavior , including unprotected coitus , than did their counterparts in the control condition . Self-reported sexual behavior and changes in self-reported behavior were unrelated to scores on a st and ard measure of social desirability response bias . There was strong evidence for the generality of intervention effects . Moderator analyses testing eight specific interaction hypotheses and correlational analyses indicated that the effects of the HIV risk-reduction intervention  did not vary as a function of the facilitator 's race or gender , participant 's gender , or the gender composition of the intervention group BACKGROUND The number of reported cases of acquired immune deficiency syndrome ( AIDS ) is increasing disproportionately among Blacks in the United States . The relatively high incidence of sexually transmitted diseases among Black adolescents suggest the need for AIDS prevention programs to reduce their risk of sexually transmitted human immunodeficiency virus ( HIV ) infection . METHODS Black male adolescents ( n = 157 ) were r and omly assigned to receive an AIDS risk reduction intervention aim ed at increasing AIDS-related knowledge and weakening problematic attitudes toward risky sexual behavior , or to receive a control intervention on career opportunities . RESULTS The adolescents who received the AIDS intervention subsequently had greater AIDS knowledge , less 
    Output:
    
Data from 12 RCTs passed quality assessment criteria and provided evidence of positive changes in non-behavioural outcomes ( e.g. knowledge and self-efficacy ) .
Intervention effects on behavioural outcomes , such as condom use , were generally limited and did not demonstrate a negative impact ( e.g. earlier sexual initiation ) .
Beneficial effect on at least one , but never all behavioural outcomes assessed was reported by about half the studies , but this was sometimes limited to a participant subgroup .