***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 Tier 1 Program of the Project P.A.T.H.S. ( Positive Adolescent Training through Holistic Social Programmes ) is a curricular-based program that attempts to promote positive youth development in Hong Kong . In the second year of the Full Implementation Phase , 20 experimental schools ( N = 2,784 students ) and 23 control schools ( N = 3,401 students ) participated in a r and omized group trial . Analyses of covariance and linear mixed models , controlling for differences between the two groups in terms of Wave 1 pretest scores , personal variables , and r and om effect of schools , showed that participants in the experimental schools had significantly higher positive youth development levels than did participants in the control schools at post-test , based on different indicators derived from the Chinese Positive Youth Development Scale . The students in the experimental schools also displayed a lower level of delinquency , but better school adjustment than did students in the control schools . Differences between experimental and control participants were also found when students who joined the Tier 1 Program and perceived the program to be beneficial were employed as participants of the experimental schools There are two tiers of programs in the Project P.A.T.H.S. ( Positive Adolescent Training through Holistic Social Programs ) . In the Tier 1 Program , teaching units based on different positive youth development constructs are covered . A total of 24 experimental schools ( N = 4,121 students ) and 24 control schools ( N = 3,854 students ) were r and omly selected to participate in a r and omized group trial . Analyses of covariance and linear mixed models controlling for differences between the two groups in terms of pretest scores , personal variables , and r and om effects of schools showed that participants in the experimental schools had significantly higher positive youth development levels than did participants in the control schools at post-test based on different indicators derived from the Chinese Positive Youth Development Scale . In conjunction with other evaluation findings reported previously , the present study suggests that the Tier 1 Program of P.A.T.H.S. promotes the positive development of Chinese adolescents in Hong Kong To underst and the implementation quality of the  Tier 1 Program ( Secondary 1 Curriculum ) of the Project P.A.T.H.S. ( Positive Adolescent Training through Holistic Social Programmes ) in the full implementation phase , 100 schools were r and omly selected to participate in personal and /or telephone interviews regarding the quality of the implementation process of the Tier 1 Program . In the interviews , the participants described the responses of the students to the program , the perceived benefits of the program , the perceived good aspects of the program , and the areas requiring improvement , difficulties encountered in the implementation process , and perceived attributes of the worker-support scheme  ( “ Co-Walker Scheme ” ) . Results showed that most workers perceived that the students had positive responses to the program and the program was beneficial to the students . They also identified several good aspects in the program , although negative comments on the program design and difficulties in the implementation process were also recorded . Roughly half of the respondents had positive comments on the “ Co-Walker Scheme ” . In sum , the respondents generally regarded the program as beneficial to the students and they were satisfied with the Tier 1 Program ( Secondary 1 Curriculum ) in the full implementation phase , although some implementation difficulties were also expressed OBJECTIVE To determine whether a multicomponent health promotion intervention for Dutch adolescents ( defined as persons between 12 and 14 years of age ) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms . DESIGN R and omized controlled trial . SETTING Ten intervention and 8 control prevocational secondary schools . PARTICIPANTS A total of 1108 adolescents ( mean age , 12.7 years ) . Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options . MAIN OUTCOME MEASURES Body height and weight , waist circumference , 4 skinfold thickness measurements , and dietary and physical activity behavior data . RESULTS Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls ( biceps skinfold and sum of 4 skinfolds ) and boys ( triceps , biceps , and subscapular skinfolds ) . Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention ( boys : -287 mL/d ; 95 % confidence interval [ CI ] , -527 to -47 ; girls : -249 ; -400 to -98 ) and at 12-month follow-up ( boys : -233 ; -371 to -95 ; girls : -271 ; -390 to -153 ) . For boys , screen-viewing behavior was significantly lower in the intervention group after 20 months ( -25 min/d ; 95 % CI , -50 to -0.3 ) . No significant intervention effects on consumption of snacks or active commuting to school were found . CONCLUSION The Dutch Obesity Intervention in Teenagers program result ed in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms OBJECTIVE To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents . DESIGN R and omized controlled trial . SETTING Urban public schools . PARTICIPANTS A total of 662 African American students in grade s 6 and 7 . INTERVENTIONS An 8-hour abstinence-only intervention targeted reduced sexual intercourse ; an 8-hour safer sex-only intervention targeted increased condom use ; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use ; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior . Participants also were r and omized to receive or not receive an intervention maintenance program to extend intervention efficacy . OUTCOME MEASURES The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up . Secondary outcomes were other sexual behaviors . RESULTS The participants ' mean age was 12.2 years ; 53.5 % were girls ; and 84.4 % were still enrolled at 24 months .  Abstinence-only intervention  reduced sexual initiation ( risk ratio [ RR ] , 0.67 ; 95 % confidence interval [ CI ] , 0.48 - 0.96 ) . The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5 % in the abstinence-only intervention and 48.5 % in the control group . Fewer abstinence-only intervention participants ( 20.6 % ) than control participants ( 29.0 % ) reported having coitus in the previous 3 months during the follow-up period ( RR , 0.94 ; 95 % CI , 0.90 - 0.99 ) . Abstinence-only intervention did not affect condom use . The 8-hour ( RR , 0.96 ; 95 % CI , 0.92 - 1.00 ) and 12-hour comprehensive ( RR , 0.95 ; 95 % CI , 0.91 - 0.99 ) interventions reduced reports of having multiple partners compared with the control group . No other differences between interventions and controls were significant . CONCLUSION Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00640653 This study tested the efficacy of an Internet-based prevention program , Trouble on the Tightrope : In Search of Skateboard Sam , on pubertal knowledge , body esteem , and self-esteem .  One hundred and ninety participants ( mean age 11.6 years ) were r and omized to either an intervention or attention placebo control condition and were assessed at baseline , after three Internet-based sessions , and at 3-month follow-up . Although the primary hypotheses were not supported , exploratory moderator analyses indicated that the intervention was beneficial for select students . Specifically , pubertal status moderated the effects on weight-related body esteem and several domains of self-esteem , result ing in positive effects for participants in the intervention group who had begun puberty . Gender differences were found on self-esteem subscales , indicating more robust effects for girls than boys . Tailored Internet programs based on personal characteristics such as gender and pubertal status may be a fruitful area for future research with adolescents OBJECTIVE Anorexia nervosa ( ' AN ' ) is notoriously difficult to treat , has high mortality rates , and has a prevalence peak in 15-year-old girls . We developed a German school-based intervention program ( ' PriMa ' ) for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls . METHOD Intervention involved nine guided lessons with special posters and group discussion s. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools ( n=1553 girls ) in 2007 and 2008 . Primary outcomes were conspicuous eating behavior , body self esteem , and AN-related knowledge . RESULTS After adjusting for the girls ' ages and the type of school , we observed significant improvements in the areas of knowledge ( d=.24 ) and body self esteem ( d=.29 ) , but not for eating behavior . CONCLUSION The PriMa intervention provides an efficient and practical model to increase AN-related protection factors BACKGROUND Physical activity is important for weight control and good health ; however , activity levels decline in the adolescent years , particularly in girls . DESIGN Group r and omized controlled trial . SETTING / PARTICIPANTS Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States . R and om , cross-sectional sample s were drawn within schools : 6th grade rs in 2003 ( n=1721 ) and 8th grade rs in 2005 ( n=3504 ) and 2006 ( n=3502 ) . INTERVENTION A 2-year study -directed intervention ( fall 2003 to spring 2005 ) targeted schools , community agencies , and girls  to increase opportunities , support , and incentives for increased physical activity . Components included programs linking schools and community agencies , physical education , health education , and social marketing . A third-year intervention used school and community personnel to direct intervention activities . MAIN OUTCOME MEASURES The primary outcome , daily MET-weighted minutes of moderate-to-vigorous physical activity ( MET-weighted MVPA ) , was assessed using accelerometry . Percent body fat was assessed using anthropometry . RESULTS After the staff-directed intervention ( pre-stated primary outcome ) , there were no differences ( mean= -0.4 , 95 % CI= -8.2 to 7.4 ) in adjusted MET-weighted MVPA between 8th- grade girls in schools assigned to intervention or control . Following the Program Champion-directed intervention , girls in intervention schools were more physically active than girls in control schools ( mean difference 10.9 MET-weighted minutes of MVPA , 95 % CI=0.52 - 21.2 ) . This difference is about 1.6 minutes of daily MVPA or 80 kcal per week . There were no differences in fitness or percent body fat at either 8th- grade timepoint . CONCLUSION A school-based , community-linked intervention modestly improved physical activity in girls Background : Studies of effectiveness of school-based prevention of substance misuse have generally overlooked gender differences . The purpose of this work was to analyse gender differences in the effectiveness of a new European school-based curriculum for prevention of substance misuse among adolescents . Methods : The European Drug Abuse Prevention ( EU-Dap ) trial took place in seven European countries during the school year 2004–05 . Schools were r and omly assigned to either a control group or a 12-session st and ardised curriculum ( “ Unplugged ” ) based on a comprehensive social influence model . The analytical sample consisted of 6359 students ( 3324 boys and 3035 girls ) . The use of cigarettes , alcohol and illicit drugs , adolescents ’ knowledge and opinions about substances , as well as social and personal skills were investigated through a self-completed anonymous question naire administered at enrolment and 3 months after the end of the programme . Adjusted Prevalence Odds Ratios were calculated as the measure of association between the intervention and behavioural outcomes using multilevel regression modelling . Results : At enrolment , boys were more likely than girls to have used cannabis and illicit drugs , whereas girls had a higher prevalence of cigarette smoking . At the follow-up survey , a significant association between the programme and a lower prevalence of all behavioural outcomes was found among boys , but not among girls . Age and self-esteem emerged as possible modifiers of these gender differences , but effects were not statistically significant . Conclusions : Comprehensive social influence school curricula against substance misuse in adolescence may perform differently among girls and boys , owing to developmental and personality factors BACKGROUND This study reports on effectiveness trial outcomes of Health in Motion , a computer tailored multiple behavior intervention for adolescents . METHODS Using school as level of assignment , students ( n=1800 ) from eight high schools in four states ( RI , TN , MA , and NY ) were stratified and r and omly assigned to no treatment or a multi-media intervention for physical activity , fruit and vegetable consumption , and limited TV viewing between 2006 and 2007 . RESULTS Intervention effects on continuous outcomes , on movement to action and maintenance stages , and on stability within action and maintenance stages were evaluated using r and om effects modeling . Effects were most pronounced for fruit and vegetable consumption and for total risks 
    Output:
    
CONCLUSIONS This exhaustive review found that well-implemented interventions can promote adolescent health .