***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: Background Epidemiologic data indicate most adolescents and adults experience multiple , simultaneous risk behaviors . Purpose The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention ( MBI ) for college students . Methods A total of 303 college students were r and omly assigned to : ( 1 ) a brief MBI or ( 2 ) a st and ard care control , with a 3-month postintervention follow-up . Results Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings , with improvements for college students receiving the brief MBI on alcohol consumption behaviors , F(6 , 261 ) = 2.73 , p = 0.01 , marijuana-use behaviors , F(4 , 278 ) = 3.18 , p = 0.01 , and health-related quality of life , F(5 , 277 ) = 2.80 , p = 0.02 , but not cigarette use , exercise , and nutrition behaviors . Participants receiving the brief MBI also got more sleep , F(1 , 281 ) = 9.49 , p = 0.00 , than those in the st and ard care control . Conclusions A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality -of-life indicators of college students The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects . In a clinical trial , 416 high school-age adolescents were r and omized to either the brief intervention or usual care control , with data collected at baseline and 3-month follow-up . The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print material s based on the behavior-image model .  Health behavior goal setting increased for participants receiving the brief intervention , with an effect size in the small range ( d = 0.33 ) . Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small ( ds = 0.16 - 0.21 ) and in favor of the brief intervention . However , adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol , frequency and quantity of cigarette smoking , and reported fewer alcohol/drug problems , with larger effects ranging from small to approaching medium in size ( ds = 0.32 - 0.43 , ps < .01 ) . This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use , particularly among drug-using older adolescents This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents . A r and omized controlled trial was conducted with participants r and omly assigned to either a brief intervention or st and ard care control with 3-month follow-up . A total of 479 students attending two public high schools participated . Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use , and increases in fruit and vegetable consumption and frequency of relaxation activities , compared to those receiving the control , P ’s = .01 . No effects were found on cigarette and marijuana use , exercise and sleep . Effect sizes were small with alcohol use cessation effects reaching medium size . Intervention effects were mediated by changes in peer influenceability for alcohol use , and self-efficacy and self-image for health promoting behaviors . Findings suggest that the brief intervention result ed in health risk and promoting behavior improvements for adolescents , with outcomes mediated by several risk factors BACKGROUND The prevention of initiation of tobacco , alcohol and drug use is a major societal challenge , for which the existing research literature is generally disappointing . This study aim ed to test the effectiveness of adaptation of Motivational Interviewing ( MI ) for universal prevention purpose s , i.e. to prevent initiation of new substance use among non-users , and to reduce risks among existing users . METHODS Cluster r and omised trial with 416 students aged 16 - 19 years old recruited in 12 London Further Education colleges without regard to substance use status .  Individualised MI was compared with st and ard practice classroom-delivered Drug Awareness intervention , both delivered over the course of one lesson . Prevalence , initiation and cessation rates for the 3 target behaviours of cigarette smoking , alcohol consumption and cannabis use , along with reductions in use and harm indicators after both 3 and 12 months were assessed . RESULTS This adaptation of MI was not demonstrated to be effective in either intention-to-treat or sub-group analyses for any outcome . Unexpected lower levels of cannabis initiation and prevalence were found in the Drug Awareness control condition . CONCLUSIONS This particular adaptation of MI is ineffective as a universal drug prevention intervention and does not merit further study BACKGROUND Heavy drinking is one of the leading causes of morbidity and mortality in young men .  Brief motivational intervention ( BMI ) has shown promising results for young people , but has never been tested in young men in the community who volunteered to receive an intervention . METHODS We evaluated the effectiveness of  BMI  in reducing alcohol use  among heavy episodic users and in maintaining low-risk drinking among nonheavy episodic users . Participants were French-speaking young men attending the m and atory Swiss army conscription process . They were offered the opportunity to receive a 20-minute BMI , and those interested were r and omized into an intervention group ( BMI immediately ) or into a control group ( BMI after the 6-month follow-up assessment , in a waiting list design ) . Analyses were conducted separately for heavy and nonheavy episodic users ( separated using baseline heavy episodic use frequency ) as the hypotheses tested were different between both groups ( primary vs. secondary prevention intervention ) . RESULTS From a pool of 6,085 young men invited to receive BMI , 727 ( 11.9 % ) showed up and 572 were included in the study ( after exclusions related to organizational aspects of the conscription process ) . Among nonheavy episodic users , there was a protective effect of BMI on weekly alcohol use ( p < 0.05 ) . Among heavy episodic users , there were no significant effects of BMI . CONCLUSIONS About 12 % of young men were interested in addressing their drinking within the BMI framework , suggesting that there is some need for easily accessible alcohol intervention . The present intervention did have a preventive effect among low-risk young drinkers in helping them maintain their patterns of alcohol use . An explanation for the lack of effectiveness among heavy episodic users might be that those individuals interested in BMI had patterns of more severe alcohol use , thereby making change more difficult AIM To test whether beneficial effects of a single session of Motivational Interviewing ( MI ) on alcohol , tobacco and illicit drug use apparent after 3 months were maintained until 12 months . DESIGN Cluster r and omized trial , allocating 200 young people in the natural groups in which they were recruited to either MI ( n = 105 ) or to an assessment -only control condition  ( n = 95 ) . SETTING Ten further education colleges across inner London . PARTICIPANTS Two hundred young people who were current users of illegal drugs ( age range 16 - 20 years ) with whom contact was established through peers trained for the project . INTERVENTION The intervention was adapted from MI in the form of a topic-based 1-hour single-session discussion . MEASUREMENTS Changes in cigarette , alcohol , cannabis and other drug use and perceptions of risk and harm between the time of recruitment and follow-up interviews after 3 and 12 months . FINDINGS A satisfactory follow-up rate ( 81 % ) was achieved . After 12 months , 3-month differences between MI and assessment -only groups have disappeared almost entirely . Unexpected improvements by the assessment -only control group on a number of outcomes suggest the possibility of reactivity to the research assessment at 3-month follow-up . CONCLUSION In the terms of the original experiment , there is little evidence of enduring intervention effectiveness shown by between-group differences after 12 months . Deterioration of effect is the most probable explanation , although reactivity to 3-month assessment , a late Hawthorne effect , can not be ruled out AIMS We examined the alcohol-tobacco relationship using two prospect i ve , ethnically diverse sample s. Trajectories of alcohol and tobacco use are portrayed overall and by sex and ethnicity . Using prospect i ve analyses , we examine directional influences between alcohol and tobacco use , and we characterize initiation versus persistence of drinking and smoking as a function of use of the other substance . DESIGN , SETTING Data were from the National Longitudinal Study of Adolescent Health ( AddHealth ) and the Adolescent Health Risk Study ( AHRS ) . Follow-up intervals for AddHealth and AHRS were 1 and 5 years , respectively . PARTICIPANTS AddHealth respondents ( n = 4831 ) were on average 14.8 years old ( 48 % male , 23 % black , 61 % white ) and AHRS respondents ( n = 1814 ) were on average 16.7 years old ( 47 % male , 44 % black , 49 % white ) . MEASUREMENTS Two alcohol consumption variables and two smoking variables were used : drinking frequency and heavy drinking frequency , and regular ( current ) smoking and daily number of cigarettes . FINDINGS Alcohol and tobacco use exhibited monotonic increases over adolescence and young adulthood . Men and white respondents reported more use than women and black respondents .  Alcohol and tobacco were moderately associated at both times . Analyses revealed that prior alcohol use predicted tobacco use more strongly than the converse . Initiation of smoking was a function of prior drinking ; to a lesser extent , initiation of drinking was a function of prior smoking . Persistence of smoking was a function of prior drinking and persistence of drinking was a function of prior smoking . CONCLUSIONS Provisional support exists for the cl aim that alcohol use predicts tobacco use more strongly than the converse . For both drinking and smoking , onset and persistence are predicted by prior use of the other substance , and these associations were robust across sex and ethnicity OBJECTIVE To examine the effectiveness of a brief , school-based intervention for preventing alcohol use . DESIGN AND SETTING R and omized , control trial assigning inner-city public school students to an intervention program or a comparison program . PARTICIPANTS Sixth , seventh , and eighth grade students in Jacksonville , Fla ( N=104 ) . INTERVENTIONS Students assigned to the intervention program were given a self-instructional module and corresponding audiotape , a health consultation with a physician or nurse , and a follow-up consultation with a trained peer health model . MAIN OUTCOME MEASURES Alcohol consumption during the month after the intervention and students ' assessment s of the interventions were measured . RESULTS Students ' t tests showed participants were more satisfied with physician or nurse consultations than with peer consultations or the self-instructional module and audiotapes ( P=.05 ) . Analysis of covariance tests showed significant main effects for 30-day quantity of alcohol use ( F=5.15 , P=.02 ) , with intervention students reporting less alcohol consumption at follow-up than comparison students , and for 30-day frequency of alcohol use ( F=5.92,P=.01 ) with intervention students again showing less frequent use at follow-up . CONCLUSIONS A multicomponent , school-based intervention using print and audiotape media , brief physician or nurse consultations , and follow-up peer contacts holds promise in altering short-term alcohol use and selected behavioral factors among inner-city youth The primary purpose of this study was to test the efficacy of a brief , multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents . A total of 604 participants , 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study . A r and omized control trial was conducted with participants r and omly assigned within grade levels to receive either a brief consultation and prescription with a mailed reinforcing follow-up flyer ( Project SPORT ) or a minimal intervention control consisting of a wellness brochure provided in school and a pamphlet about teen health and fitness mailed to the home . Differences between intervention groups were evaluated with a series of MANCOVA tests . Project SPORT participants demonstrated significant positive effects at 3-months postintervention for alcohol consumption , alcohol initiation behaviors , alcohol use risk and protective factors , drug use behaviors , and exercise habits , and at 12-months for alcohol use risk and protective factors , cigarette use , and cigarette initiation ( p 's < 0.05 ) . A post hoc analysis examining interactions between past 30-day use of marijuana and /or cigarettes by treatment group indicates significant positive effects for drug using adolescents who received Project SPORT on alcohol consumption , drug use behaviors , and drug use initiation at 3-months , and for drug use behaviors and exercise habits at 12-months ( p 's < 0.05 ) . A brief , 12-min one-on-one consultation integrating alcohol avoidance messages within those promoting fitness and other positive health behaviors holds promise for influencing adolescent alcohol and cigarette use and other health behaviors at posttreatment and 1 year later . Long-term sustained effects for cigarette and marijuana use , and both vigorous and moderate physical activity , were found among adolescents using marijuana and /or cigarettes prior to intervention AIM To test whether a single session of Motivational Interviewing ( MI ) focussing on drinking alcohol , and cigarette and cannabis smoking , would successfully lead to reductions in use or problems . METHODS Naturalistic quasi-experimental study , in  
    Output:
    
Directly addressing tobacco was not a significant moderator affecting tobacco use outcomes .