***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 : Studies of school-based anti-obesity interventions have yielded inconsistent results . Using growth screening data from a school administrative data base , we re-evaluated an obesity prevention strategy that was previously reported to have a beneficial effect on weight status of a sample of students in grade s 5–7 . Methods : Ten K-8 schools ( five control and five intervention ) participated in a 2-year cluster-r and omized trial of a multi-component nutrition education intervention . We obtained student height and weight data for 6 consecutive school years and imputed missing baseline and follow-up measurements ( 53 % and 55 % , respectively ) and defined the target population based on the intent-to-treat principle . We analyzed changes in body mass index ( BMI ) Z-scores via mixed-effects linear regression and in the prevalence of overweight/obesity via conditional logistic regression . We also assessed incidence and remission of overweight/obesity and long-term effects . Results : We analyzed data for 8186 ( 96 % ) K-8 students in the 10 schools ( 4511 in intervention ; 3675 in control ) . From baseline to the end of the intervention period , mean increases in BMI Z-score were 0.10 and 0.09 in the control and intervention groups , respectively ( P=0.671 ) . The prevalence of overweight/obesity increased by 3 % in both groups ( P=0.926 ) . There was no significant intervention effect on the incidence or remission of overweight/obesity .  Among 5469 students who attended study schools during both years of the intervention , there was no significant intervention effect . Furthermore , there was no long-term effect among students with up to 2 years of data beyond the end of the intervention . Conclusion : Using routinely collected data for the entire target population , we failed to confirm earlier findings of an intervention effect observed in a subset of students in grade s 5–7 . Volunteer bias in the prior evaluation and /or measurement error in the routinely collected data are potential reasons for the discrepant findings Project FIT was a two-year multi-component nutrition and physical activity intervention delivered in ethnically-diverse low-income elementary schools in Gr and Rapids , MI . This paper reports effects on children ’s nutrition outcomes and process evaluation of the school component . A quasi-experimental design was utilized . 3rd , 4th and 5th- grade students ( Yr 1 baseline : N = 410 ; Yr 2 baseline : N = 405 ; age range : 7.5–12.6 years ) were measured in the fall and spring over the two-year intervention . Ordinal logistic , mixed effect models and generalized estimating equations were fitted , and the robust st and ard errors were utilized . Primary outcomes favoring the intervention students were found regarding consumption of fruits , vegetables and whole grain bread during year 2 . Process evaluation revealed that implementation of most intervention components increased during year 2 . Project FIT result ed in small but beneficial effects on consumption of fruits , vegetables , and whole grain bread in ethnically diverse low-income elementary school children OBJECTIVE We aim ed to investigate the association between multiple measures of socio-economic position ( SEP ) and diet quality , using a diet quality index representing current national dietary guidelines , in the Australian adult population . DESIGN Cross-sectional study . Linear regression analyses were used to estimate the association between indicators of SEP ( educational attainment , level of income and area-level disadvantage ) and  diet quality  ( measured using the Dietary Guideline Index ( DGI ) ) in the total sample and stratified by sex and age ( ≤55 years and > 55 years ) . SETTING A large r and omly selected sample of the Australian adult population . SUBJECTS Australian adults ( n 9296 ; aged ≥25 years ) from the Australian Diabetes , Obesity and Lifestyle Study . RESULTS A higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score , across the gradient of SEP . The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts . The most disadvantaged group had a DGI score between 2 and 5 units lower ( depending on the marker of SEP ) compared with the group with the least disadvantage . CONCLUSIONS A higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined . In order to reduce socio-economic inequalities in diet quality , healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage 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 In contrast to the Special Supplemental Nutrition Program for Women , Infants , and Children , the Supplemental Nutrition Assistance Program ( SNAP ) currently allows the purchase of almost any food . This paper reconsiders the role of two forms of limiting choice in SNAP . Using economic theory , descriptive analysis of survey data , and discussion of r and om assignment evaluation evidence from the Summer Electronic Benefit Transfer for Children Demonstration , the paper argues that because households can substitute cash for SNAP , banning the use of SNAP for less nutritionally desirable foods ( e.g. , soda , c and y ) is unlikely to have a large impact . By contrast , because many households currently consume so little of more nutritionally desirable foods ( e.g. , whole grains , fruits , and vegetables ) , requiring that some portion of SNAP benefits be spent on those foods is likely to improve dietary intake . Summer Electronic Benefit Transfer for Children Demonstration impact estimates are consistent with this conjecture . Furthermore , these data and evidence from the Healthy Incentives Pilot implementation suggest that such a policy can be feasibly integrated into existing operational processes OBJECTIVE The present study examines the impact of Health Bucks , a farmers ' market incentive programme , on awareness of and access to farmers ' markets , and fruit and vegetable purchase and consumption in low-income New York City neighbourhoods . DESIGN The evaluation used two primary data collection methods : ( i ) an on-site point-of-purchase survey of farmers ' market shoppers ; and ( ii ) a r and om-digit-dial telephone survey of residents in neighbourhoods where the programme operates . Additionally , we conducted a quasi-experimental analysis examining differential time trends in consumption before and after programme introduction using secondary Community Health Survey ( CHS ) data . SETTING New York City farmers ' markets and communities . SUBJECTS Farmers ' market shoppers ( n 2287 ) completing point-of-purchase surveys in a representative sample of New York City farmers ' markets in 2010 ; residents ( n 1025 ) completing r and om-digit-dial telephone survey interviews in 2010 ; and respondents ( n 35 606 ) completing CHS interviews in 2002 , 2004 , 2008 and 2009 . RESULTS Greater Health Bucks exposure was associated with : ( i ) greater awareness of farmers ' markets ; ( ii ) increased frequency and amount of farmers ' market purchases ; and ( iii ) greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption . However , our CHS analysis did not detect impacts on consumption . CONCLUSIONS While our study provides promising evidence that use of farmers ' market incentives is associated with increased awareness and use of farmers ' markets , additional research is needed to better underst and impacts on fruit and vegetable consumption Background The Healthy Options for Nutrition Environments in Schools ( Healthy ONES ) study was an evidence -based public health ( EBPH ) r and omized group trial that adapted the Institute for Healthcare Improvement ’s ( IHI ) rapid improvement process model to implement school nutrition policy and environmental change . Methods A low-income school district volunteered for participation in the study . All schools in the district agreed to participate ( elementary = 6 , middle school = 2 ) and were r and omly assigned within school type to intervention ( n = 4 ) and control ( n = 4 ) conditions following a baseline environmental audit year . Intervention goals were to 1 ) eliminate unhealthy foods and beverages on campus , 2 ) develop nutrition services as the main source on campus for healthful eating ( HE ) , and 3 ) promote school staff modeling of HE . Schools were followed across a baseline year and two intervention years . Longitudinal assessment of height and weight was conducted with second , third , and sixth grade children .  Behavioral observation of the nutrition environment was used to index the amount of outside foods and beverages on campuses . Observations were made monthly in each targeted school environment and findings were presented as items per child per week . Results From an eligible 827 second , third , and sixth grade students , baseline height and weight were collected for 444 second and third grade and 135 sixth grade students ( 51 % reach ) . Data were available for 73 % of these enrolled students at the end of three years . Intervention school outside food and beverage items per child per week decreased over time and control school  outside food and beverage items increased over time . The effects were especially pronounced for unhealthy foods and beverage items . Changes in rates of obesity for intervention school ( 28 % baseline , 27 % year 1 , 30 % year 2 ) were similar to those seen for control school ( 22 % baseline , 22 % year 1 , 25 % year 2 ) children . Conclusions Healthy ONES adaptation of IHI ’s rapid improvement process provided a promising model for implementing nutrition policy and environmental changes that can be used in a variety of school setting s. This approach may be especially effective in assisting schools to implement the current federally-m and ated wellness policies BACKGROUND . The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic setting s. Schools are ideal setting s for population -based interventions to address obesity . OBJECTIVE . The purpose of this work was to examine the effects of a multicomponent , School Nutrition Policy Initiative on the prevention of overweight ( 85.0th to 94.9th percentile ) and obesity ( > 95.0th percentile ) among children in grade s 4 through 6 over a 2-year period . METHODS . Participants were 1349 students in grade s 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with ≥50 % of students eligible for free or reduced-price meals .  Schools were matched on school size and type of food service and r and omly assigned to intervention or control . Students were assessed at baseline and again after 2 years . The School Nutrition Policy Initiative included the following components : school self- assessment , nutrition education , nutrition policy , social marketing , and parent outreach . RESULTS . The incidences of overweight and obesity after 2 years were primary outcomes . The prevalence and remission of overweight and obesity , BMI z score , total energy and fat intake , fruit and vegetable consumption , body dissatisfaction , and hours of activity and inactivity were secondary outcomes . The intervention result ed in a 50 % reduction in the incidence of overweight . Significantly fewer children in the intervention schools ( 7.5 % ) than in the control schools ( 14.9 % ) became overweight after 2 years . The prevalence of overweight was lower in the intervention schools . No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years . CONCLUSION . A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grade s 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals BACKGROUND US fruit and vegetable ( FV ) intake remains below recommendations , particularly for low-income population s. Evidence on effectiveness of rebates in addressing this shortfall is limited . OBJECTIVE This study evaluated the USDA Healthy Incentives Pilot ( HIP ) , which offered rebates to Supplemental Nutrition Assistance Program ( SNAP ) participants for purchasing targeted FVs ( TFVs ) . DESIGN As part of a r and omized controlled trial in Hampden County , Massachusetts , 7500 r and omly selected SNAP households received a 30 % rebate on TFVs purchased with SN 
    Output:
    
Of the 10 studies of government policies , policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children , but no impact amongst adults .
Policies involving changes to built environments yielded nearly uniformly null findings in children and adults .
Overall , the largest quantity of high- quality evidence of effectiveness was for comprehensive interventions that included school policies , and government policies targeting disadvantaged children in schools .
None of the government policies targeting disadvantaged adults proved effective .
Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage .