***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 The objective of the present research was to test the efficacy of Fruit & Veg $ ense sessions in increasing fruit and vegetable consumption . DESIGN A wait-list r and omised controlled trial was conducted ( n 292 ) . Intervention participants attended a Fruit & Veg $ ense session and received newsletters at weeks 2 and 5 after attending the session . All participants completed an FFQ and a question naire measuring knowledge , attitudes , barriers and stage of change for fruit and vegetable consumption at baseline and 6 weeks . SETTING Hunter region of New South Wales , Australia . SUBJECTS Two hundred and ninety-two parents with children of primary school age . RESULTS The intervention group significantly increased its mean consumption of fruit and vegetables by 0·62 servings compared with 0·11 in the control group ( difference of 0·51 , P = 0·001 ) . Compared with the control group , there were significant increases in intervention participants ' knowledge of daily recommended servings ( for fruit and vegetables ) and serving size ( for vegetables ) , improvement in stage of change for vegetable consumption and a decrease in the number of perceived barriers to fruit and vegetable consumption . CONCLUSIONS Fruit & Veg $ ense is efficacious in increasing fruit and vegetable consumption among parents of primary -school children . The study adds significantly to the limited evidence regarding fruit and vegetable interventions and the feasibility of engaging peer educators to deliver community education sessions . A broader implementation trial to test the effectiveness of Fruit & Veg $ ense is recommended This article reports on the outcomes of the Teens Eating for Energy and Nutrition at School ( TEENS ) study , a 2-year intervention study conducted in 16 middle schools with a goal of increasing students ’  intakes of fruits , vegetables , and lower fat foods . Despite positive interim results for students r and omized to intervention schools , the positive effects of the intervention were not seen for the primary outcomes at the end of the 2nd year . Positive effects were seen only for a food choice score ( suggesting that the students usually choose lower versus higher fat foods ) and not for measures of food intake . Future studies may need to take a step back toward more controlled efficacy studies in working with this age-group . In addition , future work may consider the use of peer leaders , more intensive teacher training , ongoing formative assessment , and the testing of more powerful environmental change intervention strategies Peer education has become a popular strategy for health promotion interventions with adolescents , but it has not been used widely in school-based nutrition education . This paper describes and reports on the feasibility of the peer leader component of a school-based nutrition intervention for young adolescents design ed to increase fruit and vegetable intakes and lower fat foods .  About 1,000 seventh- grade students in eight schools received the nutrition intervention .  Of these , 272 were trained as peer leaders to assist the teacher in implementing the activities . Results from a multicomponent process evaluation based on peer leader and classroom student feedback , direct classroom observation , and teacher ratings and interviews are presented . Results show that peer-led nutrition education approaches in schools are feasible and have high acceptability among peer leaders , classroom students , and teachers OBJECTIVES ( 1 ) To describe promotional activities , particularly student-led , targeting lower-fat à la carte foods that were conducted in secondary schools ; and ( 2 ) to describe the relationships between the number and duration of total promotional activities for lower-fat à la carte foods and cafeteria sales of such foods over two years . DESIGN Promotional activities were implemented in schools that were r and omised to the intervention condition of a larger , two-year , school-based , r and omised , controlled nutrition intervention trial . SETTING Ten Minnesota secondary schools . SUBJECTS Students and school faculty , school food-service and research staff ( measured at the school level ) . RESULTS Over two years , 181 promotions were implemented ( n=49 in Year 1 and n=132 in Year 2 ) . In Year 1 , the number of promotions conducted in schools was significantly associated with percentage lower-fat food sales . In Year 2 , the duration of promotions was significantly associated with percentage lower-fat food sales . CONCLUSIONS Collaborative efforts among students , school food-service staff and research staff can be successful in implementing a large number of nutrition-related , school-wide promotional activities . These efforts can increase the sales of lower-fat foods in à la carte areas of school cafeterias OBJECTIVE We implemented a theory-based r and omized controlled trial ( Living Free of Tobacco , Plus ( LIFT+ ) in ten rural middle schools and assessed impact on  tobacco use and fruit/vegetable ( F/V ) intake in 2008 - 2010 . Data on F/V intake at baseline , immediate post intervention , and 1-year follow-up are presented . METHODS Schools were r and omized to intervention or control groups . Goal setting , peer leaders , and class workshops with parent involvement , were intervention features ; community partners were supportive . Seventh grade rs filled out surveys on health behaviors , psycho-social variables , and demographic characteristics . Adjusted models comparing intervention and control conditions were analyzed . RESULTS Sample ( n=1119 ) was 48.5 % female , 50 % White , with a mean age of 12.7 years .  Mean F/V servings were significantly higher in intervention schools at immediate post ( 3.19 servings ) and at 1-year ( 3.02 servings ) compared to controls ( 2.90 , 2.69 respectively ) . Knowledge of 5-a-day recommendation was significantly higher in intervention schools at immediate post test ( 75.0 % ) versus controls ( 53.8 % ) but not at 1-year follow-up . CONCLUSIONS Intervention schools reported significantly higher mean F/V servings at post intervention and 1-year , and for knowledge of F/V recommendations at immediate post compared to controls . Higher levels of parent and community involvement may further increase F/V intake in future interventions . Clinical Trials.gov Identifier : NCT01412697 OBJECTIVES We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias . METHODS Twenty secondary schools were r and omly assigned to either an environmental intervention or a control group for a 2-year period . The intervention increased the availability of lower-fat foods and implemented student-based promotions . RESULTS A steeper rate of increase in sales of lower-fat foods in year 1 ( 10 % intervention vs -2.8 % control , P = .002 ) and a higher percentage of sales of lower-fat foods in year 2 ( 33.6 % intervention vs 22.1 % control , P = .04 ) were observed . There were no significant changes in student self-reported food choices . CONCLUSIONS School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents PURPOSE We used principles of community-based participatory research to develop and pilot test a 5-week intervention for middle school students , Students for Nutrition and eXercise ( SNaX ) . SNaX aim ed to translate school obesity-prevention policies into practice with peer advocacy of healthy eating and school cafeteria changes . METHODS A total 425 seventh grade rs ( 63 % of all seventh grade rs ) in the intervention school were surveyed at baseline regarding cafeteria attitudes and sugar-sweetened beverage consumption ; of the 425 students , 399 ( 94 % ) were surveyed again at 1-month post-intervention . School cafeteria records were obtained from two schools : the intervention school and a nonr and omized selected comparison school with similar student socio-demographic characteristics . RESULTS A total of 140 students in the intervention school were trained as peer advocates . In the intervention school , cafeteria attitudes among peer advocates significantly improved over time ( approximately one-third of a st and ard deviation ) , whereas cafeteria attitudes of non-peer advocates remained stable ; the improvement among peer advocates was significantly greater than the pre-post-change for non-peer advocates ( b = .71 , p < .001 ) . Peer advocates significantly reduced their sugar-sweetened beverage intake ( sports and fruit drinks ) , from 33 % before intervention to 21 % after intervention ( p = .03 ) . Cafeteria records indicated that servings of fruit and healthier entrées ( salads , s and wiches , and yogurt parfaits ) significantly decreased in the comparison school and significantly increased in the intervention school ; the magnitude of changes differed significantly between the schools ( p < .001 ) . CONCLUSIONS As compared with the non-peer advocates , peer advocates appeared to benefit more from the intervention . Future research should consider engaging parents , students , and other key community stakeholders to determine acceptable and sustainable cafeteria changes HEALTHY was a multi-center primary prevention trial design ed to reduce risk factors for type 2 diabetes in adolescents . Seven centers each recruited six middle schools that were r and omized to either intervention or control . The HEALTHY intervention integrated multiple components in nutrition , physical education , behavior change and communications and promotion . The conceptual rationale as well as the design and development of the behavior intervention component are described . Pilot study data informed the development of the behavior intervention component . Principles of social learning and health-related behavior change were incorporated . One element of the behavior intervention component was a sequence of peer-led , teacher-facilitated learning activities known as FLASH ( Fun Learning Activities for Student Health ) . Five FLASH modules were implemented over five semesters of the HEALTHY study , with the first module delivered in the second semester of the sixth grade and the last module in the second semester of the eighth grade . Each module contained sessions that were design ed to be delivered on a weekly basis to foster self-awareness , knowledge , decision-making skills and peer involvement for health behavior change . FLASH behavioral practice incorporated individual and group self-monitoring challenges for eating and activity . Another element of the behavior intervention component was the family outreach strategy for extending changes in physical activity and healthy eating beyond the school day and for supporting the student 's lifestyle change choices . Family outreach strategies included the delivery of newsletters and supplemental packages with material s to promote healthy behavior in the home environment during school summer and winter holiday breaks . In conclusion , the HEALTHY behavior intervention component , when integrated with total school food and physical education environmental changes enhanced by communications and promotional campaigns , is a feasible and acceptable mechanism for delivering age-appropriate social learning for healthy eating and physical activity among an ethnically diverse group of middle school students across the United States OBJECTIVE . We design ed and tested a novel health promotion program for elementary schools that was based on peer teaching from older to younger schoolchildren ( “ Healthy Buddies ” ) . SUBJECTS AND METHODS . This prospect i ve pilot study compared the effect of our program ( 2–3 hours/week , 21 weeks ) in 2 Canadian elementary schools ( intervention : n = 232 children , the whole school implementing the program ; control : n = 151 ) . Older students ( 4th through 7th grade ) were given direct instruction from 1 intervention teacher and were paired with  younger students ( kindergarten through 3rd grade ) for the whole school year . Students in 4th through 7th grade then acted as teachers for their younger “ buddies . ” All lessons included 3 components of healthy living : nutrition , physical activity , and healthy body image . The students first learned how to be positive buddies and learned the 3 components of a healthy life . Thereafter , they learned how to overcome challenges to living a healthy life . Outcome measures ( intervention and control schools at the beginning and end of the school year ) included vali date d question naires that assessed healthy-living knowledge , behavior and attitude , a 9-minute fitness run , self-competence , body satisfaction , disordered eating symptoms , and anthropometry ( BMI , blood pressure , and heart rate ) . RESULTS . Compared with control students , both older and younger intervention students showed an increase in healthy-living knowledge , behavior , and attitude scores and a smaller increase in systolic blood pressure . BMI and weight increased less in the intervention students in 4th through 7th grade and height more in the intervention students in kindergarten through 3rd grade . CONCLUSIONS . Our student-led curriculum improved knowledge not only in older schoolchildren but also in their younger buddies . It also decreased weight velocity in the older students . Student-led teaching may be an efficient , easy-to-implement way of promoting a healthy lifestyle from kindergarten to 7th grade This article describes perceptions of adolescents involved in peer-led school-based nutrition promotions  encouraging lower-fat food purchases and assesses the differences by level of student involvement . Surveys were administered at schools . Data were collected from 397 high school students from 10 Minnesota schools r and omized to the intervention condition of the Trying Alternative Cafeteria Options in Schools study . Students were categorized as highly involved ( n=54 ) or less involved ( n=343 ) based on their level of involvement in promotional activity implementation . Chi 2 tests were conducted to measure the differences between highly-involved and less-involved students in perceptions and attitudes about lower-fat foods . Highly-involved students were significantly more likely than less-involved students to report more healthful eating behaviors and positive attitudes toward lower-fat foods . Student involvement in nutrition interventions should be integrated into programs aim ed at increasing healthful food choices among adolescents 
    Output:
    
When evaluated , programs were generally well received , while the long-term maintenance of positive impacts was a challenge .