***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: PURPOSE The purpose of this study was to examine the relationship between age at drinking onset and the development of  DSM-IV alcohol abuse and dependence in a 12-year prospect i ve study of youth in the United States . METHODS Logistic regression analyses were used to quantify the relationship between age at drinking onset and the development of alcohol abuse and dependence controlling for sociodemographic factors and problem indicators . RESULTS The odds of alcohol dependence decreased by 5 % in 1989 and 9.0 % in 1994 for each year drinking onset was delayed . In 1994 , the odds of alcohol abuse increased by 7.0 % with each decreasing year of age at drinking onset , while age at drinking onset was not related to alcohol abuse in 1989 . Several other risk factors were found to be strong and consistent predictors of abuse and dependence in 1989 and 1994 , including being male , divorced , separated or never married , younger , and having an early history antisocial behaviors and marijuana use . IMPLICATION S Implication s of the results of this study are discussed in terms of other factors that may impact on the onset-abuse and onset-dependence relationship and the need to focus future prevention efforts This article describes a small efficacy trial of the Living in 2 Worlds ( L2W ) substance use prevention curriculum , a culturally adapted version of keepin ’ it REAL ( kiR ) re design ed for urban American Indian ( AI ) middle school students . Focused on strengthening resiliency and AI cultural engagement , L2W teaches drug resistance skills , decision making , and culturally grounded prevention messages . Using cluster r and om assignment , the research team r and omized three urban middle schools with enrichment classes for AI students . AI teachers of these classes delivered the L2W curriculum in two schools ; the remaining school implemented kiR , unadapted , and became the comparison group . AI students ( N = 107 ) completed a pretest question naire before they received the manualized curriculum lessons , and a posttest ( 85 % completion ) 1 month after the final lesson . We assessed the adapted L2W intervention , compared to kiR , with paired t tests , baseline adjusted general linear models , and effect size estimates ( Cohen ’s d ) . Differences between the L2W and kiR groups reached statistically significant thresholds for four outcomes . Youth receiving L2W , compared to kiR , reported less growth in cigarette use from pretest to posttest , less frequent use of the Leave drug resistance strategy , and less loss of connections to AI spirituality and cultural traditions . For other substance use behaviors and antecedents , the direction of the non-significant effects in small sample tests was toward more positive outcomes in L2W and small to medium effect sizes . Results suggest that evidence -based substance use prevention programs that are culturally adapted for urban AI adolescents , like L2W , can be a foundation for prevention approaches to help delay initiation and slow increases in substance use . In addition to study limitations , we discuss implementation challenges in delivering school-based interventions for urban AI population ABSTRACT Background : Early substance use threatens many American Indian/Alaska Native ( AI/AN ) communities , as it is a risk factor for maladaptive use and adverse health outcomes . Marijuana is among the first substances used by AI/AN youth , and its use becomes widespread during adolescence . Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN population s. Objectives : We evaluated the effectiveness of the Circle of Life ( COL ) program in reducing marijuana use among young AI adolescents .  COL is a culturally tailored , theory-based human immunodeficiency virus ( HIV ) and sexually transmitted disease ( STD ) intervention shown to delay sexual initiation among AI youths . Methods : We conducted secondary analyses of data from a school-based group r and omized trial conducted between 2006 and 2007 in all 13 middle schools on a rural , Northern Plains reservation ( N = 635 , 47 % female ) . We used discrete-time survival analysis ( DTSA ) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling ( LGCM ) to evaluate effects on frequency of marijuana use over time . Results : DTSA models showed that the overall risk of marijuana initiation was 17.3 % lower in the COL group compared to the control group . No intervention effect on frequency of marijuana use emerged in LGCM analyses . Conclusion : COL is a multifaceted , culturally tailored , skills-based program effective in preventing marijuana uptake among AI youth This paper reports on the evaluation of a culturally grounded prevention intervention targeting substance use among urban middle-school students . The curriculum consists of 10 lessons promoting antidrug norms and teaching resistance and other social skills , reinforced by booster activities and a media campaign . Three versions were delivered : Mexican American , combined African American and European American , and Multicultural . Thirty-five middle schools were r and omly assigned to 1 of the 3 versions or the control . Students completed baseline and follow-up question naires over a 2-year period ( total 6,035 respondents ) . Analyses utilizing a generalized estimating equations approach assessed the overall effectiveness of cultural grounding and the cultural matching hypothesis . Support was found for the intervention 's overall effectiveness , with statistically significant effects on gateway drug use as well as norms , attitudes , and resistance strategies but with little support for the cultural matching hypothesis . Specific contrasts found the Mexican American and Multicultural versions impacted the most outcomes PURPOSE Toward developing attractive and effective means to reduce cancer risks faced by Native American people , this study developed and tested interactive computer software to improve dietary choices and prevent tobacco use among Native American adolescents . METHODS Based on a legend of the Seneca Nation , a cancer prevention lesson was developed and programmed for software .  A sample of 368 Native American adolescents were divided r and omly into intervention and control arms . Youths in both arms were pre-tested , youths in the intervention arm interacted with the software , and all youths were post-tested . Pre-test and post-test measures covered information and attitudes about cancer risks from dietary practice s and tobacco use . RESULTS Pre-test scores differed between the two arms on youths ' age and on one outcome variable . Relative to their counterparts in the control arm , youths in the intervention arm increased their post-test scores on 8 of 12 outcome measurement variables . Process data gathered during intervention delivery indicated that nearly all youths were involved with the interactive software and lesson . CONCLUSION Interactive computer software holds promise for delivering cancer risk reduction intervention aim ed at modifying dietary habits and preventing tobacco use among Native American youth Background The rate of smoking commercial tobacco products among American Indian youth is double the rate for white youth . Interventions are needed to reduce this disparity . Objective To test the feasibility of a Web-based intervention to influence attitudes toward and intentions about smoking cigarettes among American Indian youth who attended a Native summer camp in the Northern Plains . Methods The study website , the SmokingZine , was originally developed and tested in Canadian youth , then adapted to be appropriate for American Indian youth . We conducted a r and omized controlled trial to test the influence of exposure to the adapted SmokingZine website on smoking attitudes and behaviors among American Indian youth 12–18 years of age . Participants assigned to the intervention group were given access to the website for 1 hour per day during their camp experience and asked to sign in to the site and use it . Control group participants were not given access to the site . Results A total of 52 % of intervention youth signed in to the website at least once . Among nonsmokers , intentions to try a cigarette in the intervention group declined from 16 % to 0 % , and increased from 8 % to 25 % in the control group ( P < .05 ) . Compared with the control group , youth in the intervention group were more likely to help others quit ( 21 percentage point change in intervention versus no change in control ; P < .05 ) and had less positive attitudes about the drug effects of smoking ( –0.19 change in intervention versus 0.67 in control ; P < .05 ) . Conclusion These data indicate that SmokingZine needs more long-term , rigorous investigation as a way to keep American Indian youth from becoming regular smokers . Because the intervention group could use computers only 1 hour per day , increasing access might result in more visits and a greater effect of the website on smoking behaviors This article examines changes in the drug resistance strategies used by urban American Indian ( UAI ) middle school students during a pilot test of a substance use prevention curriculum design ed specifically for UAI youth , Living in 2 Worlds ( L2W ) .  L2W teaches four drug resistance strategies ( refuse , explain , avoid , leave [ R-E-A-L ] ) in culturally appropriate ways . Data come from 57 UAI students ( 53 % female ; mean age = 12.5 years ) who participated in L2W during an academic enrichment class for Native youth at two Phoenix schools . Students completed a pre-test question naire before the L2W lessons and a post-test 7 months later . Questions assessed the use of R-E-A-L  and alternative strategies commonly reported by UAI youth ( change the subject , use humor ) . Tests of mean differences from pre-test to post-test showed significant increases in use of refuse , explain , and leave , and an exp and ing R-E-A-L repertoire . Use of more passive strategies ( avoid , use humor ) did not change significantly , except for change the subject , which increased . Changes in the use of strategies did not differ significantly by gender , age , school grade s , parental education , or length of urban residence . The L2W curriculum appears effective in teaching culturally relevant communication strategies that exp and UAI youths ' repertoire of drug resistance skills This study developed and tested skills- and community-based approaches to prevent substance abuse among Native American youth . After completing pretest measurements , 1,396 third- through fifth- grade Native American students from 27 elementary schools in five states were divided r and omly by school into two intervention arms and one control arm . Following intervention delivery , youths in all arms completed posttest measurements and three annual follow-up measurements . Youths in schools assigned to the intervention arms learned cognitive and behavioral skills for substance abuse prevention . One intervention arm additionally engaged local community residents in efforts to prevent substance use among Native American youth . Outcome assessment batteries measured youths ' reported use of smoked and smokeless tobacco , alcohol , and marijuana . Over the course of the 3.5-year study , increased rates of tobacco , alcohol , and marijuana use were reported by youths across the three arms of the study . Though cigarette use was unaffected by intervention , follow up rates of smokeless tobacco , alcohol , and marijuana use were lower for youths who received skills intervention than for youths in the control arm . Community intervention components appeared to exert no added beneficial influence on youths ' substance use , beyond the impact of skills intervention components alone . Finally , gender differences were apparent across substances , measurements , and study arms , with girls smoking more cigarettes and boys using more smokeless tobacco , alcohol , and marijuana Objectives To evaluate the effectiveness of a multilevel intervention design ed to prevent underage alcohol use among youths living in the Cherokee Nation . Methods We r and omly assigned 6 communities to a  control , Communities Mobilizing for Change on Alcohol ( CMCA ; a community-organizing intervention targeting alcohol access ) only , CONNECT ( a school-based universal screening and brief intervention ) only , or a combined condition . We collected quarterly surveys 2012 - 2015 from students starting in 9th and 10th grade s and ending in 11th and 12th grade s. Response rates ranged from 83 % to 90 % ; 46 % of students were American Indian ( of which 80 % were Cherokee ) and 46 % were White only . Results Students exposed to CMCA , CONNECT , and both showed a significant reduction in the probability over time of 30-day alcohol use ( 25 % , 22 % , and 12 % reduction , respectively ) and heavy episodic drinking ( 24 % , 19 % , and 13 % reduction ) compared with students in the control condition , with variation in magnitude of effects over the 2.5-year intervention period . Conclusions CMCA and CONNECT are effective interventions for reducing alcohol use among American Indian and other youths living in rural communities . Challenges remain for sustaining intervention effects 
    Output:
    
Substance use prevention programs for Indigenous youth led to reductions in substance use frequency and intention to use ; improvements in substance-related knowledge , attitudes and resistance strategies ; and delay in substance use initiation .
Prevention programs have the potential to reduce substance use among Indigenous adolescents , especially when they are developed in partnership with Indigenous people .