***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 Obesity has become a global public health problem , which also affects children . It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity . Objective To evaluate the efficacy of an intervention on food habits and physical activity in school children . Methods A 2-year cluster-r and omised prospect i ve study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling ( 5–6 years of age ) in schools in the city of Granollers . The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation , Vision , Action and Change ( IVAC ) . At the beginning and at the end of the study ( 2006 and 2008 ) the weight and height of each child was measured in situ , while the families were given a self-report physical activity question naire and the Krece Plus quick test . Results Two years after the beginning of the study , the body mass index of the children in the control group was 0.89 kg/m2 higher than that of the intervention schools . The intervention reduced by 62 % the prevalence of overweight children . Similarly , the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group . In the control group , the weekly consumption of fish was reduced . Conclusions The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity Objective To compare the effectiveness of classroom based cognitive behavioural therapy with attention control and usual school provision for adolescents at high risk of depression . Design Three arm parallel cluster r and omised controlled trial . Setting Eight UK secondary schools . Participants Adolescents ( n=5030 ) aged 12 - 16 years in school year groups 8 - 11 . Year groups were r and omly assigned on a 1:1:1 ratio to cognitive behavioural therapy , attention control , or usual school provision . Allocation was balanced by school , year , number of students and classes , frequency of lessons , and timetabling . Participants were not blinded to treatment allocation . Interventions Cognitive behavioural therapy , attention control , and usual school provision provided in classes to all eligible participants . Main outcome measures Outcomes were collected by self completed question naire administered by research ers . The primary outcome was symptoms of depression assessed at 12 months by the short mood and feelings question naire among those identified at baseline as being at high risk of depression . Secondary outcomes included negative thinking , self worth , and anxiety . Analyses were undertaken on an intention to treat basis and accounted for the clustered nature of the design . Results 1064 ( 21.2 % ) adolescents were identified at high risk of depression : 392 in the classroom based cognitive behavioural therapy arm , 374 in the attention control arm , and 298 in the usual school provision arm . At 12 months adjusted mean scores on the short mood and feelings question naire did not differ for cognitive behavioural therapy versus attention control ( −0.63 , 95 % confidence interval −1.85 to 0.58 , P=0.41 ) or for cognitive behavioural therapy versus usual school provision ( 0.97 , −0.20 to 2.15 , P=0.12 ) . Conclusion In adolescents with depressive symptoms , outcomes were similar for attention control , usual school provision , and cognitive behavioural therapy . Classroom based cognitive behavioural therapy programmes may result in increased self awareness and reporting of depressive symptoms but should not be undertaken without further evaluation and research . Trial registration Current Controlled Trials IS RCT N19083628 OBJECTIVE The present study evaluated the impact of a national school programme of  universal free healthy breakfast provision in Wales , UK . DESIGN A cluster r and omised controlled trial with repeated cross-sectional design and a 12-month follow-up . Primary outcomes were breakfast skipping , breakfast diet and episodic memory . Secondary outcomes were frequency of eating breakfast at home and at school , breakfast attitudes , rest-of-day diet and class behaviour . SETTING Primary schools in nine local education authority areas . SUBJECTS A total of 4350 students ( aged 9 - 11 years ) at baseline and 4472 at follow-up in 111 schools . RESULTS Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months . Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home . No other significant differences were found . CONCLUSIONS The intervention did not reduce breakfast skipping ; rather , pupils substituted breakfast at home for breakfast at school . However , there were improvements in children 's nutritional intake at breakfast time , if not the rest of the day , and more positive attitudes to breakfast , which may have implication s for life-course dietary behaviours . There was no impact on episodic memory or classroom behaviour , which may require targeting breakfast skippers OBJECTIVE To explore whether the effects on dietary behaviours of a computer-tailored intervention aim ed to prevent excessive weight gain among adolescents , FATaintPHAT , were moderated by sociodemographic , cognitive and home environmental factors . DESIGN A two-group cluster r and omized trial . Potential moderation of the outcome measures ( consumption of sugar-sweetened beverages , snacks , fruits and vegetables ) was studied by gender , education level , ethnicity , awareness of risk behaviour , intention and home availability . SETTING Twenty schools in the Netherl and s. SUBJECTS Students ( n 883 ) aged 12 - 13 years . RESULTS Of the twenty-four interactions tested , only three were significant . The intervention effect on sugar-sweetened beverages  was moderated by level of education ( P = 0·009 ) ; intervention effects were found only among academic preparatory students . The intervention effects on fruit and vegetable intake were moderated by awareness of fruit intake ( P < 0·001 ) and home availability of vegetables ( P = 0·007 ) ; an effect on fruit intake was found only among students who were aware of their low fruit intake at baseline and an effect on vegetable consumption was found only among students who reported that vegetables were always available at their home . CONCLUSIONS The effects of the intervention generally did not differ between sociodemographic subgroups . The moderation by home availability illustrates that the environment may influence the effects of educational interventions Background To promote well-being and health behaviors among adolescents , 2 interventions were implemented at 12 secondary schools . Adolescents in the E-health4Uth  group received Web-based tailored messages focused on their health behaviors and well-being . Adolescents in the  E-health4Uth and consultation group received the same tailored messages , but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems . Objective This study evaluated the effect of E-health4Uth and E-health4Uth and consultation on well-being ( ie , mental health status and health-related quality of life ) and health behaviors ( ie , alcohol and drug use , smoking , safe sex ) . Methods A cluster r and omized controlled trial was conducted among third- and fourth-year secondary school students ( mean age 15.9 , SD 0.69 ) . School classes ( clusters ) were r and omly assigned to ( 1 ) E-health4Uth group , ( 2 ) E-health4Uth and consultation group , or ( 3 ) control group ( ie , care as usual ) . Adolescents completed a question naire at baseline and at 4-month follow-up assessing alcohol consumption , smoking , drug use , condom use , mental health via the Strengths and Difficulties Question naire ( SDQ ) and the Youth Self Report ( YSR ; only measured at follow-up ) , and health-related quality of life . Multilevel logistic , ordinal , and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up . Subsequently , it was explored whether demographics moderated the effects . Results Data from 1256 adolescents were analyzed . Compared to the control intervention , the E-health4Uth intervention , as a st and alone intervention , showed minor positive results in health-related quality of life ( B=2.79 , 95 % CI 0.72 - 4.87 ) and condom use during intercourse among adolescents of Dutch ethnicity ( OR 3.59 , 95 % CI 1.71 - 7.55 ) not replicated in the E-health4Uth and consultation group . The E-health4Uth and consultation intervention showed minor positive results in the mental health status of adolescents ( SDQ : B=−0.60 , 95 % CI −1.17 to −0.04 ) , but a negative effect on drug use among boys ( OR 0.36 , 95 % CI 0.13 - 0.96 ) . In the subgroup of adolescents who were at risk of mental health problems at baseline ( and referred for a consultation with the nurse ) , the E-health4Uth and consultation group showed minor to moderate positive results in mental health status ( SDQ : B=−1.79 , 95 % CI −3.35 to −0.22 ; YSR : B=−9.11 , 95 % CI −17.52 to −0.71 ) and health-related quality of life ( B=7.81 , 95 % CI 2.41 - 13.21 ) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline . Conclusions Findings from this study support the use of the E-health4Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems . Future research is needed to further evaluate the effects of the consultation as a st and alone intervention , and the dual approach of further tailored eHealth messages and a consultation . Trial Registration Nederl and s Trial Register : NTR 3596 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3596 ( Archived by WebCite at http://www.webcitation.org/6PmgrPOuv ) Background School-based interventions that target prevention of overweight and obesity in children have been tested with mixed results . Thus , successful interventions are still called for . The aim of the present study was to investigate effects of a multicomponent school-based intervention programme targeting physical activity , sedentary and dietary behaviours on anthropometric outcomes . Methods A 20-month intervention was evaluated in a cluster r and omised , controlled study of 1324 11-year-olds . Outcome variables were body mass index ( BMI ) , BMI -for-age z-score ( BMI z ) , waist circumference ( WC ) , waist-to-height ratio ( WTHR ) and weight status ( International Obesity Task Force 's cut-offs ) . Weight , height and WC were measured objective ly ; pubertal status was self-reported and parental education was self-reported by the parents . Intervention effects were determined by one-way analysis of covariance and logistic regression , after checking for clustering effects of school , and moderating effects of gender , pubertal status and parental education . Results Beneficial effects were found for BMI ( p=0.02 ) and BMI z ( p=0.003 ) in girls , but not in boys . While a beneficial effect was found for BMI ( p=0.03 ) in participants of parents reporting a high level of education , a negative effect was found for WTHR in participants with parents reporting a low level of education ( p=0.003 ) . There were no intervention effects for WC and weight status . Conclusions A multicomponent 20-month school-based intervention had a beneficial effect on BMI and BMI z in adolescent girls , but not in boys . Furthermore , children of higher educated parents seemed to benefit more from the intervention , and this needs attention in future interventions to avoid further increase in social inequalities in overweight and obesity Objective : To assess the efficacy of a school-based intervention programme to reduce the prevalence of overweight in 6 to 10-year-old children . Design : Cluster-r and omized , controlled study .Subjects : A total of 3135 boys and girls in grade s 1–4 were included in the study . Methods : Ten schools were selected in Stockholm county area and r and omized to intervention ( n=5 ) and control ( n=5 ) schools .  Low-fat dairy products and whole-grain bread were promoted and all sweets and sweetened drinks were eliminated in intervention schools .  Physical activity ( PA )  was aim ed to increase by 30 min day−1 during school time and sedentary behaviour restricted during after school care time . PA was measured by accelerometry .  Eating habits at home were assessed by parental report . Eating disorders were evaluated by self-report . Results : The prevalence of overweight and obesity decreased by 3.2 % ( from 20.3 to 17.1 ) in intervention schools compared with an increase of 2.8 % ( from 16.1 to 18.9 ) in control schools ( P<0.05 ) . The results showed no difference between intervention and controls , after cluster adjustment , in the longitudinal analysis of BMI sds changes . However , a larger proportion of the children who were initially overweight reached normal weight in the intervention group ( 14 % ) compared with the control group ( 7.5 % ) , P=0.017 . PA  did not differ between intervention and control schools after cluster adjustment . Eating habits at home were found to be healthier among families with children in intervention schools at the end of the intervention . There was no difference between children in intervention and control schools in self-reported eating disorders . Conclusions : A school-based intervention can reduce the prevalence of overweight and obesity in 6 to 10-year-old children and may affect eating hab 
    Output:
    
Effects of multi-level interventions on ine quality were inconsistent .
Conclusions Universal school-based interventions may narrow , widen or have no effect on ine quality .