***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 Concerns about adverse consequences of early childbearing and risk of sexually transmitted diseases ( STD ) have renewed interest in the sexual behaviour of adolescents in developing countries , where they represent a large proportion of the population and are at highest risk . To date , little is known about the sexual knowledge of adolescents in developing countries . This study 's primary objective was to evaluate the effectiveness of a responsible sexuality education programme ( RSP ) in changing knowledge associated with sex and sexuality ; secondary objectives were to evaluate changes in attitudes and behavioural intent . METHODS A cluster r and omized design r and omizing high school classes in Belize City . Subjects were 13 - 19 years old . RESULTS Seven schools in Belize City were selected ; 8 classrooms were r and omized to the intervention arm and 11 classrooms to the control arm ( N = 399 ) . The intervention was associated with two more correct answers on the post-test ( difference score was 2.22 points , 95 % CI = 0.53 , 3.91 ) after adjusting for gender and previous sexual experience . After controlling for gender and previous sexual experience , the intervention was associated with no change in the attitudes ( 0.06 , 95 % CI : -2.89 , 2.82 ) or behavioural intent domains ( 0.84 , 95 % CI : -1.12 , 2.46 ) . CONCLUSIONS Greater changes in knowledge were observed in the intervention group than in the control group following the intervention . Changes were not observed for the attitude or behavioural intent domains . These results and the results of similar studies may be used to further improve sex education programmes as it is imperative that students have access to the information necessary to make informed decisions regarding their sexual health In India , 57 % of men between 15 and 54 years and 10.8 % of women between 15 and 49 years use tobacco . A wide variety of tobacco gets used and the poor and the underprivileged are the dominant victims of tobacco and its adverse consequences . Project MYTRI ( Mobilizing Youth for Tobacco-Related Initiatives in India ) was a  tobacco prevention intervention program , a cluster-r and omized trial in 32 Indian schools which aim ed to decrease susceptibility to tobacco use among sixth- to ninth- grade students in urban setting s in India . This culture-specific intervention , which addressed both smokeless and smoked forms of tobacco , was Indian in content and communication . We qualitatively developed indicators which would help accurately measure the dose of the intervention given , received and reached . A multi-staged process evaluation was done through both subjective and objective measures . Training the teachers critically contributed toward a rigorous implementation and also correlated with the outcomes , as did a higher proportion of students participating in the classroom discussion s and better peer-leader-student communication . A sizeable proportion of subjective responses were ' socially desirable ' , making objective assessment a preferred methodology even for ' dose received ' . The peer-led health activism was successful . Teachers ' manuals need to be concise OBJECTIVE To address the 6-month efficacy of a human immunodeficiency virus ( HIV ) prevention intervention targeted to youth and delivered with and without a parental monitoring intervention in a developing country ( the Bahamas ) . DESIGN R and omized , controlled , 3-cell intervention trial with a 6-month postintervention follow-up . SETTING Elementary schools in the Bahamas . PARTICIPANTS A total of 1282 Bahamian sixth- grade students ( and 1175 parents ) in 15 schools . INTERVENTIONS Youth and parents were r and omized at the level of the school to receive the following interventions : ( 1 ) Focus on Youth in the Caribbean ( FOYC ) plus Caribbean Informed Parents and Children Together ( CImPACT ) , ( 2 ) FOYC plus an attention control for parents ( Goal for It [ GFI ] ) , or ( 3 ) an attention control for the youth ( Wonderous Wetl and s [ WW ] ) plus the GFI . The 10-session FOYC or WW curriculum was delivered as part of the elementary school curriculum . The GFI or CImPACT was delivered to parents in the evenings or on weekends . MAIN OUTCOME MEASURES Risk and protective knowledge , condom use skills , perceptions , interventions , and self-reported behaviors . RESULTS Compared with the WW , the FOYC significantly increased knowledge , condom use skills , protective perceptions , and intentions to engage in safer behaviors . Among youth , no differences were found in knowledge or condom use skills based on parent intervention ; among parents , those receiving the CImPACT demonstrated superior condom use skills after the intervention . CONCLUSIONS Protective knowledge , skills , perceptions , and intentions of youth from 1 developing country can be significantly improved by youth intervention delivered through the schools . Longer follow-up is needed to determine if risk behaviors will be reduced and how long protective results will be sustained Background The growing epidemics of emerging infectious diseases has raised the importance of a setting approach and include the Health Promoting School ( HPS ) framework to promote better health and hygiene . Built on the concept of ' the ' HPS framework , the Hong Kong Healthy Schools Award scheme includes " Personal Health Skills " as one of its key aspects to improve student hygiene knowledge and practice s. This study examines the differences in student perceptions , knowledge and health behaviours between those schools that have adopted the HPS framework and those that have not adopted . Methods A cross-sectional study using multi-stage r and om sampling was conducted among schools with awards ( HSA ) and those schools not involved in the award scheme nor adopting the concept of HPS ( non-HPS ) .  For HSA group , 5 primary schools and 7 secondary schools entered the study with 510 students and 789 students sample d respectively . For the ' Non-HPS ' group , 8 primary schools and 7 secondary schools entered the study with 676 students and 725 students sample d respectively . A self-administered question naire was used as the measuring instrument . Results Students in the HSA category were found to be better with statistical significance in personal hygiene practice , knowledge on health and hygiene , as well as access to health information . HSA schools were reported to have better school health policy , higher degrees of community participation , and better hygienic environment . ConclusionS tudents in schools that had adopted the HPS framework had a more positive health behaviour profile than those in non-HPS schools . Although a causal relationship is yet to be established , the HPS appears to be a viable approach for addressing communicable diseases Background There is an urgent need for effective , affordable interventions to prevent child mental health problems in low- and middle-income countries . Aims To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home . Method In a cluster r and omised design , 24 community pre-schools in inner-city areas of Kingston , Jamaica , were r and omly assigned to receive the Incredible Years Teacher Training intervention ( n = 12 ) or to a control group ( n = 12 ) . Three children from each class with the highest levels of teacher-reported conduct problems were selected for evaluation , giving 225 children aged 3–6 years . The primary outcome was observed child behaviour at school . Secondary outcomes were child behaviour by parent and teacher report , child attendance and parents ’ attitude to school . The study is registered as IS RCT N35476268 . Results Children in intervention schools showed significantly reduced conduct problems ( effect size ( ES ) = 0.42 ) and increased friendship skills ( ES = 0.74 ) through observation , significant reductions to teacher-reported ( ES = 0.47 ) and parent-reported ( ES = 0.22 ) behaviour difficulties and increases in teacher-reported social skills ( ES = 0.59 ) and child attendance ( ES = 0.30 ) . Benefits to parents ’ attitude to school were not significant . Conclusions A low-cost , school-based intervention in a middle-income country substantially reduces child conduct problems and increases child social skills at home and at school Background : The Health Promoting School ( HPS ) approach provides a strong foundation to improve students ’ overall health , including psychological well-being , which has its roots in resilience . The present study evaluates the effectiveness of a  resilience-enhancing programme  , building on the concept of HPS among a Chinese population . Methodology : All mainstream schools in a socially disadvantaged region of Hong Kong were eligible , and stratified r and om sampling was used to recruit both  HPS as intervention schools  and  non-HPS as control schools .  The participants included teachers and parents of grade 3 and 5 primary and grade 1 secondary school students ( aged 8 , 10 and 12 respectively ) . Vali date d surveys were used to assess resilience scores in both groups of schools before and after a series of resilience-enhancing activities in HPS , and ANOVA was used to compare the score changes between the two groups . Results : Five  primary and four  secondary HPS  and four primary and four secondary non-HPS were recruited , involving 4918 parents and 602 teachers . Among primary and secondary parents , the HPS group did not report a higher score than the non-HPS group . Among secondary teachers , the HPS group showed significantly higher scores than the non-HPS group ( p = 0.023 to < 0.001 ) Conclusion : The present study is the first to demonstrate the positive synergistic effect of a newly design ed resilience-enhancing intervention programme , building on the concept of HPS in schools among secondary teachers in Hong Kong . It was suggested that future initiatives may involve parent networking and school – family collaboration in fostering an even more resilient school environment Background This article describes an evaluation of a school-based peer education intervention for  HIV prevention among students in twenty seven high schools in Aden , Yemen . The intervention was developed after a survey among the same population in 2005 , which revealed a high level of stigma towards people living with HIV ( PLWH ) and a low level of HIV knowledge . Methods In a quasi-experimental design students who received the peer education intervention ( 78.6 % ) were compared with students who did not receive the intervention ( 21.4 % ) . No systematic procedure was applied in selecting students for the intervention condition . Data were collected using a self-administered question naire from a sample of 2510 students from all 27 high-schools in Aden governorate . To increase internal validity , students were also compared with a cohort control sample surveyed in 2005 , which was a r and om sample of 2274 students from the same schools . Results Sixty eight percent of students targeted by peer education had good knowledge scores , compared with 43.3 % of students not targeted by peer education ( χ2 = ( df = 1 ) = 111.15 , p < .01 ) . Multi-level regression analysis revealed that , although there was a significant difference among schools , the intervention effect of peer education at the individual level was significant ; students who received peer education had a statistically higher knowledge score(9.24 out of 12.0 ) compared with those not targeted ( 7.89 out of 12.0 ) , OR = 2.11 , 95 % CI = 1.04 - 4.27 , p < .05 ) . Compared with the 2005 cohort control sample , students targeted by peer education had better knowledge on the modes of transmission and prevention and fewer misconceptions ; and knowledge on the use of condoms increased from 49.4 % to 67.8 % . In addition , students who received the peer education interventions suggested significantly more actions to provide care and support for PLWH . Also , the levels of stigma and discrimination were much higher among the 2005 cohort control group , compared with those who received the peer education intervention . Conclusion The school-based peer education intervention has succeeded in improving levels of knowledge on modes of transmission and prevention , and in decreasing levels of stigma and discrimination in a culturally conservative setting Regular physical activity is associated with a reduced risk of all-cause mortality , and mortality due to cardiovascular disease and cancer . Among adolescents , physical activity is associated with benefits in the prevention and control of emotional distress , and improvement of self-esteem . Countries in transitional epidemiological scenarios , such as Chile , need to develop effective strategies to improve physical activity as a way to face the epidemic of chronic diseases . The objective of this study was to evaluate the effects of a school-based physical activity program on physical fitness and mental health status of adolescents living in a low socioeconomic status area in Santiago , Chile . A quasi-experimental design was used to evaluate the effects of the program over one academic year . The study included 198 students aged 15 years old . Two ninth grade classes were r and omly selected as the  intervention group , with two classes of the same grade as controls . A social planning approach was used to develop the intervention . The program was design ed and implemented based on student preferences , teachers ' expertise and local re sources . Changes in physiological and mental health status were assessed . After the intervention , maximum oxygen capacity achieved a significant increase of 8.5 % in the intervention versus 1.8 % in the control group ( p < 0.0001 ) . Speed and jump performance scores improved significantly more in the intervention versus the control group ( p > 0.01 ) . Anxiety score decreased 13.7 % in the intervention group versus 2.8 % in the control group ( p < 0.01 ) , and self-esteem score increased 2.3 % in the intervention group and decreased 0.1 % in the control group after the end of the program ( p < 0.0001 ) . No significant change was observed in the depressive score . Student participation and compliance with the program was > 80 % . To conclude , a school-based program to improve physical activity in adolescents of low socioeconomic status , obtained a high level of participation and achieved significant benefits in terms of physical fitness and mental health status OBJECTIVE To assess the efficacy of the Food and Agriculture Organization 's global school-based nutrition education initiative , Feeding Minds , Fighting Hunger ( FMFH ) , in improving nutrition-related knowledge levels of schoolchildren . DESIGN Adopting the cluster r 
    Output:
    
Findings suggest that a comprehensive approach addressing both individual and environmental determinants can induce long-term behavior change and significantly improve health and educational outcomes .