***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 The HEALTHY study was design ed to respond to the alarming trends in increasing rates of overweight , obesity , and type 2 diabetes mellitus in youth . The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes ( energy , macronutrients and grams consumed of selected food groups ) . Methods HEALTHY was a cluster-r and omized study in 42 public middle schools . Students , n = 3908 , self-reported dietary intake using the Block Kids Question naire . General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools . Results The reported average daily fruit consumption was 10 % higher at the end of the study in the intervention schools than in the control schools ( 138 g or approximately 2 servings versus 122 g , respectively , p = 0.0016 ) . The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control ( 483 g versus 429 g respectively ; p = 0.008 ) . There were no significant differences between intervention and control for mean intakes of energy , macronutrients , fiber , grains , vegetables , legumes , sweets , sweetened beverages , and higher- or lower-fat milk consumption . Conclusion The HEALTHY study , a five-semester middle school-based intervention program that integrated multiple components in nutrition , physical education , behavior change , and social marketing-based communications , result ed in significant changes to student 's reported fruit and water intake . Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children . Clinical Trials Registration 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 OBJECTIVE This study sought to evaluate the effectiveness of a multidisciplinary elementary school-based intervention entitled Wellness , Academics & You . The primary areas of impact examined were BMI , consumption of fruits and vegetables , and physical activity . RESEARCH METHODS AND PROCEDURES The sample consisted of 1013 students in fourth and fifth grade s from 69 classes in four states .  Intervention and comparison classes were r and omly selected at each school . Intervention teachers participated in workshops on the intervention and received program material s.  BMI was calculated for baseline and post- data points based on measured height and weight collected by trained research teams . Baseline surveys were administered by the students ' teacher in the presence of one of the research team members and collected . RESULTS SPSS ( SPSS , Inc. , Chicago , IL ) analysis of post- data shows significant positive shifts ( p = 0.01 ) in BMI in the intervention group compared with the comparison group . Notable increases in the consumption of fruits and vegetables and increased physical activity levels were reported in the intervention group . DISCUSSION Data from this study indicate that this school-based program may contribute to the reduction of overweight and obesity . The intervention was well received by the classroom teachers and shows promise for a school-based obesity prevention initiative . This program has shown the capacity to effect positive changes in BMI through consumption of fruits and vegetables and physical activity . The evaluation covered a limited time period and , therefore , warrants additional studies to determine whether long-term program fidelity will result in continued improvement BACKGROUND Despite the high rates of overweight and obesity among rural children , there have been limited interventions reported to improve the diet quality of rural , low-income children in the United States . OBJECTIVE Our aim was to evaluate students  ' diet quality at baseline and after implementing the CHANGE ( Creating Healthy , Active and Nurturing Growing-Up Environments ) study , a 2-year ( 2007 - 2009 ) r and omized , controlled , community- and school-based intervention to prevent unhealthy weight gain among rural school-aged children . DESIGN We used a school and community-based group r and omized , controlled design . PARTICIPANTS / SETTING Data were collected in eight rural communities in California , Kentucky , Mississippi , and South Carolina ( one elementary school per community ) . Children in grade s 1 to 6 participated in the study ( n=432 ; mean age=8.65 years ± 1.6 years ) . Students ' diets were assessed at baseline ( spring or early fall 2008 ) and post intervention ( spring 2009 ) using the Block Food Screener for ages 2 to 17 years . STATISTICAL ANALYSES Mixed-model analysis of variance was used to examine the effect of the CHANGE study intervention on students ' diets . Results were adjusted for corresponding baseline dietary values , sex , age , grade , race/ethnicity , and state , with school included as a r and om effect nested within condition . RESULTS At the end of 1 year , students enrolled in the CHANGE study intervention schools consumed significantly more vegetables ( 0.08 cups/1,000 kcal/day ; P=0.03 ) and combined fruits and vegetables ( 0.22 cups/1,000 kcal/day ; P<0.05 ) compared with students in control schools . Students in the intervention schools also showed a reduction in the average daily dietary glycemic index ( GI=-1.22 ; P<0.05 ) and a trend toward more fruit consumption ( 0.15 cups/1,000 kcal/day ; P=0.07 ) . There were no significant differences in students ' consumption of whole grains , legumes , dairy , potatoes/potato products , saturated fat , added sugars , or dietary fiber consumption . CONCLUSIONS The CHANGE study enhanced some aspects of rural students ' dietary intake . Implementing similar interventions in rural America can be promising to support vegetable consumption BACKGROUND Obesity among US children has increased in recent years . Although increased fruit and vegetable consumption has not been directly linked to obesity prevalence , it has been posited that more fruits and vegetables ( FV ) could reduce the consumption of high-fat , energy-dense foods and may protect against childhood illnesses including asthma and other respiratory diseases . The purpose of this current research was to assess the impact of a large public school district 's hybrid approach to nutrition education programming on attitudes , beliefs , and behaviors related to fruit and vegetable consumption . METHODS A total of 12 elementary schools from the Los Angeles Unified School District ( 9 intervention schools , 3 control schools ) were r and omly selected to participate in a " hybrid " school-based nutrition education program . Data were collected at baseline ( beginning of school year ) and postintervention data ( end of school year 9 months later ) . Linear mixed models were developed to assess the impact of the intervention . RESULTS The intervention result ed in a significant change in teacher influence on students ' attitudes toward FV ( p < .05 ) and students ' attitudes toward vegetables ( p < .01 ) , even after adjusting for gender , grade , and race/ethnicity . Although not statistically significant , there was a slight increase in fruit and vegetable consumption from pretest to posttest for both the intervention and control schools . CONCLUSION The hybrid model reflects a more accurate representation of school-based interventions . More research is needed to identify the specific components of this model that are most successful in impacting fruit and vegetable consumption among US children 
    Output:
    
Several factors , including ( but not limited to ) intervention duration , type of theory used , style of intervention leadership , and positively affecting antecedents of fruit and vegetable consumption were compared ; however , no dominant factor was found to be shared among the studies with significant findings .