***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: OBJECTIVES ( 1 ) To conduct a contemporary analysis of historical data on short-term efficacy of a 3-year hearing conservation program conducted from 1992 to 1996 in Wisconsin , USA , with 753 high school students actively involved in farm work ; ( 2 ) to establish procedures for assessment of hearing loss for use in a recently funded follow-up of this same hearing conservation program cohort . METHODS We analyzed a pragmatic cluster-r and omized controlled trial , with schools as the unit of r and omization . Thirty-four rural schools were recruited and r and omized to intervention or control . The intervention included classroom instruction , distribution of hearing protection devices , direct mailings , noise level assessment s , and yearly audiometric testing . The control group received the audiometric testing . RESULTS Students exposed to the hearing conservation program reported more frequent use of hearing protection devices , but there was no evidence of reduced levels of noise-induced hearing loss ( NIHL ) . CONCLUSION Our analysis suggests that , since NIHL is cumulative , a 3-year study was likely not long enough to evaluate the efficacy of this intervention . While improvements in reported use of hearing protection devices were noted , the lasting impact of these behaviors is unknown and the finding merits corroboration by longer term objective hearing tests . A follow-up study of the cohort has recently been started OBJECTIVES : Concerts have long periods of intense sound with short break intervals . Hearing concerns are well known to performers ; concertgoers largely ignore them . Preperformance and postperformance audiograms were compared to assess hearing threshold shifts with and without earplugs . METHODS : A prospect i ve , r and omized study in which 29 volunteers attended 3 concerts , encompassing 3 music genres . Audiograms , seating location , sound intensity , and earplug-use data were collected . Data were analyzed to determine frequency test-retest variability . RESULTS : Sound levels averaged 99.8 dBA , and the maximum was 125.6 dBA . Sixty-four percent ( 9/14 ) of participants without earplugs showed significant threshold shifts compared with 27 % ( 4/15 ) of those using earplugs . No significant differences existed between music genres or seating location . CONCLUSIONS : This study showed a high incidence of threshold shifts in unprotected concertgoers . Sound levels exceeded all Occupational Safety and Health Act rules despite st and ardized sound systems . A significant reduction in threshold shifts was seen with the use of earplugs This experiment investigated the effect of  small-group versus individual hearing loss prevention ( HLP ) training on the attenuation performance of passive insert-type hearing protection devices ( HPDs )  . A subject-fit ( SF ) methodology , which gave naive listeners access only to the instructions printed on the HPD product label , was used to determine real-ear attenuation at threshold ( REAT ) at third-octave noise b and s between 125–8000 Hz . REAT measurements were augmented by use of the Hearing Loss Prevention Attitude-Belief ( HLPAB ) survey , a field-tested self- assessment tool developed by the National Institute for Occupational Safety and Health ( NIOSH ) . Participants were r and omly assigned to one of four experimental groups , consisting of 25 listeners each , in a controlled behavioral-intervention trial . There were two types of HPDs ( formable and premolded ) and two training formats ( individual and small group ) . A short multimedia program , including a practice session , was presented to all 100 listeners . Results showed training to have a significant effect , for both HPDs on real-ear attenuation and attitude , but , importantly , there was no difference between small-group and individual training Background About 15 % of adolescents in the Netherl and s have mental health problems and many also have health risk behaviours such as excessive alcohol consumption , cigarette smoking , use of drugs , and having unsafe sex . Mental health problems and health risk behaviours may have adverse effects on the short and longer term . Therefore , in the Netherl and s there is a considerable support for an additional public health examination at age 15–16 years . The study evaluates the effect of two options for such an additional examination . Adolescents in the ‘ E-health4Uth ’  group receive internet-based tailored health messages on their health behaviour and well-being . Adolescents in the ‘ E-health4Uth + counselling ’ group receive the computer-tailored messages combined with personal counselling for adolescents at risk of mental health problems . Methods and design A three-arm cluster r and omised controlled trial will be conducted in the Netherl and s among fourth- grade secondary school students . School classes are the unit of r and omisation . Both intervention groups complete the computer-tailored program during one class session ; the program focuses on nine topics related on health behaviour and well-being . For each topic a score is computed that can be compared with the Dutch health norms for adolescents . Based on the score , a message is presented that reflects the person ’s current behaviour or well-being , the Dutch health norm , and offers advise to change unhealthy behaviour or to talk to a person they trust . Adolescents in the ‘ E-health4Uth + counselling ’ group are also invited for an appointment to see the nurse when they are at risk of mental health problems . The control group receives ‘ care as usual’.The primary outcome measures are health behaviour ( alcohol , drugs , smoking , safe sex ) and mental health status . The secondary outcome measure is health-related quality of life . Data will be collected with a question naire at baseline and at 4-months follow-up . A process evaluation will also be conducted . Discussion It is hypothesized that at follow-up adolescents in the ‘ E-health4Uth ’ group and adolescents in the ‘ E-health4Uth + counselling ’ group will show fewer mental health problems and less risky behaviour compared to the control group . Trial registration Current Controlled Trials OBJECTIVE To assess the impact of a web-based intervention supplemented with text messages to reduce cancer risk linked with smoking , unhealthy diet , alcohol consumption , obesity , sedentary lifestyle and sun exposure . METHODS A total of 2001 voluntary adolescents from Spain and Mexico were recruited between 2009 and 2012 and r and omly assigned to : one control group and two experimental groups , which received exclusively the online intervention ( experimental group 1 ) or the intervention supplemented with encouraging text messages ( experimental group 2 ) . The educational intervention was based on both : successful psychosocial models ( i.e. A.S.E. and Transtheoretical model ) and the school curriculum . RESULTS After a 9-month follow-up , the prevalence of students who did not eat fruit was reduced significantly in all groups : experimental group 1 ( -62.6 % ) , experimental group 2 ( -71.5 % ) and even the control group ( -66.8 % ) . Being overweight was only reduced in the experimental group 2 ( -19.6 % ) . The total cancer behavioral risk score , which ranged from 0 to 100 points ( highest risk ) , was significantly reduced in the experimental group 1 ( -3.5 points ) and in the experimental group 2 ( -5.3 points ) . The text-supplemented online intervention increased the probability of improving the post-test total cancer behavioral risk ( OR=1.62 ) . CONCLUSION The web-based intervention supplemented with text messages had a positive global impact , but it lead to only minimal changes in risky behaviors . This intervention appears useful in controlling overweight adolescents . CLINICAL TRIAL REGISTRATION NUMBER IS RCT N27988779 OBJECTIVE To assess the efficacy of a hearing conservation program in changing acoustic risk-taking and hearing conservation behaviors in elementary school children . STUDY DESIGN Prospect i ve , r and omized , mixed design controlled study . METHODS Participants were grade -six students from 16 Vancouver School Board schools . Differences between the intervention and control group responses on a behavioral question naire were measured at baseline , and then at 2 weeks and 6 months after administration of a hearing conservation program ( Sound Sense ™ ) . RESULTS The intervention result ed in significant interactions for improved earplug use at dances ( P = .019 ) , rock concerts ( P = .001 ) , with percussion musical instruments ( P = .002 ) , and electric guitars ( P = .028 ) at 2 weeks postintervention relative to baseline . Improvements in children 's earplug use at dances ( P = .041 ) , rock concerts ( P = .0024 ) , and with power lawn mowers ( P = .043 ) at 6 months postintervention relative to baseline were also observed . Behavior in the intervention group compared to control group improved in earplug use with any " other noises " at 2 weeks ( P = .001 ) , and 6 months ( P = .022 ) relative to baseline . There was a tendency in the intervention group to reduce the duration of use of personal music devices at 2 weeks and 6 months after the hearing conservation program , which was nonsignificant . CONCLUSION The Sound Sense ™ hearing conservation program improved earplug use practice s in elementary school children in the short and long term . The development , implementation and evaluation of a community-based health promotion project around hearing loss can serve as a tremendous opportunity for students to develop their knowledge and skills in health advocacy Adolescents working in agricultural setting s may be exposed to noise levels that result in hearing loss . The article describes the design , implementation , and results of a four-year , hearing conservation program ( HCP ) conducted at school . Thirty-four schools ( 753 students ) were r and omly assigned to either an intervention or control group . The intervention included multicomponent educational strategies and employed features of an industrial HCP . Final compliance surveys indicated 87.5 % of intervention students reported using  hearing protection devices ( HPD ) at least some of the time , compared to 45 % of control students . The HCP components with the greatest reported influence were distribution of HPDs for use on the farm and yearly hearing tests . Eighty percent of intervention students reported intention to use HPDs in the future . It is feasible to conduct a hearing conservation program with junior high school and senior high school students , and it appears possible to persuade teen-agers to protect themselves from exposure to loud noise while working on a farm Abstract Objective : Adolescent farmworkers are exposed to loud noise during farm activities . We present a prospect i ve study that evaluated the efficacy of low-cost , technology-based intervention approaches in high schools to enhance the use of hearing protection among adolescent farmworkers . Design : Six high schools in Iowa that agreed to participate in the study were divided into three equal groups through cluster-r and omisation with each group receiving one of the three formats of hearing protection intervention : ( a ) classroom training , ( b ) classroom training coupled with smartphone app training and ( c ) computer training . Participants completed baseline ( pre-training ) and six-week post-intervention surveys for assessing hearing protection knowledge , attitudes and behaviour . Study Sample : Seventy participants from six schools were initially enrolled but 50 completed both pre- and post-intervention surveys . Results : In most cases , all three groups showed significant improvement in hearing protection knowledge , attitude and frequency of use from pre- to post-intervention . However , changes between groups were statistically non-significant . Conclusions : Although all three formats led to improvements on hearing protection knowledge , attitude and behaviour , the findings of the study , perhaps due to the small sample size , did not allow us to detect whether technology-based hearing protection interventions were more effective than the traditional face-to-face training for adolescent farmworkers OBJECTIVES : We had the rare opportunity to conduct a cluster-r and omized controlled trial to observe the long-term ( 16-year ) effects of a well- design ed hearing conservation intervention for rural high school students . This trial assessed whether the intervention result ed in ( 1 ) reduced prevalence of noise-induced hearing loss ( NIHL ) assessed clinical ly and /or ( 2 ) sustained use of hearing protection devices . METHODS : In 1992–1996 , 34 rural Wisconsin schools were recruited and 17 were assigned r and omly to receive a comprehensive , 3-year , hearing conservation intervention . In 2009–2010 , extensive efforts were made to find and contact all students who completed the original trial . Participants in the 16-year follow-up study completed an exposure history question naire and a clinical audiometric examination . Rates of NIHL and use of hearing protection were compared . RESULTS : We recruited 392 participants from the original trial , 200 ( 53 % ) from the intervention group and 192 ( 51 % ) from the control group . Among participants with exposure to agricultural noise , the intervention group reported significantly greater use of hearing protection compared with the control group ( 25.9 % vs 19.6 % ; P = .015 ) . The intervention group also reported significantly greater use of hearing protection for shooting guns ( 56.2 % vs 41.6 % ; P = .029 ) , but the groups reported similar uses of protection in other context s. There was no significant difference between groups with respect to objective measures of NIHL . CONCLUSION : This novel trial provides objective evidence that a comprehensive educational intervention by itself may be of limited effectiveness in preventing NIHL in a young rural population PURPOSE Few computer-based HIV , sexually transmitted infection ( STI ) , and pregnancy prevention programs are available , and even fewer target early adolescents . In this study , we tested the efficacy of It 's Your Game (IYG)-Tech , a completely computer-based , middle school sexual health education program . The primary hypothesis was that students who received IYG-Tech  would significantly delay sexual initiation by ninth grade . METHODS We evaluated IYG-Tech using a r and omized , two-arm nested design among 19 schools in a large , urban school district in southeast Texas ( 20 schools were originally r and omized ) . The target population was English-speaking eighth- grade students who were followed into the ninth grade . The final analytic sample included 1,374 students . Multilevel logistic regression models were used to test for differences 
    Output:
    
While use of technology in hearing conservation educational programs offers promise , its effectiveness has not been studied