***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: Summary Background Findings of large r and omised trials have shown that lowering LDL cholesterol with statins reduces vascular morbidity and mortality rapidly , but limited evidence exists about the long-term efficacy and safety of statin treatment . The aim of the extended follow-up of the Heart Protection Study ( HPS ) is to assess long-term efficacy and safety of lowering LDL cholesterol with statins , and here we report cause-specific mortality and major morbidity in the in-trial and post-trial periods . Methods 20 536 patients at high risk of vascular and non-vascular outcomes were allocated either 40 mg simvastatin daily or placebo , using minimised r and omisation . Mean in-trial follow-up was 5·3 years ( SD 1·2 ) , and post-trial follow-up of surviving patients yielded a mean total duration of 11·0 years ( SD 0·6 ) . The primary outcome of the long-term follow-up of HPS was first post-r and omisation major vascular event , and analysis was by intention to treat . This trial is registered with IS RCT N , number 48489393 . Findings During the in-trial period , allocation to simvastatin yielded an average reduction in LDL cholesterol of 1·0 mmol/L and a proportional decrease in major vascular events of 23 % ( 95 % CI 19–28 ; p<0·0001 ) , with significant divergence each year after the first . During the post-trial period ( when statin use and lipid concentrations were similar in both groups ) , no further significant reductions were noted in either major vascular events ( risk ratio [ RR ] 0·95 [ 0·89–1·02 ] ) or vascular mortality ( 0·98 [ 0·90–1·07 ] ) . During the combined in-trial and post-trial periods , no significant differences were recorded in cancer incidence at all sites ( 0·98 [ 0·92–1·05 ] ) or any particular site , or in mortality attributed to cancer ( 1·01 [ 0·92–1·11 ] ) or to non-vascular causes ( 0·96 [ 0·89–1·03 ] ) . Interpretation More prolonged LDL-lowering statin treatment produces larger absolute reductions in vascular events . Moreover , even after study treatment stopped in HPS , benefits persisted for at least 5 years without any evidence of emerging hazards . These findings provide further support for the prompt initiation and long-term continuation of statin treatment . Funding UK Medical Research Council , British Heart Foundation , Merck & Co , Roche Vitamins Background Few studies have reported energy balance-related behavior ( EBRB ) change for peer leaders delivering health promotion programs to younger students in secondary schools . Our study assessed the impact of the Students As LifeStyle Activists ( SALSA ) program on SALSA peer leaders ’ EBRBs , and their intentions regarding these behaviors . Methods We used a pre – post study design to assess changes in EBRBs and intentions of Year 10 secondary school students ( 15–16 year olds ) who volunteered to be peer leaders to deliver the SALSA program to Year 8 students ( 13–14 year olds ) . This research is part of a larger study conducted during 2014 and 2015 in 23 secondary schools in Sydney , Australia . We used an online question naire before and after program participation to assess Year 10 peer leaders ’  fruit and vegetable intake , daily breakfast eating , sugar sweetened beverage ( SSB ) intake , moderate-to-vigorous physical activity ( MVPA ) participation and school-day recreational screen time  behaviors and intentions regarding these EBRBs . Generalized estimating equations with a robust variance structure and exchangeable correlation structure were used to estimate the individual-level summary statistics and their 95 % CIs , adjusted for clustering . We further assessed the effect of covariates on EBRB changes . Results There were significant increases in the proportion of Year 10 peer leaders ( n = 415 ) who reported eating ≥2 serves fruit/day fruit from 54 to 63 % ( P < 0.01 ) ; eating ≥5 serves vegetables/day from 8 to 12 % ( P < 0.01 ) ; and drinking < 1 cup/day of SSBs from 56 to 62 % ( P < 0.01 ) . Change in ≥60 min MVPA participation/day depended on gender ( P < 0.01 ) : Boys increased 14 % while girls decreased −2 % . Changes in eating breakfast daily also depended on gender ( P < 0.004 ) : Boys increased 13 % while girls decreased −0.4 % . The change in peer leaders recreational screen time differed by socio-economic status ( P < 0.05 ) : above average communities decreased by −2.9 % while below average communities increased 6.0 % . Significant shifts were seen in peer leaders ’ intentions , except MVPA which remained stable . Conclusions The SALSA program had a positive impact on peer leaders ’ EBRBs , with gender and socio-economic status moderating some outcomes .Trial registration ACTRN12617000712303 retrospectively registered 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 This study reports the effect of a  school-r and omized fruit and vegetable intervention consisting of a subscription to the Norwegian School Fruit Programme at no parental cost , and the Fruit and Vegetables Make the Marks ( FVMM ) educational programme , both delivered in the school year of 2001 - 02 . Nine r and omly chosen schools received the intervention and 10 schools served as control schools . Participating pupils completed question naires at baseline ( September 2001 ) , at Follow-up 1 ( May-June 2002 ) and at Follow-up 2 ( May 2003 ) . A total of 517 pupils ( 84 % ; mean age , 11.3 years at baseline ) participated in all three surveys . At both Follow-up 1 and Follow-up 2 , strong intervention effects were observed for all-day fruit and vegetable intake ( effect sizes were 0.6 and 0.5 portions , respectively ) . The sustained effect at Follow-up 2 , 1 year after the end of the intervention , can partly be explained by greater participation rates in the School Fruit Programme ( st and ard paid subscription ) . We conclude that the effects observed are most likely due to the no-cost subscription and not due to the FVMM educational programme , and that providing pupils with a piece of fruit or a vegetable at school at no cost for the parents is an effective strategy to increase  school children 's intake of fruit and vegetables . The effect is also sustained 1 year after the end of the no-cost subscription , providing increased health benefits OBJECTIVE To evaluate whether a school-based multicomponent educational program could improve adiposity measures in middle-school adolescents . METHODS A non-r and omized controlled pilot study was conducted in six state middle schools ( 487 adolescents , 11 - 15 years ) in townships in an urban area around Milan , three schools ( n = 262 adolescents ) being assigned to the intervention group and three schools ( n = 225 adolescents ) to the control group . The two-school-year intervention included changes in the school environment ( alternative healthy vending machines , educational posters ) and individual reinforcement tools ( school lessons , textbook , text messages , pedometers , re-usable water bottles ) . The main outcome measure was change in BMI z-score . The secondary outcomes were changes in waist-to-height ratio ( WHtR ) and behavioral habits . RESULTS The intervention was associated with a significant difference in BMI z-score ( -0.18 ± 0.03 , P<0.01 ) and in WHtR ( -0.04 ± 0.002 , P < 0.001 ) , after controlling for baseline covariates . Subgroup analysis showed the maximum association between the intervention and the difference in BMI z-score for girls with overweight/obesity  . Physical activity increased and consumption of sugar-sweetened beverages and high-energy snacks decreased in adolescents after the intervention . CONCLUSIONS A school-based multicomponent intervention conducted at both environmental and individual levels may be effective for reducing adiposity measures mainly in adolescents with overweight/obesity Background and purpose : The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology . The purpose of this paper is to present the development of the intervention , the design of the effectiveness study , and the test-retest reliability of the main outcome measures in the HEalth In Adolescents ( HEIA ) study . Methods / design : The HEIA intervention programme was developed based on literature review s , a social ecological framework , and focus groups . The intervention aim ed to increase total physical activity ( PA ) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages . The intervention programme consisted of a classroom component , including dietary behaviour lessons , computer tailoring , fruit/vegetable and PA breaks , and posters , and an environmental component including active transport campaigns , equipment , suggestions for easy improvements of schoolyards , inspirational courses for teachers ( all with regards to PA ) , and fact sheets to parents . The effect of the intervention programme is evaluated in a cluster r and omised controlled trial design ( intervention = 12 schools , control = 25 schools ) including process evaluation . Main outcomes include anthropometry , PA , screen time , and consumption of fruit , vegetables , and sugar-sweetened beverages . A 2-week test— retest study was conducted among 114 pupils . Determinants of the behaviours were assessed . Similar data were collected from parents . Children ’s PA was measured objective ly by accelerometers . Conclusions : The HEIA study represents a theoretically informed r and omised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures . The study will contribute to a better underst and ing of determinants of healthy weight development among young people and how such determinants can be modified BACKGROUND This study reports on effectiveness trial outcomes of Health in Motion , a computer tailored multiple behavior intervention for adolescents . METHODS Using school as level of assignment , students ( n=1800 ) from eight high schools in four states ( RI , TN , MA , and NY ) were stratified and r and omly assigned to no treatment or a multi-media intervention for physical activity , fruit and vegetable consumption , and limited TV viewing between 2006 and 2007 . RESULTS Intervention effects on continuous outcomes , on movement to action and maintenance stages , and on stability within action and maintenance stages were evaluated using r and om effects modeling . Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention . Co-variation of behavior change occurred within the treatment group , where individuals progressing to action or maintenance for one behavior were 1.4 - 4.2 times more likely to make similar progress on another behavior . CONCLUSION Health in Motion is an innovative , multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback . The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination Objectives This paper aims to identify the mediating mechanisms of a school-based obesity prevention program ( DOiT ) . Methods The DOiT-program was implemented in Dutch prevocational secondary schools and evaluated using a controlled , cluster-r and omised trial ( September 2003 to May 2004 ) . We examined mediators of effects regarding ( 1 ) consumption of sugar containing beverages ( SCB ) ; ( 2 ) consumption of high caloric snacks ; ( 3 ) screen-viewing behaviour ; and ( 4 ) active commuting to school . To improve these behaviours the DOiT-program tried to influence the following potentially mediating variables : attitude , subjective norm , perceived behavioural control , and habit-strength . Results Both in boys ( n = 418 ) and girls ( n = 436 ) the DOiT-intervention  reduced SCB consumption ( between group difference in boys = -303.5 ml/day , 95 % CI : -502.4;-104 
    Output:
    
Interventions appeared more effective when they involved peers , used educational media to deliver health messages , increased availability of healthy foods in school , and incorporated computer-based individualized feedback with normative information on eating behaviours .