***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 African American men with hypertension in low socioeconomic urban population s achieve poor rates of hypertension control and suffer early from its complications . METHODS In a r and omized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years , we evaluated the effectiveness of a more intensive comprehensive educational-behavioral-pharmacologic intervention by a nurse practitioner-community health worker-physician ( NP/CHW/MD ) team and a less intensive education and referral intervention in controlling blood pressure ( BP ) and minimizing progression of left ventricular hypertrophy ( LVH ) and renal insufficiency . Changes in BP , left ventricular mass ( LVM ) , and serum creatinine from baseline to 36 months were compared between groups . RESULTS At 36 months , the mean systolic BP/diastolic BP change from baseline was -7.5/-10.1 mm Hg for the more intensive group and + 3.4/-3.7 mm Hg for the less intensive group ( P = .001 and .005 for between-group differences in systolic BP and diastolic BP , respectively ) . The proportion of men with controlled BP ( < 140/90 mm Hg ) was 44 % in the more intensive group and 31 % in the less intensive group ( P = .045 ) . The LVM was significantly lower in the more intensive group than in the less intensive group ( more intensive , 274 g ; less intensive , 311 g ; P = .004 ) . There was a trend toward slowing of the progression of renal insufficiency ( incidence of 50 % increase in serum creatinine ) in the more intensive group compared to the less intensive group ( more intensive , 5.2 % ; less intensive , 8.0 % ; P = .08 ) . CONCLUSIONS During 36 months , the more intensive intervention led to a lower BP and decreased progression of LVH in a sample of hypertensive young African American men We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7 - 10 days among African-American WIC participants . Of the 242 women with complete data , 48 % initiated breastfeeding , but only 31 % were still breastfeeding at 7 - 10 days . Initiation was associated with cesarean delivery , infant feeding instruction , no artificial milk discharge pack , attending the peer counselor only-intervention site , and intention to breastfeed . Continuation was influenced by infant feeding instruction , no artificial milk discharge pack , and intention to breastfeed . Overall , trends toward a positive impact of the breastfeeding promotion activities were evident but weak , and largely gone by 7 - 10 days postpartum BACKGROUND This article provides a descriptive overview of the implementation process of the Heart , Body , and Soul program . The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African Americans in East Baltimore . METHOD This study constitutes a prospect i ve r and omized trial among inner-city African Americans design ed to improve quit rates among church attenders . A r and om-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking , examine attendant attitudes , and determine the presence of known cardiovascular risk factors among community residents of the catchment area . A similar survey was conducted among churchgoers to establish a baseline . Twenty-two churches were recruited and r and omly assigned to either intensive or minimal ( self-help ) intervention strategies . Baseline health screenings were held in all participating churches . Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches . RESULTS Pastors of all churches were directly involved in all aspects of the planning and implementation process . A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches . An additional 272 church members were trained to conduct their church 's health screenings . CONCLUSION The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies . This description of the project is presented to assist others involved in church-based trials in urban African American communities OBJECTIVES We sought to determine the effects of a community-based , culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes . METHODS One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit , Michigan , to participate in the Racial and Ethnic Approaches to Community Health ( REACH ) Detroit Partnership  diabetes lifestyle intervention . The curriculum , delivered by trained community residents , was aim ed at improving dietary , physical activity , and diabetes self-care behaviors . Baseline and postintervention levels of diabetes-specific quality -of-life , diet , physical activity , self-care knowledge and behaviors , and hemoglobin A1C were assessed . RESULTS There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge . A statistically significant improvement in A1C level was achieved among REACH Detroit program participants ( P<.0001 ) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed ( P=.160 ) . CONCLUSIONS A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements This r and omized trial recruited and followed underserved , inner-city , hypertensive ( HTN ) , young black men and investigated whether a nurse-community health worker team in combination with usual medical care ( SI ) increased entry into care and reduced high blood pressure ( HBP ) , in comparison to usual medical care ( UC ) alone . Emergency department records , advertising , and BP screenings identified potential participants with HBP . Telephone calls and personal contacts tracked enrollees . Of 1391 potential participants , 803 ( 58 % ) responded to an invitation to be screened and scheduled a visit . Of these , 528 ( 66 % ) kept an appointment , 207 ( 35 % ) were BP eligible , and 204 ( 99 % ) consented to enroll . At 12 months 91 % of men were accounted for and 85.8 % ( adjusted for death , in jail , or moved away ) were seen . Mean BP changed from 153(16)/98(10 ) to 152(19)/94(11 ) mm Hg in the SI group and 151(18)/98(11 ) to 147(21)/92(14 ) mm Hg in the UC group ( P = NS ) . High rates of participation are attainable in this population ; however , culturally acceptable ways of delivering HBP care are needed OBJECTIVES To evaluate the costs of implementing a church-based , telephone-counseling program for increasing mammography use , and to identify the components of costs and the likely cost-effectiveness in hypothetical communities with varying characteristics . DATA SOURCES / STUDY SETTING An ethnically and socioeconomically diverse sample of 1,443 women recruited from 45 churches participating in the Los Angeles Mammography Promotion ( LAMP ) program were followed from 1995 to 1997 . STUDY DESIGN Churches were stratified into blocks and r and omized into three intervention arms-telephone counseling , mail counseling , and control . We surveyed participants before and after the intervention to collect data on mammography use and demographic characteristics . DATA COLLECTION / EXTRACTION METHODS We used call records , activity reports , and interviews to collect data on the time and material s needed to organize and carry out the intervention . We constructed a st and ard model of costs and cost-effectiveness based on these data and the Year One results of the LAMP program . PRINCIPAL FINDINGS The cost in material s and overhead to the church site was $ 10.89 per participant and $ 188 per additional screening . However , when the estimated cost for church volunteers ' time was included , the cost of the intervention increased substantially . CONCLUSIONS A church-based program to promote the use of mammography would be feasible for many churches with the use of volunteer labor and re sources Purpose . To examine the relationship between intervention dose and health behavior change in Healthy Directions – Health Centers , an intervention design ed to reduce cancer risk factors . Design . Analysis of intervention condition participant data from a r and omized controlled trial . Setting . Community health centers in Massachusetts . Subjects . Patients residing in low-income , working-class , multiethnic neighborhoods . Intervention . Components were clinician endorsement , in-person counseling session and four telephone counseling sessions with a trained health advisor , and social- context ual tailored material s. Measures . Intervention dose was number of six possible intervention components completed by each participant . Changes in fruit and vegetable consumption , red meat consumption , physical activity , and multivitamin intake between baseline ( n = 1088 ) and 8-month follow-up ( n = 967 ; 89 % of baseline sample ) were determined . Analysis . Bivariate and multivariate associations between intervention dose and change in health behaviors were examined . Results . In multivariate analysis , the association between intervention dose and increase in multivitamin intake approached significance ( p < .07 ) . Seventy percent of participants completed all intervention activities . In bivariate analysis , completion of four telephone counseling calls was associated with decrease in red meat consumption ( p < .05 ) . Conclusion . These findings indicate that future studies should examine the number , content , and length of contacts needed for behavior change . The results also suggest that health centers are a channel for reaching diverse population s , as shown by the high level of intervention implementation PURPOSE The purpose of this r and omized controlled trial is to determine the effectiveness of an intervention led by promotoras ( community lay workers ) on the glycemic control , diabetes knowledge , and diabetes health beliefs of Mexican Americans with type 2 diabetes living in a major city on the Texas-Mexico border . METHODS One hundred fifty Mexican American participants were recruited at a Catholic faith-based clinic and r and omized into 2 groups . Personal characteristics , acculturation , baseline A1C level , diabetes knowledge , and diabetes health beliefs were measured . The intervention was culturally specific and consisted of participative group education , telephone contact , and follow-up using inspirational faith-based health behavior change postcards . The A1C levels , diabetes knowledge , and diabetes health beliefs were measured 3 and 6 months postbaseline , and the mean change between the groups was analyzed . RESULTS The 80 % female sample , with a mean age of 58 years , demonstrated low acculturation , income , education , health insurance coverage , and strong Catholicism . No significant changes were noted at the 3-month assessment , but the mean change of the A1C levels , F(1 , 148 ) = 10.28 , P < .001 , and the diabetes knowledge scores , F(1 , 148 ) = 9.0 , P < .002 , of the intervention group improved significantly at 6 months , adjusting for health insurance coverage . The health belief scores decreased in both groups . CONCLUSIONS The intervention result ed in decreased A1C levels and increased diabetes knowledge , suggesting that using promotoras as part of an interdisciplinary team can result in positive outcomes for Mexican Americans who have type 2 diabetes . Clinical implication s and recommendations for future research are suggested OBJECTIVE We previously reported that monthly telephone contact by lay personnel , to promote self-care for patients with osteoarthritis ( OA ) , was associated with improved joint pain and physical function after 1 year of followup . The present study was a secondary analysis to determine whether improvement was contingent on intensified medical treatment . METHODS We reanalyzed control/treatment group differences in all 40 subjects with radiographically confirmed knee OA who had had no changes in antirheumatic drug therapy or institution of physical therapy during the period of observation . RESULTS Group differences in measured pain remained significant ( effect size [ ES ] = 0.65 SD , P less than 0.01 ) . The same trend was observed for physical function ( ES = 0.53 SD , P not significant ) . CONCLUSION The findings in this re analysis suggest that periodic telephone support interventions are effective enough to be regarded as an adjunctive treatment for OA OBJECTIVES A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program , a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older . METHODS A stratified r and om sample of 801 African American women completed baseline ( 1993 - 1994 ) and follow-up ( 1996 - 1997 ) surveys . The primary outcome was self-reported mammography use in the previous 2 years . RESULTS The intervention was associated with an overall 6 percentage point increase ( 95 % confidence interval [ CI ] = -1 , 14 ) in community-wide mammography use .  Low-income women in intervention counties showed an 11 percentage point increase ( 95 % CI = 2 , 21 ) in use above that exhibited by low-income women in comparison counties . Adjustment for potentially confounding characteristics did not change the results . CONCLUSIONS A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income , rural population BACKGROUND This paper describes the implementation of the Healthy Directions-Health Centers intervention and examines the characteristics of participants associated with completion of intervention activities . Healthy Directions-Health Centers was design ed to address social context ual factors relevant to cancer prevention interventions 
    Output:
    
We found mixed evidence for CHW effectiveness on participant behavior change ( 22 studies ) and health outcomes ( 27 studies ): some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes when compared with various alternatives , but other studies suggested that CHW interventions provide no statistically different benefits than alternatives .
The literature showed mixed results of effectiveness when analyzed by clinical context : CHW interventions had the greatest effectiveness relative to alternatives for some disease prevention , asthma management , cervical cancer screening , and mammography screening outcomes .
CHW interventions were not significantly different from alternatives for clinical breast examination , breast self-examination , colorectal cancer screening , chronic disease management , or most maternal and child health interventions .
Limited evidence described characteristics of CHW training ; no studies examined the impact of CHW training on health outcomes .
CHWs can serve as a means of improving outcomes for underserved population s for some health conditions .