***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: Aims : To assess the effectiveness and acceptability of a brief community-based educational program on changing the drinking pattern of alcohol in a rural community . Methods : A longitudinal cohort study was carried out in two rural villages in Sri Lanka . One r and omly selected village received a community education program that utilized street dramas , poster campaigns , leaflets and individual and group discussion s. The control village had no intervention during this period . The Alcohol Use Disorder Identification Test ( AUDIT ) was used to measure the drinking pattern before and at 6 and 24 months after the intervention in males over 18 years of age in both villages . The recall and the impact of various components of the intervention were assessed at 24 months post-intervention . Results : The intervention was associated with the development of an active community action group in the village and a significant reduction in illicit alcohol outlets . The drama component of the intervention had the highest level of recall and preference . Comparing the control and intervention villages , there were no significant difference between baseline drinking patterns and the AUDIT . There was a significant reduction in the AUDIT scores in the intervention village compared with the control at 6 and 24 months ( P < 0.0001 ) . Conclusions : A community-based education program had high acceptance and produces a reduction in alcohol use that was sustained for 2 years In a cluster r and omized controlled trial , Anthony Shakeshaft and colleagues measure the effectiveness of a multi-component community-based intervention  for reducing alcohol-related harm OBJECTIVE To examine 12-year changes in alcohol use and cigarette smoking in response to community-based prevention activities  among Icel and ic adolescents . METHODS This study used a quasi-experimental , non-r and omized control group design to compare outcomes in 4 Icel and ic communities ( n=3117 ) that participated in community-based substance use prevention activities design ed to increase levels of parental monitoring and adolescent engagement in healthy leisure-time activities and a matched group of 7 comparison communities ( n=1,907 ) . Annual , nationwide , population -based cross-sectional surveys of the prevalence of adolescent substance use were conducted among cohorts of Icel and ic adolescents , aged 14 - 15 years ( N=5,024 ) , in all communities from 1997 to 2009 . RESULTS Parental monitoring and adolescent participation in organized sports increased in communities that adopted the intervention program compared to communities that did not , whereas unmonitored idle hours and attendance at unsupervised parties decreased . Over time , alcohol use ( OR=0.89 , 95 % CI 0.82 , 0.98 , p=0.012 ) and being intoxicated during the last 30 days ( OR=0.86 , 95 % CI 0.78 , 0.96 , p=0.004 ) decreased more in the intervention than control communities . CONCLUSION Community-based prevention design ed to strengthen parental monitoring and participation in organized sports may confer some protection against adolescent substance use OBJECTIVE This article reports the results of the Sacramento Neighborhood Alcohol Prevention Project ( SNAPP ) . SNAPP set as its goal the reduction of alcohol access , drinking , and related problems in two low-income , predominantly ethnic minority neighborhoods , focusing on individuals between the ages 15 and 29 , an age group identified with high rates of alcohol-involved problems . METHOD Two neighborhoods in Sacramento were selected to be the intervention sites because they were economically and ethnically diverse and had high rates of crime and other drinking-related problems . The quasi-experimental design of the study took a " phased " approach to program implementation and statistical examination of outcome data . Outcome -related data were collected in the intervention sites as well as in the Sacramento community at large . Five project interventions included a mobilization component to support the overall project , a community awareness component , a responsible beverage-service component , an underage-access law enforcement component , and an intoxicated-patron law enforcement component . Archival data were collected to measure and evaluate study outcomes and to provide background and demographic information for the study . RESULTS Overall , we found significant ( p < .05 ) reductions in assaults as reported by police , aggregate emergency medical services ( EMS ) outcomes , EMS assaults , and EMS motor vehicle accidents . CONCLUSIONS Results from the Sacramento Neighborhood Alcohol Prevention Project demonstrate the effectiveness of neighborhood-based interventions in the reduction of alcohol-related problems such as assaults , motor vehicle crashes , and sale of alcohol to minors BACKGROUND The study 's objective was to examine the effects of " real-world , " community-based implementation of universal preventive interventions selected from a menu , including effects specific to higher- and lower-risk sub sample s. DESIGN School districts were selected based on size and location , and then r and omly assigned to a control condition or to an experimental condition in a cohort sequential design . SETTING / PARTICIPANTS The study included 28 public school districts in Iowa and Pennsylvania that were located in rural towns and small cities , ranging in size from 6975 to 44,510 . Sixth and seventh grade rs in these school districts participated in the study . INTERVENTION Community teams were mobilized ; each team implemented one of three evidence -based , family-focused interventions ( 5 to 12 sessions ) and one of three evidence -based school interventions ( 11 to 15 sessions ) , for 6th and 7th grade rs , respectively . Observations showed that interventions were implemented with fidelity . MAIN OUTCOME MEASURES Outcomes included student reports of past month , past year , and lifetime use of alcohol , cigarettes , marijuana , methamphetamines , ecstasy , and inhalants , as well as indices of gateway and illicit substance initiation , at pretest and at a follow-up assessment 18 months later . RESULTS Intent-to-treat analyses demonstrated significant effects on substance initiation ( marijuana , inhalants , methamphetamines , ecstasy , gateway index , illicit-use index ) , as well as past-year use of marijuana and inhalants , with positive trends for all substances measured . For three outcomes , intervention effects were stronger for higher-risk students than lower-risk students . CONCLUSIONS Community-based implementation of brief universal interventions design ed for general population s has potential for public health impact by reducing substance use among adolescents Many young , South African men use alcohol and drugs and have multiple partners , but avoid health care setting s — the primary site for delivery of HIV intervention activities . To identify the feasibility of engaging men in HIV testing and reducing substance use with soccer and vocational training programs .  In two Cape Town neighborhoods , all unemployed men aged 18–25 years were recruited and r and omized by neighborhood to : ( 1 ) an immediate intervention condition with access to a soccer program , r and om rapid diagnostic tests ( RDT ) for alcohol and drug use , and an opportunity to enter a vocational training program ( n = 72 ) ; or ( 2 ) a delayed control condition ( n = 70 ) . Young men were assessed at baseline and 6 months later by an independent team . Almost all young men in the two neighborhoods participated ( 98 % ) ; 85 % attended at least one practice ( M = 42.3 , SD = 34.4 ) ; 71 % typically attended practice . Access to job training was provided to the 35 young men with the most on-time arrivals at practice , drug-free RDT , and no red cards for violence . The percentage of young men agreeing to complete RDT at soccer increased significantly over time ; RDTs with evidence of alcohol and drug use decreased over time . At the pre-post assessment s , the frequency of substance use decreased ; and employment and income increased in the immediate condition compared to the delayed condition . HIV testing rates , health care contacts , sexual behaviors , HIV knowledge , condom use and attitudes towards women were similar over time . Alternative engagement strategies are critical pathways to prevent HIV among young men . This feasibility study shows that soccer and job training offer such an alternative , and suggest that a more robust evaluation of this intervention strategy be pursued OBJECTIVES This study evaluated a community-based program in China to prevent initiation of  drug use in young men . METHODS Similar intervention and control areas were selected . Village leaders , teachers , and women and youth leaders were recruited to participate in the program . Community activities were organized and intervention activities in schools were implemented . Incidence of new drug users was estimated . RESULTS There was a 2.7-fold greater reduction in drug use initiation in the intervention area ( 1.59 % vs 0.60 % ) . Reduction was highest among males aged 15 to 19 , single men , illiterate men , and the Jingpo minority .  HIV/AIDS knowledge and attitudes and recognition of drug problems were all significantly better in the intervention area . CONCLUSIONS Community-based intervention programs to prevent drug use can be successful in rural areas of China This study tests the impact of an in-school mediated communication campaign based on social marketing principles , in combination with a participatory , community-based media effort , on marijuana , alcohol and tobacco uptake among middle-school students . Eight media treatment and eight control communities throughout the US were r and omly assigned to condition . Within both media treatment and media control communities , one school received a research -based prevention curriculum and one school did not , result ing in a crossed , split-plot design . Four waves of longitudinal data were collected over 2 years in each school and were analyzed using generalized linear mixed models to account for clustering effects . Youth in intervention communities ( N = 4,216 ) showed fewer users at final post-test for marijuana [ odds ratio ( OR ) = 0.50 , P = 0.019 ] , alcohol ( OR = 0.40 , P = 0.009 ) and cigarettes ( OR = 0.49 , P = 0.039 ) , one-tailed . Growth trajectory results were significant for marijuana ( P = 0.040 ) , marginal for alcohol ( P = 0.051 ) and non-significant for cigarettes ( P = 0.114 ) . Results suggest that an appropriately design ed in-school and community-based media effort can reduce youth substance uptake . Effectiveness does not depend on the presence of an in-school prevention curriculum PURPOSE Communities That Care ( CTC ) is a prevention system design ed to reduce levels of adolescent delinquency and substance use through the selection and use of effective preventive interventions tailored to a community 's specific profile of risk and protection . This article describes early findings from the first group-r and omized trial of CTC . METHODS A panel of 4407 fifth- grade students was surveyed annually through seventh grade . Analyses were conducted to assess the effects of CTC on reducing levels of targeted risk factors and reducing initiation of delinquent behavior and substance use in seventh grade , 1.67 years after implementing preventive interventions selected through the CTC process . RESULTS Mean levels of targeted risks for students in seventh grade were significantly lower in CTC communities compared with controls . Significantly fewer students in CTC communities than in control communities initiated delinquent behavior between grade s 5 and 7 . No significant intervention effect on substance use initiation by spring of seventh grade was observed . CONCLUSIONS CTC 's theory of change hypothesizes that it takes from 2 to 5 years to observe community-level effects on risk factors and 5 or more years to observe effects on adolescent delinquency or substance use . The early findings indicating hypothesized effects of CTC on targeted risk factors and initiation of delinquent behavior are promising OBJECTIVE Communities Mobilizing for Change on Alcohol ( CMCA ) was a r and omized 15-community trial of a community organizing intervention design ed to reduce the accessibility of alcoholic beverages to youths under the legal drinking age . METHOD Data were collected at baseline before r and om assignment of communities to intervention or control condition , and again at follow-up after a 2.5-year intervention . Data collection included in-school surveys of twelfth grade rs , telephone surveys of 18- to 20-year-olds and alcohol merchants , and direct testing of the propensity of alcohol outlets to sell to young buyers . Analyses were based on mixed-model regression , used the community as the unit of assignment , took into account the nesting of individual respondents or alcohol outlets within each community , and controlled for relevant covariates . RESULTS Results show that the CMCA intervention significantly and favorably affected both the behavior of 18- to 20-year-olds  ( effect size = 0.76 , p<.01 ) and the practice s of on-sale alcohol establishments ( effect size = 1.18 , p<.05 ) , may have favorably affected the practice s of off-sale alcohol establishments ( effect size = 0.32 , p = .08 ) , but had little effect on younger adolescents . Alcohol merchants appear to have increased age- identification checking and reduced propensity to sell to minors . Eighteen- to 20-year-olds reduced their propensity to provide alcohol to other teens and were less likely to try to buy alcohol , drink in a bar or consume alcohol . CONCLUSIONS Community organizing is a useful intervention approach for mobilizing communities for institutional and policy change to improve the health of the population Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field . Community-based interventions design ed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem , but studies design ed to evaluate such interventions are sparse . To address this issue we conducted a r and omized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components design ed to reduce underage access to alcohol . The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers , but did not reduce underage drinking or the perceived availability 
    Output:
    
Narrative synthesis indicated some reductions in AOD-related assault rates and arrests , but were equivocal for quantity of alcohol consumed , 12-month illicit drug use , assault or abuse , motor vehicle accidents and hospital admissions .