human
***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 To investigate the association between distance to the closest supermarket and a composite measure of diet , the diet quality index for pregnancy ( DQI-P ) was constructed . METHODS Data from the Pregnancy , Infection and Nutrition ( PIN ) cohort , a prospect i ve study of determinants of preterm birth , were analyzed . Food frequency question naires were used to construct DQI-P which includes : servings of grains , vegetables , fruits , folate , iron and calcium intake , percentage of calories from fat , and meal pattern score . Street address of residence , supermarkets , grocery and convenience stores were geocoded . Participants with complete food frequency and address data were included ( n = 918 ) .  Multinomial logistic regression was used to estimate the conditional association of food outlets on diet quality , controlling for confounders and using a robust variance estimator to account for clustering of neighborhood characteristics . RESULTS Women living greater than 4 miles from a supermarket were more than twice the odds ( adjusted odds ratio = 2.16 ; 95 % confidence interval = 1.2 , 4.0 ) of falling into the lowest compared to highest DQI-P tertile compared to women living within 2 miles of a supermarket , after controlling for individual characteristics , other food retail outlets . CONCLUSION These findings suggest that proximity of food retail outlets influences the diet quality of pregnant women OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention Background Overweight and obesity have a dramatic negative impact on children 's health not only during the childhood but also throughout the adult life . Preventing the development of obesity in children is therefore a world-wide health priority . There is an obvious urge for sustainable and evidence d-based interventions that are suitable for families with young children , especially for families with overweight or obese parents . We have developed a prevention program , Early STOPP , combating multiple obesity-promoting behaviors such unbalanced diet , physical inactivity and disturbed sleeping patterns . We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents . This protocol outlines methods for the recruitment phase of the study . Design and methods This r and omized controlled trial ( RCT ) targets overweight and /or obese parents with infants , recruited from the Child Health Care Centers ( CHCC ) within the Stockholm area . The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach ( dietitian , physiotherapist or a nurse ) . The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC , which include advices on healthy food choices and eating patterns , increasing physical activity/reducing sedentary behavior  and regulating  sleeping patterns . Discussion The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population , defining a feasible , theory-based intervention and assessing multiple measurements to vali date and interpret the program effectiveness . The early years hold promise as a time in which obesity prevention may be most effective . To our knowledge , this longitudinal RCT is the first attempt to demonstrate whether an early , long-term , targeted health promotion program focusing on  healthy eating , physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective . If proven so , Early STOPP may protect children from the development of overweight and obesity . Trial registration The protocol for this study is registered with the clinical trials registry clinical trials.gov , ID : ES-2010 OBJECTIVE To determine associations between younger youths ' susceptibility to smoking and four household variables related to tobacco socialization : parental and sibling smoking , restrictions on smoking in the home and exposure to smoking in vehicles . METHODS A secondary analysis of the 2004/05 Canadian Youth Smoking Survey used logistic regression to investigate the relationships between youth susceptibility to smoking , gender , and four household variables related to tobacco socialization . Susceptibility to smoking was operationalized by three levels of smoking experience and intention : non-susceptible non-smoker , susceptible non-smoker and experimenter/smoker . The national survey included 29 243 grade 5 to 9 students from r and omly sample d public and private schools in ten provinces . RESULTS For non-smokers , the odds of being susceptible to smoking increased with having a sibling who smokes , a lack of a total household smoking ban and riding in a vehicle with a smoker in the previous week , when adjusting for all other variables in the model . These variables also increased the odds of being an experimenter/smoker versus a susceptible non-smoker . Parent smoking status  was not significant in these models . CONCLUSION Denormalization messages , through enforced home and vehicle smoking bans , appear to support youth in maintaining a resolve to not smoke , regardless of parental smoking status OBJECTIVE . The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school . METHODS . The participants in this r and omized , controlled cluster trial were second- and third- grade rs from 32 elementary schools in socially deprived areas of 2 German cities .  Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools ( N = 17 ) to promote water consumption .  Control group schools ( N = 15 ) did not receive any intervention . The prevalence of overweight ( defined according to the International Obesity Task Force criteria ) , BMI SD scores , and beverage consumption ( in glasses per day ; 1 glass was defined as 200 mL ) self-reported in 24-hour recall question naires , were determined before ( baseline ) and after the intervention . In addition , the water flow of the fountains was measured during the intervention period of 1 school year ( August 2006 to June 2007 ) . RESULTS . Data on 2950 children ( intervention group : N = 1641 ; control group : N = 1309 ; age , mean ± SD : 8.3 ± 0.7 years ) were analyzed . After the intervention , the risk of overweight was reduced by 31 % in the intervention group , compared with the control group , with adjustment for baseline prevalence of overweight and clustering according to school . Changes in BMI SD scores did not differ between the intervention group and the control group . Water consumption after the intervention was 1.1 glasses per day greater in the intervention group . No intervention effect on juice and soft drink consumption was found . Daily water flow of the fountains indicated lasting use during the entire intervention period , but to varying extent . CONCLUSION . Our environmental and educational , school-based intervention proved to be effective in the prevention of  overweight among children in elementary school , even in a population from socially deprived areas This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherl and s. A cluster r and omized controlled trial was conducted .  Intervention cafeterias ( n=13 ) , where the Choices logo was used to promote healthier eating for a 3-week period , were compared with control cafeterias ( n=12 ) , which offered the same menu without the logo .  Sales data were collected daily for 9 weeks , from March to May 2009 . In addition , employees from one intervention and one control company completed an online question naire at baseline and after the intervention ( n=368 ) in which the behavioral determinants of food choice ( ie , attitude , self-efficacy , and intention ) and logo use were measured . Generalized estimating equation analyses , χ² tests , t tests and linear regression analyses were performed . No nutritionally meaningful intervention effects were found in the sales of s and wiches , soups , snacks , fruit , and salads . Also , no significant differences in behavioral determinants were found . " Intention to eat healthier " and " paying attention to product information " were positively associated with self-reported consumption of foods with the Choices logo at lunch . The intervention did not have a significant effect on employees ' lunchtime food choices . Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change . Further research should focus on the possible health benefits of menu reformulation in the catering sector Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity Background — The estimated effects of recent pubic and workplace smoking restriction laws suggest that they produce significant declines in community rates of heart attack . The consistency of these declines with existing estimates of the relative risk of heart attack in individuals attributable to passive smoking exposure is poorly understood . The objective is to determine the consistency of estimates of reductions in community rates of heart attacks result ing from smoking restriction laws with estimates of the relative risk of heart disease in individuals exposed to passive smoking . Methods and Results — Meta-analyses of existing estimates of declines in community rates were compared with a mathematical model of the relationship between individual risk and community rates . The outcome measure is the ratio of community rates of acute myocardial infa rct ion ( after divided by before implementation of a smoking restriction law ) . There is a significant drop in the rate of acute myocardial infa rct ion hospital admissions associated with the implementation of strong smoke-free legislation . The primary reason for heterogeneity in results of different studies is the duration of follow-up after adoption of the law . The pooled r and om-effects estimate of the rate of acute myocardial infa rct ion hospitalization 12 months after implementation of the law is 0.83 ( 95 % confidence interval , 0.80 to 0.87 ) , and this benefit grows with time . This drop in admissions is consistent with a range of plausible individual risk and exposure scenarios . Conclusion — Passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced acute myocardial infa rct ions , and these benefits grow with time BACKGROUND Secondary school students often do not drink sufficient quantities of water during the school day to prevent dehydration , promote learning and good health . The study aim ed to measure the effect of health promotion and the free provision of cooled filtered water on the consumption of water and soft drinks . It also aim ed to explore students ' views of drinking water provision . METHODS A study was conducted with three secondary schools in North Tyneside . Over a 3 month period one school was given cooled filtered water and active promotion ( W + P ) , another had water only ( W ) . The control school ( C ) took part in post-intervention focus group work . RESULTS The average volume of water drunk by students , in school ' W + P ' was greater ( P = 0.05 ) than that drunk in school ' W ' and control school ' C ' . The volume of soft drinks purchased by students in all three schools before and during the intervention remained static . Focus group data revealed that students viewed their existing water provision as poor and wanted sufficient supplies of cooled filtered water in school . CONCLUSIONS This pilot study indicates that active promotion of water drinking increased consumption of water by secondary school students . Further developments of the project are suggested OBJECTIVES We examined the relationship between students ' tobacco use  and the density and proximity of tobacco retailers near their schools . METHODS We used data from the 2003 - 2004 California Student Tobacco Survey and California retail licensing data . Measures included students ' self-reported tobacco use and geocoded state-reported locations of tobacco retailers . We used r and om-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors . RESULTS Density of retailers was associated with experimental smoking ( odds ratio [ OR ] = 1.11 ; 95 % confidence interval [ CI ] = 1. 
    Output:
    
agent
Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified , providing a set of specific evidence -based strategies that deserve close attention and prioritization for wider implementation .
Effective interventions included specific approaches in all 6 domains evaluated for improving diet , increasing activity , and reducing tobacco use .
The writing group also identified several specific interventions in each of these domains for which current evidence was less robust , as well as other inconsistencies and evidence gaps , informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies .
This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
***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 To investigate the association between distance to the closest supermarket and a composite measure of diet , the diet quality index for pregnancy ( DQI-P ) was constructed . METHODS Data from the Pregnancy , Infection and Nutrition ( PIN ) cohort , a prospect i ve study of determinants of preterm birth , were analyzed . Food frequency question naires were used to construct DQI-P which includes : servings of grains , vegetables , fruits , folate , iron and calcium intake , percentage of calories from fat , and meal pattern score . Street address of residence , supermarkets , grocery and convenience stores were geocoded . Participants with complete food frequency and address data were included ( n = 918 ) .  Multinomial logistic regression was used to estimate the conditional association of food outlets on diet quality , controlling for confounders and using a robust variance estimator to account for clustering of neighborhood characteristics . RESULTS Women living greater than 4 miles from a supermarket were more than twice the odds ( adjusted odds ratio = 2.16 ; 95 % confidence interval = 1.2 , 4.0 ) of falling into the lowest compared to highest DQI-P tertile compared to women living within 2 miles of a supermarket , after controlling for individual characteristics , other food retail outlets . CONCLUSION These findings suggest that proximity of food retail outlets influences the diet quality of pregnant women OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention Background Overweight and obesity have a dramatic negative impact on children 's health not only during the childhood but also throughout the adult life . Preventing the development of obesity in children is therefore a world-wide health priority . There is an obvious urge for sustainable and evidence d-based interventions that are suitable for families with young children , especially for families with overweight or obese parents . We have developed a prevention program , Early STOPP , combating multiple obesity-promoting behaviors such unbalanced diet , physical inactivity and disturbed sleeping patterns . We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents . This protocol outlines methods for the recruitment phase of the study . Design and methods This r and omized controlled trial ( RCT ) targets overweight and /or obese parents with infants , recruited from the Child Health Care Centers ( CHCC ) within the Stockholm area . The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach ( dietitian , physiotherapist or a nurse ) . The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC , which include advices on healthy food choices and eating patterns , increasing physical activity/reducing sedentary behavior  and regulating  sleeping patterns . Discussion The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population , defining a feasible , theory-based intervention and assessing multiple measurements to vali date and interpret the program effectiveness . The early years hold promise as a time in which obesity prevention may be most effective . To our knowledge , this longitudinal RCT is the first attempt to demonstrate whether an early , long-term , targeted health promotion program focusing on  healthy eating , physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective . If proven so , Early STOPP may protect children from the development of overweight and obesity . Trial registration The protocol for this study is registered with the clinical trials registry clinical trials.gov , ID : ES-2010 OBJECTIVE To determine associations between younger youths ' susceptibility to smoking and four household variables related to tobacco socialization : parental and sibling smoking , restrictions on smoking in the home and exposure to smoking in vehicles . METHODS A secondary analysis of the 2004/05 Canadian Youth Smoking Survey used logistic regression to investigate the relationships between youth susceptibility to smoking , gender , and four household variables related to tobacco socialization . Susceptibility to smoking was operationalized by three levels of smoking experience and intention : non-susceptible non-smoker , susceptible non-smoker and experimenter/smoker . The national survey included 29 243 grade 5 to 9 students from r and omly sample d public and private schools in ten provinces . RESULTS For non-smokers , the odds of being susceptible to smoking increased with having a sibling who smokes , a lack of a total household smoking ban and riding in a vehicle with a smoker in the previous week , when adjusting for all other variables in the model . These variables also increased the odds of being an experimenter/smoker versus a susceptible non-smoker . Parent smoking status  was not significant in these models . CONCLUSION Denormalization messages , through enforced home and vehicle smoking bans , appear to support youth in maintaining a resolve to not smoke , regardless of parental smoking status OBJECTIVE . The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school . METHODS . The participants in this r and omized , controlled cluster trial were second- and third- grade rs from 32 elementary schools in socially deprived areas of 2 German cities .  Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools ( N = 17 ) to promote water consumption .  Control group schools ( N = 15 ) did not receive any intervention . The prevalence of overweight ( defined according to the International Obesity Task Force criteria ) , BMI SD scores , and beverage consumption ( in glasses per day ; 1 glass was defined as 200 mL ) self-reported in 24-hour recall question naires , were determined before ( baseline ) and after the intervention . In addition , the water flow of the fountains was measured during the intervention period of 1 school year ( August 2006 to June 2007 ) . RESULTS . Data on 2950 children ( intervention group : N = 1641 ; control group : N = 1309 ; age , mean ± SD : 8.3 ± 0.7 years ) were analyzed . After the intervention , the risk of overweight was reduced by 31 % in the intervention group , compared with the control group , with adjustment for baseline prevalence of overweight and clustering according to school . Changes in BMI SD scores did not differ between the intervention group and the control group . Water consumption after the intervention was 1.1 glasses per day greater in the intervention group . No intervention effect on juice and soft drink consumption was found . Daily water flow of the fountains indicated lasting use during the entire intervention period , but to varying extent . CONCLUSION . Our environmental and educational , school-based intervention proved to be effective in the prevention of  overweight among children in elementary school , even in a population from socially deprived areas This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherl and s. A cluster r and omized controlled trial was conducted .  Intervention cafeterias ( n=13 ) , where the Choices logo was used to promote healthier eating for a 3-week period , were compared with control cafeterias ( n=12 ) , which offered the same menu without the logo .  Sales data were collected daily for 9 weeks , from March to May 2009 . In addition , employees from one intervention and one control company completed an online question naire at baseline and after the intervention ( n=368 ) in which the behavioral determinants of food choice ( ie , attitude , self-efficacy , and intention ) and logo use were measured . Generalized estimating equation analyses , χ² tests , t tests and linear regression analyses were performed . No nutritionally meaningful intervention effects were found in the sales of s and wiches , soups , snacks , fruit , and salads . Also , no significant differences in behavioral determinants were found . " Intention to eat healthier " and " paying attention to product information " were positively associated with self-reported consumption of foods with the Choices logo at lunch . The intervention did not have a significant effect on employees ' lunchtime food choices . Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change . Further research should focus on the possible health benefits of menu reformulation in the catering sector Objective : To investigate the effect of two contrasting physical activity worksite interventions versus a reference intervention ( REF ) on various health outcomes . Methods : A 1-year r and omized controlled trial was conducted with specific resistance training ( SRT ) , all-round physical exercise ( APE ) , and REF . Results : SRT and APE compared with REF showed significant reductions in systolic blood pressure ( ∼6 mm Hg ) , body fat percentage ( ∼2.2 body fat% ) , as well as shoulder and back pain ( ∼30 % reduction in duration ) . Muscle strength ( APE and SRT ) and maximal oxygen uptake ( APE ) increased approximately 10 % . Conclusions : Worksite intervention with both SRT as well as APE is recommended , since these activities compared with REF result ed in clinical ly relevant reductions of cardiovascular and metabolic syndrome-related risk factors as well as musculoskeletal pain symptoms , in combination with minor increases in physical capacity Background — The estimated effects of recent pubic and workplace smoking restriction laws suggest that they produce significant declines in community rates of heart attack . The consistency of these declines with existing estimates of the relative risk of heart attack in individuals attributable to passive smoking exposure is poorly understood . The objective is to determine the consistency of estimates of reductions in community rates of heart attacks result ing from smoking restriction laws with estimates of the relative risk of heart disease in individuals exposed to passive smoking . Methods and Results — Meta-analyses of existing estimates of declines in community rates were compared with a mathematical model of the relationship between individual risk and community rates . The outcome measure is the ratio of community rates of acute myocardial infa rct ion ( after divided by before implementation of a smoking restriction law ) . There is a significant drop in the rate of acute myocardial infa rct ion hospital admissions associated with the implementation of strong smoke-free legislation . The primary reason for heterogeneity in results of different studies is the duration of follow-up after adoption of the law . The pooled r and om-effects estimate of the rate of acute myocardial infa rct ion hospitalization 12 months after implementation of the law is 0.83 ( 95 % confidence interval , 0.80 to 0.87 ) , and this benefit grows with time . This drop in admissions is consistent with a range of plausible individual risk and exposure scenarios . Conclusion — Passage of strong smoke-free legislation produces rapid and substantial benefits in terms of reduced acute myocardial infa rct ions , and these benefits grow with time BACKGROUND Secondary school students often do not drink sufficient quantities of water during the school day to prevent dehydration , promote learning and good health . The study aim ed to measure the effect of health promotion and the free provision of cooled filtered water on the consumption of water and soft drinks . It also aim ed to explore students ' views of drinking water provision . METHODS A study was conducted with three secondary schools in North Tyneside . Over a 3 month period one school was given cooled filtered water and active promotion ( W + P ) , another had water only ( W ) . The control school ( C ) took part in post-intervention focus group work . RESULTS The average volume of water drunk by students , in school ' W + P ' was greater ( P = 0.05 ) than that drunk in school ' W ' and control school ' C ' . The volume of soft drinks purchased by students in all three schools before and during the intervention remained static . Focus group data revealed that students viewed their existing water provision as poor and wanted sufficient supplies of cooled filtered water in school . CONCLUSIONS This pilot study indicates that active promotion of water drinking increased consumption of water by secondary school students . Further developments of the project are suggested OBJECTIVES We examined the relationship between students ' tobacco use  and the density and proximity of tobacco retailers near their schools . METHODS We used data from the 2003 - 2004 California Student Tobacco Survey and California retail licensing data . Measures included students ' self-reported tobacco use and geocoded state-reported locations of tobacco retailers . We used r and om-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors . RESULTS Density of retailers was associated with experimental smoking ( odds ratio [ OR ] = 1.11 ; 95 % confidence interval [ CI ] = 1. 
    Output:
    