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: OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .007 ) and fewer dinners eaten while watching TV ( adjusted difference = -1.60 meals/week , 95 % CI -2.99 , -.21 ; d = .59 ; P = .03 ) . Treatment group girls also reported less concern about weight ( d = .60 ; P = .03 ) , and a trend toward improved school grade s ( d = .51 ; P = .07 ) . CONCLUSIONS This study confirmed the feasibility , acceptability , and potential efficacy of using dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , in African-American girls OBJECTIVE . The objective of this study was to determine whether a generalizable best- practice individualized behavioral intervention  reduced BMI z score relative to st and ard dietetic care among overweight children . METHODS . The design consisted of an assessor-blinded , r and omized , controlled trial involving 134 overweight children ( 59 boys , 75 girls ; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years ) who were r and omly assigned to a best- practice behavioral program ( intervention ) or st and ard care ( control ) .  The intervention used family-centered counseling and behavioral strategies to modify diet , physical activity , and sedentary behavior . BMI z score , weight , objective ly measured physical activity and sedentary behavior , fat distribution , quality of life , and height z score were recorded at baseline and at 6 and 12 months . RESULTS . The intervention had no significant effect relative to st and ard care on BMI z score from baseline to 6 months and 12 months . BMI z score decreased significantly in both groups from baseline to 6 and 12 months . For those who complied with treatment , there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months . There were significant between-group differences in favor of the intervention for changes in total physical activity , percentage of time spent in sedentary behavior , and light-intensity physical activity . CONCLUSIONS . A generalizable , best- practice individualized behavioral intervention had modest benefits on objective ly measured physical activity and sedentary behavior but no significant effect on BMI z score compared with st and ard care among overweight children . The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention , although such treatments may not be realistic for many health care systems BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity BACKGROUND The proportion of overweight adolescents has increased , but the behavioral risk factors for overweight youth are not well understood . OBJECTIVE To examine how diet , physical activity , and sedentary behaviors relate to overweight status in adolescents . DESIGN AND SETTING Baseline data from the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition Project , a r and omized controlled trial of adolescents to determine the effects of a clinic-based intervention on physical activity and dietary behaviors . PARTICIPANTS A total of 878 adolescents aged 11 to 15 years , 42 % of whom were from minority background s. MAIN OUTCOME MEASURE Centers for Disease Control and Prevention body mass index-for-age percentiles divided into 2 categories : normal weight ( < 85th percentile ) and at risk for overweight plus overweight ( AR + O ) ( > or=85th percentile ) . RESULTS Overall , 45.7 % of the sample was classified as AR + O with a body mass index for age at the 85th percentile or higher . More girls from minority background s ( 54.8 % ) were AR + O compared with non-Hispanic white girls ( 42 % ) ( chi(2)(1 ) = 7.6 ; P = .006 ) . Bivariate analyses indicated that girls and boys in the AR + O group did fewer minutes per day of vigorous physical activity , consumed fewer total kilojoules per day , and had fewer total grams of fiber per day than those in the normal-weight group . Boys in the AR + O group also did fewer minutes per day of moderate physical activity and watched more minutes per day of television on nonschool days than normal-weight boys . Final multivariate models indicated that independent of socioeconomic status ( as assessed by household education level ) , girls had a greater risk of being AR + O if they were Hispanic or from another minority background ( odds ratio [ OR ] = 1.65 ; 95 % confidence interval [ CI ] , 1.09 - 2.49 ) and a reduced risk of being AR + O as minutes per day of vigorous physical activity increased ( OR = 0.93 ; 95 % CI , 0.89 - 0.97 ) . A low level of vigorous physical activity was the only significant risk factor for boys being AR + O ( OR = 0.92 ; 95 % CI , 0.89 - 0.95 ) . Analyses based on meeting behavioral guidelines supported these findings and showed that failing to meet the 60 min/d moderate to vigorous physical activity guideline was associated with overweight status for both girls and boys . In addition , boys who failed to meet sedentary behavior and dietary fiber guidelines were more likely to be overweight . CONCLUSIONS Of the 7 dietary and physical activity variables examined in this cross-sectional study , insufficient vigorous physical activity was the only risk factor for higher body mass index for adolescent boys and girls . Prospect i ve studies are needed to clarify the relative importance of dietary and physical activity behaviors on overweight in adolescence Background : Youth may choose to be sedentary rather than physically active . Purpose : The purpose of this study was to use behavioral economics methods to investigate how experimental changes in the amount of sedentary behaviors influenced physical activity . Methods : Fifty-eight 8-to 16-year-old youth were studied in a within-subject crossover design with three 3-week phases : baseline , increasing , and decreasing targeted sedentary behaviors by 25 % to 50 % . Results : At baseline , boys were more active than girls ( 518.9 vs. 401.2 accelerometer counts/min , p = .02 ) , and obese youth more sedentary than nonobese youth ( 240.5 vs. 174.4 min/day , p = .003 ) . During the increase sedentary behavior phase , targeted sedentary behaviors increased by 52.1 % , with girls increasing sedentary behaviors more than boys ( 114.7 vs. 79.8 min/day , p = .04 ) . Physical activity decreased ( −48.3 counts/min , p < .01 ) when sedentary behaviors increased , with obese youth decreasing total and moderate to vigorous physical activity ( MVPA ) more than nonobese youth ( −110.4 vs. 8.9 counts/min , p < .001 ; −3.3 vs. −.03%MVPA , p = .013 ) . During the decrease sedentary behavior phase , targeted sedentary behaviors decreased by 55.6 % from baseline as nonobese youth increased physical activity , whereas obese youth decreased physical activity ( 55.8 vs. −48.0 counts/min , p = .042 ; 1.1 vs. −2.1 % MVPA , p = .021 ) . Youth who substituted physical activity when sedentary behaviors were increased had greater st and ardized body mass index ( z-body mass index = 1.4 vs. 0.4 , p = .018 ) , whereas youth who substituted physical activity when sedentary behaviors were decreased were less active at baseline ( 396.1 vs. 513.7 counts/min , p = .035 ) . Conclusions : Behavioral economics provides a methodology to underst and changes in physical activity when sedentary behaviors are modified and to identify factors associated with substitution of physically active for sedentary behaviors BACKGROUND Television is a source from which children gain information about life and experience different types of behavior . The Child Behavior Checklist ( CBCL ) has not been used thoroughly to evaluate the behavioral effects of television viewing  on children . OBJECTIVE To examine the competency and problem behavior correlates of television viewing in school-aged children using the CBCL . DESIGN Cross-sectional survey . SETTING Two r and omly selected grade schools , one from a high-income district and the other from a low-income district . PARTICIPANTS Students in grade s 2 and 3 and their parents . MAIN OUTCOME MEASURES A question naire on  children 's time spent watching television and engaging in other daily activities  and the CBCL were sent to the parents of 888 second- and third- grade students . RESULTS Results of the question naire reported that the overall mean + /- SD daily television viewing time was 2.5 + /- 1.3 hours . Overall television viewing time had a negative correlation with social and school achievement ( r = -0.17 , P<.001 and r = 0.11 , P = .03 , respectively ) subscale scores . Withdrawn ( r = 0.11 , P = .004 ) , social problem ( r = 0.14 , P = .001 ) , thought problem ( r = 0.11 , P = .03 ) , attention problem ( r = 0.20 , P<.001 ) , delinquent behavior ( r = 0.12 , P<.001 ) , aggressive behavior ( r = 0.22 , P<.001 ) , and externalization ( r = 0.19 , P<.001 ) subscales and total problem ( r = 0.15 , P<.001 ) scores were positively correlated with time spent watching television . Stepwise logistic regression analysis revealed that the only significant variables associated with a risk of watching television for more than 2 hours were age , gender , social subscale , and attention problem subscale scores of the CBCL . CONCLUSION As evaluated by the CBCL , television viewing time is positively associated with social problems , delinquent behavior , aggressive behavior , externalization , and total problem scores . Older age , male gender , and decreasing social subscale and increasing attention problem subscale scores on the CBCL increases the risk of watching television for more than 2 hours Background Schools are the most frequent target for intervention programs aim ed at preventing child obesity ; however , the overall effectiveness of these programs has been limited . It has therefore been recommended that interventions target multiple ecological levels ( community , family , school and individual ) to have greater success in changing risk behaviors for obesity . This study examined the immediate and short-term , sustained effects of the Switch program , which targeted three behaviors ( decreasing children 's screen time , increasing fruit and vegetable consumption , and increasing physical activity ) at three e 
    Output:
    
agent
There is a large body of evidence from all study design s which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5 - 17 years .
In particular , the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health , and that lowering sedentary time leads to reductions in BMI
***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: OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .007 ) and fewer dinners eaten while watching TV ( adjusted difference = -1.60 meals/week , 95 % CI -2.99 , -.21 ; d = .59 ; P = .03 ) . Treatment group girls also reported less concern about weight ( d = .60 ; P = .03 ) , and a trend toward improved school grade s ( d = .51 ; P = .07 ) . CONCLUSIONS This study confirmed the feasibility , acceptability , and potential efficacy of using dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , in African-American girls OBJECTIVE . The objective of this study was to determine whether a generalizable best- practice individualized behavioral intervention  reduced BMI z score relative to st and ard dietetic care among overweight children . METHODS . The design consisted of an assessor-blinded , r and omized , controlled trial involving 134 overweight children ( 59 boys , 75 girls ; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years ) who were r and omly assigned to a best- practice behavioral program ( intervention ) or st and ard care ( control ) .  The intervention used family-centered counseling and behavioral strategies to modify diet , physical activity , and sedentary behavior . BMI z score , weight , objective ly measured physical activity and sedentary behavior , fat distribution , quality of life , and height z score were recorded at baseline and at 6 and 12 months . RESULTS . The intervention had no significant effect relative to st and ard care on BMI z score from baseline to 6 months and 12 months . BMI z score decreased significantly in both groups from baseline to 6 and 12 months . For those who complied with treatment , there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months . There were significant between-group differences in favor of the intervention for changes in total physical activity , percentage of time spent in sedentary behavior , and light-intensity physical activity . CONCLUSIONS . A generalizable , best- practice individualized behavioral intervention had modest benefits on objective ly measured physical activity and sedentary behavior but no significant effect on BMI z score compared with st and ard care among overweight children . The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention , although such treatments may not be realistic for many health care systems BACKGROUND Epidemiological studies have shown television watching to be a risk factor for the development of obesity in children . The effect of reducing television watching and other sedentary behaviors as a component of a comprehensive obesity treatment program has not been thoroughly tested . OBJECTIVE To compare the influence of targeting decreases in sedentary behavior vs. increases in physical activity in the comprehensive treatment of obesity in 8- to 12-year-old children . DESIGN R and omized , controlled outcome study . SETTING Childhood obesity research clinic . DESIGN Ninety families with obese 8- to 12-year-old children were r and omly assigned to groups that were provided a comprehensive family-based behavioral weight control program that included dietary , and behavior change information but differed in whether sedentary or physically active behaviors were targeted and the degree of behavior change required . RESULTS Results during 2 years showed that targeting either decreased sedentary behaviors or increased physical activity was associated with significant decreases in percent overweight and body fat and improved aerobic fitness . Self-reported activity minutes increased and targeted sedentary time decreased during treatment . Children substituted nontargeted sedentary behaviors for some of their targeted sedentary behaviors . CONCLUSION These results support reducing sedentary behaviors as an adjunct in the treatment of pediatric obesity BACKGROUND The proportion of overweight adolescents has increased , but the behavioral risk factors for overweight youth are not well understood . OBJECTIVE To examine how diet , physical activity , and sedentary behaviors relate to overweight status in adolescents . DESIGN AND SETTING Baseline data from the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition Project , a r and omized controlled trial of adolescents to determine the effects of a clinic-based intervention on physical activity and dietary behaviors . PARTICIPANTS A total of 878 adolescents aged 11 to 15 years , 42 % of whom were from minority background s. MAIN OUTCOME MEASURE Centers for Disease Control and Prevention body mass index-for-age percentiles divided into 2 categories : normal weight ( < 85th percentile ) and at risk for overweight plus overweight ( AR + O ) ( > or=85th percentile ) . RESULTS Overall , 45.7 % of the sample was classified as AR + O with a body mass index for age at the 85th percentile or higher . More girls from minority background s ( 54.8 % ) were AR + O compared with non-Hispanic white girls ( 42 % ) ( chi(2)(1 ) = 7.6 ; P = .006 ) . Bivariate analyses indicated that girls and boys in the AR + O group did fewer minutes per day of vigorous physical activity , consumed fewer total kilojoules per day , and had fewer total grams of fiber per day than those in the normal-weight group . Boys in the AR + O group also did fewer minutes per day of moderate physical activity and watched more minutes per day of television on nonschool days than normal-weight boys . Final multivariate models indicated that independent of socioeconomic status ( as assessed by household education level ) , girls had a greater risk of being AR + O if they were Hispanic or from another minority background ( odds ratio [ OR ] = 1.65 ; 95 % confidence interval [ CI ] , 1.09 - 2.49 ) and a reduced risk of being AR + O as minutes per day of vigorous physical activity increased ( OR = 0.93 ; 95 % CI , 0.89 - 0.97 ) . A low level of vigorous physical activity was the only significant risk factor for boys being AR + O ( OR = 0.92 ; 95 % CI , 0.89 - 0.95 ) . Analyses based on meeting behavioral guidelines supported these findings and showed that failing to meet the 60 min/d moderate to vigorous physical activity guideline was associated with overweight status for both girls and boys . In addition , boys who failed to meet sedentary behavior and dietary fiber guidelines were more likely to be overweight . CONCLUSIONS Of the 7 dietary and physical activity variables examined in this cross-sectional study , insufficient vigorous physical activity was the only risk factor for higher body mass index for adolescent boys and girls . Prospect i ve studies are needed to clarify the relative importance of dietary and physical activity behaviors on overweight in adolescence Background : Youth may choose to be sedentary rather than physically active . Purpose : The purpose of this study was to use behavioral economics methods to investigate how experimental changes in the amount of sedentary behaviors influenced physical activity . Methods : Fifty-eight 8-to 16-year-old youth were studied in a within-subject crossover design with three 3-week phases : baseline , increasing , and decreasing targeted sedentary behaviors by 25 % to 50 % . Results : At baseline , boys were more active than girls ( 518.9 vs. 401.2 accelerometer counts/min , p = .02 ) , and obese youth more sedentary than nonobese youth ( 240.5 vs. 174.4 min/day , p = .003 ) . During the increase sedentary behavior phase , targeted sedentary behaviors increased by 52.1 % , with girls increasing sedentary behaviors more than boys ( 114.7 vs. 79.8 min/day , p = .04 ) . Physical activity decreased ( −48.3 counts/min , p < .01 ) when sedentary behaviors increased , with obese youth decreasing total and moderate to vigorous physical activity ( MVPA ) more than nonobese youth ( −110.4 vs. 8.9 counts/min , p < .001 ; −3.3 vs. −.03%MVPA , p = .013 ) . During the decrease sedentary behavior phase , targeted sedentary behaviors decreased by 55.6 % from baseline as nonobese youth increased physical activity , whereas obese youth decreased physical activity ( 55.8 vs. −48.0 counts/min , p = .042 ; 1.1 vs. −2.1 % MVPA , p = .021 ) . Youth who substituted physical activity when sedentary behaviors were increased had greater st and ardized body mass index ( z-body mass index = 1.4 vs. 0.4 , p = .018 ) , whereas youth who substituted physical activity when sedentary behaviors were decreased were less active at baseline ( 396.1 vs. 513.7 counts/min , p = .035 ) . Conclusions : Behavioral economics provides a methodology to underst and changes in physical activity when sedentary behaviors are modified and to identify factors associated with substitution of physically active for sedentary behaviors BACKGROUND Television is a source from which children gain information about life and experience different types of behavior . The Child Behavior Checklist ( CBCL ) has not been used thoroughly to evaluate the behavioral effects of television viewing  on children . OBJECTIVE To examine the competency and problem behavior correlates of television viewing in school-aged children using the CBCL . DESIGN Cross-sectional survey . SETTING Two r and omly selected grade schools , one from a high-income district and the other from a low-income district . PARTICIPANTS Students in grade s 2 and 3 and their parents . MAIN OUTCOME MEASURES A question naire on  children 's time spent watching television and engaging in other daily activities  and the CBCL were sent to the parents of 888 second- and third- grade students . RESULTS Results of the question naire reported that the overall mean + /- SD daily television viewing time was 2.5 + /- 1.3 hours . Overall television viewing time had a negative correlation with social and school achievement ( r = -0.17 , P<.001 and r = 0.11 , P = .03 , respectively ) subscale scores . Withdrawn ( r = 0.11 , P = .004 ) , social problem ( r = 0.14 , P = .001 ) , thought problem ( r = 0.11 , P = .03 ) , attention problem ( r = 0.20 , P<.001 ) , delinquent behavior ( r = 0.12 , P<.001 ) , aggressive behavior ( r = 0.22 , P<.001 ) , and externalization ( r = 0.19 , P<.001 ) subscales and total problem ( r = 0.15 , P<.001 ) scores were positively correlated with time spent watching television . Stepwise logistic regression analysis revealed that the only significant variables associated with a risk of watching television for more than 2 hours were age , gender , social subscale , and attention problem subscale scores of the CBCL . CONCLUSION As evaluated by the CBCL , television viewing time is positively associated with social problems , delinquent behavior , aggressive behavior , externalization , and total problem scores . Older age , male gender , and decreasing social subscale and increasing attention problem subscale scores on the CBCL increases the risk of watching television for more than 2 hours Background Schools are the most frequent target for intervention programs aim ed at preventing child obesity ; however , the overall effectiveness of these programs has been limited . It has therefore been recommended that interventions target multiple ecological levels ( community , family , school and individual ) to have greater success in changing risk behaviors for obesity . This study examined the immediate and short-term , sustained effects of the Switch program , which targeted three behaviors ( decreasing children 's screen time , increasing fruit and vegetable consumption , and increasing physical activity ) at three e 
    Output:
    