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: BACKGROUND The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved . The study reported on here uses data from a social experiment to assess the association of r and omly assigned variation in neighborhood conditions with  obesity and diabetes . METHODS From 1994 through 1998 , the Department of Housing and Urban Development ( HUD ) r and omly assigned 4498 women with children living in public housing in high-poverty urban census tracts ( in which ≥40 % of residents had incomes below the federal poverty threshold ) to one of three groups : 1788 were assigned to receive housing vouchers  , which were redeemable only if they moved to a low-poverty census tract ( where < 10 % of residents were poor ) , and counseling on moving ; 1312 were assigned to receive unrestricted , traditional vouchers , with no special counseling on moving ;  and 1398 were assigned to a control group that was offered neither of these opportunities . From 2008 through 2010 , as part of a long-term follow-up survey , we measured data indicating health outcomes , including height , weight , and level of glycated hemoglobin ( HbA(1c ) ) . RESULTS As part of our long-term survey , we obtained data on body-mass index ( BMI , the weight in kilograms divided by the square of the height in meters ) for 84.2 % of participants and data on glycated hemoglobin level for 71.3 % of participants . Response rates were similar across r and omized groups . The prevalences of a BMI of 35 or more , a BMI of 40 or more , and a glycated hemoglobin level of 6.5 % or more were lower in the group receiving the low-poverty vouchers than in the control group , with an absolute difference of 4.61 percentage points ( 95 % confidence interval [ CI ] , -8.54 to -0.69 ) , 3.38 percentage points ( 95 % CI , -6.39 to -0.36 ) , and 4.31 percentage points ( 95 % CI , -7.82 to -0.80 ) , respectively . The differences between the group receiving traditional vouchers and the control group were not significant . CONCLUSIONS The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes . The mechanisms underlying these associations remain unclear but warrant further investigation , given their potential to guide the design of community-level interventions intended to improve health . ( Funded by HUD and others . ) The research design of the r and omised controlled trial is primarily associated today with medicine . It tends either to be ignored or regarded with suspicion by many in such disciplines as health promotion , public policy , social welfare , criminal justice , and education . However , all professional interventions in people 's lives are subject to essentially the same questions about acceptability and effectiveness . As the social reformers Sidney and Beatrice Webb pointed out in 1932 , there is far more experimentation going on in “ the world sociological laboratory in which we all live ” than in any other kind of laboratory , but most of this social experimentation is “ wrapped in secrecy ” and thus yields “ nothing to science.”1 # # # Summary points Many social scientists argue that r and omised controlled trials are inappropriate for evaluating social interventions , but they ignore a considerable history , mainly in the United States , of the use of r and omised controlled trials to assess different approaches to public policy and health promotion A tradition of experimental sociology was well established by the 1930s , built on the early use of controlled experiments in psychology and education From the early 1960s to early 1980s r and omised experiments were considered the optimal design for evaluating public policy interventions in the United States , and major evaluations using this design were carried out This approach became less popular as policy makers reacted negatively to evidence of “ near zero ” effects Lessons to be learnt about implementing r and omised controlled trials in real life setting s include the difficulty of assessing complex multi-level interventions and the challenge of integrating qualitative data The Webbs argued for a more “ scientific ” social policy , with social scientists being trained in experimental methods and evaluations of social interventions being carried out by independent investigators . They were apparently unaware that a strong tradition in experimental sociology had already been established , mainly in the United States . INTRODUCTION Lower-income Americans are suffering from declines in income , health , and longevity over time . Income and employment policies have been proposed as a potential non-medical solution to this problem . METHODS An interrupted time series analysis of state-level incremental supplements to the Earned Income Tax Credit ( EITC ) program  was performed using data from 1993 to 2010 Behavioral Risk Factor Surveillance System surveys and state-level life expectancy . The cost effectiveness of state EITC supplements was estimated using a microsimulation model , which was run in 2015 . RESULTS Supplemental EITC programs  increased health-related quality of life and longevity among the poor . The program costs about $ 7,786/ quality -adjusted life-year gained ( 95 % CI=$4,100 , $ 13,400 ) for the average recipient . This ratio increases with larger family sizes , costing roughly $ 14,261 ( 95 % CI=$8,735 , $ 19,716 ) for a family of three . CONCLUSIONS State supplements to EITC appear to be highly cost effective , but r and omized trials are needed to confirm these findings Opportunity  NYC-Family Rewards was the first conditional cash transfer , r and omized controlled trial for low-income families in the United States . From 2007 to 2010 , Family Rewards offered 2,377 New York City families cash transfers  that were conditional upon their investments in education , preventive health care , and parental employment . Their health and other outcomes were compared to those of a  control group of 2,372 families . The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care . It improved parents ' perception of their own health and levels of hope , mainly through improvements in reported financial well-being . While the program 's impacts on physical health were weaker , our study might not have captured effects on chronic disease risk that take longer to accrue . In the context of New York City 's operating social-safety-net programs , conditional cash transfers may have led to positive , albeit modest , improvements in the health of poor families Abstract The r and omized controlled trial is commonly used by both epidemiologists and economists to test the effectiveness of public health interventions . Yet we have noticed differences in practice between the two disciplines . In this article , we propose that there are some underlying differences between the disciplines in the way trials are used , how they are conducted and how results from trials are reported and disseminated . We hypothesize that evidence -based public health could be strengthened by underst and ing these differences , harvesting best- practice across the disciplines and breaking down communication barriers between economists and epidemiologists who conduct trials of public health interventions Policy Points : We take advantage of Oregon 's Medicaid lottery to gauge the causal effects of Medicaid coverage on mental health care , how effectively it addresses unmet needs , and how those effects differ for those with and without a history of depression . Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50 % and untreated depression by more than 60 % . It increased use of medications and reduced the share of respondents reporting unmet mental health care needs by almost 40 % . There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable population s. CONTEXT Exp and ing Medicaid to previously uninsured adults has been shown to increase detection and reduce the prevalence of depression , but the ways that Medicaid affects mental health care , how effectively it addresses unmet needs , and how those effects differ for those with and without a history of depression remain unclear . METHODS We take advantage of  Oregon 's Medicaid lottery  to gauge the causal effects of Medicaid coverage using a r and omized-controlled design , drawing on both primary and administrative data sources . FINDINGS Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50 % and untreated depression by more than 60 % . It increased use of medications frequently prescribed to treat depression and related mental health conditions and reduced the share of respondents reporting unmet mental health care needs by almost 40 % . The share of respondents screening positive for depression dropped by 9.2 percentage points overall , and by 13.1 for those with preexisting depression diagnoses , with greatest relief in symptoms seen primarily in feeling down or hopeless , feeling tired , and trouble sleeping-consistent with the increase observed not just in medications targeting depression but also in those targeting sleep . CONCLUSIONS Medicaid coverage had significant effects on the diagnosis , treatment , and outcomes of a population with substantial unmet mental health needs . Coverage increased access to care , reduced the prevalence of untreated and undiagnosed depression , and substantially improved the symptoms of depression . There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable population OBJECTIVES We examined whether Jobs First , a multicenter r and omized trial of a  welfare reform  program conducted in Connecticut , demonstrated increases in employment , income , and health insurance relative to traditional welfare ( Aid to Families with Dependent Children ) . We also investigated if higher earnings and employment improved mortality of the participants . METHODS We revisited the  Jobs First r and omized trial , successfully linking 4612 participant identifiers to 15 years of prospect i ve mortality follow-up data through 2010 , producing 240 deaths . The analysis was powered to detect a 20 % change in mortality hazards . RESULTS Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients , particularly for the most disadvantaged groups . However , although none of these reached statistical significance , all participants in Jobs First ( overall , across centers , and all subgroups ) experienced higher mortality hazards than traditional welfare recipients . CONCLUSIONS Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival OBJECTIVES We used 37 years of follow-up data from a r and omized controlled trial to explore the linkage between an early educational intervention and adult health . METHODS We analyzed data from the High/Scope Perry Preschool Program ( PPP )  , an  early school-based intervention in which 123 children were r and omized to a prekindergarten education group or a control group . In addition to exploring the effects of the program on health behavioral risk factors and health outcomes , we examined the extent to which educational attainment , income , family environment , and health insurance access mediated the relationship between r and omization to PPP and behavioral and health outcomes . RESULTS The PPP led to improvements in educational attainment , health insurance , income , and family environment Improvements in these domains , in turn , lead to improvements in an array of behavioral risk factors and health ( P = .01 ) . However , despite these reductions in behavioral risk factors , participants did not exhibit any overall improvement in physical health outcomes by the age of 40 years . CONCLUSIONS Early education reduces health behavioral risk factors by enhancing educational attainment , health insurance coverage , income , and family environments . Further follow-up will be needed to determine the long-term health effects of PPP During the 1990s reforms to the US welfare system introduced new time limits on people 's eligibility to receive public assistance . These limits were developed to encourage welfare recipients to seek employment . Little is known about how such social policy programs may have affected participants ' health . We explored whether the Florida Family Transition Program r and omized trial , a welfare reform experiment , led to long-term changes in mortality among participants . The Florida program included a 24 - 36-month time limit for welfare participation , intensive job training , and placement assistance . We linked 3,224 participants from the experiment to 17 - 18 years of prospect i ve mortality follow-up data and found that participants in the program experienced a 16 percent higher mortality rate than recipients of traditional welfare . If our results are generalizable to national welfare reform efforts , they raise questions about whether the cost savings associated with welfare reform justify the additional loss of life BACKGROUND Supported housing , integrating clinical and housing services , is a widely advocated intervention for homeless people with mental illness . In 1992 , the US Department of Housing and Urban Development ( HUD ) and the US Department of Veterans Affairs ( VA ) established the HUD-VA Supported Housing ( HUD-VASH ) program . METHODS Homeless veterans with psychiatric and /or substance abuse disorders or both ( N = 460 ) were r and omly assigned to 1 of 3 groups : ( 1 ) HUD-VASH , with Section 8 vouchers ( rent subsidies ) and intensive case management ( n = 182 ) ; ( 2 ) case management only , without special access to Section 8 vouchers ( n = 90 ) ; and ( 3 )  st and ard VA care  ( n = 188 ) Primary outcomes were days housed and days homeless . Secondary outcomes were mental health status , community adjustment , and costs from 4 perspectives . RESULTS During a 3-year follow-up , HUD-VASH veterans had 16 % more days housed than the case management-only group and 25 % more days housed than the st and ard care group ( P<.001 for both ) . The case management-only group had only 7 % more days housed than the st and ard care group ( P = .29 ) . The HUD-VASH group also experienced 35 % and 36 % fewer days homeless than each of the control groups ( P<.005 for both ) . There were no significant differences on 
    Output:
    
agent
Our comprehensive review and meta- analysis of these experiments find suggestive evidence of health benefits associated with investments in early life , income support , and health insurance interventions .
Housing and neighborhood trials had no effect on the outcomes included in the meta-analyses .
A positive effect of the trial on its primary socioeconomic outcome was associated with higher odds of reporting health improvements .
Early life , income , and health insurance interventions have the potential to improve health .
***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 The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved . The study reported on here uses data from a social experiment to assess the association of r and omly assigned variation in neighborhood conditions with  obesity and diabetes . METHODS From 1994 through 1998 , the Department of Housing and Urban Development ( HUD ) r and omly assigned 4498 women with children living in public housing in high-poverty urban census tracts ( in which ≥40 % of residents had incomes below the federal poverty threshold ) to one of three groups : 1788 were assigned to receive housing vouchers  , which were redeemable only if they moved to a low-poverty census tract ( where < 10 % of residents were poor ) , and counseling on moving ; 1312 were assigned to receive unrestricted , traditional vouchers , with no special counseling on moving ;  and 1398 were assigned to a control group that was offered neither of these opportunities . From 2008 through 2010 , as part of a long-term follow-up survey , we measured data indicating health outcomes , including height , weight , and level of glycated hemoglobin ( HbA(1c ) ) . RESULTS As part of our long-term survey , we obtained data on body-mass index ( BMI , the weight in kilograms divided by the square of the height in meters ) for 84.2 % of participants and data on glycated hemoglobin level for 71.3 % of participants . Response rates were similar across r and omized groups . The prevalences of a BMI of 35 or more , a BMI of 40 or more , and a glycated hemoglobin level of 6.5 % or more were lower in the group receiving the low-poverty vouchers than in the control group , with an absolute difference of 4.61 percentage points ( 95 % confidence interval [ CI ] , -8.54 to -0.69 ) , 3.38 percentage points ( 95 % CI , -6.39 to -0.36 ) , and 4.31 percentage points ( 95 % CI , -7.82 to -0.80 ) , respectively . The differences between the group receiving traditional vouchers and the control group were not significant . CONCLUSIONS The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes . The mechanisms underlying these associations remain unclear but warrant further investigation , given their potential to guide the design of community-level interventions intended to improve health . ( Funded by HUD and others . ) The research design of the r and omised controlled trial is primarily associated today with medicine . It tends either to be ignored or regarded with suspicion by many in such disciplines as health promotion , public policy , social welfare , criminal justice , and education . However , all professional interventions in people 's lives are subject to essentially the same questions about acceptability and effectiveness . As the social reformers Sidney and Beatrice Webb pointed out in 1932 , there is far more experimentation going on in “ the world sociological laboratory in which we all live ” than in any other kind of laboratory , but most of this social experimentation is “ wrapped in secrecy ” and thus yields “ nothing to science.”1 # # # Summary points Many social scientists argue that r and omised controlled trials are inappropriate for evaluating social interventions , but they ignore a considerable history , mainly in the United States , of the use of r and omised controlled trials to assess different approaches to public policy and health promotion A tradition of experimental sociology was well established by the 1930s , built on the early use of controlled experiments in psychology and education From the early 1960s to early 1980s r and omised experiments were considered the optimal design for evaluating public policy interventions in the United States , and major evaluations using this design were carried out This approach became less popular as policy makers reacted negatively to evidence of “ near zero ” effects Lessons to be learnt about implementing r and omised controlled trials in real life setting s include the difficulty of assessing complex multi-level interventions and the challenge of integrating qualitative data The Webbs argued for a more “ scientific ” social policy , with social scientists being trained in experimental methods and evaluations of social interventions being carried out by independent investigators . They were apparently unaware that a strong tradition in experimental sociology had already been established , mainly in the United States . INTRODUCTION Lower-income Americans are suffering from declines in income , health , and longevity over time . Income and employment policies have been proposed as a potential non-medical solution to this problem . METHODS An interrupted time series analysis of state-level incremental supplements to the Earned Income Tax Credit ( EITC ) program  was performed using data from 1993 to 2010 Behavioral Risk Factor Surveillance System surveys and state-level life expectancy . The cost effectiveness of state EITC supplements was estimated using a microsimulation model , which was run in 2015 . RESULTS Supplemental EITC programs  increased health-related quality of life and longevity among the poor . The program costs about $ 7,786/ quality -adjusted life-year gained ( 95 % CI=$4,100 , $ 13,400 ) for the average recipient . This ratio increases with larger family sizes , costing roughly $ 14,261 ( 95 % CI=$8,735 , $ 19,716 ) for a family of three . CONCLUSIONS State supplements to EITC appear to be highly cost effective , but r and omized trials are needed to confirm these findings Opportunity  NYC-Family Rewards was the first conditional cash transfer , r and omized controlled trial for low-income families in the United States . From 2007 to 2010 , Family Rewards offered 2,377 New York City families cash transfers  that were conditional upon their investments in education , preventive health care , and parental employment . Their health and other outcomes were compared to those of a  control group of 2,372 families . The experiment led to a modest improvement in health insurance coverage and a large increase in the use of preventive dental care . It improved parents ' perception of their own health and levels of hope , mainly through improvements in reported financial well-being . While the program 's impacts on physical health were weaker , our study might not have captured effects on chronic disease risk that take longer to accrue . In the context of New York City 's operating social-safety-net programs , conditional cash transfers may have led to positive , albeit modest , improvements in the health of poor families Abstract The r and omized controlled trial is commonly used by both epidemiologists and economists to test the effectiveness of public health interventions . Yet we have noticed differences in practice between the two disciplines . In this article , we propose that there are some underlying differences between the disciplines in the way trials are used , how they are conducted and how results from trials are reported and disseminated . We hypothesize that evidence -based public health could be strengthened by underst and ing these differences , harvesting best- practice across the disciplines and breaking down communication barriers between economists and epidemiologists who conduct trials of public health interventions Policy Points : We take advantage of Oregon 's Medicaid lottery to gauge the causal effects of Medicaid coverage on mental health care , how effectively it addresses unmet needs , and how those effects differ for those with and without a history of depression . Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50 % and untreated depression by more than 60 % . It increased use of medications and reduced the share of respondents reporting unmet mental health care needs by almost 40 % . There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable population s. CONTEXT Exp and ing Medicaid to previously uninsured adults has been shown to increase detection and reduce the prevalence of depression , but the ways that Medicaid affects mental health care , how effectively it addresses unmet needs , and how those effects differ for those with and without a history of depression remain unclear . METHODS We take advantage of  Oregon 's Medicaid lottery  to gauge the causal effects of Medicaid coverage using a r and omized-controlled design , drawing on both primary and administrative data sources . FINDINGS Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50 % and untreated depression by more than 60 % . It increased use of medications frequently prescribed to treat depression and related mental health conditions and reduced the share of respondents reporting unmet mental health care needs by almost 40 % . The share of respondents screening positive for depression dropped by 9.2 percentage points overall , and by 13.1 for those with preexisting depression diagnoses , with greatest relief in symptoms seen primarily in feeling down or hopeless , feeling tired , and trouble sleeping-consistent with the increase observed not just in medications targeting depression but also in those targeting sleep . CONCLUSIONS Medicaid coverage had significant effects on the diagnosis , treatment , and outcomes of a population with substantial unmet mental health needs . Coverage increased access to care , reduced the prevalence of untreated and undiagnosed depression , and substantially improved the symptoms of depression . There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable population OBJECTIVES We examined whether Jobs First , a multicenter r and omized trial of a  welfare reform  program conducted in Connecticut , demonstrated increases in employment , income , and health insurance relative to traditional welfare ( Aid to Families with Dependent Children ) . We also investigated if higher earnings and employment improved mortality of the participants . METHODS We revisited the  Jobs First r and omized trial , successfully linking 4612 participant identifiers to 15 years of prospect i ve mortality follow-up data through 2010 , producing 240 deaths . The analysis was powered to detect a 20 % change in mortality hazards . RESULTS Significant employment and income benefits were realized among Jobs First recipients relative to traditional welfare recipients , particularly for the most disadvantaged groups . However , although none of these reached statistical significance , all participants in Jobs First ( overall , across centers , and all subgroups ) experienced higher mortality hazards than traditional welfare recipients . CONCLUSIONS Increases in income and employment produced by Jobs First relative to traditional welfare improved socioeconomic status but did not improve survival OBJECTIVES We used 37 years of follow-up data from a r and omized controlled trial to explore the linkage between an early educational intervention and adult health . METHODS We analyzed data from the High/Scope Perry Preschool Program ( PPP )  , an  early school-based intervention in which 123 children were r and omized to a prekindergarten education group or a control group . In addition to exploring the effects of the program on health behavioral risk factors and health outcomes , we examined the extent to which educational attainment , income , family environment , and health insurance access mediated the relationship between r and omization to PPP and behavioral and health outcomes . RESULTS The PPP led to improvements in educational attainment , health insurance , income , and family environment Improvements in these domains , in turn , lead to improvements in an array of behavioral risk factors and health ( P = .01 ) . However , despite these reductions in behavioral risk factors , participants did not exhibit any overall improvement in physical health outcomes by the age of 40 years . CONCLUSIONS Early education reduces health behavioral risk factors by enhancing educational attainment , health insurance coverage , income , and family environments . Further follow-up will be needed to determine the long-term health effects of PPP During the 1990s reforms to the US welfare system introduced new time limits on people 's eligibility to receive public assistance . These limits were developed to encourage welfare recipients to seek employment . Little is known about how such social policy programs may have affected participants ' health . We explored whether the Florida Family Transition Program r and omized trial , a welfare reform experiment , led to long-term changes in mortality among participants . The Florida program included a 24 - 36-month time limit for welfare participation , intensive job training , and placement assistance . We linked 3,224 participants from the experiment to 17 - 18 years of prospect i ve mortality follow-up data and found that participants in the program experienced a 16 percent higher mortality rate than recipients of traditional welfare . If our results are generalizable to national welfare reform efforts , they raise questions about whether the cost savings associated with welfare reform justify the additional loss of life BACKGROUND Supported housing , integrating clinical and housing services , is a widely advocated intervention for homeless people with mental illness . In 1992 , the US Department of Housing and Urban Development ( HUD ) and the US Department of Veterans Affairs ( VA ) established the HUD-VA Supported Housing ( HUD-VASH ) program . METHODS Homeless veterans with psychiatric and /or substance abuse disorders or both ( N = 460 ) were r and omly assigned to 1 of 3 groups : ( 1 ) HUD-VASH , with Section 8 vouchers ( rent subsidies ) and intensive case management ( n = 182 ) ; ( 2 ) case management only , without special access to Section 8 vouchers ( n = 90 ) ; and ( 3 )  st and ard VA care  ( n = 188 ) Primary outcomes were days housed and days homeless . Secondary outcomes were mental health status , community adjustment , and costs from 4 perspectives . RESULTS During a 3-year follow-up , HUD-VASH veterans had 16 % more days housed than the case management-only group and 25 % more days housed than the st and ard care group ( P<.001 for both ) . The case management-only group had only 7 % more days housed than the st and ard care group ( P = .29 ) . The HUD-VASH group also experienced 35 % and 36 % fewer days homeless than each of the control groups ( P<.005 for both ) . There were no significant differences on 
    Output:
    