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: Purpose . Examine the effects of three iterative tailored feedback letters addressing smoking ; physical activity ; and fruit , vegetable , and fat intake , and test the additional effects of providing feedback on action plans . Design . A tailored , print-based intervention was developed and tested in a r and omized control trial with a posttest after 9 months . Setting . A total of 2827 respondents agreed to participate . They were recruited from a r and om sample of 35,000 addresses obtained through the Dutch national telephone company . Subjects . The mean age was 49 years , and 55 % were female . Intervention . The experimental group received three printed tailored letters , and the control group received three printed generic letters . Respondents from the experimental group r and omly received either a third letter with tailored information or tailored information and action-planning feedback . Measures . The question naire assessed physical activity ; smoking ; consumption of fruit , vegetables and fat ; motivational determinants ; action plans ; and demographics . Results . Tailored information result ed in more improvement over time than generic information for the intake of fruit , vegetables , and fat and for physical activity . No differences between the conditions were found for smoking because of high cessation rates in all conditions . Action-planning feedback did not increase the effects . Conclusions . Tailored lifestyle information can be effective for adults in changing nutrition behavior and physical activity Background This paper explores smoking cessation participants ’ perceptions of attempting weight management alongside smoking cessation within the context of a  health improvement intervention implemented in Glasgow , Scotl and . Methods One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and r and omised to intervention , receiving dietary advice , or to control groups .  The primary outcome of the study was to determine the % change in body weight . Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 ( during the intervention ) and 24 ( at the end of the intervention ) . The current paper , though predominantly qualitative , links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better underst and ing of the mediators influencing multiple behaviour change . Results Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle , and hence attempt behaviour changes concurrently , may be at comparative advantage in positively achieving dual outcomes . Conclusions These findings highlight the need to assess participants ’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change . Further testing of this hypothesis is warranted . Trial Registration IS RCT Objective To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community . Design Population based prospect i ve study ( EPIC-Norfolk ) . Setting Norfolk , United Kingdom . Participants 20 040 men and women aged 40 - 79 with no known stroke or myocardial infa rct ion at baseline survey in 1993 - 7 , living in the general community , and followed up to 2007 . Main outcome measure Participants scored one point for each health behaviour : current non-smoking , physically not inactive , moderate alcohol intake ( 1 - 14 units a week ) , and plasma concentration of vitamin C ≥50 µmol/l , indicating fruit and vegetable intake of at least five servings a day , for a total score ranging from 0 to 4 . Results There were 599 incident strokes over 229 993 person years of follow-up ; the average follow-up was 11.5 years . After adjustment for age , sex , body mass index ( BMI ) , systolic blood pressure , cholesterol concentration , history of diabetes and aspirin use , and social class , compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 ( 95 % confidence interval 0.89 to 1.49 ) for three health behaviours , 1.58 ( 1.22 to 2.05 ) for two , 2.18 ( 1.63 to 2.92 ) for one , and 2.31 ( 1.33 to 4.02 ) for none ( P<0.001 for trend ) . The relations were consistent in subgroups stratified by sex , age , body mass index , and social class , and after exclusion of deaths within two years . Conclusion Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women Background We report the main results , among adults , of a cluster-r and omised-trial of Well London , a community-engagement programme  promoting healthy eating , physical activity and mental well-being in deprived neighbourhoods . The hypothesis was that benefits would be neighbourhood-wide , and not restricted to intervention participants . The trial was part of a multicomponent process/ outcome evaluation which included non-experimental components ( self-reported behaviour change amongst participants , case studies and evaluations of individual projects ) which suggested health , well-being and social benefits to participants . Methods Twenty matched pairs of neighbourhoods in London were r and omised to intervention/control condition . Primary outcomes ( five portions fruit/vegetables/day ; 5 × 30 m of moderate intensity physical activity/week , abnormal General Health Question naire (GHQ)-12 score and Warwick – Edinburgh Mental Well-being Scale ( WEMWBS ) score ) were measured by postintervention question naire survey , among 3986 adults in a r and om sample of households across neighbourhoods . Results There was no evidence of impact on primary outcomes : healthy eating ( relative risk [ RR ] 1.04 , 95 % CI 0.93 to 1.17 ) ; physical activity ( RR:1.01 , 95 % CI 0.88 to 1.16 ) ; abnormal GHQ12 ( RR:1.15 , 95 % CI 0.84 to 1.61 ) ; WEMWBS ( mean difference [ MD ] : −1.52 , 95 % CI −3.93 to 0.88 ) . There was evidence of impact on some secondary outcomes : reducing unhealthy eating-score ( MD : −0.14 , 95 % CI −0.02 to 0.27 ) and increased perception that people in the neighbourhood pulled together ( RR : 1.92 , 95 % CI 1.12 to 3.29 ) . Conclusions The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours , well-being and social outcomes . Low participation rates and population churn likely compromised any impact of the intervention . Imprecise estimation of outcomes and sampling bias may also have influenced findings . There is a need for greater investment in refining such programmes before implementation ; new methods to underst and , longitudinally different pathways residents take through such interventions and their outcomes , and new theories of change that apply to each pathway PURPOSE To investigate the long-term ( 6- and 12-month ) effects of the Strong Healthy Women intervention on health-related behaviors , weight and body mass index ( BMI ) , and weight gain during pregnancy .  Strong Healthy Women is a small-group behavioral intervention for pre- and interconceptional women design ed to modify key risk factors for adverse pregnancy outcomes ; pretest-posttest findings from a r and omized , controlled trial have been previously reported . The following questions are addressed : 1 ) were significant pretest-posttest changes in health-related behaviors ( previously reported ) maintained over the 12-month follow-up period ; 2 ) did the intervention impact weight and BMI over the 12-month follow-up period ; and 3 ) did the intervention impact pregnancy weight gain for those who gave birth during the follow-up period ? METHODS Data are from 6- and 12-month follow-up telephone interviews of women in the original trial of the Strong Healthy Women intervention ( n = 362 ) and from birth records for singleton births ( n = 45 ) during the 12-month follow-up period . Repeated measures regression was used to evaluate intervention effects . MAIN FINDINGS At the 12-month follow-up , participants in the Strong Healthy Women intervention were significantly more likely than controls to use a daily multivitamin with folic acid and to have lower weight and BMI . The intervention 's effect on reading food labels for nutritional values dropped off between the 6- and 12-month follow-up . Among those who gave birth to singletons during the follow-up period , women who participated in the intervention had lower average pregnancy weight gain compared with controls . Although the intervention effect was no longer significant when controlling for pre-pregnancy obesity , the adjusted means show a trend toward lower weight gain in the intervention group . CONCLUSION These findings provide important evidence that the Strong Healthy Women behavior change intervention is effective in modifying important risk factors for adverse pregnancy outcomes and may improve an important pregnancy outcome , weight gain during pregnancy . Because the intervention seems to help women manage their weight in the months after the intervention and during pregnancy , it may be an effective obesity prevention strategy for women before , during , and after the transition to motherhood Background Computer tailoring and motivational interviewing show promise in promoting lifestyle change , despite few head-to-head comparative studies . Purpose Vitalum is a r and omized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults . Methods Participants ( n = 1,629 ) were recruited via 23 general practice s and r and omly received either four tailored print letters , four motivational telephone calls , two of each type of intervention , or no information . The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption . Results All three intervention groups ( i.e. , the tailored letters , the motivational calls , and the combined version ) were equally and significantly more effective than the control group in increasing physical activity ( hours/day ) , intake of fruit ( servings/day ) , and consumption of vegetables ( grams/day ) from baseline to the intermediate measurement ( week 25 ) , follow-up 1 ( week 47 ) and 2 ( week 73 ) . Effect sizes ( Cohen ’s d ) ranged from 0.15 to 0.18 . Participants rated the interventions positively ; interviews were more positively evaluated than letters . Conclusions Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors Background Few studies have evaluated how to combine dietary and physical activity ( PA ) interventions to enhance adherence . Purpose We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes . Methods Two hundred participants over age 44 years not meeting national PA and dietary recommendations ( daily fruit and vegetable servings and percent of calories from saturated fat ) were r and omized to one of four 12-month telephone interventions : sequential ( exercise first or diet first ) , simultaneous , or attention control . At 4 months , the other health behavior was added in the sequential arms . Results Ninety-three percent of participants were retained through 12 months . At 4 months , only exercise first improved PA , and only the simultaneous and diet-first interventions  improved dietary variables . At 12 months , mean levels of all behaviors in the simultaneous arm met recommendations , though not in the exercise- and diet-first arms . Conclusions We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation Background This intervention aim ed to ascertain whether a low-cost , accessible , physical activity and nutrition program could improve physical activity and nutrition behaviours of insufficiently active 60–70 year olds residing in Perth , Australia . Methods A 6-month home-based r and omised controlled trial was conducted on 478 older adults ( intervention , n = 248 ; control , n = 230 ) of low to medium socioeconomic status . Both intervention and control groups completed postal question naires at baseline and post-program , but only the intervention participants received project material s. A modified fat and fibre question naire measured nutritional behaviours , whereas  physical activity was measured using the International Physical Activity Question naire . Generalised estimating equation models were used to assess the repeated outcomes over both time points . Results The final sample consisted of 176 intervention participants and 199 controls ( response rate 78.5 % ) with complete data . After controlling for demographic and other confounding factors , the intervention group demonstrated increased participation in strength exercise ( p < 0.001 ) , walking ( p = 0.029 ) and vigorous activity ( p = 0.015 ) , together with significant reduction in mean sitting time ( p < 0.001 ) relative to controls . Improvements in nutritional behaviours for the intervention group were also evident in terms of fat avoidance ( p < 0.001 ) , fat intake ( p = 0.021 ) and prevalence of frequent fruit intake ( p = 0.008 ) . Conclusions A minimal contact , low-cost and home-based physical activity program can positively influence seniors ’ physical activity and nutrition behaviours . Trial registration anzctr.org.au Identifier : Background Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact . Yet , few r and omized controlled trials have tested this assumption . Objective The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on  multiple lifestyle behaviors . Methods A r and omized controlled trial was conducted with 3 tailoring conditions ( ie , sequential , simultaneous , and control conditions ) in the Netherl and s in 2009 - 2012 . Follow-up measurements took place after 12 and 24 months . The intervention content was based on the I-Change model . In a health risk appraisal , all respondents ( N=5055 )  received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity , vegetable consumption , fruit consumption , alcohol intake , and smoking .  Particip 
    Output:
    
agent
Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
***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: Purpose . Examine the effects of three iterative tailored feedback letters addressing smoking ; physical activity ; and fruit , vegetable , and fat intake , and test the additional effects of providing feedback on action plans . Design . A tailored , print-based intervention was developed and tested in a r and omized control trial with a posttest after 9 months . Setting . A total of 2827 respondents agreed to participate . They were recruited from a r and om sample of 35,000 addresses obtained through the Dutch national telephone company . Subjects . The mean age was 49 years , and 55 % were female . Intervention . The experimental group received three printed tailored letters , and the control group received three printed generic letters . Respondents from the experimental group r and omly received either a third letter with tailored information or tailored information and action-planning feedback . Measures . The question naire assessed physical activity ; smoking ; consumption of fruit , vegetables and fat ; motivational determinants ; action plans ; and demographics . Results . Tailored information result ed in more improvement over time than generic information for the intake of fruit , vegetables , and fat and for physical activity . No differences between the conditions were found for smoking because of high cessation rates in all conditions . Action-planning feedback did not increase the effects . Conclusions . Tailored lifestyle information can be effective for adults in changing nutrition behavior and physical activity Background This paper explores smoking cessation participants ’ perceptions of attempting weight management alongside smoking cessation within the context of a  health improvement intervention implemented in Glasgow , Scotl and . Methods One hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and r and omised to intervention , receiving dietary advice , or to control groups .  The primary outcome of the study was to determine the % change in body weight . Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 ( during the intervention ) and 24 ( at the end of the intervention ) . The current paper , though predominantly qualitative , links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better underst and ing of the mediators influencing multiple behaviour change . Results Our findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle , and hence attempt behaviour changes concurrently , may be at comparative advantage in positively achieving dual outcomes . Conclusions These findings highlight the need to assess participants ’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change . Further testing of this hypothesis is warranted . Trial Registration IS RCT Objective To quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community . Design Population based prospect i ve study ( EPIC-Norfolk ) . Setting Norfolk , United Kingdom . Participants 20 040 men and women aged 40 - 79 with no known stroke or myocardial infa rct ion at baseline survey in 1993 - 7 , living in the general community , and followed up to 2007 . Main outcome measure Participants scored one point for each health behaviour : current non-smoking , physically not inactive , moderate alcohol intake ( 1 - 14 units a week ) , and plasma concentration of vitamin C ≥50 µmol/l , indicating fruit and vegetable intake of at least five servings a day , for a total score ranging from 0 to 4 . Results There were 599 incident strokes over 229 993 person years of follow-up ; the average follow-up was 11.5 years . After adjustment for age , sex , body mass index ( BMI ) , systolic blood pressure , cholesterol concentration , history of diabetes and aspirin use , and social class , compared with people with the four health behaviours the relative risks for stroke for men and women were 1.15 ( 95 % confidence interval 0.89 to 1.49 ) for three health behaviours , 1.58 ( 1.22 to 2.05 ) for two , 2.18 ( 1.63 to 2.92 ) for one , and 2.31 ( 1.33 to 4.02 ) for none ( P<0.001 for trend ) . The relations were consistent in subgroups stratified by sex , age , body mass index , and social class , and after exclusion of deaths within two years . Conclusion Four health behaviours combined predict more than a twofold difference in incidence of stroke in men and women Background We report the main results , among adults , of a cluster-r and omised-trial of Well London , a community-engagement programme  promoting healthy eating , physical activity and mental well-being in deprived neighbourhoods . The hypothesis was that benefits would be neighbourhood-wide , and not restricted to intervention participants . The trial was part of a multicomponent process/ outcome evaluation which included non-experimental components ( self-reported behaviour change amongst participants , case studies and evaluations of individual projects ) which suggested health , well-being and social benefits to participants . Methods Twenty matched pairs of neighbourhoods in London were r and omised to intervention/control condition . Primary outcomes ( five portions fruit/vegetables/day ; 5 × 30 m of moderate intensity physical activity/week , abnormal General Health Question naire (GHQ)-12 score and Warwick – Edinburgh Mental Well-being Scale ( WEMWBS ) score ) were measured by postintervention question naire survey , among 3986 adults in a r and om sample of households across neighbourhoods . Results There was no evidence of impact on primary outcomes : healthy eating ( relative risk [ RR ] 1.04 , 95 % CI 0.93 to 1.17 ) ; physical activity ( RR:1.01 , 95 % CI 0.88 to 1.16 ) ; abnormal GHQ12 ( RR:1.15 , 95 % CI 0.84 to 1.61 ) ; WEMWBS ( mean difference [ MD ] : −1.52 , 95 % CI −3.93 to 0.88 ) . There was evidence of impact on some secondary outcomes : reducing unhealthy eating-score ( MD : −0.14 , 95 % CI −0.02 to 0.27 ) and increased perception that people in the neighbourhood pulled together ( RR : 1.92 , 95 % CI 1.12 to 3.29 ) . Conclusions The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours , well-being and social outcomes . Low participation rates and population churn likely compromised any impact of the intervention . Imprecise estimation of outcomes and sampling bias may also have influenced findings . There is a need for greater investment in refining such programmes before implementation ; new methods to underst and , longitudinally different pathways residents take through such interventions and their outcomes , and new theories of change that apply to each pathway PURPOSE To investigate the long-term ( 6- and 12-month ) effects of the Strong Healthy Women intervention on health-related behaviors , weight and body mass index ( BMI ) , and weight gain during pregnancy .  Strong Healthy Women is a small-group behavioral intervention for pre- and interconceptional women design ed to modify key risk factors for adverse pregnancy outcomes ; pretest-posttest findings from a r and omized , controlled trial have been previously reported . The following questions are addressed : 1 ) were significant pretest-posttest changes in health-related behaviors ( previously reported ) maintained over the 12-month follow-up period ; 2 ) did the intervention impact weight and BMI over the 12-month follow-up period ; and 3 ) did the intervention impact pregnancy weight gain for those who gave birth during the follow-up period ? METHODS Data are from 6- and 12-month follow-up telephone interviews of women in the original trial of the Strong Healthy Women intervention ( n = 362 ) and from birth records for singleton births ( n = 45 ) during the 12-month follow-up period . Repeated measures regression was used to evaluate intervention effects . MAIN FINDINGS At the 12-month follow-up , participants in the Strong Healthy Women intervention were significantly more likely than controls to use a daily multivitamin with folic acid and to have lower weight and BMI . The intervention 's effect on reading food labels for nutritional values dropped off between the 6- and 12-month follow-up . Among those who gave birth to singletons during the follow-up period , women who participated in the intervention had lower average pregnancy weight gain compared with controls . Although the intervention effect was no longer significant when controlling for pre-pregnancy obesity , the adjusted means show a trend toward lower weight gain in the intervention group . CONCLUSION These findings provide important evidence that the Strong Healthy Women behavior change intervention is effective in modifying important risk factors for adverse pregnancy outcomes and may improve an important pregnancy outcome , weight gain during pregnancy . Because the intervention seems to help women manage their weight in the months after the intervention and during pregnancy , it may be an effective obesity prevention strategy for women before , during , and after the transition to motherhood Background Computer tailoring and motivational interviewing show promise in promoting lifestyle change , despite few head-to-head comparative studies . Purpose Vitalum is a r and omized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults . Methods Participants ( n = 1,629 ) were recruited via 23 general practice s and r and omly received either four tailored print letters , four motivational telephone calls , two of each type of intervention , or no information . The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption . Results All three intervention groups ( i.e. , the tailored letters , the motivational calls , and the combined version ) were equally and significantly more effective than the control group in increasing physical activity ( hours/day ) , intake of fruit ( servings/day ) , and consumption of vegetables ( grams/day ) from baseline to the intermediate measurement ( week 25 ) , follow-up 1 ( week 47 ) and 2 ( week 73 ) . Effect sizes ( Cohen ’s d ) ranged from 0.15 to 0.18 . Participants rated the interventions positively ; interviews were more positively evaluated than letters . Conclusions Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors Background Few studies have evaluated how to combine dietary and physical activity ( PA ) interventions to enhance adherence . Purpose We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes . Methods Two hundred participants over age 44 years not meeting national PA and dietary recommendations ( daily fruit and vegetable servings and percent of calories from saturated fat ) were r and omized to one of four 12-month telephone interventions : sequential ( exercise first or diet first ) , simultaneous , or attention control . At 4 months , the other health behavior was added in the sequential arms . Results Ninety-three percent of participants were retained through 12 months . At 4 months , only exercise first improved PA , and only the simultaneous and diet-first interventions  improved dietary variables . At 12 months , mean levels of all behaviors in the simultaneous arm met recommendations , though not in the exercise- and diet-first arms . Conclusions We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation Background This intervention aim ed to ascertain whether a low-cost , accessible , physical activity and nutrition program could improve physical activity and nutrition behaviours of insufficiently active 60–70 year olds residing in Perth , Australia . Methods A 6-month home-based r and omised controlled trial was conducted on 478 older adults ( intervention , n = 248 ; control , n = 230 ) of low to medium socioeconomic status . Both intervention and control groups completed postal question naires at baseline and post-program , but only the intervention participants received project material s. A modified fat and fibre question naire measured nutritional behaviours , whereas  physical activity was measured using the International Physical Activity Question naire . Generalised estimating equation models were used to assess the repeated outcomes over both time points . Results The final sample consisted of 176 intervention participants and 199 controls ( response rate 78.5 % ) with complete data . After controlling for demographic and other confounding factors , the intervention group demonstrated increased participation in strength exercise ( p < 0.001 ) , walking ( p = 0.029 ) and vigorous activity ( p = 0.015 ) , together with significant reduction in mean sitting time ( p < 0.001 ) relative to controls . Improvements in nutritional behaviours for the intervention group were also evident in terms of fat avoidance ( p < 0.001 ) , fat intake ( p = 0.021 ) and prevalence of frequent fruit intake ( p = 0.008 ) . Conclusions A minimal contact , low-cost and home-based physical activity program can positively influence seniors ’ physical activity and nutrition behaviours . Trial registration anzctr.org.au Identifier : Background Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact . Yet , few r and omized controlled trials have tested this assumption . Objective The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on  multiple lifestyle behaviors . Methods A r and omized controlled trial was conducted with 3 tailoring conditions ( ie , sequential , simultaneous , and control conditions ) in the Netherl and s in 2009 - 2012 . Follow-up measurements took place after 12 and 24 months . The intervention content was based on the I-Change model . In a health risk appraisal , all respondents ( N=5055 )  received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity , vegetable consumption , fruit consumption , alcohol intake , and smoking .  Particip 
    Output:
    