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 To compare 2 strategies , stage-matched nursing and community intervention ( SMN+CI ) and community intervention ( CI ) alone in changing cardiovascular risk factors in up to 3 behavioral areas : diet , physical activity , and /or smoking among rural women . METHODS A 14-month , multisite r and omized controlled trial of 117 rural women was conducted . Transtheoretical model was used in identification of stage of change and development of the SMN+CI nursing interventions . A social-ecological model was used to address issues of rurality in the development of interventions . FINDINGS The SMN + CI group was superior on 4 outcomes . There were significant increases in 2 measures of dietary intake ; improvement in dietary stage of change for fruits and vegetables ; and reduced diastolic blood pressure ( DBP ) in the SMN + CI group . After log transformation DBP significance was lost . The CI group had a significant reduction in change in total cholesterol ; however , significance was lost after control for the initiation of lipid lowering medications . There was a significant reduction in Framingham risk scores pre- to postintervention , regardless of group . CONCLUSIONS There continues to be a need to improve cardiovascular risk factors in rural women . There should be an exploration of whether intensified dose and fidelity of the intervention strategies of diet and physical activity are effective in improving anthropometric and laboratory values . Further investigation is warranted into factors influencing the pre- to postreduction in Framingham risk scores Background : Ecological models of healthy eating and physical activity emphasize the influence of behavioral setting s such as homes and worksites in shaping behavior . Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating . Objective : Using a community-based participatory research ( CBPR ) approach , the Emory Prevention Research Center ( EPRC ) , Cancer Coalition of South Georgia , and the EPRC 's Community Advisory Board ( CAB ) design ed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults . Methods : The 6-week intervention consisted of a tailored home environment profile , goal - setting , and behavioral contracting delivered through two home visits and two telephone calls . The study used a quasi-experimental design with data collected via telephone interviews at baseline , 2 and 4 months post-baseline . Ninety households ( n = 90 ) completed all three telephone interviews . Results : Multilevel models indicated that intervention households reported significant improvements in household food inventories , purchasing of fruit and vegetables , healthier meal preparation , meals with the TV off , and family support for healthy eating , relative to comparison households . Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households . Percent of fat intake decreased significantly , but no changes were observed for fruit and vegetable intake , physical activity , or weight among intervention relative to comparison households , although trends were generally in a positive direction . Conclusion : Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults Introduction Collaborative and multilevel interventions to effectively address obesity-related behaviors among rural communities with health disparities can be challenging , and traditional research approaches may be unsuitable . The primary objective of our 15-week r and omized controlled pilot study , which was guided by community-based participatory research ( CBPR ) principles , was to determine the effectiveness of providing twice-weekly access to group fitness classes , with and without weekly nutrition and physical activity education sessions , in Caswell County , North Carolina , a rural region devoid of medical and physical activity re sources . Methods Participants were r and omly divided into 2 groups : group 1 was offered fitness sessions and education in healthful eating and physical activity ; group 2 was offered fitness sessions only . Outcome measures were assessed at baseline and immediately after the intervention . St and ardized assessment procedures , vali date d measures , and tests for analysis of variance were used . Results Of 91 enrolled participants , most were African American ( 62 % ) or female ( 91 % ) . Groups were not significantly different at baseline . Group 1 experienced significantly greater improvements in body mass index ( F = 15.0 , P < .001 ) and waist circumference ( F = 7.0 , P = .01 ) , compared with group 2 . Both groups significantly increased weekly minutes of moderate physical activity ( F = 9.4 , P < .003 ) . Participants in group 1 also had significantly greater weight loss with higher attendance at the education ( F = 14.7 , P < .001 ) and fitness sessions ( F = 18.5 , P < .001 ) . Conclusion This study offers effective programmatic strategies that can reduce weight and increase physical activity and demonstrates feasibility for a larger scale CBPR obesity trial targeting underserved residents affected by health disparities . This study also signifies successful collaboration among community and academic partners engaged in a CBPR coalition Social network interventions that utilize informal systems of helping can be an important strategy for health promotion change . This article describes the development , implementation and evaluation of a natural ( lay ) helping intervention for health promotion change , specifically design ed for women in small rural blue-collar worksites . One hundred and four women in four intervention worksites were recruited as natural helpers , and received health and skill-building education over an 18-month period . Qualitative evaluation showed : ( 1 ) two patterns of natural helping for women , i.e. participation due to a specific health concern with either themselves or others in their personal networks , and participation due to a larger sense of the importance of health and prevention ; ( 2 ) over time natural helpers exp and ed the diffusion of health promotion information from close network members to co-workers and were more likely to be approached by their co-workers for information ; ( 3 ) group activities at the worksite , particularly around physical activity , increased over time ; and ( 4 ) because of time constraints at the workplace , written material s were a major way of spreading information to co-workers . This study shows that women can be recruited and trained to diffuse health promotion information and provide support to co-workers for health behavior change This study tested the efficacy of two school-based programs for prevention of body weight/fat gain in comparison to a control group , in all participants and in overweight children . The Louisiana ( LA ) Health study utilized a longitudinal , cluster r and omized 3-arm controlled design , with 28 months of follow-up . Children ( N=2060 ; M age = 10.5 years , SD = 1.2 ) from rural communities in Grade s 4 to 6 participated in the study . 17 school clusters ( M = 123 children/cluster ) were r and omly assigned to one of three prevention arms : 1 ) Primary Prevention ( PP ) , an environmental modification program , 2 ) Primary + Secondary Prevention ( PP+SP ) , the environmental program with an added classroom and internet education component , or 3 ) Control ( C ) . Primary outcomes were changes in percent body fat and body mass index z scores . Secondary outcomes were changes in behaviors related to energy balance . Comparisons of PP , PP+SP , and C on changes in body fat and BMI z scores found no differences . PP and PP+SP study arms were combined to create an environmental modification arm ( EM ) . Relative to C , EM decreased body fat for boys ( −1.7 % ± 0.38 % versus −0.14 % ± 0.69 % ) and attenuated fat gain for girls ( 2.9 % ± 0.22 % versus 3.93 % ± 0.37 % ) , but st and ardized effect sizes were relatively small ( < 0.30 ) . In conclusion , this school-based environmental modification programs had modest beneficial effects on changes in percent body fat . Addition of a classroom/internet program to the environmental program did not enhance weight/fat gain prevention , but did impact physical activity and social support in overweight children Background The preschool years are a critical window for obesity prevention efforts ; representing a time when children establish healthy eating habits and physical activity patterns . Underst and ing the context in which these behaviors develop is critical to formulating a model to address childhood obesity . The Colorado LEAP Study , an intervention study design ed to prevent early childhood obesity , utilizes a social ecological approach to explore individual , family and environmental factors and their relationship to child weight status over a 3 year timeframe . Methods The study is located in 5 rural Colorado preschool centers and elementary schools ( 2 treatment and 3 control ) . Treatment sites receive The Food Friends ® nutrition ( 12 weeks ) and physical activity ( 18 weeks ) interventions during preschool . Observational measures assess 3 layers of the social ecological model including individual , family and organizational inputs . Children ’s food preferences , food intake , gross motor skills , physical activity ( pedometers/accelerometers ) , cognitive , physical and social self-competence and height/weight are collected . Parents provide information on feeding and activity practice s , child ’s diet , oral sensory characteristics , food neophobia , home food and activity environment , height/weight and physical activity ( pedometers ) . School personnel complete a school environment and policy assessment . Measurements are conducted with 3 cohorts at 4 time points – baseline , post-intervention , 1- and 2-year follow-up . Discussion The design of this study allows for longitudinal exploration of relationships among eating habits , physical activity patterns , and weight status within and across spheres of the social ecological model . These methods advance traditional study design s by allowing not only for interaction among spheres but predictively across time . Further , the recruitment strategy includes both boys and girls from ethnic minority population s in rural areas and will provide insights into obesity prevention effects on these at risk population s . Trial registration Clinical Trials.gov : NCT01937481 Background : Unhealthy diet and lack of physical activity increase rural midlife and older women 's risk of chronic diseases and premature death , and they are behind urban residents in meeting Healthy People 2010 objectives . Objectives : The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity  and  healthy eating  among rural women . Methods : In a r and omized-by-site , community-based , controlled , clinical trial , Wellness for Women , 225 women aged 50 to 69 years were recruited in two similar rural areas . Over 12 months , women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions ( benefits , barriers , self-efficacy , and interpersonal support ) , activity , and eating . Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed by repeated- measures analysis of variance and chi-square tests ( & agr ; < .05 ) . Results : Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat , whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months . Both groups increased stretching and strengthening exercise , whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months . Both groups had several changes in biomarkers over the study . A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity , fruit and vegetable servings , and percentage of calories from fat at 12 months . Discussion : Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months . Tailored newsletters were more efficacious in facilitating change over 12 months PURPOSE Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child . This paper reports the first pretest-posttest results from a r and omized trial of a unique , multidimensional , small group format intervention , Strong Healthy Women , design ed to improve the health behaviors and health status of preconceptional and interconceptional women . METHODS Nonpregnant pre- and interconceptional women ages 18 - 35 were recruited in 15 low-income rural communities in Central Pennsylvania ( n = 692 ) . Women were r and omized in a ratio of 2-to-1 to intervention and control groups ; participants received a baseline and follow-up health risk assessment at 14 weeks and completed question naires to assess behavioral variables . The analytic sample for this report consists of 362 women who completed both risk assessment s. Outcomes include measures of attitudinal and health-related behavior change . MAIN FINDINGS Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes ; greater intent to eat healthy foods and be more physically active ; and greater frequency of reading food labels , physical activity consistent with recommended levels , and daily use of a multivitamin with folic acid . Significant dose effects were found : Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes , reading food labels , engaging in relaxation exercise or meditation for stress management , and daily use of a multivitamin with folic acid . CONCLUSIONS The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity . These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions BACKGROUND Poor nutrition and inactivity are widespread and contribute to the epidemic problem of childhood obesity . This study examined the effectiveness of a school-based pilot program to improve nutrition and activity in elementary ( ES ) and high school ( HS ) students . METHODS The Improving Meals and Physical Activity in Children and Teens ( IMPACT ) school-based curriculum used a train-the-trainer model to improve activity and nutrition . Nine students were recruited from one rural North Carolina high school and trained in the IMPACT curriculum and leadership skills . Four 4th grade classes at a neighboring elementary school were 
    Output:
    
agent
***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 To compare 2 strategies , stage-matched nursing and community intervention ( SMN+CI ) and community intervention ( CI ) alone in changing cardiovascular risk factors in up to 3 behavioral areas : diet , physical activity , and /or smoking among rural women . METHODS A 14-month , multisite r and omized controlled trial of 117 rural women was conducted . Transtheoretical model was used in identification of stage of change and development of the SMN+CI nursing interventions . A social-ecological model was used to address issues of rurality in the development of interventions . FINDINGS The SMN + CI group was superior on 4 outcomes . There were significant increases in 2 measures of dietary intake ; improvement in dietary stage of change for fruits and vegetables ; and reduced diastolic blood pressure ( DBP ) in the SMN + CI group . After log transformation DBP significance was lost . The CI group had a significant reduction in change in total cholesterol ; however , significance was lost after control for the initiation of lipid lowering medications . There was a significant reduction in Framingham risk scores pre- to postintervention , regardless of group . CONCLUSIONS There continues to be a need to improve cardiovascular risk factors in rural women . There should be an exploration of whether intensified dose and fidelity of the intervention strategies of diet and physical activity are effective in improving anthropometric and laboratory values . Further investigation is warranted into factors influencing the pre- to postreduction in Framingham risk scores Background : Ecological models of healthy eating and physical activity emphasize the influence of behavioral setting s such as homes and worksites in shaping behavior . Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating . Objective : Using a community-based participatory research ( CBPR ) approach , the Emory Prevention Research Center ( EPRC ) , Cancer Coalition of South Georgia , and the EPRC 's Community Advisory Board ( CAB ) design ed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults . Methods : The 6-week intervention consisted of a tailored home environment profile , goal - setting , and behavioral contracting delivered through two home visits and two telephone calls . The study used a quasi-experimental design with data collected via telephone interviews at baseline , 2 and 4 months post-baseline . Ninety households ( n = 90 ) completed all three telephone interviews . Results : Multilevel models indicated that intervention households reported significant improvements in household food inventories , purchasing of fruit and vegetables , healthier meal preparation , meals with the TV off , and family support for healthy eating , relative to comparison households . Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households . Percent of fat intake decreased significantly , but no changes were observed for fruit and vegetable intake , physical activity , or weight among intervention relative to comparison households , although trends were generally in a positive direction . Conclusion : Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults Introduction Collaborative and multilevel interventions to effectively address obesity-related behaviors among rural communities with health disparities can be challenging , and traditional research approaches may be unsuitable . The primary objective of our 15-week r and omized controlled pilot study , which was guided by community-based participatory research ( CBPR ) principles , was to determine the effectiveness of providing twice-weekly access to group fitness classes , with and without weekly nutrition and physical activity education sessions , in Caswell County , North Carolina , a rural region devoid of medical and physical activity re sources . Methods Participants were r and omly divided into 2 groups : group 1 was offered fitness sessions and education in healthful eating and physical activity ; group 2 was offered fitness sessions only . Outcome measures were assessed at baseline and immediately after the intervention . St and ardized assessment procedures , vali date d measures , and tests for analysis of variance were used . Results Of 91 enrolled participants , most were African American ( 62 % ) or female ( 91 % ) . Groups were not significantly different at baseline . Group 1 experienced significantly greater improvements in body mass index ( F = 15.0 , P < .001 ) and waist circumference ( F = 7.0 , P = .01 ) , compared with group 2 . Both groups significantly increased weekly minutes of moderate physical activity ( F = 9.4 , P < .003 ) . Participants in group 1 also had significantly greater weight loss with higher attendance at the education ( F = 14.7 , P < .001 ) and fitness sessions ( F = 18.5 , P < .001 ) . Conclusion This study offers effective programmatic strategies that can reduce weight and increase physical activity and demonstrates feasibility for a larger scale CBPR obesity trial targeting underserved residents affected by health disparities . This study also signifies successful collaboration among community and academic partners engaged in a CBPR coalition Social network interventions that utilize informal systems of helping can be an important strategy for health promotion change . This article describes the development , implementation and evaluation of a natural ( lay ) helping intervention for health promotion change , specifically design ed for women in small rural blue-collar worksites . One hundred and four women in four intervention worksites were recruited as natural helpers , and received health and skill-building education over an 18-month period . Qualitative evaluation showed : ( 1 ) two patterns of natural helping for women , i.e. participation due to a specific health concern with either themselves or others in their personal networks , and participation due to a larger sense of the importance of health and prevention ; ( 2 ) over time natural helpers exp and ed the diffusion of health promotion information from close network members to co-workers and were more likely to be approached by their co-workers for information ; ( 3 ) group activities at the worksite , particularly around physical activity , increased over time ; and ( 4 ) because of time constraints at the workplace , written material s were a major way of spreading information to co-workers . This study shows that women can be recruited and trained to diffuse health promotion information and provide support to co-workers for health behavior change This study tested the efficacy of two school-based programs for prevention of body weight/fat gain in comparison to a control group , in all participants and in overweight children . The Louisiana ( LA ) Health study utilized a longitudinal , cluster r and omized 3-arm controlled design , with 28 months of follow-up . Children ( N=2060 ; M age = 10.5 years , SD = 1.2 ) from rural communities in Grade s 4 to 6 participated in the study . 17 school clusters ( M = 123 children/cluster ) were r and omly assigned to one of three prevention arms : 1 ) Primary Prevention ( PP ) , an environmental modification program , 2 ) Primary + Secondary Prevention ( PP+SP ) , the environmental program with an added classroom and internet education component , or 3 ) Control ( C ) . Primary outcomes were changes in percent body fat and body mass index z scores . Secondary outcomes were changes in behaviors related to energy balance . Comparisons of PP , PP+SP , and C on changes in body fat and BMI z scores found no differences . PP and PP+SP study arms were combined to create an environmental modification arm ( EM ) . Relative to C , EM decreased body fat for boys ( −1.7 % ± 0.38 % versus −0.14 % ± 0.69 % ) and attenuated fat gain for girls ( 2.9 % ± 0.22 % versus 3.93 % ± 0.37 % ) , but st and ardized effect sizes were relatively small ( < 0.30 ) . In conclusion , this school-based environmental modification programs had modest beneficial effects on changes in percent body fat . Addition of a classroom/internet program to the environmental program did not enhance weight/fat gain prevention , but did impact physical activity and social support in overweight children Background The preschool years are a critical window for obesity prevention efforts ; representing a time when children establish healthy eating habits and physical activity patterns . Underst and ing the context in which these behaviors develop is critical to formulating a model to address childhood obesity . The Colorado LEAP Study , an intervention study design ed to prevent early childhood obesity , utilizes a social ecological approach to explore individual , family and environmental factors and their relationship to child weight status over a 3 year timeframe . Methods The study is located in 5 rural Colorado preschool centers and elementary schools ( 2 treatment and 3 control ) . Treatment sites receive The Food Friends ® nutrition ( 12 weeks ) and physical activity ( 18 weeks ) interventions during preschool . Observational measures assess 3 layers of the social ecological model including individual , family and organizational inputs . Children ’s food preferences , food intake , gross motor skills , physical activity ( pedometers/accelerometers ) , cognitive , physical and social self-competence and height/weight are collected . Parents provide information on feeding and activity practice s , child ’s diet , oral sensory characteristics , food neophobia , home food and activity environment , height/weight and physical activity ( pedometers ) . School personnel complete a school environment and policy assessment . Measurements are conducted with 3 cohorts at 4 time points – baseline , post-intervention , 1- and 2-year follow-up . Discussion The design of this study allows for longitudinal exploration of relationships among eating habits , physical activity patterns , and weight status within and across spheres of the social ecological model . These methods advance traditional study design s by allowing not only for interaction among spheres but predictively across time . Further , the recruitment strategy includes both boys and girls from ethnic minority population s in rural areas and will provide insights into obesity prevention effects on these at risk population s . Trial registration Clinical Trials.gov : NCT01937481 Background : Unhealthy diet and lack of physical activity increase rural midlife and older women 's risk of chronic diseases and premature death , and they are behind urban residents in meeting Healthy People 2010 objectives . Objectives : The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity  and  healthy eating  among rural women . Methods : In a r and omized-by-site , community-based , controlled , clinical trial , Wellness for Women , 225 women aged 50 to 69 years were recruited in two similar rural areas . Over 12 months , women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions ( benefits , barriers , self-efficacy , and interpersonal support ) , activity , and eating . Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed by repeated- measures analysis of variance and chi-square tests ( & agr ; < .05 ) . Results : Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat , whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months . Both groups increased stretching and strengthening exercise , whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months . Both groups had several changes in biomarkers over the study . A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity , fruit and vegetable servings , and percentage of calories from fat at 12 months . Discussion : Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months . Tailored newsletters were more efficacious in facilitating change over 12 months PURPOSE Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child . This paper reports the first pretest-posttest results from a r and omized trial of a unique , multidimensional , small group format intervention , Strong Healthy Women , design ed to improve the health behaviors and health status of preconceptional and interconceptional women . METHODS Nonpregnant pre- and interconceptional women ages 18 - 35 were recruited in 15 low-income rural communities in Central Pennsylvania ( n = 692 ) . Women were r and omized in a ratio of 2-to-1 to intervention and control groups ; participants received a baseline and follow-up health risk assessment at 14 weeks and completed question naires to assess behavioral variables . The analytic sample for this report consists of 362 women who completed both risk assessment s. Outcomes include measures of attitudinal and health-related behavior change . MAIN FINDINGS Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes ; greater intent to eat healthy foods and be more physically active ; and greater frequency of reading food labels , physical activity consistent with recommended levels , and daily use of a multivitamin with folic acid . Significant dose effects were found : Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes , reading food labels , engaging in relaxation exercise or meditation for stress management , and daily use of a multivitamin with folic acid . CONCLUSIONS The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity . These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions BACKGROUND Poor nutrition and inactivity are widespread and contribute to the epidemic problem of childhood obesity . This study examined the effectiveness of a school-based pilot program to improve nutrition and activity in elementary ( ES ) and high school ( HS ) students . METHODS The Improving Meals and Physical Activity in Children and Teens ( IMPACT ) school-based curriculum used a train-the-trainer model to improve activity and nutrition . Nine students were recruited from one rural North Carolina high school and trained in the IMPACT curriculum and leadership skills . Four 4th grade classes at a neighboring elementary school were 
    Output:
    