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 Alcohol consumption of college students has a fluctuating nature , which might impact the measurement of intervention effects . By using 25 follow-up time-points , this study tested whether intervention effects are robust or might vary over time . Methods Data were used from a two-arm parallel group r and omized controlled trial applying ecological momentary assessment ( EMA ) with 30 data time-points in total . Students between 18 and 24 years old who reported heavy drinking in the past six months and who were ready to change their alcohol consumption were r and omly assigned to the experimental ( n = 456 : web-based brief alcohol intervention ) and control condition ( n = 451 : no intervention ) . Outcome measures were weekly alcohol consumption , frequency of binge drinking , and heavy drinking status . Results According to the intention-to-treat principle , regression analyses revealed that intervention effects on alcohol consumption varied when exploring multiple follow-up time-points . Intervention effects were found for a ) weekly alcohol consumption at 1 , 2 , 3 , 4 , and 7 weeks follow-up , b ) frequency of binge drinking at 1 , 2 , 7 , and 12 weeks follow-up , and c ) heavy drinking status at 1 , 2 , 7 , and 16 weeks follow-up . Conclusions This research showed that the commonly used one and six month follow-up time-points are relatively arbitrary and not using EMA might bring forth erroneous conclusions on the effectiveness of interventions . Therefore , future trials in alcohol prevention research and beyond are encouraged to apply EMA when assessing outcome measures and intervention effectiveness . Trial registration Netherl and s Trial Register Background Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results . Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale , there is a need for further study . Objective This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden . Methods Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question . These students ( N=1605 ) gave consent and were r and omized into a 2-arm parallel group r and omized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback . Results After 2 months , there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses , although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10 % reduction ( 95 % CI –30 % to 10 % ) in total weekly alcohol consumption . Also , differences in effect sizes between universities were seen with participants from a major university ( n=365 ) reducing their weekly alcohol consumption by 14 % ( 95 % CI –23 % to –4 % ) . However , lower recruitment than planned and differential attrition in the intervention and control group ( 49 % vs 68 % ) complicated interpretation of the outcome data . Conclusions Any effects of current national provision are likely to be small and further research and development work is needed to enhance effectiveness . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 02335307 ; http://www.is rct n.com/IS RCT N02335307 ( Archived by WebCite at http://www.webcitation.org/6ZdPUh0R4 ) Background Hazardous alcohol consumption is a leading modifiable cause of mortality and morbidity among young people .  Screening and brief intervention ( SBI ) is a key strategy to reduce alcohol-related harm in the community , and web-based approaches ( e-SBI ) have advantages over practitioner-delivered approaches , being cheaper , more acceptable , administrable remotely and infinitely scalable . An efficacy trial in a university population showed a 10-minute intervention could reduce drinking by 11 % for 6 months or more among 17 - 24 year-old undergraduate hazardous drinkers . The e-SBINZ study is design ed to examine the effectiveness of e-SBI across a range of universities and among Māori and non-Māori students in New Zeal and . Methods / Design The e-SBINZ study comprises two parallel , double blind , multi-site , individually r and omised controlled trials . This paper outlines the background and design of the trial , which is recruiting 17 - 24 year-old students from seven of New Zeal and 's eight universities . Māori and non-Māori students are being sample d separately and are invited by e-mail to complete a web question naire including the AUDIT-C. Those who score > 4 will be r and omly allocated to no further contact until follow-up ( control ) or to assessment and personalised feedback ( intervention ) via computer . Follow-up assessment will occur 5 months later in second semester . Recruitment , consent , r and omisation , intervention and follow-up are all online . Primary outcomes are ( i ) total alcohol consumption , ( ii ) frequency of drinking , ( iii ) amount consumed per typical drinking occasion , ( iv ) the proportions exceeding medical guidelines for acute and chronic harm , and ( v ) scores on an academic problems scale . Discussion The trial will provide information on the effectiveness of e-SBI in reducing hazardous alcohol consumption across diverse university student population s with separate effect estimates for Māori and non-Māori students . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) Background Online self-help interventions for problem drinkers show promising results , but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined . Objective The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers , with the hypotheses that e-therapy would ( 1 ) reduce weekly alcohol consumption , and ( 2 ) improve health status . Reasons for dropout were also systematic ally investigated . Method In an open r and omized controlled trial , Dutch-speaking problem drinkers in the general population were r and omly assigned ( in blocks of 8 , according to a computer-generated r and om list ) to the 3-month e-therapy program ( n = 78 ) or the waiting list control group ( n = 78 ) . The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously , via the Internet only . Participants in the waiting list control group received “ no-reply ” email messages once every 2 weeks . The primary outcome measures were ( 1 ) the difference in the score on weekly alcohol consumption , and ( 2 ) the proportion of participants drinking under the problem drinking limit . Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up . A dropout question naire was sent to anyone who did not complete the 3-month assessment . Reasons for dropout were independently assessed by the first and third author . Results Of the 156 individuals who were r and omly assigned , 102 ( 65 % ) completed assessment at 3 months . In the intention-to-treat analyses , the e-therapy group ( n = 78 ) showed a significantly greater decrease in alcohol consumption than those in the control group ( n = 78 ) at 3 months . The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group , a difference in means of 25.6 units on a weekly basis ( 95 % confidence interval 15.69 - 35.80 , P < .001 ) . The between-group effect size ( pooled SD ) was large ( d = 1.21 ) . The results also showed that 68 % ( 53/78 ) of the e-therapy group was drinking less than 15 ( females ) or 22 ( males ) units a week , compared with 15 % ( 12/78 ) in the control group ( OR 12.0 , number needed to treat 1.9 , P < .001 ) . Dropout analysis showed that the main reasons for dropouts ( n = 54 ) were personal reasons unrelated to the e-therapy program , discomfort with the treatment protocol , and satisfaction with the positive results achieved . Conclusions E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem . Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts . Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program . Trial registration IS RCT N39104853 ; http://controlled-trials.com/IS RCT N39104853/IS RCT N39104853 ( Archived by WebCite at http://www.webcitation.org/5uX1R5xfW OBJECTIVE To determine whether ( a ) social networks influence the extent to which college students initiate and /or maintain reductions in drinking following an alcohol intervention and ( b ) students with riskier networks respond better to a counselor-delivered , vs. a computer-delivered , intervention . METHOD M and ated students ( N = 316 ; 63 % male ) provided their perceptions of peer network members ' drinking statuses ( e.g. , heavy drinker ) and how accepting each friend would be if the participant reduced his or her drinking . Next , they were r and omized to receive a brief motivational intervention ( BMI ) or Alcohol Edu for Sanctions ( EDU ) . In latent growth models controlling for baseline levels on outcomes , influences of social networks on 2 phases of intervention response were examined : initiation of reductions in drinks per heaviest week , peak blood alcohol content ( BAC ) , and consequences at 1 month ( model intercepts ) and maintenance of reductions between 1 and 12 months ( model slopes ) . RESULTS Peer drinking status predicted initiation of reductions in drinks per heaviest week and peak BAC ; peer acceptability predicted initial reductions in consequences . Peer Acceptability × Condition interactions were significant or marginal for all outcomes in the maintenance phase . In networks with higher perceived acceptability of decreasing use , BMI and EDU exhibited similar growth rates . In less accepting networks , growth rates were significantly steeper among EDU than BMI participants . For consumption outcomes , lower perceived peer acceptability predicted steeper rates of growth in drinking among EDU but not BMI participants . CONCLUSIONS Underst and ing how social networks influence behavior change and how interventions mitigate their influence is important for optimizing efficacy of alcohol interventions OBJECTIVES Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States ; binge drinking peaks at age 21 - 25 years . Underage drinking is associated with many negative consequences , including academic problems and risk of intentional and unintentional injuries . This study tested the effectiveness of pediatric emergency department ( PED ) screening and brief intervention to reduce alcohol consumption and associated risks . METHODS A three-group r and omized assignment trial was structured to test differences between intervention ( I ) and st and ard assessed control ( AC ) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control ( MAC ) group to adjust for the effect of assessment reactivity on control group behavior . Patients aged 14 - 21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test ( AUDIT ) or for binge drinking or high-risk behaviors . The MAC group received a re source h and out , written advice about alcohol-related risks , and a 12-month follow-up appointment . Patients in the AC group were assessed using st and ardized instruments in addition to the MAC protocol . The I group received a peer-conducted motivational intervention , referral to community re sources and treatment if indicated , and a 10-day booster in addition to assessment . Measurements included 30-day self-report of alcohol consumption and alcohol-related behaviors , screens for depression and posttraumatic stress disorder , and self-report of attempts to quit , cut back , or change conditions of use , all repeated at follow-up . Motor vehicle records and medical records were also analyzed for changes from baseline to 1-year follow-up . RESULTS Among 7,807 PED patients screened , 1,202 were eligible ; 853 enrolled ( I , n = 283 ; AC , n = 284 ; MAC , n = 286 ) , with a 12-month follow-up rate of 72 % . At 12 months , more than half of enrollees in Reaching Adolescents for Prevention ( RAP ) attempted to cut back on drinking , and over a third tried to quit . A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees , and there was a numerically but not significantly greater likelihood ( p = 0.065 ) among the I group for efforts to cut back on drinking . At 3 months , the likelihood of the I group making attempts to cut back was almost triple that of ACs . For efforts to quit , it was double , and for trying to be careful about situations when drinking , there was a 72 % increase in the odds ratio ( OR ) for the I group . Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful . Consumption declined in both groups from baseline to 3 months to 12 months , but there were no significant between-group differences in alcohol-related consequences at 12 months or in alcohol-related risk behaviors . We found a pattern suggestive of assessment reactivity in only one variable at 12 months : the attempt to cut back ( 73.3 % for the I group vs. 64.9 % among the AC group and 54.8 % among the MAC group ) . CONCLUSIONS Brief motivational intervention result ed in significant efforts to change behavior ( quit drinking and be careful about situations while drinking ) but did not alter between-group consumption or consequences ABSTRACT Background : Because of their ability to reach a 
    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: Background Alcohol consumption of college students has a fluctuating nature , which might impact the measurement of intervention effects . By using 25 follow-up time-points , this study tested whether intervention effects are robust or might vary over time . Methods Data were used from a two-arm parallel group r and omized controlled trial applying ecological momentary assessment ( EMA ) with 30 data time-points in total . Students between 18 and 24 years old who reported heavy drinking in the past six months and who were ready to change their alcohol consumption were r and omly assigned to the experimental ( n = 456 : web-based brief alcohol intervention ) and control condition ( n = 451 : no intervention ) . Outcome measures were weekly alcohol consumption , frequency of binge drinking , and heavy drinking status . Results According to the intention-to-treat principle , regression analyses revealed that intervention effects on alcohol consumption varied when exploring multiple follow-up time-points . Intervention effects were found for a ) weekly alcohol consumption at 1 , 2 , 3 , 4 , and 7 weeks follow-up , b ) frequency of binge drinking at 1 , 2 , 7 , and 12 weeks follow-up , and c ) heavy drinking status at 1 , 2 , 7 , and 16 weeks follow-up . Conclusions This research showed that the commonly used one and six month follow-up time-points are relatively arbitrary and not using EMA might bring forth erroneous conclusions on the effectiveness of interventions . Therefore , future trials in alcohol prevention research and beyond are encouraged to apply EMA when assessing outcome measures and intervention effectiveness . Trial registration Netherl and s Trial Register Background Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results . Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale , there is a need for further study . Objective This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden . Methods Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question . These students ( N=1605 ) gave consent and were r and omized into a 2-arm parallel group r and omized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback . Results After 2 months , there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses , although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10 % reduction ( 95 % CI –30 % to 10 % ) in total weekly alcohol consumption . Also , differences in effect sizes between universities were seen with participants from a major university ( n=365 ) reducing their weekly alcohol consumption by 14 % ( 95 % CI –23 % to –4 % ) . However , lower recruitment than planned and differential attrition in the intervention and control group ( 49 % vs 68 % ) complicated interpretation of the outcome data . Conclusions Any effects of current national provision are likely to be small and further research and development work is needed to enhance effectiveness . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 02335307 ; http://www.is rct n.com/IS RCT N02335307 ( Archived by WebCite at http://www.webcitation.org/6ZdPUh0R4 ) Background Hazardous alcohol consumption is a leading modifiable cause of mortality and morbidity among young people .  Screening and brief intervention ( SBI ) is a key strategy to reduce alcohol-related harm in the community , and web-based approaches ( e-SBI ) have advantages over practitioner-delivered approaches , being cheaper , more acceptable , administrable remotely and infinitely scalable . An efficacy trial in a university population showed a 10-minute intervention could reduce drinking by 11 % for 6 months or more among 17 - 24 year-old undergraduate hazardous drinkers . The e-SBINZ study is design ed to examine the effectiveness of e-SBI across a range of universities and among Māori and non-Māori students in New Zeal and . Methods / Design The e-SBINZ study comprises two parallel , double blind , multi-site , individually r and omised controlled trials . This paper outlines the background and design of the trial , which is recruiting 17 - 24 year-old students from seven of New Zeal and 's eight universities . Māori and non-Māori students are being sample d separately and are invited by e-mail to complete a web question naire including the AUDIT-C. Those who score > 4 will be r and omly allocated to no further contact until follow-up ( control ) or to assessment and personalised feedback ( intervention ) via computer . Follow-up assessment will occur 5 months later in second semester . Recruitment , consent , r and omisation , intervention and follow-up are all online . Primary outcomes are ( i ) total alcohol consumption , ( ii ) frequency of drinking , ( iii ) amount consumed per typical drinking occasion , ( iv ) the proportions exceeding medical guidelines for acute and chronic harm , and ( v ) scores on an academic problems scale . Discussion The trial will provide information on the effectiveness of e-SBI in reducing hazardous alcohol consumption across diverse university student population s with separate effect estimates for Māori and non-Māori students . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) Background Online self-help interventions for problem drinkers show promising results , but the effectiveness of online therapy with active involvement of a therapist via the Internet only has not been examined . Objective The objective of our study was to evaluate an e-therapy program with active therapeutic involvement for problem drinkers , with the hypotheses that e-therapy would ( 1 ) reduce weekly alcohol consumption , and ( 2 ) improve health status . Reasons for dropout were also systematic ally investigated . Method In an open r and omized controlled trial , Dutch-speaking problem drinkers in the general population were r and omly assigned ( in blocks of 8 , according to a computer-generated r and om list ) to the 3-month e-therapy program ( n = 78 ) or the waiting list control group ( n = 78 ) . The e-therapy program consisted of a structured 2-part online treatment program in which the participant and the therapist communicated asynchronously , via the Internet only . Participants in the waiting list control group received “ no-reply ” email messages once every 2 weeks . The primary outcome measures were ( 1 ) the difference in the score on weekly alcohol consumption , and ( 2 ) the proportion of participants drinking under the problem drinking limit . Intention-to-treat analyses were performed using multiple imputations to deal with loss to follow-up . A dropout question naire was sent to anyone who did not complete the 3-month assessment . Reasons for dropout were independently assessed by the first and third author . Results Of the 156 individuals who were r and omly assigned , 102 ( 65 % ) completed assessment at 3 months . In the intention-to-treat analyses , the e-therapy group ( n = 78 ) showed a significantly greater decrease in alcohol consumption than those in the control group ( n = 78 ) at 3 months . The e-therapy group decreased their mean weekly alcohol consumption by 28.8 units compared with 3.1 units in the control group , a difference in means of 25.6 units on a weekly basis ( 95 % confidence interval 15.69 - 35.80 , P < .001 ) . The between-group effect size ( pooled SD ) was large ( d = 1.21 ) . The results also showed that 68 % ( 53/78 ) of the e-therapy group was drinking less than 15 ( females ) or 22 ( males ) units a week , compared with 15 % ( 12/78 ) in the control group ( OR 12.0 , number needed to treat 1.9 , P < .001 ) . Dropout analysis showed that the main reasons for dropouts ( n = 54 ) were personal reasons unrelated to the e-therapy program , discomfort with the treatment protocol , and satisfaction with the positive results achieved . Conclusions E-therapy for problem drinking is an effective intervention that can be delivered to a large population who otherwise do not seek help for their drinking problem . Insight into reasons for dropout can help improve e-therapy programs to decrease the number of dropouts . Additional research is needed to directly compare the effectiveness of the e-therapy program with a face-to-face treatment program . Trial registration IS RCT N39104853 ; http://controlled-trials.com/IS RCT N39104853/IS RCT N39104853 ( Archived by WebCite at http://www.webcitation.org/5uX1R5xfW OBJECTIVE To determine whether ( a ) social networks influence the extent to which college students initiate and /or maintain reductions in drinking following an alcohol intervention and ( b ) students with riskier networks respond better to a counselor-delivered , vs. a computer-delivered , intervention . METHOD M and ated students ( N = 316 ; 63 % male ) provided their perceptions of peer network members ' drinking statuses ( e.g. , heavy drinker ) and how accepting each friend would be if the participant reduced his or her drinking . Next , they were r and omized to receive a brief motivational intervention ( BMI ) or Alcohol Edu for Sanctions ( EDU ) . In latent growth models controlling for baseline levels on outcomes , influences of social networks on 2 phases of intervention response were examined : initiation of reductions in drinks per heaviest week , peak blood alcohol content ( BAC ) , and consequences at 1 month ( model intercepts ) and maintenance of reductions between 1 and 12 months ( model slopes ) . RESULTS Peer drinking status predicted initiation of reductions in drinks per heaviest week and peak BAC ; peer acceptability predicted initial reductions in consequences . Peer Acceptability × Condition interactions were significant or marginal for all outcomes in the maintenance phase . In networks with higher perceived acceptability of decreasing use , BMI and EDU exhibited similar growth rates . In less accepting networks , growth rates were significantly steeper among EDU than BMI participants . For consumption outcomes , lower perceived peer acceptability predicted steeper rates of growth in drinking among EDU but not BMI participants . CONCLUSIONS Underst and ing how social networks influence behavior change and how interventions mitigate their influence is important for optimizing efficacy of alcohol interventions OBJECTIVES Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States ; binge drinking peaks at age 21 - 25 years . Underage drinking is associated with many negative consequences , including academic problems and risk of intentional and unintentional injuries . This study tested the effectiveness of pediatric emergency department ( PED ) screening and brief intervention to reduce alcohol consumption and associated risks . METHODS A three-group r and omized assignment trial was structured to test differences between intervention ( I ) and st and ard assessed control ( AC ) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control ( MAC ) group to adjust for the effect of assessment reactivity on control group behavior . Patients aged 14 - 21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test ( AUDIT ) or for binge drinking or high-risk behaviors . The MAC group received a re source h and out , written advice about alcohol-related risks , and a 12-month follow-up appointment . Patients in the AC group were assessed using st and ardized instruments in addition to the MAC protocol . The I group received a peer-conducted motivational intervention , referral to community re sources and treatment if indicated , and a 10-day booster in addition to assessment . Measurements included 30-day self-report of alcohol consumption and alcohol-related behaviors , screens for depression and posttraumatic stress disorder , and self-report of attempts to quit , cut back , or change conditions of use , all repeated at follow-up . Motor vehicle records and medical records were also analyzed for changes from baseline to 1-year follow-up . RESULTS Among 7,807 PED patients screened , 1,202 were eligible ; 853 enrolled ( I , n = 283 ; AC , n = 284 ; MAC , n = 286 ) , with a 12-month follow-up rate of 72 % . At 12 months , more than half of enrollees in Reaching Adolescents for Prevention ( RAP ) attempted to cut back on drinking , and over a third tried to quit . A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees , and there was a numerically but not significantly greater likelihood ( p = 0.065 ) among the I group for efforts to cut back on drinking . At 3 months , the likelihood of the I group making attempts to cut back was almost triple that of ACs . For efforts to quit , it was double , and for trying to be careful about situations when drinking , there was a 72 % increase in the odds ratio ( OR ) for the I group . Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful . Consumption declined in both groups from baseline to 3 months to 12 months , but there were no significant between-group differences in alcohol-related consequences at 12 months or in alcohol-related risk behaviors . We found a pattern suggestive of assessment reactivity in only one variable at 12 months : the attempt to cut back ( 73.3 % for the I group vs. 64.9 % among the AC group and 54.8 % among the MAC group ) . CONCLUSIONS Brief motivational intervention result ed in significant efforts to change behavior ( quit drinking and be careful about situations while drinking ) but did not alter between-group consumption or consequences ABSTRACT Background : Because of their ability to reach a 
    Output:
    