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 Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants . PURPOSE To examine the prevalence , longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents . METHODS Eight health risk behaviors  ( no regular consumption of fruit , vegetables or breakfast , overweight or obesity , physical inactivity , smoking , alcohol use and cannabis use ) were assessed in a prospect i ve population study ( second and third wave ) . Participants were assessed in three waves between ages 10 and 17 ( 2001 - 2008 ; n=2230 ) .  Multiple linear regression was used to assess the influence of gender , self-control , parental health risk behaviors , parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors ( analysis : 2013 - 2014 ) . RESULTS Rates of > 5 health risk behaviors were high : 3.6 % at age 13.5 and 10.2 % at age 16 . Smoking at age 13.5 was frequently associated with health risk behaviors at age 16 . No regular consumption of fruit , vegetables and breakfast , overweight or obesity , physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up . Significant predictors of the development of multiple health risk behaviors were  adolescents ' levels of self-control , socioeconomic status and maternal smoking . CONCLUSIONS Multiple health risk behaviors are common among adolescents . Individual and social factors predict changes in multiple health risk behaviors , showing that prevention targeting multiple risk behaviors is needed . Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes Objective : Given its prevalence and impact on health and well-being , children 's exposure to traumatic experiences is of growing importance to pediatricians and other medical providers . Little is known , however , about the traumatic experiences profiles , trauma-related sequelae , and service use patterns of youth with chronic or recurrent medical problems/disabilities . This study aim ed to fill this research gap . Method : Participants were children less than 18 years of age who were referred for assessment and /or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s ) ( n = 9885 ; mean = 11 years , SD = 4.3 ; 52.3 % girls ) . Generalized linear mixed models were used to examine associations among types of trauma , emotional and behavioral problems , and rates of service utilization adjusting for treatment center-level r and om effects , demographic characteristics , and the total number of types of trauma exposures . Results : Among children seeking treatment for traumatic stress , those with comorbid medical problems/disabilities had different demographic characteristics , different types of trauma exposure , and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities . Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures , associated symptoms , and higher levels of behavioral problems at home , school , or day care . Those with medical disorders/disabilities were at 30 % to 40 % higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms , used more medical and mental health services for trauma , and had more emotional and behavioral concerns . Conclusion : Given that pediatricians are more likely to see children with medical disabilities and concerns than those without , there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience . Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions Objectives : The purpose of this study was to identify the factors that predict good adherence to health regimens by adolescents with diabetes ( insulin-dependent diabetes mellitus ) . Methods : Altogether , 300 individuals aged 13—17 years were r and omly selected from the Finnish Social Insurance Institution 's register . Ninety-seven per cent ( N=289 ) of the selected adolescents returned the question naire . The data were analysed using the SPSS ( Statistical Package for Social Sciences ) for Windows software package . Logistic regression was used to find the factors that predict good adherence to health regimens . Results : About one-fifth ( 19 % ) of the respondents with diabetes felt that they complied fully with the health regimens , while 75 % placed themselves in the category of satisfactory adherence , and the remaining 6 % reported poor adherence . The most powerful predictor was the threat to mental wellbeing . The likelihood that adolescents who felt the disease to be a threat to their mental wellbeing would comply with health regimens was 7.68-fold as compared to those who did not regard the disease as a threat to their mental wellbeing . The next most powerful predictor was support from physician . The support from nurses , and the motivation , energy and willpower to take care of themselves and the threat to physical wellbeing , also predicted good adherence . The logistic regression model explained 82 % of the variance , and the model predicted correctly 88 % of the adolescents with good adherence . Discussion : This paper shows that adolescents with diabetes show quite good adherence . It also indicates the factors that predict good adherence to health regimens . To improve adherence , these factors should be given special attention in the care of adolescents BACKGROUND A growing body of literature indicates that adolescents with chronic conditions are as likely , or more likely , to take risky behaviours than their healthy peers . The objective of this research was to assess whether adolescents with chronic illness in Catalonia differ from their healthy peers in risk-taking behaviour . METHODS Data were drawn from the Catalonia Adolescent Health data base , a survey including a r and om school-based sample of 6952 young people , aged 14 - 19 years . The index group ( IG ) included 665 adolescents ( 450 females ) reporting several chronic conditions . The comparison group ( CG ) comprised 6287 healthy adolescents ( 3306 females ) .  Personal , family and school-related variables were analysed to ensure comparability between groups . Sexual behaviour , drug use ( tobacco , alcohol , cannabis , cocaine and synthetic drugs ) and perception of drug use among peers and in school were compared . Analysis was carried out separately by gender . chi-square , Fisher 's and Student 's tests were used to compare categorical and continuous variables . RESULTS The prevalence of chronic conditions was 9.6 % , with females showing a higher prevalence than males . The IG showed similar or higher rates of sexual intercourse and risky sexual behaviour . For most studied drugs , IG males reported slightly lower rates of use than CG males , while IG females showed higher rates for every drug studied . No differences were found in the perceptions of drug use among peers or in their school . CONCLUSIONS Similar to previous research , chronically ill adolescents in our sample are as likely , or more likely , to take risky behaviours than their healthy counterparts and should receive the same anticipatory guidance BACKGROUND Health-compromising behaviors among survivors of childhood cancer may increase their risks of cancer recurrence and the onset of chronic disease in adulthood . Regardless of whether such behaviors occur singly or in combination with one another , multiple behavioral risk factors must be identified and addressed early to promote better health outcomes within this special population . Adolescent survivors may be especially vulnerable , as reported rates of smoking and other risky behaviors are at or near levels of their healthy peers . The psychological literature suggests stress may play a role in risk behavior initiation and maintenance , including multiple behavioral risks , and that adolescent survivors are stress-prone . This report focuses on the prevalence and co-occurrence of three behavioral risk factors ( cigarette use , insufficient physical activity , and non-adherence to sun protection recommendations ) and describes stress-health behavior relationships in this special population . PROCEDURE All patients in this study ( n = 75 ) were adolescent survivors of childhood cancer and completed a baseline assessment of their  health behaviors and stress  as part of a r and omized controlled trial of health promotion . RESULTS Twenty-eight percent of the patients reported one of three risk factors , 12 % reported two of three risk factors , and 7 % reported all three risk factors . Non-adherence to sun protection was the single most common risk factor ; physical inactivity and non-adherent sun protection were the most common co-occurring risk factors . Greater age and stress were significantly associated with the presence of more behavioral risk factors . CONCLUSIONS The evidence suggests interventions to reduce multiple health-compromising behaviors in these patients are warranted , and that efforts to address these patients ' personal and family stress levels are important as well OBJECTIVE High rates of substance-use disorders ( SUD ) have been found in sample s of adolescents and adults with attention-deficit/hyperactivity disorder ( ADHD ) . Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied . The main aims of this study were to identify clinical ly meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex . METHOD Subjects were children and adolescents with ( n = 268 ; mean age ± st and ard deviation = 10.9 ± 3.2 years ) and without ( n = 229 ; mean age 11.9 ± 3.3 years ) DSM-III-R ADHD followed prospect ively and blindly over a 10-year follow-up period onto young adult years . Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs . RESULTS Over the 10-year follow-up period , ADHD was found to be a significant predictor of any SUD ( hazards ratio 1.47 ; 95 % confidence interval 1.07 - 2.02 ; p = .01 ) and cigarette smoking ( 2.38 ; 1.61 - 3.53 ; p < .01 ) . Within ADHD , comorbid conduct disorder ( 2.74 ; 1.66 - 4.52 ; p < .01 ) and oppositional defiant disorder ( 2.21 ; 1.40 - 3.51 ; p < .01 ) at baseline were also found to be significant predictors of SUDs . Similar results were found for cigarette- , alcohol- , and drug-use disorders . There were few meaningful sex interaction effects . No clinical ly significant associations were found for any social or family environment factors or for cognitive functioning factors ( p > .05 for all comparisons ) . CONCLUSIONS These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes BACKGROUND The authors investigated correlates of depression in a general population sample of adolescents ( 15 - 19 years ) and young adults ( 20 - 24 years ) . METHODS As part of the Finnish Health Care Survey a r and om sample of 509 adolescents ( 281 females , 228 males ) and 433 young adults ( 224 females , 209 males ) was interviewed in 1996 .  DSM-IIR major depressive episode ( MDE ) was assessed by the University of Michigan Composite International Diagnostic Interview Short Form ( UM-CIDI SF ) . RESULTS In multivariable regression analysis , current smoking ( odds ratio ( OR ) 5.54 ; 95 % confidence interval ( CI ) 1.44 , 21.3 ) and chronic illness ( OR 3.77 ; 95 % CI : 1.04 , 13.7 ) associated with MDE among adolescents . Among young adults , drunkenness at least twice a month ( OR 4.48 ; 95 % CI : 1.44 , 14.0 ) or once a month ( OR 2.79 ; 95 % CI : 1.14 , 6.83 ) , not being married nor cohabiting ( OR 3.50 ; 95 % CI : 1.35 , 9.08 ) and infrequent physical exercise ( OR 4.01 ; 95 % CI : 1.18 , 14.0 ) were related to MDE . Female MDE associated with not being married nor cohabiting ( OR 3.56 ; 95 % CI : 1.23 , 10.1 ) and living in southern Finl and ( OR 2.30 ; 95 % CI : 1.06 , 5.02 ) . Drunkenness at least twice a month was related to MDE among males ( OR 4.54 ; 95 % CI : 1.27 , 16.3 ) . CONCLUSIONS Attention should be paid to compromised health and health-related behaviour associating with MDE in youth . Specifically , the association between smoking and major depression in early adolescence should be borne in mind , and drinking habits or frequency of drunkenness should be carefully noted OBJECTIVES : To trace patterns of health and health behaviour in those with ancestry in the Indian subcontinent ( British Asians ) compared with the general population of their age ( 1 ) in the younger generation age 14 - 15 mainly born in the UK and ( 2 ) in the older mainly migrant generation . DESIGN : Cross sectional r and om sample surveys of two age groups in Glasgow . SAMPLE S : 334 British Asians ( 86 % born in the UK ) and 490 non-Asians , all aged 14 - 15 ; 173 British Asians aged 30 - 40 ( mean age 35 , 93 % born abroad 
    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 Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants . PURPOSE To examine the prevalence , longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents . METHODS Eight health risk behaviors  ( no regular consumption of fruit , vegetables or breakfast , overweight or obesity , physical inactivity , smoking , alcohol use and cannabis use ) were assessed in a prospect i ve population study ( second and third wave ) . Participants were assessed in three waves between ages 10 and 17 ( 2001 - 2008 ; n=2230 ) .  Multiple linear regression was used to assess the influence of gender , self-control , parental health risk behaviors , parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors ( analysis : 2013 - 2014 ) . RESULTS Rates of > 5 health risk behaviors were high : 3.6 % at age 13.5 and 10.2 % at age 16 . Smoking at age 13.5 was frequently associated with health risk behaviors at age 16 . No regular consumption of fruit , vegetables and breakfast , overweight or obesity , physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up . Significant predictors of the development of multiple health risk behaviors were  adolescents ' levels of self-control , socioeconomic status and maternal smoking . CONCLUSIONS Multiple health risk behaviors are common among adolescents . Individual and social factors predict changes in multiple health risk behaviors , showing that prevention targeting multiple risk behaviors is needed . Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes Objective : Given its prevalence and impact on health and well-being , children 's exposure to traumatic experiences is of growing importance to pediatricians and other medical providers . Little is known , however , about the traumatic experiences profiles , trauma-related sequelae , and service use patterns of youth with chronic or recurrent medical problems/disabilities . This study aim ed to fill this research gap . Method : Participants were children less than 18 years of age who were referred for assessment and /or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s ) ( n = 9885 ; mean = 11 years , SD = 4.3 ; 52.3 % girls ) . Generalized linear mixed models were used to examine associations among types of trauma , emotional and behavioral problems , and rates of service utilization adjusting for treatment center-level r and om effects , demographic characteristics , and the total number of types of trauma exposures . Results : Among children seeking treatment for traumatic stress , those with comorbid medical problems/disabilities had different demographic characteristics , different types of trauma exposure , and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities . Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures , associated symptoms , and higher levels of behavioral problems at home , school , or day care . Those with medical disorders/disabilities were at 30 % to 40 % higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms , used more medical and mental health services for trauma , and had more emotional and behavioral concerns . Conclusion : Given that pediatricians are more likely to see children with medical disabilities and concerns than those without , there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience . Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions Objectives : The purpose of this study was to identify the factors that predict good adherence to health regimens by adolescents with diabetes ( insulin-dependent diabetes mellitus ) . Methods : Altogether , 300 individuals aged 13—17 years were r and omly selected from the Finnish Social Insurance Institution 's register . Ninety-seven per cent ( N=289 ) of the selected adolescents returned the question naire . The data were analysed using the SPSS ( Statistical Package for Social Sciences ) for Windows software package . Logistic regression was used to find the factors that predict good adherence to health regimens . Results : About one-fifth ( 19 % ) of the respondents with diabetes felt that they complied fully with the health regimens , while 75 % placed themselves in the category of satisfactory adherence , and the remaining 6 % reported poor adherence . The most powerful predictor was the threat to mental wellbeing . The likelihood that adolescents who felt the disease to be a threat to their mental wellbeing would comply with health regimens was 7.68-fold as compared to those who did not regard the disease as a threat to their mental wellbeing . The next most powerful predictor was support from physician . The support from nurses , and the motivation , energy and willpower to take care of themselves and the threat to physical wellbeing , also predicted good adherence . The logistic regression model explained 82 % of the variance , and the model predicted correctly 88 % of the adolescents with good adherence . Discussion : This paper shows that adolescents with diabetes show quite good adherence . It also indicates the factors that predict good adherence to health regimens . To improve adherence , these factors should be given special attention in the care of adolescents BACKGROUND A growing body of literature indicates that adolescents with chronic conditions are as likely , or more likely , to take risky behaviours than their healthy peers . The objective of this research was to assess whether adolescents with chronic illness in Catalonia differ from their healthy peers in risk-taking behaviour . METHODS Data were drawn from the Catalonia Adolescent Health data base , a survey including a r and om school-based sample of 6952 young people , aged 14 - 19 years . The index group ( IG ) included 665 adolescents ( 450 females ) reporting several chronic conditions . The comparison group ( CG ) comprised 6287 healthy adolescents ( 3306 females ) .  Personal , family and school-related variables were analysed to ensure comparability between groups . Sexual behaviour , drug use ( tobacco , alcohol , cannabis , cocaine and synthetic drugs ) and perception of drug use among peers and in school were compared . Analysis was carried out separately by gender . chi-square , Fisher 's and Student 's tests were used to compare categorical and continuous variables . RESULTS The prevalence of chronic conditions was 9.6 % , with females showing a higher prevalence than males . The IG showed similar or higher rates of sexual intercourse and risky sexual behaviour . For most studied drugs , IG males reported slightly lower rates of use than CG males , while IG females showed higher rates for every drug studied . No differences were found in the perceptions of drug use among peers or in their school . CONCLUSIONS Similar to previous research , chronically ill adolescents in our sample are as likely , or more likely , to take risky behaviours than their healthy counterparts and should receive the same anticipatory guidance BACKGROUND Health-compromising behaviors among survivors of childhood cancer may increase their risks of cancer recurrence and the onset of chronic disease in adulthood . Regardless of whether such behaviors occur singly or in combination with one another , multiple behavioral risk factors must be identified and addressed early to promote better health outcomes within this special population . Adolescent survivors may be especially vulnerable , as reported rates of smoking and other risky behaviors are at or near levels of their healthy peers . The psychological literature suggests stress may play a role in risk behavior initiation and maintenance , including multiple behavioral risks , and that adolescent survivors are stress-prone . This report focuses on the prevalence and co-occurrence of three behavioral risk factors ( cigarette use , insufficient physical activity , and non-adherence to sun protection recommendations ) and describes stress-health behavior relationships in this special population . PROCEDURE All patients in this study ( n = 75 ) were adolescent survivors of childhood cancer and completed a baseline assessment of their  health behaviors and stress  as part of a r and omized controlled trial of health promotion . RESULTS Twenty-eight percent of the patients reported one of three risk factors , 12 % reported two of three risk factors , and 7 % reported all three risk factors . Non-adherence to sun protection was the single most common risk factor ; physical inactivity and non-adherent sun protection were the most common co-occurring risk factors . Greater age and stress were significantly associated with the presence of more behavioral risk factors . CONCLUSIONS The evidence suggests interventions to reduce multiple health-compromising behaviors in these patients are warranted , and that efforts to address these patients ' personal and family stress levels are important as well OBJECTIVE High rates of substance-use disorders ( SUD ) have been found in sample s of adolescents and adults with attention-deficit/hyperactivity disorder ( ADHD ) . Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied . The main aims of this study were to identify clinical ly meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex . METHOD Subjects were children and adolescents with ( n = 268 ; mean age ± st and ard deviation = 10.9 ± 3.2 years ) and without ( n = 229 ; mean age 11.9 ± 3.3 years ) DSM-III-R ADHD followed prospect ively and blindly over a 10-year follow-up period onto young adult years . Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs . RESULTS Over the 10-year follow-up period , ADHD was found to be a significant predictor of any SUD ( hazards ratio 1.47 ; 95 % confidence interval 1.07 - 2.02 ; p = .01 ) and cigarette smoking ( 2.38 ; 1.61 - 3.53 ; p < .01 ) . Within ADHD , comorbid conduct disorder ( 2.74 ; 1.66 - 4.52 ; p < .01 ) and oppositional defiant disorder ( 2.21 ; 1.40 - 3.51 ; p < .01 ) at baseline were also found to be significant predictors of SUDs . Similar results were found for cigarette- , alcohol- , and drug-use disorders . There were few meaningful sex interaction effects . No clinical ly significant associations were found for any social or family environment factors or for cognitive functioning factors ( p > .05 for all comparisons ) . CONCLUSIONS These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes BACKGROUND The authors investigated correlates of depression in a general population sample of adolescents ( 15 - 19 years ) and young adults ( 20 - 24 years ) . METHODS As part of the Finnish Health Care Survey a r and om sample of 509 adolescents ( 281 females , 228 males ) and 433 young adults ( 224 females , 209 males ) was interviewed in 1996 .  DSM-IIR major depressive episode ( MDE ) was assessed by the University of Michigan Composite International Diagnostic Interview Short Form ( UM-CIDI SF ) . RESULTS In multivariable regression analysis , current smoking ( odds ratio ( OR ) 5.54 ; 95 % confidence interval ( CI ) 1.44 , 21.3 ) and chronic illness ( OR 3.77 ; 95 % CI : 1.04 , 13.7 ) associated with MDE among adolescents . Among young adults , drunkenness at least twice a month ( OR 4.48 ; 95 % CI : 1.44 , 14.0 ) or once a month ( OR 2.79 ; 95 % CI : 1.14 , 6.83 ) , not being married nor cohabiting ( OR 3.50 ; 95 % CI : 1.35 , 9.08 ) and infrequent physical exercise ( OR 4.01 ; 95 % CI : 1.18 , 14.0 ) were related to MDE . Female MDE associated with not being married nor cohabiting ( OR 3.56 ; 95 % CI : 1.23 , 10.1 ) and living in southern Finl and ( OR 2.30 ; 95 % CI : 1.06 , 5.02 ) . Drunkenness at least twice a month was related to MDE among males ( OR 4.54 ; 95 % CI : 1.27 , 16.3 ) . CONCLUSIONS Attention should be paid to compromised health and health-related behaviour associating with MDE in youth . Specifically , the association between smoking and major depression in early adolescence should be borne in mind , and drinking habits or frequency of drunkenness should be carefully noted OBJECTIVES : To trace patterns of health and health behaviour in those with ancestry in the Indian subcontinent ( British Asians ) compared with the general population of their age ( 1 ) in the younger generation age 14 - 15 mainly born in the UK and ( 2 ) in the older mainly migrant generation . DESIGN : Cross sectional r and om sample surveys of two age groups in Glasgow . SAMPLE S : 334 British Asians ( 86 % born in the UK ) and 490 non-Asians , all aged 14 - 15 ; 173 British Asians aged 30 - 40 ( mean age 35 , 93 % born abroad 
    Output:
    