***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 There is an established link between socioeconomic status ( SES ) and performance of health behaviors with more health protective and fewer health-risking behaviors in higher SES groups . Purpose This research is novel in testing the moderating effect of SES on the relationship among intention , self-efficacy , and subsequent behavior . Methods Effects were tested on data from three prospect i ve correlational studies examining smoking initiation in adolescents ( N = 826 ) , breastfeeding in primiparous women ( N = 202 ) , and physical activity in working adults ( N = 509 ) . Results Despite examining different behaviors , sample s , time intervals , and measures of SES , each study showed significant interactions between intention and SES in predicting behavior . In all three tests , the intention – behavior relationship was attenuated among individuals from lower SES groups . No moderation effects of SES were found for self-efficacy . Conclusions The intention – health behavior relationship can be attenuated in lower SES sample s. This finding may contribute to our underst and ing of SES differences in health behaviors Background Regular physical activity ( PA ) is a key contributor to healthy ageing . However , despite known health benefits , only one third of older adults in Germany reach the PA levels recommended for persons aged 65 years and above by the World Health Organization . The aim of the current study is to evaluate the effectiveness of two web-based interventions for the initiation and maintenance of regular PA ( i.e. , intervention groups 1 and 2 ) compared to a delayed intervention control group of older adults aged 65 to 75 years . Methods / Design Study participants will be r and omly assigned to one of three study arms in five communities in the Bremen-Oldenburg metropolitan region : a ) Participants in the first arm will receive access to a web-based intervention for 10 weeks allowing them to track their weekly PA ( subjective self-monitoring , intervention group 1 ) ; b ) participants in the second arm will receive access to the web-based intervention for 10 weeks and , in addition , track PA using Fitbit Zips ( objective self-monitoring , intervention group 2 ) ; c ) participants in the delayed intervention control group will receive access to the intervention implemented in the first study arm after completion of the 12-week follow-up in the other two groups within each community . In addition , weekly group meetings in the communities will be offered to study participants in the intervention groups providing the opportunity to address questions related to the use of the website and to practice PA in groups ( e.g. , neighborhood walks , strength and balance exercises ) . To evaluate short-term effects of the intervention on physical and psychological health , PA , physical fitness , and cognitive and psychological variables will be assessed at baseline and 12-week follow-up . Discussion This study will provide answers regarding acceptance and effectiveness of web-based interventions promoting uptake and maintenance of regular PA in persons aged 65–75 years . Study findings will contribute to a growing body of evidence in Germany concerning the role of community-based interventions for the promotion of PA and healthy ageing in older adults . Trial registration German Clinical Trials Register DRKS00010052 ( Date of registration 07–11 - 2016 ) BACKGROUND Physical activity has a protective effect against  cardiovascular disease ( CVD )  in high-income countries , where physical activity is mainly recreational , but it is not known if this is also observed in lower-income countries , where physical activity is mainly non-recreational . We examined whether different amounts and types of physical activity are associated with lower mortality and CVD  in countries at different economic levels . METHODS In this prospect i ve cohort study , we recruited participants from 17 countries ( Canada , Sweden , United Arab Emirates , Argentina , Brazil , Chile , Pol and , Turkey , Malaysia , South Africa , China , Colombia , Iran , Bangladesh , India , Pakistan , and Zimbabwe ) . Within each country , urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity . Within these communities , we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years .  Total physical activity  was assessed using the  International Physical Activity Question naire ( IPQA ) . Participants with pre-existing CVD were excluded from the analyses . Mortality and CVD were recorded during a mean of 6·9 years of follow-up . Primary clinical outcomes during follow-up were mortality plus major CVD ( CVD mortality , incident myocardial infa rct ion , stroke , or heart failure ) , either as a composite or separately . The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household , community , and country clustering . FINDINGS Between Jan 1 , 2003 , and Dec 31 , 2010 , 168 916 participants were enrolled , of whom 141 945 completed the IPAQ . Analyses were limited to the 130 843 participants without pre-existing CVD . Compared with low physical activity ( < 600 metabolic equivalents [ MET ] × minutes per week or < 150 minutes per week of moderate intensity physical activity ) , moderate ( 600 - 3000 MET × minutes or 150 - 750 minutes per week ) and high physical activity ( > 3000 MET × minutes or > 750 minutes per week ) were associated with grade d reduction in mortality ( hazard ratio 0·80 , 95 % CI 0·74 - 0·87 and 0·65 , 0·60 - 0·71 ; p<0·0001 for trend ) , and major CVD ( 0·86 , 0·78 - 0·93 ; p<0·001 for trend  ) . Higher physical activity was associated with lower risk of CVD and mortality  in high-income , middle-income , and low-income countries . The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0 % for mortality and 4·6 % for major CVD , and for not meeting high physical activity was 13·0 % for mortality and 9·5 % for major CVD . Both recreational and non-recreational physical activity were associated with benefits . INTERPRETATION Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income , middle-income , and high-income countries . Increasing physical activity is a simple , widely applicable , low cost global strategy that could reduce deaths and CVD in middle age . FUNDING Population Health Research Institute , the Canadian Institutes of Health Research , Heart and Stroke Foundation of Ontario , Ontario SPOR Support Unit , Ontario Ministry of Health and Long-Term Care , AstraZeneca , Sanofi-Aventis , Boehringer Ingelheim , Servier , GSK , Novartis , King Pharma , and national and local organisations in participating countries that are listed at the end of the Article Reducing health inequalities is a key objective for many governments and public health organizations . Whether inequalities are measured on the absolute ( difference ) or relative ( ratio ) scale can have a significant impact on judgments about whether health inequalities are increasing or decreasing , but both of these measures are not often presented in empirical studies . In this study we investigated the impact of selective presentation of health ine quality measures on judgments of health ine quality trends among 40 university undergraduates . We r and omized participants to see either a difference or ratio measure of health ine quality alongside raw mortality rates in 5 different scenarios . At baseline there were no differences between treatment groups in assessment s of ine quality trends , but selective exposure to the same raw data augmented with ratio versus difference ine quality graphs altered participants ’ assessment s of ine quality change . When absolute ine quality decreased and relative ine quality increased , exposure to ratio measures increased the probability of concluding that ine quality had increased from 32.5 % to 70 % , but exposure to difference measures did not ( 35 % vs. 25 % ) . Selective exposure to ratio versus difference ine quality graphs thus increased the difference between groups in concluding that ine quality had increased from 2.5 % ( 95 % CI −9.5 % to 14.5 % ) to 45 % ( 95 % CI 29.4 to 60.6 ) . A similar pattern was evident for other scenarios where absolute and relative ine quality trends gave conflicting results . In cases where measures of absolute and relative ine quality both increased or both decreased , we did not find any evidence that assignment to ratio vs. difference graphs had an impact on assessment s of ine quality change . Selective reporting of measures of health ine quality has the potential to create biased judgments of progress in ameliorating health inequalities Background Healthy ageing is an important concern for many societies facing the challenge of an ageing population . Physical activity ( PA ) is a major contributor to healthy ageing ; however insufficient PA levels are prevalent in old age in Germany .  Community capacity building and community involvement are often recommended as key strategies to improve equitable access to prevention and health promotion . However , evidence for the effectiveness of these strategies is scarce . This study aims to assess the community readiness for PA promotion in local environments and to analyse the utility of strategies to increase community readiness for reaching vulnerable groups . Methods / Design We design ed a mixed method intervention trial comprising three study modules . The first module includes an assessment of  community readiness for PA interventions in older adults . The assessment is carried out in a sample of 24 municipalities in the Northwest of Germany using structured key informant interviews . In the second module , eight municipalities with the low community readiness are selected from the sample and r and omly assigned to one of two study groups : active enhancement of community readiness ( intervention ) versus no enhancement ( control ) . After enhancing community readiness in the active enhancement group , older adults in both study groups will be recruited for participation in a PA intervention .  Participation rates are compared between the study groups to evaluate the effects of the intervention . In addition , a cost-effectiveness analysis is carried out calculating recruitment costs per person reached in the two study groups . In the third module , qualitative interviews are conducted with participants and non- participants of the PA intervention exploring reasons for participation or non-participation . Discussion This study offers the potential to contribute to the evidence base of reaching vulnerable older adults for PA interventions and provide ideas on how to reduce participation barriers . Its findings will inform governmental authorities , professionals , academics , and NGOs with an estimate of re sources necessary to achieve equitable access to physical activity programs for vulnerable older adults . Trial registration German Clinical Trials Register DRKS00009564 ( Date of registration 03 - 11 - 2015 Background Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany . Physical activity promotion programs for older adults are often not successful , one reason is insufficient relevance of intervention measures for the study population . Community-based participatory research ( CBPR ) is a possible key strategy for tailoring more meaningful intervention programs to a specific community . However , evidence for the effectiveness of CBPR in the general population is scarce . This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults . Methods / design The OUTDOOR ACTIVE intervention trial is a cluster-r and omised intervention study carried out in a r and om sample of eight subdistricts in the city of Bremen , Germany . The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and l and use mix of the subdistrict . Within the pairs , the subdistricts are assigned r and omly to the two study arms : participatory development and implementation of a community-based program to promote outdoor physical activity ( intervention ) versus no intervention ( controls ) . For evaluation , a survey is carried out before ( baseline ) and after ( follow-up ) the intervention period . The measurements include 7-day accelerometer measurement , physical fitness test , blood pressure , basic anthropometry , and self-administered question naire . Discussion The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting . Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group , and it will inform policy makers and other stakeholders how to benefit from the results .Trial registration German Clinical Trials Register DRKS00015117 ( Date of registration 17 - 07 - 2018 ) 
    Output:
    
The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation , compliance with and acceptance of interventions , as well as the efficacy of interventions .
Equity impact assessment s are beneficial for prioritizing interventions most likely to be effective in reducing health inequalities