***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 The Dutch government recently added universal Human Papilloma Virus ( HPV ) vaccination for 12-year-old girls to the existing national immunization program . The participation rate for the initial catch-up campaign for girls aged 13 to 16 years in 2009 was lower ( 47 % ) than expected ( 70 % ) . To inform future HPV information campaigns , this paper examines the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009 . Methods A r and om sample of girls and their mothers was chosen from the Dutch vaccination register and received a letter inviting them to participate ( n = 5,998 mothers and daughters ) . In addition , a r and om sample was recruited via an online panel by a marketing research company ( n = 650 mothers ; n = 350 daughters ) . Both groups were asked to complete a web-based question naire with questions on social demographic characteristics , social-psychological factors and HPV vaccination intention . Backward linear regression analyses were conducted to examine which social-psychological factors were most dominantly associated with vaccination intention . Results Data from 952 mothers ( 14 % ) and 642 daughters ( 10 % ) were available for the intended analyses . The contribution of social demographic variables to the explained variance of HPV vaccination intention was small but significant for mothers ( ΔR2 = .01 ; p = .007 ) , but not significant for daughters ( ΔR2 = .02 ; p = .17 ) after controlling for HPV vaccination uptake and the sample . In addition , social-psychological determinants largely contributed to the explained variance of HPV vaccination intention of mothers ( ΔR2 = .35 ; p < .001 ) and daughters ( ΔR2 = .34 ; p < .001 ) . Attitudes , beliefs , subjective norms and habit strength were significantly associated with participants ’ HPV vaccination intentions . Conclusions Because of the large contribution of social-psychological variables to the explained variance of HPV vaccination intentions among the mothers and daughters , future communication strategies targeting HPV vaccination uptake should address attitudes , beliefs , subjective norms and habit strength . There is a need for longitudinal research to confirm the causality of the association between these determinants and HPV vaccination behavior indicated by this study Background Austria introduced a school-based gender-neutral human papillomavirus ( HPV ) immunization program in February 2014 . In order to assure high coverage , factors influencing acceptance of the vaccine need to be identified . In this study we aim to assess parents ’ attitude and related socio-demographic factors in relation to the newly implemented gender-neutral , school-based HPV Immunization program . Methods Parents of 4th grade school children in 20 r and omly selected primary schools were asked to fill out question naires on socio-demographic factors and on the level of information and attitude towards HPV infection and HPV vaccine . Results A total of 439 parents with 449 vaccine eligible children participated in the study . Fifty nine percent of vaccine eligible girls and 51.8 % of eligible boys received the first dose of the vaccine . Fear of side effects and child being too young for the vaccine were the most commonly cited reasons by parents electing not to let child receive the vaccine . Children who had received other school-based vaccines have more than fifteen times higher probability of receiving HPV vaccine . To have received HPV-related information from physicians positively influenced vaccine acceptance ( OR ( 95 % CI)=1.60 ( 1.06–2.43 ) ) . Higher paternal ( fathers ’ ) educational status significantly increased the chances of a male child to be HPV vaccinated ( OR ( 95 % CI)=2.45 ( 1.29–4.78 ) ) . Conclusion Despite the efforts to provide HPV vaccine free-of-costs and as a school-based program , the study found that a significant proportion of vaccine eligible children failed to receive the vaccine . Involvement front line physicians and men with higher educational status may be utilised by public health policy makers in the effort to increase awareness . For a better acceptability of the vaccine , there is a need to consider lifting the age of “ eligibility ” for the school-based vaccination program Background Human papillomavirus ( HPV ) infection has been causally linked to six cancers , and many disproportionately affect minorties . This study reports on the development and effectiveness of an intervention aim ed at increasing HPV vaccine uptake among African American and Hispanic pediatric patients in safety-net clinics . Methods Formative research , community engagement , and theory guided development of the intervention . A clustered , non-r and omized controlled pragmatic trial was conducted in four clinics providing healthcare for the underserved in Tennessee , U.S. , with two intervention sites and two usual care sites . Patients aged 9 - 18 years ( N = 408 ) and their mothers ( N = 305 ) enrolled , with children clustered within families . The intervention consisted of two provider/staff training sessions and provision of patient education material s , consisting of a video/flyer promoting HPV vaccine . Medical records were review ed before/after the initial visit and after 12 months . Results At the initial visit , provision of patient education material s and provider recommendation were higher at intervention sites versus usual care sites , and receipt of HPV vaccine was higher at intervention sites ( 45.4 % versus 32.9 % ) but not significantly after adjusting for patient ’s age and mother ’s education . Provider recommendation , but not education material s , increased the likelihood of vaccine receipt at the initial visit , although over one-third of intervention mothers cited the flyer/video as motivating vaccination . Completion of the 3-dose series at follow-up was lower in the intervention arm . Conclusions Future interventions should combine patient education , intensive provider/staff education , and patient reminders . Research should compare patient education focusing on HPV vaccine only versus all adolescent vaccines . Trial registration Retrospectively registered with Clinical Trials.gov NCT02808832 , OBJECTIVE The study aims were to assess the influence of provider recommendations on parental vaccine perceptions and identify the most potent parent vaccine perceptions for HPV vaccine series initiation considering provider recommendation strength . METHODS We administered a question naire and assessed HPV vaccine cl aims among a stratified-r and om sample of parents of 9 - 17 year old girls enrolled in Florida 's Medicaid and the Children 's Health Insurance Program . Using multivariate analyses , we evaluated the associations between : ( 1 ) parent vaccine perceptions and provider recommendation strength , and ( 2 ) parent vaccine perceptions and HPV vaccine series initiation ( ≥1 vaccine cl aim or positive parental report ) controlling for provider recommendation strength . RESULTS The majority of the 2422 participating parents agreed that the  HPV vaccine  was safe ( 61 % ) , would not make girls more likely to have sex ( 69 % ) , and prevented cervical cancer ( 71 % ) . About half ( 44 % ) reported receiving a strong provider recommendation . Compared to parents without recommendations , parents with strong recommendations had 2 to 7 times higher odds of agreeing that : vaccines are safe , the HPV vaccine is safe , not concerned about side effects , and the vaccine prevents cervical cancer . Even when considering provider recommendation strength , HPV vaccine series initiation was more likely among girls of parents who agreed rather than disagreed that the HPV vaccine was safe [ odds ratio (OR)=5.8 , 95 % confidence interval (CI)=3.1 , 11.1 ] , does not cause sex ( OR=2.0 , 95 % CI=1.2 , 3.4 ) , prevents cervical cancer ( OR=2.0 , 95 % CI=1.0 , 3.4 ) , and prevents HPV infections ( OR=1.8 , 95 % CI=1.0 , 3.0 ) . CONCLUSIONS Parent concerns about HPV vaccine are similar to their concerns about other vaccines . Providers should focus HPV vaccine discussion s with parents on vaccine safety and illness prevention Background In 2008 Fiji implemented a nationwide Human Papillomavirus ( HPV ) vaccine campaign targeting all girls aged 9–12 years through the existing school-based immunisation program . Parents of vaccine-eligible girls were asked to provide written consent for vaccination . The purpose of this study was to describe parents ’ knowledge , experiences and satisfaction with the campaign , the extent to which information needs for vaccine decision-making were met , and what factors were associated with vaccine consent . Methods Following vaccine introduction , a cross-sectional telephone survey was conducted with parents of vaccine-eligible girls from r and omly selected schools , stratified by educational district . Factors related to vaccine consent were explored using Generalised Estimating Equations . Results There were 560 vaccine-eligible girls attending the participating 19 schools at the time of the campaign . Among these , 313 parents could be contacted , with 293 agreeing to participate ( 93.6 % ) . Almost 80 % of participants reported having consented to HPV vaccination ( 230/293 , 78.5 % ) . Reported knowledge of cervical cancer and HPV prior to the campaign was very low . Most respondents reported that they were satisfied with their access to information to make an informed decision about HPV vaccination ( 196/293 , 66.9 % ) . and this was very strongly associated with provision of consent . Despite their young age , the vaccine-eligible girls were often involved in the discussion and decision-making . Most consenting parents were satisfied with the campaign and their decision to vaccinate , with almost 90 % indicating they would consent to future HPV vaccination . However , negative media reports about the vaccine campaign created confusion and concern . Local health staff were cited as a trusted source of information to guide decision-making . Just over half of the participants who withheld consent cited vaccine safety fears as the primary reason ( 23/44 , 52.3 % ) . Conclusion This is the first reported experience of HPV introduction in a Pacific Isl and nation . In a challenging environment with limited community knowledge of HPV and cervical cancer , media controversy and a short lead-time for community education , Fiji has implemented an HPV vaccine campaign that was largely acceptable to the community and achieved a high level of participation . Community sensitisation and education is critical and should include a focus on the local health workforce and the vaccine target group BACKGROUND In the Netherl and s , HPV-vaccination uptake among 12-year-old girls remains to be lower ( 61 % in 2016 ) than expected . The present study is about 1 ) replicating the extent to which social-psychological determinants found in earlier cross-sectional studies explain HPV-vaccination intention , and 2 ) testing whether HPV-vaccination intention , as well as other social-psychological determinants , are good predictors of future HPV-vaccination uptake in a longitudinal design . METHODS A r and om sample of mothers of girls invited for the vaccination in 2015 was drawn from the Dutch vaccination register ( Praeventis ) ( N=36,000 ) and from three online panels ( N=2483 ) . Two months prior to the vaccination of girls , their mothers were requested to complete a web-based question naire by letter ( Praeventis sample ) or by e-mail ( panel sample s ) .  HPV-vaccination  uptake was derived from Praeventis . Backward linear and logistic regression analyses were conducted to examine most dominant predictors of HPV-vaccination intention and uptake , respectively . The total sample used for data analyses consisted of 8062 mothers . Response rates were 18 % for the Praeventis sample and 47 % for the panel sample s. RESULTS HPV-vaccination intention was best explained by attitude , beliefs , subjective norms , habit , and perceived relative effectiveness of the vaccination ; they explained 83 % of the variance in HPV-vaccination intention . Intention appeared to be the only stable predictor of HPV-vaccination uptake and explained 43 % of the variance in HPV-vaccination uptake . CONCLUSIONS These results confirm what was found by earlier cross-sectional studies , and provide strong leads for selecting relevant targets in the planning of future communication strategies aim ing to improve HPV-vaccination uptake Background There are few data on factors influencing human papillomavirus ( HPV ) vaccination uptake in sub-Saharan Africa . We examined the characteristics of receivers and non-receivers of HPV vaccination in Tanzania and identified reasons for not receiving the vaccine . Methods We conducted a case control study of HPV vaccine receivers and non-receivers within a phase IV cluster-r and omised trial of HPV vaccination in 134 primary schools in Tanzania . Girls who failed to receive vaccine ( pupil cases ) and their parents/guardians ( adult cases ) and girls who received dose 1 ( pupil controls ) of the quadrivalent vaccine ( Gardasil ™ ) and their parents/guardians ( adult controls ) were enrolled from 39 schools in a 1∶1 ratio and interviewed about cervical cancer , HPV vaccine knowledge and reasons why they might have received or not received the vaccine . Conditional logistic regression was used to determine factors independently associated with not receiving HPV vaccine . Results We interviewed 159 pupil/adult cases and 245 pupil/adult controls . Adult-factors independently associated with a daughter being a case were older age , owning 
    Output:
    
Findings indicate suboptimal levels of HPV vaccine uptake , twofold lower among boys , that may be improved by increasing physician recommendations , addressing parental safety concerns and promoting parents ' positive beliefs about vaccines , in addition to exp and ing insurance coverage and reducing out-of-pocket costs .