***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 
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    ***EXAMPLES*** 
    Input: Background : Interventions to improve adherence to regular mammography screening  have had conflicting results . Many studies have depended on women ’s self-report rather than clinical evidence of a mammography encounter . Methods : We tested the impact of two interventions on a population -based sample of NH women who were not receiving routine mammography to determine if adherence to screening could be improved . The interventions included a mailing of women ’s health information and a telephone counseling intervention based on the Transtheoretical Model . Participant eligibility and outcome measures were based on clinical events obtained from a population -based mammography registry . Results : Two hundred and fifty eight women completed all aspects of the intervention study . The women were r and omly assigned to one of two study groups : 51 % received the mail intervention and 49 % received the telephone intervention . Among women who received the telephone counseling intervention , 67 % percent reported being in either an action or maintenance stage at Call 1 , which increased to 84 % at Call 2 ( p<0.001 ) . Seventy-six percent of women identified barriers to screening mammography at Call 1 , which decreased to 44 % at Call 2 ( p<0.01 ) . The most frequently identified barrier was confusion over the guidelines for screening mammography . At the first assessment time interval , greater than 60 % of women were up-to- date for screening mammography in the group that received telephone counseling versus 48 % in the group that received health information by mail ( p = 0.04 ) . However , women ’s status as up-to- date fell for both groups between the first and second assessment time intervals . Conclusions : Tailored telephone counseling based on the Transtheoretical Model can improve adherence to screening mammography , though the duration of this effect is in question The effect on women ’s breast cancer screening utilization of a barrier-specific telephone counseling ( BSTC ) intervention , with and without a concurrent continuing medical education ( CME ) activity for their physicians , was evaluated . All participants ( 50 - 80 years of age ) were not regular mammography users at baseline . A 4-arm quasi-experimental design was employed . Women were r and omized to the BSTC or no BSTC group and assigned ( with their physicians ) to the CME or no CME group based on place of residence . Pre- and postintervention data were obtained for 1,601 women using telephone interviews conducted during 1995 and 1998 , respectively . Among women who had ever used mammography at baseline , those who received BSTC were more likely than the control group to become regular mammography users at follow-up ( OR = 1.4 , p = .033 ) . Greater reductions in perceived barriers to mammography , from baseline to follow-up , were significantly associated with receiving BSTC compared with the control group ( p = .001 ) , among women with previous mammography experience . Findings suggest that CME may have potential for initiating mammography use among women who never had a previous mammogram . However , because of the small sample available for analyses of the CME intervention and differential attrition among women who never had a previous mammogram , further study is needed to confirm this hypothesis BACKGROUND Few health promotion trials have evaluated strategies to increase regular mammography screening . We conducted a r and omized controlled trial of two theory-based interventions in a population -based , nationally representative sample of women veterans . METHODS Study c and i date s 52 years and older were r and omly sample d from the National Registry of Women Veterans and r and omly assigned to three groups . Groups 1 and 2 received interventions that varied in the extent of personalization ( tailored and targeted vs targeted-only , respectively ) ; group 3 was a survey-only control group . Postintervention follow-up surveys were mailed to all women after 1 and 2 years . Outcome measures were self-reported mammography coverage ( completion of one postintervention mammogram ) and compliance ( completion of two postintervention mammograms ) . In decreasingly conservative analyses ( intention-to-treat [ ITT ] , modified intention-to-treat [ MITT ] , and per- protocol [ PP ] ) , we examined crude coverage and compliance estimates and adjusted for covariates and variable follow-up time across study groups using Cox proportional hazards regression . For the PP analyses , we also used logistic regression . RESULTS None of the among-group differences in the crude incidence estimates for mammography coverage was statistically significant in ITT , MITT , or PP analyses . Crude estimates of compliance differed at statistically significant levels in the PP analyses and at levels approaching statistical significance in the ITT and MITT analyses . Absolute differences favoring the intervention over the control groups were 1%-3 % for ITT analysis , 1%-5 % for MITT analysis , and 2%-6 % for the PP analysis . Results from Cox modeling showed no statistically significant effect of the interventions on coverage or compliance in the ITT , MITT , or PP analyses , although hazard rate ratios ( HRRs ) for coverage were consistently slightly higher in the intervention groups than the control group ( range for HRRs = 1.05 - 1.09 ) . A PP analysis using logistic regression produced odds ratios ( ORs ) that were consistently higher than the corresponding hazard rate ratios for both coverage and compliance ( range for ORs = 1.15 - 1.29 ) . CONCLUSIONS In none of our primary analyses did the tailored and targeted intervention result in higher mammography rates than the targeted-only intervention , and there was limited support for either intervention being more effective than the baseline survey alone . We found that adjustment for variable follow-up time produced more conservative ( less favorable ) intervention effect estimates Community clinics provide inadequate breast cancer screening services to low-income , racially- and ethnically-diverse communities . This study develops and evaluates the effectiveness of multifaceted organizational system interventions —operational assessment s , tracking systems , reminder calls , tailored education , physician prompts and a tailored counseling call — on mammography rescreening rates  within three community clinics . We used the Chronic Care Model and Put Prevention Into Practice framework to re design breast screening delivery services within the California Cancer Detection Programs : Every Woman Counts(CDP : EWC ) , community clinic setting s. We used a quasi-experimental design with a r and om selection of 400 patients at pre-intervention . To establish a post-intervention clinic ’s rescreening rate a new comparable cross-sectional r and om sample of 347 women was drawn . Measures A chart abstract ion instrument was used to establish clinics ’ rescreening rates . Subjects Participants at pre and post-intervention were low-income women 50 years of age and older who had received normal mammography results and had not been diagnosed with breast cancer in the last five years . General linear mixed model analysis revealed significant improvements for the organizational system re design condition [ pre-intervention rescreening rate : 32.1 percent v. post-intervention rescreening rate 50.2 percent , ( p < .001 ) ] . For the organizational system re design plus tailored counseling call condition , there was maintenance in the rescreening rate following the intervention [ pre-intervention : 44.4 percent v. post-intervention : 45.1 percent , ( p > 0.05 ) ] . Multilevel interventions directed at re design ing community clinics primary care breast cancer screening services , can improve mammography rescreening rates OBJECTIVES This study assessed the effectiveness of telephone counseling in a church-based mammography promotion intervention trial . METHODS Thirty churches were r and omized to telephone counseling and control conditions ; telephone interview data were used in assessing intervention effects on mammography adherence . Separate analyses were conducted for baseline-adherent participants ( maintaining adherence ) and baseline-nonadherent participants ( conversion to adherence ) . RESULTS Year 1 follow-up data indicated that the telephone counseling intervention  maintained mammography adherence among baseline-adherent participants and reduced the nonadherence rate from 23 % to 16 % . CONCLUSIONS Partnerships between the public health and faith communities are potentially effective conduits to promote maintenance of widely endorsed health behaviors such as regular cancer screening Mammography screening continues to be under-utilized , especially among women from lower socioeconomic groups . In order to determine whether having direct access to health care services has an effect on mammography use among low income women , we conducted a r and omized trial of two alternative letter reminders among 1,717 women who were enrolled at two locations of a multi-site inner city health department in Detroit . All participants were 39 1/2 years of age and older and were due for a screening mammogram at r and omization . A physician-directed reminder form was placed in each of the participant ’s medical records at the beginning of the study . In addition participants were r and omized to receive either a letter directing them to visit their primary care physician , a letter directing them to contact the clinic directly to schedule a mammogram , or no letter .  Study participants were predominantly African – American , two-thirds of whom were over age 50 , and who had minimal health insurance coverage . During the intervention year , mammograms were completed by 179 out of 967 study women at site one ( 18.5 % ) , and 90 out of 750 study women at site two ( 12 % ) . A multivariate model controlling for the simultaneous effect of age , insurance type , visit history and past mammography use , showed no significant independent effect of either type of letter reminder on mammography completion during the study year . In conclusion , letters targeted at women due for screening mammograms did not have a beneficial effect on mammography utilization above and beyond that of a physician medical record reminder Participation in breast cancer screening programmes often declines in the course of the programme . The purpose of the present study was to examine whether health education could diminish the amount of drop-outs between two screening rounds . The health education was tailored to women who previously underwent mammography . Based on the Elaboration Likelihood Model two versions of the tailored leaflet were made : a simple version and a version with additional peripheral cues . In an experimental study among 2961 women the effects of the tailored leaflets on reparticipation were tested against a st and ard leaflet .  Re-participation rates were high ( > 90 % ) and did not differ between the 3 groups . No significant differences regarding beliefs about re-participating were found between the 3 groups . Results indicate that the tailored information leaflets did not enhance re-participation . Therefore , the required additional efforts and costs do not seem to be justified . The results of the study provide indications that less painful mammograms and friendly staff might improve re-participation BACKGROUND Despite widespread promotion of mammography screening , a distinct minority of women have remained underusers of this effective preventive measure . We sought to measure the effects of barrier-specific telephone counseling ( BSTC ) and a physician-based educational intervention ( MD-ED ) on mammography utilization among underusers of mammography screening . DESIGN This was a r and omized controlled trial . Women meeting criteria for mammography underuse at baseline ( grouped by practice affiliation ) were r and omized to a reminder control condition ( RC group received annual mailed reminders ) , BSTC or MD-ED interventions and followed for 3 years . Underuse was defined by failure to get two annual or biannual mammograms over a 2- to 4-year period prior to a baseline survey . PARTICIPANTS AND SETTING The study included 1655 female underusers of mammography aged 50 - 80 years who were members of two health maintenance organizations ( HMO ) in central Massachusetts . INTERVENTIONS BSTC consisted of periodic brief , scripted calls from trained counselors to women who had not had a mammogram in the preceding 15 months . Women could receive up to three annual calls during the study . MD-ED consisted of physician and office staff trainings aim ed at improving counseling skills and office reminder systems . MAIN OUTCOME MEASURE Self-report of mammography use during the study period was the main outcome measure . Regular use was defined as > or = 1 mammogram every 24 months . RESULTS Forty-four percent in each intervention group became regular users compared to 42 % in the RC group . Among subjects who had prior but not recent mammograms at baseline , BSTC was effective ( OR=1.48 ; 95 % CI=1.04 ; 2 . 10 ) , and MD-ED marginally effective ( OR=1.28 ; 95 % CI=0.88 , 1.85 ) . Most recent users at baseline and few never users became regular users ( 61 % and 17 % , respectively ) regardless of intervention status . CONCLUSIONS Among mammography underusers BSTC modestly increases utilization for former users at a reasonable cost ( $ 726 per additional regular user ) OBJECTIVE To assess added value of a booster dose of a tailored mammography intervention . METHODS Participants , non-adherent at baseline , were r and omly assigned to usual care or one of three tailored interventions . Intervention group members ( n=657 ) were further r and omly assigned to receive/not receive a booster intervention dose .  Electronic record mammography data were collected following initial intervention and at 6 and 15 months post-booster . RESULTS Booster had no effect among women not screened after first intervention dose ( n=337 ) . Among women screened after initial dose ( n=320 ) , booster predicted re-screening at 6 but not 15 months . A boosterxrace interaction showed a booster effect at 6 months for African Americans ( OR=4.66 , p=.0005 ) but not Caucasians ( OR=0.74 , p=.44 ) . CONCLUSIONS 
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We also can not conclude that reminder-only intervention strategies are more effective than alternate strategies .