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 Research suggests that gain-framed messages are generally more effective than loss-framed messages at promoting preventive health behaviors . Virtually all previous studies , however , have examined prevention behaviors that require regular and repeated action to be effective . Little is known about the utility of message framing for promoting low-frequency prevention behaviors such as vaccination . Moreover , few studies have identified mediators of framing effects . Purpose We investigated whether behavioral frequency ( operationalized as the number of shots required ) moderated the effect of framed health messages on women ’s intentions to receive the human papillomavirus ( HPV ) vaccine . We also sought to identify mediators of framing effects . Method Undergraduate women ( N = 237 ) were r and omly assigned to read an  HPV vaccination booklet that varied by message frame ( gain vs. loss ) and behavioral frequency ( one shot vs. six shots ) . Results We observed a frame-by-frequency interaction such that the loss-framed message led to greater vaccination intentions than did the gain-framed message but only among participants in the one-shot condition . Perceived susceptibility to HPV infection mediated the observed framing effects . Conclusions This study provides an important exception to the commonly observed gain-framed advantage for preventive health behaviors . Loss-framed appeals appear to be particularly effective in promoting interest in low-frequency prevention behaviors such as HPV vaccination Background : For human papillomavirus ( HPV ) vaccination to have maximum benefit to public health , both men and women should be vaccinated . Although efficacy trials in men are still ongoing , the HPV vaccine will likely be licensed for men in the near future . Little is known about men 's interest in HPV vaccination . This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s ) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone . Predictors of HPV vaccine acceptability were also identified . Methods : Heterosexual male college students ( n = 356 ) were r and omly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine . Participants provided demographic and sexual history information , HPV-related awareness and knowledge , health beliefs , and HPV vaccination intentions . Results : Men reported moderate interest in the HPV vaccine ; vaccine acceptability did not differ by experimental condition . A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity , perceived susceptibility to HPV , perceived benefits of the vaccine , perceived hassle and cost of vaccination , self-efficacy for vaccination , and perceived norms for vaccination . Conclusion : Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men 's interest in the vaccine . Correlates of vaccine acceptability among men were generally consistent with those identified for women . Findings have important implication s for future HPV vaccination campaigns targeting young adult men Abstract Objective : To examine human papillomavirus ( HPV ) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students . Participants : Females aged 18 to 26 attending a university health service gynecology clinic ( n = 256 ) . Methods : Participants were r and omized to receive either HPV-specific education with a mailed reminder or st and ard care . Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified . Results : At baseline , 41 % intended to undergo HPV vaccination . Participants who were currently sexually active and lacked supplemental health insurance had decreased intent . Perceived parental approval regarding HPV vaccination , perceived vulnerability to HPV infection , and belief in health benefits of HPV vaccine were associated with increased intent . HPV vaccine uptake was low ( 5.5 % ) and did not differ by study group . However , baseline intent was significantly associated with HPV vaccine uptake . Conclusions : Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination Objective To assess the risk of serious adverse events after vaccination of adolescent girls with quadrivalent human papillomavirus ( qHPV ) vaccine .  Design Register based cohort study . Setting Denmark and Sweden , October 2006 to December 2010 . Participants 997 585 girls aged 10 - 17 , among whom 296 826 received a total of 696 420 qHPV vaccine doses . Main outcome measures Incident hospital diagnosed autoimmune , neurological , and venous thromboembolic events ( 53 different outcomes ) up to 180 days after each qHPV vaccine dose . Only events with at least five vaccine exposed cases were considered for further assessment . Rate ratios adjusted for age , country , calendar year , and parental country of birth , education , and socioeconomic status were estimated , comparing vaccinated and unvaccinated person time . For outcomes where the rate ratio was significantly increased , we regarded three criteria as signal strengthening : analysis based on 20 or more vaccine exposed cases ( reliability ) , rate ratio 3.0 or more ( strength ) , and significantly increased rate ratio in country specific analyses ( consistency ) . We additionally assessed clustering of events in time and estimated rate ratios for a risk period that started on day 181 . Results Among the 53 outcomes , at least five vaccine exposed cases occurred in 29 and these were analysed further . Whereas the rate ratios for 20 of 23 autoimmune events were not significantly increased , exposure to qHPV vaccine was significantly associated with Behcet ’s syndrome , Raynaud ’s disease , and type 1 diabetes . Each of these three outcomes fulfilled only one of three predefined signal strengthening criteria . Furthermore , the pattern of distribution in time after vaccination was r and om for all three and the rate ratios for these outcomes in the period from day 181 after vaccination were similar to the rate ratios in the primary risk period . The rate ratios for five neurological events were not significantly increased and there were inverse associations with epilepsy ( rate ratio 0.66 , 95 % confidence interval 0.54 to 0.80 ) and paralysis ( 0.56 , 0.35 to 0.90 ) . There was no association between exposure to qHPV vaccine and venous thromboembolism ( 0.86 , 0.55 to 1.36 ) . Conclusions This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune , neurological , and venous thromboembolic adverse events . Although associations for three autoimmune events were initially observed , on further assessment these were weak and not temporally related to vaccine exposure . Furthermore , the findings need to be interpreted considering the multiple outcomes assessed OBJECTIVE Use of message framing for encouraging vaccination , an increasingly common preventive health behavior , has received little empirical investigation . The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer . DESIGN Undergraduate women ( N = 121 ) were r and omly assigned to read a booklet describing the benefits of receiving ( gain-framed message ) or the costs of not receiving ( loss-framed message ) a prophylactic HPV vaccine . After reading the booklet , participants indicated their intent to obtain the HPV vaccine . MAIN OUTCOME MEASURE A 5-item composite representing intentions to obtain the HPV vaccine . RESULTS The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation . A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms . The loss-frame advantage was also observed among participants high in avoidance motivation . CONCLUSION Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance . This study has practical implication s for the development of health communications promoting vaccination Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States . The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years , though it is approved for females aged 9–26 to protect against the primary types of high-risk HPV ( HPV-16 and HPV-18 ) that cause approximately 70 % of cervical cancer cases . Few culturally-tailored Spanish HPV vaccine awareness programs have been developed . This study evaluates the efficacy of a Spanish radionovela as an educational tool . Rural Hispanic parents of daughters aged 9–17 ( n = 88 ; 78 mothers and 10 fathers ) were r and omized to listen to the HPV vaccine radionovela or to another public service announcement . Participants completed a 30 min pretest posttest question naire . Parents who listened to the HPV radionovela ( intervention group ) scored higher on six knowledge and belief items . They were more likely to confirm that HPV is a common infection ( 70 % vs. 48 % , P = .002 ) , to deny that women are able to detect HPV ( 53 % vs. 31 % , P = .003 ) , to know vaccine age recommendations ( 87 % vs. 68 % , P = .003 ) , and to confirm multiple doses ( 48 % vs. 26 % , P = .03 ) than control group parents . The HPV vaccine radionovela  improved HPV and HPV vaccine knowledge and attitudes .  Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents INTRODUCTION We conducted a r and omized controlled trial to determine if an in-home educational intervention conducted by lay health workers ( LHWs ) could increase adherence among low-income , inner-city , African-American women to breast and cervical cancer screening schedules . METHODS We recruited 321 African-American women from diverse inner-city sources . After baseline interviews , they were r and omly assigned to either the intervention ( n = 163 ) or the control ( n = 158 ) group . Those in the intervention group were visited in their homes up to three times by LHWs who provided a culturally sensitive educational program that emphasized the need for screening . RESULTS Ninety-three ( 93 ) women in the intervention group and 102 in the control group completed the postintervention interview . For Pap smears , the increase in screening was similar in both groups . For clinical breast exams ( CBEs ) , however , there was a modest increase in the intervention group . The improvement was greatest for mammography , for which there was a 10 % to 12 % increase . Among women who were not on recommended schedules at baseline , the improvement was substantial and greater in the intervention group . CONCLUSIONS LHWs ' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms , but had no effect on Pap smears . A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention OBJECTIVES . Prophylactic vaccines against human papillomavirus ( HPV ) are expected to be available for public use by 2007 and likely will be targeted to preadolescent children . Parental acceptance of these vaccines will be critical for their success . The objectives of this study were ( 1 ) to determine the overall acceptance of HPV vaccines for preadolescent children by parents , ( 2 ) to evaluate the influence of written educational information about HPV on parental acceptability of HPV vaccines , and ( 3 ) to identify independent predictors associated with HPV vaccine acceptability by parents . METHODS . A r and omized intervention study within a cross-sectional survey was conducted . Parental HPV vaccine acceptability was measured under 3 different hypothetical scenarios . A self-administered survey on the  knowledge , attitudes  , and beliefs about HPV and HPV vaccines was sent to 1600 parents of 8- to 12-year-old children . In addition to a baseline paragraph about HPV that was received by all study participants , a r and om half of the study participants received a detailed “ HPV Information Sheet ” outlining the epidemiology and potential clinical sequelae of HPV infection . Independent predictors of parental HPV vaccine acceptability were determined using multivariate linear regression models . RESULTS . Parents who received the HPV information sheet had higher mean scores on the HPV knowledge assessment tool than the control group . However , despite this apparent improvement in knowledge , there was not a statistically significant difference in HPV vaccine acceptability between the 2 groups . CONCLUSIONS . Providing parents with an HPV information sheet did seem to improve knowledge about HPV , but this increased knowledge had little effect on the acceptability of these vaccines by parents for their children . Instead , attitudes and life experiences seemed to be more important factors influencing HPV vaccine acceptability among parents This longitudinal study reports on the development and evaluation of a narrative intervention aim ed at increasing  human papillomavirus ( HPV ) vaccination among college women . The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer , the second leading cause of cancer deaths among women worldwide . Pilot work utilizing culture-centric narrative theory guided development of the intervention content 
    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 Research suggests that gain-framed messages are generally more effective than loss-framed messages at promoting preventive health behaviors . Virtually all previous studies , however , have examined prevention behaviors that require regular and repeated action to be effective . Little is known about the utility of message framing for promoting low-frequency prevention behaviors such as vaccination . Moreover , few studies have identified mediators of framing effects . Purpose We investigated whether behavioral frequency ( operationalized as the number of shots required ) moderated the effect of framed health messages on women ’s intentions to receive the human papillomavirus ( HPV ) vaccine . We also sought to identify mediators of framing effects . Method Undergraduate women ( N = 237 ) were r and omly assigned to read an  HPV vaccination booklet that varied by message frame ( gain vs. loss ) and behavioral frequency ( one shot vs. six shots ) . Results We observed a frame-by-frequency interaction such that the loss-framed message led to greater vaccination intentions than did the gain-framed message but only among participants in the one-shot condition . Perceived susceptibility to HPV infection mediated the observed framing effects . Conclusions This study provides an important exception to the commonly observed gain-framed advantage for preventive health behaviors . Loss-framed appeals appear to be particularly effective in promoting interest in low-frequency prevention behaviors such as HPV vaccination Background : For human papillomavirus ( HPV ) vaccination to have maximum benefit to public health , both men and women should be vaccinated . Although efficacy trials in men are still ongoing , the HPV vaccine will likely be licensed for men in the near future . Little is known about men 's interest in HPV vaccination . This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s ) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone . Predictors of HPV vaccine acceptability were also identified . Methods : Heterosexual male college students ( n = 356 ) were r and omly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine . Participants provided demographic and sexual history information , HPV-related awareness and knowledge , health beliefs , and HPV vaccination intentions . Results : Men reported moderate interest in the HPV vaccine ; vaccine acceptability did not differ by experimental condition . A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity , perceived susceptibility to HPV , perceived benefits of the vaccine , perceived hassle and cost of vaccination , self-efficacy for vaccination , and perceived norms for vaccination . Conclusion : Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men 's interest in the vaccine . Correlates of vaccine acceptability among men were generally consistent with those identified for women . Findings have important implication s for future HPV vaccination campaigns targeting young adult men Abstract Objective : To examine human papillomavirus ( HPV ) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students . Participants : Females aged 18 to 26 attending a university health service gynecology clinic ( n = 256 ) . Methods : Participants were r and omized to receive either HPV-specific education with a mailed reminder or st and ard care . Predictors of HPV vaccine intent and uptake at 6 months following enrollment were identified . Results : At baseline , 41 % intended to undergo HPV vaccination . Participants who were currently sexually active and lacked supplemental health insurance had decreased intent . Perceived parental approval regarding HPV vaccination , perceived vulnerability to HPV infection , and belief in health benefits of HPV vaccine were associated with increased intent . HPV vaccine uptake was low ( 5.5 % ) and did not differ by study group . However , baseline intent was significantly associated with HPV vaccine uptake . Conclusions : Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination Objective To assess the risk of serious adverse events after vaccination of adolescent girls with quadrivalent human papillomavirus ( qHPV ) vaccine .  Design Register based cohort study . Setting Denmark and Sweden , October 2006 to December 2010 . Participants 997 585 girls aged 10 - 17 , among whom 296 826 received a total of 696 420 qHPV vaccine doses . Main outcome measures Incident hospital diagnosed autoimmune , neurological , and venous thromboembolic events ( 53 different outcomes ) up to 180 days after each qHPV vaccine dose . Only events with at least five vaccine exposed cases were considered for further assessment . Rate ratios adjusted for age , country , calendar year , and parental country of birth , education , and socioeconomic status were estimated , comparing vaccinated and unvaccinated person time . For outcomes where the rate ratio was significantly increased , we regarded three criteria as signal strengthening : analysis based on 20 or more vaccine exposed cases ( reliability ) , rate ratio 3.0 or more ( strength ) , and significantly increased rate ratio in country specific analyses ( consistency ) . We additionally assessed clustering of events in time and estimated rate ratios for a risk period that started on day 181 . Results Among the 53 outcomes , at least five vaccine exposed cases occurred in 29 and these were analysed further . Whereas the rate ratios for 20 of 23 autoimmune events were not significantly increased , exposure to qHPV vaccine was significantly associated with Behcet ’s syndrome , Raynaud ’s disease , and type 1 diabetes . Each of these three outcomes fulfilled only one of three predefined signal strengthening criteria . Furthermore , the pattern of distribution in time after vaccination was r and om for all three and the rate ratios for these outcomes in the period from day 181 after vaccination were similar to the rate ratios in the primary risk period . The rate ratios for five neurological events were not significantly increased and there were inverse associations with epilepsy ( rate ratio 0.66 , 95 % confidence interval 0.54 to 0.80 ) and paralysis ( 0.56 , 0.35 to 0.90 ) . There was no association between exposure to qHPV vaccine and venous thromboembolism ( 0.86 , 0.55 to 1.36 ) . Conclusions This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune , neurological , and venous thromboembolic adverse events . Although associations for three autoimmune events were initially observed , on further assessment these were weak and not temporally related to vaccine exposure . Furthermore , the findings need to be interpreted considering the multiple outcomes assessed OBJECTIVE Use of message framing for encouraging vaccination , an increasingly common preventive health behavior , has received little empirical investigation . The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer . DESIGN Undergraduate women ( N = 121 ) were r and omly assigned to read a booklet describing the benefits of receiving ( gain-framed message ) or the costs of not receiving ( loss-framed message ) a prophylactic HPV vaccine . After reading the booklet , participants indicated their intent to obtain the HPV vaccine . MAIN OUTCOME MEASURE A 5-item composite representing intentions to obtain the HPV vaccine . RESULTS The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation . A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms . The loss-frame advantage was also observed among participants high in avoidance motivation . CONCLUSION Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance . This study has practical implication s for the development of health communications promoting vaccination Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States . The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years , though it is approved for females aged 9–26 to protect against the primary types of high-risk HPV ( HPV-16 and HPV-18 ) that cause approximately 70 % of cervical cancer cases . Few culturally-tailored Spanish HPV vaccine awareness programs have been developed . This study evaluates the efficacy of a Spanish radionovela as an educational tool . Rural Hispanic parents of daughters aged 9–17 ( n = 88 ; 78 mothers and 10 fathers ) were r and omized to listen to the HPV vaccine radionovela or to another public service announcement . Participants completed a 30 min pretest posttest question naire . Parents who listened to the HPV radionovela ( intervention group ) scored higher on six knowledge and belief items . They were more likely to confirm that HPV is a common infection ( 70 % vs. 48 % , P = .002 ) , to deny that women are able to detect HPV ( 53 % vs. 31 % , P = .003 ) , to know vaccine age recommendations ( 87 % vs. 68 % , P = .003 ) , and to confirm multiple doses ( 48 % vs. 26 % , P = .03 ) than control group parents . The HPV vaccine radionovela  improved HPV and HPV vaccine knowledge and attitudes .  Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents INTRODUCTION We conducted a r and omized controlled trial to determine if an in-home educational intervention conducted by lay health workers ( LHWs ) could increase adherence among low-income , inner-city , African-American women to breast and cervical cancer screening schedules . METHODS We recruited 321 African-American women from diverse inner-city sources . After baseline interviews , they were r and omly assigned to either the intervention ( n = 163 ) or the control ( n = 158 ) group . Those in the intervention group were visited in their homes up to three times by LHWs who provided a culturally sensitive educational program that emphasized the need for screening . RESULTS Ninety-three ( 93 ) women in the intervention group and 102 in the control group completed the postintervention interview . For Pap smears , the increase in screening was similar in both groups . For clinical breast exams ( CBEs ) , however , there was a modest increase in the intervention group . The improvement was greatest for mammography , for which there was a 10 % to 12 % increase . Among women who were not on recommended schedules at baseline , the improvement was substantial and greater in the intervention group . CONCLUSIONS LHWs ' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms , but had no effect on Pap smears . A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention OBJECTIVES . Prophylactic vaccines against human papillomavirus ( HPV ) are expected to be available for public use by 2007 and likely will be targeted to preadolescent children . Parental acceptance of these vaccines will be critical for their success . The objectives of this study were ( 1 ) to determine the overall acceptance of HPV vaccines for preadolescent children by parents , ( 2 ) to evaluate the influence of written educational information about HPV on parental acceptability of HPV vaccines , and ( 3 ) to identify independent predictors associated with HPV vaccine acceptability by parents . METHODS . A r and omized intervention study within a cross-sectional survey was conducted . Parental HPV vaccine acceptability was measured under 3 different hypothetical scenarios . A self-administered survey on the  knowledge , attitudes  , and beliefs about HPV and HPV vaccines was sent to 1600 parents of 8- to 12-year-old children . In addition to a baseline paragraph about HPV that was received by all study participants , a r and om half of the study participants received a detailed “ HPV Information Sheet ” outlining the epidemiology and potential clinical sequelae of HPV infection . Independent predictors of parental HPV vaccine acceptability were determined using multivariate linear regression models . RESULTS . Parents who received the HPV information sheet had higher mean scores on the HPV knowledge assessment tool than the control group . However , despite this apparent improvement in knowledge , there was not a statistically significant difference in HPV vaccine acceptability between the 2 groups . CONCLUSIONS . Providing parents with an HPV information sheet did seem to improve knowledge about HPV , but this increased knowledge had little effect on the acceptability of these vaccines by parents for their children . Instead , attitudes and life experiences seemed to be more important factors influencing HPV vaccine acceptability among parents This longitudinal study reports on the development and evaluation of a narrative intervention aim ed at increasing  human papillomavirus ( HPV ) vaccination among college women . The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer , the second leading cause of cancer deaths among women worldwide . Pilot work utilizing culture-centric narrative theory guided development of the intervention content 
    Output:
    