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: OBJECTIVE . A human papillomavirus vaccine was licensed in June 2006 . The vaccine is quadrivalent , protecting against 2 human papillomavirus strains that cause cervical cancer and 2 that cause genital warts . The objective of this study was to determine physician characteristics , knowledge , and attitudes associated with an intention to recommend human papillomavirus vaccination . METHODS . Between August and October 2005 , a cross-sectional survey was administered to a national network of 431 pediatricians . The network was developed from a r and om sample of American Academy of Pediatrics members and was design ed to be representative of the organization ’s membership with respect to urban/rural location , practice type , and region . The survey was conducted before human papillomavirus vaccine licensure and therefore focused on a c and i date quadrivalent human papillomavirus vaccine and a range of potential vaccination recommendations . The main outcome measure was intention to recommend a quadrivalent human papillomavirus vaccine  to young adolescent ( 10- to 12-year-old ) females . RESULTS . Survey response rate was 68 % . If endorsed by national health organizations , 46 % of respondents would recommend vaccination for 10- to 12-year-old females , 77 % for 13- to 15-year-old females , and 89 % for 16- to 18-year-old females . Corresponding rates for males were 37 % , 67 % , and 82 % , respectively . Whereas 60 % of respondents thought that parents would be concerned that human papillomavirus vaccination may encourage risky sexual behaviors , 11 % reported that they themselves had this concern . Respondents who believed that other new adolescent immunization recommendations ( eg , meningococcal , pertussis ) would facilitate human papillomavirus vaccine implementation were more likely to intend to recommend vaccination . CONCLUSIONS . Although a national sample of pediatricians expressed a high level of acceptance of human papillomavirus vaccination in older adolescent females , fewer than one half anticipated giving human papillomavirus vaccine to younger female patients . Provider concerns about parental vaccine acceptance will need to be addressed to optimize human papillomavirus vaccination implementation Background : Human papillomavirus ( HPV ) vaccine is now approved for use in males in the United States to prevent genital warts . We conducted an experiment to see whether framing HPV vaccination as also preventing cancer in men would increase men 's  vaccination willingness . Methods : We conducted an online survey in January 2009 with a national sample of men ages 18 to 59 years who self-identified as gay/bisexual ( n = 312 ) or heterosexual ( n = 296 ) . In the within-subjects experiment , men read four r and omly ordered vignettes that described hypothetical vaccines that prevented either genital warts alone , or genital warts and either anal cancer , oral cancer , or penile cancer . We analyzed data using repeated measures ANOVA and tested whether perceived severity or perceived likelihood mediated the effect of disease outcome framing on men 's HPV vaccination willingness . Results : Although only 42 % of men were willing to receive HPV vaccine  when it was framed as preventing genital warts alone , 60 % were willing to get it when it was framed as preventing cancer in addition to genital warts ( P < 0.001 ) . The effect of outcome framing was the same for heterosexual and gay/bisexual men and for the three cancer types examined . Perceived severity of disease partially mediated the association between disease outcome and HPV vaccination willingness . Conclusions : Men may be more accepting of HPV vaccine  when it is framed as preventing cancer , regardless which of the three most common HPV-related cancers in men is described . Impact : Study findings may be useful in developing health communication messages that maximize HPV vaccine acceptability among young men . Cancer Epidemiol Biomarkers Prev ; 19(8 ) ; 1937–44 . © 2010 AACR 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 PURPOSE We assessed U.S. physicians ' attitudes and perceptions regarding potential  human papillomavirus ( HPV ) vaccination  of males . METHODS We surveyed a r and om sample of 2,714 pediatricians and family practitioners identified in administrative cl aims of a U.S. health plan as HPV vaccinators of females ; 595 pediatricians and 499 family practitioners participated . RESULTS Most physicians would recommend HPV vaccination to males aged 11 - 12 ( 63.9 % ) , 13 - 18 ( 93.4 % ) , and 19 - 26 ( 92.7 % ) years . Physicians agreed that males should be vaccinated to prevent them from getting genital and anal warts ( 52.9 % strongly and 36.0 % somewhat ) and to protect females from cervical cancer ( 75.3 % strongly and 20.8 % somewhat ) . Physicians agreed that an HPV vaccine recommendation for males would increase opportunities to discuss sexual health with adolescent male patients ( 58.7 % strongly , 35.3 % somewhat ) . Most did not strongly agree ( 15.4 % strongly , 45.4 % somewhat ) that parents of adolescent male patients would be interested in HPV vaccination for males , that a gender-neutral HPV vaccine recommendation would increase acceptance by adolescent females and their parents ( 19.6 % strongly , 42.0 % somewhat ) , or that a gender-neutral recommendation would improve current female vaccination rates ( 10.4 % strongly , 26.0 % somewhat ) . CONCLUSIONS Physicians who currently vaccinate females against HPV supported the concept of vaccinating males for its benefits for both sexes . They agreed that a gender-neutral HPV vaccination recommendation would be appropriate with regard to public health and believed that it would increase opportunities for sexual health discussion s , but were less sure that such a recommendation would change patient or parental attitudes toward HPV vaccination or improve current HPV vaccination efforts PURPOSE Human papillomavirus ( HPV ) vaccination in the United States remains a public health challenge with vaccine rates of 50 % . Although health care providers can facilitate HPV vaccination , several factors may impede their ability to universally recommend the vaccine . To maximize the potential of HPV vaccines , it is important to underst and challenges providers face in the clinical environment . The study sought to identify factors associated with recommendation of the HPV vaccine for low-income adolescents in the early ( 9 - 10 ) , target ( 11 - 12 ) , early adolescent catch-up ( 13 - 14 ) , and late adolescent catch-up ( 15 - 17 ) vaccination groups . METHODS Surveys were mailed between October 2009 and April 2010 to a r and om sample of Florida-based physicians serving Medicaid-enrolled adolescents . Data were analyzed in 2013 . RESULTS Among early adolescents , discomfort discussing sexually transmitted infections ( STIs ) with teens ( odds ratio [ OR ] = 1.75 ) , difficulty ensuring vaccine completion ( OR = .73 ) , and discomfort discussing STIs with parents ( OR = .44 ) were associated with recommendation . For target adolescents , discomfort discussing STIs with teens ( OR = 2.45 ) , time constraints ( OR = .70 ) , vaccine efficacy concerns ( OR = .65 ) , discomfort discussing STIs with parents ( OR = .33 ) , obstetrics/gynecology ( OR = .25 ) and family medicine ( OR = .24 ) specialty , and non-Hispanic black patient ( OR = .15 ) were associated with recommendation . In early catch-up adolescents , concerns that teens will practice riskier behaviors ( OR = .57 ) , discomfort discussing STIs with parents ( OR = .47 ) , and family medicine specialty ( OR = .20 ) were associated with recommendation . For late catch-up adolescents , family medicine specialty ( OR = .13 ) was associated with recommendation . CONCLUSIONS Modifiable factors that impede or influence provider recommendations of HPV vaccines can be addressed through intervention . Overall , findings suggest that efforts should focus on sexuality communication and family medicine specialty 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 OBJECTIVE The purpose of this study was to determine the prevalence of physician recommendation of human papillomavirus  ( HPV ) vaccination in early ( ages 11 - 12 ) , middle ( 13 - 17 ) , and late adolescent/young adult ( 18 - 26 ) female patients by physician specialty , and to identify factors associated with recommendation in early adolescents . METHODS A 38-item survey was conducted April 2009 through August 2009 among a nationally representative r and om sample of 1538 Family Physicians , Pediatricians , and Obstetricians and Gynecologists obtained from the American Medical Association Physician Masterfile . A multivariable model was used to assess factors associated with frequency of physician recommendation of HPV vaccination  ( " always"=76 - 100 % of the time vs. other=0 - 75 % ) within the past 12 months . RESULTS Completed surveys were received from 1013 physicians , including 500 Family Physicians , 287 Pediatricians , and 226 Obstetricians and Gynecologists ( response rate=67.8 % ) . Across the specialties , 34.6 % of physicians reported they " always " recommend the HPV vaccine to early adolescents , 52.7 % to middle adolescents , and 50.2 % to late adolescents/young adults . The likelihood of " always " recommending the HPV vaccine was highest among Pediatricians for all age groups ( P<0.001 ) . Physician specialty , age , ethnicity , reported barriers , and Vaccines for Children provider status were significantly associated with " always " recommending HPV vaccination for early adolescents . CONCLUSIONS Findings suggest missed clinical opportunities for HPV vaccination , and perceived barriers to vaccination may drive decisions about recommendation . Results suggest the need 
    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: OBJECTIVE . A human papillomavirus vaccine was licensed in June 2006 . The vaccine is quadrivalent , protecting against 2 human papillomavirus strains that cause cervical cancer and 2 that cause genital warts . The objective of this study was to determine physician characteristics , knowledge , and attitudes associated with an intention to recommend human papillomavirus vaccination . METHODS . Between August and October 2005 , a cross-sectional survey was administered to a national network of 431 pediatricians . The network was developed from a r and om sample of American Academy of Pediatrics members and was design ed to be representative of the organization ’s membership with respect to urban/rural location , practice type , and region . The survey was conducted before human papillomavirus vaccine licensure and therefore focused on a c and i date quadrivalent human papillomavirus vaccine and a range of potential vaccination recommendations . The main outcome measure was intention to recommend a quadrivalent human papillomavirus vaccine  to young adolescent ( 10- to 12-year-old ) females . RESULTS . Survey response rate was 68 % . If endorsed by national health organizations , 46 % of respondents would recommend vaccination for 10- to 12-year-old females , 77 % for 13- to 15-year-old females , and 89 % for 16- to 18-year-old females . Corresponding rates for males were 37 % , 67 % , and 82 % , respectively . Whereas 60 % of respondents thought that parents would be concerned that human papillomavirus vaccination may encourage risky sexual behaviors , 11 % reported that they themselves had this concern . Respondents who believed that other new adolescent immunization recommendations ( eg , meningococcal , pertussis ) would facilitate human papillomavirus vaccine implementation were more likely to intend to recommend vaccination . CONCLUSIONS . Although a national sample of pediatricians expressed a high level of acceptance of human papillomavirus vaccination in older adolescent females , fewer than one half anticipated giving human papillomavirus vaccine to younger female patients . Provider concerns about parental vaccine acceptance will need to be addressed to optimize human papillomavirus vaccination implementation Background : Human papillomavirus ( HPV ) vaccine is now approved for use in males in the United States to prevent genital warts . We conducted an experiment to see whether framing HPV vaccination as also preventing cancer in men would increase men 's  vaccination willingness . Methods : We conducted an online survey in January 2009 with a national sample of men ages 18 to 59 years who self-identified as gay/bisexual ( n = 312 ) or heterosexual ( n = 296 ) . In the within-subjects experiment , men read four r and omly ordered vignettes that described hypothetical vaccines that prevented either genital warts alone , or genital warts and either anal cancer , oral cancer , or penile cancer . We analyzed data using repeated measures ANOVA and tested whether perceived severity or perceived likelihood mediated the effect of disease outcome framing on men 's HPV vaccination willingness . Results : Although only 42 % of men were willing to receive HPV vaccine  when it was framed as preventing genital warts alone , 60 % were willing to get it when it was framed as preventing cancer in addition to genital warts ( P < 0.001 ) . The effect of outcome framing was the same for heterosexual and gay/bisexual men and for the three cancer types examined . Perceived severity of disease partially mediated the association between disease outcome and HPV vaccination willingness . Conclusions : Men may be more accepting of HPV vaccine  when it is framed as preventing cancer , regardless which of the three most common HPV-related cancers in men is described . Impact : Study findings may be useful in developing health communication messages that maximize HPV vaccine acceptability among young men . Cancer Epidemiol Biomarkers Prev ; 19(8 ) ; 1937–44 . © 2010 AACR 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 PURPOSE We assessed U.S. physicians ' attitudes and perceptions regarding potential  human papillomavirus ( HPV ) vaccination  of males . METHODS We surveyed a r and om sample of 2,714 pediatricians and family practitioners identified in administrative cl aims of a U.S. health plan as HPV vaccinators of females ; 595 pediatricians and 499 family practitioners participated . RESULTS Most physicians would recommend HPV vaccination to males aged 11 - 12 ( 63.9 % ) , 13 - 18 ( 93.4 % ) , and 19 - 26 ( 92.7 % ) years . Physicians agreed that males should be vaccinated to prevent them from getting genital and anal warts ( 52.9 % strongly and 36.0 % somewhat ) and to protect females from cervical cancer ( 75.3 % strongly and 20.8 % somewhat ) . Physicians agreed that an HPV vaccine recommendation for males would increase opportunities to discuss sexual health with adolescent male patients ( 58.7 % strongly , 35.3 % somewhat ) . Most did not strongly agree ( 15.4 % strongly , 45.4 % somewhat ) that parents of adolescent male patients would be interested in HPV vaccination for males , that a gender-neutral HPV vaccine recommendation would increase acceptance by adolescent females and their parents ( 19.6 % strongly , 42.0 % somewhat ) , or that a gender-neutral recommendation would improve current female vaccination rates ( 10.4 % strongly , 26.0 % somewhat ) . CONCLUSIONS Physicians who currently vaccinate females against HPV supported the concept of vaccinating males for its benefits for both sexes . They agreed that a gender-neutral HPV vaccination recommendation would be appropriate with regard to public health and believed that it would increase opportunities for sexual health discussion s , but were less sure that such a recommendation would change patient or parental attitudes toward HPV vaccination or improve current HPV vaccination efforts PURPOSE Human papillomavirus ( HPV ) vaccination in the United States remains a public health challenge with vaccine rates of 50 % . Although health care providers can facilitate HPV vaccination , several factors may impede their ability to universally recommend the vaccine . To maximize the potential of HPV vaccines , it is important to underst and challenges providers face in the clinical environment . The study sought to identify factors associated with recommendation of the HPV vaccine for low-income adolescents in the early ( 9 - 10 ) , target ( 11 - 12 ) , early adolescent catch-up ( 13 - 14 ) , and late adolescent catch-up ( 15 - 17 ) vaccination groups . METHODS Surveys were mailed between October 2009 and April 2010 to a r and om sample of Florida-based physicians serving Medicaid-enrolled adolescents . Data were analyzed in 2013 . RESULTS Among early adolescents , discomfort discussing sexually transmitted infections ( STIs ) with teens ( odds ratio [ OR ] = 1.75 ) , difficulty ensuring vaccine completion ( OR = .73 ) , and discomfort discussing STIs with parents ( OR = .44 ) were associated with recommendation . For target adolescents , discomfort discussing STIs with teens ( OR = 2.45 ) , time constraints ( OR = .70 ) , vaccine efficacy concerns ( OR = .65 ) , discomfort discussing STIs with parents ( OR = .33 ) , obstetrics/gynecology ( OR = .25 ) and family medicine ( OR = .24 ) specialty , and non-Hispanic black patient ( OR = .15 ) were associated with recommendation . In early catch-up adolescents , concerns that teens will practice riskier behaviors ( OR = .57 ) , discomfort discussing STIs with parents ( OR = .47 ) , and family medicine specialty ( OR = .20 ) were associated with recommendation . For late catch-up adolescents , family medicine specialty ( OR = .13 ) was associated with recommendation . CONCLUSIONS Modifiable factors that impede or influence provider recommendations of HPV vaccines can be addressed through intervention . Overall , findings suggest that efforts should focus on sexuality communication and family medicine specialty 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 OBJECTIVE The purpose of this study was to determine the prevalence of physician recommendation of human papillomavirus  ( HPV ) vaccination in early ( ages 11 - 12 ) , middle ( 13 - 17 ) , and late adolescent/young adult ( 18 - 26 ) female patients by physician specialty , and to identify factors associated with recommendation in early adolescents . METHODS A 38-item survey was conducted April 2009 through August 2009 among a nationally representative r and om sample of 1538 Family Physicians , Pediatricians , and Obstetricians and Gynecologists obtained from the American Medical Association Physician Masterfile . A multivariable model was used to assess factors associated with frequency of physician recommendation of HPV vaccination  ( " always"=76 - 100 % of the time vs. other=0 - 75 % ) within the past 12 months . RESULTS Completed surveys were received from 1013 physicians , including 500 Family Physicians , 287 Pediatricians , and 226 Obstetricians and Gynecologists ( response rate=67.8 % ) . Across the specialties , 34.6 % of physicians reported they " always " recommend the HPV vaccine to early adolescents , 52.7 % to middle adolescents , and 50.2 % to late adolescents/young adults . The likelihood of " always " recommending the HPV vaccine was highest among Pediatricians for all age groups ( P<0.001 ) . Physician specialty , age , ethnicity , reported barriers , and Vaccines for Children provider status were significantly associated with " always " recommending HPV vaccination for early adolescents . CONCLUSIONS Findings suggest missed clinical opportunities for HPV vaccination , and perceived barriers to vaccination may drive decisions about recommendation . Results suggest the need 
    Output:
    