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 Educational interventions may be a strategy to increase human papillomavirus ( HPV ) vaccination among female university students , but studies to date have shown mixed results . This study evaluated the effect of MeFirst , an individually tailored , online educational intervention , on HPV vaccine-related knowledge , vaccination intention , and uptake among previously unvaccinated female university students . METHODS All female students aged 18 - 26 years who reported being unvaccinated against HPV at a midwestern university were invited via email to enroll . Participants completed an online survey that assessed baseline HPV vaccine-related knowledge , attitudes and vaccination intention .  Participants ( n = 661 ) were then r and omized to receive either an educational website automatically tailored to their baseline survey responses ( MeFirst intervention ) or a st and ard CDC information factsheet on HPV vaccine ( control ) .  Vaccine uptake and repeat knowledge and attitude measures were assessed with online surveys 3 months following the intervention and analyzed using logistic regression models . RESULTS HPV vaccine uptake was similar in both the MeFirst and control groups at 3 months following the intervention ( p = 0.98 ) . Three months after the intervention , the proportion of participants with high knowledge regarding HPV vaccination increased from baseline ( 32 % to 50 % ; p < 0.0001 ) but the proportion with favorable intention was unchanged . CONCLUSIONS We found that an individually tailored , online educational tool had similar effects as a nontailored factsheet on HPV-related knowledge , intention to HPV undergo vaccination , and HPV vaccine uptake among previously unvaccinated female university students OBJECTIVE Vaccination is an effective preventive measure to reduce influenza transmission , especially important in a p and emic . Despite the messages encouraging vaccination during the last p and emic , uptake remained low ( 37.6 % in clinical risk groups ) . This study investigated the effect of different types of messages regarding length , content type , and framing on vaccination intention . METHOD An online experiment was conducted in February 2015 . A representative sample of 1424 people living in Engl and read a mock newspaper article about a novel influenza p and emic before being r and omised to one of four conditions : st and ard Department of Health ( DoH ) ( long message ) and three brief theory-based messages - an abridged version of the st and ard DoH and two messages additionally targeting p and emic influenza severity and vaccination benefits ( framed as risk-reducing or health-enhancing , respectively ) . Intention to be vaccinated and potential mediators were measured . RESULTS The shortened DoH message increased vaccination intention more than the longer one , by increasing perceived susceptibility , anticipated regret and perceived message personal relevance while lowering perceived costs , despite the longer one being rated as slightly more credible . Intention to be vaccinated was not improved by adding information on severity and benefits , and the health-enhancing message was not more effective than the risk-reducing . CONCLUSION A briefer message result ed in greater intention to be vaccinated , whereas emphasising the severity of p and emic influenza and the benefits of vaccination did not . Future campaigns should consider using brief theoretically-based messages , targeting knowledge about influenza and pre caution ary measures , perceived susceptibility to p and emic influenza , and the perceived efficacy and reduced costs of vaccination CONTEXT Vaccination can decrease the morbidity and mortality caused by influenza , yet vaccination rates remain low , especially among minority groups . Previous studies have found that important barriers to vaccination include the fear of adverse reactions and concern that the vaccine causes influenza . BACKGROUND This research aim ed to assess the effects of messages design ed to address concerns about the safety and effectiveness of vaccination among blacks aged > or=50 years . DESIGN In a r and omized controlled trial conducted in 2007 with pre-exposure and post-exposure measurements , participants were r and omly assigned to read either the vaccine safety messages ( VSM ) developed for the study ( treatment condition ) or the vaccine information statement ( VIS ) currently given to those getting the vaccine ( control condition ) . SETTING / PARTICIPANTS A total of 108 participants participated in the study . Data were collected in either participants ' residences , community setting s , or university conference rooms . MAIN OUTCOME MEASURES Influenza vaccine-related beliefs and intention to receive vaccination were assessed . RESULTS Data analysis in 2007 and 2008 found that the r and omization hypotheses of equal groups were retained . Participants exposed to the VSM showed greater improvement in post-exposure beliefs about how the vaccine works ( p=0.0006 ) and the transmission of the flu ( p=0.0034 ) as well as greater post-exposure disagreement with the belief that the vaccine causes influenza ( p=0.0411 ) . CONCLUSIONS The VSM affected beliefs about vaccine safety and effectiveness to a greater degree than did the VIS . These findings show that VSM are effective in changing beliefs empirically linked with influenza vaccination and vaccination disparities . The dissemination of VSM to older blacks may increase vaccination rates and reduce vaccination disparities Objective : We examined pregnant women 's intention to obtain the seasonal influenza vaccine  via a r and omized controlled study examining the effects of immunization history , message exposure , and sociodemographic correlates . Methods : Pregnant women ages 18–50 participated in a  r and omized message framing study from September 2011 through May 2012 . Venue-based sampling was used to recruit racial and ethnic minority women throughout Atlanta , Georgia . Key outcomes were evaluated using bivariate and multivariate analyses . Results : History of influenza immunization was positively associated with intent to immunize during pregnancy [ OR = 2.31 , 90%CI : ( 1.06 , 5.00 ) ] . Significant correlates of intention to immunize included perceived susceptibility to influenza during pregnancy [ OR = 3.8 , 90 % CI : ( 1.75 , 8.36 ) ] and vaccine efficacy [ OR = 10.53 , 90 % CI : ( 4.34 , 25.50 ) ] . Single message exposure did not influence a woman 's intent to vaccinate . Conclusions : Prior immunization , perceived flu susceptibility and perceived vaccine effectiveness promoted immunization intent among this population of pregnant minority women .  Vaccine efficacy and disease susceptibility are critical to promoting immunization among women with no history of seasonal influenza immunization , while those who received the vaccine are likely to do so again . These findings provide evidence for the promotion of repeated exposure to vaccine messages emphasizing vaccine efficacy , normative support , and susceptibility to influenza OBJECTIVE In an experimental online study we compared the effects of different types of persuasive evidence in promoting the acceptance of a personal health risk . DESIGN 118 men who have sex with men ( MSM ) at-risk for infection with the hepatitis B virus ( HBV ) were recruited via a range of websites and r and omly assigned to one of 4 conditions ( 2 experimental and 2 control ) : narrative evidence ( i.e. , a personal account ) , statistical evidence ( i.e. , abstract prevalence data ) , mere assertion of increased risk , and no risk information . MAIN OUTCOME MEASURES  Narrative evidence was expected to be more effective than statistical evidence in increasing MSM 's perceived risk of infection with HBV and intention to obtain vaccination . RESULTS AND CONCLUSION As predicted , perceptions of personal risk and intention to obtain vaccination against HBV were highest after presentation of narrative evidence , and risk perception mediated the effect of type of message evidence on intention . We propose that narrative evidence effectively promotes a sense of personal risk because it is less affected by defensive message processing result ing from the threat to important self-beliefs that seems inherent in health risk communication This study assessed the effects of role models in persuasive messages about risk and social norms to increase motivation to obtain hepatitis B virus ( HBV ) vaccination in men who have sex with men ( MSM ) . MSM at risk for HBV in The Netherl and s ( N = 168 ) were recruited online via a range of websites and were r and omly assigned to one of four conditions in a 2 ( risk communication : yes and no ) × 2 ( social norms communication : yes and no ) factorial design . In each condition , participants subsequently provided self-completed assessment s of their perceived risk of HBV infection , perceived social norms regarding HBV vaccination and their intention to obtain vaccination against HBV . Risk communication and social norms communication that used social role models were effective in significantly increasing men 's intention to obtain vaccination against HBV . No additive effect was found for a combined message . Mediation analyses showed that communications influenced intention via perceived risk and social norms . Findings extend previous theorizing and research and show that both role model-based risk communication and social norms communication can be effective in increasing intentions to obtain HBV vaccination in MSM . This knowledge contributes to the development of effective health promotion to increase HBV vaccination in MSM Objective To improve primary prevention of human papillomavirus ( HPV ) infection by promoting vaccination and increased condom use among upper secondary school students . Design Cluster r and omised controlled trial . Setting 18 upper secondary schools in Sweden . Participants Schools were first r and omised to the intervention or the control group , after which individual classes were r and omised so as to be included or not . Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse , 751 ( 90.2 % ) agreed to participate and 741 ( 89.1 % ) students completed the study . Interventions The intervention was based on the Health Belief Model ( HBM ) . According to HBM , a person 's health behaviour can be explained by individual beliefs regarding health actions . School nurses delivered 30 min face-to-face structured information about HPV , including cancer risks and HPV prevention , by propagating condom use and HPV vaccination . Students in the intervention and the control groups completed question naires at baseline and after 3 months . Main outcome measures Intention to use condom with a new partner and beliefs about primary prevention of HPV , and also specifically vaccination status and increased condom use . Results All statistical analyses were performed at the individual level . The intervention had a significant effect on the intention to use condom ( p=0.004 ) . There was also a significant effect on HBM total score ( p=0.003 ) , with a 2.559 points higher score for the intervention group compared to the controls . The influence on the HBM parameters susceptibility and severity was also significant ( p<0.001 for both variables ) . The intervention also influenced behaviour : girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls ( p=0.02 ) . No harms were reported . Conclusions The school-based intervention had favourable effects on the beliefs about primary prevention of HPV , and increased the HPV vaccination rates in a diverse population of adolescents . Trial registration number NCT02280967 ; Results Objective : We examined pregnant women ’s likelihood of vaccinating their infants against seasonal influenza via a r and omized message framing study . Using Prospect Theory , we tested gain- and loss-frame message effects and demographic and psychosocial correlates of influenza immunization intention . We also explored interactions among pregnant women who viewed “ Contagion ” to underst and cultural influences on message perception . Methods : Pregnant women ages 18–50 participated in a r and omized message framing study from September 2011 through May 2012 that included exposure to intervention or control messages , coupled with question naire completion . Venue-based sampling was used to recruit racial and ethnic minority female participants at locations throughout Atlanta , Georgia . Bivariate and multivariate analyses were conducted to evaluate key outcomes . Results : The study population ( n = 261 ) included many lower income ( ≤ $ 20 000/yearly household earnings ) pregnant participants ( 69.2 % , n = 171 ) inclusive of Black/African Americans ( 88.5 % , n = 230 ) , Hispanic/Latinas ( 7.3 % , n = 19 ) , and Other/Multicultural women ( 4.2 % , n = 11 ) . Both gain [ OR = 2.13 , 90 % CI : ( 1.120 , 4.048 ) ] and loss-frame messages [ OR = 2.02 , 90 % CI : ( 1.083 , 3.787 ) ] were significantly associated with infant influenza vaccination intention compared with the control condition . Intention to immunize against influenza during pregnancy had a strong effect on intent to immunize infants [ OR = 10.83 , 90%CI : ( 4.923 , 23.825 ) ] . Those who had seen the feature film “ Contagion ” ( n = 54 , 20.69 % ) viewed gain- and loss-framed messages as appealing ( x2 = 6.03 , p = 0.05 ) , novel ( x2 = 6.24 , p = 0.03 ) , and easy to remember ( x2 = 16.33 , P = 0.0003 ) . Conclusions : In this population , both gain- and loss-framed messages were positively associated with increased maternal intent to immunize infants against influenza . Message resonance was enhanced among those who saw the film “ Contagion . ” Additionally , history of immunization was strongly associated with infant immunization intention About 90 % of all influenza 
    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 Educational interventions may be a strategy to increase human papillomavirus ( HPV ) vaccination among female university students , but studies to date have shown mixed results . This study evaluated the effect of MeFirst , an individually tailored , online educational intervention , on HPV vaccine-related knowledge , vaccination intention , and uptake among previously unvaccinated female university students . METHODS All female students aged 18 - 26 years who reported being unvaccinated against HPV at a midwestern university were invited via email to enroll . Participants completed an online survey that assessed baseline HPV vaccine-related knowledge , attitudes and vaccination intention .  Participants ( n = 661 ) were then r and omized to receive either an educational website automatically tailored to their baseline survey responses ( MeFirst intervention ) or a st and ard CDC information factsheet on HPV vaccine ( control ) .  Vaccine uptake and repeat knowledge and attitude measures were assessed with online surveys 3 months following the intervention and analyzed using logistic regression models . RESULTS HPV vaccine uptake was similar in both the MeFirst and control groups at 3 months following the intervention ( p = 0.98 ) . Three months after the intervention , the proportion of participants with high knowledge regarding HPV vaccination increased from baseline ( 32 % to 50 % ; p < 0.0001 ) but the proportion with favorable intention was unchanged . CONCLUSIONS We found that an individually tailored , online educational tool had similar effects as a nontailored factsheet on HPV-related knowledge , intention to HPV undergo vaccination , and HPV vaccine uptake among previously unvaccinated female university students OBJECTIVE Vaccination is an effective preventive measure to reduce influenza transmission , especially important in a p and emic . Despite the messages encouraging vaccination during the last p and emic , uptake remained low ( 37.6 % in clinical risk groups ) . This study investigated the effect of different types of messages regarding length , content type , and framing on vaccination intention . METHOD An online experiment was conducted in February 2015 . A representative sample of 1424 people living in Engl and read a mock newspaper article about a novel influenza p and emic before being r and omised to one of four conditions : st and ard Department of Health ( DoH ) ( long message ) and three brief theory-based messages - an abridged version of the st and ard DoH and two messages additionally targeting p and emic influenza severity and vaccination benefits ( framed as risk-reducing or health-enhancing , respectively ) . Intention to be vaccinated and potential mediators were measured . RESULTS The shortened DoH message increased vaccination intention more than the longer one , by increasing perceived susceptibility , anticipated regret and perceived message personal relevance while lowering perceived costs , despite the longer one being rated as slightly more credible . Intention to be vaccinated was not improved by adding information on severity and benefits , and the health-enhancing message was not more effective than the risk-reducing . CONCLUSION A briefer message result ed in greater intention to be vaccinated , whereas emphasising the severity of p and emic influenza and the benefits of vaccination did not . Future campaigns should consider using brief theoretically-based messages , targeting knowledge about influenza and pre caution ary measures , perceived susceptibility to p and emic influenza , and the perceived efficacy and reduced costs of vaccination CONTEXT Vaccination can decrease the morbidity and mortality caused by influenza , yet vaccination rates remain low , especially among minority groups . Previous studies have found that important barriers to vaccination include the fear of adverse reactions and concern that the vaccine causes influenza . BACKGROUND This research aim ed to assess the effects of messages design ed to address concerns about the safety and effectiveness of vaccination among blacks aged > or=50 years . DESIGN In a r and omized controlled trial conducted in 2007 with pre-exposure and post-exposure measurements , participants were r and omly assigned to read either the vaccine safety messages ( VSM ) developed for the study ( treatment condition ) or the vaccine information statement ( VIS ) currently given to those getting the vaccine ( control condition ) . SETTING / PARTICIPANTS A total of 108 participants participated in the study . Data were collected in either participants ' residences , community setting s , or university conference rooms . MAIN OUTCOME MEASURES Influenza vaccine-related beliefs and intention to receive vaccination were assessed . RESULTS Data analysis in 2007 and 2008 found that the r and omization hypotheses of equal groups were retained . Participants exposed to the VSM showed greater improvement in post-exposure beliefs about how the vaccine works ( p=0.0006 ) and the transmission of the flu ( p=0.0034 ) as well as greater post-exposure disagreement with the belief that the vaccine causes influenza ( p=0.0411 ) . CONCLUSIONS The VSM affected beliefs about vaccine safety and effectiveness to a greater degree than did the VIS . These findings show that VSM are effective in changing beliefs empirically linked with influenza vaccination and vaccination disparities . The dissemination of VSM to older blacks may increase vaccination rates and reduce vaccination disparities Objective : We examined pregnant women 's intention to obtain the seasonal influenza vaccine  via a r and omized controlled study examining the effects of immunization history , message exposure , and sociodemographic correlates . Methods : Pregnant women ages 18–50 participated in a  r and omized message framing study from September 2011 through May 2012 . Venue-based sampling was used to recruit racial and ethnic minority women throughout Atlanta , Georgia . Key outcomes were evaluated using bivariate and multivariate analyses . Results : History of influenza immunization was positively associated with intent to immunize during pregnancy [ OR = 2.31 , 90%CI : ( 1.06 , 5.00 ) ] . Significant correlates of intention to immunize included perceived susceptibility to influenza during pregnancy [ OR = 3.8 , 90 % CI : ( 1.75 , 8.36 ) ] and vaccine efficacy [ OR = 10.53 , 90 % CI : ( 4.34 , 25.50 ) ] . Single message exposure did not influence a woman 's intent to vaccinate . Conclusions : Prior immunization , perceived flu susceptibility and perceived vaccine effectiveness promoted immunization intent among this population of pregnant minority women .  Vaccine efficacy and disease susceptibility are critical to promoting immunization among women with no history of seasonal influenza immunization , while those who received the vaccine are likely to do so again . These findings provide evidence for the promotion of repeated exposure to vaccine messages emphasizing vaccine efficacy , normative support , and susceptibility to influenza OBJECTIVE In an experimental online study we compared the effects of different types of persuasive evidence in promoting the acceptance of a personal health risk . DESIGN 118 men who have sex with men ( MSM ) at-risk for infection with the hepatitis B virus ( HBV ) were recruited via a range of websites and r and omly assigned to one of 4 conditions ( 2 experimental and 2 control ) : narrative evidence ( i.e. , a personal account ) , statistical evidence ( i.e. , abstract prevalence data ) , mere assertion of increased risk , and no risk information . MAIN OUTCOME MEASURES  Narrative evidence was expected to be more effective than statistical evidence in increasing MSM 's perceived risk of infection with HBV and intention to obtain vaccination . RESULTS AND CONCLUSION As predicted , perceptions of personal risk and intention to obtain vaccination against HBV were highest after presentation of narrative evidence , and risk perception mediated the effect of type of message evidence on intention . We propose that narrative evidence effectively promotes a sense of personal risk because it is less affected by defensive message processing result ing from the threat to important self-beliefs that seems inherent in health risk communication This study assessed the effects of role models in persuasive messages about risk and social norms to increase motivation to obtain hepatitis B virus ( HBV ) vaccination in men who have sex with men ( MSM ) . MSM at risk for HBV in The Netherl and s ( N = 168 ) were recruited online via a range of websites and were r and omly assigned to one of four conditions in a 2 ( risk communication : yes and no ) × 2 ( social norms communication : yes and no ) factorial design . In each condition , participants subsequently provided self-completed assessment s of their perceived risk of HBV infection , perceived social norms regarding HBV vaccination and their intention to obtain vaccination against HBV . Risk communication and social norms communication that used social role models were effective in significantly increasing men 's intention to obtain vaccination against HBV . No additive effect was found for a combined message . Mediation analyses showed that communications influenced intention via perceived risk and social norms . Findings extend previous theorizing and research and show that both role model-based risk communication and social norms communication can be effective in increasing intentions to obtain HBV vaccination in MSM . This knowledge contributes to the development of effective health promotion to increase HBV vaccination in MSM Objective To improve primary prevention of human papillomavirus ( HPV ) infection by promoting vaccination and increased condom use among upper secondary school students . Design Cluster r and omised controlled trial . Setting 18 upper secondary schools in Sweden . Participants Schools were first r and omised to the intervention or the control group , after which individual classes were r and omised so as to be included or not . Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse , 751 ( 90.2 % ) agreed to participate and 741 ( 89.1 % ) students completed the study . Interventions The intervention was based on the Health Belief Model ( HBM ) . According to HBM , a person 's health behaviour can be explained by individual beliefs regarding health actions . School nurses delivered 30 min face-to-face structured information about HPV , including cancer risks and HPV prevention , by propagating condom use and HPV vaccination . Students in the intervention and the control groups completed question naires at baseline and after 3 months . Main outcome measures Intention to use condom with a new partner and beliefs about primary prevention of HPV , and also specifically vaccination status and increased condom use . Results All statistical analyses were performed at the individual level . The intervention had a significant effect on the intention to use condom ( p=0.004 ) . There was also a significant effect on HBM total score ( p=0.003 ) , with a 2.559 points higher score for the intervention group compared to the controls . The influence on the HBM parameters susceptibility and severity was also significant ( p<0.001 for both variables ) . The intervention also influenced behaviour : girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls ( p=0.02 ) . No harms were reported . Conclusions The school-based intervention had favourable effects on the beliefs about primary prevention of HPV , and increased the HPV vaccination rates in a diverse population of adolescents . Trial registration number NCT02280967 ; Results Objective : We examined pregnant women ’s likelihood of vaccinating their infants against seasonal influenza via a r and omized message framing study . Using Prospect Theory , we tested gain- and loss-frame message effects and demographic and psychosocial correlates of influenza immunization intention . We also explored interactions among pregnant women who viewed “ Contagion ” to underst and cultural influences on message perception . Methods : Pregnant women ages 18–50 participated in a r and omized message framing study from September 2011 through May 2012 that included exposure to intervention or control messages , coupled with question naire completion . Venue-based sampling was used to recruit racial and ethnic minority female participants at locations throughout Atlanta , Georgia . Bivariate and multivariate analyses were conducted to evaluate key outcomes . Results : The study population ( n = 261 ) included many lower income ( ≤ $ 20 000/yearly household earnings ) pregnant participants ( 69.2 % , n = 171 ) inclusive of Black/African Americans ( 88.5 % , n = 230 ) , Hispanic/Latinas ( 7.3 % , n = 19 ) , and Other/Multicultural women ( 4.2 % , n = 11 ) . Both gain [ OR = 2.13 , 90 % CI : ( 1.120 , 4.048 ) ] and loss-frame messages [ OR = 2.02 , 90 % CI : ( 1.083 , 3.787 ) ] were significantly associated with infant influenza vaccination intention compared with the control condition . Intention to immunize against influenza during pregnancy had a strong effect on intent to immunize infants [ OR = 10.83 , 90%CI : ( 4.923 , 23.825 ) ] . Those who had seen the feature film “ Contagion ” ( n = 54 , 20.69 % ) viewed gain- and loss-framed messages as appealing ( x2 = 6.03 , p = 0.05 ) , novel ( x2 = 6.24 , p = 0.03 ) , and easy to remember ( x2 = 16.33 , P = 0.0003 ) . Conclusions : In this population , both gain- and loss-framed messages were positively associated with increased maternal intent to immunize infants against influenza . Message resonance was enhanced among those who saw the film “ Contagion . ” Additionally , history of immunization was strongly associated with infant immunization intention About 90 % of all influenza 
    Output:
    