The in-in effective action formalism is used to derive the semiclassical correction to Einsteins equations due to a massless scalar quantum field conformally coupled to small gravitational perturbations in spatially flat cosmological models. The vacuum expectation value of the stress tensor of the quantum field is directly derived from the renormalized in-in effective action. The usual in-out effective action is also discussed and it is used to compute the probability of particle creation. As one application, the stress tensor of a scalar field around a static cosmic string is derived and the back-reaction effect on the gravitational field of the string is discussed.