***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: Objectives To investigate the links between health warning labels ( WLs ) on cigarette packets and relapse among recently quit smokers . Design Prospect i ve longitudinal cohort survey . Setting Australia , Canada , the UK and the USA . Participants 1936 recent ex-smokers ( 44.4 % male ) from one of the first six waves ( 2002–2007 ) of the International Tobacco Control 4-Country policy evaluation survey , who were followed up in the next wave . Main outcome measures Whether participants had relapsed at follow-up ( approximately 1 year later ) . Results In multivariate analysis , very frequent noticing of WLs among ex-smokers was associated with greater relapse 1 year later ( OR : 1.52 , 95 % CI 1.11 to 2.09 , p<0.01 ) , but this effect disappeared after controlling for urges to smoke and self-efficacy ( OR : 1.29 , 95 % CI 0.92 to 1.80 , p=0.135 ) . In contrast , reporting that WLs make staying quit ‘ a lot ’ more likely ( compared with ‘ not at all ’ likely ) was associated with a lower likelihood of relapse 1 year later ( OR : 0.65 , 95 % CI 0.49 to 0.86 , p<0.01 ) and this effect remained robust across all models tested , increasing in some . Conclusions This study provides the first longitudinal evidence that health warnings can help ex-smokers stay quit . Once the authors control for greater exposure to cigarettes , which is underst and ably predictive of relapse , WL effects are positive . However , it may be that ex-smokers need to actively use the health consequences that WLs highlight to remind them of their reasons for quitting , rather than it being something that happens automatically . Ex-smokers should be encouraged to use pack warnings to counter urges to resume smoking . Novel warnings may be more likely to facilitate this BACKGROUND In June 2012 , Canada implemented new pictorial warnings on cigarette packages , along with package inserts with messages to promote response efficacy ( i.e. , perceived quitting benefits ) and self-efficacy ( i.e. , confidence to quit ) . This study assessed smokers ' attention toward warnings and inserts and its relationship with efficacy beliefs , risk perceptions and cessation at follow-up . METHODS Data were analyzed in 2015 from a prospect i ve online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014 . Generalized Estimating Equation models were estimated to assess associations between reading inserts , reading warnings and efficacy beliefs ( self-efficacy , response efficacy ) , risk perceptions , quit attempts of any length , and sustained quit attempts ( i.e. , 30days or more ) at follow-up . Models adjusted for socio-demographics , smoking-related variables , and time-in- sample effects . RESULTS Over the study period , reading warnings significantly decreased ( p<0.0001 ) while reading inserts increased ( p=0.004 ) . More frequent reading of warnings was associated independently with stronger response efficacy ( Boften/very often vs never=0.28 , 95 % CI : 0.11 - 0.46 ) and risk perceptions at follow-up ( Boften/very often vs never=0.31 , 95 % CI : 0.06 - 0.56 ) . More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up ( Btwice or more vs none=0.30 , 95 % CI : 0.14 - 0.47 ) , quit attempts ( ORtwice or more vs none=1.68 , 95 % CI : 1.28 - 2.19 ) , and sustained quit attempts ( ORtwice or more vs none=1.48 , 95 % CI : 1.01 - 2.17 ) . CONCLUSIONS More frequent reading of inserts was associated with self-efficacy to quit , quit attempts , and sustained quitting at follow-up , suggesting that inserts complement pictorial HWLs Objectives : To examine the impact of health warnings on smokers by comparing the short-term impact of new graphic ( 2006 ) Australian warnings with : ( i ) earlier ( 2003 ) United Kingdom larger text-based warnings ; ( ii ) and Canadian graphic warnings ( late 2000 ) ; and also to extend our underst and ing of warning wear-out . Methods : The International Tobacco Control Policy Evaluation Survey ( ITC Project ) follows prospect i ve cohorts ( with replenishment ) of adult smokers annually ( five waves : 2002–2006 ) , in Canada , United States , UK and Australia ( around 2000 per country per wave ; total n = 17 773 ) . Measures were of pack warning salience ( reading and noticing ) ; cognitive responses ( thoughts of harm and quitting ) ; and two behavioural responses : forgoing cigarettes and avoiding the warnings . Results : All four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings . Controlling for date of introduction , they stimulated more cognitive responses than the UK ( text-only ) changes , and were avoided more , did not significantly increase forgoing cigarettes , but were read and noticed less . The findings also extend previous work showing partial wear-out of both graphic and text-only warnings , but the Canadian warnings have more sustained effects than UK ones . Conclusions : Australia ’s new health warnings increased reactions that are prospect ively predictive of cessation activity . Warning size increases warning effectiveness and graphic warnings may be superior to text-based warnings . While there is partial wear-out in the initial impact associated with all warnings , stronger warnings tend to sustain their effects for longer . These findings support arguments for governments to exceed minimum FCTC requirements on warnings Recent research has made significant progress identifying measures of the perceived effectiveness ( PE ) of persuasive messages and providing evidence of a causal link from PE to actual effectiveness ( AE ) . This article provides additional evidence of the utility of PE through unique analysis and consideration of another dimension of PE important to underst and ing the PE – AE association . Current smokers ( N=1,139 ) watched four r and omly selected antismoking Public Service Announcements ( PSAs ) .  PE scores aggregated by message were used instead of individual PE scores to create a summed total , minimizing the likelihood that PE perceptions are consequences of an individual 's intention to quit , supporting instead the PE → AE order . Linear regression analyses provide evidence of PE 's positive and significant influence on smoking-cessation-related behavioral intentions The objective of this research was to compare the response of adult smokers in Malaysia to newly proposed pictorial cigarette warnings against the current text-only warnings . The study population included 140 adult male smokers who were enrolled in a r and omized trial to view either the new pictorial warnings ( intervention ) or the old text-only warnings ( control ) . Participants completed pre-exposure and post-exposure question naires that assessed their awareness of the health risks of smoking , response to the package warnings , and interest in quitting smoking . Exposure to the pictorial warnings result ed in increased awareness of the risks of smoking , stronger behavioral response to the warnings and increased interest in quitting smoking . The new warnings in Malaysia will increase smokers ’ knowledge of the adverse health effects of smoking and have a positive effect on interest in quitting Background Cigarette smoking is considered the first preventable cause of death in the world . Social , familial , and personal factors play an important role in prevention or cessation of smoking . Educating the public in order to enhance their knowledge , change their attitude and improve their habits is also effective in this respect . In 2007 , the executive protocol of the Comprehensive Law on Smoking Control was compiled in the Ministry of Health and according to the Article 5 of this law pictorial health warning labels had to be applied on cigarette packaging . This study was design ed and conducted in 2 phases of before and 9 months after the implementation of this law and evaluated the effect of it on smokers ’ knowledge , attitude and pattern of smoking . Material s and Methods This was a cross-sectional descriptive study conducted to evaluate the effect of cigarette packs ’ pictorial health warning labels on the knowledge , attitude and smoking pattern of smokers residing in Tehran . After calculating the size of under study population and estimation of the exclusions , 1731 subjects were r and omly selected using the multiphase cluster method from the 22 districts of Tehran . Data were collected using a question naire design ed according to the st and ard question naire of the World Health Organization ( WHO ) and International Union Against Tuberculosis and Lung Disease ( IUATLD ) . Qualitative and quantitative value and reliability of the variables including cigarette consumption , knowledge about the law , and pattern of smoking were evaluated in 2 phases and the quality of pictures and their effects on the mentioned variables were assessed in the 2nd phase . Results Before adopting the pictorial warning labels in the first phase of the study , 1731 respondents were evaluated out of which 71.8 % were males and 28.2 % were females . These cases had an average of 17.6±12.3 years history of smoking . A total of 38 % ( 675 subjects ) used Iranian cigarette br and s and 39.5 % were aware of the implementation of pictorial health warning labels on cigarette packs . In terms of smokers ’ attitude towards the implementation of this law , they mostly had no opinion about it . A total of 33.3 % stated that they may cut down on smoking as the result of this law . Men had a higher percentage of smoking a cigarette first thing in the morning before breakfast and women had a higher rate of consuming foreign cigarette br and s ( P < 0.001 ) . In the second phase of the study , 1590 cases of the phase 1 subjects participated . Subjects had a significantly higher knowledge about the implementation of pictorial health warning labels on cigarette packs ( P < 0.001 ) . Attitude towards this law did not change significantly compared to the first phase although the mean score improved by 0.07 % . Enforcement of this law result ed in decreased consumption in 7.6 % of the participants . However , the Wilcoxon test did not show any significant difference . In terms of the quality of pictures , 61.6 % had no opinion , and 28.7 % expressed that the pictures had poor quality . No significant difference was observed between the Iranian or foreign br and s in terms of smoking rate after applying the pictorial warning labels . Conclusion We believed that the smoking rate would decrease after applying the pictorial health warning labels on cigarette packs . However , it did not happen . Also , adopting these labels did not have a significant effect on smokers changing their favorite br and from Iranian to foreign br and s or vice versa . Type and quality of pictures require major revision and corrections This study reports consumer reactions to the graphic health warnings selected by the Food and Drug Administration to be placed on cigarette packs in the United States . We recruited three sets of respondents for an experimental study from a national opt-in e-mail list sample : ( i ) current smokers aged 25 or older , ( ii ) young adult smokers aged 18 - 24 and ( iii ) youth aged 13 - 17 who are current smokers or who may be susceptible to initiation of smoking . Participants were r and omly assigned to be exposed to a pack of cigarettes with one of nine graphic health warnings or with a text-only warning statement . All three age groups had overall strong negative emotional ( ß = 4.7 , P < 0.001 for adults ; ß = 4.6 , P < 0.001 for young adults and ß = 4.0 , P < 0.001 for youth ) and cognitive ( ß = 2.4 , P < 0.001 for adults ; ß = 3.0 , P < 0.001 for young adults and ß = 4.6 , P < 0.001 for youth ) reactions to the proposed labels . The strong negative emotional and cognitive reactions following a single exposure to the graphic health warnings suggest that , with repeated exposures over time , graphic health warnings may influence smokers ' beliefs , intentions and behaviors Background It is important to monitor whether anti-smoking messages ( if any ) are noticed by the public in China and whether they have any impact on smokers ’ quitting behaviours over time Purpose This study aim ed to examine Chinese smokers ' exposure to anti-smoking messages in a range of channels and to determine if exposure was associated with subsequent quit attempts . Method A prospect i ve cohort design was employed . Participants were 6,509 adult smokers who completed at least one of the first three waves ( 2006–2009 ) of the International Tobacco Control ( ITC ) China Survey sample d from six Chinese cities . The main measures were reported exposure to  anti-smoking messages  in a range of channels and smokers ' subsequent quit attempts . Generalized Estimating Equations ( GEE ) modelling was used to combine respondents from all three waves while accounting for inherent within-person correlation . Results The overall exposure levels to anti-smoking messages were low and varied between cities and from one channel to another . Television was the medium with the greatest overall exposure ( over 50 % in almost all the cities across all the waves ) . After controlling for a range of covariates , higher level of combined exposure were positively related to higher subsequent quit attempts ( adjusted odds ratio = 1.03 , 95 % CI 1.02 ~ 1.05 , p < .001 ) ; among the individual channels , exposures in newspapers and on posters were significant in their own right . Conclusion The findings suggest that anti-smoking warning messages have the potential to stimulate Chinese smokers to make quit attempts , but they also indicate that the levels and strength of warning messages in China need to be increased . China should consider adopting proven international practice s , including m and ating pictorial health warnings on cigarette packages , adopting prominent point-of-sale warnings , and carrying out strong and ongoing mass media campaigns INTRODUCTION Article 11 of the World Health Organ 
    Output:
    
Strengthened warnings increased attention to warnings , recall of warnings , and thinking about the health risks of smoking .
Strengthened warnings also increased several perceived effectiveness outcomes , including perceptions that warnings reduce smoking and motivate quitting .
Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act .