***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 The U.S. Food and Drug Administration ( FDA ) is working to introduce new graphic warning labels for cigarette packages , the first change in cigarette warnings in more than 25 years . We sought to examine whether warnings discouraged participants from wanting to smoke and altered perceived likelihood of harms among adolescent males and whether these warning effects varied by age . Methods A national sample of 386 non-smoking American males ages 11–17 participated in an online experiment during fall 2010 . We r and omly assigned participants to view warnings using a 2 × 2 between-subjects design . The warnings described a harm of smoking ( addiction or lung cancer ) using text only or text plus an image used on European cigarette package warnings . Analyses tested whether age moderated the warnings ' impact on risk perceptions and smoking motivations . Results The warnings discouraged most adolescents from wanting to smoke , but lung cancer warnings discouraged them more than addiction warnings did ( 60 % vs. 34 % were “ very much ” discouraged , p<.001 ) . Including an image had no effect on discouragement . The warnings affected several beliefs about the harms from smoking , and age moderated these effects . Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer . They also believed that their true likelihood of experiencing any harm was lower than what an expert would say . Conclusions Our findings suggest that warnings focusing on lung cancer , rather than addiction , are more likely to discourage wanting to smoke among adolescent males and enhance their ability to imagine the harmful consequences of smoking . Including images on warnings had little effect on non-smoking male adolescents ' discouragement or beliefs , though additional research on the effects of pictorial warnings for this at-risk population is needed as the FDA moves forward with developing new graphic labels Objectives To compare adolescents ’ responses to three different styles of cigarette packaging : novelty ( br and ed packs design ed with a distinctive shape , opening style or bright colour ) , regular ( br and ed pack with no special design features ) and plain ( brown pack with a st and ard shape and opening and all br and ing removed , aside from br and name ) . Design Cross-sectional in-home survey . Setting UK . Participants R and om location quota sample of 1025 never smokers aged 11–16 years . Main outcome measures Susceptibility to smoking and composite measures of pack appraisal and pack receptivity derived from 11 survey items . Results Mean responses to the three pack types were negative for all survey items . However , ‘ novelty ’ packs were rated significantly less negatively than the ‘ regular ’ pack on most items , and the novelty and regular packs were rated less negatively than the ‘ plain ’ pack . For the novelty packs , logistic regressions , controlling for factors known to influence youth smoking , showed that susceptibility was associated with positive appraisal and also receptivity . For example , those receptive to the innovative Silk Cut Superslims pack were more than four times as likely to be susceptible to smoking than those not receptive to this pack ( AOR=4.42 , 95 % CI 2.50 to 7.81 , p<0.001 ) . For the regular pack , an association was found between positive appraisal and susceptibility but not with receptivity and susceptibility . There was no association with pack appraisal or receptivity for the plain pack . Conclusions Pack structure ( shape and opening style ) and colour are independently associated , not just with appreciation of and receptivity to the pack , but also with susceptibility to smoke . In other words , those who think most highly of novelty cigarette packaging are also the ones who indicate that they are most likely to go on to smoke . Plain packaging , in contrast , was found to directly reduce the appeal of smoking to adolescents Abstract Objective To compare the hazards of cigarette smoking in men who formed their habits at different periods , and the extent of the reduction in risk when cigarette smoking is stopped at different ages . Design Prospect i ve study that has continued from 1951 to 2001 . Setting United Kingdom . Participants 34 439 male British doctors . Information about their smoking habits was obtained in 1951 , and periodically thereafter ; cause specific mortality was monitored for 50 years . Main outcome measures Overall mortality by smoking habit , considering separately men born in different periods . Results The excess mortality associated with smoking chiefly involved vascular , neoplastic , and respiratory diseases that can be caused by smoking . Men born in 1900 - 1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers . Cessation at age 60 , 50 , 40 , or 30 years gained , respectively , about 3 , 6 , 9 , or 10 years of life expectancy . The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s . The cigarette smoker versus non-smoker probabilities of dying in middle age ( 35 - 69 ) were 42 % ν24 % ( a twofold death rate ratio ) for those born in 1900 - 1909 , but were 43 % ν 15 % ( a threefold death rate ratio ) for those born in the 1920s . At older ages , the cigarette smoker versus non-smoker probabilities of surviving from age 70 to 90 were 10 % ν 12 % at the death rates of the 1950s ( that is , among men born around the 1870s ) but were 7 % ν 33 % ( again a threefold death rate ratio ) at the death rates of the 1990s ( that is , among men born around the 1910s ) . Conclusion A substantial progressive decrease in the mortality rates among non-smokers over the past half century ( due to prevention and improved treatment of disease ) has been wholly outweighed , among cigarette smokers , by a progressive increase in the smoker ν non-smoker death rate ratio due to earlier and more intensive use of cigarettes . Among the men born around 1920 , prolonged cigarette smoking from early adult life tripled age specific mortality rates , but cessation at age 50 halved the hazard , and cessation at age 30 avoided almost all of it Cigarette package health warnings can be an important and low-cost means of communicating the health risks of smoking . We examined whether viewing health warnings in an experimental study influenced beliefs about the health effects of smoking , by conducting surveys with ~500 adult male smokers and ~500 male and female youth ( age 16–18 ) in Beijing , China ( n = 1070 ) , Mumbai area , India ( n = 1012 ) , Dhaka , Bangladesh ( n = 1018 ) , and Republic of Korea ( n = 1362 ) . Each respondent was r and omly assigned to view and rate pictorial health warnings for 2 of 15 different health effects , after which they reported beliefs about whether smoking caused 12 health effects . Respondents who viewed relevant health warnings ( vs. other warnings ) were significantly more likely to believe that smoking caused that particular health effect , for several health effects in each sample . Approximately three-quarters of respondents in China ( Beijing ) , Bangladesh ( Dhaka ) , and Korea ( which had general , text-only warnings ) thought that cigarette packages should display more health information , compared to approximately half of respondents in the Mumbai area , India ( which had detailed pictorial warnings ) . Pictorial health warnings that convey the risk of specific health effects from smoking can increase beliefs and knowledge about the health consequences of smoking , particularly for health effects that are lesser-known 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 INTRODUCTION Cigarette packaging is among the most prominent forms of tobacco marketing . This study examined the impact of cigarette pack design among young women in the United States . METHOD A national sample of 18- to 19-year-old females in the United States completed an online survey in February 2010 . Participants were r and omized to view eight cigarette packs design ed according to one of four experimental conditions : fully br and ed female packs , same packs without descriptors ( e.g. , " slims " ) , same packs without br and imagery or descriptors ( " plain " packs ) , and br and ed non-female br and s. Participants rated packs on measures of appeal and health risk and completed a behavioral pack selection task . RESULTS Fully br and ed female packs were rated significantly more appealing than the same packs without descriptors , " plain " packs , and non-female-br and ed packs . Female-br and ed packs were associated with a greater number of positive attributes including glamour , slimness , and attractiveness and were more likely to be perceived as less harmful . Approximately 40 % of smokers and nonsmokers requested a pack at the end of the study ; female-br and ed packs were 3 times more likely to be selected than plain packs . CONCLUSION Plain packaging and removing descriptors such as " slims " from cigarette packs may reduce smoking susceptibility among young women CONTEXT There is no vali date d , theory-based tool for assessing the onset of nicotine dependence . However , the use of all addictive substances can result in a loss of autonomy . We propose that nicotine dependence begins when autonomy is lost , ie , when the sequelae of tobacco use , either physical or psychological , present a barrier to quitting . OBJECTIVES To test the autonomy theory of nicotine dependence , and to evaluate the  Hooked on Nicotine Checklist ( HONC )  as a measure of the loss of autonomy over tobacco use . DESIGN The psychometric performance and concept validity of the HONC were evaluated in a 30-month prospect i ve longitudinal study of the natural history of tobacco use in a cohort of 679 seventh- grade students . RESULTS As hypothesized , endorsement of a single item on the HONC was associated with a failed attempt at smoking cessation ( odds ratio [ OR ] , 29 ; 95 % confidence interval [ CI ] , 13 - 65 ) , continued smoking until the end of follow-up ( OR , 44 ; 95 % CI , 17 - 114 ) , and daily smoking ( OR , 58 ; 95 % CI , 24 - 142 ) . Scores on the HONC correlated with the maximum amount smoked ( r = 0.65 ; P<.001 ) and the maximum frequency of smoking ( r = 0.79 ; P<.001 ) . Internal reliability was 0.94 . A 1-factor solution explained 66 % of the total variance . CONCLUSIONS The data support the autonomy theory that dependence begins with the loss of autonomy . The autonomy theory represents a potentially useful alternative to current concepts of nicotine dependence for adolescents , and the HONC appears to measure lost autonomy in adolescents . Construct validity was demonstrated by its utility in predicting failed cessation and the progression of tobacco use . In addition , the psychometric properties were excellent PURPOSE Cigarette packaging is the most prominent form of tobacco marketing remaining in countries such as the United Kingdom . The current study examined perceptions of cigarette packaging among female youth and the potential impact of " plain " cigarette packaging regulations . METHODS A national sample of 947 16- to 19-year-old female subjects in the United Kingdom completed an online survey . Participants were r and omized to view 10 cigarette packs design ed according to one of four experimental conditions : fully br and ed female packs , the same packs without descriptor words , the same packs without br and imagery or descriptors ( " plain " packs ) , and br and ed non-female br and s. Participants rated packs on measures of appeal and health risk , positive smoker image , and completed a behavioral pack selection task . RESULTS Plain packs were rated as the least appealing and worse tasting compared with all other conditions . Plain packs were also associated with fewer false beliefs about health risks compared with br and ed packs . Removing br and descriptors from packs significantly reduced measures of appeal and taste , particularly for br and s with flavor descriptors , such as cherry and vanilla . Plain packs were significantly less likely to 
    Output:
    
Graphic health warnings were perceived as more effective than text-only warnings , with warnings depicting lung cancer , and oral diseases being perceived as particularly effective .
Health warnings increased viewer fear , anxiety , shock , and guilt and were considered effective in preventing non-smokers from experimenting with tobacco and prompting current smokers to quit .
Plain packaging reduced the attractiveness and other positive attributes of cigarette packaging , with darker colours found to be the most effective .
When used in combination , plain packaging increased the visibility of graphic health warnings , with participants also perceiving them as having an increased tar content and having more serious health risks , and increased thoughts of quitting amongst smokers .
Conclusions Graphic health warnings and plain packaging appear to increase  adolescent awareness of the dangers of tobacco use .