***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: PURPOSE To examine the extent to which increasingly plainer packaging might increase recall of health warnings . DESIGN A 4 ( pack ID levels ) x 2 ( smoking status : smokers and non-smokers ) between-subjects design in which participants were r and omly assigned to view one package . SAMPLE Two hundred and twenty students from three universities in Nova Scotia , Canada , participated in the survey . MEASURES Participants were asked to recall the health warning on their package . ANALYSIS A sequential binary logistic regression test to examine whether plain packaging and /or smoking status affects health warning recall . RESULTS The odds of recalling the correct health warnings were significantly higher for the two plainest packages relative to the original package . The odds of recalling the correct health warning were also higher for non-smokers relative to smokers . CONCLUSIONS The results provide compelling evidence that health warnings on plain packages can be more easily recalled 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 Background This study sought to examine the impact of cigarette packaging on young women , including the impact of ‘ plain ’ packaging . Methods Participants were r and omised to view eight cigarette packs design ed according to one of four experimental conditions :  fully-br and ed female br and s ; the same br and s without descriptors ( eg , ‘ slims ’ ) ; the same br and s without br and imagery or descriptors ( ie , ‘ plain ’ packs ) ; and fully br and ed non-female br and s as a control condition . Participants rated packs on perceived appeal , taste , tar , health risks and smoker ‘ traits ’ . Results Fully-br and ed female packs were rated as significantly more appealing than ‘ no descriptor ’ packs , ‘ 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 , compared to br and s without descriptors and ‘ plain ’ packs . Women who viewed plain packs were less likely to believe that smoking helps people control their appetite — an important predictor of smoking among young women — compared to women who viewed br and ed female packs . Conclusions ‘ Plain ’ packaging — removing colours and design elements— and removing descriptors such as ‘ slims ’ from packs may reduce br and appeal and thereby susceptibility to smoking among young women 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 Objective To examine the effect of br and ing , as indicated by br and name , on evaluation of the  cigarette smoking experience . Design Between-subjects and within-subjects experimental study . Participants were r and omly allocated to smoke a cigarette from a pack featuring a premium br and name and a cigarette from a pack featuring a value br and name . Within each condition , participants unknowingly smoked two identical cigarettes ( either two premium or two value cigarettes ) . Setting Australia , October 2014 , 2 years after tobacco plain packaging implementation . Participants 81 current cigarette smokers aged 19–39 years . From apparently premium and value br and -name packs , 40 smokers were allocated to smoke the same actual premium cigarettes and 41 were allocated to smoke the same actual value cigarettes . Primary outcome measures Experienced taste ( flavour , satisfaction , enjoyment , quality , liking , mouthfeel and aftertaste ) , harshness , dryness , staleness , harm/strength measures ( strength , tar , lightness , volume of smoke ) , draw effort and purchase intent . Results Cigarettes given a premium br and name were rated as having a better taste , were less harsh and less dry than identical cigarettes given a value br and name . This pattern was observed irrespective of whether the two packs actually contained premium or value cigarettes . These effects were specific : the br and name did not influence ratings of cigarette variant attributes ( strength , tar , volume of smoke , lightness and draw effort ) . Conclusions Despite the belief that br and names represent genuine differences between cigarette products , the results suggest that at least some of this perceived sensory difference is attributable to br and image Objective To investigate whether st and ardised cigarette packaging increases the time spent looking at health warnings , regardless of the format of those warnings . Study design A factorial ( two pack styles x three warning types ) within-subject experiment , with participants r and omised to different orders of conditions , completed at a university in London , UK . Methods Mock-ups of cigarette packets were presented to participants with their br and ed portion in either st and ardised ( plain ) or manufacturer- design ed ( br and ed ) format . Health warnings were present on all packets , representing all three types currently in use in the UK : black & white text , colour text , or colour images with accompanying text . Gaze position was recorded using a specialised eye tracker , providing the main outcome measure , which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet . Results An opportunity sample of 30 ( six male , mean age = 23 ) young adults met the following inclusion criteria : 1 ) not currently a smoker ; 2 ) < 100 lifetime cigarettes smoked ; 3 )  gaze position successfully tracked for > 50 % viewing time . These participants spent a greater proportion of the available time gazing at the warning-label region when the br and ed section of the pack was st and ardised ( following current Australian guidelines ) rather than containing the manufacturer 's preferred design ( mean difference in proportions = 0.078 , 95 % confidence interval 0.049 to 0.106 , p < 0.001 ) . There was no evidence that this effect varied based on the type of warning label ( black & white text vs. colour text vs. colour image & text ; interaction p = 0.295 ) . Conclusions During incidental viewing of cigarette packets , young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use st and ardised packaging , regardless of the warning design Objectives To investigate the impact of Australia 's plain tobacco packaging policy on two stated purpose s of the legislation — increasing the impact of health warnings and decreasing the promotional appeal of packaging — among adult smokers . Design Serial cross-sectional study with weekly telephone surveys ( April 2006–May 2013 ) . Interrupted time-series analyses using ARIMA modelling and linear regression models were used to investigate intervention effects . Participants 15 745 adult smokers ( aged 18 years and above ) in New South Wales ( NSW ) , Australia . R and om selection of participants involved recruiting households using r and om digit dialling and selecting the nth oldest smoker for interview . Intervention The introduction of the legislation on 1 October 2012 .  Outcomes Salience of tobacco pack health warnings , cognitive and emotional responses to warnings , avoidance of warnings , perceptions regarding one 's cigarette pack . Results Adjusting for background trends , seasonality , antismoking advertising activity and cigarette costliness , results from ARIMA modelling showed that , 2–3 months after the introduction of the new packs , there was a significant increase in the absolute proportion of smokers having strong cognitive ( 9.8 % increase , p=0.005 ) , emotional ( 8.6 % increase , p=0.01 ) and avoidant ( 9.8 % increase , p=0.0005 ) responses to on-pack health warnings . Similarly , there was a significant increase in the proportion of smokers strongly disagreeing that the look of their cigarette pack is attractive ( 57.5 % increase , p<0.0001 ) , says something good about them ( 54.5 % increase , p<0.0001 ) , influences the br and they buy ( 40.6 % increase , p<0.0001 ) , makes their pack st and out ( 55.6 % increase , p<0.0001 ) , is fashionable ( 44.7 % increase , p<0.0001 ) and matches their style ( 48.1 % increase , p<0.0001 ) . Changes in these outcomes were maintained 6 months postintervention . Conclusions The introductory effects of the plain packaging legislation among adult smokers are consistent with the specific objectives of the legislation in regard to reducing promotional appeal and increasing effectiveness of health warnings Objectives This study aim ed to test the potential impact of plain packaging for cigarettes on br and appeal among highly socioeconomically disadvantaged smokers using the new design for cigarettes implemented in Australia , which combines plain packaging with larger health warning labels . Design A 2 × 2 factorial design trial embedded within a cross-sectional computer touchscreen survey . Data were collected between March and December 2012 . Setting Socially disadvantaged welfare aid recipients were recruited through a large Social and Community Service Organisation in New South Wales , Australia . Participants N=354 smokers . The majority of the sample had not completed high school ( 64 % ) , earned less than $ A300/week ( 55 % ) and received their income from Government payments ( 95 % ) . Interventions Participants were r and omised to one of the four different pack conditions determined by br and name : Winfield versus Benson & Hedges , and packaging type : br and ed versus plain . Participants were required to rate their assigned pack on measures of br and appeal and purchase intentions . Results Plain packaging was associated with significantly reduced smoker ratings of ‘ positive pack characteristics ’ ( p<0.001 ) , ‘ positive smoker characteristics ’ ( p=0.003 ) and ‘ positive taste characteristics ’ ( p=0.033 ) in the Winfield br and name condition only . Across the four pack conditions , no main differences were found for ‘ negative smoker characteristics ’ ( p=0.427 ) or ‘ negative harm characteristics ’ ( p=0.411 ) . In comparison to plain packaging , the presentation of br and ed packaging was associated with higher odds of smokers ’ purchase intentions ( OR=2.18 , 95 % CI 1.34 to 3.54 ; p=0.002 ) . Conclusions Plain packs stripped of br and ing elements , featuring larger health warning labels , were associated with reduced positive cigarette br and image and purchase intentions among highly socioeconomically disadvantaged smokers Background : Cigarette packaging is a key marketing strategy for promoting br and image . Plain packaging has been proposed to limit br and image , but tobacco companies would resist removal of br and ing design elements . Method : A 3 ( br and types ) × 4 ( degree of plain packaging ) between-subject experimental design was used , using an internet online method , to expose 813 adult Australian smokers to one r and omly selected cigarette pack , after which respondents completed ratings of the pack . Results : Compared with current cigarette packs with full br and ing , cigarette packs that displayed progressively fewer br and ing design elements were perceived increasingly unfavourably in terms of smokers ’ appraisal s of the packs , the 
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Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using st and ardised packs , reduced dem and for st and ardised packs and reduced craving .
Corroborative evidence for the latter finding came from studies assessing non-behavioural outcomes , which in general found greater warning salience when viewing st and ardised , than br and ed packs .
There was mixed evidence for quitting cognitions , whereas findings with youth generally pointed towards st and ardised packs being less likely to motivate smoking initiation than br and ed packs .
We found the most consistent evidence for appeal , with st and ardised packs rating lower than br and ed packs .
Tobacco in st and ardised packs was also generally perceived as worse-tasting and lower quality than tobacco in br and ed packs .
St and ardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others , but only when dark colours were used for the uniform colour of the pack .
The available evidence suggests that st and ardised packaging may reduce  smoking prevalence .
A reduction in smoking behaviour is supported by routinely collected data by the Australian government .
Data on the effects of st and ardised packaging on non-behavioural outcomes ( e.g. appeal ) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence .
We did not find any evidence suggesting st and ardised packaging may increase tobacco use