***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 Background In 2010 , the US Food and Drug Administration ( FDA ) proposed a series of 36 graphic warning labels for cigarette packages . We sought to evaluate the effects of the labels on fear-related emotions about health consequences of smoking and smoking motivations of young adults . Methods We conducted an experimental study in 2010–2011 with 325 smokers and non-smokers ages 18–30 years whom we recruited through community distribution lists in North Carolina and through a national survey company . Each participant viewed 27 labels ( 18 of the proposed labels with graphic images and text warnings and 9 with text-only warnings ) in a r and om order , evaluating each label on underst and ability and its effects on fear-related reactions and discouragement from wanting to smoke . Results Respondents found most of the proposed labels easy to underst and . Of the 36 labels , 64 % induced greater fear-related reactions and 58 % discouraged respondents from wanting to smoke more than the corresponding text-only labels did . Labels with the greatest effects had photographs ( as compared with drawings or other art graphics ) or depicted diseased body parts or suffering or dead people . In almost every comparison , smokers reported lower fear-related reactions and feeling less discouraged from wanting to smoke relative to non-smokers . Conclusions Most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels , although some had larger effects than others . All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations Introduction Graphic warnings ( GWs ) on cigarette packs are widely used internationally and perhaps will be in the US but their impact is not well understood . This study tested support for competing hypotheses in different subgroups of young adults defined by their history of cigarette smoking and individual difference variables ( e.g. , psychological reactance ) . One hypothesis predicted adaptive responding ( GWs would lower smoking-related intentions ) and another predicted defensive responding ( GWs would raise smoking-related intentions ) . Methods Participants were an online sample of 1,169 Americans ages 18–24 , who were r and omly assigned either to view nine GWs design ed by the FDA or to a no-label control . Both the intention to smoke in the future and the intention to quit smoking ( among smokers ) were assessed before and after message exposure . Results GWs lowered intention to smoke in the future among those with a moderate lifetime smoking history ( between 1 and 100 cigarettes ) , and they increased intention to quit smoking among those with a heavy lifetime smoking history ( more than 100 cigarettes ) . Both effects were limited to individuals who had smoked in some but not all of the prior 30 days ( i.e. , occasional smokers ) . No evidence of defensive “ boomerang effects ” on intention was observed in any subgroup . Conclusion Graphic warnings can reduce interest in smoking among occasional smokers , a finding that supports the adaptive-change hypothesis . GWs that target occasional smokers might be more effective at reducing cigarette smoking in young adults ABSTRACT The U.S. Family Smoking Prevention and Tobacco Control Act ( Tobacco Control Act ) of 2009 paved the way for the Food and Drug Administration ( FDA ) to propose nine different graphic warning labels ( GWLs ) intended for prominent placement on the front and back of cigarette packs and on cigarette advertisements . Those GWLs were adjudicated as unconstitutional on the ground that they unnecessarily infringed tobacco companies ’ free speech without sufficiently advancing the government ’s public health interests . This study examines whether less extensive alternatives to the original full-color GWLs , including black- and -white GWLs and text-only options , have similar or divergent effects on visual attention , negative affect , and health risk beliefs . We used a mobile media research lab to conduct a r and omized experiment with two population s residing in socioeconomically disadvantaged communities : biochemically confirmed adult smokers ( N = 313 ) and middle school youth ( N = 340 ) . Results indicate that full-color GWLs  capture attention for longer than black- and -white GWLs among both youth and adult smokers . Among adults , packages with GWLs ( in either color or black- and -white ) engendered more negative affect than those with text-only labels , while text-only produced greater negative affect than the packages with br and imagery only . Among youth , GWLs and text-only labels produced comparable levels of negative affect , albeit more so than br and imagery . We thus offer mixed findings related to the cl aim that a less extensive alternative could satisfy the government ’s compelling public health interest to reduce cigarette smoking rates Introduction Cigarette graphic-warning labels elicit negative emotion . Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes . The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion . Methods Nationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were r and omly assigned to view one of three warning types ( text-only , text with low-emotion images , or text with high-emotion images ) four times over 2 weeks . Participants recorded their emotional reaction to the warnings ( measured as arousal ) , smoking risk perceptions , and quit intentions . Primary analyses used structural equation modeling . Results Participants in the high-emotion condition reported greater emotional reaction than text-only participants ( bAdult = 0.21 ; bTeen = 0.27 , p 's < .004 ) ; those in the low-emotion condition reported lower emotional reaction than text-only participants ( bAdult = -0.18 ; bTeen = -0.22 , p 's < .018 ) . Stronger emotional reaction was associated with increased risk perceptions in both sample s ( bAdult = 0.66 ; bTeen = 0.85 , p 's < .001 ) and greater quit intentions among adults ( bAdult = 1.00 , p < .001 ) . Compared to text-only warnings , low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions . Conclusion Warning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings . However , graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions versus text-only warnings . Implication s This research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings . Among adult and teen smokers , high-emotion graphic warnings were associated with increased risk perceptions and quit intentions versus text-only warnings . Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions versus text-only warnings . Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers ' risk perceptions and quit intentions . Low-emotion graphic warnings will not necessarily produce desired population -level benefits relative to text-only or high-emotion warnings Objective : To test the effect of exposure to the US Food and Drug Administration ’s proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes towards smoking . Design and methods : A two-session web-based study was conducted with 2192 young adults 18–25-years-old . During session one , demographics , smoking behaviour , and baseline implicit and explicit attitudes were assessed . Session two , completed on average 18 days later , contained r and om assignment to viewing one of three sets of cigarette packages , graphic images with text warnings , text warnings only , or current US Surgeon General ’s text warnings . Participants then completed post-exposure measures of implicit and explicit attitudes . ANCOVAs tested the effect of condition on the outcomes , controlling for baseline attitudes . Results : Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions ( p = .004 ) . For the entire sample , explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current US Surgeon General ’s text warnings ( p = .014 ) , but there was no difference compared to those who viewed text-only warnings . Conclusion : Graphic health warnings on cigarette packages can influence  young adult smokers ’ implicit attitudes towards smoking This study investigates gain-framed and loss-framed messages on graphic cigarette warning labels and their effects on adolescents ' smoking-related attitudes and behaviors .  Canadian cigarette warning labels emphasizing health consequences of smoking ( loss-framed ) were digitally manipulated into gain-framed versions .  High school students ( N = 210 ) completed a question naire measuring attitudes , perceptions of the warnings , and behavioral intentions . The study used a posttest-only comparison group design with r and om assignment . The independent variable was message framing ( loss-framed , gain-framed avoidance , gain-framed benefits ) , and the dependent variables were ( a ) attitudes toward the warning , ( b ) attitudes toward smoking , ( c ) effectiveness in reducing smoking levels , ( d ) intentions to smoke , ( e ) effectiveness in improving one 's ability to quit , and ( f ) effectiveness in increasing the likelihood of a smoker quitting . Results indicate that adolescents had more favorable attitudes toward the loss-framed warnings and perceived them as more effective than the gain-framed warnings . Further , smokers exposed to the loss-framed version featuring decaying teeth had significantly lower intentions to smoke in the future . Loss-framed warning labels appear to have a positive influence on adolescents ' smoking-related attitudes and behavioral intentions INTRODUCTION Population -level communication interventions , such as graphic warning labels ( GWLs ) on cigarette packs , have the potential to reduce or exacerbate tobacco-related health disparities depending on their effectiveness among disadvantaged sub- population s. This study evaluated the likely impact of nine GWLs proposed by the US Food and Drug Administration on ( 1 ) African American and ( 2 ) Hispanic smokers , who disproportionately bear the burden of tobacco-related illness , and ( 3 ) low education smokers , who have higher smoking rates . METHODS Data were collected online from current smokers r and omly assigned to see GWLs ( treatment ) or the current text-only warning labels ( control ) .  Participants were stratified by age ( 18 - 25 ; 26 + ) in each of four groups : general population ( n = 1246 ) , African Americans ( n = 1200 ) , Hispanics ( n = 1200 ) , and low education ( n = 1790 ) . We tested the effectiveness of GWLs compared to text-only warning labels using eight outcomes that are predictive of quitting intentions or behaviors including negative emotion , intentions to hold back from smoking , intentions to engage in avoidance behaviors , and intentions to quit . RESULTS Across all outcomes , GWLs were significantly more effective than text-only warning labels more often than expected by chance . Results suggested that African Americans , Hispanics and smokers with low education did not differ from the general population of smokers in their reactions to any of the nine individual GWLs . CONCLUSIONS The nine GWLs were similarly effective for disadvantaged sub- population s and the general population of smokers . Implementation of GWLs is therefore unlikely to reduce or exacerbate existing tobacco-related health disparities , but will most likely uniformly increase intentions and behaviors predictive of smoking cessation 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 c 
    Output:
    
Generally , PWLs led to higher attention , stronger cognitive and affective reactions , more negative pack attitudes and smoking attitudes , and increased intentions not to use tobacco products compared to text warnings .
PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs .
The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people .
Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products