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The photograph shows Obama standing on a balcony with Italian Prime Minister Matteo Renzi, clutching with his right hand a small rectangular item, which closely resembles a box of cigarettes, while using his left hand to pluck something from the box

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Health experts say that graphic images and warnings can counter the impression that smoking is glamorous or "cool." Studies have shown that similar campaigns have significantly lowered tobacco use in Uruguay, Brazil, Canada and Australia

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[6] [7] Psychoactive substances have been used medicinally and to alter consciousness