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U.S. Releases Graphic Images to Deter Smokers

The different images, to be shown on packs of cigarettes beginning in 2012, have been opposed by the tobacco industry.

Federal health officials released on Tuesday their final selection of nine graphic warning labels to cover the top half of cigarette packages beginning next year, over the opposition of tobacco manufacturers.

In the first major change to warning labels in more than a quarter-century, the graphic images will include photos of horribly damaged teeth and lungs and a man exhaling smoke through a tracheotomy opening in his neck. The Department of Health and Human Services selected nine color images among 36 proposed to accompany larger text warnings.

Health advocacy groups praised the government plan in the hope that images would shock and deter new smokers and motivate existing smokers to quit. The images are to cover the upper half of the front and back of cigarette packages produced after September 2012, as well as 20 percent of the space in cigarette advertisements.

“These labels are frank, honest and powerful depictions of the health risks of smoking, and they will help encourage smokers to quit, and prevent children from smoking,” Kathleen Sebelius, the secretary of health and human services, said Tuesday in a statement.

The four leading tobacco companies were all threatening legal action, saying the images would unfairly hurt their property and free-speech rights by obscuring their brand names in retail displays, demonizing the companies and stigmatizing smokers.

The government won one case last year in a federal court in Kentucky on its overall ability to require larger warning labels with images; the specific images released Tuesday are likely to stir further legal action. The Kentucky case is before the United States Court of Appeals for the Sixth Circuit.

The new labels were required under landmark antismoking legislation giving the Food and Drug Administration power to regulate, but not ban, tobacco products. The Family Smoking Prevention and Tobacco Control Act required F.D.A. action on the graphic warning labels by Wednesday, two years after President Obama signed it into law.

The United States was the first nation to require a health warning on cigarette packages 45 years ago. Since then, at least 39 other nations, including Canada and many in Europe, have imposed more eye-catching warnings, including graphic photos.

“This is a critical moment for the United States to move forward in this area,” the F.D.A. commissioner, Dr. Margaret A. Hamburg, said in an interview. “The trends in smoking really support the need for more action now. For four decades, there was a steady decline in smoking, but five to seven years ago we leveled off at about the 20 percent level of adult and youth smoking in this country.” 

Dr. Lawrence R. Deyton, director of the F.D.A.’s Center for Tobacco Products, said the government estimates, based on other countries’ experience, that the new warning labels will prompt an additional 213,000 Americans to quit smoking in 2013, the first full year with the graphic labels.

“We are pleased with the images they picked,” said Nancy Brown, chief executive of the American Heart Association. “They strongly depict the adverse consequences of smoking. They will get people’s attention. And they will certainly be much more memorable than the current warning labels.” 

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The warnings cover the top half of cigarette packages.Credit...U.S. Food and Drug Administration, via Associated Press

Gregory N. Connolly, a professor and tobacco expert at the Harvard School of Public Health, also praised the strength of the warnings, but said the F.D.A. needed to take tougher action against cigarettes. “What’s on the pack is important, but if you really want to cut smoking rates, you’ve got to get inside the pack and deal with ingredients like menthol and nicotine,” he said.  

The nine images chosen in the United States include some that are among the most graphic of the 36 draft images. But they also include some of the less vivid, including a cartoon depiction of a baby rather than a photo in the draft set that showed a mother blowing smoke at a baby.

The images, which are to appear on cigarette packs on a rotating basis, also include one of a man proudly wearing a T-shirt that says: “I QUIT.”

All of the packs will also display a toll-free telephone number for smoking cessation services.

The F.D.A. has already proposed nine text warnings to be paired with the images, including: “Warning: Cigarettes cause cancer” and “Warning: Quitting smoking now greatly reduces serious risks to your health.”

The government surveyed 18,000 Americans of all ages to determine which of the 36 proposed labels would be most effective to deter smoking. The F.D.A. can revise the selection of images in the future.

A few smokers surveyed on New York sidewalks were unswayed by the images. Khariton Popilevsky, 46, a pawnbroker, shrugged and said: “Telling me things we already know. I’ll still be smoking.”

Hayley Sapp, 28, a paralegal, said: “There are lots of other high risks out there, you know. Obesity is huge.”

Saiful Islam, 34, a convenience store clerk, said higher prices would cut sales a lot more than the images on cigarette packs.

A submission to the F.D.A. by R.J. Reynolds, Lorillard and Commonwealth Brands, the second, third and fourth largest United States cigarette makers, said the “nonfactual and controversial images” were “intended to elicit loathing, disgust and repulsion” about a legal product.

Those companies and others filed suit in Kentucky in August 2009 over provisions of the law. Judge Joseph H. McKinley Jr. of Federal District Court in Bowling Green, Ky., ruled that the companies could be forced to put graphic warning labels on the packages but said they could not be forced to limit marketing materials to black text on a white background, saying that was too broad an intrusion on commercial free speech.

Gregg Perry, a spokesman for Lorillard Tobacco, said on Tuesday that the company was reviewing the graphics and would not comment at this time. A spokeswoman for R.J. Reynolds repeated its earlier opposition to the graphic labels. The Altria Group, the largest tobacco company in the United States, said it would not comment.

Altria, the parent company of Philip Morris, the only major tobacco company to support the overall F.D.A. legislation, said in a letter this year that the graphic warning provision was an unconstitutional part of the law “added in a last-minute amendment.”

The rate of smoking in America has been cut roughly in half, to about 19 percent, from 42 percent in 1965. Smoking remains the leading cause of preventable death, killing 443,000 Americans a year, according to the Centers for Disease Control and Prevention. Each day, the government says, an estimated 4,000 youths try their first cigarette, and 1,000 a day become regular smokers.

A version of this article appears in print on  , Section B, Page 1 of the New York edition with the headline: U.S. Selects Cigarette Warning Images. Order Reprints | Today’s Paper | Subscribe

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