Images like a cadaver with a chest-length scar and grotesquely diseased lungs should become prominent features on cigarette packages, government officials said Wednesday in a major escalation of their war against smoking.
The U.S. Food and Drug Administration revealed proposals for the graphic warning labels it plans to require manufacturers to use by late 2012. The vivid warnings, stamped across half of the front and back of cigarette packs, aren't as shocking as those used in some countries. But they mark the most significant change to American cigarette health labeling in a quarter century.
Cigarettes cause cancer. Smoking can kill you. Tobacco smoke can harm your children. If the messages in the images aren't already crystal clear, simple warning statements will hammer them home.
"With these picture warnings, you won't be noticing so much the Marlboro name and the colors. What you will see is the advertisement for lung cancer," said David Hammond, a Canadian professor who has researched the impact of cigarette warning labels internationally. "That is really going to change the fundamental appeal of the pack and people's image of smoking."
Smokers already see a warning — a small, written message that hasn't deterred Tina McDonald of Apollo Beach. The 44-year-old Virginia Slims smoker says a new label won't tell her anything she doesn't already know.
"I know it's bad without seeing a graphic picture," said McDonald, who began smoking 10 years ago during a divorce. "I know the dangers. I don't think seeing someone else in these kinds of states is going to change my mind."
On a smoke break during work hours in downtown Tampa, McDonald explained she isn't opposed to the new warning labels. She just doesn't think they'll help her quit. She has a prescription for Chantix, a medication used to help people break the habit, but hasn't gotten it filled.
Still, federal officials and experts believe the labels can deliver a jolt of shock therapy to their fading antismoking efforts.
Smoking remains the leading cause of premature and preventable death in the United States, responsible for 443,000 deaths each year. The nation's smoking rates declined from about 42 percent in 1965 to just under 21 percent in 2004, but have remained flat since.
"That's bad news," said Health and Human Services Secretary Kathleen Sebelius. "Every day, 4,000 young people try cigarettes for the first time and 1,000 continue to smoke."
Research suggests that disturbing warning labels on cigarette packaging can make a difference.
In Canada, the first country to impose such strong warnings in 2000, one-third of smokers said the images helped motivate them to quit, said Hammond, an assistant professor in health studies at the University of Waterloo.
Perhaps more significantly, he noted that 90 percent of Canadian youth say the warnings made smoking less attractive and discouraged them from picking up the habit.
"It's impossible to say smoking rates are going to drop by 'X' percent, but all the evidence points to the fact that these things help to reduce smoking," said Hammond, a World Health Organization adviser on the topic.
More than 30 countries have required a warning picture on cigarette packages. The graphics proposed by the U.S. government follow their lead.
Federal officials have released 36 proposals for public comment. They plan to select nine for use by June.
The images include a man with a tracheotomy smoking a cigarette and a skeletal woman seemingly on her deathbed. The FDA also is considering less disturbing images, including cartoons in the style of graphic novels.
By Oct. 22, 2012, cigarette manufacturers no longer can distribute cigarettes that do not display the warnings.
Reynolds American Inc., parent company of the nation's second-largest cigarettemaker, R.J. Reynolds, is reviewing the labeling plan. Spokesman David Howard said the legality of the new labels is part of a pending federal lawsuit by the company and others.
The tobaccomakers in the suit argued the warnings would relegate the companies' brands to the bottom half of the cigarette package, making them "difficult, if not impossible, to see."
Barbara McGreal of Tampa, acknowledged the warnings might provide just the push she needs. She started smoking more than 30 years ago. These days, she smokes just under a pack per day.
And she has tried to quit before. Once she and her husband, who also smokes, succeeded together. In six months, they saved enough on cigarettes to take a Thanksgiving cruise to the Bahamas.
But while on their vacation, they picked up cigarettes again.
"I'm kind of on the fence about quitting," said McGreal, 53, taking a late afternoon smoke break in downtown Tampa. "I don't know if the pictures will help to push me over the edge."
Times researcher Shirl Kennedy contributed to this report, which contains information from the Associated Press and Los Angeles Times.