F.D.A. unveils graphic cigarette warning labels as part of campaign to get smokers to quit

Federal drug regulators unveiled 36 proposed warning labels for cigarette packages on Wednesday, including some that are striking pictures of smoking’s effects.

Designed to cover half of a pack’s surface area, the new labels are intended to spur smokers to quit by providing graphic reminders of tobacco’s dangers. The labels are required under a law passed last year that gave the Food and Drug Administration the power to regulate tobacco products for the first time.

The proposed labels include pictures of a man smoking from a tracheostomy tube inserted into his throat; a diseased lung; and a woman holding a baby in a smoke-filled room. The proposals stayed away from some of the more gruesome labels used in other countries, where pictures of blackened teeth and diseased mouths are common.

“Today marks an important milestone in protecting our children and the health of the American public,” Health and Human Services Secretary Kathleen Sebelius said on Wednesday.

The United States was the first country to require that tobacco products bear health warnings, and all cigarette packages now sold in the United States have modest and widely ignored messages, like “Surgeon General’s Warning: Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy.”

A growing number of countries have gone well beyond such brief warnings, though, and now require large, graphic depictions of smoking’s effects. With Wednesday’s announcement, the United States – whose first European settlements in the 17th century helped to create and feed a global tobacco addiction – edges a step closer to joining those nations’ efforts to reduce the resulting centuries-long epidemic of tobacco-related deaths.

“This is the most important change in cigarette health warnings in the history of the United States,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

The labels unveiled on Wednesday are part of a formal rule-making procedure by the F.D.A. The agency will accept public comment on the 36 proposed labels, and expects to choose the final nine by June. By Oct. 22, 2012, manufacturers will no longer be allowed to distribute cigarettes for sale in the United States that do not display the new graphic health warnings.

Public health officials are hoping that the new labels will re-energize the nation’s antismoking efforts, which have stalled in recent years. About 20.6 percent of the nation’s adults, or 46.6 million people, and about 19.5 percent of high school students, or 3.4 million teenagers, are smokers. Every day, roughly 1,000 teenagers and children become regular smokers, and 4,000 try smoking for the first time. About 400,000 people die every year from smoking-related health problems, and the cost to treat such problems exceeds $96 billion a year.

“When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes,” said Dr. Margaret Hamburg, the commissioner of the Food and Drug Administration.

Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic, said he was hopeful that the new labels would save lives, although he said that a higher federal tax and tougher workplace smoking restrictions were also needed.

“The evidence is that graphic labels do make a difference in enticing smokers to stop smoking,” he said.

But he predicted that cigarette makers would devise schemes to blunt the labels’ effects with slip covers and other packaging efforts. “It’ll be interesting to see what they try to do,” Dr. Hurt said.

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