Images of cancer-riddled lungs and gangrenous feet are part of a new anti-tobacco arsenal that confronts Australian smokers during their cigarette breaks.
Such pictures are part of the increasingly more graphic images that health officials in other countries are imposing on tobacco products.
In many cases, the warnings in other nations are considerably more blunt than the warnings required in the USA:
* New warnings adopted by Australia in late June now show pictures of cancerous lungs and bloodied brains with text that cautions, ''Smoking doubles your risk of stroke.''
* England has had packages for years that feature large, blunt messages such as ''Smoking kills.'' The messages span at least a third of the box in large lettering.
* In Canada, a pack of smokes comes with stark images of decayed teeth.
Such images work well to curb smoking, says Greg Connolly, a former Massachusetts health official now with Harvard's School of Public Health.
''If you can show it graphically, it communicates risk and breaks down the denial,'' Connolly says.
A Canadian Cancer Society study in 2002 found that 58% of smokers who saw graphic images on cigarette packages thought twice about the health costs of smoking. About 38% said the newer warnings in 2001 factored into their decision to kick the habit.
Terry Pechacek, an associate director with the Centers for Disease Control and Prevention, says warning labels are ''one component in a comprehensive effort'' to combat smoking through marketing. The European Union, for example, sponsors an anti-smoking campaign that targets 12- to 18-year-olds, who account for an estimated 80% of new smokers.
The United States launched the era of warning labels on cigarettes with a surgeon general's report in 1964. In subsequent years, cigarette packs had to carry a variety of warnings, such as ''Quitting smoking now greatly reduces serious risks to your health.'' Since 1964, 10 million people have died from smoking-related illnesses.
Some smokers overseas aren't happy with the newer, bold statements and have found clever ways to counter the official messages. They turn to stores or Web sites to buy replacement stickers they can affix over the official labels, which say things such as ''You will get fat if you stop smoking.''
A recent U.S. Public Health Service fact sheet concedes that labeling in the USA is ''weaker, less informative and less obvious'' than in some other countries.
Connolly says anti-smoking efforts over the past 20 years have stalled, pointing to Congress' ''failure to protect the public health'' of Americans and caving in to the tobacco lobbies.
Although the CDC said last week that it didn't have any specific plans to recommend new labeling, a proposed FDA tobacco oversight bill, sponsored by Sens. Ted Kennedy, D-Mass., and Mike DeWine, R-Ohio, would call for stronger messages on cigarette packs.
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