The 13 new warnings describe in greater detail how smoking damages the body. One notes that smoking causes cataracts, which can lead to blindness. Another says smoking can cause erectile dysfunction. Others note the possibility of getting diabetes or bladder cancer, and developing reduced blood flow to the limbs, which can require amputation.
In a 2019 report, the World Health Organization said warning labels “are most effective when they are pictorial, graphic, comprehensive, and strongly worded.” More than 91 countries have adopted what the organization considers strong labels, which cover at least half of the package. These include warnings about impotence — featuring sad-looking couples in bed — and magnified images of rotten teeth and cateract-covered eyeballs. Another 22 countries require graphic warnings that cover 30 percent of the pack, according to the organization.
Several published studies found mixed smoker reactions to the initial nine proposed labels. A February 2016 study published by University of Illinois researchers in the journal Communication Research suggests that graphic images could backfire, with smokers viewing the lurid images as “a threat to their freedom, choice or autonomy.”
Researchers at the University of North Carolina, Chapel Hill said in June 2016 that 40 percent of participants in their study said they were more likely to consider quitting after exposure to the graphic images, compared with 34 percent with the text warning. And a study led by Cornell University researchers found that graphic warnings reduced the appeal of cigarette brands among youth relative to social cue advertisements with the Surgeon General’s warnings. Neither graphic nor text warnings influenced people’s beliefs about the health risks of smoking.
But public health organizations have been pushing for them. In 2016, with the F.D.A. lagging on its revised labels, a coalition of public health groups, including the American Academy of Pediatrics, the American Cancer Society, the American Lung Association and others, sued the agency for taking too long.
In March, a federal court ruled in the groups’ favor, noting that the F.D.A. had “unlawfully withheld,” and “unreasonably delayed” action to require the graphic warnings. Judge Indira Talwani set a deadline of Thursday, Aug. 15 for the agency to issue a draft, and March 15, 2020, for the final rule.