Get ready for pictures of rotted teeth, diseased lungs and other shocking images on cigarette packs.
Nine powerful images, which were released Tuesday by federal health officials, will cover the top half of cigarette packages in the first significant change in warnings on the labels since 1985.
It will be difficult to escape them. A pack-a-day smoker will see the images more than 7,000 times a year.
"We know from studies around the world that the more gruesome the image the more effective the label is at deterring people from smoking and stimulating some smokers to quit," said K. Michael Cummings, chairman of the department of health behavior at Roswell Park Cancer Institute and a veteran tobacco researcher.
The thinking goes that people who see the graphic warning labels are more likely to attempt to quit smoking and or to never start. That conclusion is backed up by years of research.
"The emotional reaction to a shocking image is more likely to make an impact on a decision to smoke. That's a consistent message from studies done in Buffalo, the U.S. and around the world," said Maansi Bansal-Travers, a behavioral research scientist at Roswell Park.
President Obama in 2009 signed the Family Smoking Prevention and Tobacco Control Act, which gave the Food and Drug Administration the authority to require the labels. The FDA, after a scientific review and 18,000-person survey of 36 proposed labels, announced the selections.
Tobacco companies must change their labels by September 2012. The images must appear on the top 50 percent of both the front and rear panels of each cigarette package and be accompanied by new warning statements, such as "Warning: Cigarettes are addictive" and "Warning: Cigarettes cause strokes and heart disease."
The FDA also required manufacturers to print a toll-free number for quit-smoking services on the labels, 1-800-QUIT-NOW. Stop-smoking advocates suggested smokers also can turn to the New York State Smokers' Quitline at 1-866-NY-QUITS.
"That toll-free number on the label is a critical step because it links smokers to the resources and support to quit," said Bansal-Travers, who has conducted research on the impact of cigarette pack design.
She was the lead author of a study this year in the American Journal of Preventive Medicine that added more evidence to the mounting body of work indicating that large, graphic health warnings are most effective at conveying the risks of smoking.
Anti-smoking advocates and tobacco researchers praised the move as a turning point in public health measures to help smokers quit and prevent nonsmokers, especially young people, from starting to smoke.
"It's a huge step in the right direction. Truthful marketing helps us in what we do," said Anthony Billoni, coordinator of the Erie-Niagara Tobacco-Free Coalition, which educates the public about the health risks of tobacco.
Canada in 2000 was the first country to require graphic warnings on labels, and more than 30 other countries have adopted the practice. Studies show that labels -- both their design and the textual information -- play a major role in influencing smokers' perception of health risks. Surveys also suggest that cigarette labels serve as the primary source of information about the product for many smokers.
Cigarette smoking is the leading cause of preventable death in the United States, accounting for about 443,000 deaths each year, according to the federal Centers for Disease Control and Prevention. The rate of smoking declined from 42 percent of adults in 1965 to 21 percent in 2003 but has remained at about 20 percent since then.
The FDA reported that it plans to evaluate the effects of the warnings to determine if their effect wears out and they need to be changed.
"While there's more work to be done to prevent the use of cigarettes, this step will go a long way towards improving the health and well being of Americans, and we hope it will prevent our children and future generations from picking up this addictive and deadly habit," Kathleen Sebelius, secretary of health and human services, said in a statement.