A dead man in a coffin, a crying baby, a bald cancer patient and a close-up of dirty teeth and a malignant lip lesion are among new graphic warnings the United States is proposing for cigarette packs.
The changes revealed Wednesday are part of a 2009 law that requires new and larger labels on cigarettes to depict the negative health consequences of smoking.
A series of 36 graphics are available on the Food and Drug Administration's website and the government agency will accept comments from the public through January 9 before deciding on nine of them, it said.
The warnings are to take up about half the space on the front of each cigarette pack, located on the upper portion so they are visible in most store displays.
"Today, FDA takes a crucial step toward reducing the tremendous toll of illness and death caused by tobacco use by proposing to dramatically change how cigarette packages and advertising look in this country," said FDA Commissioner Margaret Hamburg.
"When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes."
By October 2012 the new warnings will be mandatory on all cigarette packs distributed in the United States and in all cigarette advertisements.
Currently, the standard warning on cigarette packs in the United States is found in small print along the side of the box: "Surgeon General's warning: cigarette smoke contains carbon monoxide."
A total of 443,000 people die in the United States each year due to tobacco use, making it the leading cause of premature and preventable death, the FDA said.
"Smoking can kill you," "Smoking during pregnancy can harm your baby," and "Tobacco smoke causes fatal lung disease in nonsmokers" are among the suggested text warnings.
Others include "Cigarettes cause strokes and heart disease," and "Cigarettes cause cancer."
But it is the color images accompanying the the text that aim to jar consumers out of the habit.
"Warning! Cigarettes are addictive," reads one graphic, accompanied by a cartoon drawing of a man injecting a cigarette into his arm like a needle.
Another uses the same words but shows a photo of a man with a tracheotomy, cigarette in hand, smoke emerging from the hole in his neck.
One uses childlike handwriting on a lined background like school paper to say: "Tobacco smoke can harm your children."
Warnings in advertisements must take up at least 20 percent of the ad, according to the new rules.
In small advertisements consisting of less than 12 square inches (78 square centimeters), small warning icons can be placed instead.
Those suggested graphics include a circle with a line through a lit cigarette, a commonly seen no-smoking symbol that would appear in the upper right hand corner of the front of the pack.
Another graphic is an exclamation point inside a triangle. Both graphics are in red, white and black.