Delayed Implementation of Graphic Warning Labels on Cigarettes Harms Public Health

April 17, 2023

The Family Smoking Prevention and Tobacco Control Act (TCA) of 2009 required graphic warnings cover the top half of the front and back of cigarette packs and 20 percent of cigarette advertising. Studies have found the current text-only warnings on cigarettes do not attract attention and do not provide sufficient information about the harmful health effects of smoking. Despite the significant research findings showing how smoking increases the risk for many cancers,[i] many individuals who smoke are not aware of the full health harms smoking causes. This is not surprising given the tobacco industry has spent decades lying to the public, saying their products are not addictive, harmful or deadly. Studies around the world have shown that graphic warnings are effective at informing consumers about the health risks of smoking, preventing children and others from starting to smoke, and motivating people who smoke to quit.[ii],[iii],[iv]

Prior to passage of the TCA in 2009, only 18 countries required graphic warnings. Now, more than 120+ countries require large, graphic cigarette warnings. In 2021, the World Health Organization (WHO) estimated that 4.7 billion people (60% of the world’s population) benefit from large graphic warnings on cigarette pack labels featuring all WHO-recommended characteristics.[v] The U.S. is far behind the rest of the world on implementing graphic warnings.

Implementation of graphic warnings in the U.S. has been thwarted by tobacco industry legal challenges. The American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN), along with our partners, have fought back in the judicial system, using litigation to both compel the U.S. Food and Drug Administration (FDA) to issue graphic warning regulations and help the U.S. Department of Justice (DOJ) defend the regulations finalized by FDA.


[i] American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2021-2022. Atlanta: American Cancer Society; 2021.

[ii] Hammond, D., G.T. Fong, R. Borland, et al.‘‘Text and Graphic Warnings on Cigarette Packages: Findings from the International Tobacco Control Four Country Study.’’ American Journal of Preventive Medicine, 32(3):202–209, 2007. Available at

[iii] WHO Report on the Global Tobacco Epidemic, Geneva: World Health Organization; 2019.

[iv] Fathelrahman, A.I., L. Li, R. Borland, et al. “Stronger Pack Warnings Predict Quitting More than Weaker Ones: Finding from the ITC Malaysia and Thailand Surveys.” Tobacco Induced Diseases, 11(1):20, 2013. Available at

[v] WHO report on the global tobacco epidemic 2021: addressing new and emerging products. Geneva: World Health Organization, 2021. Retrieved from