Report: U.S. Ranks Last for Warning Labels on Cigarettes

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Report Follows Health Groups’ Lawsuit to Force Action on Graphic Warning Law

WASHINGTON, D.C. – November 10, 2016 – More than 100 countries worldwide now require pictorial health warnings on cigarette packages, according to a new report by the Canadian Cancer Society. The report, Cigarette Package Health Warnings: International Status Report, ranks 205 countries/jurisdictions based on the size of the health warnings on cigarette packages. The report ranks the United States and 52 other countries last (153rd) based on the size and design of the current health warnings on tobacco packaging.

The report, released Wednesday, comes just weeks after eight public health groups filed suit in federal court to force the U.S. Food and Drug Administration (FDA) to issue a final rule requiring graphic health warnings, as mandated by a 2009 federal law.

“The fact is the longer we delay using graphic labels the more lives we’re going to lose to smoking,” said Chris Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN). “This report is more proof that graphic warnings can save lives and need to be implemented in this country as they are in more than 100 other countries around the world.

There has been tremendous progress worldwide in implementing health warnings on cigarette packages. Canada was the first country to implement graphic warnings in 2001. Since then, 104 other countries have finalized graphic warnings and now require them on cigarette packages. Those 105 countries make up 58 percent of the world’s population.

The 2009 Family Smoking Prevention and Tobacco Control Act required graphic warnings covering the top half of the front and back of cigarette packs and 20 percent of cigarette advertising and gave the FDA until June 22, 2011, to issue a final rule requiring such warnings. While the FDA met that deadline, the specific graphic warnings required by the FDA were struck down in August 2012 by a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit, which ruled 2-1 that the proposed warnings violated the First Amendment. That ruling only applied to the specific images proposed by the FDA and did not address the law’s underlying requirement.

Ruling in a separate case in March 2012, the U.S. Court of Appeals for the Sixth Circuit upheld the law’s requirement for graphic warnings, finding that this provision did not violate the First Amendment. That court found the warnings, “are reasonably related to the government’s interest in preventing consumer deception and are therefore constitutional.” The U.S. Supreme Court declined to hear a tobacco industry appeal of this ruling.

Taken together, these two federal court decisions mean the FDA is still legally obligated to require graphic health warnings, and the agency is free to use different images than those struck down by the D.C. Circuit in 2012.

“Larger, graphic warning labels have the potential to encourage adults to quit smoking cigarettes and deter children from starting in the first place,” said Hansen. “This report highlights the urgency for the FDA to act on this important public health requirement.”

The lawsuit was filed by the American Academy of Pediatrics, the Massachusetts Chapter of the American Academy of Pediatrics, the American Cancer Society, the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association, the Campaign for Tobacco-Free Kids, Truth Initiative and several individual pediatricians.


ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit

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