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The U.S. first mandated the use of warning labels stating, “Cigarettes may be hazardous to your health” in 1965. The current warning labels _ put on cigarette packs in the mid-1980s _ say more explicitly that smoking can cause lung cancer, heart disease and other illnesses. But the warnings contain no pictures; they consist only of text in a small box.

The share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to about 20 percent. But the rate has stalled since about 2004, with about 46 million adults in the U.S. smoking cigarettes. It’s unclear why it hasn’t budged, but some experts have cited tobacco company discount coupons on cigarettes and lack of funding for programs to discourage smoking or to help smokers quit.

In recent years, more than 40 countries or jurisdictions have introduced labels similar to those created by the FDA. The World Health Organization said in a survey done in countries with graphic labels that a majority of smokers noticed the warnings and more than 25 percent said the warnings led them to consider quitting.

In 2000, Canada introduced blunt warning labels that included images of a pregnant woman smoking, a child and parent puffing away, and a drooping cigarette to illustrate the risk of impotence from smoking. Since then, the county’s smoking rate has declined from about 26 percent to about 20 percent. How much the warnings contributed is unclear because the country took other steps to reduce smoking.

David Hammond, a health behavior researcher at the University of Waterloo in Canada, who worked with the firm designing the labels for the FDA, said that while the images are graphic, they are necessary.

“This isn’t about doing what’s pleasant for people,” he said.

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Associated Press Writers Lisa Cornwell in Cincinnati and Anna McFall in Montgomery, Ala., contributed to this report.

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Michael Felberbaum can be reached at http://www.twitter.com/MLFelberbaum.

Online:

New Cigarette Warning Labels: http://1.usa.gov/j2DI5f.