The US Supreme Court declined on Monday to decide whether federally mandated warnings on cigarette packs that graphically illustrate the health risks of smoking violate the free speech rights of tobacco companies opposed to the labels. The justices turned away an appeal by RJ Reynolds and other tobacco companies of a lower court's ruling that found that a set of health warnings required by the US Food and Drug Administration did not violate the rights of the companies under the US Constitution's First Amendment. The action by the justices means the lower court's ruling stands. The rule was adopted by the agency in 2020 during Donald Trump's first presidential administration. The FDA required that warnings about the risks of smoking occupy the top 50% of cigarette packs and top 20% of advertisements. The regulation is technically in effect, but the FDA has generally withheld enforcing it amid legal challenges. The set of 11 warnings include depictions of feet with amputated toes, a baby whose fetal growth had been stunted, and a woman with a large protrusion in her neck caused by cancer, along with written descriptions of various health risks. RJ Reynolds, which is part of British American Tobacco, ITG Brands, which is part of Imperial Brands IMB.L, Liggett, which is part of Vector Group, and other tobacco companies sued in 2020 to challenge the warning labels. The companies claimed, among other things, that the health warnings violated their free speech rights by compelling the companies to endorse the US government's anti-smoking message through images they said misrepresented or exaggerated health consequences of smoking. US smoking rates have fallen dramatically in the past six decades, from 42.6% of American adults in 1965 to 11.6% in 2022, according to the American Lung Association. But, according to the US Centers for Disease Control and Prevention, smoking still causes more than 480,000 US deaths annually. The FDA said the warnings were justified by the US government's interest in promoting greater understanding of the health risks from smoking, and reducing confusion and deception. The agency argued that the illustrated warnings were necessary because text-only warnings failed to deter teenagers from smoking. US District Judge J. Campbell Barker in Tyler, Texas, in 2022 blocked the regulation, finding that the graphic warnings violated First Amendment protections. But the New Orleans-based 5th U.S. Circuit Court of Appeals in March found that the disputed warnings were "factual and uncontroversial," thus satisfying the relevant legal standard under the First Amendment. This prompted the tobacco companies to appeal to the Supreme Court. RJ Reynolds declined on Monday to comment on the court's decision to deny its appeal. In a separate case involving the FDA, the Supreme Court on December 2 is set to hear arguments over the agency's denial of applications to sell flavored vape products.