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CAIRO, Egypt — Offering a cigarette is as common as a handshake in Egypt, where the culture of smoking is so entrenched that patients sometimes light up in hospital rooms. But now the government is getting serious about the health risks, launching a new campaign of stark visual warnings about tobacco's dangers.

Starting Aug. 1, cigarette labels in Egypt will be required to carry images of the effects of smoking: a dying man in an oxygen mask, a coughing child, and a limp cigarette symbolizing impotence.

It's a major step in Egypt's fledgling anti-smoking efforts and a dramatic change in a country where public discussion of smoking's health risks is nearly nonexistent.

"I would like to quit, but I just can't. But when you see pictures like this, like that sick man, that has an effect — it does encourage you to stop," said Osama Sabri Mohammed, a 39-year-old civil servant puffing on a cigarette outside a government building in downtown Cairo.

The impotence message might have a particular effect on Egyptians, he said, because "they are really concerned about that."

The photo of the limp cigarette comes with the warning that "long-term smoking has an effect on marital relations" — somewhat more coy than a version the European Union has recommended for its member countries, which states directly that smoking causes impotence and shows a discontented young married couple sitting apart in bed.

Twelve countries, including Canada, Jordan, Brazil and Thailand, require graphic photos of the effects of smoking to be printed on cigarette packs — and many have reported success in at least reminding smokers of the dangers.

But the campaign faces a tough challenge among Egypt's smokers.

Egypt is one of the top 15 smoking countries in the world: Nearly 60 percent of all male adults in the country of 79 million people use tobacco in some form, compared with 24 percent of men in the United States. An estimated 2 percent of Egyptian women smoke — though most researchers believe female smoking is greatly underreported due to social taboos that push female smoking into private areas.

In 2005, Egypt ratified the World Health Organization's Framework Convention on Tobacco Control, which lays out methods to combat tobacco use, including pictorial warning labels.

Since then, the first baby steps have been taken to ban smoking in some areas. Airports and Cairo's metro are strictly no-smoking, and a 2007 law banned smoking in government buildings — though enforcement is still an issue.