Call it the ultimate backhanded compliment: "Your ads are distasteful, revolting," read a posting on the Web site getoutraged.com, "and they helped me quit smoking two years ago this month."

This was in response to anti-tobacco advertising run by Massachusetts, one of several states that have turned to graphic imagery as part of their efforts to discourage smoking, particularly among teens. These campaigns sometimes feature TV ads that borrow their look and tone from reality shows and music videos and often include shocking, close-up images of body parts disfigured by smoking- related illnesses.

"They're not home runs, they're grand slams," says Gregory Connolly, director of the Massachusetts Tobacco Prevention Program. "We found it really moved the needle on numbers of people deciding to quit."

The idea of using shock advertising first took root in Australia. Now, the Iowa landscape is dotted with anti-chewing tobacco billboards that feature mouths with black and green sores where the lower lip should be and the tagline: "Going without dip is hard, going without a lip is harder." A California TV spot shows a close-up of a middle-aged woman named Debi who has been smoking since age 13. "They say nicotine isn't addictive," she says in a notably froggy voice. After taking a puff of a cigarette directly through a hole in her throat, she asks, "How can they say that?" Washington State is running a "Real World"- style series on the Web about five teenagers who talk about their feelings as they're exposed to evidence of the dangers of smoking, including lesion-pocked lungs in a hospital pathology lab.

The states are largely funding their aggressive countermarketing campaigns with money they have received from tobacco companies as part of legal settlements reached in 1997 and 1998. Naturally, that doesn't stop the states from attacking tobacco companies for deceptive advertising that downplays the dangers of smoking and glamorizes the images of the companies themselves. California is running a series of ads, funded by an increase in tobacco taxes approved by voters in 1998, about a cynical tobacco marketing executive. He brags about getting tobacco companies "back on TV" by sponsoring sports events and demonstrates how point-of-sale advertising is placed carefully at counter level to build brand recognition among small children.

Several of the state-sponsored ads have won national awards. Mississippi, the first state to sue tobacco companies, was a winner with an ad showing a lawyer being taken through a futuristic-looking prison to meet with a defendant who "killed 11,000 people a day." As a guard briefs him about the perp, the lawyer looks at several diseased faces and organs that appear even more fragile and damaged against the stark backdrop of the prison.

Health officials working on these ads repeatedly emphasize that they are merely one weapon in their arsenal, part of comprehensive anti- tobacco programs that also include high cigarette taxes and restrictions on smoking in public places. Still, the graphic ads do seem to strike a nerve. One University of Massachusetts study indicated that people who saw the state's ads were 50 percent less likely to start smoking.

Rates of teen smoking, which had been on the rise throughout the 1990s, began to dip a bit in 1998. It's impossible to separate out how much the drop is attributable to advertising, as opposed to other state anti-tobacco efforts. That may change, though, with the advent of the American Legacy Foundation. Established by the 1998 nationwide tobacco settlement, the foundation has $1 billion to spend over five years on ads that feature body bags and other graphic imagery (some borrowed from Florida's anti-tobacco "Truth" campaign).

That's not much money compared with the tobacco industry's annual $6 billion expeditures on advertising and promotion. But if the foundation ads bring down smoking rates where there are no state-run programs, it will show that putting an ugly public face on cancer and emphysema was the right way to combat them.