Tough anti-smoking laws came into effect in Italy today, imposing large fines for several offences and making it illegal to smoke in a car carrying children or pregnant women.

The laws require cigarette packs to carry stark pictures of people who suffered from the effects of smoking, including one of a woman coughing up blood and another of a man who died of a heart attack being zipped up in a body bag.

Those caught smoking in cars with children or pregnant women risk fines of up to 500 euros ($546). Smoking will also be prohibited outdoors near schools and hospitals. Tobacconists caught selling cigarettes to minors risk fines of up to 3,000 euros or losing their license.

Throwing cigarette butts on the pavement could cost an offender up to 300 euros.

The laws were passed in 2015 in response to an EU directive requiring member states to toughen smoking laws. Health officials and consumer groups estimate that smoking causes some 80,000 deaths a year in Italy