Whichever it is, the pictures that stare out from a murky green cigarette pack are haunting. So much so, that of all the graphic images currently being splashed across the plain packs - there are seven in circulation and seven more to be introduced next year - this is the one smokers do not want to have to look at.

''We are hearing about people who are being given that pack and they're saying, 'Look, I don't want that one, give me another one','' Quit Victoria executive director Fiona Sharkie says.

''It's a very human connection, rather than just a body part, and it's having a really shocking impact on people.''

The story of exactly how Bryan Curtis came to appear on our plain packs is unclear. The Department of Health will only say that Mr Curtis was a US citizen who died of smoking-related lung cancer. It entered into a confidential agreement with his family to use the images.

Fairfax Media believes it was Mr Curtis' dying wish to prevent even one child sharing the same fate. An article published in the St Petersburg Times in Florida in June 1999, just weeks after he died, tells the story of the St Petersburg mechanic, roofer and construction worker, who smoked two packs of Marlboro Reds a day for nearly 20 years, until he died, aged 34.

In the weeks before his death, the father of two urged his mother to help him spread the anti-smoking message. She subsequently rang newspapers, radio and television stations seeking someone who would tell her son's story.

That person was Sue Landry of the St Petersburg Times. Since then, her article and the accompanying images have been shared across the internet. His shocking image is also believed to have been published in Time magazine and pinned on fridges, in schools and in factories around the world.

In 2000, his mother, Louise Curtis, told the same newspaper: ''His last wish worked. He said he'd be happy if he even reached one person. I have no idea how many people that picture has touched. But I'd bet it's been thousands.'' It's now potentially millions.

Attempts by Fairfax Media to contact Mr Curtis' family were unsuccessful. His wife, and son, who was just two when he died, were charged with attempted murder in September.

But on learning that Mr Curtis' image was being used in Australia, Ms Landry said: ''I think Bryan's mother would feel wonderful knowing that her son's dying wish has come true … I am sure she feels gratified that at least his message spread so far and has most likely saved lives.''

Ms Sharkie says that for the first time calls to the Quitline have increased in December. She attributes it directly to the introduction of plain packs from December 1.

This comes despite reports of smokers using Post-It notes, masking tape and even Band-Aids to cover the graphic warnings, which are three times larger than on the previous packs.

''We are hearing of a lot of avoidance behaviours,'' says Ms Sharkie. ''But that doesn't mean they're not working … the fact that people go to the trouble to not see it is a very positive thing from our perspective.''