A three-judge panel of the US Court of Appeals for the Fifth Circuit rejected a challenge Thursday from tobacco companies that alleged a bill requiring graphic imagery on cigarette packaging and advertisements was a violation of the First Amendment to the US Constitution.

The Family Smoking Prevention and Tobacco Control Act (TCA) was enacted by Congress in 2009. It required cigarette packaging to include “color graphics depicting the negative health consequences of smoking to accompany the label statements.” The warnings were to “comprise the top 50 percent of the front and rear panels of [a] package” and “at least 20 percent of the area of any advertisement.” The law was challenged by tobacco companies as unconstitutional but was upheld by the US Court of Appeals for the Sixth Circuit in 2012. After the loss, tobacco companies challenged the implementation of FDA regulations, leading to this latest case against FDA rules.

Plaintiffs in the case argued that the FDA rules interpreting the TCA violated First Amendment principles of freedom of speech by compelling the companies to include warnings that “misrepresent or exaggerate the potential effects of smoking.” The FDA warnings in question included pictures of diseased lungs, amputations, and surgical scars, in addition to various images of people suffering from other negative effects of tobacco use.

Ultimately, Judge Jerry Smith ruled that although the warnings were compelled speech, they were both “factual and uncontroversial, despite the emotional impacts the graphics may have.” The court further ruled that the warnings were justified by a legitimate state interest and were not unduly burdensome on the plaintiffs. The court rejected arguments that the graphic images were not factual and held that the images were not dissimilar to those a medical student would see in a textbook.

Despite the panel’s rejection of the First Amendment claim, the court preserved the plaintiff’s argument that the regulations violated the Administrative Procedure Act (APA), which governs how regulations are made.

The case is the latest high-profile case concerning government-compelled speech in the commercial arena, coming after a recent case in Maryland concerning suicide prevention literature in gun stores.