While advertisements for cigarettes can no longer be shown in cinemas before movies, audiences are often exposed to pro-smoking imagery during the movie. In 2002, the total amount of smoking in movies was greater in youth-rated films than adult-rated films, significantly increasing adolescent exposure to movie smoking. Smoking in the movies decreased from 1950 to 1990 and then increased rapidly so that smoking in movies in 2002 was as common as in 1950.1 A 2006 study, the most comprehensive research to date examining total depictions of smoking in movies, found that the total number of smoking characters is declining.2 The study included the top 100 US box office hits for each year from 1996 to 2004. This downward trend was, however, weakest in films aimed at an adolescent audience. Although many of the movies included in the study depict no adult smoking, more than one-third depict smoking as being more prevalent than among US adults at the time of release. A 2010 study that controlled for the methodological problems of assessing smoking portrayals in movies over time found that tobacco content has declined considerably in movies since 1950. Total tobacco-related content peaked around 1961, while the decline in portrayal of main character use was already underway in 1950.3 This pattern closely parallels the time frame of drops in US per capita cigarette consumption and the increase in tobacco control efforts. A UK study also found a significant drop in smoking depictions in movies over a 20-year period from 1989 to 2008.4
Several review articles have shown that smoking in movies is associated with increases in adolescent smoking initiation.1,5–7 A possible limiting factor of this body of research is that the majority of the studies have been conducted with American youth.8 However, a UK study found that British youths were exposed to 28% more smoking impressions in UK youth-rated movies than US youth-rated movies, because 79% of movies rated for adults in the US are classified as suitable for youths in the UK, reflecting the less conservative nature of film classification in the UK.9
In a US cohort study, 52.2% of smoking initiation was attributed to exposure to smoking in movies.10 A longer term cohort study of non-smoking youth found that those youth who had watched more movies with smoking depictions were more likely to be smokers at the seven-year follow-up. After controlling for baseline characteristics, the authors estimated that 34.9% of established smoking in this cohort could be attributed to movie smoking exposure.11 A criticism of such studies is that smoking may be just one of a constellation of movie characteristics that have broad appeal to children attracted to such films.12 If smoking were removed from such movies, youth who are more likely to smoke may still be attracted to the same sort of films because of wider characteristics of characters and scenes in such movies. Smoking scenes may therefore not be independently predictive of smoking among youth.
Depictions of smoking also enhance positive views of smokers and increase intent to smoke. Teenagers whose favourite stars smoke on the big screen are three times more likely to smoke than those whose favourite stars do not smoke.13 Adolescents who smoke are also more likely to find smoking characters in films attractive.14 Many current movie stars are frequently pictured smoking both on and off the screen.
There is limited research on the effects or amount of smoking imagery on television. A New Zealand study of prime time television content found that one in four programs contained tobacco imagery, most of which might be regarded as 'neutral or positive'. This equalled to two smoking scenes for every hour of programming.15 A US study examined the level of youth exposure to televised movie trailers that contained smoking imagery between August 2001 and July 2002. The researchers found that 14.4% of televised trailers included images of tobacco use.16 Tobacco use was shown in 24% of the trailers for R-ratedi (restricted) movies and 7.5% of the trailers for PG-13 and PG-rated (parental guidance) movies. Ninety-five per cent of all youth aged 12 to 17 years in the US saw at least one movie trailer depicting tobacco use on television during the study period. Youth are also exposed to smoking images through video and DVD rentals of both current and historical movie releases.17
There is some evidence to suggest that showing an anti-smoking, counter-advertisement before films that glamorise smoking negates positive associations. An Australian study with adolescent females showed that viewing a counter-advertisement increased the number of non-smokers who disapproved of the smoking scenes in the movie and increased the number of smokers who believed they would not be smoking within the next year.18 A similarly designed study with American adolescents found that those who viewed the counter-advertising prior to a film showing characters smoking held more negative opinions about the smoking actors.19 A second Australian study with youth cinema patrons found that while placing an anti-smoking advertisement before movies containing smoking scenes can help to immunise non-smokers against the influences of film stars' smoking, caution must be exercised in the type of advertisement screened.20 Some types of advertising were found to reinforce smokers' intentions to smoke. Another concern is whether Quit campaigns could provide sufficiently attractive and fresh advertising material on a long-term basis.
Despite publicly denying that it has not and does not pay for product placement (paying a fee for a product to appear on screen) in movies, study of internal tobacco industry documents reveals a history of paid promotion.21,22 Examples include:
In November 2006, Philip Morris USA issued a press release announcing that the company was asking that its brands no longer be displayed on screen and urged the movie industry to no longer use any tobacco products in films aimed at a youth audience.24 This campaign has been criticised as being an industry 'PR campaign' that hopes to skirt meaningful regulation.25
Smoking imagery in movies is not limited to the Hollywood film industry. In May 2005, India's health minister announced a total ban on smoking and tobacco product imagery in all Indian films.26 The Indian film industry volunteered to control the amount of smoking in Bollywood films instead of accepting an outright ban. According to research conducted by the Indian agency, the Burning Brain Society, and supported by the World Health Organization, despite film industry promises to self-regulate tobacco promotion on screen, tobacco brands have appeared in more than 40% of Indian films released since 2004.27 In January 2009 the Delhi High Court overturned the ban, citing that such a ban restricted the right to freedom of speech and creative expression.28
The Smoke Free Movies group based at the University of California, San Francisco, has outlined four policy actions to reduce smoking depictions in films:29
In 2007, Disney agreed to include anti-smoking advertisements on DVDs of its films that have cigarette smoking.30 In May 2007, the MPAA announced it would consider smoking—alongside sex, violence and 'adult' language—when it was deciding what rating to assign films. Films that glamorised smoking could receive a higher rating. The MPAA ruled out giving all films containing scenes with smoking an R or restricted rating.31 In a study with US parents about whether cigarette use should be included as a movie ratings criteria and if movies with tobacco use should be rated R, only 52% of parents believed that cigarettes should be used as movie ratings criteria and only 28.9% supported an R rating for movies that featured smoking.32 The authors commented that 'if parents disagree with an R rating exclusively for smoking, applying R ratings to movies with smoking potentially could lead parents to become more lenient in their restrictions'(p223).32
Thailand has banned smoking scenes on all local television channels since 2000. Any image of an actor smoking or a tobacco product is 'pixilated' or blurred out. There is no published data available on the effectiveness of this policy in preventing youth uptake.
In Australia, Action on Smoking and Health (ASH) has called for action to amend the Tobacco Advertising Prohibition Act 1992 (TAP Act) to ensure that inducements to promote tobacco products and smoking in films and other media are clearly illegal, with substantial penalties for breaches, and to increase funding for counter-advertising.33 ASH has also called for the end of government assistance for films that show smoking.34
Finally, it should be pointed out that there is not universal agreement on controlling the promotion of smoking in the movies.35,36 Important questions of limiting freedom of speech and censoring artistic licence arise when there is no evidence that smoking imagery has been sponsored by the industry. Additionally, portrayals of smoking in movies can vary from overtly glamorous to neutral to remarkably negative; removal of all tobacco imagery could be a disadvantage to tobacco control. An Australian study of viewer reactions to the movie, The Insider, a movie containing varied smoking images, found participants held more negative views of the business conduct of the tobacco industry than those who saw an equivalent control film.37
Taking into account all these options and considerations, the National Preventative Health Taskforce recommended making smoking a 'classifiable element' in movies and video games.38 The Australian Government's response to the taskforce indicated that it was not in favour of such a move and instead recommended that the Australian National Preventive Health Agency (to be established as part of national prevention strategy) be tasked to review the evidence for such reforms and to discuss them with other key departments, including the Department of Broadband, Communications and the Digital Economy; the Department of the Environment, Water, Heritage and the Arts; the Office of Film and Literature Classification; and Screen Australia. In an August 2010 newspaper article, the director of the Australian Classification Board was quoted as stating that the board already considered community standards on harm caused by 'inappropriate' smoking or substance misuse when classifying films.34
i The Australian MA rating is similar to the US R rating. Children over 15 are permitted to view MA-rated movies provided they are accompanied by a parent or guardian.
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