5.16 Smoking in movies, TV and other popular culture/media

Last updated:  April 2022   Suggested citation: Hanley-Jones, S., Wood, L., & Scollo, MM. 5.16 Smoking in movies, TV and other popular culture/media. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2022. Available from: https://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-16-smoking-in-movies-tv-and-other-pop

 

There is worldwide scientific consensus that exposing young people to onscreen tobacco imagery is associated with the uptake of smoking.^1-4 Article 13 of the WHO Framework Convention on Tobacco Control guidelines specifically recommend participating governments around the world ban all tobacco advertising, promotion and sponsorship in traditional media (print, television and radio) and all media platforms, including the Internet, mobile phones and other new technologies, as well as films.⁴

This section summarises research that has attempted to quantify the extent of portrayals of smoking in popular culture, and the impact of such portrayals on attitudes to smoking and smoking uptake. The second half of this section explores various policies that have been proposed to address the effects of smoking in movies and other forms of culture and entertainment, including proposals in Australia.

5.16.1 Quantifying smoking imagery in movies and other popular media

5.16.1.1 Movies (films)

While advertisements for cigarettes can no longer be shown in cinemas before movies in Australia, audiences are often exposed to pro-smoking imagery during the movie itself.

Numerous studies have attempted to quantify the incidence of smoking in movies.^5-10 The most common methodology used in these studies involves analysis of content over a particular period of time; this method is useful for showing increases and declines over time. While another popular methodology instead relies on young people’s own reported perceptions of tobacco in movies.¹¹ One advantage of this is that it potentially captures exposure to movies or films that may not have fallen within the category analysed by content analysis studies (for instance movies that are not top grossing¹² ).

While total tobacco-related content in movies peaked around 1961, research shows a considerable decline since 1950.⁹ However, in recent times this decline has been more modest,^{6, 8} and not necessarily reflecting the degree of decline observed in actual population smoking prevalence.

In a study of US movies, for example, one-third were found to over represent actual adult tobacco use, portraying smoking as more prevalent than it actually was in the US at the time of the films’ release.⁶ It has also been noted that the degree of decline varies considerably by film rating classification, and by motion picture company.¹⁰

From 2002 to 2019 researchers at the Center for Tobacco Control Research and Education, University of California published a series titled Smoking in top-grossing US movies quantifying tobacco incidents in movies and audience impressions of tobacco imagery.¹³ In 2019 the report found that 51% of top-grossing US movies depicted tobacco, equalling 3,618 of tobacco incidents, the most in more than a decade. Broken down into ratings categories, tobacco was present in 23% of movies rated G/PG, 43% of PG-13 movies and 76% of R-rated movies.¹³ Since 2002, the beginning of the survey of tobacco content in top-grossing US movies, more than half (56%) of the movies, featuring 50,684 tobacco incidents, have delivered 371 billion in-theatre tobacco impressions to domestic audiences of all ages.¹³

A report by Truth Initiative found that in 2020, 38% of top US movies included depictions of tobacco, including 10 movies that were rated PG-13 or under.³ In total the report shows there were close to 1,000 incidents of combustible tobacco depiction in the top movies of 2020.³

5.16.1.2 Television and online streaming services

There is far less research about the volume of smoking imagery on television, and almost none in Australia, although as a pervasive medium through which movies are also screened and viewed, much of the concern about smoking in movies also applies to television.

Research in New Zealand in 2002¹⁴ and again in 2014,¹⁵ found 25% and 29% of programs aired on prime time television contained at least one scene with tobacco imagery. The researchers deemed there to be no significant change over this time in the number of programs containing tobacco imagery on commercial television.¹⁵

Researchers in 2010 found one-third of all prime time free-to-air television programs broadcast in the UK included tobacco content.¹⁶ A follow up study in 2015 also found tobacco content present in about one–third of all programs.¹⁷ In 2019, this time a study specifically focusing on UK television soap operas, researchers again found a consistent one–third of the television episodes included tobacco content.¹⁸

In 2019 the same UK researchers incorporated the newer ‘video-on-demand’(VOD)- streaming services, specifically Netflix and Amazon Prime, into their research and found VOD original programming contained a significantly higher amount of tobacco imagery than terrestrial television content from past studies.¹⁹ The content analysis of a sample of 50 episodes from the five highest rated series released on Netflix and Amazon Prime in 2016, found tobacco content present in 37/50 (74%) episodes.¹⁹ This was significantly higher than the consistent 33% in previous studies that focused on terrestrial television programming.

Online streaming services allow viewers to select what they want to watch when they want to watch it, and to consume multiple episodes in one sitting, referred to as ‘binge watching’. In 2018²⁰ and again in 2019²¹ the US anti-smoking group Truth Initiative published a report titled While you were Streaming: Smoking on Demand. The report examined the rise of tobacco imagery via new online streaming services as well as traditional broadcast/cable TV. In 2018 and 2019, Truth Initiative researchers analysed tobacco content in the same episodic programming most popular with young people between 15 and 24 years old in the US. In both reports, episodic programming on Netflix had a greater total number of tobacco depictions than programs aired on broadcast or cable TV. Overall, 92% of the shows, both from Netflix and broadcast/cable TV, analysed contained images of tobacco in the 2016–17 report, up from 79% in the 2015–16 report. After the report came out, Netflix responded by saying they would make efforts to reduce smoking images and depictions in their original programming.²²

Going forward, all new projects that we commission with ratings of TV-14 or below for series or PG-13 or below for films, will be smoking and e-cigarette free -- except for reasons of historical or factual accuracy.²²

 

 

Image Source: The Irish Sun ‘ Love Island’

Notably, in 2017, the popular UK reality show Love Island, attracted widespread media criticism regarding the contestants smoking on screen.²³ Despite advertising legislation and broadcasting regulations in place in the UK, series three of Love Island delivered millions of general as well as branded tobacco impressions both to children and adults in the UK. Cigarettes had been repackaged in plain white packs, removing identifiable branding and health warnings, however there were multiple instances where Lucky Strike Double Crisp branding was identifiable via logos on the cigarette sticks. The series finale of season three was viewed by 2.6 million people in the UK and attracted more than half (52.3%) of all television viewing from the 16–24 age group. Researchers estimated that the 21 episodes delivered 559 million tobacco gross impressions to the UK population alone, including 47 million tobacco impressions to children under 16 years. The researchers also stressed that the estimated number of tobacco impressions delivered from the show was grossly under representative of the true number, which would be much higher, due to the ability to watch, and rewatch, the show globally via online streaming services.²³

Not only is the presence or amount of tobacco use portrayed on television a concern, so too is the extent to which these portrayals convey smoking in a positive or non-negative light. In an Australian content analysis of smoking portrayal in The Simpsons television series (first 18 episodes) ²⁴, 35% of the depicted instances of smoking (n=275) reflected smoking in a negative way; 63% in a neutral way (n=504) and 16.2% in a positive way (n=127). While the positive portrayals formed the minority, 16% is not insubstantial, and as the authors note, The Simpsons is an iconic and extremely popular show with children and adolescents, and has spawned a proliferation of merchandise that is directed at children.²⁴ However they also noted that children and adolescent characters were far more likely to be involved in negative portrayals of smoking compared with adult characters.

5.16.1.3 Music video clips

Smoking is also featured in music videos made with the youth market in mind.²⁵ These music videos offer largely unregulated opportunities for exposure to, and brand advertising of, tobacco products.²⁶ An analysis of the top 2020 Billboard songs by Truth Initiative showed that 23% of the songs had tobacco in their music videos. On YouTube these music videos with tobacco imagery depicted in them have, at 2022, garnered more than 6 billion views, most likely by young people.³ The R&B/Hip-Hop genre, it was noted, make up a large proportion of these tobacco incidences.

A 2018 study found prevalence of smoking imagery in hip-hop music videos, specifically, was 44% in 2017. In the analysis of leading hip-hop songs during five years from 2013 to 2017, the researchers reported four central findings. Firstly, between 2013 and 2017, the proportion of leading hip-hop videos containing smoking imagery (combustible, electronic use, smoke or vapor) ranged from 40.2% to 50.7%, which corresponded to over 39 billion views at the time of publication. Second, an increasingly larger share of combustible and electronic use was brand placement. Third, nearly 60% of combustible tobacco use were by main or featured musical artists. And lastly, the prevalence of tobacco use rose with the popularity of songs.²⁶

In a 2015 study investigating preferential consumption of particular music genres and use of alcohol, cigarettes and marijuana, researchers found listening to ‘energetic music’, i.e. rap or hip-hop and soul or funk genres, positively correlated with marijuana use. While listening to pop, country, and religious genres negatively correlated with cigarette smoking.²⁷

Other research found that early exposure to music channels is associated with later increases in smoking and association with smoking peers, even after controlling for demographic, dispositional and parent behaviour variables.²⁸ The researchers argue that music channels also influence the smoking behaviour of young people via the development of social identity, rather than solely through social cognitive processes.²⁸

5.16.1.4 Video games

A report in 2020 estimated that close to 3.1 billion people globally play video games, the most common medium for gaming being smartphones.²⁹ Despite the enormous growth and presence of this industry, there is a dearth of research exploring video games and tobacco.

A report in 2015 examining tobacco imagery in video games found 42% of the video games included in the study contained tobacco-related content.³⁰ The adolescent gamers in the study were conscious of the tobacco imagery in the games they played, as shown by their high recall. However, the presence of tobacco imagery was not adequately labelled by the Entertainment and Software Ratings Board (ESRB).

Truth Initiative, in a 2016 report, argued that in the same way the US Surgeon General concluded that exposure to tobacco imagery in movies promotes smoking among young people, ‘[p]laying video games, which youth spend more time doing than going to movies and which are more active and intense experiences, is likely to work in similar ways.’³¹

A 2016 systematic review³² examining research on the relationship between video games and smoking was unable to draw any conclusions due to a lack of research in this area. However, since 2016, two studies have been published attempting to examine the relationship between exposure to tobacco imagery in gaming and tobacco use. The first study found that, after adjusting for sex and age, British adolescents aged 11–17 years exposed to tobacco content in video games were more likely to have used tobacco.³³ The second study found greater exposure to tobacco content in video games was associated with higher likelihood of smoking among early adolescent Argentinian girls, but not early adolescent Argentinian boys, who play video games.³⁴

5.16.2 Has the promotion of smoking in movies been purposeful?

We must continue to exploit new opportunities to get cigarettes on screen and into the hands of smokers.’Hamish Maxwell, president of Philip Morris, 1983 ³⁵

Directors of movies and TV productions often use smoking to denote particular characteristics—rebellious, risk-taking, or, in more recent times, working class or less well educated. While they may have the effect of promoting smoking, if no person involved with the film or production received any payment or other inducement to use a particular product then it is unlikely to constitute purposeful promotion of smoking and is certainly not a form of commercial promotion.

Despite publicly asserting that it has not and does not pay for product placement (paying a fee for a product to appear on screen) in movies, a study of internal tobacco industry documents does reveal a history of paid promotion.^8,36,37 Examples include:

• $350,000 to have Lark cigarettes appear in the James Bond movie License to Kill
• $42,000 to place Marlboro cigarettes in Superman II
• $30,000 to place Eve cigarettes in Supergirl
• $5,000 to have Lucky Strike appear in Beverly Hills Cop
• an agreement to pay a $500,000 fee to actor, Sylvester Stallone, to use Brown and Williamson products in five feature films.³⁸

Product placement of tobacco products in movies is illegal in Australia under provisions of the Tobacco Advertising Prohibition Act 1992. The WHO Framework Convention on Tobacco Control (FCTC), to which 181 nations and territories, including Australia, are signatories, Article 13 bars tobacco promotion in entertainment media as part of comprehensive advertising bans. In the US, where most motion pictures viewed in Australia are made, and where the FCTC has not been ratified, the 1998 Master Settlement Agreement prohibited tobacco manufacturers from paying to have their products shown in movies, television shows, music videos and video games. However, the agreement does not cover content in newer online streaming services such as Netflix.³⁵ According to researchers at University of California San Francisco, streaming services, specifically Netflix, “seems hardly to be regulated by anyone” and appears to actively resist any forms of regulation.³⁹ Moreover, a well-established Hollywood producer has said that Netflix is “not worried” about smoking in its shows, including shows tailored towards kids.³⁹

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.⁴⁰ This campaign has been criticised as being an industry ‘PR campaign’ one aim of which may be to assist the company to skirt meaningful regulation.⁴¹

Many of the studies cited in this section have been undertaken post-Agreement, demonstrating that portrayal of smoking in movies remains common. However there does not appear to be evidence of industry funding of product placement in Australia since the passage of the Tobacco Advertising Prohibition Act 1992, or in the US since the finalisation of the Master Settlement Agreement.

5.16.3 Does portrayal of smoking in movies and other forms of popular media influence smoking uptake?

5.16.3.1 What is the evidence that exposure to the portrayal of smoking in popular media contributes to uptake?

In 2008 the US National Cancer Institute published an extensive review of studies on the effects of on-screen smoking, concluding that exposure to on-screen smoking is not merely associated with smoking among young people: it causes young people to start smoking.⁴²

The total weight of evidence from cross-sectional, longitudinal, and experimental studies, combined with the high theoretical plausibility from the perspective of social influences, indicates a causal relationship between exposure to movie smoking depictions and youth smoking initiation.’ Chapter 10, p.413⁴²

After the 2008 publication of the NCI report, multiple population-based cross-sectional studies continued to be published, providing consistent evidence supporting a causal relationship between exposure to depictions of smoking in movies and smoking among young people.²

The Surgeon General's 2012 report Preventing tobacco use among youth and young adults contains an extensive discussion of the effects of smoking in movies on young people. The conclusion being, movies with smoking cause young people to smoke.

The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people. Chapter 1, p.10²

The Surgeon General considers on-screen smoking in the same context as conventional cigarette marketing activities. The 2012 report also concludes that lowering young people’s level of exposure to on-screen smoking leads to lower risk of smoking.²

The depiction of tobacco and its use in entertainment media is recognised as a form of tobacco advertising in the WHO Framework Convention on Tobacco Control (WHO FCTC)⁴³ , and as noted in the implementation guidelines for Article 13 (tobacco advertising) of the WHO FCTC, ‘the depiction of tobacco in entertainment media products, such as films, theatre and games, can strongly influence tobacco use, particularly among young people’.⁴⁴

In 2016 the World Health Organization (WHO) published the third edition of Smoke-free movies: from evidence to action. The report summarised large amounts of scientific research providing strong evidence that exposure to smoking in films affects adolescent smoking, specifically the summary showed:

• ‘Exposure of young people to smoking in films is common;
• The mechanisms by which film smoking influences adolescent smoking have strong theoretical grounds;
• Population-based scientific surveys of exposure to smoking in films showed that such exposure is linked to adolescent smoking in a variety of socioculturual contexts;
• Indirect scientific surveys of exposure showed that it is linked to adolescent smoking;
• Trend studies show that the prevalence of smoking, both generally and among adolescents, tends to parallel trends in film smoking;
• Randomized experiments have shown that smoking in films affects short-term attitudes and that anti-smoking advertisements shown prior to films with smoking diminish those effects;
• A brain imaging study showed that showing smokers film clips with smoking stimulated the part their brain that generates pleasurable feelings as well as the part of their brain that controls moving their hand, which helps explain how seeing onscreen smoking stimulates smoking;
• Cinema exit studies among smokers show greater craving among those who had seen films with smoking.’ ⁴ p.12

Since the publication of the 2016 WHO report studies have continued to be published,^45-51 providing consistent evidence supporting the causal relationship between exposure to depictions of smoking in movies, TV and other media and smoking among young people.

5.16.3.2 What is the mechanism through which movies may link to smoking?

In a review examining the effects of depictions of smoking in the media (including smoking occurring in movies, television programming and news coverage, as well as traditional direct forms of tobacco advertising and promotion and pro-health messages) on young people, Australian researchers identified a number of ways in which depictions of smoking in the media may influence smoking behaviour (including whether or not young people experiment with smoking):²⁵

• by shaping and reflecting social values about smoking
• by communicating new information about smoking
• through offering models of behaviour
• by directly reinforcing smoking (or non-smoking) behaviour
• by prompting discussion and debate about smoking
• by influencing other ‘intervening’ factors that help shape the decision to smoke or not to smoke (for example by making older smokers less willing to give cigarettes to young people)
• by shaping societal attitudes and influencing the broader regulatory climate.

Although smoking behaviour has become more commonly associated with the antagonists (‘bad guys’) in US movies,⁵² this does not necessarily make smoking unappealing. It is not even necessarily important that lead characters be shown smoking, since ‘background’ smoking still teaches adolescents about how, when and where to smoke.⁵³ Even though specific brands may not be identified, it has been argued that positive imagery associated with smoking can potentially be even more powerful than explicit tobacco advertising, and can help reinforce a smoker’s identity.⁵⁴ Imagery does not have to be overtly pro-smoking to have an influence on young people⁵⁵ —for instance in a Western Australian study, school students were shown a range of smoking imagery in print and other media, and were found to identify with the social and stress-relieving aspects of smoking despite being aware of its harmful effects.⁵⁶ And in an Australian randomised controlled trial assessing the impact of smoking images in magazines on smokers and non-smokers aged 14–17 years, it was found that that seeing the imagery acted as a prompt to smoke and as a reinforcement of smoking behaviour.⁵⁷

Smoking in movies may also influence social norms and normative beliefs about smoking. For instance, one study found that among young children in particular (9–15 years), higher exposure to smoking in movies was associated with higher perceived prevalence of adult smoking in the community.⁵⁸ Similarly, a 2005 systematic review of the relationship between smoking in movies and adolescent smoking also noted that the depiction of smoking in movies can increase perceptions of smoking prevalence, and rarely shows the negative health consequences associated with smoking.⁵

Most of the research and advocacy to date has been couched in terms of the depiction of smoking in movies per se; however there is also a potential ripple effect associated with the portrayal of smoking by popular movie stars. For example, one study found that teenagers whose favourite stars smoked on the big screen were three times more likely to smoke than those whose favourite stars do not smoke.⁵⁹ In another study, adolescents who smoked were more likely to find smoking characters in films attractive.⁶⁰

Other contextual factors related to movie or TV viewing have also been implicated in the association between on-screen portrayals of tobacco and adolescent smoking uptake or attitudes. Environmental factors include factors associated with the home environment, such as having an unsupervised television in the bedroom, which have been shown to be significant predictors of smoking uptake in white adolescents.⁶¹ Also related to the home environment, it has been found that adolescents who report parental rules about TV/film watching were less likely to smoke than those who did not, while those who mainly watched films with friends had higher exposure to film smoking and were more likely to smoke.⁶²

5.16.3.3 How robust is the evidence?

Evidence of a causal relationship between smoking in movies and smoking uptake among young people is strong. The US National Cancer Institute,⁴² the US Surgeon General,² and the World Health Organization⁴ have all compiled strong evidence and agree that there is a causal relationship between exposure to depictions of smoking in movies and smoking uptake among young people.

Due to a lack of research, television, online streaming services, music videos and video games, however, do not have the same level of evidence to conclude a causal relationship.

In extrapolating findings from other countries to Australia it is important to consider contextual issues, such as international variations in the way films are classified. For instance, 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 UK⁶³ In Australia the rating system is different again, with an M (mature) rating, which falls between the ratings of PG and MA15+. The M rating category in Australia actually captures many of the movies popular with young people, and which may receive an R rating in the US, where there is no equivalent ‘M’ category. BladeRunner and The King’s Speech are two examples of films released as M in Australia but as R in the US. It is likely that parents in Australia, while happy to allow young teenagers to watch M-rated movies, are more careful about their exposure to movies rated MA. If the Australian rating system has more credibility with parents than the system in the US (where just about every teen movie is rated R), then it is possible that the average age of viewers exposed to smoking portrayals in movies is somewhat higher in Australia than it is in the US—see Figure 5.16.2 

5.16.4 What might be appropriate policy responses to the problem of smoking and movies?

A number of recommended policy responses have been offered in the literature, including the 2016 World Health Organization report titled ‘Smoke-free movies: from evidence to action - Third edition’,⁴ and the University of California San Francisco Smokefree Media campaign.⁷¹ Both agree on the same five evidence-based policies, none of which bans tobacco imagery or restricts creative choices, but which together aims to permanently reduce exposure to tobacco imagery on screen.  The evidence-based policies recommended by WHO and Smokefree Media include:

• Adult-rating future media productions with tobacco imagery
• Running strong anti-tobacco advertisements before films with smoking, in all media, regardless of the media production's age-classification
• Requiring production executives to certify that no one associated with a production with smoking, regardless of its rating, received anything of value for the presence of that imagery
• Ending display of tobacco brands in entertainment media, regardless of rating
• Making media productions with tobacco imagery ineligible for public subsidies or 'incentives' such as production grants, tax credits or rebates.^4,71

Each of these options is described briefly below.

5.16.4.1 Restrictive rating of movies depicting smoking

A growing number of bodies internationally are calling for restrictive ratings of movies with smoking imagery. The WHO report Smoke Free Movies: from Evidence to Action recommends that movies with tobacco imagery should be given an ‘adult rating’, hence restricting their viewing by minors, and it is similarly supported by the WHO Framework Convention on Tobacco Control (WHO FCTC).⁷² Other peak bodies that have recommended this approach include the US Centers for Disease Control and Prevention and the Ontario Ministry of Health Promotion.⁷³ Restrictive ratings have also been advocated in published studies on the association between smoking depictions in movies and smoking initiation.^73-80 Waylen and colleagues for example argue that the dose–response relationship observed in their large-scale study of a cohort of British adolescents supports introduction of an ‘adult/18’ rating to movies depicting smoking, suggesting that ‘films ought to be rated by exposure to smoking in the same way that they are currently rated by level of violence’.⁷⁴

An automatic Rrating of films depicting smoking is recommended by the Smoke Free Media group based at the University of California, San Francisco, as one of five policy actions to reduce smoking depictions in films. Specifically, the recommendation is that:

Any future film that shows or implies tobacco should be given an adult rating — in the U.S., an R-rating. There are only two categorical exceptions: (a) when the depiction unambiguously reflects the dangers and consequences of tobacco use, or (b) the depiction exclusively represents the tobacco use of an actual person, as in a biographical drama or documentary.’⁷¹

Although restricted ratings are now advocated by the WHO, ⁴ there is some contention around this measure even within tobacco control. For example, it has been argued that mandating ‘adults-only’ rating classifications for movies with smoking imagery may fuel a potentially negative backlash for tobacco control from what some may see as censorship going too far.^81,82

Moreover, even an R rating for all movies with smoking content will by no means prevent all young people from viewing such films, given that (US) R-rated movies are still watched by a sizeable proportion of adolescents.⁸³ A US paper published in 2007 reported for example that 84% of young people aged 10–14 years reported watching R-rated films with parental permission.⁸³ Similarly, in a New Zealand study of data collected from Year 10 students between 2002 and 2004, 81.2% of males and 75.6 % of females watched an R-rated film at least once a month.⁸⁴ In one study, adolescents who were more likely to watch R-rated movies (i.e. who had a higher relative exposure to R-rated movies) were more likely to have initiated smoking in the follow-up phase of the study.⁸³

However, WHO⁴ and others⁷³ have argued that the primary drive for recommending adult content rating policies for movies with smoking content is not just about restricting young people’s viewing of such films. Rather, it is to create an economic incentive for film makers and producers to omit smoking from films that they hope to target at the very lucrative youth market. Given the far higher return on investment for movie makers for youth versus R-rated movies, it is hoped that R-rated restrictions would provide an economic incentive to reduce smoking content.

5.16.4.2 Counter-advertising screened before movies

The WHO has recommended that strong anti-smoking advertisements or warnings be displayed at the beginning of any entertainment media depicting tobacco products or smoking.⁴ Article 13(4)(b) of the WHO FCTC “[R]equire[s] that health or other appropriate warnings or messages accompany all tobacco advertising and, as appropriate, promotion and sponsorship ...”. The recommended approach, according to the guidelines, is to “require the display of prescribed anti-tobacco advertisements at the beginning of any entertainment media product that depicts tobacco products, use or images”.⁴ This is also advocated by the US Smoke Free Media group, which recommends that studios and theatres should require a genuinely strong anti-smoking advertisement (not one produced by a tobacco company) to run before any film with any tobacco presence, in any distribution channel, regardless of its Motion Picture Association of America (MPAA) rating.⁷¹

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 year⁸⁵ 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.⁸⁶ A second Australian study found that while placing an anti-smoking advertisement before movies containing smoking scenes can help to ‘immunise’ young non-smokers against the influences of film stars’ smoking, caution must be exercised in the type of advertisement screened.⁸⁷ A German quasi-experimental study assessing the effects of an anti-smoking advertisement under real-world conditions found movie goers exposed to antismoking advertisements had a higher awareness of smoking in the movie, lower levels of approval of smoking in the movie, and a more negative attitude towards smoking in general, compared with those not exposed.⁸⁸

Advertisements played before movies in cinemas tend to promote glamorous products and to have very high production values (computer-generated special effects, international locations, some of the world’s most beautiful models, etc.). Experienced Quit campaigners advise⁸⁹ that the beneficial effect of anti-smoking advertisements before movies would likely depend on the quality, longevity and frequency of turnover of the advertisements used.

WHO also adds that older media, which was once dispersed, is converging on digital technology, of which adolescents in many countries have easy access to, therefore effective anti-tobacco advertisements should be added to videos and other distribution channels, including cable and satellite, video-on-demand/streaming and Internet downloads after distribution.⁴

5.16.4.3 Banning product placement and/or brand-specific imagery

Although brand-specific images of tobacco products in movies are less common now than in past decades (see Section 5.16.2), these can still occur, and there have been calls from the WHO⁴ and the US Smoke Free Media⁷¹ group for explicitly banning product placement. WHO argue that ‘total ban on brand identification on screen would be the most straightforward extension of national restrictions on tobacco branding in all media.’⁴ Smoke Free Media group also recommend that any identification of tobacco brands in movies be banned, regardless of the work's age classification, including tobacco brand identification or imagery such as billboards that may appear in the background of a movie scene.⁷¹

5.16.4.4 Certify no payoffs

The WHO⁴ points out that Article 13(4)(d) of the FCTC requires the tobacco industry to disclose any expenditures on advertising, promotion and sponsorship. To ensure that tobacco companies are not marketing their products via product placement in films, Article 13 guidelines also recommend that Parties should:

[i]mplement a mechanism requiring that when an entertainment media product depicts tobacco products, use or imagery of any type, the responsible executives at each company involved in the production, distribution or presentation of that entertainment media product certify that no money, gifts, free publicity, interest-free loans, tobacco products, public relations assistance or anything else of any value has been given in exchange for the depiction.’⁴

The WHO⁴  and Smoke Free Media⁷¹ recommend the inclusion of a ‘certificate’ in the closing credits of films containing any tobacco imagery declaring the above recommendation has been followed. The certification should require a sworn affidavit on public file from the responsible executive at every company credited for the production and distribution of a film. Where imported films dominate a country’s film market, such as Australia, WHO recommends that countries require certification of no payoffs as a condition for granting an exhibition licence.

5.16.4.5 Ending taxpayer subsidy of movies that portray smoking

Public taxpayers subsidise much of Hollywood’s production costs through tax credits and other subsidies.⁷¹  The WHO,⁴ the US Centers for Disease Control and Prevention (CDC) and Smoke Free Media⁷¹ have all pointed out that public subsidies for smoking films conflicts with government funded tobacco control efforts. The WHO recommend that the statutes and regulations governing subsidy of media productions should be amended so that any media production representing or referencing tobacco use or depicting a tobacco product, non-pharmaceutical nicotine device or tobacco brand name, trademark, marketing collateral or paraphernalia is ineligible for any form of public benefit for project development, production, marketing or distribution, including grants, loans, investments, spending rebates, tax credits or other favourable tax or trade treatment.⁴

US Smoke Free Media suggest an amendment in state legislation that defines which films productions qualify for public subsidy to exclude ‘…any production that depicts or refers to any tobacco product or non-pharmaceutical nicotine delivery device or its use, associated paraphernalia or related trademarks or promotional material.’⁷¹

Similar to the US, the Australian Government seeks to support the local film industry through the provision of concessions for amounts invested in movies made in Australia. In addition to taxpayer subsidies to investors, the Australian Government provides grants for film development to encourage local content, foster talented new film makers, support Aboriginal and Torres Strait Islander film making and encourage the development of creative material that resonates with Australia. See funding guidelines for bodies such as Screen Australia— http://www.screenaustralia.gov.au/funding. For further information on tax offsets for investment in films see: Film industry incentives 2021 | Australian Taxation Office (ato.gov.au)

5.16.4.6 Other potential policy responses

5.16.4.6.1 Bans on portrayal of smoking in movies

A complete ban on smoking portrayals in movies has not been advocated in Australia, and this policy option has generated controversy within the tobacco-control field. For instance, one Australian public health expert argues that advocacy for the total banning of the depiction of smoking in movies may potentially generate a negative backlash for tobacco-control efforts resulting from what some would see as promotion of censorship that goes too far.^{81, 82}

To date, India is the only country to have attempted a wide-scale ban of this nature, but this was not effective and has since been overturned. A total ban on smoking and tobacco product imagery in all Indian films was announced by India’s Health Minister in May 2005,⁹⁰ but the Indian film industry volunteered to control the amount of smoking in Bollywood films instead of accepting an outright ban. Despite these film industry promises to self-regulate tobacco promotion on screen, research conducted by the Burning Brain Society in India found that tobacco brands appeared in more than 40% of Indian films released since 2004.^{91, 92}  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.⁹⁰ In October 2012 Indian’s Government introduced new rules related to the depiction of tobacco imagery in all films and TV programs screen in India. Under the new rules, all films containing tobacco imagery had to have strong justification for any tobacco product display, an audio-visual disclaimer on the ill-effects of tobacco use and an anti-tobacco health spot, at the beginning and the middle of the film, and a prominent, static, anti-tobacco health warning at the bottom of the screen every time tobacco use is depicted on screen. Research has since shown that India’s 2012 rules were followed by a reduction in tobacco depictions in Bollywood films.⁹³

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. No published data are available on the effectiveness of this policy in contributing to discouraging smoking among young people, and it is unclear how such a measure would be regarded in Western countries, including Australia. The WHO include ‘pixelization’ of tobacco imagery among measures it deems as having limited effectiveness.⁴

In 2019 China’s central government ordered its entertainment censors to clamp down on smoking scenes in film and TV series. Scenes involving tobacco images that were deemed irrelevant to the plot faced being edited out, and productions that featured extensive tobacco imagery were to be barred from awards.⁹⁴  

5.16.5 Public support for proposals to address smoking in movies

Compared to the plethora of studies of public support for other tobacco-control measures (such as smokefree public places), there have been surprisingly few published studies investigating levels of public support for smoking restrictions in movies.

As part of a 2004 New South Wales survey of smoking-related perceptions and practices, 1154 adults participated in a computer-assisted telephone interview about perceptions relating to smoking depictions in movies and television.⁹⁵ When participants were asked what government measures they would support to limit exposure of smoking depictions in films, 63.1% supported screening anti-smoking ads before movies that had any smoking in them, 50.7% supported regulating the movie industry to limit the portrayal of smoking in movies, and 37.2% supported including smoking in the movie rating system.

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.⁹⁶ 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’(p223.⁹⁶ )

There are no reports of studies canvassing public opinion about taxpayer subsidies of movies depicting smoking.

5.16.6 Status in Australia of proposals to address smoking in movies, TV and other popular culture/media

The Tobacco Advertising Prohibition Act 1992 prohibits anyone in Australia from broadcasting in cinemas or on TV any material deemed to be a tobacco advertisement—see Chapter 11, Section 11.3 for further details. As amended by the Tobacco Advertising Prohibition Amendment Act 2012 ⁱ the Act also prohibits Australians from advertising tobacco products on the Internet except where the advertisement provides a direct facility to purchase products.⁹⁷ However the legislation does not pertain to depictions of smoking that could not be deemed to be an advertisement in the sense that no financial benefit is gained by the transmitting party.

In 2004 in Australia, Cancer Council NSW proposed that counter-advertising be shown before all remaining films that contain pro-smoking imagery.³⁸ Its suggested action points included:

• that all movies are assessed for inappropriate smoking content prior to release
• that once they have been identified, these films be accompanied by strong smoking education advertisements
• that this requirement be written into law at state, territory and national levels.

In the lead up to World No Tobacco Day in the same year, the Australian Democrats referred to this proposal and called on the Federal Government to take action. Health spokesperson Senator Lyn Allison moved a motion that urged the Government to:

(b) ... heed the latest call by the Australian Medical Association and adopt strategies and regulatory measures to counter the influence of smoking in films, including:

 

(i) a film classification system that provides clear warnings about the extent and nature of smoking in films with films attracting an appropriate descriptor such as ‘pervasive smoking’ in the same way that descriptors warn of coarse language, sexual references, nudity and violence,

 

(ii) anti-smoking announcements before films that depict smoking, and

(iii) changes to guidelines to ensure that public funds are not used to support Australian films that glamorise or promote smoking.’⁹⁸

Allison went on to propose the introduction of legislation,ⁱⁱ the Tobacco Advertising (Film, Internet and Misleading Promotion) Amendment Bill, which was released for public consultation. This bill was never voted on in the Senate. There has been little discussion since this time about whether it is appropriate for film funding agencies to provide grants to films that do not receive financial support from tobacco companies but that nevertheless could be said to glamorise smoking.

In its draft National Preventative Health Strategy⁹⁹ the Preventative Health Taskforce steered away from any proposals involving automatic restrictive ratings or bans on funding. It recommended rather that the Government encourage the Australian Classification Board to take smoking into account along with all the other factors it considers when rating movies, video games and publications for sale, hire or exhibition in Australia.

9.5       Make smoking a ‘classifiable element’ in movies and video games. 9.5.1     Designate tobacco use as a ‘classifiable element’, to be taken into account by the Classification Board when rating films. 9.5.2     Produce guidance notes to the Board and to television licensees based on the literature on the impact of portrayals of smoking on young people. 9.5.3     Fund a project to raise awareness among people working in the Australian film, television and entertainment industries of the damaging effects of seductive portrayals of smoking in popular entertainment viewed by children. 9.5.4     Include training to decode depictions of smoking in movies in drug education in schools.

 

The Australian Government’s response to the Taskforce¹⁰⁰ indicated that it was not going to take immediate action and instead indicated that it would ask the Australian National Preventive Health Agency (established as part of national prevention strategy) 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, Donald McDonald, was quoted as stating that the board already considered community standards on harm caused by ‘inappropriate’ smoking or substance misuse when classifying films.¹⁰¹ No recent data in Australia are available on the prevalence of depictions of smoking in movies popular with Australian teenagers, or on the relative prevalence in movies rated MA as opposed to PG or M.

The National Tobacco Strategy 2012-2018¹⁰² acknowledged that the promotion of smoking in movies remained an important means of glamorising smoking and promoting smoking to mass audiences. The Taskforce recommended that smoking should be made a ‘classifiable element’ in movies and video games to be taken into account by the Australian Classification Board.

The recommended action, to be guided under the responsibility of the Australian Government; non-government organisations; and other relevant bodies, was as follows:

6.6.10 Monitor and explore options to regulate the portrayal of smoking in visual media such as movies, TV programs, music clips, video games and digital media, and the adequacy of the current classification guidelines.’¹⁰²

In the Consultation Draft National Tobacco Strategy 2022–2030¹⁰³ it is said that the portrayal of smoking in digital content, including films, television and computer games, is managed under the classifiable element of themes through the National Classification Code, the Guidelines for the Classification of Films and the Guidelines for the Classification of Computer Games. The Australian Government has commenced a review of Australian classification regulations, which seeks to update the criteria used to classify films, episodic series and computer games, and redesign current classification laws to reflect the current and future digital environment.

The recommended action, to be guided under the responsibility of the Australian Government, state and territory governments, and the Australian Communications and Media Authority and broadcasters, is written as follows:

6.5 Consider the adequacy of the current classification guidelines for television, films and computer games in relation to the portrayal of smoking.¹⁰³

 

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated  August 2022

References

1. Polansky J and Glantz S. What is hollywood hiding? How the entertainment industry downplays the danger to kids from smoking on screen. Center for Tobacco Control Research and Education: UCSF, 2020. Available from: https://escholarship.org/uc/item/3pw661mg.

2. U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Available from: https://www.ncbi.nlm.nih.gov/books/NBK99237/pdf/Bookshelf_NBK99237.pdf.

3. Truth Initiative. Nicotine on demand: Tobacco remains rampant in the year’s most popular shows, movies, and music videos, fueling the ongoing youth e-cigarette epidemic. While you were streaming 2021, 2022. Available from: https://rb.gy/oznwyb

4. Organization WH. Smoke-free movies: From evidence to action - third edition. World Health Organization (WHO),  2016. Available from: https://www.who.int/publications/i/item/9789241509596.

5. Charlesworth A and Glantz SA. Smoking in the movies increases adolescent smoking: A review. Pediatrics, 2005; 116:1516-28. Available from: http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1516

6. Worth K, Dal Cin S, and Sargent J. Prevalence of smoking among major movie characters: 1994-2004. Tobacco Control, 2006; 15:442-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17130372

7. Kacirk K and Glantz S. Smoking in movies in 2000 exceeded rates in the 1960s. Tobacco Control, 2001; 10:397-8. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/10/4/397

8. Mekemson C, Glik D, Titus K, Myerson A, Shaivitz A, et al. Tobacco use in popular movies during the past decade. Tobacco Control, 2004; 13:400-2. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/13/4/400

9. Jamieson PE and Romer D. Trends in US movie tobacco portrayal since 1950: A historical analysis. Tobacco Control, 2010; 19(3):179. Available from: http://tobaccocontrol.bmj.com/content/19/3/179.abstract

10. Glantz S, Titus K, Mitchell S, Polansky J, and Kaufmann R. Smoking in top-grossing movies—United States, 1991–2009. MMWR Morb Mortal Wkly Rep, 2010; 59(32):1014-7. Available from: http://www.medscape.com/viewarticle/727552

11. Choi K, Forster J, Erickson D, Lazovich DA, and Southwell BG. The reciprocal relationships between changes in adolescent perceived prevalence of smoking in movies and progression of smoking status. Tobacco Control, 2011. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21828229

12. Glantz S, Titus K, Mitchell S, Polansky J, and Kaufmann R. Smoking in top-grossing movies--United States, 1991-2009. MMWR. Morbidity and Mortality Weekly Report, 2010; 59(32):1014–7. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5932a2.htm

13. Polansky J, Driscoll D, and Glantz S. Smoking in top-grossing US movies: 2019. Center for Tobacco Control Research and Education,  2019. Available from: https://escholarship.org/uc/item/86q9w25v.

14. McGee R and Ketchel J. Tobacco imagery on New Zealand television 2002-2004. Tobacco Control, 2006; 15(5):412-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16998178

15. Marsh L, McGee R, Robertson L, Ward M, and Llewellyn R. Little change in tobacco imagery on New Zealand television: 10 years on. Australian and New Zealand Journal of Public Health, 2016; 40(3):218-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27242253

16. Lyons A, McNeill A, and Britton J. Tobacco imagery on prime time UK television. Tobacco Control, 2014; 23(3):257-63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23479113

17. Barker AB, Whittamore K, Britton J, and Cranwell J. Content analysis of tobacco content in UK television. Tobacco Control, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30104409

18. Barker AB, Britton J, Thomson E, and Murray RL. Tobacco and alcohol content in soap operas broadcast on UK television: A content analysis and population exposure. J Public Health (Oxf), 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32614043

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458014/pdf/fdaa091.pdf

19. Barker AB, Smith J, Hunter A, Britton J, and Murray RL. Quantifying tobacco and alcohol imagery in Netflix and Amazon Prime instant video original programming accessed from the UK: A content analysis. BMJ Open, 2019; 9(2):e025807. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30765410

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398653/pdf/bmjopen-2018-025807.pdf

20. Truth Initiative. While you were streaming. Final Report,  2018. Available from: http://truthinitiative.org/sites/default/files/Smoking-in-Streaming-Final-Report.pdf.

21. Truth Initiative. While you were streaming: Smoking on demand. Truth Initiative,  2019. Available from: http://www.truthinitiative.org/sites/default/files/media/files/2019/07/WUWS-SOD-FINAL.pdf.

22. Drum N. Anti-smoking backlash prompts Netflix to tone down tobacco use in original series. Comicbook, 2019. Available from: https://comicbook.com/tv-shows/news/netflix-pledges-to-reduce-smoking/

23. Barker AB, Opazo Breton M, Cranwell J, Britton J, and Murray RL. Population exposure to smoking and tobacco branding in the UK reality show 'love island'. Tobacco Control, 2018; 27(6):709-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29437828

https://tobaccocontrol.bmj.com/content/tobaccocontrol/27/6/709.full.pdf

24. Eslick GD and Eslick MG. Smoking and The Simpsons. Medical Journal of Australia, 2009; 190(11):637-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19485843

25. Wakefield M, Flay B, Nichter M, and Giovino G. Role of the media in influencing trajectories of youth smoking. Addiction, 2003; 98 i79-103.

26. Knutzen KE, Moran MB, and Soneji S. Combustible and electronic tobacco and marijuana products in hip-hop music videos, 2013-2017. JAMA Intern Med, 2018; 178(12):1608-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30326017

27. Oberle CD and Garcia JA. Predicting alcohol, cigarette, and marijuana use from preferential music consumption. Journal of Drug Education, 2015; 45(2):113-25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26400900

28. Slater MD and Hayes AF. The influence of youth music television viewership on changes in cigarette use and association with smoking peers: A social identity, reinforcing spirals perspective. Communication Research, 2010; 37(6):751. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21318085

29. Bankhurst A. Three billion people worldwide now play video games, new report shows. IGN, 2020. Available from: https://www.ign.com/articles/three-billion-people-worldwide-now-play-video-games-new-report-shows

30. Forsyth SR and Malone RE. Tobacco imagery in video games: Ratings and gamer recall. Tobacco Control, 2016; 25(5):587-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26371111

31. Truth Initiative. Played: Smoking and video games.  2016. Available from: https://truthinitiative.org/sites/default/files/media/files/2019/03/Played-Smoking-in-Video-Games-2017.pdf.

32. Forsyth SR and Malone RE. Smoking in video games: A systematic review. Nicotine and Tobacco Research, 2016; 18(6):1390-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26209852

33. Cranwell J, Whittamore K, Britton J, and Leonardi-Bee J. Alcohol and tobacco content in UK video games and their association with alcohol and tobacco use among young people. Cyberpsychology, Behavior, and Social Networking, 2016; 19(7):426–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27428030

34. Perez A, Thrasher J, Cabrera N, Forsyth S, Pena L, et al. Exposure to tobacco in video games and smoking among gamers in Argentina. Tobacco Control, 2019; 28(4):427-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30030410

35. Elliott T. From the ashes: Smoking’s curious comeback on the silver screen. The Sydney Morning Herald, 2022. Available from: https://www.smh.com.au/culture/tv-and-radio/from-the-ashes-smoking-s-curious-comeback-on-the-silver-screen-20220120-p59py5.html

36. Popular documents: Smoking in movies. Legacy Tobacco Documents Library, 2007. Last update: Viewed Available from: http://legacy.library.ucsf.edu/popular_documents_movies.html.

37. Mekemson C and Glantz S. How the tobacco industry built its relationship with Hollywood. Tobacco Control, 2002; 11(suppl. 1):i81-91. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/11/suppl_1/i81

38. Cancer Council NSW. Action on smoking in movies. Sydney: Cancer Council NSW, 2005. Last update: Viewed Available from: http://www.cancercouncil.com.au/editorial.asp?pageid=1070.

39. Polansky J. A tobacco map of film and TV. Smokefree Movies: UCSF Center for Tobacco Control Research and Education, 2019. Available from: https://smokefreemovies.ucsf.edu/sites/default/files/Tobacco%20map%20of%20film%20and%20TV%20050718.pdf

40. Philip Morris USA. Philip Morris USA supports eliminating its brand imagery in movies. Philip Morris USA, Press Release, 2006. Last update: Viewed.

41. Smoke Free Movies. It's what Philip Morris doesn't say about movies that counts. Smokefree Movies, 2007. Last update: Viewed Available from: http://www.smokefreemovies.ucsf.edu/problem/PM_doesnt_say.html.

42. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco Control monograph no. 19. NIH Pub. No. 07-6242 Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2008. Available from: https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-19.

43. WHO Framework Convention on Tobacco Control. Guidelines for implementation of article 13 tobacco advertising, promotion and sponsorship. Geneva: World Health Organization, 2013. Available from: https://fctc.who.int/publications/m/item/tobacco-advertising-promotion-and-sponsorship.

44. World Health Organization (WHO). Smoke-free movies: From evidence to action. Geneva: WHO 2009. Available from: http://whqlibdoc.who.int/publications/2009/9789241597937_eng.pdf.

45. Fulmer EB, Neilands TB, Dube SR, Kuiper NM, Arrazola RA, et al. Protobacco media exposure and youth susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US youth. PLoS One, 2015; 10(8):e0134734. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26308217

46. Gendall P, Hoek J, Edwards R, and Glantz S. Effect of exposure to smoking in movies on young adult smoking in New Zealand. PLoS One, 2016; 11(3):e0148692. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26960189

47. Leonardi-Bee J, Nderi M, and Britton J. Smoking in movies and smoking initiation in adolescents: Systematic review and meta-analysis. Addiction, 2016; 111(10):1750-63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27043456

48. Lorenzo-Blanco EI, Abad-Vivero EN, Barrientos-Gutierrez I, Arillo-Santillan E, Perez Hernandez R, et al. Movie language orientation, gender, movie smoking exposure, and smoking susceptibility among youth in Mexico. Nicotine and Tobacco Research, 2018; 20(11):1378-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29065195

49. Mejia R, Perez A, Pena L, Kollath-Cattano C, Morello P, et al. Smoking in movies and adolescent smoking initiation: A longitudinal study among argentinian adolescents. Journal of Pediatrics, 2017; 180:222-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28029343

50. Janssen T, Cox MJ, Stoolmiller M, Barnett NP, and Jackson KM. The role of sensation seeking and R-rated movie watching in early substance use initiation. J Youth Adolesc, 2018; 47(5):991-1006. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28889368

51. Sohn M and Jung M. The influence of exposure to smoking in movies on cigarette cravings among adolescents: A contextual quasi-experimental model. Health Communication, 2020; 35(1):83-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30418039

52. Omidvari K, Lessnau K, Kim J, Mercante D, Weinacker A, et al. Smoking in contemporary american cinema. Chest, 2005; 128:746-54. Available from: http://www.chestjournal.org/cgi/reprint/128/2/746

53. Nichter M. Smoking:  What does culture have to do with it? Addiction, 2003; 98:i139-45.

54. MacFadyen L, Amos A, Hastings G, and Parkes E. 'They look like my kind of people'--perceptions of smoking images in youth magazines. Social Science & Medicine, 2003 56:491-9.

55. BMA Board of Science. Forever cool: The influence of smoking imagery on young people. British Medical Association, 2008. Available from: https://www.researchgate.net/publication/281283664_Forever_cool_the_influence_of_smoking_imagery_on_young_people_BMA_July_2008.

56. Watson N, Clarkson J, Donovan R, and Giles-Corti B. Filthy or fashionable? Young people’s perceptions of smoking in the media Health Education Research, 2003; 18:554-67. Available from: http://her.oxfordjournals.org/content/18/5/554.full.pdf+html

57. Carter OBJ, Donovan RJ, Weller NM, and Jalleh G. Impact of smoking images in magazines on the smoking attitudes and intentions of youth: An experimental investigation. Tobacco Control, 2007; 16(6):368-72. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/16/6/368

58. Sargent JD, Dalton MA, Beach ML, Mott LA, Tickle JJ, et al. Viewing tobacco use in movies: Does it shape attitudes that mediate adolescent smoking? . American Journal of Preventive Medicine, 2002; 22(3):137-45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11897456

59. Tickle JJ, Sargent JD, Dalton MA, Beach ML, and Heatherton TF. Favourite movie stars, their tobacco use in contemporary movies, and its association with adolescent smoking. Tobacco Control, 2001; 10(1):16-22. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/10/1/16

60. Hanewinkel R, Isensee B, Maruska K, Sargent JD, and Morgenstern M. Denormalising smoking in the classroom: Does it cause bullying? Journal of Epidemiology and Community Health, 2010; 64(3):202-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19767320

61. Jackson C, Brown J, and L'Engle K. R-rated movies, bedroom televisions, and intiation of smoking by white and black adolescents. Archives of Pediatric Adolescent Medicine, 2007; 161:260-8.

62. Hunt K, Henderson M, Wight D, and Sargent JD. Exposure to smoking in films and own smoking among Scottish adolescents: A cross-sectional study. Thorax, 2011; 66(10):866-74. Available from: http://thorax.bmj.com/content/66/10/866.abstract

63. Anderson SJ, Millett C, Polansky JR, and Glantz SA. Exposure to smoking in movies among British adolescents 2001-2006. Tobacco Control, 2010; 19(3):197-200. Available from: http://tobaccocontrol.bmj.com/content/19/3/197.abstract

64. Unknown. Motion picture rating system. Wikipedia, 2012. Last update: Viewed Available from: http://www.classification.gov.au/www/cob/classification.nsf/Page/Home.

65. Australian Government. Classification website. Canberra: Commonwealth of Australia, 2022. Last update: Viewed Available from: https://www.classification.gov.au/.

66. Office of Film & Literature Classification. Website. Wellington: Government of New Zealand, 2012. Last update: Viewed Available from: http://www.censorship.govt.nz/.

67. Motion Picture Association - Canada. Home entertainment classification. Toronto: MPAC, 2012. Last update: Viewed Available from: http://www.mpa-canada.org/?q=content/home-entertainment-classification.

68. British Board of Film Classification. Classification guidelines. London: BBFC, 2012. Last update: Viewed Available from: http://www.bbfc.co.uk/classification/guidelines/.

69. Irish Film Classification Office. Website. Dublin: IFCO, 2022. Last update: Viewed Available from: http://www.ifco.ie/.

70. The Classification and Rating Administration. Film ratings.Com. Washington: Motion Picture Association of America, 2012. Last update: Viewed Available from: http://www.filmratings.com/filmRatings_Cara/#/home/.

71. No authors listed. Smoke Free Media. University of California San Francisco  2022. Last update: Viewed Available from: https://smokefreemedia.ucsf.edu/policy-solutions.

72. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Guidelines for implementation of article 13 (tobacco advertising, promotion and sponsorship). Decision FCTC/COP3(12) Geneva: World Health Organization, 2008. Available from: https://apps.who.int/gb/fctc/PDF/cop3/FCTC_COP3_REC1-en.pdf.

73. Millett C, Polansky JR, and Glantz SA. Government inaction on ratings and government subsidies to the US film industry help promote youth smoking. PLoS Medicine, 2011; 8(8):e1001077. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21886486

74. Waylen AE, Leary SD, Ness AR, Tanski SE, and Sargent JD. Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study. Thorax, 2011; 66(10):856-61. Available from: http://thorax.bmj.com/content/66/10/856.abstract

75. Lyons A and Britton J. Protecting young people from smoking imagery in films: Whose responsibility? Thorax, 2011; 66(10):844-6. Available from: http://thorax.bmj.com/content/66/10/844.short

76. Charlesworth A and Glantz SA. Smoking in the movies increases adolescent smoking: A review. Pediatrics, 2005; 116(6):1516-28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16322180

77. Lochbuehler K, Peters M, Scholte R, and Engels R. Effects of smoking cues in movies on immediate smoking behavior. Nicotine & Tobacco Research, 2010; 12(9):913-8. Available from: http://ntr.oxfordjournals.org/cgi/content/full/ntq115v1

78. Sargent JD and Hanewinkel R. Viewing movie smoking undermines antismoking parenting practices. Przeglad Lekarski, 2008; 65(10):415-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19189513

79. Thrasher J, Sargent J, Huang L, Arillo-Santillan E, Dorantes-Alonso A, et al. Does film smoking promote youth smoking in middle-income countries?: A longitudinal study among Mexican adolescents. Cancer Epidemiology, Biomarkers & Prevention, 2009; 18(12):3444–50. Available from: http://cebp.aacrjournals.org/content/18/12/3444.long

80. Titus-Ernstoff L, Dalton MA, Adachi-Mejia A, Longacre M, and Beach M. Longitudinal study of viewing smoking in movies and initiation of smoking by children. Pediatrics, 2008; 121:15-21. Available from: http://pediatrics.aappublications.org/cgi/reprint/121/1/15

81. Chapman S and Farrelly M. Four arguments against the adult-rating of movies with smoking scenes. PLoS Medicine, 2011; 8(8):e1001078. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21886487

82. Chapman S, Public health advocacy and tobacco control: Making smoking history.  Melbourne: Blackwell Publishing; 2007. Available from: https://www.amazon.com.au/Public-Health-Advocacy-Tobacco-Control/dp/1405161639.

83. Jackson C, Brown J, and L'Engle K. R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents. Archives of Pediatric Adolescent Medicine, 2007; 161:260-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17339507

84. Laugesen M, Scragg R, Wellman R, and JR D. R-rated film viewing and adolescent smoking. Preventive Medicine, 2007; 45(6):454-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17707897

85. Edwards CA, Harris WC, Cook DR, Bedford KF, and Zuo Y. Out of the smokescreen: Does an anti-smoking advertisement affect young women's perception of smoking in movies and their intention to smoke? Tobacco Control, 2004; 13(3):277–82. Available from: http://tc.bmjjournals.com/cgi/content/abstract/13/3/277

86. Pechmann C and Shih CF. Smoking scenes in movies and antismoking advertisements before movies: Effects on youth. Journal of Marketing, 1999; 63(3):1–13. Available from: http://www.jstor.org/pss/1251772

87. Edwards CA, Oakes W, and Bull D. Out of the smokescreen ii: Will an advertisement targeting the tobacco industry affect young people's perception of smoking in movies and their intention to smoke? Tobacco Control, 2007; 16(3):177-81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17565137

88. Hanewinkel R, Isensee B, Sargent JD, and Morgenstern M. Effect of an antismoking advertisement on cinema patrons' perception of smoking and intention to smoke: A quasi-experimental study. Addiction, 2010; 105(7):1269-77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20642510

89. Preventative Health Taskforce. Australia: The healthiest country by 2020 - a discussion paper. Preventative Health Taskforce: Commonwealth of Australia, 2008. Last update: Viewed Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/discussion-healthiest.

90. Reuters. Indian court stubs out ban on smoking in Bollywood, Dalje, Editor 2009. Available from: http://dalje.com/en-world/indian-court-stubs-out-ban-on-smoking-in-bollywood/227481.

91. World Health Organization. Smoke-free movies: From evidence to action. Geneva: WHO 2009. Available from: http://whqlibdoc.who.int/publications/2009/9789241597937_eng.pdf.

92. Goswami H and Kashyap R. Tobacco in movies: A report. Chandigarh: Burning Brain Society, 2006. Available from: https://www.academia.edu/3101180/Tobacco_in_Movies_and_Effect_on_Youth.

93. Nazar GP, Arora M, Sharma N, Shrivastava S, Rawal T, et al. Changes in tobacco depictions after implementation of tobacco-free film and TV rules in Bollywood films in India: A trend analysis. Tobacco Control, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34312318

94. You T. China censors films and TV series that have 'too many' smoking scenes to keep its youth away from cigarettes. Daily Mail Australia, 2019. Available from: https://www.dailymail.co.uk/news/article-7661347/China-clamps-films-TV-series-smoking-scenes.html

95. Paul C, Walsh R, Stacey F, Tzelepis F, Oakes W, et al. Smoking in movies in Australia: Who feels over-exposed and what level of regulation will the community accept? Health Promotion Journal of Australia, 2008; 19(3):229–31. Available from: http://www.unboundmedicine.com/medline/ebm/record/19053942/full_citation/Smoking_in_movies_in_Australia:_who_feels_over_exposed_and_what_level_of_regulation_will_the_community_accept

96. Longacre M, Adachi-Mejia A, Titus-Ernstoff L, Gibson J, Beach M, et al. Parental attitudes about cigarette smoking and alcohol use in the motion picture association of America rating system. Archives of Pediatrics and Adolescent Medicine, 2009; 163(3):218–24. Available from: http://archpedi.ama-assn.org/cgi/content/full/163/3/218

97. Tobacco advertising prohibition amendment act 2012 (cth). 2012; Available from: http://www5.austlii.edu.au/au/legis/cth/num_act/tapaa2012394/sch1.html.

98. L Allison. Proposal on smoking in films, business, consideration of legislation, official hansard no. 4. Thursday 15 May Canberra: Senate, Parliament of Australia, 2008. Available from: http://parlinfo.aph.gov.au/parlInfo/genpdf/chamber/hansards/2008-05-15/0060/hansard_frag.pdf;fileType=application%2Fpdf.

99. Preventative Health Taskforce. Australia: The healthiest country by 2020 – national preventative health strategy – the roadmap for action. Canberra: Commonwealth of Australia, 2009. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/discussion-technical-1.

100. Australian Government. Taking preventative action: Government's response to Australia: The healthiest country by 2020. 2010 Canberra: Department of Health and Ageing, 2010. Available from: http://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcare.

101. Corderoy A. Smoking in children's movies angers critics. Sydney Morning Herald, 2010; 22 Aug. Available from: http://www.smh.com.au/lifestyle/wellbeing/smoking-in-childrens-movies-angers-critics-20100822-13at5.html

102. Intergovernmental Committee on Drugs. National tobacco strategy 2012-2018.  2012. Available from: https://www.health.gov.au/sites/default/files/national-tobacco-strategy-2012-2018_1.pdf.

103. Commonwealth of Australia (Department of Health). Consultation draft national tobacco strategy 2022–2030.  2022. Available from: https://consultations.health.gov.au/atodb/national-tobacco-strategy-2022-2030/supporting_documents/Draft%20NTS%2020222030%20for%20consultaion%20hub.pdf.