Jump to full article: World Health Organization (WHO), 2009-06-01
Intro: The tobacco industry knows that motion pictures are one of humanity’s most common entertainment experiences. In a world with two billion urban dwellers (12), cinemas sold eight billion movie tickets in 2006, an all-time high. Of these, 20% were sold in the United States and Canada; however, 80% of admissions and 63% of box office revenues were in other countries (13). Based on figures from exhibitors, distributors and market analysts, the world spends an estimated US$ 100 billion a year on cinema tickets and on legitimate or pirated video copies of films. Roughly 30% is spent on single viewings in theatres, while 70% is spent on videos that can be viewed multiple times. Motion pictures are increasingly viewed outside movie theatres and distributed through other channels. The movie medium is extended by the Internet, TV, DVDs and other video access, reaching widely across cultures and economies. Thus, exposure to film content is vastly underestimated by movie theatre attendance data . . .
In an analysis of more than 1200 US-produced live action films – nearly the entire body of feature films released to theatres both by major studios and by independent producers in 1999- 2006 – tobacco imagery permeated both youth- rated (G/PG/PG-13) and adult-rated (R) movies, with more than three quarters of US-made movies featuring tobacco imagery (14). More specifically, close to 90% of all R-rated movies included smoking, while smoking appeared in three quarters of movies rated PG-13 and was found in more than a third of movies rated G or PG. Altogether, live action movies of all ratings produced in the United States between 1999 and 2006 contained approximately 8400 tobacco incidents.iii
Of these incidents, 68% were in movies rated R; 29% in movies rated PG-13; and 3% in movies rated G or PG. (See Box 1 for an explanation of the rating system.) There was no significant trend in tobacco incidents per film, either up or down, over the period 1999–2006. . . .
Movies, especially those made in the United States, are a major source of viewer identification with celebrities. They can encapsulate dreams, craft hopes and help viewers escape the tedium of everyday life. For the tobacco industry, films can provide an opportunity to convert a deadly consumer product into a cool, glamorous and desirable lifestyle necessity. The Marlboro Man is a powerful salesman, but even he lacks the draw of popular historical and contemporary movie stars from Hollywood, Bollywood and other film production centres. In contrast to traditional advertising, film stars provide indirect but nonetheless powerful information about the “benefits” of smoking.
Experimental and observational studies (27,31) show that cigarette smoking in films can influence young peoples’ beliefs about social norms for smoking, beliefs about the function and consequences of smoking and their personal intention to smoke. The presentation of smoking in films does not reflect reality. In reality, smoking tends to be highest among lower socioeconomic groups. In films, the prevalence of smoking depicted by characters, in particular among the higher-socioeconomic characters frequently portrayed by lead actors, is higher than the prevalence of smoking by comparable people in the general population (40). The real health consequences of smoking are rarely shown (40). Young people, especially, look to those celebrities for reassurance about their choices in fashion and behaviour. As they formulate their lifestyles, the film medium may provide a particularly attractive resource to promote these choices. . . .
When developing policy, both national and global perspectives should be considered. Well designed, evidence-based public health policy will improve population health both nationally and globally. The primary objective of actions to reduce smoking imagery in the movies is:
To substantially and permanently reduce children’s and adolescents’ exposure to tobacco imagery in movies.
Only options that meet this objective would then be evaluated for political feasibility, legality, sustainability and cost. The principles that guide such evaluation include:
• Principle 1: Seek “upstream” solutions
Policy should motivate change in the film industry’s behaviour so as to reduce harmful content at the source (“upstream”) instead of burdening the adolescents in the audience and their parents with taking some sort of protective measures (“downstream”). Films with smoking imagery are causally associated with smoking initiation, and therefore industries that profit from marketing these health risks should be responsible for making them safe. . . .
In May 2007, the Motion Picture Association of America (MPAA) proposed adding descriptors such as “pervasive smoking” or “glamorized smoking” to some ratings, absent a “mitigating context” (69).xiv Such content descriptors fail to convey the harmful effect of the film’s smoking imagery. It is the cumulative exposure to smoking in films – not the amount of smoking in a particular film – that best predicts the effect on adolescents. The recommended approach is to precede any film with tobacco imagery, in any distribution channel, with an effective anti-tobacco spot message. . . .
The Indian experience demonstrates the importance of exposing and neutralizing counter- strategies from the tobacco industry or its surrogates and allies. Successful implementation requires not only judicial intervention but also raising public awareness of the serious harm resulting from onscreen promotion of tobacco. The analytic studies in 2003 and 2004– 5 clearly established that, like the US films dominating screens in other countries, Indian films were depicting more tobacco imagery following implementation of the TCA and thus influencing young people to smoke. National interventions in India, as in the United States, can thus have global impacts in preventing smoking initiation. . . .
Experience shows that whenever tobacco advertising and promotion is restricted in one medium, it migrates to another. Tobacco appearances in films accelerated in the United States while tobacco advertising in other media was being restricted, and in India a similar process occurred after tobacco advertising in other media was prohibited. Because smoking on screen is uniquely vivid and because young people see so many films so often, its promotional effect on smoking initiation is striking. Any country seeking to ban or restrict tobacco advertising and promotion must address the issue of smoking on screen or risk having its public health efforts being severely compromised. The most vulnerable age group (adolescents) must not continue to be exposed to the most powerful promotional channel for smoking imagery available in today’s globalized economy. A comprehensive approach to combating smoking imagery in film is therefore required. . . .
There are a number of levels of intervention whereby smoking in the movies can be restricted. The overall evidence suggests that voluntary and self-regulatory measures have not been successful. Advocacy approaches to obtain stronger labelling requirements (adult ratings) for movies showing smoking imagery as well as anti-smoking messages and assurances that no payoffs are received from the tobacco industry have received wide support recently in both the United States and India. It is clear that restrictions of smoking imagery in movies with wide global distribution will serve a larger, multinational public good. Thus national approaches, and even local approaches, can have wide-ranging positive global effects. Multinational cooperation will also be critical in restricting the global reach of movie-based tobacco imagery.
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