31st May 2013, Volume 126 Number 1375

Ninya Maubach, Janet Hoek, Richard Edwards, Julian Crane, Judith McCool

New Zealand has a proud history of tobacco control and was among the first countries to prohibit tobacco advertising in broadcast media.1 Other protective measures followed quickly; in 1973, the tobacco industry agreed not to advertise their products on billboards or in cinemas,2 nearly all tobacco sponsorships ended in 1995,1,2 point of sale displays came down in 2012,3 and legislation requiring plain packaging is in preparation.

The New Zealand Government, in its response to the findings of the Māori Affairs Select Committee on the tobacco industry has now committed to the goal of making New Zealand a smokefree nation by 2025—this will be the single most important public health achievement in New Zealand—and yet there remain barriers to its successful implementation.

Tobacco control measures have made (and will continue to make) major contributions to reducing smoking prevalence, which, at 17%,4 is now substantially lower than the more than 50% of men (>35% of women) who smoked during the 1950s and 60s.1

Dismantling tobacco marketing in its many guises has greatly reduced youth exposure to smoking and has been associated with rapid reductions in both regular and daily smoking (from 28% in 1999 to under 10% in 2011, and from over 15% in 1999 to under 5% in 2011, respectively, for adolescents aged 14 to 15 years).5 However, these declines in smoking prevalence have finally stalled6. In order to continue this decline in youth smoking to zero it is important to continue to reduce exposure to smoking as much as possible.

The tobacco industry has not observed these measures with any great sanguinity; instead it addressed each new restriction by developing alternative media strategies.7 Thus, despite increasingly comprehensive marketing restrictions, smoking continues to be widely promoted through media that have strong youth and young adult reach and appeal.

Among other media currently depicting smoking, tobacco promotion occurs through product placement in films. Often arranged through formal contracts with film companies and actors,8many films present smoking as a common, normal and even aspirational behaviour, performed by adults (often role models for young people) who rarely, if ever, appear to suffer any ill effects from smoking.9

Film producers have argued that smoking contributes to character development and setting ambience, and claim these are artistically necessary.10 They therefore defend their use of illusory images that present smoking as a badge of maturity and a conduit to aspirational attributes, irrespective of evidence that young people actively draw on these attributes as they define and project their social identity.11

Thus, despite highly incongruous instances of smoking in films, such as Sigourney Weaver’sAvatar character,12 or cartoon characters, movie producers have claimed smoking confers realism on their creative product and positions characters’ personalities.13 The argument for realism for a science-fiction fantasy film like Avatar is especially hard to justify, given that the smoking occurred on a space station, a setting where in reality, smoking would be absolutely prohibited due to the risk of explosion.

However, a large body of research evidence investigating the effects of child and adolescent exposure to smoking in films has overwhelmingly concluded that smoking imagery in films increases the risk of initiation and continuation of smoking among youth.

In a recent meta-analysis, exposure of adolescents to smoking in films increased smoking initiation by 113% and established smoking by 68%14. Furthermore, there is a clear dose-response relationship: the greater the number of exposures to smoking in movies, the greater the risk of smoking experimentation.15

A recent multi-country European Study prospectively followed 10,000 adolescents and showed a 13% increase in smoking onset for every 1,000 smoking images seen, after controlling for age, gender, family affluence, school performance, TV screen time, personality characteristics, and smoking status of peers, parents, and siblings16.

Summarised in a recent National Cancer Institute monograph,9 and in the 2012 US Surgeon General’s report on Preventing Tobacco Use Among Youth and Young Adults,17 the evidence shows a clear causal relationship between exposure to smoking in films and both youth smoking uptake and smoking maintenance. The Surgeon General determined that smoking in films was simply another covert (and effective) form of tobacco advertising and the NCI concluded:

The depiction of cigarette smoking is pervasive in movies, occurring in three-quarters or more of contemporary box-office hits. Identifiable cigarette brands appear in about one-third of films. The total weight of evidence from cross-sectional, longitudinal, and experimental studies indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation.18

This evidence is alarming and is compounded by the fact that, although the number of tobacco incidents in popular youth-rated US films declined from 2005 to 2010,19 this trend sharply reversed from 2010 with a 34% increase in tobacco incidents per film in G, PG or PG-13 rated films20 and a 54% increase in 2012.21

As New Zealand youth audiences enjoy many of Hollywood’s films, the pattern of exposure is likely to be very similar here and movie-going New Zealand children will be at increased risk of smoking experimentation. In fact, New Zealand children are likely to receive greater exposure to smoking in films, than their US counterparts because of differences in film classification. For example, of the 67 top grossing films in 2012 there were a total of 2619 tobacco incidents. Nearly all of these smoking instances appeared in youth rated or unrestricted films in New Zealand (95%) compared to only 44% in the US.

Conversely, over half of these 67 films (36 or 54%), were adult-rated in the US but only 4 (6%) were adult rated in New Zealand. (personal communication Jonathan Polansky, consultant to UCSF Center for Tobacco Control Research and Education).

However, not only are New Zealand children being harmed by exposure to smoking in films, but New Zealand films are making a substantial national and international contribution to the problem.22 “The Hobbit” with its unrestricted M-rating, exposed thousands of New Zealand children and millions of children worldwide to frequent smoking scenes.

Although hobbits and elderly magicians are not widely regarded as role models for children, the research evidence shows the most important predictor of smoking initiation is the overall number of smoking incidents to which children are exposed, regardless of the context.

Other recent M-rated films featuring smoking likely to have appealed to youth audiences include “Men in Black 3”, “Mission: Impossible - Ghost Protocol”, “Skyfall” and “X-Men: First Class”. While less common these days, even cartoons have included positive depictions of tobacco use, such as “Rango” (PG, which contained about 60 instances of completely fictional characters smoking). It seems hard to justify the artistic necessity, ambience setting or requirement for realism for a cartoon character to smoke, and indeed, Disney films have now agreed to ban all smoking from their future productions.

In order to be smokefree by 2025 it is clear that New Zealand needs to both continue to support current smokers in their attempts to quit smoking and do everything possible to discourage children and adolescents from starting. Reducing exposure to smoking and to smoking imagery in all media is an important part of that strategy and requires better control of smoking in films, the key loophole through which such exposure is perpetuated.

The key measure required to reduce children’s exposure to smoking is to apply adult-ratings to all films which portray smoking. The only exceptions should be films which portray historical characters who were smokers and films which depict, as a major focus, the adverse health effects of smoking.

Such recommendations are supported by the World Health Organization, in its 2011 report on smoking in films “Smoke free movies: from evidence to action”:

Most youth exposure to on-screen smoking comes from smoking incidents in youth rated films. Because fewer children and adolescents view adult-rated films, official ratings for age appropriateness would be an effective method to reduce adolescent exposure to tobacco use without interfering with movie content.

Any future movie with tobacco imagery should be given an adult rating, with the possible exception of movies that unambiguously depict the dangerous consequences of tobacco use or portray smoking by an actual historical figure who smoked. Older films should not be rerated.

Further, the Framework Convention on Tobacco Control, to which New Zealand is a signatory, recommends adult ratings for films that depict any tobacco or smoking imagery:

Implementing a ratings or classification system that takes into account the depiction of tobacco products, use or images in rating or classifying entertainment media products (for example, requiring adult ratings which restrict access of minors) and that ensures that entertainment media aimed at children (including cartoons) do not depict tobacco products, use or imagery.

Alternative approaches such as editing smoking out of scenes or running banners about the harm associated with smoking (as has recently been implemented in India) would be more difficult, expensive, and detract from the filmgoer’s experience. Amongst current smokers some pre-film anti-smoking advertisements may even reinforce smoking behaviour23.

As more countries adopt adult ratings for films containing smoking, smoking in cartoons and child and adolescent targeted films will rapidly decline given that the film industry will not want such films rated for older audiences with no interest in viewing them. This should lead in turn to a serious review by the film industry of all smoking in all films.

Restricting all smoking to adult rated films would be a simple, evidence-based and inexpensive method of reducing child and adolescent exposure to smoking and would reduce smoking experimentation and initiation in this age group. As such, it would make an important contribution to achieving the Government’s goal of a smokefree New Zealand by 2025.

No doubt a few may view such a change as yet another nail in the coffin of free speech or artistic expression; however, we argue that it is no restriction at all in speech or imagery directed at children, that smoking has nothing whatsoever to do with artistic expression and that restricting smoking in films to adults only will help reduce future nails in future coffins of New Zealand children.

Ninya Maubach, Janet Hoek, Richard Edwards, Julian Crane
ASPIRE2025, 
University of Otago

Judith McCool
School of Population Health
University of Auckland

Author Information

Ninya Maubach, Janet Hoek, Richard Edwards, Julian Crane, ASPIRE2025, University of Otago, Judith McCool, School of Population Health, University of Auckland

References

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