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Thursday, Dec 22, 2005

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Opinion - Leader Page Articles

How rational is a ban on smoking in movies?

Madhu Purushothaman

Responsible for millions of deaths worldwide, tobacco use is certainly the most important preventable public health problem in the world today. Banning smoking in movies takes the public health battle to the doorsteps of not only the tobacco industry, but also the film industry.

THE ADVERSE health effects of smoking have long been established. Cigarette smoking increases the risk for many types of cancer, including cancers of the lung, lip, oral cavity, larynx (voice box), oesophagus, pancreas, uterine cervix, urinary bladder, and kidney. The risk of coronary heart disease, stroke, peripheral vascular disease and chronic obstructive lung disease are significantly increased among cigarette smokers. Smoking also has many adverse reproductive and early childhood effects, including an increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS).

The deleterious consequences of smoking on human health in terms of morbidity, mortality, and productivity are enough justification for aggressive measures to prevent smoking initiation during the most vulnerable years of adolescence and young adulthood. Understanding and eliminating the factors that contribute to the promotion of tobacco use among youth is an essential element of tobacco control.

Smoking initiation in adolescence is not thought to be the result of a rational or highly premeditated thought process. Instead, smoking initiation typically signifies a reaction to social events in which adolescents find themselves confronted by the opportunity to smoke. Movie tobacco use, when viewed in doses to which adolescents are typically exposed, is almost as influential on their attitudes as having friends who smoke. In Indian society where cinema has a pervasive influence on people's lives, the impact of movie smoking in shaping human behaviour cannot be underestimated.

The Institute of Medicine Report titled "Growing up Tobacco Free" elucidates that "in developing norms, adolescents look to the greater social environment for concepts of adult identity, particularly the behavior of leaders, heroes, and film stars, and in the media." According to the social learning theory, which underscores the importance of the interplay between individual traits and the environment, mass media have an enormous influence on lifestyle choices of young adults.

A number of research studies have shown that exposure to movie smoking does promote the smoking habit among youth. A study conducted in 2001 at the Dartmouth Medical School in Hanover, United States, concluded that "the portrayal of tobacco use in contemporary motion pictures, particularly by stars who are admired by adolescents, contributes to adolescent smoking." In a longitudinal cohort study published in The Lancet in 2003, it was found that adolescents who had a significant exposure to movie smoking were almost thrice as likely to initiate smoking compared with those who had little exposure to movie smoking. The Lancet article concluded that more than 50 per cent of smoking initiation among adolescents in the study could be attributed to exposure to movie smoking.

In a study published as recently as November 2005 in the journal Pediatrics, it was clearly established that exposure to movie smoking is an independent, primary risk factor for smoking initiation among adolescents. In this study, adolescents were grouped into four different quartiles based on their level of movie smoking exposure and it was found that the smoking prevalence rose steadily with increasing levels of exposure to movie smoking.

Movie smoking has also been shown to shape behavioural patterns in young adults. In a study published in the Journal of Applied Psychology in 2000, undergraduate students were exposed to 20-minute clips of the movie Die Hard — one with the smoking scenes retained and another with the smoking scenes edited out. Students who viewed the smoking clip reported a greater willingness than those who viewed the non-smoking clip to become friends with a smoker. It is well known that young adults who are part of peer groups that smoke have an increased likelihood of becoming smokers themselves.

The magnitude of the impact of movie smoking is evident in a 2002 Centers for Disease Control report that attributes the slower-than-expected decline in adolescent cigarette use in the 1990s in part to the effects of smoking in movies.

A World Health Organisation report that examined the prevalence of smoking in Indian films and its impact on adolescents reported similar patterns of smoking in Indian movies as had been observed in U.S.-produced movies. Although cigarette smokers comprise only 14 per cent of India's total tobacco-using population, tobacco use appeared in 76 per cent of the films sampled, and cigarettes accounted for 72 per cent of these incidents. According to the report, Indian adolescents reported that they are influenced by smoking in the movies, because they wish to emulate their stars' behaviour.

The tobacco industry has long recognised the value of smoking in movies to promote cigarettes and developed extensive programmes to promote smoking in the movies. The themes common to cigarette advertising are also common in movies. Smoking is routinely used to portray glamour, independence, rebelliousness, relaxation, stress relief, and romance. Tobacco industry protagonists believe that movie smoking is more influential on the susceptible populations than commercials on television and ads in magazines, because the audience is totally unaware of the sponsor involvement. In the 1980s, it was revealed that the tobacco company Philip Morris paid to place Marlboro cigarettes in the film Superman II. This revelation prompted a U.S. Congressional hearing and the advent of legislation that made it compulsory for the tobacco industry to disclose information on expenditures for product placement in movies to the U.S. Federal Trade Commission.

Evidence abounds on the increase in sales of products other than cigarettes when used on-screen by popular movie stars. Examples include a 65 per cent increase in the sales of Hershey's Reese's Pieces candy after its use by the main characters in the movie ET, and the dramatic increases in demand for the BMW Z3 automobile, evident by long waiting lists and the withdrawal of discounts for purchase, following the James Bond character's use of the car in the movie Golden Eye. If the on-screen use of these products can result in a dramatic boost in their sales, there is no reason to doubt the impact of movie smoking on cigarette sales.

Research data strongly suggest that levels of smoking in movies may undermine other public health tobacco control efforts and need to be monitored carefully. Interventions designed to discourage actors from smoking in movies and to limit adolescent exposure to smoking in movies should have a high public health priority.

Responsible for millions of deaths worldwide, tobacco use is certainly the most important preventable public health problem in the world today. Unlike many other preventable public health problems, which involve chasing biological and microbial targets, the prevention of tobacco use through public health measures is well within the ambit of the human will. What is required is a strong political will for astute policy-making and implementation — the courage, conviction, and intellectual honesty to confront the all-powerful and wealthy tobacco industry.

Questions like "why is the government trying to ban movie smoking instead of directly imposing a ban on tobacco products" stem from a lack of understanding that any radical policy change can be made only in incremental steps. The logistics and politics of a ban on movie smoking are far less complex than that those relating to the sale of tobacco products. Banning smoking in movies takes the public health battle to the doorsteps of not only the tobacco industry, but also the film industry. We cannot be but proud of the fact that, if the ban fructifies, India's Health Minister Anbumani Ramadoss, would have set an outstanding precedent for the rest of the world in tackling the tobacco menace.

(Dr. Madhu Purushothaman, MBBS, AB (Pediatrics), FAAP, is Clinical Assistant Professor of Pediatrics, Medical College of Georgia, USA; and President Elect, Young Physicians Section, American Association of Physicians of Indian Origin. He can be reached at: madhu.purushothaman@gmail.com)

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