The European Commission has recently completed a public consultation on the future provision of state aid for audiovisual works. Although not its main aim, the consultation provided an important opportunity to challenge the way that EU governments currently subsidize US and domestic films with tobacco imagery. Given the growing evidence, initially from the USA but now from seven European countries, of a causal link between exposure to tobacco imagery in films and smoking initiation among youth, recently brought together in updated WHO guidance,1 we call on EU governments to end their subsidies that now amount to €263 million over 2008–11 for films with tobacco imagery.

Exposure to on-screen smoking recruits new adolescent smokers

More than two dozen observational and experimental studies on four continents have established that exposure to on-screen smoking is strongly associated with adolescents starting to smoke and progressing to regular, addicted smoking.1 Of most direct relevance to the EU, a 2011 cross-sectional study investigated whether this relationship holds across diverse European cultural contexts using more than 16 551 students (mean age, 13 years) in Germany, Iceland, Italy, the Netherlands, Poland and Scotland.2 After adjusting for other factors affecting adolescent tobacco use, including age and peer smoking behaviour, adolescents in the top quartile of on-screen smoking exposure were 1.7 times (95% CI 1.4–2.0) more likely to have ever smoked than those adolescents in the bottom quartile. These findings are consistent with those from two recent studies conducted in England and Scotland.3,4

Policy responses to on-screen smoking

Article 13 of the WHO Framework Convention on Tobacco Control commits parties to the Convention, including the EU, to banning tobacco advertising, promotion and sponsorship. In 2009, the WHO recommended that films made in future with tobacco content be assigned an ‘adult’ (e.g. ‘18’) rating, ‘with the possible exception of movies that reflect the dangers and consequences of tobacco use or depict smoking by an actual historical figure who smoked’.1 However, no government or film classification body has yet implemented this adult rating.

Government subsidies to films with tobacco imagery

Many European Union governments go even further than tolerating rating systems that certify films with tobacco use as appropriate for children by funding the promotion of smoking to youth through generous subsidies to the movie industries. Government support (‘State aid’) for film and television production currently makes no distinction between projects whose tobacco content plays an important role in recruiting adolescents to smoke and those that do not.

A recent study of public policy towards on-screen smoking estimated that, in the UK from 2003 to 2009, £338 million (€387 million) in Film Tax Credits were routed to British productions of US-developed ‘British’ films with tobacco imagery, almost all age-classified for adolescents and children.5 The same estimation method applied to the sample of all 488 top-grossing films released January 2008–June 2011 yields these results for members of the European Union:

  • European Union Member States were the primary production location for 13% (60/488) of these top-grossing films.

  • Sixty-three percent (38/60) of top-grossing films shot in EU countries included tobacco.

  • EU countries accounted for € 433 million (21% of global total) in public subsidies of top-grossing films released over the 42-month period sampled.

  • Among the EU countries, 61% (€ 263 million / € 433 million) of public subsidies for top-grossing films went to films with tobacco (Table 1).

  • Within the EU, the UK provided nearly half of subsidies for top-grossing films with tobacco imagery. Germany provided about one-quarter with the remainder provided by Italy (9%), the Czech Republic (7%), France (6%) and Hungary (5%).

In recent years, six of the ten countries awarding the largest amount of public subsidies to top-grossing movies with tobacco imagery were in the European Union. They contributed 26% of all such subsidies.

Table 1

Global Share: Public subsidies for top-grossing movies with tobacco, 2008–11

Country Percent of global total (€ 1.02 billion) Public subsidy (estimated) 
USA 58 € 595 million 
UK 12 € 127 million 
Canada 10 € 96 million 
Germany € 63 million 
New Zealand € 39 million 
Australia € 26 million 
Italy € 25 million 
Czech Republic € 19 million 
France € 16 million 
Hungary € 14 million 
Country Percent of global total (€ 1.02 billion) Public subsidy (estimated) 
USA 58 € 595 million 
UK 12 € 127 million 
Canada 10 € 96 million 
Germany € 63 million 
New Zealand € 39 million 
Australia € 26 million 
Italy € 25 million 
Czech Republic € 19 million 
France € 16 million 
Hungary € 14 million 

New policy recommendations

New policy guidance from the WHO states that government subsidy programmes ‘should be amended to make film and television projects with tobacco imagery or reference ineligible for public subsidy’.2 It notes that ‘Public subsidy of media productions known to promote youth smoking initiation is counter to WHO FCTC Article 13 and its guidelines. Public support for and policies favouring media producers, whether the rationale is cultural conservation or commercial competition, should be harmonized with the fundamental public health imperative to protect populations from tobacco promotion and with Article 13 of the WHO FCTC.’

Implementing the WHO recommendations would not prevent filmmakers from including tobacco imagery in a film. Nor would it force a filmmaker to adopt an anti-tobacco message. It would simply bring public subsidies designed to encourage private endeavours deemed in the public interest into harmony with public health policies that EU Member States have committed to as parties to the FCTC. We urge the European Commission to act on the strong and growing scientific evidence linking tobacco imagery in films and smoking initiation among European youth and the new WHO recommendations by making audiovisual works with tobacco imagery ineligible for state subsidies.

Conflicts of interest: None declared.

References

1
World Health Organization
Smoke-free movies: from evidence to action, September 2011
2nd edn
 
Available at: whqlibdoc.who.int/publications/2011/9789241502399_eng.pdf
2
Morgenstern
M
Poelen
EAP
Scholte
R
, et al.  . 
Smoking in movies and adolescent smoking: cross-cultural study in six European countries
Thorax
  
[Epub ahead of print 25 August 2011; doi:10.1136/thoraxjnl-2011-200489]
3
Waylen
AE
Leary
SD
Ness
AR
, et al.  . 
Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study. October 2011
Thorax
 , 
2011
, vol. 
66
 (pg. 
856
-
61
)
4
Hunt
K
Henderson
M
Wight
D
Sargent
JD
Exposure to smoking in films and own smoking amongst Scottish adolescents: a cross-sectional study
Thorax
 , 
2011
, vol. 
66
 (pg. 
866
-
74
)
5
Millett
C
Polansky
JR
Glantz
SA
Government inaction on ratings and government subsidies to the US film industry help promote youth smoking 2011
PLoS Med
 , 
2011
, vol. 
8
 pg. 
e1001077
 

Comments

2 Comments
Does public health really want to embrace cultural censorship?
28 December 2011
Simon Chapman

Could any irony have been intended by the editors in publishing a multi-authored call for effective censorship of smoking scenes in movies[1] on the same day that the death of the North Korean hermit kingdom despot Kim Jung Il was announced? With the possible exception of the cultural ambitions of the Afghan Taliban who think all movies are evil, the North Korean state is the apotheosis of state control of cultural expression, routinely ranked last in international press freedom indexes. Movie content is routinely censored and banned, all in the name of an ideology which professes to benefit the population.

Fortunately, much of the rest of the world is moving in the other direction when it comes to freedom of cultural expression.

The authors of this proposal [1] will predictably say that they are not calling for censorship, but simply for an exceptionalist change of policy where any smoking in a movie other than real historical figure use would cause its producers to lose government subsidy. If such a policy were ever to be introduced and enforced, self-censorship by film producers would of course follow. The authors are thus effectively trying to pull the levers of censorship without using the word which they are presumably astute enough to realize would appall millions of people.

All manner of bad behavior occurs often in movies. It is not the mission of cinema to only present pro-social views of the world or to service health educational agenda. Many movies have a sustained focus on violence, war, crime, injustice, child abuse, racism, misanthropy, misogyny, deceit, reckless driving, dangerous extreme risk taking, excessive alcohol use, gluttony and physical inactivity, to name just a few. Often several of these issues appear together and smoking is often in the mix too.

If the proposal were to be accepted that governments should intervene in the cultural production industry at the level of content censorship of smoking, by the same mandate, should not advocates concerned about cinematic socializing influences on the above health and social problems also hope to see subsidies end for any film that might promote dangerous driving, crime, racism etc? The reductio of this reasoning is that movies subsidized by governments should in effect depict only wholesome themes. Many would consider this a narrow, neo-puritan and ultimately philistine view of the scope of cinema. Many disreputable regimes have burned books and censored the arts in the name of a diverse range of religious, political and social agendas.

Proposals for any smoking scene to automatically trigger an R (adult) rating in a film imply an equivalence of smoking scenes with the sort of extreme adult content that now triggers R ratings. Is this reasonable? In Australia, only high level violence, sustained coarse language, illicit drug use and explicit sex scenes generate R ratings. It is common to see and hear low level violence, sex and coarse language in movies rated suitable for children or children accompanied by adults. Such content can been seen on Australian television between 9pm and 5am. Each of these adult-rating triggers mirror either the illegality or total social unacceptability of (for example) public fornication or injecting drug use. By contrast, it is unfortunately a rare day that one does not see someone publicly smoking.

As I have argued elsewhere[3], when an actor smokes, that is not all they do which might explain their appeal to youth at risk for smoking. None of the many studies that purport to demonstrate a causal relationship between smoking in movies and subsequent smoking have ever tried to disentangle smoking from the imbroglio of all the other youth appealing things that smoking characters tend to do. The consistent associations that have been demonstrated between seeing smoking in movies and later smoking may be nothing more than an artifactual association between preference for certain genres of movies where smoking is more likely to occur and later smoking in those with such preferences. And given the consummate ease with which youth can access adult-rated content, what would be the point in restricting access only to cinema screenings by adult-rating such movies, even it was accepted that this would achieve anything?

It is no wonder that no government has yet introduced the proposal they call for.

References

1. Millett C, Hanewinkel R, Britton J, Florek E, Faggiano F, Ness A, McKee M, Polansky JR, Glantz SA. European governments should stop subsidizing films with tobacco imagery. Eur J Public Health first published online December 16, 2011 doi:10.1093/eurpub/ckr183

2. http://en.wikipedia.org/wiki/Censorship_in_North_Korea

3. Chapman S, Farrelly M. Four arguments against the adult-rating of movies with smoking scenes. PLoS Med 2011; e1001078. doi:10.1371/journal.pmed.1001078

Conflict of Interest:

None declared

Submitted on 28/12/2011 7:00 PM GMT
Does public health really want to embrace cultural censorship? Reply
9 January 2012
Christopher Millett (with Reiner Hanewinkel, John Britton, Ewa Florek, Fabrizio Faggiano, Andrew Ness, Martin McKee, Jonathan R. Polansky, and Stanton A. Glantz)

The value to the tobacco industry of mass-marketed films that depict smoking is evidenced by myriad industry documents showing that the tobacco industry has systematically, recurrently, and covertly exploited motion picture content to promote smoking and their brands, including through product placement (1,2). Public subsidies are intended to encourage private activities in the public interest. In contrast, subsidy of films proven to recruit large numbers of new young smokers worldwide subvert public health priorities. Finally, the proposed rating solutions do not restrict film producers any more than already existing film classifications standards, whether these are administered by public bodies or by the film industry itself: anyone anywhere would still be free to make wide-release films with smoking, accepting an adult-rating just they do now for other content. Taxpayers should not, however, be obliged to underwrite these films.

1. Lum KL, Polansky JR, Jackler RK, Glantz SA (2008) Signed, sealed and delivered: Big Tobacco in Hollywood, 1927-1951. Tobacco Control 17: 313-323.

2. Mekemson C, Glantz SA (2002) How the tobacco industry built its relationship with Hollywood. Tobacco Control 11:i81-i91

Conflict of Interest:

None declared

Submitted on 09/01/2012 7:00 PM GMT