Editorials

Smoking in teenagers and watching films showing smoking

Hollywood needs to stop promoting smoking worldwide

Papers p 1394

The tobacco industry recruits and retains smokers by associating its products with excitement, sex, wealth, rebellion, and independence. Films are a powerful way to make this connectionand, as a paper in this week's issue of Tobacco Control shows,¹ they succeed.

The tobacco industry has cultivated its relationship with Hollywood using everything from large payments to film studios to distributing free cigarettes to the people who make films. ^{2 3} And it has been a two way street. For example, in 1972 the president of a production company wrote to RJ Reynolds Tobacco reporting that all the characters in a suspense thriller his company was producing smoked, and added, "Movies are better than any commercial that has been run on television or any magazine, because the audience is totally unaware of any sponsor involvement."⁴ The public has viewed smoking in films with increasing alarm, particularly after it became known that the tobacco industry was making large surreptitious payments to get scenes with smoking in films, and the United States Congress held hearings in 1989. ^{2 3} As a result, the cigarette companies adopted a voluntary code that purportedly ended product placement in films.

Despite this voluntary code, the amount of smoking shown in American films increased dramatically from 1991 and now exceeds that present in 1960.⁵ More importantly, and in contrast to reality, smoking in films is usually associated with high profile, successful figures.⁶ The appearance of specific brands, with Philip Morris's Marlboro dominating, is high, and use of specific brands by actors on screen has increased dramatically.⁷ Smoking by high profile actors is associated with favourable attitudes towards smoking and actual smoking among teenagers. ^{8 9} Like its friends in the tobacco industry, Hollywood has dealt with expressions of concern by spouting rhetoric about "free expression"while shamelessly editing films to maximise revenuesand denying that smoking in films actually contributes to smoking.

The paper by Sargent et al in this issue (p 1394) provides powerful new evidence showing that the more smoking teenagers see in films the more likely they are to smoke.⁹ Using a survey of 9-15 year olds, they related whether these children had smoked a cigarette to the amount of smoking they watched in films. Most of the viewing was on videotape and digital videodiscs. Watching films with 51-150 incidents of tobacco use doubled the odds that the teenagers had tried tobacco, and watching films with more than 150 incidents tripled these odds, compared with teenagers who had watched films with 50 or fewer incidents. Moreover, many of these films were made years earlier, giving them a much longer shelf life than any other tobacco promotion. ^{7 1}

Teenagers in the United States are not the only victims. Films made in Hollywood offer a major marketing vehicle for the tobacco industry worldwide and a way to present smoking as a way to be "American"despite the fact that smoking has a socially negative value in America now. In addition, American movie stars have appeared in tobacco advertisements from Japan to Argentina.

Tobacco companies are long time liars and deniers, so we can hardly turn to them for candour.¹⁰ As late as 1994 their executives swore under oath that nicotine was not addictive, and they did not disclose fully their Hollywood connections to Congress in 1989. ^{2 3} As part of the settlement of litigation agreed with individual states in the US, they again agreed to stop using films to promote smokingbut it is hard to believe them. After all, no one is better than the tobacco industry at covering things up and hiding financial dealings.¹¹

What about Hollywood? Why does it continue to serve multinational corporations that have buried many of its most gifted members and that carry on killing three million people worldwide each year? It is time for the entertainment industry to accept responsibility for its actions and stop serving the interests of tobacco companies. To promote a discussion of these issues in Hollywood, I have been running an educational campaign called "Smoke Free Movies" which places advertisements in the entertainment trade press (http://SmokeFreeMovies.ucsf.edu). The campaign challenges Hollywood to take effective steps to make their films smoke free (see box). None of these measures will choke creativity or restrict content. Each will make American films much less complicit in the global tobacco epidemic.

Stanton A Glantz, professor of medicine. 

University of California, San Francisco, CA 94143

Footnotes

   This work was supported by the Robert Wood Johnson Foundation and Richard and Rhoda Goldman Fund.