Smoking in films remains a "major and persistent driver" of smoking uptake among kids and young people, which all the responsible parties -- film makers, regulators, and politicians -- are "abjectly failing to control," write leading tobacco control experts in a Thorax editorial.
Dr Ailsa Lyons and Professor John Britton of the UK Centre for Tobacco Control Studies detail their futile efforts to persuade the national regulator, the British Board of Film Classification (BBFC), and the government's Department for Culture Media and Sport (DCMS) to reclassify films depicting smoking into the same restrictive category applied to those depicting sex and violence.
In response to the allegation that current practice in film classification is failing to protect children from "this potential harmful imagery," the BBFC told the authors that their guidelines were "proportionate; take due account of the available evidence of harm; and reflect the clear wishes of the public."
A senior BBFC policy advisor subsequently told them that "any change in current practice would be likely to provoke powerful opposition from the film industry, and was therefore unlikely to occur in the absence of public complaint or a directive from the DCMS."
"Protecting children from an exposure that is so potentially damaging is, however, a national governmental responsibility and the solution to the problem is simple: for the UK and indeed other film classification agencies to apply a default 18 classification on all films containing smoking," contend the authors.
They conclude: "Smoking in films remains a major and persistent driver of smoking uptake among children and young people, which the actions of the irresponsible film makers, incompetent regulators, and insouciant politicians are abjectly failing to control."
Evidence in support of their argument comes from several studies published in the current issue of Thorax, one of which shows that teenagers in the UK and elsewhere, who are exposed to smoking imagery in films, are significantly more likely to start (and continue) smoking themselves.
The Bristol University researchers used information on smoking behaviour collected from more than 5000 15 year olds, who were part of the Avon Longitudinal Study of Parents and Children (ALSPAC).
The teens were asked whether they had seen 50 films, randomly selected from among 366 box office hits released between 2001 and 2005, and whether they had ever tried a cigarette and/or were current smokers.
Each of the 50 films had been analysed for the total number of smoking depictions it contained, with the average reaching 68, but ranging from 38 to more than 109. The teens had seen an average of 17 of the 50 films.
Their responses showed that the more films they saw containing depictions of smoking, the more likely they were to have tried smoking themselves.
Teens exposed to movie content with the most depictions of smoking were 59% more likely to have started smoking than those exposed to the least, after taking account of other influential social and family factors.
And even after taking account of alcohol use and smoking among their peers, both of which are known to influence initiation of smoking, these teenagers were still 32% more likely to start smoking themselves.
A combined analysis of this study and similar published research from several countries shows that teens exposed to high levels of smoking depictions in films are more than twice as likely to start smoking as their peers exposed to low levels, the authors found.
"Even after controlling for social, family, and behavioural factors and mediating variables, increased exposure to smoking depictions in films increases the risk of smoking initiation in adolescence," they write.
They point out that UK teens are exposed to considerably more smoking depictions in films than their US peers, because 79% of films rated as "adult" in the US are rated as suitable for young people in the UK.
"Films ought to be rated by exposure to smoking in the same way that they are currently rated by level of violence: smoking and its adverse consequences are certainly a larger public health problem," they say.