August 27, 2011

Stanton A. Glantz, PhD

SMOKING IN MOVIES: ARGUMENTS VS. EVIDENCE

Simon Chapman and Matthew Farrelly published an essay in PLoS Medicine that appeared in the same issue as our paper repeating Simon’s well-worn arguments.  Their essay is here.

Here is our comment on their arguments:

SMOKING IN MOVIES: ARGUMENTS VS. EVIDENCE

Chapman and Farrelly’s essay [1], “Four Arguments Against the Adult-Rating of Movies with Smoking Scenes,” reflects the same fundamental misunderstanding of the logic and implications of modernizing the ratings system that Chapman made in a similar essay in 2008 [2].

Chapman and Farrelly’s critique of the scientific evidence (their first argument) is particularly disappointing. The concern that high-risk youth may self-select for films that happen to include smoking has been at the top of the list in virtually every epidemiological study done to date on the linkage between onscreen smoking and smoking behavior. It is a key question that every authoritative body has carefully considered when examining the evidence linking onscreen smoking with youth behavior. (See, for example, Table 10.3 of the National Cancer Institute’s [3] analysis that led it to conclude a causal link between onscreen smoking and smoking behavior). Simply listing theoretical possibilities without providing a convincing quantitative analysis that these theoretical possibilities proves nothing particularly in the face of large body of experimental work that illuminates the mechanism of the links the epidemiology documents (which they completely ignore).

A key element of the scientific consensus -- that includes the National Cancer Institute, World Health Organization, US Centers for Disease Control and Prevention, and a wide range of health professional organizations – that smoking in movies causes youth smoking is the consistent finding of a dose-response relationship.

As with any public health problem in which there is a dose-response, a sensible solution is to lower the dose. An adult content rating for onscreen smoking and tobacco use will do just that, not mainly by keeping children from seeing the movies (as Chapman and Farrelly assert in their second and third arguments), but by creating an economic incentive for producers to leave smoking out of films with smoking that they want to market to youth. Eliminating tobacco from youth-rated films would cut the dose – and the effect – of onscreen smoking by about half. Experience in the United States shows that some major studio-distributors find it eminently feasible to reduce tobacco incidents in youth-rated films by 90% or more [4], although whether recent progress in just a part of the film industry can persist without an adult-rating in place for all of the film industry is in doubt.

Chapman and Farrelly assert that an adult content rating would amount to “censorship” (their fourth argument). The rating proposal does not prohibit including smoking in films. Quite the contrary, producers would remain free to include smoking in their films; they would simply do so knowing that this decision would trigger an adult content rating. Such decisions are made routinely in the motion picture industry when calibrating the language, sexual content and level of violence for every film.

Criticism is the key to scientific and public health progress. For this criticism to be productive, however, the critics need to address the actual policy proposals being advanced. When Chapman and Farrelly argue, “The reductio ad absurdum of arguments to prevent children ever seeing smoking in movies would be to stop children seeing smoking anywhere,” they are simply knocking down their own straw man.

As noted above, the justification for the adult content rating is not to “stop children from seeing smoking anywhere,” but simply to substantially reduce the dose of exposure delivered to them in powerful entertainment products designed to be sold to children and that have a proven, substantial effect on children becoming smokers.

Finally, Chapman and Farrelly ignore the implications of the fact that governments are now spending billions of dollars subsidizing films that promote smoking [5] or the Centers for Disease Control and Prevention’s recommendation that this practice be ended [4]. Is silence agreement? Should governments be spending millions on smoking prevention and, at the same time, millions on smoking promotion?

Christopher Millett
Department of Primary Care and Public Health, Imperial College London, London, United Kingdom and South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India

Jonathan R. Polansky
Onbeyond LLC, Fairfax, California, United States of America

Stanton A. Glantz
Division of Cardiology, University of California, San Francisco, California, United States of America, 5 Center for Tobacco Control Research and Education, University of California, San Francisco, California, United States of America

References

1. Chapman S, Farrelly M (2011) Four arguments against the adult-rating of movies with smoking scenes. PLoS Medicine 8: e1001078. doi:1001010.1001371/journal.pmed.1001078.
2. Chapman S (2008) What should be done about smoking in movies? Tob Control 17: 363-367.
3. National Cancer Institute (2008) Tobacco Control Monograph 19: The Role of the Media in Promoting and Reducing Tobacco Use. Bethesda, MD: US National Cancer Institute.
4. Centers for Disease Control and Prevention (2011) Smoking in top-grossing movies --- United States, 2010. MMWR Morb Mortal Wkly Rep 60: 910-913.
5. Millett C, Polansky J, Glantz S (2011) Government inaction on ratings and government subsidies to the US film industry help promote youth smoking. PLoS Medicine 8: e1001077. doi:1001010.1001317/journal.pmed.1001077.

This is available here, as is their response.

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