Discussion

Exposure to tobacco smoking and other forms of tobacco imagery in film is a potent driver of youth and adult smoking,8–10 with major consequences for the subsequent health of the smoker such as lung cancer, COPD and pneumonia.2 The serious potential hazard represented by tobacco exposure should also be a determinant of film classification, to prevent unnecessary or inappropriate exposure of children and young people to smoking role models. The BBFC guidelines on classification in relation to smoking state only that where ‘[smoking and tobacco use] feature to a significant extent in works which appeal to children, this will normally be indicated in the Consumer Advice and/or Extended Classification Information.’ (p. 12).33 Tobacco imagery appears not to have any considerable bearing on the BBFC age classification that a film receives. This study shows that appearances of all types of tobacco intervals in films viewed in the UK has declined substantially over the past 20 years, but that appearances remain common in most of the commercially successful films, and persist to some extent in films in all BBFC categories. It also shows that about two-thirds of films including tobacco intervals are currently classified by the BBFC as suitable for viewing by people aged <18, and over half (61%) by people aged <15. Over the past 5 years (2004–8) the proportion of films containing tobacco deemed suitable for those aged under 18 to watch has increased to 97%.

We found that smoking imagery is also more likely to occur in films that originate wholly or partly in the UK. The specific, repeated occurrence of some brands of cigarette in some films raises the possibility that product placement by tobacco companies is still occurring.

Our study was limited, for logistic reasons, to the top 15 most popular films each year, but, as these typically represent ∼50% or more of total UK annual box office takings, they are likely to reflect the predominant pattern of tobacco exposure in films seen in UK cinemas each year. Coding the occurrence of any behaviour in films is difficult and there is no standardised method; we used an approach that has been widely used in film analysis,19 21 23 27 is reliable,19 23 27 and has been validated as a measure to detect relative changes in levels of behaviour.34 The 5 min interval method we used was the same as used by several other researchers,19 23 27 35 though other approaches, such as coding scene changes as separate incidents with a 5 min interval approach,21 or using 1 min intervals18 or separate scenes to define intervals20 26 or methods of continuous measurement,22 24 25 have been described. Like Everett et al23 we divided the number of 5 min intervals by the length of the film to take into consideration the differences in film lengths. The different approaches have relative strengths and weaknesses, but the main impact of their differences will be in the quantification of occurrence frequency. The presence of tobacco intervals, and their relative frequency, is measured by all approaches.

Our finding that tobacco use, imagery and brand appearances are commonplace in films reflects the findings of several previous studies.18–24 26 35 36 However, ours is the first study to look at trends over time in appearances, including a wide range of tobacco paraphernalia and inference, and specific brand appearances, in the films most popular with UK audiences. Glantz et al35 limited their definition of ‘tobacco usage’ to include only smoking or the appearance of ashtrays or advertisements, and Omidvari et al22 only actual smoking. Escamilla et al27 included other paraphernalia (eg, cigarettes), merchandise and advertising in their investigations. Brand appearances24 25 have previously been defined similarly to the definition employed here. Our finding that 70% of the films viewed contained at least one tobacco interval or brand appearance is consistent with, though slightly lower than, estimates from other studies, most of which explored earlier time periods18–21 in which our data show occurrence to have been higher. The difference in results is likely to be explained by the differing time periods investigated.

There is little consensus in previous studies as to whether tobacco and related imagery in film has increased,21 stayed the same19 or decreased over time.18 Our study confirms a fall in the frequency of tobacco intervals in the most popular films viewed in the UK, and that exposure to tobacco use (but not to other imagery) in U-rated films has ceased since 2000. This is both important and encouraging from the point of view of public health, and in large part possibly reflects the impact of the 1998 Master Settlement Agreement37 in the USA in 1998, in which the tobacco industry agreed to curtail or cease certain marketing practices in the USA, and after which appearances of tobacco intervals in a study of US films fell by about half.24 However, this and the reported decline in brand appearances over a similar period25 may have affected predominantly adult-restricted films (BBFC 18).24 Others36 suggest this may be the result of several factors working together (including a reduction overall in film production, and a producer–distributor shift away from adult-rated films). Although the number of brand appearances in our study was small, our other findings suggest that the decline in appearances in general has affected all films; brand appearances still persist in films rated suitable for viewing by children and young people. Titus et al36 also found brand appearances persisting in films, and suggest that they may actually be increasing.

Previous research from the USA on individual brand appearances has identified Marlboro to be the most common brand,24 25 36 as in the present study, and this perhaps reflects the fact that Marlboro is the market leader in the USA, accounting for 42.4% of sales.38 However Silk Cut holds only 5.2% of the UK market39 and does not have a market share in the USA, so whilst it is not surprising that the brand did not feature in any American film, the strong brand prominence of Silk Cut in two UK films appears disproportionate. Whilst it can be argued that use of Silk Cut was accurate brand translation from book to film in Bridget Jones's Diary, that argument does not justify the brand prominence in About a Boy.

BBFC classification guidelines do not directly refer to tobacco use under the suitability criteria for certifying ratings of films submitted, but do state in U and PG category guidance that films receiving these certifications will show ‘No potentially dangerous behaviour which young children are likely to copy’ (p. 21).33 No reference to tobacco use, smoking or imitable behaviour is mentioned in either of the other youth-rated age categories (BBFC 12/12A or 15). Given that the BBFC refers specifically to use of drugs, violence, bad language and sex in official guidelines (including strict limitations in youth-rated films), it is surprising, given the extent of the harm caused by smoking and other tobacco use, that these guidelines do not include tobacco.

Most adult smokers first become addicted in their teens3 and predominantly do so for psychosocial reasons40 such as perceiving it as a sought-after adult behaviour, or as being rebellious. Direct advertising promotes smoking initiation by young people,41 and predicts established smoking in young adulthood.42 Furthermore, research has linked the presence of tobacco on screen to smoking initiation among young people,8 9 43 44 increased positive attitudes towards smoking45 and the reinforcement of normative perceptions regarding smoking. On these grounds, some have called for films containing tobacco imagery to be automatically rated for adult viewing only,36 46–48 or for antitobacco adverts to be screened before films containing tobacco and for brand identification to be prohibited.49 It has been argued that depiction of smoking in films should continue in the interests of factual accuracy and freedom of expression,48 yet tobacco depicted in films is rarely factually accurate.12 However, these considerations are not mutually exclusive from the need to protect children and young people from imagery, which can easily be achieved by more rational application of BBFC classification, such as ensuring that smoking and other tobacco use be excluded from all youth-rated films (BBFC U, PG, 12/12A, and 15), except where an actual historical figure is being represented or where the harms associated with smoking are being shown.12 Specific brand exposure can also be avoided by the use of fictional brands, as in the case of ‘Red Apple’.

Thus, although smoking imagery and branding images in the most popular films have become substantially less common over the past 20 years, it is apparent that children and young people watching films in the UK are still exposed to frequent and at times specifically branded tobacco imagery, particularly in films originating from the UK. More consistent application of BBFC guidance by the BBFC could dramatically reduce this exposure, and hence protect children and young people from damaging imagery and encourage film makers to avoid tobacco imagery in films intended for younger audiences, without compromising artistic freedoms or factual accuracy.