The story of tobacco control in Canada is generally a positive one. Canadian smoking rates have been declining steadily for over four decades, beginning in 1964 when the United States Surgeon General, Luther Terry, released the first comprehensive report demonstrating that cig- arette smoking causes cancer as well as cardiovascular and res- piratory diseases. A number of health organizations (including the Canadian National Department of Health and Welfare) had previously issued statements about the dangers of smoking, but the 1964 Surgeon General’s Report had a significant impact on public attitudes and policy regarding tobacco use, and after its release, smoking rates across North America began to decline. Important policy measures followed, including tobacco tax programs, smoking prevention and cessation campaigns, restrictions on tobacco advertising and promotion, restrictions on public smoking and second-hand smoke, warning labels on cigarette packs, and school anti-smoking programs.

The cumulative effect of these initiatives was to contin- ue to reduce national smoking rates. Data from the Canadian Heart and Stroke Foundation show that while 50 percent of the population smoked in 1965 (when monitor- ing first began), by 1985 this figure was under 35 percent, and in 2005 the smoking rate among Canadians aged 15 and older was 19 percent. These are very positive trends, yet despite these decreases, there is strong evidence that rates will not continue to decline unless anti-smoking programs are maintained at least at current levels and a sustained effort is made to close existing promotional loopholes for the tobacco industry. One of the most critical of these is the high prevalence of smoking scenes in movies.

Currently, smoking is still the leading cause of preventable death in Canada, with over 45,000 Canadians succumbing to smoking-related diseases each year. In addition to the loss of life and the emotional burden on friends and families, this translates into billions of dollars in health care costs and lost productivity. According to a 2006 report issued by the Canadian Centre on Substance Abuse, tobacco use cost Canadian taxpay- ers an estimated $17 billion in 2002, while contributing only $5.3 billion in federal and provincial taxes. Of the $17 billion lost, over $4.4 billion went toward direct health care costs (i.e., physician fees, hospital stays, prescription drugs), with additional smoking attributable costs of $12.5 billion dollars resulting from lost productivity (including worker absenteeism and lost income due to premature death).

The optimistic notion that the bur- den of tobacco-related morbidity and mortality will eventually go away as smoking rates continue to decline is challenged by the fact that in 2005, almost one in five Canadian youth (aged 15-19) and one in four young adults (aged 20-24) smoked. Despite the overall downward trend in smoking among older adults, young people are continu- ing to take up smoking, providing the tobacco industry with new customers and contributing to the future ill health of Canadians, related health care costs and lost productivity. The uptake of smoking by youth is critical for the success of the tobacco industry ”” over time, adult smokers decrease in number because they either quit smoking or eventually die, and few nonsmokers start smoking in adulthood.

It is not surprising, therefore, that the tobacco industry has a long history of targeting youth. In a rigorous examination of internal tobacco industry documents made public through court proceedings, Richard Pollay and Anne Lavack found that starting in the 1970s, tobacco companies spent millions of dollars researching strategies for influencing the youth ”œstarter” market. This industry research led to the development of cigarette advertising campaigns that featured images of freedom, independ- ence, and self-reliance to appeal to youths’ emerging need for autonomy. The research also encouraged the pro- motion of cigarettes as a ”œbadge prod- uct” and a vehicle to gain acceptance with peers. A number of measures were undertaken to restrict tobacco advertis- ing aimed at youth, including the Tobacco Act of 1997 in Canada and the 1998 Master Settlement Agreement in the United States. Nevertheless, despite the efficacy of these policies evidence suggests that a major loophole still remains, in the highly visible depic- tions of smoking in Hollywood films.

Since the 1940s, the cigarette has had a prominent place in Hollywood films. Humphrey Bogart, Orson Welles, Lauren Bacall and Bette Davis are just a few of the actors who regularly lit up on screen, imbuing the cigarette with such meanings as toughness, glamour and sexiness. Despite the decrease in tobac- co use in North American society over the past 40 years, the cigarette has con- tinued to have a starring role in Hollywood movies. Tobacco industry documents reveal that throughout the 1980s, tobacco companies paid large sums of money to place their products in movies in order to promote specific brands as well as increase the social acceptability of tobacco use. This subtle form of advertising was especially appealing as tobacco companies faced legislated restrictions on advertising in the broadcast media.

Toward the end of the 1980s, the relationship between Hollywood and the tobacco industry came under scrutiny, and in an attempt to prevent the imple- mentation of legislation the tobacco industry applied a voluntary ban (the Cigarette Advertising and Promotion Code) on paid tobacco placements in film. Content analyses of tobacco use in movies conducted by researchers at the University of California at San Francisco’s Center for Tobacco Control Research and Education demonstrate that despite the voluntary ban, smoking rates in films actually increased through- out the 1990s, and by 2002 rates were at levels previously seen in the 1950s, when the occurrence of smoking in ”œreal life” was twice that of today. The contin- ued appearance of smoking in movies has led anti-tobacco activists to surmise that a rela- tionship between Big Tobacco and Hollywood remains ”” even though the tobacco industry might not pay for the placement of specific brands in movies.

A growing body of research supports the conclusion that exposure to tobacco use in movies encourages youth to smoke. Not only does the over- representation of smoking in films serve to normalize smoking in the eyes of young people, but tobacco use in movies is often linked with glamour, wealth, and other images that have a high level of appeal to youth and that serve to make smoking attrac- tive. A group led by James Sargent at Dartmouth Medical School has conduct- ed several large surveys that demonstrate that youth who have a favourite actor who smokes on-screen are more likely to smoke, and that youth with higher lev- els of exposure to movie smoking exhib- it increased levels of smoking experimentation after controlling for other risk factors. Contributing to this co-relational research are longitudinal studies that show a direct relationship between the prevalence of tobacco use in films and youth smoking uptake. The Dartmouth group has linked exposure to smoking in movies with youth smoking initiation, while additional research at the University of California at San Francisco demonstrates that having a favourite actor who smokes on-screen predicts subsequent smoking behaviour among female adolescents.

These studies are valuable, as they draw attention to the persistent inclusion of smoking in Hollywood movies, as well as the impacts of these images on youth smoking. Nevertheless, they beg the question of how movies exert this persuasive effect and how it might best be countered. Recent research conducted in Canada offers insight into how youth encounter and make sense of smoking in movies and into some of the policy options for overcoming these effects.

A research team led by Robert Sparks at the University of British Columbia recently concluded a three-year survey of 3,200 high school students that showed that Canadian youth have significant exposure to movies on DVD/video, tele- vision and in theatres (over 100 films per year on average in the BC survey), and that most notice when actors smoke. Canadian youth are watching essentially the same films as American youth watch, 71 percent of which contain smoking scenes. Despite this exposure, however, relatively few of the students in Sparks’s survey could accurately recall the name of a movie they saw in the previous year that had smoking in it and very few recalled seeing cigarettes explicitly pro- moted in a movie in the last year, which means that the smoking scenes are pass- ing ”œunder their radar.”

Equally importantly, a majority felt that smoking helps make movie characters believable and realistic, and one in four non-smokers and one in three youth who experimented with smoking had pretended to smoke like a character in a movie, which suggests a role-modeling effect. For non-smok- ers, ”œpretending to smoke” meant using a prop such as a pencil or rolled up piece of paper.

To further explore these results, Shannon Jette conducted focus groups with adolescent Canadian girls to exam- ine how these young women interpret smoking scenes in movies. Interviews with smokers revealed that watching smoking in movies generally made them crave a cigarette, whereas non-smokers indicated that they notice smoking in films but are not bothered by it, largely because they cannot smell it. Overall, the female participants tended to take an ”œaware but don’t care” attitude toward tobacco use in movies, but it appears that they also have the potential to be critical viewers of movie smoking. Some partici- pants drew on their knowledge of the negative health consequences of smok- ing to critique depictions of tobacco use as ”œunrealistic,” and several adolescents in both groups (smokers and non-smok- ers) were aware that tobacco placements in films served as a form of product promotion. At the same time, however, they typically discussed its promo- tional value only when specifically asked why a direc- tor might include smoking in a film. In contrast, the notion that tobacco use in films serves to make the movies more realistic and believable was repeatedly mentioned throughout the interviews and emerged spontaneously. Participants also flatly reject- ed the notion that they would ever be influenced to start smoking by depictions of tobacco use in Hollywood films. Smokers denied that their smoking initiation was impacted by smoking in movies, while non-smokers ridiculed anyone who would be ”œstupid” enough to be influenced to start smoking by see- ing a favourite actor smoke. These find- ings suggest that within youth culture, it is not ”œcool” to be influenced (or to appear to be influenced) by the media or ”œduped” by advertisers. Although the participants were able to differentiate between a promotional and an artistic rationale for including smoking in movies, and some drew on health knowl- edge to critique smoking scenes, it was not at all clear to what extent they would critically deconstruct smoking scenes when deeply engrossed in a movie under normal viewing circumstances.

A laboratory-based study by Sonya Dal Cin provides additional insight into these issues. Dal Cin set out to assess a dimension of people’s psychological responses to stories called ”œtransporta- tion.” When people are ”œtransported” by a story, their mental resources are engaged with the narrative, their focus on the ”œreal world” diminishes, and the potential to ignore prior knowledge and existing information (such as the nega- tive health effects of smoking) increases. The more people are ”œtransported” by a narrative or storyline, the more likely they are to endorse story-consistent beliefs. In the context of media smoking, youth who are highly engaged or engrossed in a film will tend to be more easily persuaded by positive, tobacco- related messages. Dal Cin manipulated exposure to on-screen smoking in a tele- vision show to test this hypothesis with university-aged females.

Among her key findings was that participants with high levels of trans- portation rated depictions of the star character smoking as more glamourous than those with low levels of transporta- tion. Importantly, this finding held for both smokers and non-smokers. Those with high levels of transportation also had greater intentions to smoke when viewing a video of the television show containing smoking (as opposed to those who watched the same show without the smoking). Again, this was the case for both smokers and non-smokers. In these situations, the effects of smok- ing portrayals may be outside the per- son’s awareness such that even media savvy viewers can be susceptible to glam- ourized images. This research points to ”œdisrupting” transportation as a possible strategy to diminish the impacts of posi- tive media portrayals of smoking on young Canadians, as well as the need to limit exposure of children and young people to these cues.

In response to the continued high incidence of smoking in films, Stanton Glantz, director of the University of California at San Francisco’s Center for Tobacco Control Research and Education, has made the following four policy recommendations, with the aim of limiting exposure and decreasing the impact of on-screen smoking on adoles- cent viewers: 1) any film that depicts smoking or tobacco use should be rated ”œR,” the only exceptions being when rep- resentations of smoking clearly illustrate the dangers and negative consequences of tobacco use or when they reflect the smoking of a real historical figure; 2) the closing credits of films should certify that no individual involved in the production of the film received payment of any kind (cash, free cigarettes, free publicity, etc.) in exchange for using or displaying tobacco; 3) anti-smoking ads (not pro- duced by a tobacco company) should run before any movies that depict tobacco use; and 4) tobacco brands should not be identified in movies (including tobacco brand images, such as billboards, in the backgrounds of movie scenes).

These recommendations are intend- ed to accommodate artistic license and to avoid artistic censorship by inte- grating tobacco control measures with the current film-rating system, and in this sense they are constructive and quite manageable. If implemented and properly enforced,ùsame time, however, it is clear that they are not in and of themselves sufficiently comprehensive to close the movie loophole entirely in Canada. The limitations of the rating system are well known. Youth are very capable of gaining access to R-rated films by downloading them off the Internet, renting them on DVD, and going to the theatre with a person over the age of 18.

Inserting disclosure information about tobacco contracts in the credits would discourage producers from using tobacco money or in-kind contributions to fund movies, and implicitly help to limit pro- smoking messages, but it is not a safe- guard against unfunded scenes that include smoking for artistic purposes. Inserting anti-smoking ads as counter- messages prior to movies with smoking scenes may increase awareness, vigi- lance, and critical viewing among some youth, but it would not necessarily have the desired effect on youth who fast-for- ward, tune-out or otherwise ignore the anti-smoking messages or who are desensitized to health warnings. Finally, disallowing the display of tobacco brands would break the persuasive effect of linking brands to desirable social con- ditions and personal attributes, but it would not necessarily eliminate glam- ourized depictions of smoking as an activity, nor would it apply retroactively to the existing inventory of portrayals of smoking in movies already in circula- tion. To enhance the effectiveness of the kinds of measures that Glantz has pro- posed, therefore, it would be advisable to undertake a social marketing program (using, for example, media literacy methods) to help sensitize viewers to the role of movies in promoting smoking, just as has been done with tobacco advertising. Such a program would help to shape the overall context of movie viewing and could be built into existing media literacy curricula in public schools and smoking prevention campaigns.

The Canadian research outlined here points to the potential efficacy of such an approach. A media literacy class project was pilot tested in Vancouver in conjunction with the research done by Sparks. Youth were shown a video that documents the history of the tobacco industry’s use of movies to target young people, and they were invited to take control of the media they watch by bringing clips of smoking scenes to class. When strung together in succession, the scenes create an overstated parody of the original. Evidence suggests that these steps help activate young people’s criti- cal thinking skills. The fact that young people do not wish to appear as if they have been ”œduped” by the media adds to the value of educating them about the tobacco industry’s history of targeting youth through Hollywood films. Although this can be done in a tradition- al teacher-student interaction, a more active approach is to help youth them- selves spread the message that they are being targeted by the tobacco industry through cigarette placements in movies. Reality Check is one example of a youth- activist group that speaks out against tobacco placement in films. The organization is based in New York, and it teaches young people how to educate their peers about the tobacco industry. In Canada also, there is a growing effort to involve young people in anti-tobacco advocacy, as seen by the for- mation of the Youth Action Committee (YAC) and Stu- dents Working Against Tobacco (SWAT). Stanton Glantz also supports youth advocacy and media literacy and promotes this approach through his Smoke- FreeMovies Web site. The tobacco industry has long recognized that young peo- ple are the experts in predicting youth behaviour, and it has invested heavily in researching young people’s activities, interests and opinions. It is therefore an interesting turn of events that the anti-tobacco community, too, has recognized that youth are an impor- tant group for helping to catch the industry and counter its promotional activities. Combining youth activism and media literacy campaigns with Stan- ton Glantz’s four measures would signif- icantly help to close the movie promotional loophole for cigarettes in Canada.

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