Accomplished Hollywood actor Keanu Reeves, in Constantine

Studies have established that portrayal of tobacco use in films is one of the biggest influencer for young people to begin tobacco use. Since The Cigarette and other Tobacco Products Act (2003) came into increasing effect, not only tobacco use in films have been on the rise, but also tobacco brand placement. Time is high before we realize the untold story: The link between rising tobacco use in youth and films.

For the past few years, the Smokefree Movies Action Network (SFMAN) has promoted an International Day of Action for Smokefree Movies before Hollywood's star-studded Academy Awards. This year, SFMAN is promoting an International Week of Action (IWA, February 17-25) to allow the greatest number of groups around the world to participate. The theme of SFMAN is: "STOP TOXIC MOVIES: ... it's the most deadly commercial threat to the largest generation in history."

For every person who watches the average Hollywood movie in a U.S. theater, at least two people watch that movie in other parts of the world. If smoking in U.S. movies is having an effect on youth in other nations comparable to its documented impact on adolescents in the U.S. (helping to recruit more than 50% of new youth smokers), Hollywood films will help recruit hundreds of millions of smokers in this generation and will be responsible for tens of millions of future deaths. The worldwide death toll from tobacco, now five million a year, is projected to double to ten million a year by 2030 and to keep rising.

The number of people 18 and younger in the world today - 2.4 billion - is the largest generation in history. Unless trends change, experts project a total of 450 million tobacco deaths worldwide by 2050.

One of the easiest ways to significantly bring down number of children and youth who get initiated to tobacco use in India, without any budgetary allocation for this public health exercise, is to remove depiction of tobacco use in films and TV, rightly said our Union Minister for Health and Family Welfare, Government of India, Dr Anbumani Ramadoss last year while accepting a reputed award (Luther Terry award 2006) in Washington DC, USA.

One of the major influences on the uptake of teen tobacco use is the glamourisation of tobacco use in movies and on television. This has been well documented by comprehensive research studies in India and US.

Dartmouth Medical School, National Cancer Institute USA and American Legacy Foundation report, titled "First Look Report, Trends in Top Box Office Movie Tobacco use - 1996-2004," was released in Washington DC during 13th World Conference on Tobacco or Health by Union Health Minister of India Dr Anbumani Ramadoss. This report has an exhaustive content analysis of top 100 box office movie hits each year for nine years duration (1996-2004). This report confirms that smoking continues to be depicted in nearly three-quarters of movies. Two studies conducted earlier by the Dartmouth Medical School found that one-third to one-half of youth smoking initiation is explained by exposure to smoking in movies.

Similar study done by World Health Organization and Indian Ministry of Health and Family Welfare in 2003 revealed that 76% of Indian movies had tobacco use shown in them. In 1991, where 22% of top box office movie hits had lead characters using tobacco on-screen, in 2002, this escalated to 53% tobacco use depiction by lead characters in Indian movies. This study also demonstrated that 52.2% of children in India who had their first smoke were influenced by tobacco use depicted in movies.

A repeat follow-up study conducted by WHO and Ministry of Health and Family Welfare in India on top box office movie hits during 2004-2005 demonstrated that tobacco use depiction in movies has become more aggressive as compared to previous years. During 2004-2005, 89% of all movies analyzed contained tobacco use on screen and 75.5% movies depicted leading stars using tobacco on screen. Moreover 41% of movies screened had clear and distinct tobacco brand placement. Not surprising, that 33.7% of youth respondents could recall brand use in films too.

Dr Anbumani Ramadoss says categorically that stopping depiction of tobacco use in films is an evidence based public health measure. India has the world's largest film industry rolling out over 900 films per year. Through cinema theatres, these movies reach 60 million people and through cable television network, they further reach another 70 million people in India.

"Curbing exposure to children and adolescents to tobacco in films/TV is the single most effective public health intervention for any society in the world" remarks Dr Ramadoss.
Dr Stanton Glantz, Professor of Medicine, Centre for Tobacco Control Research and Education at the University of California, San Francisco, also runs a Smoke-free Movies project since past five years now. He says "The only exception when tobacco use should be depicted in films is when the presentation of tobacco clearly and unambiguously reflects the dangers and consequences of tobacco use or when it is necessary to represent accurately a historic figure."

Dr Ramadoss said "film and tobacco industry are hands-in-glove involved" and suggested big pay-offs too. Dr Ramadoss' proposal to ban tobacco use in movies and TV was vehemently opposed by film industry. Now they are considering rating movies and TV serials depicting tobacco use as "A."

Dr Ramadoss said that 46.5% men and 13.8% women use tobacco in India. Apart from over 1 million tobacco related deaths in India, 40% of health related problems in India are due to tobacco consumption and 50% of cancer deaths, majority of cardio-vascular and lung disorders are due to tobacco too. This is a huge avoidable burden of disease, disability and death and India needs to prevent these needless deaths and ought to do everything possible to bring down tobacco-related-mortality said Dr Ramadoss.

Dr Ramadoss further explained that total economic cost of treating 3 major diseases due to tobacco use in India was Rs 30,833 crores in 2002-2003. In 2004-2005, total tobacco industry in India per year was worth US$ 8 billion and yearly revenue loss due to tobacco related diseases in India was US$ 8.5 billion, remarked Dr Ramadoss. He said that there is no doubt now that tobacco control is also one of the most neglected areas impeding health and development in India.