Signed, sealed and delivered: "big tobacco" in Hollywood, 1927-1951

The analgesic effect of nostalgia elicited by idiographic and nomothetic approaches on thermal stimulus

Nostalgia is shown to relieve an individual's perception of pain evoked by cold water, pressure, and thermal stimuli. However, there is no direct evidence to show the analgesic effects of different nostalgia-inducing methods on various stimulus intensities. We conducted two studies to examine the analgesic effect, at different pain intensities, after inducing nostalgia either idiographically or nomothetically. Study 1 (N = 118) induced nostalgia through an idiographic approach (i.e., event reflection task) and found that nostalgia relieved both high and low thermal pain. Study 2 (N = 66) induced nostalgia through a nomothetic approach (i.e., viewing nostalgic pictures) and found that nostalgia relieved low but not high thermal pain. The findings verify the analgesic effect of nostalgia on thermal pain and suggest the potential moderating role of the nostalgia induction approach and pain intensity. Practically, these findings have implications for using nostalgia as a nonpharmacological treatment for pain.

Tobacco imagery in entertainment media: evolution of tobacco-free movies and television programmes rules in India

INTRODUCTION

Tobacco imagery in films and television increased in India after it ended conventional tobacco advertising in 2004. The Ministry of Health and Family Welfare (MoHFW) introduced rules to eliminate this tobacco imagery in 2005 which took effect in amended form in 2012. This study presents the enablers and barriers in development and implementation of the regulations to curb tobacco imagery in films and television in India.

METHOD

We reviewed legislation, evolving regulations, parliamentary questions, judicial decisions, Bollywood trade publications and relevant news articles from 2003 to 2019 and interviewed key informants.

RESULTS

Based on the WHO reports and civil society demands, the MoHFW issued a complete ban on tobacco imagery in movies and television programmes in 2005. The Ministry of Information and Broadcasting (MoIB) joined the film industry in opposing the rules. A filmmaker challenged the rules in court, which ruled that they violated constitutional freedoms. On appeal by MoHFW, the Supreme Court allowed the rules to take effect. Continuing opposition by MoIB and the film industry weakened the rules and delayed implementation until 2012. As of 2020, rather than a ban, all films with tobacco imagery require strong editorial justification, 100 s of antitobacco messages produced by the MoHFW, and a static health warning at the bottom of screen during tobacco imagery display. In 2015, less than 48% of movies had tobacco imagery compared with 89% in 2005.

CONCLUSIONS

Although, not a ban, MoHFW, supported by local advocates and WHO, issued regulations that resulted in a substantial drop in on-screen tobacco imagery and increased exposure to antitobacco messages. India's experience informs WHO Framework Convention on Tobacco Control parties as they develop and implement policies to curb tobacco imagery in entertainment media.

An examination of portrayals of smoking in graphic novels/comic books: A picture is worth a thousand words

INTRODUCTION

Smoking continues to extract an unacceptably high toll in Ireland in terms of both mortality and morbidity. Therefore, attention needs to focus on examining pro-smoking influences on teenagers and young adults, as most smokers start smoking before the age of 21 years. Given that this critical period is one of identity formation and assertion of adulthood, it is useful to look at media representation of smoking. One form of increasingly pervasive media that may require further examination is that of the portrayal of smoking in graphic novels. The broad appeal of graphic novels has been well noted, particularly to those aged under 35 years.

METHODS

This research examined a random selection of ten graphic novels chosen from the main library in a provincial Irish City. The novels were examined on a panel-by-panel basis for images of smokers. Smokers were coded by gender.

RESULTS

Analysis identified a total of 526 panels depicting smoking. Substantial variation was noted in the number of smoking images between novels, varying from 0 to 267. A dramatic difference in the number of male to female smokers was observed, the ratio being approximately 17:1.

CONCLUSIONS

Graphic novels must be considered as a potentially significant source of portrayals of smoking to adolescent and young adult readers of this form of literature.

Movies promote tobacco use amongst adolescents: The need for policies to prevent this phenomenon

Tobacco use is the primary preventable cause of death and disability in the world. To combat the tobacco epidemic, most countries have signed and ratified the World Health Organzation's Framework Convention on Tobacco Control (WHO FCTC). Article 13 of this treaty requires implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship. Implementation guidelines for Article 13 recognize that the depiction of tobacco use in commercially-produced films promotes tobacco use amongst young people. In this article we review the relationship between the tobacco industry and the movie industry over the past 100 years; the cross sectional and longitudinal studies that demonstrate a causal relationship between exposure to movie smoking depictions and youth smoking initiation; and the policy interventions recommended by the WHO to limit youth exposure to tobacco in movies.

Effect of Viewing Smoking Scenes in Motion Pictures on Subsequent Smoking Desire in Audiences in South Korea

Background

In the modern era of heightened awareness of public health, smoking scenes in movies remain relatively free from public monitoring. The effect of smoking scenes in movies on the promotion of viewers’ smoking desire remains unknown.

Objective

The study aimed to explore whether exposure of adolescent smokers to images of smoking in fılms could stimulate smoking behavior.

Methods

Data were derived from a national Web-based sample survey of 748 Korean high-school students. Participants aged 16-18 years were randomly assigned to watch three short video clips with or without smoking scenes. After adjusting covariates using propensity score matching, paired sample t test and logistic regression analyses compared the difference in smoking desire before and after exposure of participants to smoking scenes.

Results

For male adolescents, cigarette craving was significantly higher in those who watched movies with smoking scenes than in the control group who did not view smoking scenes (t_307.96=2.066, P<.05). In the experimental group, too, cigarette cravings of adolescents after viewing smoking scenes were significantly higher than they were before watching smoking scenes (t_161.00=2.867, P<.01). After adjusting for covariates, more impulsive adolescents, particularly males, had significantly higher cigarette cravings: adjusted odds ratio (aOR) 3.40 (95% CI 1.40-8.23). However, those who actively sought health information had considerably lower cigarette cravings than those who did not engage in information-seeking: aOR 0.08 (95% CI 0.01-0.88).

Conclusions

Smoking scenes in motion pictures may increase male adolescent smoking desire. Establishing a standard that restricts the frequency of smoking scenes in films and assigning a smoking-related screening grade to films is warranted.

Here Comes Trouble: A Career as a Tobacco Control Activist

Dr Glantz is Professor of Medicine in the Division of Cardiology, the Truth Initiative Distinguished Professor of Tobacco Control, and Director of the Center for Tobacco Control Research and Education at the University of California, San Francisco School of Medicine. He obtained a BSc in aerospace engineering from the University of Cincinnati in 1969 and an MSc and PhD in applied mechanics from Stanford University. He is the author of 4 books, including The Cigarette Papers and Primer of Biostatistics He is also a member of the University of California, San Francisco Cardiovascular Research Institute and Institute for Health Policy Studies and Co-leader of the University of California, San Francisco Comprehensive Cancer Center Tobacco Program. He was elected to the Institute of Medicine in 2005.

Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review

The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.

Exposure of Secondary School Adolescents from Argentina and Mexico to Smoking Scenes in Movies: a Population-based Estimation

BACKGROUND

Smoking scenes in movies promote adolescent smoking onset; thus, the analysis of the number of images of smoking in movies really reaching adolescents has become a subject of increasing interest.

OBJECTIVE

The aim of this study was to estimate the level of exposure to images of smoking in movies watched by adolescents in Argentina and Mexico.

METHODS

First-year secondary school students from Argentina and Mexico were surveyed. One hundred highest-grossing films from each year of the period 2009-2013 (Argentina) and 2010-2014 (Mexico) were analyzed. Each participant was assigned a random sample of 50 of these movies and was asked if he/she had watched them. The total number of adolescents who had watched each movie in each country was estimated and was multiplied by the number of smoking scenes (occurrences) in each movie to obtain the number of gross smoking impressions seen by secondary school adolescents from each country.

RESULTS

Four-hundred and twenty-two movies were analyzed in Argentina and 433 in Mexico. Exposure to more than 500 million smoking impressions was estimated for adolescents in each country, averaging 128 and 121 minutes of smoking scenes seen by each Argentine and Mexican adolescent, respectively. Although 15, 16 and 18-rated movies had more smoking scenes in average, movies rated for younger teenagers were responsible for the highest number of smoking scenes watched by the students (67.3% in Argentina and 54.4% in Mexico) due to their larger audience.

CONCLUSION

At the population level, movies aimed at children are responsible for the highest tobacco burden seen by adolescents.

Biological, psychological and social processes that explain celebrities' influence on patients' health-related behaviors

Background

Celebrities can have substantial influence as medical advisors. However, their impact on public health is equivocal: depending on the advice’s validity and applicability, celebrity engagements can benefit or hinder efforts to educate patients on evidence-based practices and improve their health literacy. This meta-narrative analysis synthesizes multiple disciplinary insights explaining the influence celebrities have on people’s health-related behaviors.

Methods

Systematic searches of electronic databases BusinessSource Complete, Communication & Mass Media Complete, Humanities Abstracts, ProQuest Political Science, PsycINFO, PubMed, and Sociology Abstracts were conducted. Retrieved articles were used to inform a conceptual analysis of the possible processes accounting for the substantial influence celebrities may have as medical advisors.

Results

Fourteen mechanisms of celebrity influence were identified. According to the economics literature, celebrities distinguish endorsed items from competitors and can catalyze herd behavior. Marketing studies tell us that celebrities’ characteristics are transferred to endorsed products, and that the most successful celebrity advisors are those viewed as credible, a perception they can create with their success. Neuroscience research supports these explanations, finding that celebrity endorsements activate brain regions involved in making positive associations, building trust and encoding memories. The psychology literature tells us that celebrity advice conditions people to react positively toward it. People are also inclined to follow celebrities if the advice matches their self-conceptions or if not following it would generate cognitive dissonance. Sociology explains how celebrities’ advice spreads through social networks, how their influence is a manifestation of people’s desire to acquire celebrities’ social capital, and how they affect the ways people acquire and interpret health information.

Conclusion

There are clear and deeply rooted biological, psychological and social processes that explain how celebrities influence people’s health behaviors. With a better understanding of this phenomenon, medical professionals can work to ensure that it is harnessed for good rather than abused for harm. Physicians can discuss with their patients the validity of celebrity advice and share more credible sources of health information. Public health practitioners can debunk celebrities offering unsubstantiated advice or receiving inappropriate financial compensation, and should collaborate with well-meaning celebrities, leveraging their influence to disseminate medical practices of demonstrated benefit.

Electronic supplementary material

The online version of this article (doi:10.1186/2049-3258-73-3) contains supplementary material, which is available to authorized users.

Profile of e-cigarette use and its relationship with cigarette quit attempts and abstinence in Kansas adults

OBJECTIVE

The aim of this study is to describe electronic cigarette use in Kansas adults and its relationship with cigarette cessation.

METHODS

The Kansas Adult Tobacco Survey (ATS) is a 2012-2013 phone survey of non-institutionalized Kansas adults (N=9656). The ATS was analyzed to create a profile of cigarette and e-cigarette users, and demonstrate associations between e-cigarette use and cigarette cessation attempts and cigarette abstinence.

RESULTS

In 2013, 45% of adult cigarette smokers had tried e-cigarettes and 14% had used e-cigarettes in the past month. The prevalence of current cigarette smoking was 76.5% among past-month e-cigarette users. Adults who only use e-cigarettes are younger and more affluent than adults who only smoke cigarettes. The prevalence of past-month e-cigarette use among smokers who made a quit attempt in the past year is more than double that of smokers who did not. E-cigarette use was negatively associated with past-month (aPOR=0.21, 95% CI: 0.11-0.38) and past-year cigarette abstinence (aPOR=0.14, 95% CI: 0.10-0.22).

CONCLUSIONS

E-cigarette use is common among cigarette smokers. E-cigarette use is more common among smokers who made a recent quit attempt and many smokers report using smokeless tobacco or e-cigarettes to help quit. Recent cigarette abstinence, however, is negatively associated with e-cigarette use.

Out smoking on the big screen: tobacco use in LGBT movies, 2000-2011

OBJECTIVE

Lesbian, gay, bisexual and transgender (LGBT) people have significantly higher smoking prevalence than heterosexual people in the U.S.A. The reasons for this disparity remain unclear. Tobacco use in movies has a substantial influence on tobacco use behaviours, particularly among youth. Yet, no research has examined tobacco use in movies for LGBT audiences or containing LGBT characters.

METHODS

We identified 81 U.S. movies from 2000 to 2011 with a theatre release and with LGBT themes or characters. We then selected a random sample of these movies (n=45) for quantitative content analysis to examine the proportion of movies with depictions of tobacco use and the number of occurrences of tobacco use.

RESULTS

Tobacco use was depicted in 87% (95% CI 80% to 94%) of movies with an average of four occurrences of tobacco use per hour (95% CI 3 to 5). Only 15% (95% CI 8% to 23%) of movies and 3% of all depictions of tobacco use conveyed any harms of tobacco use.

CONCLUSIONS

Viewers of movies with LGBT themes or characters are exposed, on average, to one depiction of tobacco use for every 15 min of movie run-time. As a major component of the entertainment media environment, movies may contribute to smoking among LGBT people.

Tobacco control efforts in Europe

Smoking is prevalent across Europe, but the severity and stage of the smoking epidemic, and policy responses to it, vary substantially between countries. Much progress is now being made in prohibition of paid-for advertising and in promotion of smoke-free policies, but mass media campaigns are widely underused, provision of services for smokers trying to quit is generally poor, and price policies are undermined by licit and illicit cheap supplies. Monitoring of prevalence is inadequate in many countries, as is investment in research and capacity to address this largest avoidable cause of death and disability across Europe. However, grounds for optimism are provided by progress in implementation of the WHO Framework Convention on Tobacco Control, and in the development of a new generation of nicotine-containing devices that could enable more widespread adoption of harm-reduction strategies. The effect of commercial vested interests has been and remains a major barrier to progress.

Protection from secondhand smoke in countries belonging to the WHO European Region: an assessment of legislation

OBJECTIVES

Comprehensive smokefree laws, as recommended by the WHO Framework Convention of Tobacco Control (WHO FCTC), are the most effective tool to protect the population from secondhand smoke (SHS) and to ensure healthy environments. Studies evaluating how laws govern SHS protection are scarce. This study assessed the level of protection from SHS of laws from countries belonging to the WHO European Region.

METHODS

A new methodology system was developed to evaluate the smokefree legislation according to the principles provided by the WHO guidelines for the correct implementation of Article 8 of the FCTC. For each law, six main sectors and 28 facilities were evaluated.

RESULTS

Overall 68 laws from 48 countries from the WHO European Region were reviewed. 'Education' and 'Public transport' were the most protected sectors from SHS. Many WHO European laws do not provide protection from SHS across all public sectors. For example, 48.5% of general health facilities and 71.2% of restaurants are unprotected from SHS. The level of protection provided in the 28 facilities studied was low; many WHO European laws still allow smoking under certain conditions, permitting smoking in designated and/or ventilated areas.

CONCLUSIONS

Nine years after the adoption of the WHO FCTC there are still legal formulas in which smoking is allowed in several facilities, through the inclusion of separated areas, ventilated areas and other conditions. Tobacco control efforts still face the challenge of eradicating the legal clauses that prevent 100% smokefree environments.

Tobacco industry argues domestic trademark laws and international treaties preclude cigarette health warning labels, despite consistent legal advice that the argument is invalid

OBJECTIVES

To analyse the tobacco industry's use of international trade agreements to oppose policies to strengthen health warning labels (HWLs).

DESIGN

A review of tobacco industry documents, tobacco control legislation and international treaties.

RESULTS

During the early 1990s, the tobacco industry became increasingly alarmed about the advancement of HWLs on cigarettes packages. In response, it requested legal opinions from British American Tobacco's law firms in Australia and England, Britain's Department of Trade and Industry and the World Intellectual Property Organisation on the legality of restricting and prohibiting the use of their trademarks, as embodied in cigarette packages. The consistent legal advice, privately submitted to the companies, was that international treaties do not shield trademark owners from government limitations (including prohibition) on the use of their trademarks. Despite receiving this legal advice, the companies publicly argued that requiring large HWLs compromised their trademark rights under international treaties. The companies successfully used these arguments as part of their successful effort to deter Canadian and Australian governments from enacting laws requiring the plan packaging of cigarettes, which helped delay large graphic HWLs, including 'plain' packaging, for over a decade.

CONCLUSIONS

Governments should not be intimidated by tobacco company threats and unsubstantiated claims, and carefully craft HWL laws to withstand the inevitable tobacco industry lawsuits with the knowledge that the companies' own lawyers as well as authoritative bodies have told the companies that the rights they claim do not exist.

'A real man smells of tobacco smoke'--Chinese youth's interpretation of smoking imagery in film

Previous studies have associated youth's exposure to filmic images of smoking with real-life smoking acquisition; initial research in low- and middle-income countries confirms this relationship. The present study in Yunnan, southwest China sought answers to the following questions: How do young people in China make sense of smoking imagery they have seen in film? How are these perceptions shaped by the cultural and social context of images? How do these understandings relate to real-life tobacco use? A study with focus groups and grounded theory was conducted in 2010 and 2011 (Sept-Jan) with middle-school students ages 12 and 13 (n=68, focus groups=12, schools=6). Films and media literacy were important means through which knowledge about smoking was constructed and communicated. Film representations of smoking concurred with Chinese social behaviour (Confucian social networks, face-making, and the notion of society as a harmonious social unit), and were interpreted as congruent with real-life smoking. This pattern, in turn, was intertwined with perceived gender identities of smokers, gender-specific social behaviour, and willingness of girls to explore issues of gender equity. These findings lend new insights into interaction between smoking imagery in film and Chinese youth's smoking beliefs. Tobacco control programs in China should consider young people's interpretations of smoking and the ways they are nested in cultural and social milieu.

Global teens and tobacco: a review of the globalization of the tobacco epidemic

Worldwide, the burden of suffering to children caused by tobacco does not just originate from exposure to tobacco smoke or smoking, but includes exposure to tobacco-friendly media, poverty associated with money spent on tobacco, increased incidence of tobacco-related fires, and the harms related to child labor in tobacco cultivation. Despite global efforts through human rights acts, the Framework Convention on Tobacco Control, and the MPOWER report, tobacco use continues to accelerate in most countries. While the efforts that have been taken, such as smoking bans in public, are worthy actions, not enough is being done to protect children and teens. More can be done at the policy level, by individuals, and by health care providers.

Four arguments against the adult-rating of movies with smoking scenes

Simon Chapman and Matthew Farrelly argue against recent calls in the US and elsewhere for movies with smoking scenes to be adult-rated.

A framework for developing an evidence-based, comprehensive tobacco control program

Background

Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualization, assessment of population impact, and the changing nature of the threat.

Methods

In the context of Israel's health targeting initiative, Healthy Israel 2020, we describe the steps taken to develop a comprehensive tobacco control strategy. We elaborate on the following: a) scientific issues influencing the choice of tobacco control strategies; b) organization of existing evidence of effectiveness of interventions into a manageable form, and c) consideration of relevant philosophical and political issues. We propose a framework for developing a plan and illustrate this process with a case study in Israel.

Results

Broad consensus exists regarding the effectiveness of most interventions, but current recommendations differ in the emphasis they place on different strategies. Scientific challenges include integration of complex and sometimes conflicting information from authoritative sources, and lack of estimates of population impact of interventions. Philosophical and political challenges include the use of evidence-based versus innovative policymaking, the importance of individual versus governmental responsibility, and whether and how interventions should be prioritized.

The proposed framework includes: 1) compilation of a list of potential interventions 2) modification of that list based on local needs and political constraints; 3) streamlining the list by categorizing interventions into broad groupings of related interventions; together these groupings form the basis of a comprehensive plan; and 4) refinement of the plan by comparing it to existing comprehensive plans.

Conclusions

Development of a comprehensive tobacco control plan is a complex endeavour, involving crucial decisions regarding intervention components. "Off the shelf" plans, which need to be adapted to local settings, are available from a variety of sources, and a multitude of individual recommendations are available. The proposed framework for adapting existing approaches to the local social and political climate may assist others planning for smoke-free societies. Additionally, this experience has implications for development of evidence-based health plans addressing other risk factors.

[The impact of smoking in movies on children and adolescents. A systematic review]

In accordance with the conclusion of the US National Cancer Institute to consider smoking in films, in addition to other factors, as one risk factor for the initiation of smoking among children and adolescents, the World Health Organization has invited its member states to implement rules for limiting smoking depictions in films. Results of methodically high-value longitudinal and experimental studies which provide empirical evidence for the association between smoking depictions in films and smoking among children and adolescents are presented. Interpretation of this association as causal according to Hill criteria is discussed. In this systematic review, future personal and structural preventive interventions to address this problem in Germany are presented and discussed. Of special importance is the enhancement of both parental competence in media education as well as media literacy in children and adolescents. Rating films depicting smoking as approved for adults only could yield the largest effect, since it leads to an enduring reduction of exposure.