Protecting young people from smoking imagery in films: whose responsibility?

Every day thousands of children try a cigarette for the first time, a seemingly innocuous step that for many leads to a lifelong and ultimately fatal addiction to smoking. Preventing this early experimentation is crucially important to preventing the huge toll of death and disability—particularly from respiratory diseases—that smoking causes. There is now increasing international evidence that exposure to smoking behaviour and other imagery in films is a major cause of smoking experimentation and uptake among children and young people.1–3 Three new studies in this issue of Thorax provide further evidence on this effect, this time in UK populations. In a study of 15-year-old adolescents in the Avon birth cohort, Waylen et al 4 demonstrate a direct relation between exposure to smoking in films and experimentation with smoking which remains significant even after exhaustive adjustment for potential confounders. Among Scottish adolescents exposed to smoking in films, Hunt et al 5 report an exposure-related increase in the odds of smoking that was enhanced by allowance for repeated viewings. In a wider European study, Morgenstern et al 6 demonstrate exposure-related increases in the odds of smoking among adolescents exposed to smoking in films in six countries, including the UK, demonstrating that this association applies across different cultural contexts and levels of implementation of other tobacco control policy. These new studies thus provide further and urgent evidence in support of calls—as yet unheeded—for a radical overhaul of film classification to protect all children and young people from this pervasive and highly damaging imagery.2 3 7–9 The British Board of Film Classification (BBFC) is an independent organisation which, in return for fees paid by film makers, allocates all UK films intended for general release into one of five age classifications (table 1).10 The BBFC lists drug misuse and dangerous imitable …