It is known that smoking increases DHEAS, the precursor of DHEA. The
same should happen because of exposure to secondhand smoke.
DHEA is the active molecule, so increases in DHEAS may indicate that
smoking is reducing DHEA. DHEA is known to be important to normal
pregnancy-associated outcomes.
I suggest the findings of Peppone, et al., may be explained by
reduced DHEA in these women.
In their article, “Existing technologies to reduce specific toxicant
emissions in cigarette smoke,” RJ O’Connor & PJ Hurley list
technologies that, they propose, manufacturers could use to comply with
ceilings on nine smoke constituents proposed by the WHO Study Group on
Tobacco Product Regulation (TobReg).
Initially, it is important to address any conjecture that these
ceilings will reduce the harm cause...
In their article, “Existing technologies to reduce specific toxicant
emissions in cigarette smoke,” RJ O’Connor & PJ Hurley list
technologies that, they propose, manufacturers could use to comply with
ceilings on nine smoke constituents proposed by the WHO Study Group on
Tobacco Product Regulation (TobReg).
Initially, it is important to address any conjecture that these
ceilings will reduce the harm caused by cigarette smoking. Even TobReg
concedes that there is no evidence – only “hope” – that its proposal will
reduce the risks of smoking. Public health officials and scientists have
long stated, however, that selectively reducing cigarette smoke
constituents is unlikely to benefit public health.
Like TobReg, O’Connor & Hurley seem to take for granted that
manufacturers can easily comply with the proposed ceilings. But their
article proves the opposite. It highlights the difficulty, if not
impossibility, of complying with ceilings on nine individual constituents
(among thousands) in tobacco smoke, especially on a commercial scale.
Although an exhaustive treatment of each listed technology is beyond
the scope of this letter, the following points illustrate pragmatic
difficulties with applying these technologies in the real world.
• Using less Burley tobacco and more Bright (Virginia Flue-cured)
tobacco to reduce TSNA. This would increase emissions of formaldehyde,
another carcinogen in cigarette smoke.
• Using DNA from salmon sperm to reduce PAH or adding haemoglobin to
reduce carbon monoxide emissions. It is difficult to envision how such
options, which even the authors question, would be acceptable from a
regulatory viewpoint or could be commercialized on a large scale.
• Adding ammonia compounds, including urea, to cigarettes to reduce
formaldehyde. Public health authorities have alleged (although we
disagree) that ammonia compounds are added to cigarettes to increase the
addictive effects of nicotine.
These examples underscore the need for a science-based, rational
approach to tobacco policy that applies science consistently and
coherently when examining regulatory and public health proposals.
O’Connor & Hurley concede that TobReg’s proposal would force the
majority of existing cigarette brands off the market. We fully agree.
Viewed through this lens, the proposal is not “a conservative first step”
as TobReg contends. It is a strategy to remove as many tobacco products
from the market as possible.
Resources would be better spent on developing a regulatory framework
that includes evidence-based standards for reduced risk assessment, rather
than on promoting poorly-reasoned, speculative performance standards that
are not likely to reduce the risk of tobacco-related diseases.
Jim Sargent says I support business as usual for Hollywood. What I
emphatically and unapologetically do support is business as usual for
consistency. R-rating of any scene of smoking invites unavoidable
questions about parallel controls on a wide range of activity that an
equally wide range of interest groups would wish to see implemented in the
name of health, religion or morality. Jonathan Klein implies that because
ni...
Jim Sargent says I support business as usual for Hollywood. What I
emphatically and unapologetically do support is business as usual for
consistency. R-rating of any scene of smoking invites unavoidable
questions about parallel controls on a wide range of activity that an
equally wide range of interest groups would wish to see implemented in the
name of health, religion or morality. Jonathan Klein implies that because
nicotine is addictive, this confers exceptionalist status on the
importance of keeping smoking scenes away from children. Smoking is
extraordinarily dangerous, but is it any worse than violence, crime, or
racism to name but three which are often seen in movies to which children
are admitted?
The reductio ad absurdum of arguments to prevent children seeing any
smoking in movies would be to stop children seeing any smoking anywhere.
By what magic process could the sight of smoking in film be influential
while being benign in reality? Doubtless the time is not far away when
someone wielding research will call for public smoking to classified
alongside indecent exposure as a felony. I would not wish to be associated
with such nonsense and believe many others share my concerns that momentum
to selectively prune unacceptable health related behaviours from film
holds open the door for a conga line of other supplicants using the same
reasoning. This should be resisted by all who value freedom of expression.
I do not doubt that a majority of Americans agree with the
proposition that any smoking scene should cause a movie to be R-rated. But
I’d be confident that many of the same people who support that proposition
would also support proposals to do the same with scenes showing liquor or
many other health concerns, blasphemy and various moral panics. And let’s
remember also that many Americans also believe in miracles (89%), hell
(69%), ghosts (51%), astrology (31%) and reincarnation (27%) [1] and 40%-
50% accept a creationist account of the origins of life [2]. The
popularity of beliefs is not always a reliable guide to their wisdom. Not
long ago, the “wardrobe malfunction” that exposed Janet Jackson’s breast
on national TV for a nano-second caused national outrage. Such reactions
perplex many outside the US who have long been used to far more relaxed
regulation of film and television.
R-rating advocates are fond of arguing that scenes of smoking should
be treated identically to use of the word “fuck”, which many in the USA
apparently believe holds special powers to corrupt and deprave children.
Perhaps some of these advocates need to get out more and broaden their
horizons. Non R-rated movies in many other nations (eg: Europe, Australia,
Canada) frequently contain swearing, moderate violence and sex scenes
where panels appointed to judge the rating for the entire film have
decided that these scenes do not overwhelm the overall suitability of the
film to be screened to those legally defined as children. These panels are
typically not constrained by prescribed formulae as would appear to be
the case with swearing in the USA, but asked to make a holistic judgement
with reference to unspecified community standards. Part of the problem in
this debate may lie in US advocates believing that the rest of the world
shares (or ought to share) its standards, which have historical roots in
Puritanism.
Finally, if my critics are correct that smoking scenes in movies have
increased in the last 15 years, that these scenes “predict one-third to
half of smoking uptake”, and that there is a dose-response relationship
between exposure and smoking uptake, how do they reconcile this with the
major declines in youth smoking that have happened in the USA[3], Canada
[4] and Australia (to name three) over the same period? The answer can
only be that whatever effect smoking in movies has is small in relation to
other influences which are acting to reduce uptake. Such a conclusion
needs to be taken into consideration when we discuss moves to direct
artistic expression in the name of health.
I do support R ratings (actually M15, as this is roughly the
Australian equivalent to an American R) for films that decidedly
glamourise or blatantly promote smoking. I do however believe that smoking
can be shown in films in ways that do not promote the product - without
having to be a hit-you-over-the-head health message.
While I agree the current system of ratings for films has to be
considered in any realist...
I do support R ratings (actually M15, as this is roughly the
Australian equivalent to an American R) for films that decidedly
glamourise or blatantly promote smoking. I do however believe that smoking
can be shown in films in ways that do not promote the product - without
having to be a hit-you-over-the-head health message.
While I agree the current system of ratings for films has to be
considered in any realistic smoking in movies tobacco control strategy,
why doesn't the system that supports the absurdity of counting F-word
instances merit questioning? I appreciate that supporters and researchers
of smokefree movies have done the hard yards and found a solution to
eliminate tobacco promotion that best fits with the American moving making
and rating system. That doesn't mean that those of us who are relatively
newish to the debate cannot argue that the blunt instrument of an
automatic R rating that equates seeing any onscreen smoking as enticing
children to smoke is a poor tool.
Yes, movie making is a business, and as the current economic climate
attests, businesses must be regulated in order to protect the public
interests. But is this black and white form of regulation truly the ONLY
way forward?
Disclaimer: Simon Chapman is my PhD supervisor but my opinions are my own.
The responses so far to Dr. Chapman's article have missed the
fundamental point of his argument: that a policy requiring an R-rating for
any movie which depicts smoking is a narrow-minded one that treats smoking
differently than other dangerous health behaviors depicted in films and
which fails to address the overall public health problem of the media
portrayal of unhealthy behaviors.
The responses so far to Dr. Chapman's article have missed the
fundamental point of his argument: that a policy requiring an R-rating for
any movie which depicts smoking is a narrow-minded one that treats smoking
differently than other dangerous health behaviors depicted in films and
which fails to address the overall public health problem of the media
portrayal of unhealthy behaviors.
In order to defend the policy from Dr. Chapman's criticism, one would
have to justify why smoking should be treated differently than the myriad
of other unhealthy behaviors shown in films that influence adolescent
behavior: violence, unprotected sex, alcohol abuse, sexual abuse, and
physical abuse. While Smoke Free Movies and other public health groups are
calling for a single depiction of smoking - under virtually any
circumstances - to automatically trigger an "R" rating, they fail to argue
that depictions of violence, alcohol abuse, and sexual or physical abuse
should similarly trigger an automatic "R" rating.
In fact, this narrow-minded approach results in the rather perverse
result of having these organizations publicly "endorse" (with a thumbs-up
rating) a number of movies which don't depict smoking, but which show
alcohol abuse, violence, and spousal abuse.
Dr. Klein makes an attempt to differentiate smoking by arguing that
unlike these other behaviors, it is addictive. This argument not only
fails (alcohol is also an addictive drug) but seems irresponsible, since
it sanctions the depiction of violence and abuse on the grounds that these
are not addictive behaviors.
The ultimate point which Dr. Chapman makes is that we in tobacco
control must maintain a wide, public health-based view of societal
problems and avoid looking at the world with blinders so that all we see
are problems related to smoking. We should not be a single issue-oriented
movement; we should be a public health movement that is concerned about
all threats to the well-being of the public.
Simon Chapman's editorial supports business as usual for Hollywood.
By considering only the commercial element of paid product placement, he
ignores that making films in Hollywood is a business. Free artistic speech
is a fundamental right that everyone in Western societies supports, but
Hollywood uses it as a mantra to avoid changing how they do business.
Movies are a combination of art and business, just like many othe...
Simon Chapman's editorial supports business as usual for Hollywood.
By considering only the commercial element of paid product placement, he
ignores that making films in Hollywood is a business. Free artistic speech
is a fundamental right that everyone in Western societies supports, but
Hollywood uses it as a mantra to avoid changing how they do business.
Movies are a combination of art and business, just like many other
products that include artistic design elements, such as cars, furniture
and appliances. Movie production includes negotiations about what is
suitable for the audience and what sells tickets. Big movie producers
shoot several endings and focus group tests determine which one to use and
decide on the rating they want before they shoot a frame. That’s why an R
rating for smoking would simply cause them to leave smoking out of films
aimed at kids. Just as they trim violence and sex to get the rating they
want, they would also trim the smoking.
Chapman unfairly criticizes the Smoke Free Movies R-rating proposal
under the “Banning all Smoking in Movies” section of his editorial. In
the R rating proposal, smoking triggers and R rating not a ban. Movie
ratings systems are designed to warn parents of unsuitable content. We
are used to thinking of violent content as unsuitable, and few one
question that trigger. The research that links movie smoking with kid
smoking is new, but it is also very compelling, with movies being
responsible for one-third to one-half of youth smoking onset. Movie
ratings systems are designed to warn parents of unsuitable content. From
a health perspective, trying smoking is one of the biggest mistakes an
adolescent can make. Surely this warrants an R-rating as much as using
the “F” word twice, one of the current MPAA triggers.
Chapman argues against an R rating because it would not prevent all
children from seeing all smoking onscreen. No one has ever suggested that
the R rating would eliminate exposure to onscreen smoking for all
adolescents, just reduce it. The average R-rated movie is seen by only
14% of young adolescents, compared to about 30% for a typical PG-13 movie
(see Sargent, J. D., S. E. Tanski, et al. (2007). Exposure to Movie
Smoking Among US Adolescents Aged 10 to 14 Years: A Population Estimate.
Pediatrics 119(5): e1167-1176). Movie producers know that fewer
adolescents see R rated movies; that's why they fight an R rating for
smoking.
Because so many adolescents see smoking in PG and PG-13 movies,
rating smoking R would cut exposure to onscreen smoking in newly released
movies by about half, without violating anyone's free speech rights. This
would reduce smoking onset because, as Chapman himself notes, exposure to
onscreen smoking causes adolescents to smoke. But the trigger has to be
unambiguous, or Hollywood will just announce the incorporation of smoking
into the ratings system and then do nothing, maintaining its business as
usual stance. Fortunately, smoking is as easy to recognize in movies as
the "F" word.
Simon Chapman’s recent commentary on smoking in movies misses several
important points with regard to the influence of media portrayal of
tobacco on
children’s health (1). Chapman fails to recognize the ease with which
other
socially questionable behavior is rated R in US films. Using the Motion
Picture
Association of America voluntary ratings system (2), use of the 'F' word
as an
exclamation twice, or once in a sexu...
Simon Chapman’s recent commentary on smoking in movies misses several
important points with regard to the influence of media portrayal of
tobacco on
children’s health (1). Chapman fails to recognize the ease with which
other
socially questionable behavior is rated R in US films. Using the Motion
Picture
Association of America voluntary ratings system (2), use of the 'F' word
as an
exclamation twice, or once in a sexual context, yields an "R".
Other potentially adverse role modeled behavior does not have
tobacco's
highly addictive drug, nicotine, as a factor in children's exposure. The
behavioral expectancy establishes a modeled response which then is
reinforced by pharmacology, with well established and substantial health
results. This is why the American Academy of Pediatrics and many other
medical and public health organizations have endorsed the R rating. The
other Smoke-Free Movie goals: certification of no payoffs, true nonsmoking
counter-messages in trailers, and elimination of brand identification, are
important compliments to the R rating in helping protect youth. Together,
these strategies will moderate the smoking that youth may still be exposed
if
smoking were out of the G, PG, and PG-13 rated movies that are designed
specifically for children. Far from triggering the "backlash" that Chapman
fears, national surveys have shown that 70 percent of US adults agree that
movies that show smoking should be rated R (3).
The evidence base for what strategies are most effective for changing
the
effect of smoking in the movies is less strong. However, proposing
experiments to discover the best way to change the imagery promoting
social
acceptability of smoking would not be appropriate or ethical. Ridiculing
strategies to make it easier for parents to avoid or counter pro-smoking
imagery, as Chapman does, is also not terribly helpful. Definitive action
should be taken now, consistent with each nation's intent to protect their
youth.
Jonathan D. Klein, MD, MPH, Director
American Academy of Pediatrics Julius B. Richmond Center of Excellence
www.aap.org/richmondcenter
(585)275-7760
fax 585-242-9733
jklein@aap.org
1) Chapman, S. What should be done about smoking in movies? Tobacco
Control 2008;17:363-367; doi:10.1136/tc.2008.027557.
http://tobaccocontrol.bmj.com/cgi/content/full/17/6/363.
<http://tobaccocontrolbmj.com/cgi/content/full/17/6/363.> Accessed
11/25/08.
2) Motion Picture Association of America. Rating system. 2005.
http://www.mpaa.org/FilmRatings.asp. Accessed 11/25/08.
3) McMillen R.C., Tanski S., Winickoff J.P., Valentine N. (2007)
Attitudes about
smoking in the movies. Social Climate Survey of Tobacco Control.
Mississippi
State University Social Science esearch Center, American Academy of
Pediatrics. http://socialclimate.org/pdf/smoking-attitudes-movies.pdf
Accessed 11/25/08.
I would have written Simon Chapman's editorial 15 years ago, when I
first joined behind-the-scenes discussions in Hollywood to advocate the
same "solutions" he is now. Serious and sustained efforts by many
organizations (sometimes at substantial cost) to pursue the ideas Chapman
is now proposing repeatedly failed. Indeed, the amount of smoking
onscreen actually increased during this time. We only developed the
Smoke...
I would have written Simon Chapman's editorial 15 years ago, when I
first joined behind-the-scenes discussions in Hollywood to advocate the
same "solutions" he is now. Serious and sustained efforts by many
organizations (sometimes at substantial cost) to pursue the ideas Chapman
is now proposing repeatedly failed. Indeed, the amount of smoking
onscreen actually increased during this time. We only developed the
Smoke Free Movies policies (available at
www.smokefreemovies.ucsf.edu/solution) in consultation with people who
know how the motion picture industry actually works after these repeated
failures. The four Smoke Free Movies policies, particularly the R rating,
are designed to substantially reduce the dose of smoking delivered to
youth onscreen and the corresponding response of tobacco use without the
kind of outright ban that Simon, and we, find unacceptable.
An important new marker of the denormalisation of the tobacco
industry has occurred in Australia in 2008. It is traditional – indeed
usually mandatory -- for industries which may be affected by proposed
changes in government policy or legislation to be fully consulted through
formal processes prior to any changes taking place. In 2008, the
Australian government established a Preventative (sic) Health Task Force,
with s...
An important new marker of the denormalisation of the tobacco
industry has occurred in Australia in 2008. It is traditional – indeed
usually mandatory -- for industries which may be affected by proposed
changes in government policy or legislation to be fully consulted through
formal processes prior to any changes taking place. In 2008, the
Australian government established a Preventative (sic) Health Task Force,
with several key sub-committees, to examine ways that Australia could more
effectively prevent its major causes of chronic disease. The Task
Force’s chief mission was to “provide a blueprint for tackling the burden
of chronic disease currently caused by obesity, tobacco, and excessive
consumption of alcohol. It will be directed at primary prevention and will
address all relevant arms of policy and all available points of leverage,
in both the health and non-health sectors, in formulating its
recommendations.” The group’s report on tobacco control has now been
published (see
http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/tech
-tobacco).
The terms of reference for the Task Force included a requirement to
obtain “Input from the food, alcohol and medicines industries, from
stakeholders in these industries”. Significantly, no such requirement was
mandated for consultation with the tobacco industry.
This omission would appear to indicate that the Australian government
sees no merit in consulting with the tobacco industry when it comes to
preventing health problems. The local industry has often made overtures to
governments, including statements that it supports all platforms of
tobacco control [1]. The exclusion of the tobacco industry from routine
forms of consultation would seem to be yet another example of its ever-
spiralling pariah status in the community.
References
1. Davies D (Philip Morris) Speech to National Press Club Canberra
2005
http://tobacco.health.usyd.edu.au/site/supersite/resources/pdfs/DDavies_%20HR_%202005.pdf
The authors's Figure 2 identifies the 'smokers' zone' overlaid on a
map of modern Rome as resembling "the
location of the Jewish ghetto during the Third Reich."
In fact, a Jewish community has existed in Rome for over two thousand
years. In 1555 Pope Paul IV created a walled-ghetto for Jews as one of a
series of anti-semitic measures. The walls were torn down in 1870 when
Italy was unified as a single nation, lea...
The authors's Figure 2 identifies the 'smokers' zone' overlaid on a
map of modern Rome as resembling "the
location of the Jewish ghetto during the Third Reich."
In fact, a Jewish community has existed in Rome for over two thousand
years. In 1555 Pope Paul IV created a walled-ghetto for Jews as one of a
series of anti-semitic measures. The walls were torn down in 1870 when
Italy was unified as a single nation, leading to full emancipation of
Jews. Today's Jewish quarter, with its magnificent synagogue adjacent to
the Tiber river, is located on the same area, and is still referred to as
the Jewish Ghetto. It is unrelated to the German Third Reich.
It is known that smoking increases DHEAS, the precursor of DHEA. The same should happen because of exposure to secondhand smoke.
DHEA is the active molecule, so increases in DHEAS may indicate that smoking is reducing DHEA. DHEA is known to be important to normal pregnancy-associated outcomes.
I suggest the findings of Peppone, et al., may be explained by reduced DHEA in these women.
In their article, “Existing technologies to reduce specific toxicant emissions in cigarette smoke,” RJ O’Connor & PJ Hurley list technologies that, they propose, manufacturers could use to comply with ceilings on nine smoke constituents proposed by the WHO Study Group on Tobacco Product Regulation (TobReg).
Initially, it is important to address any conjecture that these ceilings will reduce the harm cause...
Jim Sargent says I support business as usual for Hollywood. What I emphatically and unapologetically do support is business as usual for consistency. R-rating of any scene of smoking invites unavoidable questions about parallel controls on a wide range of activity that an equally wide range of interest groups would wish to see implemented in the name of health, religion or morality. Jonathan Klein implies that because ni...
I do support R ratings (actually M15, as this is roughly the Australian equivalent to an American R) for films that decidedly glamourise or blatantly promote smoking. I do however believe that smoking can be shown in films in ways that do not promote the product - without having to be a hit-you-over-the-head health message.
While I agree the current system of ratings for films has to be considered in any realist...
The responses so far to Dr. Chapman's article have missed the fundamental point of his argument: that a policy requiring an R-rating for any movie which depicts smoking is a narrow-minded one that treats smoking differently than other dangerous health behaviors depicted in films and which fails to address the overall public health problem of the media portrayal of unhealthy behaviors.
In order to defend the polic...
Simon Chapman's editorial supports business as usual for Hollywood. By considering only the commercial element of paid product placement, he ignores that making films in Hollywood is a business. Free artistic speech is a fundamental right that everyone in Western societies supports, but Hollywood uses it as a mantra to avoid changing how they do business. Movies are a combination of art and business, just like many othe...
Simon Chapman’s recent commentary on smoking in movies misses several important points with regard to the influence of media portrayal of tobacco on children’s health (1). Chapman fails to recognize the ease with which other socially questionable behavior is rated R in US films. Using the Motion Picture Association of America voluntary ratings system (2), use of the 'F' word as an exclamation twice, or once in a sexu...
I would have written Simon Chapman's editorial 15 years ago, when I first joined behind-the-scenes discussions in Hollywood to advocate the same "solutions" he is now. Serious and sustained efforts by many organizations (sometimes at substantial cost) to pursue the ideas Chapman is now proposing repeatedly failed. Indeed, the amount of smoking onscreen actually increased during this time. We only developed the Smoke...
An important new marker of the denormalisation of the tobacco industry has occurred in Australia in 2008. It is traditional – indeed usually mandatory -- for industries which may be affected by proposed changes in government policy or legislation to be fully consulted through formal processes prior to any changes taking place. In 2008, the Australian government established a Preventative (sic) Health Task Force, with s...
The authors's Figure 2 identifies the 'smokers' zone' overlaid on a map of modern Rome as resembling "the location of the Jewish ghetto during the Third Reich."
In fact, a Jewish community has existed in Rome for over two thousand years. In 1555 Pope Paul IV created a walled-ghetto for Jews as one of a series of anti-semitic measures. The walls were torn down in 1870 when Italy was unified as a single nation, lea...
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