Tobacco and tobacco branding in films most popular in the UK from 2009 to 2017

Abstract

Background Exposure to tobacco content in films is a cause of smoking uptake in young people. In an earlier study, we reported that tobacco content occurred in 70% of UK box office films popular between 1989 and 2008. We now report an analysis of tobacco content in a sample of the top grossing UK box office films between 2009 and 2017, and of population exposure resulting from audience exposure to the 2017 films.

Methods Occurrence of tobacco intervals (actual tobacco use, implied use, appearance of smoking paraphernalia or branding) was measured by 5 min interval coding in the 15 most commercially successful films in the UK in each year from 2009 to 2017. A nationally representative survey was used to estimate population exposure to the top 15 films from 2017.

Results We coded 3248 intervals from the 135 films. Tobacco content appeared in 245 intervals (8%, 95% CI 7% to 9%) across 56 (41%, 95% CI 33% to 49%) films. Tobacco content occurred in films in all BBFC age ratings, and 36 (64%, 95% CI 51% to 77%) of films containing tobacco imagery were classified as suitable for viewing by people aged under 15 years. Although less prevalent than in our earlier study, there was no evidence of a secular decline in tobacco content during this study period. The top 15 films from 2017 delivered approximately 21.6 (95% CI 21.06–22.14) million tobacco impressions to young people aged 10–18 years in the UK.

Conclusions Tobacco content continues to appear in UK Box Office films and is widely seen by young people, representing a major driver of smoking uptake.

Full text

ORIGINAL RESEARCH
Tobacco and tobacco branding in films most popular
in the UK from 2009 to2017
Alexander Barker ,1 Jo Cranwell,2 Iona Fitzpatrick,3 Kathy Whittamore,1
Khaldoon Alfayad,1 Amira Haridy,1 Rachael Murray,1 John Britton1
Smoking
To cite: BarkerA, CranwellJ,
FitzpatrickI, etal. Thorax
Epub ahead of print: [please
include Day Month Year].
doi:10.1136/
thoraxjnl-2020-214743
1Division of Epidemiology and
Public Health, University of
Nottingham, Nottingham, UK
2Department for Health,
University of Bath, Bath, UK
3Tobacco Control Research
Group (partner in Stopping
Tobacco Organisations and
Products), Department for
Health, University of Bath,
Bath, UK
Correspondence to
Dr Alexander Barker, Division of
Epidemiology and Public Health,
University of Nottingham,
Nottingham NG5 1PB, UK;
alexander. barker@ nottingham.
ac. uk
Received 2 March 2020
Revised 31 July 2020
Accepted 5 August 2020
© Author(s) (or their
employer(s)) 2020. Re- use
permitted under CC BY.
Published by BMJ.
ABSTRACT
Background Exposure to tobacco content in films is a
cause of smoking uptake in young people. In an earlier
study, we reported that tobacco content occurred in
70% of UK box office films popular between 1989 and
2008. We now report an analysis of tobacco content in a
sample of the top grossing UK box office films between
2009 and 2017, and of population exposure resulting
from audience exposure to the 2017 films.
Methods Occurrence of tobacco intervals (actual
tobacco use, implied use, appearance of smoking
paraphernalia or branding) was measured by 5 min
interval coding in the 15 most commercially successful
films in the UK in each year from 2009 to 2017. A
nationally representative survey was used to estimate
population exposure to the top 15 films from 2017.
Results We coded 3248 intervals from the 135 films.
Tobacco content appeared in 245 intervals (8%, 95%
CI 7% to 9%) across 56 (41%, 95% CI 33% to 49%)
films. Tobacco content occurred in films in all BBFC age
ratings, and 36 (64%, 95% CI 51% to 77%) of films
containing tobacco imagery were classified as suitable
for viewing by people aged under 15 years. Although
less prevalent than in our earlier study, there was no
evidence of a secular decline in tobacco content during
this study period. The top 15 films from 2017 delivered
approximately 21.6 (95% CI 21.06–22.14) million
tobacco impressions to young people aged 10–18 years
in the UK.
Conclusions Tobacco content continues to appear in
UK Box Office films and is widely seen by young people,
representing a major driver of smoking uptake.
INTRODUCTION
Smoking is the largest avoidable cause of death and
disability in rich countries, killing half of all life-
long smokers1 and in 2018 causing an estimated 95
600 deaths and more than half a million hospital
admissions in the UK.2 Since most smokers in the
UK begin regular smoking before reaching the age
of 18 years,3 identifying and preventing causes of
smoking uptake in these young people remain a
public health priority.
Exposure to tobacco imagery in film is a
recognised cause of smoking uptake,4–6 and a meta-
analysis of prospective cohort studies has estimated
that children exposed to high levels of smoking
imagery in film are more than 40% more likely to
become smokers than those with little or no expo-
sure.7 This exposure would be preventable through
the age- classification systems that most countries
apply to films if smoking and other tobacco imagery
were considered harmful by regulators. In the UK,
for example, age classification ratings are provided
by the British Board of Film Classification (BBFC),
whose mission includes protecting the public, and
especially children, from content which might
cause harm.8 The BBFC provide guidance to fami-
lies to help them make informed decisions about
what films are suitable for children. However, the
BBFC does not appear to consider smoking to be
harmful. In relation to smoking, BBFC guidelines
state only that if smoking features to a significant
extent in works which appeal to children, this will
be indicated in information provided alongside the
age classification and that, despite evidence that the
effect of smoking is independent of film character
type (‘good guy or bad guy’), classification decisions
only take into account promotion or glamorisation
of smoking.9
We have previously reported that 70% of 300
top- grossing UK cinema films in the years 1989–
2008 included tobacco content and that 56% of
those containing tobacco were rated as suitable
for viewing by children aged under 15 years.10 To
determine whether tobacco imagery continues to be
prevalent in contemporary UK box office films, we
now report an analysis of tobacco content in the
top- grossing box office films distributed in the UK
between 2009 and 2017 and estimate the popula-
tion reach of this tobacco imagery in terms of UK
audience impressions (the estimated number of
times tobacco content was seen by an audience) to
see how much of this content is being seen by young
audience.
Key messages
What is the key question?
►Is tobacco content still prevalent in UK box
office films?
What is the bottom line?
►Tobacco content continues to appear in UK box
office films and is widely seen by young people,
representing a major driver of smoking uptake.
Why read on?
►We present a content analysis of the annual top
15 grossing films at the UK box office between
the years 2009 and 2017.
1BarkerA, etal. Thorax 2020;0:1–6. doi:10.1136/thoraxjnl-2020-214743
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Smoking
METHODS
Tobacco content in the 15 annual top grossing box office films
in the UK for the years 2009–2017, identified from the British
Film Industry Statistical Year Books,11 was measured semiquanti-
tatively using the 5 min interval coding method described previ-
ously.12 Coding for each film began at the start of each film and
continued until the end of the credits. In each interval, tobacco
content was recorded in each of the following categories.
Actual tobacco use: actual observed use of tobacco onscreen
by any character, coded as cigarette, cigar, pipe or other
(such as water pipe or chewing tobacco).
Implied tobacco use: any implied tobacco use without any
actual use onscreen (eg, holding a cigarette without actual
smoking or a comment about going for a cigarette), coded as
verbal or non- verbal.
Tobacco paraphernalia: the presence of tobacco or tobacco-
related materials, coded by the type of appearance (including
cigarette or other tobacco pack, matches, lighter, ashtray, no
smoking or smoking area signs).
Brand appearance: The presence of clear and unambiguous
tobacco branding, including cigarette or other tobacco packs,
secondary advertising (advertisements appearing within oth-
er programmes) and branded merchandising.
Any tobacco content: Any of the aforementioned.
For coding purposes, multiple instances of the same category
in the same 5 min interval were considered to be single event,
while instances that ran into consecutive 5 min periods were
coded as separate events. Instances in different categories in the
same interval were recorded as different events. Approximately
10% of all films were double coded and any discrepancies were
discussed between coders and amended accordingly. Informa-
tion on the age rating of each film was gained from the BBFC;
information on the production of each film was gained from the
Internet Movie Database.
To estimate exposure to a sample of films included in our
content analysis, we included questions on viewing the 15
annual top grossing box office films in the UK for the year 2017
in a national survey of young people carried out by YouGov PLC.
In accordance with YouGov practice, people aged 10–18 years
were recruited by direct email invitations to a random sample
of panellists from a database of individuals who had consented
to be contacted. Consenting respondents then followed a link
to an online survey where they were asked to indicate which
of the 15 films they had seen. We then combined our estimates
of tobacco imagery content in the films seen with UK mid- year
population estimates for 201813 to estimate gross and per capita
impressions, using previously reported methods.14 Dividing
gross impressions by population mid- year estimates provided
per capita impressions, the estimated number of tobacco impres-
sions delivered to each person.
Coding data were entered directly on a Microsoft Excel
(Version 16) spreadsheet as the films were watched and anal-
ysed using basic descriptive procedures and regression analysis
in the Statistical Package for the Social Sciences (IBM SPSS
V.24). Spearman’s correlation was used to assess the relationship
between the amount of tobacco intervals per hour of film over
time. P values of <0.05 were deemed statistically significant.
RESULTS
The 135 films analysed totalled 265.2 hours (15 912 min) of
film time, with a mean of 117.87 (SD 22.10) min/film, and a
range from 82 min (Secret Life of Pets) to 174 min (The Wolf
of Wall Street). The BBFC U, PG, 12/12A, 15 and 18 categories
contained 17%, 16%, 50%, 14% and 2% of films, respectively.
The majority of films analysed (59%, 95% CI 51% to 67%,
79/135) were produced solely in the USA. UK producers were
involved in 25% (34/135) of films and were solely responsible
for 3% (95% CI 1% to 5%, 4/135) of films. Other countries
were involved in creating 17% (95% CI 11% to 23%, 23/135)
of films. Only one film (Taken 2) had no UK or US production
involvement.
There were 3248 5 min intervals in the films, with a mean
of 24 per film, range 17–35. Tobacco content occurred in 245
intervals (8% of the total, 95% CI 7% to 9%) across 56 (41%,
95% CI 33% to 49%) films. The respective proportions of films
containing any tobacco intervals in each of the BBFC age catego-
ries are shown in table 1.
Tobacco intervals occurred in 40% (95% CI 32% to 48%,
53/132) of all films rated suitable for watching by people aged
under 18 years by the BBFC, as did 87% (95% CI 83% to 91%
214/245) of all tobacco intervals. Nearly two- thirds (64%,
95% CI 51% to 77%) of films containing tobacco imagery
were classified as suitable for viewing by people aged under 15
years. Tobacco imagery occurred in 39% (95% CI 31% to 47%,
50/129) of films produced with some US involvement, and in all
six (100%, 95% CI 100% to 100%) of those produced with no
US involvement (p=0.004, Fisher’s exact test).
The average number of intervals containing the different
categories of tobacco content per hour of film varied from
Figure 1 Trends in mean tobacco intervals per hour of film, 2009–2017.
2BarkerA, etal. Thorax 2020;0:1–6. doi:10.1136/thoraxjnl-2020-214743
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Smoking
year to year, though not to a statistically significant extent
and with no obvious trend. However, the mean number of
tobacco intervals per hour of film has been particularly low
since 2015 (figure 1).
Actual tobacco use occurred in 50% of all tobacco inter-
vals (95% CI 44% to 56%, 123/245), in 24% of films (95%
CI 17% to 31%, 32/135) and in a majority of cases (72
intervals, 59%, 95% CI 53% to 65%) involved cigarette
smoking. Almost all (31/32) films featuring actual tobacco
use were in BBFC 15 and lower categories, and more than
half (56%, 95% CI 38% to 73%, 18/32) were rated suitable
for audiences age 12 or lower. There was no clear trend in
the frequency of tobacco intervals, or of intervals including
tobacco use, per hour of film within BBFC age- classification
categories, though there was no tobacco use in any U- rated
film (figure 2). Tobacco use was much more common in films
produced solely in the UK (occurring in 23 of 85 intervals,
28%, 95% CI 18% to 38%) than those produced in the US
(49/1850 intervals, 3%, 95% CI 2% to 4%, p<0.001).
Implied tobacco use occurred in 92 intervals (3%, 95% CI
2% to 4%, 92/3248) in 29 films (21%, 95% CI 14% to 28%,
29/135), typically in the form of non- verbal cues (83%, 95%
CI 75% to 91%, 72/92). Tobacco paraphernalia occurred
in 46 films (34%, 95% CI 26% to 42%, of all films) and
in 4% of all intervals (95% CI 3% to 5%, 135/3248), typi-
cally in the form of ashtrays (alone or with other parapher-
nalia; 44% of paraphernalia intervals (95% CI 35% to 52%,
59/135), cigarette or other tobacco packs (12%,95% CI 7%
to 17%, 16/135), lighters (18%, 95% CI 17%–31%, 24/135)
or matches (7%, 95% CI 3% to 11%, 10/135).
Tobacco branding, typically on tobacco packs, was present in
seven intervals in six films. Five of these films were US produc-
tions, and one solely UK. Marlboro was the only brand to appear
in more than one film, with Marlboro Gold appearing in two
intervals in Slumdog Millionaire and Marlboro in a single interval
in The Amazing Spiderman. More than one brand occurred in
Table 1 Proportion of films in BBFC age category containing tobacco
intervals
BBFC age rating*
Proportion of films in each age category
containing tobacco intervals
U 1/23 (4%, 95% CI 0% to 12%)
PG 5/22 (23%, 95% CI 5% to 41%)
12/12A 30/68 (44% 95% CI 32% to 56%)
15 17/19 (89% 95% CI 75% to 100%)
18 3/3 (100%, 95% CI 100% to 100%)
*U, suitable for all ages; PG, parental guidance; 12/12A, suitable for 12 years and
over; 15, suitable for 15 years and over; 18, suitable only for adults.
BBFC, British Board of Film Classification.
Figure 2 Trends in mean numbers of intervals containing any tobacco imagery, or tobacco use, per hour each year in relation to British Board of
Film Classification category. There were no films rated 18 in the top UK box office films for 2009–2013. 12/12A, suitable for 12 years and over; 15,
suitable for 15 years and over; 18, suitable only for adults; PG, parental guidance; U, suitable for all ages.
3BarkerA, etal. Thorax 2020;0:1–6. doi:10.1136/thoraxjnl-2020-214743
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Smoking
a single interval in Men in Black 3 (Lucky Strike, Embassy).
A fictional brand (Old Toby) appeared in one interval in The
Hobbit and multiple fictional brands (Wellesley, Emperor and
Carolina Menthol) in one interval in IT (table 2).
Trends over time
When the data from the current study were compared with the
data from the previous study, the mean number of tobacco inter-
vals per year are negatively correlated (r(27)=−0.789, p<0.01)
(figure 3).
UK population exposure
Our YouGov Omnibus survey obtained data on which of the 15
2017 films sampled, four of which included tobacco content,
had been seen by a nationally representative sample of 935
young people aged 10–18 years. The film with the most content,
IT, was rated 15 and was seen by 26% (95% CI 23% to 28%) of
young people aged 10–18 years in the UK. Using UK population
estimates,15 we estimate that the four films delivered 21.6 (95%
CI 21.06 to 22.14) million tobacco impressions to young people
aged 10–18 years (table 3).
DISCUSSION
This study demonstrates that tobacco content, including
tobacco smoking, continues to occur frequently in the most
popular UK films; that this content is included in films in
almost all age classification groups and that a majority of
films containing smoking are classified by the BBFC as suit-
able for viewing by people aged under 15 years; and that
tobacco imagery is significantly more likely to occur in films
produced by UK companies. Although the proportion of films
containing tobacco, at 40%, is much lower than the 70% we
reported in an earlier analysis of films popular between 1989
and 2008,10 the proportion of films containing tobacco clas-
sified as suitable for viewing by people aged under 15 years
was unchanged. Thus, while film makers may have reduced the
amount of smoking imagery they include in films over the past
decade, BBFC classification policy remains consistently passive
in relation to this content,9 with classification decisions only
taking into account promotion or glamorisation of smoking.
Since there is strong causal evidence that exposure to tobacco
imagery in films increases smoking uptake in adolescents,7 the
BBFC thus continues to fail to meet its mission of protecting
children from harmful content.8
Table 2 Films containing tobacco branding
Title Release year Country of origin BBFC rating Branding intervals, n Brand(s)
Slumdog Millionaire 2009 UK 15 2 Marlboro (Gold)
Hangover II 2011 USA 15 1 K&J Lights
Amazing Spider Man 2012 USA 12 1 Marlboro
Men in Black 3 2012 USA PG 1 Lucky Strike, Embasssy
The Hobbit: An Unexpected Journey 2012 USA/NZ 12 1 Old Toby
IT 2017 USA/Canada 15 1 Wellesley, Emperor, Carolina Menthol
BBFC, British Board of Film Classification.
Figure 3 Mean number of intervals containing tobacco content per hour of film, 1989–2017.
4BarkerA, etal. Thorax 2020;0:1–6. doi:10.1136/thoraxjnl-2020-214743
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Smoking
Our study was limited by available coding resources to the top
15 most popular films each year, but these are likely to reflect
the prominent pattern of tobacco exposure in films seen in UK
cinemas each year since they typically represent around 50% or
more of total annual box office takings.16 To code content in
films, we used a method which has been widely used across a
variety of audiovisual media12 14 16–24 and used double coding to
ensure consistency between coders. Due to the lack of precise
viewing figures, a nationally representative YouGov Omnibus
survey was used to estimate the number of tobacco impres-
sions delivered to a sample of the UK population. Our popula-
tion exposure estimate included films from a single year, 2017;
therefore, the UK population exposure to tobacco content in
UK box office films throughout the study period is thought to
be much higher. The amount of tobacco content in films from
2017 was relatively low; our population estimate reflects this
and would likely be higher for years with more tobacco content.
Our tobacco exposure estimate is for the UK population, but
these films are viewed worldwide, and therefore, UK popula-
tion exposure figures probably represent a very small propor-
tion of the true total global exposure. We used interval coding
methods to generate semiquantitative measures of content over a
standardised period of time to allow direct comparison between
programmes which are shown for different amounts of time,
therefore allowing an exploration of the percentage proportion
of a programme. This method can lead to both underestima-
tion (if high- frequency appearances are concentrated in short
periods of time) and overestimation (if short appearances tran-
sition into two intervals) and has been widely used in previous
studies.12 14 17 19–23 25–32 Alternative approaches such as frequency
analysis,33–37 whereby all visual appearances are counted as indi-
vidual events irrespective of duration, are available but assume
that a single long appearance carries the same impact as a short
appearance. Our estimate of population exposure is also based
on 5 min intervals, rather than incidents, and therefore may be
lower than estimates based on incidents alone.
While it is promising that tobacco content in films occurred less
frequently during the present study period from 2009 to 2017,
this does not appear to reflect a secular trend; rather, our find-
ings mirror those reported in US films in which the frequency of
tobacco content declined to 2010 and then increased.38 Further-
more, even at this lower level of occurrence, this content in UK
films generates substantial population exposure, with films in a
single year delivering 21.6 million tobacco impressions to young
viewers.
It is important to consider that many of these films were also
released to an American audience. While there are differences in
the age ratings between the UK and the USA, and the way that
these ratings prevent young people from viewing content unsuit-
able for them, 17 films which were rated 15 in the UK were
rated higher (‘R’) in the USA. In our population exposure, the
film containing the most tobacco content and which delivered
the most viewer impressions, IT was rated a 15 in the UK and an
‘R’ in the US. If the film had been given an adult (18) rating in
the UK, this may have prevented this film from delivering a large
proportion of tobacco impressions to young people.
Viewing habits are changing and online video- on- demand
(VOD) services such as Netflix and Amazon Prime Instant Video,
which allow users to watch whatever they choose at any time of
day, are becoming increasingly popular.39–44 A number of films
included in the present study are now featured on VOD services,
thereby increasing exposure to tobacco content found in these
films. These changes in the way that film content is consumed
make it even more important that film classification authorities
such as the BBFC follow WHO guidance, by prohibiting the
appearance of branding in films and applying adult classifications
to films containing tobacco imagery,45 since film makers tailor
content carefully to the requirements of their target age rating
for each film. Knowing that including tobacco would ensure an
adult rating in the global fourth largest national film market46
would therefore be likely to result in widespread exclusion of
tobacco imagery from all films aiming for a less than adult rating.
We concede that due to changing viewing habits, a limitation of
the current study is the focus on the top-15 UK box office films
released annually in a cinema’s, as these films as viewers can
watch films from previous years on VOD services. Furthermore,
a number of films and series are released exclusively on VOD
services. Future studies should explore films on these services.
The current study did not measure e- cigarette content; as
e- cigarettes have become more popular over time, it is likely
that this will be reflected in UK box office films. Future studies
should explore the changing representation of tobacco products
in films.
The current study thus provides further evidence in support
of more effective UK implementation of the tobacco promotion
policies outlined in the Framework Convention for Tobacco
Control47 to reduce youth exposure to smoking in movies. It
also provides clear evidence that the BBFC has yet to deliver on
its mission to protect children from this form of harmful imagery
when they visit the cinema. Future tobacco content, whether
glamorised or not, should be considered when assigning age
classifications to films, and all films containing tobacco content
should be assigned an adult (18) rating to protect children from
this content.
Twitter Alexander Barker @abbarkerpsych
Contributors AB, JC and IF contributed to data collection, analysis and manuscript
preparation. KW, KA and AH contributed to data collection. RM and JB contributed
to manuscript preparation.
Funding This work was supported by the Medical Research Council (grant number
MR/K023195/1) and the UK Centre for Tobacco and Alcohol Studies, with core
funding from the British Heart Foundation, Cancer Research UK, Economic and
Social Research Council and the Department of Health under the auspices of the
UK Clinical Research Collaboration. The funders had no role in the study design,
data collection and analysis, decision to publish or preparation of the manuscript.
Table 3 Estimated gross and per capita tobacco impressions delivered to 10–18 year olds in the UK from the four sampled films from 2017
containing tobacco imagery
Film Age rating (BBFC)
Gross impressions
(million) 95% CI Per capita impressions 95% CI
IT 15 10.53 10.22 to 10.84 1.56 1.51 to 1.61
Spiderman: Homecoming 12a 6.21 6.09 to 6.33 0.92 0.90 to 0.94
Dunkirk 12a 1.35 1.30 to 1.40 0.2 0.19 to 0.21
Jumanji: Welcome to the Jungle 12a 3.51 3.45 to 3.57 0.52 0.51 to 0.53
BBFC, British Board of Film Classification.
5BarkerA, etal. Thorax 2020;0:1–6. doi:10.1136/thoraxjnl-2020-214743
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Smoking
This work was also supported by Bloomberg Philanthropies Stopping Tobacco
Organizations and Products project funding ( www. bloomberg. org).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data
on the tobacco content of films included in this content analysis are available from
Alexander Barker ( Alexander. barker@ nottingham. ac. uk) upon reasonable request.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits
others to copy, redistribute, remix, transform and build upon this work for any
purpose, provided the original work is properly cited, a link to the licence is given,
and indication of whether changes were made. See:https:// creativecommons. org/
licenses/ by/ 4. 0/.
ORCID iD
AlexanderBarker http:// orcid. org/ 0000- 0003- 4568- 5114
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