Cinema is a core element in mass media approaches to normalizing smoking, states the World Health Organization. Since smoking in films is not perceived as advertising, it does not draw the skepticism that advertising engenders. Tobacco industry has funded film producers to feature specific tobacco brands and launched advertising campaigns through latest films using top stars.

The British Medical Association, the US National Cancer Institute, the US Centers for Disease Control and Prevention all cite several reasons why smoking in films should be addressed as a public health problem. Films reach every corner of the globe effectively promoting smoking, in the absence of public health scrutiny until now.

However, public health researchers and institutions are increasingly paying close attention to this important exposure. The tobacco industry knows that motion pictures are one of humanity’s most common entertainment experiences. Half of world’s households now have Internet access, including nearly one third of households in developing countries.

Worldwide, one in three individuals now has a mobile-broadband, which is five times more than in 2008. The rapid spread of multiple media platforms for viewing films outside of cinemas, across cultures and economies, means that exposure to film content is vastly underestimated by cinema attendance alone.

Films offer not only para-social relationships with world famous stars, but also an imagined view of life; insofar as adolescents hope to take part in the glamorous and exciting lifestyles depicted in films, they may adopt the behaviour they see in them. Tobacco industry has been able to covert a deadly product into a status symbol or token of independence through films.

Hollywood and Bollywood films provide powerful information about the “benefits” of smoking, instead of traditional advertising. Young people imitate, not only “positive” characters, but also the villain who smokes can have even more influence on them than the hero. The USA National Cancer Institute in 2008 and the USA Surgeon General in 2012 concluded that smoking in films causes adolescent smoking.

There are strong theoretical grounds about the mechanisms by film smoking influencing adolescent smoking. Population based scientific surveys and indirect scientific surveys on exposure to smoking in films show links that adolescent smoking in a range of socio-cultural contexts. Trend studies show that prevalence of smoking, both generally and among adolescents, tend to parallel trends in film smoking.

A brain imaging study shows how seeing on-screen smoking stimulates smoking and generates pleasurable feelings. WHO-FCTC Article 13 guidelines obligate Parties to enact comprehensive bans on banning tobacco advertising, promotion and sponsorship within five years of ratification. It clearly states that depiction of tobacco in entertainment media, such as films, theatre and games, is a form of tobacco advertising and promotion.

It also calls specifically for a ban on cross-border advertising to prevent the entry of banning advertising and promotion into their territories. This regulation applies to all forms of commercial communication including print, television, radio, internet, mobile phones and other new technologies, recommendation or action and all forms of contribution to any event, activity or individual with the aim, effect or likely effect of promoting a tobacco product, brand names or tobacco use either directly or indirectly.

The WHO-FCTC asserts that implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship should not prevent legitimate expression. The presentation of smoking on screen is, however, rarely realistic, generally showing images more consistent with cigarette advertising than with authentic representations of the dire health consequences of tobacco use. Some people raise concern on free expression of measures limiting smoking in films. Most of the concern is based on distorted accounts of the policies actually proposed to reduce tobacco imagery in films.

On-screen smoking increases the initiation of smoking by young people. Therefore, measures to limit film smoking should be there to establish a comprehensive tobacco control strategy. Policy-makers must also take into account the rapid evolution of the media and the emergence of new platforms in order to provide “future-proof” solutions.

One way to counteract the effect of film smoking on smoking attitudes might be to show an anti-smoking spot before any film with smoking. Well-designed, evidence-based public health policy will improve population health both nationally and globally.