Category: Smoking

A citywide ban on public smoking in Colorado led to significant decreases in maternal smoking and preterm births, providing the first evidence in the U.S. that such interventions can impact maternal and fetal health, according to an article in Journal of Women’s Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers.

Prenatal exposure to tobacco smoke–whether the mother is a smoker or exposure is from environmental sources– is associated with premature births and low birth weight. The results of a “natural experiment” that compared outcomes in two cities, one with a smoking ban and one without a ban, showed reductions in both maternal smoking and premature births in the city with a smoking ban.

In the article “A Citywide Smoking Ban Reduced Maternal Smoking and Risk for Preterm, Not Low Birth Weight, Births: A Colorado Natural Experiment,” Robert Lee Page II, PharmD, MSPH, Julia Slejko, BA, and Anne Libby, PhD, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences and School of Medicine, Aurora, CO, concluded that a population-level intervention using a smoking ban improved maternal and fetal outcomes.

“Exposure to tobacco smoke is associated with not only death from lung cancer and heart disease but also risks to developing fetuses,” says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women’s Health, Executive Director of the Virginia Commonwealth University Institute for Women’s Health, Richmond, VA, and President of the Academy of Women’s Health. “The promising results of this study suggest that pregnant women and their fetuses represent an important population for further study of health and cost effects of smoke-free ordinances.”

For years researchers have found that exercise can curb nicotine cravings, but have struggled to show a practical benefit in trials. Newly published research suggests a reason: the effect is too ephemeral. The next step, funded by a 5-year grant, will be to see how frequently exercise might be needed to have a lasting therapeutic effect.

Dozens of studies on whether moderate exercise can curb the nicotine cravings of women smokers have added up to an apparent contradiction: it seems to work in short-term, well controlled lab experiments, but then fizzles out in treatment trials. A new study may explain why and help researchers devise a practical therapy.

The explanation suggested in the results of research led by David Williams, an assistant professor of community health at Brown University, is that while exercise does help improve the mood of smokers and curtail their cravings, the effect is short-lived.

"What we found is that although there is no chronic effect of exercise on cigarette cravings and affective withdrawal symptoms, there is an acute effect that diminishes over a period of several hours to 1-2 days, but can be renewed with each bout of exercise," said Williams, first author of the study published May 11 in the journal Addictive Behaviors. "One implication for these findings is that exercise may be a useful treatment strategy, but it has to be done frequently enough and consistently enough because the effects that it has diminish over time."

To conduct their pilot study, Williams and colleagues at The Miriam Hospital, the University of Massachusetts at Boston, and St. George University of London signed up 60 female smokers for an 8-week regimen of smoking cessation treatment. They were all given quitting counseling and nicotine patches. Half were assigned to the exercise group, in which they briskly walked on a treadmill at the study center for 50 minutes three times a week. The 30 women in the control group watched 30-minute health and wellness videos three times a week.

For each group the researchers asked them about their mood and cigarette cravings immediately before and after each session. They also asked them again when they reached their next destination after each exercise or wellness session.

The researchers found that, relative to participants in the control group, those who exercised were more likely to experience improved mood and decreased cigarette cravings, but that these effects dissipated by the time of their next exercise session. On one hand, the improvements in affect and cravings are encouraging, Williams said, but clearly it wasn't sustained even over a matter of a few days.

The next step, he said, is to enroll a larger sample of women in a randomized, controlled trial. That work is well underway because in February his pilot research led to a new NIH grant for $2.2 million over 5 years to study the issue in further detail. The study will allow him and his team to provide enrolled women with electronic devices where they can record their cravings and mood more frequently.

Once Williams has a better sense of when the effects of exercise wear off, he'll know how frequent exercise needs to be to sustain its anti-craving benefit.

In addition to Williams, other authors are Shira Dunsiger, Joseph T. Ciccolo and Ernestine Jennings of the Warren Alpert Medical School of Brown University and The Miriam Hospital, Jessica Whiteley of the University of Massachusetts at Boston, and Michael H. Ussher of St. George's University of London, UK.

The National Institutes of Health funded the research.

Smoking bans in public/workplaces don't drive smokers to light up more at home, suggests a study of four European countries with smoke free legislation, published online in Tobacco Control.

If anything, a ban may prompt smokers to smoke less at home, the research suggests.

The authors base their findings on two waves of the International Tobacco Control Policy Evaluation Project (ITC Project) Europe Surveys.

These were carried out before and after legislation banning smoking in public places had come into force in Ireland, France, Germany and the Netherlands, and in the UK, excluding Scotland, before legislation was enacted.

The surveys, which were conducted between 2003/4 and 2008/9, depending on when bans took effect, involved 4634 smokers in the four countries with smoke free legislation and 1080 smokers in the UK, which served as comparison country at a time when no public/workplace smoking ban had come into force.

Before a ban came into force, most smokers had at least partial restrictions on smoking at home, although the proportions varied significantly among all four countries, with the highest levels of restrictions in Germany and France.

The presence of a young child in the household and supporting a smoking ban in bars were key factors associated with choosing to restrict smoking at home.

After legislation was enacted, the percentage of smokers who banned smoking at home increased significantly in all countries, rising by 25% in Ireland, 17% in France, 38% in Germany and 28% in the Netherlands by the time of the second survey.

This increase was irrespective of whether the public/workplace smoking ban was comprehensive or allowed for some exceptions.

Home smoking bans were more likely to be adopted when the smoker planned to quit smoking, when there was a birth of a child, and among those smokers who supported a smoking ban in bars.

In the UK, the percentage of smokers who implemented a home smoking ban also rose 22% between the two surveys, the second of which was carried out just a few months before the smoking ban came into force.

After taking account of several demographic and smoking history variables, the percentage of continuing smokers banning smoking at home increased significantly in all four countries, but did not significantly increase in the UK.

Current thinking suggests that the consequences of banning smoking in public end up either boosting the amount of smoking at home as smokers try to compensate — the displacement hypothesis — or encouraging smokers to apply the same restrictions at home — the social diffusion hypothesis.

"Opponents of workplace or public smoking bans have argued that smoke-free policies — albeit intended to protect non-smokers from tobacco smoke — could lead to displacement of smoking into the home and hence even increase the second hand smoke exposure of non-smoking family members and, most importantly, children," write the authors.

In fact, the findings support the "social diffusion hypothesis" — that banning smoking in public places "may stimulate smokers to establish total smoking bans in their homes."

The introduction of national, comprehensive smoke-free legislation in Scotland is linked with significant falls in preterm delivery and small for dates (gestational age) infants according to a study led by Jill Pell from the University of Glasgow and recently published in PLoS Medicine.

These findings add to the growing evidence of the wide-ranging health benefits of smoke-free legislation and support the adoption of such legislation in other countries, which have yet to implement smoking bans.

The authors say: "There is growing evidence of the potential for tobacco control legislation to have a positive impact on health."

Scotland was the first country in the United Kingdom to ban smoking in public places, which was implemented as part of the Smoking, Health and Social Care (Scotland) Bill on 26 March 2006. In their study, the authors collected information on preterm delivery and small for dates in all babies born between January 1996 and December 2009 and found that following implementation of the legislation there was a significant reduction — a fall from 25.4% pre-ban to 18.8% post-ban — in the number of mothers who smoked. Furthermore, there was a significant drop (over 10%) in overall preterm deliveries and in the number of infants born small (a drop of almost 5%), and very small (a drop of nearly 8%). Importantly, the authors found that these significant reductions occurred both in mothers who smoked and those who had never smoked, emphasizing the impact on health of second-hand smoke.

According to the authors, although survival from preterm deliveries has improved, these infants are at risk of developing long-term health problems and state "Any intervention that can reduce the risk of preterm delivery has the potential to produce important public health benefits."

The authors conclude: "The results of our study add to the growing evidence of the wide ranging health benefits of smoke-free legislation and lend support to the adoption of such legislation in countries where it does not currently exist."

— More than 75 percent of fourth-graders in urban and rural settings have measurable levels of a nicotine breakdown product in their saliva that documents their second-hand smoke exposure, researchers report.

A study of 428 fourth graders and 453 parents in seven rural and seven urban Georgia schools also showed that the urban children were more likely to be smokers — 14.9 percent versus 6.6 percent. Additionally urban children have the most exposure to smokers: 79.6 percent versus 75.3 percent, according to findings presented to the 15^th World Conference on Tobacco or Health March 20-24 in Singapore.

"It's bad news," said Dr. Martha S. Tingen, Co-Director of Georgia Health Sciences University's Child Health Discovery Institute and Interim Program Leader of the GHSU Cancer Center's Cancer Prevention and Control Program. "Smoking is one of the major causes of low-birth weight infants, it increases the incidence of Sudden Infant Death Syndrome by 10 times, increases breathing problems, asthma-related hospital admissions, ear and upper-respiratory infections, yet all these kids are living in a smoking environment."

The findings are another reminder to pediatricians to talk with parents and children about smoking habits during every checkup and to researchers that more community-based studies are needed to give parents and children alike the skills they need to avoid or stop smoking, Tingen said. They also indicate that geography and health disparities need to figure heavily into tailoring solutions.

In the study group, researchers found children in the rural areas were more likely to be white and living with both parents; children in urban settings tended to be poorer, live with one parent, receive health care at community health clinics and have a parent who smoked.

At GHSU, young pediatricians such as Dr. Ketarah Robinson learn early to be vigilant and forthright about major health issues such as smoking and obesity with the parents and children they see in clinic, asking tough questions about whether the kids are getting pressured to smoke and if they've already given in. Like the children in the study, some kids say "yes" as early as age 10. Then doctors such as Robinson give them readily discernible reasons not to. "At that age we give them more concrete things like: Do you want to stink and have yellow teeth?" said Robinson, Co-Chief Resident in Pediatrics at GHS Children's Medical Center. Robinson and second-year Medical College of Georgia student Prathyusha Mididoddi will present the rural versus urban findings in Singapore. Tingen, who holds the Charles W. Linder Endowed Chair in Pediatrics, is first author.

Mididoddi echoed the fact that a significant percentage of kids getting regular smoke exposure is both "scary" and preventable. She and Robinson agree the findings re-emphasize the need for thorough social histories to get a clear picture of where and how children live.

"At any age, cigarette smoke really affects kids, whether it's a grandmother they visit with on weekends or a parent they are with every day," Robinson said. Now in her fourth year of training, Robinson already has seen educational efforts help parents stop smoking or at least keep them from smoking around their children. But she's also had a few patients start smoking.

Amazingly, some of those young smokers might already have trouble breathing. In a related study of 2,636 eighth-to-10^th graders in four rural Georgia schools, GHSU researchers also found that nearly 40 percent of white females and nearly 27 percent of white boys with wheezing, coughing asthma symptoms said they smoked. There were other unhealthy indicators: children with an actual asthma diagnosis — whether or not they had symptoms — had a higher percentage of body fat as measured by a higher body mass index.

The study looked at children with no asthma diagnosis, a diagnosis and symptoms, a diagnosis and no symptoms and active symptoms — but no actual diagnosis — in a 30 day-period. While smoke exposure is bad for anyone, it's at the top of the list of asthma triggers. The asthma study, along with another study yielding encouraging news that home-based intervention can help black parents feel confident about their ability to make their home tobacco-free, are being presented as posters during the tobacco research meeting.

The study compared general health education to parents learning life skills geared at improving communication, emphasizing their strength as role models and fundamentals such as best parenting practices. The study was in a mix of urban and rural parents who were largely black and an average age of 38. Parents who got life skills training significantly increased their self-efficacy.

"It's an expectation that we are not going to smoke and nobody is going to smoke in our house," said Tingen, who has been taking these types of educational programs to schools and communities for years. "It's an expectation that when you grow up, you are not going to smoke." Tingen hopes this type of positive life-skills training will one day be available to children and parents in every school.

Dr. Dennis Ownby, Chief of the Medical College of Georgia Section of Allergy-Immunology and Rheumatology at GHSU, is Co-Principal Investigator with Tingen on a National Heart, Lung and Blood Institute grant that helped fund the studies and is a co-author on the asthma poster. Other research team members attending the conference include Maudesta Caleb, Research Associate; Kelora Cofer, Research Assistant; and Matthew Humphries; Research Manager, all with the Georgia Prevention Institute and MCG Department of Pediatrics.

Smoking bans have become more common on university campuses, but do they work? Do they help reduce smoking in this newly independent age group? According to an Indiana University study, they do.

A campus smoking ban — lightly enforced at that — significantly reduced student smoking during a two-year period and changed students' attitudes toward smoking regulations, according to a study that examined students' smoking behaviors on two similar campuses — one with (Indiana) and one without (Purdue) a campus-wide smoke-free air policy.

"Although we haven't pinpointed which element of the campus-wide smoke-free air policy contributed the most to the positive changes in students' smoking rates, having such a policy in place does appear to influence students' smoking-related norms and behaviors even without strong enforcement of the policy," said Dong-Chul Seo, associate professor in IU's School of Health, Physical Education and Recreation. "These results are encouraging for university administrators considering stronger tobacco control policies."

Despite growing concerns about the harmful effects of second-hand smoke, as college student smoking rates hover around 20 percent, this study by IU tobacco control and health behaviors experts is the first published report to evaluate the impact of smoke-free campus policies on student smoking. It found that not only did the student smoking rates drop after the campus-wide smoking ban was implemented, but those who continued smoking consumed fewer cigarettes.

The study, "The effect of a smoke-free campus policy on college students' smoking behaviors and attitudes," appeared online in the journal Preventive Medicine. Co-authors are Jonathan T. Macy, Mohammad R. Torabi and Susan E. Middlestadt, all from the Department of Applied Health Science in IU's School of HPER.

The researchers chose to study students at Purdue University and Indiana University Bloomington because of the numerous demographic similarities between the students at each campus and because West Lafayette and Bloomington both had comprehensive city-wide smoke-free air policies during the two-year study, which ended in 2009.

More findings from the study:

• The percentage of students smoking at IU dropped by 3.7 percentage points during the study to 12.8 percent, while the smoking rate increased slightly at Purdue to 10.1 percent.
• The number of cigarettes (5.9) students reported smoking at IU decreased during the study but increased at Purdue (6.8).
• The perception by students that 26 percent or more of their peers smoked decreased at IU but increased by almost 8 percentage points at Purdue. When asked if two or more of their closest friends smoked, the rate decreased to 38.7 percent at IU but increased to 34.4 percent at Purdue.
• IU saw a drop in the percentage of IU students who thought smoking among students was OK and that most people believed students should be able to smoke. A smaller percentage of Purdue students agreed that smoking among students was acceptable but the percentage of students who thought most people believed students should be allowed to smoke increased by 7 percentage points.
• The percentage of IU students who agreed that regulating smoking in public places is good increased to 82.1 percent during the study period but decreased at Purdue to 81.5 percent. The percentage of IU students supporting a campus smoking ban increased by 5 percentage points to 62.5 percent while it decreased slightly at Purdue to 61.3 percent.

Seo said he was somewhat surprised by the reduced smoking rate at IU because the campus-wide smoke-free air policy was not actively enforced and people can be seen smoking on a regular basis.

"The positive changes may be attributable to increased awareness of the policy due to signage, media coverage, and a campus bus completely wrapped with anti-tobacco messaging," he said.

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Journal Reference:

1. Dong-Chul Seo, Jonathan T. Macy, Mohammad R. Torabi, Susan E. Middlestadt. The effect of a smoke-free campus policy on college students' smoking behaviors and attitudes. Preventive Medicine, 2011; DOI: 10.1016/j.ypmed.2011.07.015

 Children who live in households where they are exposed to tobacco smoke miss more days of school than do children living in smoke-free homes, a new nationwide study confirms. The report from investigators at Massachusetts General Hospital (MGH) — which finds these children have higher rates of respiratory illnesses that can be caused by second-hand smoke and details the probable economic costs of their increased school absence — has been released in the online edition of Pediatrics.

"Among children ages 6 to 11 who live with smokers, one quarter to one third of school absences are due to household smoking," says Douglas Levy, PhD, of the Mongan Institute for Health Policy at MGH, the paper's lead author. "On a national basis these absences result in $227 million in lost wages and time for caregivers or their employers."

The authors note that one-third of U.S. children live with at least one smoker, and more than half of those aged 3 to 11 have detectable levels of a blood marker for tobacco exposure. Second-hand smoking has been shown to increase incidence of ear infections and several respiratory conditions, and school absenteeism is an accessible measure of serious illness in children. Earlier studies of the relationship between lost school days and household smoking have focused on local populations and did not evaluate the severity of the problem's impact. The MGH team analyzed data from the 2005 National Health Interview Study, an annual in-person survey of representative households nationwide.

Adults responding from households with schoolchildren ages 6 to 11 were asked to evaluate each child's general health and to answer the following questions:

• how many people smoked inside the home
• how many school days the child missed due to illness or injury during the previous year
• whether the child had three or more ear infections during the previous year
• whether the child had a chest cold or gastrointestinal illness during the preceding two weeks
• whether the child had been disgnosed with asthma, and if so, whether the child had any recent asthma attacks

Of the 3,087 children whose information was analyzed for this study, more than 14 percent lived in a home with at least one person who smoked in the house — 8 percent lived with one household smoker and 6 percent with two or more — which represents 2.6 million children nationwide. Children living with one in-home smoker had an average of 1.06 more days absent, and those living with two or more had 1.54 more days absent than did children living in homes where no one smoked indoors.

Illnesses associated with exposure to tobacco smoke — including ear infections and chest colds -accounted for 24 percent of absences in children living in homes where one person smoked indoors and 34 percent for those living in homes with at least two in-home smokers. Household smoking did not increase gastrointestinal illness, and while there also was no association with an asthma diagnosis or asthma attacks, the study sample may have included too few children with asthma to reflect smoke exposure's known role as an asthma trigger.

The researchers also calculated the potential costs associated with the need to care for children absent from school due to smoke-exposure related illness — costs including lost income for parents without paid time off, the costs to employers of the lost work, and the inability of caregivers not employed outside the home to take care of usual household tasks. "The total impact nationwide was $227 million in lost wages and household work for the families of the 2.6 million children living with smokers and for their employers," Levy says. "Since almost half of the smoking households in our study had low incomes, that impact may be strongest on households least able to afford it."

He adds, "The health impact of living with a smoker is probably more extensive than our study shows, since the survey only asked about three conditions associated with smoke exposure and we know there are several more. And since the absentee levels we report are averages, there are probably are kids who miss much more school because they live with smokers than our study found. More research is needed to help understand the long-term health, developmental and economic consequence of growing up in a home where people smoke." Levy is an assistant professor of Medicine at Harvard Medical School.

Nancy Rigotti, MD, of the Mongan Institute for Health Policy and the MGH Tobacco Research and Treatment Center is senior author of the Pediatrics report, and Jonathan Winickoff, MD, MPH, MassGeneral Hospital for Children is a co-author. The study was supported by grants from the Flight Attendant Medical Research Institute, the American Academy of Pediatrics, and the National Heart, Lung and Blood Institute.

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Journal Reference:

1. D. E. Levy, J. P. Winickoff, N. A. Rigotti. School Absenteeism Among Children Living With Smokers. Pediatrics, 2011; DOI: 10.1542/peds.2011-1067

State governments, including California as well as others in Canada and the United Kingdom, pour hundreds of millions of taxpayer dollars into major motion pictures that depict smoking — leading to thousands of new teen smokers every year, a University of California, San Francisco (UCSF) researcher has found.

According to a survey published in PLoS Medicine, those subsidies, along with government inaction on stricter ratings for movies that depict smoking, also promote youth smoking and undermine tobacco control efforts.

In California, approximately 70 percent of all released PG-13 movies subsidized under the state's program depict smoking, researchers have independently found.

"California's state film subsidy program is undermining its longstanding tobacco control efforts," said lead author Stanton Glantz, PhD, UCSF professor of medicine and director of the Smoke Free Movies Project based at UCSF. "These activities never made sense, but are even more remarkable at a time when health and education programs are being slashed."

"In addition to ending subsidies for films that promote smoking, modernizing the rating system to give smoking films an R rating will provide a market incentive for producers to keep smoking out of movies that they market to adolescents."

In the United States, 40 states offer a combined $1.3 billion in film and video "production incentives" to the film industry, the article reports citing data from 2008. The bulk of the annual funds come from five states: New York, California, Louisiana, Massachusetts, and Pennsylvania.

"These grants, commonly in the form of tax credits, cover 25 percent of Hollywood's day-to-day production costs," the study said. "TV series and undistributed low-budget film also draw from the subsidy pool."

In California, which has provided film subsidies since 2009, a bill currently pending would extend a state subsidy of $500 million for an additional five years. Health groups and the Tobacco Education and Research Oversight Committee, which advises California officials on tobacco-related issues, have urged that the bill be amended to make ineligible future film and TV productions with tobacco imagery or branding.

Previous studies have estimated that exposure to on-screen smoking accounts for 44 percent of all adolescent smokers in the United States, with more than one million teens nationwide currently smoking. Almost all of their exposure to smoking comes from films produced by U.S. studios.

About half of movies in the United States with smoking are rated "R" for other reasons, namely because of violent or sexual content or because of graphic language, meaning that they cannot be marketed directly to youth.

In Canada and the United Kingdom, however, most of these movies are re-rated as appropriate for teens or children, largely because of more permissive attitudes toward language and sex. As a result, youths in these countries experience greater exposure to onscreen smoking, suggesting that more Canadian or British youths may begin to smoke due to smoking in films than youths in the United States, the researchers conclude. In 2010, 45 percent of films with smoking were rated for youth in the United States, 93 percent in the UK, and 82 percent in Canada.

The World Health Organization and the federal Centers for Disease Control and Prevention also recommend that in the future films with smoking be given an adult rating (R in the U.S.).

In July, the CDC drew attention to the problem of state subsidies being provided to movies that promote smoking, advising that states harmonize their film subsidies with their public health imperatives by making productions with smoking ineligible for taxpayer subsidies.

Co-authors are Christopher Millet, PhD, a clinical senior lecturer at Imperial College London, and Jonathan R. Polansky, a consultant with Onbeyond LLC in Fairfax, California.

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Journal Reference:

1. Christopher Millett, Jonathan R. Polansky, Stanton A. Glantz. Government Inaction on Ratings and Government Subsidies to the US Film Industry Help Promote Youth Smoking. PLoS Medicine, 2011; 8 (8): e1001077 DOI: 10.1371/journal.pmed.1001077

Governments in the UK, US and Canada are undermining tobacco prevention campaigns by subsidising top-grossing US films that contain smoking, a report by public health researchers says. The paper, published in the open access journal PLoS Medicine, argues that films with tobacco imagery should be ineligible for public funding to ensure that film subsidy programmes do not conflict with public health goals.

Earlier research shows that young people who are heavily exposed to tobacco imagery in films are about three times more likely to begin smoking as lightly exposed youths. This evidence led the World Health Organisation to recommend in 2009 that future films with scenes of smoking be given an adult content rating, to create an economic incentive for producers to leave smoking out.

The report says that this recommendation has been largely ignored in the UK, US and Canada. Moreover, the governments in these countries help underwrite many films that promote youth smoking with generous public subsidies.

The researchers looked at subsidies given to the American film industry in the UK, US and Canada. They estimate that between 2003 and 2009, £338 million of tax credits in Britain went to US-produced films with tobacco imagery.

Out of the "high-grossing" films that had their tobacco content monitored, 66 per cent featured tobacco imagery. Over half (57 per cent) of the films containing smoking were rated U, PG or 12A, and only 8 per cent were given an 18 certificate.

In the UK, films that meet criteria for being "British" receive an effective tax relief of 16 per cent against their British spend, or 20 per cent if its budget is below £20 million. According to data from the UK Film Council, 144 films produced by American companies were certified "British" between 2003 and 2009, constituting 15 per cent of "British" films but, between 2006 and 2008, these took an estimated three-quarters of the value of available UK film subsidies.

Lead author Dr Christopher Millett, from the School of Public Health at Imperial College London, said: "In the period we looked at, the government gave £48 million a year in tax credits to American films that feature smoking, almost all of which were rated suitable for children and adolescents. By comparison, the government spent £23 million a year — less than half as much — on mass media anti-smoking campaigns.

"By promoting smoking in films, the government is seriously undermining tobacco control efforts. We think film subsidy programmes should be harmonised with public health goals by making films with tobacco imagery ineligible for public subsidies. This wouldn't cost anything to implement so in the current financial climate it should be an attractive policy option."

Martin Dockrell, Director of Research at Action on Smoking and Health, said: "The research is clear: the more a young person sees smoking in films the more likely they are to try smoking themselves. The effect is probably strongest in countries like the UK where conventional tobacco advertising has been stopped. Earlier this year the Government promised to look at what more could be done to tackle the role of TV and films in stimulating smoking among children. At the moment we have a film funding system that makes the problem worse, by investing millions in films made for young people that have the effect of encouraging them to smoke."

A public consultation on the rules governing EU member states' financial aid to the film sector is currently being undertaken by the European Commission. The consultation closes on 30th September 2011.

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Journal Reference:

1. Christopher Millett, Jonathan R. Polansky, Stanton A. Glantz. Government Inaction on Ratings and Government Subsidies to the US Film Industry Help Promote Youth Smoking. PLoS Medicine, 2011; 8 (8): e1001077 DOI: 10.1371/journal.pmed.1001077