As far as we have come in the 50 years since the U.S. Surgeon General first warned of the dangers of smoking, many obstacles remain.
More laws banning smoking would help. So would higher taxes. Support for both could be achieved with wider awareness of how severely nonsmokers are affected by cigarettes: Secondhand smoke causes up to 75,000 deaths from heart disease and up to 129,000 heart attacks each year, while long-term exposure can hike risk for coronary heart disease by 30 percent.Lucky Strike Click&Roll
As the nation's largest heart-health organization, the American Heart Association is committed to making a difference. We have worked with the American Cancer Society, American Lung Association, Americans for Non-Smokers Rights, the Campaign for Tobacco-Free Kids, and many more to continue battling the leading preventable cause of death: tobacco use.
Another part of the ongoing battle is Hollywood's continued glamorization of smoking. Every time a star lights a cigarette, a negative message is sparked.
That is the subject of the rest of this column, penned by leaders of Legacy, the nation's largest public health foundation devoted to the issue of tobacco use prevention and cessation. Legacy was created as part of the 1998 Master Settlement Agreement between the major tobacco companies, 46 U.S. states, the District of Columbia and five U.S. territories, and I proudly serve on Legacy's board of directors.
While their focus is on one recent commercial, it clearly shows a systematic pattern that is far more part of the problem at a time when we could use more solutions.
The first "House of Cards" Season 2 trailer released by Netflix last month reveals very little about the upcoming season: no dialogue, no indication of future plot lines, not even the title of the show. The promo, in black and white, is simply 30 seconds of Robin Wright smoking a cigarette.
In recent years, we have seen some promising trends in the portrayal of smoking in entertainment media, including a decline in tobacco use in top-grossing movies from 2005-2010. However, smoking imagery in movies and TV shows, including those popular among youth and young adults, persists, and "House of Cards," a Netflix-original show and the epitome of Internet-age television, is yet another alarming example.
Decades of research have shown that smoking imagery in television and movies influences youth uptake of smoking. The National Cancer Institute (NCI) has concluded that there is evidence for a causal relationship between exposure to smoking imagery in movies and youth smoking initiation, with studies showing that youth with the most exposure to onscreen tobacco imagery are about twice as likely to start smoking.
The portrayal of smoking in the "House of Cards" episodes and its recent trailer is of serious public health concern, especially given the series' popularity and accessibility to anyone with a Netflix account, which ensures broad exposure to smoking imagery. Within just 12 days of the show's launch early this year, a Cowen research survey indicated 10 percent of Netflix subscribers had watched the show. With Netflix subscribers in the U.S. at 31.1 million and rising, the number of smoking depictions from the show -- and, now, its second-season trailer -- may total well into the millions.
The trailer's sole focus on one of its main characters smoking is indicative of how deeply smoking is part of the identity of the show. At the end of each day, Washington, D.C. power couple Frank and Claire Underwood share a cigarette, a symbol of intimacy in their relationship. This sharing of a cigarette by characters who do not smoke otherwise ignores the reality of the powerful addictive nature of cigarettes. Rather, smoking is portrayed as a bridge to intimacy and stress relief -- ironic, given the toll of tobacco-related disease. Also disturbing is that the Underwoods reflect modern-day, high-income, influential individuals, displaying one of the most positive portrayals of smoking in recent entertainment history (excluding examples such as "Mad Men," which reflect historically high rates of smoking). Media coverage of the unusual trailer helps further perpetuate positive perceptions of smoking, with headlines such as AdWeek's "Netflix promo leaves you craving more" and the popular blog We Got This Covered's "Robin Wright is smoking hot in first teaser for `House of Cards' Season 2."
Unlike what is portrayed on the show, smoking is addictive, extraordinarily harmful and has a disproportionate impact on those with low incomes and limited education. Although the smoking rate in the U.S. has reduced by more than half since the 1960s, tobacco-related disease still kills more than 430,000 people each year. Approximately 88 percent of adults who smoke started smoking before the age of 18, making the teenage years a critical time in which initiation can be influenced by different factors, including smoking on TV shows.
Despite 50 years of social norm change since the U.S. Surgeon General released the first landmark Report on Smoking and Health in 1964, this kind of promotion threatens to normalize a product that kills more Americans than AIDS, alcohol, car accidents, murders, suicides, drugs and fires combined.
Given the conclusive evidence that smoking imagery portrayed across entertainment media impacts youth and young adult smoking initiation, positive portrayals of tobacco use threaten to reverse the critical progress the U.S. has made over the past five decades in reducing smoking. We call on Netflix and others in the entertainment industry to minimize the mythology around smoking -- it's a deadly addiction, and there's nothing glamorous about that.
Greater Sudbury will have some of the toughest anti-smoking rules in the province later this year, when a bylaw tighten the city’s anti-tobacco rules is ready for approval.
Meeting Tuesday, city councillors easily approved two measures further restricting where you can legally smoke a cigarette. Following a presentation by the Sudbury and District Health Unit, council passed resolutions directing staff to prepare laws banning smoking on city property, as well as on outdoor bar patios. Galaxy Astatium
Facilities such as Pioneer Manor are exempt – it’s covered by provincial legislation -- and certain areas in municipal parking lots will be designated for smokers. Also, the city can’t ban smoking in cars, sidewalks or on roadways.
But places such as libraries, arenas, citizen service centres and city hall would be covered by the ban.
In response to a question, Francine Brunet-Fechnera, a nurse with the health unit, agreed some people won’t be happy with the new rules.
“There’s always some resistance to change -- it’s part of human nature,” Brunet-Fechnera said.
But the health benefits are worth the challenges, which include enforcing the ban over several more areas. Ward 9 Coun. Doug Craig asked where smokers at city rinks could smoke.
“Where will these people go?” Craig asked.
He was told smoking is still legal on sidewalks, although the status of outdoor patios that sit on sidewalks was less certain and would be covered in the language when the bylaw is ready later this year.
Ward 1 Coun. Joe Cimino was concerned about enforcement, in particular, how it would be done and who will be in charge of it. Violators will face warnings and fines for breaking the new rules. Since bylaw enforcement is usually complaint-driven, Cimino wondered how staff would be able to respond to complaints.
But Ward 7 Coun. Dave Kilgour said similar concerns were raised a decade ago when the smoking ban was extended to bars. But “peer pressure” proved to be extremely effective, he said.
“Someone will likely mention it, or you will get a dirty look,” Kilgour said. “If there are problems, you deal with them as they come up.”
“Most people are pretty good to comply,” said Ward 10 Coun. Frances Caldarelli. “The more areas we can make smoke-free, the better.”
Greater Sudbury Mayor Marianne Matichuk says it would be key to engage affected staff in implementing new rules, to keep them informed, and of the options available to them to help them quit.
“It’s important for staff to be part of the process,” Matichuk said.
The tougher rules follow approval in June 2013 of a bylaw banning smoking in city parks and sporting fields. Following that process, councillors directed staff to explore extending the ban to all municipal buildings. In conjunction with the health unit, they also agreed to look at the outdoor patio ban.
In a June presentation to city council, Michael Perley, head of the Ontario Campaign for Action on Tobacco, said there’s a perception that outdoor patios don't affect anyone other than the smokers. In fact, he said, they are a workplace for bar and restaurant staff, and significant amounts of second-hand smoke drifts indoors.
“It makes what should be smoke-free indoor premises, smoking premises,” Perley said. “Brief exposure to second-hand smoke can trigger health events like heart attacks and asthma attacks.”
While smoking rates in Sudbury have fallen significantly over the last 10 years, 18 per cent of adults smoke, significantly higher than Ontario's overall rate of 12 per cent. Cities like Kingston, Thunder Bay and Ottawa have already banned smoking in outdoor patios, Perley said in June, and Toronto is expected to follow suit soon.
As governing bodies nationwide debate the use of electronic cigarettes, and whether they should be allowed in non-smoking areas, the issue remains in a fairly gray area in Temple.
The City Council tightened Temple’s smoking ordinance in December 2012. The ordinance prohibits smoking in bowling alleys, indoor entertainment facilities and city parks, and mandates hotel and motel owners to limit smoking to 25 percent of their rooms. The ordinance also increased the percentage of alcohol sales needed for a business to allow smoking to 50 percent; the previous ordinance permitted establishments in which alcohol made up 45 percent of sales to allow smoking.