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Behavioural science teaches us that people sometimes make seemingly irrational decisions, such as consuming tobacco despite knowing its deadly harms, because their decisions are manipulated by peripheral factors. Cues in their environment, like the barrage of tobacco depictions in films as glamorous and desirable, can push people towards a habit despite knowing its harms.

In India, as in other countries, product placement of tobacco in films increased when international and national regulations against the direct advertising of tobacco came into force. The tobacco industry now spends billions of dollars globally to carefully cultivate the image of tobacco use as glamorous, desirable and commonplace, through misleading depictions in film and TV.

Scientific studies have shown that exposure to such positive depictions has increased tobacco consumption, particularly among youth.

The problem is particularly acute in India. A study by the World Health Organization and the Health Ministry found that 76 percent of 1,000 movies made in India in one year depicted tobacco use. In terms of audience, around 15 million people see Bollywood films on a daily basis. In terms of influence, 52.2 percent of Indians who initiated tobacco use in childhood said they were influenced by cinematic depictions of tobacco. Indian students who are highly exposed to tobacco imagery in films have more than twice the risk of being a tobacco user as those with low exposure.

Youth are misled into thinking that tobacco use is normal, acceptable, socially beneficial and more common in society than it actually is.

To help counter this problem, in 2011 India implemented the “Film Rule”, under the Cigarettes and Other Tobacco Products Act 2003 (COPTA). TV programmes and films that show tobacco use must include messages – as flashing subtitles for the duration of the scene – that warn of tobacco’s harms, with anti-tobacco public service announcements (PSAs) shown before, during and after the broadcast itself. So the Film Rule, which is currently “under review” after lobbying from the film and tobacco industries, is helping to increase awareness and change attitudes regarding the real harms of tobacco use. Alongside graphic warnings, it is a critical tool in delivering information to populations with lower levels of literacy, who may not be reached by traditional health education campaigns.

Another, little-discussed aspect of the Film Rule is that it is giving a voice to a generation of young tobacco victims, empowering them to share their stories – their truth and the truth of many others in India today.

The tobacco industry effectively cocoons current and prospective tobacco users with soothing images of superstars smoking, which produces the deceptive comfort that the tobacco user, like the fictional characters on screen, is protected from the risk of disease and death.

The raw and real PSAs featuring victims of tobacco, currently broadcast under the Film Rule, pierce that bubble. They replace the glossy veneer that the industry seeks to peddle with the harsh reality of disfiguring disease and death, heartbreak among families and real economic loss in communities. And those PSAs, many developed by Vital Strategies, are produced to deliver the strongest possible impact while remaining respectful of the victim.

As we described in a paper published in the British Medical Journal publication, Tobacco Control , the PSAs are carefully developed in close concert with the victims, their families and their attending physicians. Each PSA is then tested among focus groups of tobacco users to ascertain if the message is clear and understood by those whom it seeks to save. Ultimately, we have found that it is critical to the victims themselves, and to tobacco users in the focus groups, that the true voice of the victim be heard, relating the actual pain of their suffering, and speaking their exhortations against others similarly falling prey to tobacco.

We must trust that the review of India’s Film Rule does not remove this vital tool from the armoury of our battle against the tobacco industry. The realities of tobacco must not be censored or sanitized.

We owe it to simply too costly.

India has the highest rate of oral cancers among young adults in the world. In a single year, tobacco-related illnesses cost our economy US$22.4 billion.

Today, tobacco causes 1.3 million deaths every year. Without urgent action, this toll is expected to rise to 8 million annually.

Rather than taking a backward step in revoking aspects of the Film Rule, India should be moving forward. Socially conscious TV and film industry professionals should be asking themselves whether tobacco needs to be in the picture. health professionals and tobacco victims would say it doesn’t.

And as we move towards a tobacco free world, depictions of tobacco use will look increasingly out of touch.

Dr. Nandita Murukutla, Vital Strategies

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