January 28, 2014

Stanton A. Glantz, PhD

Summary of key points on smoking in the movies in the 2014 Surgeon General's report

Portrayals of tobacco use in U.S. films appear to have rebounded upward in the past 2 years (Chapter 14). In 2012, youth were exposed to an estimated 14.9 million in-theater tobacco use impressions in youth-rated films (Polansky et al. 2013).  Youth who are exposed to images of smoking in movies are more likely to smoke; those who get the most exposure to onscreen smoking are about twice as likely to begin smoking as those who get the least exposure (USDHHS 2012). [Exec Summary page 15]
 
Actions that would eliminate the depiction of tobacco use in movies, which are produced and rated as appropriate for children and adolescents, could have a significant effect on preventing youth from becoming tobacco users. [Exec Summary, page 15]
 
After the broadcast advertising ban [in 1971], ciga­rette advertising and marketing continued to grow, but shifted to print publications, outdoor billboards, sponsor­ship of sports, placement of brand implants in movies, and a number of other methods.  [page 26]
 
In 1964, tobacco companies were major sponsors of popular television shows on all three television networks (Pollay 1994). These companies also arranged for product place­ments in movies, and other entertainment media, to increase the social image of smoking as popular, sophis­ticated, and classy (Mekemson and Glantz 2002; USDHHS 2012). As reviewed in previous [Surgeon General] reports, the tobacco com­panies have viewed the movie industry as an opportunity for advertising as far back as the Nickelodeon era when movies were silent, cost only a nickel, and ad slides played between reels (USDHHS 2012).  [page 774]
 
..  [T]he number of tobacco incidents increased between 2002–2005, then declined from 2005–2010 and rebounded in 2011 and 2012 (Figure 14.3A). [page 775]
 
While R-rated films on average include more smok­ing than PG-13 films, youth are much less likely to view R-rated films than PG-13 films; as a result, youth receive about three times the absolute exposure to smoking images from PG-13 films than R-rated films (Sargent et al. 2012). In 2012, impressions delivered by youth-rated movies comprised 56% (14.9 billion/26.5 billion) of all in-theater tobacco impressions (Polansky et al. 2012). [page 775]
 
The 2012 Surgeon General’s report concluded that there is a causal relationship between depictions of smok­ing in movies and initiation of smoking among young people (USDHHS 2012). [page 775]
 
As many forms of direct advertising and promotion of tobacco products have been curtailed, it has been noted that the entertainment media are among the few remain­ing channels for transmission of aspirational images of smoking to large audiences (Kline 2000). The billions of impressions of tobacco use that movies deliver (Figure 14.3B), combined with the fact that conventional cigarette advertising on television and radio has been banned since 1971, and billboards banned and other forms of cigarette advertising directed at youth severely restricted since 1999 by the [Master Settlement Agreement], emphasizes the importance of onscreen smoking in the movies as one of the largest remaining unrestricted traditional media channels promoting smok­ing and tobacco use to youth.  [page 797]
 
Evidence from tobacco company documents has provided confirmation of a com­mercial relationship between the tobacco industry and film studios that began in the 1920s and continued into the 1970s after cigarette advertising was banned on televi­sion (Mekemson and Glantz 2002; Lum et al. 2008). [page 797]
 
Based on the findings in the 2012 Surgeon General’s report that there is a causal rela­tionship between the depictions of smoking in the movies  it appeared that voluntary policies by three of the major motion picture studios had all but eliminated smoking from their youth-rated films [in 2010]. It has been suggested that controlling for rating, budget and other factors, on average movies with smoking make less money than smokefree movies (Glantz and Polansky 2011). However, data from 2011 and 2012 (Figure 14.3A) suggest that this decline has reversed (Glantz et al. 2012; McAfee and Tynan 2012).  [pages 797-8]
 
… [Y]outh who are exposed to images of smoking in movies are more likely to smoke; those who get the most exposure to onscreen smoking are about twice as likely to begin smoking as those who get the least exposure (USDHHS 2012). [page 818]
 
Because youth and young adults continue to be heavily exposed to protobacco media —including images of smoking in movies, adver­tising, and promotion — public education campaigns are needed to prevent tobacco use initiation and to promote cessation (CDC 2007; USDHHS 2012). [page 818]
 
In addition, because smoking in movies is such a major source of protobacco media exposure, if smoking in PG-13-rated movies was reduced to the fifth percentile of exposure, youth smoking rates could be reduced by 18% (Sargent et al. 2012). The magnitude of this effect would be similar to an increase in the price of cigarettes from about $6.00 per pack to over $7.50 average price. [page 818]
 
… [S]ince onscreen smoking imagery continues in home media (e.g., broadcast, cable, satellite, and on-demand; on DVD and Blu-ray and on streaming media), there is a con­tinuing need for public education campaigns to prevent tobacco use initiation.  [page 818]
 
Many factors are responsible for the rapid increase of cigarette smoking, but the tobacco industry was the central driver (see Chapter 2) through: (1) development of industrial technology enabling cigarette mass produc­tion, packaging, and distribution (USDHHS 2000b); (2) aggressive pricing and marketing combined with positive portrayals of cigarettes in movies—and endorsements by movie stars, sports idols, and even physicians ...  [page 846]
 
Adolescents are highly vulnerable to tobacco indus­try marketing, smoking imagery in movies, and peer influ­ence, and are not fully able to appreciate the health risks they face in the future (USDHHS 2012b).  [page 846]
 
The pace of social norm change could be slowed by the recent increase in the level of tobacco depictions in top-grossing U.S. movies (see Chapter 14, Figures 14.3A and 14.3B) and the aggressive marketing and promotions for electronic cigarette brands (U.S. House of Representatives 2013).  [page 852]
 
As reviewed in Chapter 14, the portrayals of tobacco use in U.S. films appear to have rebounded upward in the last 2 years (see Chapter 14, Figures 14.3A and 14.3B). Based on box office attendance data, it has been estimated that youth were exposed to 14.9 billion in-theater tobacco-use impressionsin youth-rated films in 2012. Youth who are exposed to images of smoking in movies are more likely to smoke; those who experience the most exposure to onscreen smoking are approximately twice as likely to begin smoking as those who receive the least exposure (USDHHS 2012). Actions that would eliminate depiction of tobacco use in movies that are produced and rated as appropriate for children and adolescents could have a significant benefit in reducing the numbers of youth who become tobacco users. It has been suggested that the movie industry modernize the Motion Picture Association of America voluntary rating system to eliminate smoking from youth-rated films by awarding any film with smoking or other protobacco imagery an R rating (with exceptions for real historical figures who actually smoked or films that actually depict the dangers of smoking or exposure to secondhand smoke) (Glantz and Polansky 2012; Sargent et al. 2012). Further, if such a change in the Motion Pic­ture Association of America rating system would reduce in-theater exposures from a current median of about 275 annual exposures per adolescent from PG-13 movies down to approximately 10 or less, adolescent smoking would be reduced by an estimated 18% (95% confidence interval, 14–21%) (Sargent et al. 2012).  [page 872-3]
 
If smoking persists at the current rate among young adults in this country, 5.6 million of today’s Americans younger than 18 years of age are projected to die prematurely from a smoking-related illness (Chapter 12). [Exec Summary, page 1]
 
Combining these two facts leads to the conclusion that an R-rating for movies with smoking would avert one million tobacco deaths among today’s children and adolescents.
 
The full 2014 Surgeon General Report is available at http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html
 
For more on Smokefree Movies and the Surgeon General's reports, go to http://smokefreemovies.ucsf.edu/godeeper/Surgeon_General-2014.html

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