Campaign aims to snuff out on-screen tobacco use

The AMA and other health advocacy groups view the Screen Out! effort as a way to curb the number of young people who start smoking.

By Susan J. Landers — Posted Aug. 21, 2006

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Every time movie stars -- especially Hollywood's young, hip and cool -- play characters that light up cigarettes on the silver screen, the risk becomes greater that teenagers and even younger children will emulate that behavior.

Studies, for instance, indicate that viewing tobacco use in movies persuades at least half of new, young smokers in the country to try it for themselves.

To turn this tide, several health advocacy groups, including the AMA, on July 13 launched Screen Out!, a campaign to eliminate smoking from youth-rated films. Given that tobacco is responsible for the deaths of 440,000 Americans annually and about 80% of smokers begin by age 18, the groups consider obstructing these images to be a public health imperative.

A project of the Smokefree Movies Action Network, Screen Out! is going after studios that allow tobacco use in their films. It is particularly targeting productions likely to be seen by young teens. About half of exposure to on-screen smoking occurs in R-rated films, according to recent research, but the other half occurs in movies rated G, PG and PG-13, which are ostensibly intended to attract young viewers. "The Chronicles of Narnia," the "Bad News Bears" and "Bee Season" are among the latter category.

The group wants parents to urge studios to eliminate smoking from films for children and young teens and to keep their children away from R-rated movies.

Smokefree Movies was started by Stanton A. Glantz, PhD, professor of medicine at the University of California, San Francisco, and a long-time anti-smoking advocate. After years of trying to persuade studio heads to leave tobacco use on the cutting room floor, little progress has been made, said Dr. Glantz, who spoke at a briefing on the project during the 13th World Conference on Tobacco OR Health, held last month in Washington, D.C.

In addition to the AMA, Screen Out! is endorsed by the American Heart Assn., the State of New York Dept. of Health and the American Legacy Foundation, a smoking cessation group formed with funding from the 1998 Master Settlement Agreement between state attorneys general and the tobacco industry.

A Screen Out! guide is available to help parents and community groups understand the influential role that movies play in children's health decisions and to provide information that can be used to bring the issue to the attention of the studios, said Dr. Glantz, who also directs the university's Center for Tobacco Control Research and Education.

The guide will be distributed by members of the AMA Alliance, a nonprofit health advocacy network of more than 25,000 spouses of physicians, said Stephen Havas, MD, MPH, AMA vice president for Science, Quality and Public Health, who also spoke at the briefing.

A powerful influence

"Sadly, many producers excuse themselves from their role in teen smoking, citing artistic necessity and ignoring the health threats their films pose to millions of America's children," said Dr. Havas.

But the power of on-screen smoking can't be overlooked, briefing participants said. "Research continues to prove the link between young people seeing smoking in movies and starting to smoke," said Cheryl Healton, DrPH, president and CEO of the American Legacy Foundation.

The Centers for Disease Control and Prevention reports that children whose favorite actors have smoked in three or more of their recent films are 16 times more likely to feel positively about smoking -- making them much more likely to start smoking themselves. The World Health Organization found a direct relationship between children's exposure via the big screen and how many start to smoke: the more they see, the more likely they are to try it.

Children often watch several movies a week, multiplying their exposure many times over, said James Sargent, MD, a pediatrician and professor at Dartmouth Medical School in Hanover, N.H., and director of cancer control at the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center. He also spoke at the briefing.

The project guide draws on findings from studies conducted by Dr. Sargent and his colleagues and funded by the American Legacy Foundation and the National Cancer Institute.

To examine the prevalence of smoking in movies, the Dartmouth researchers studied the 100 highest-grossing movies each year from 1996 to 2004 and found that although smoking in movies was declining overall, it was still present in more than three-quarters of films rated acceptable for viewing by children and young teens.

"While we do see a downward trend in movie smoking, which is encouraging from a public health perspective, we need to remember that youths continue to see smoking in most of the movies they see," said Dr. Sargent. The researchers also found more smoking in films rated G, PG and PG-13 than in R-rated films.

Their research is published in the report, "Trends in Top Box Office Movie Tobacco Use 1996 -- 2004."

The importance of focusing prevention efforts on teens was supported by separate research findings released at the World Tobacco Conference. A survey conducted by the Roswell Park Cancer Institute in Buffalo, N.Y., found that 64% of teen and young adult smokers said they had tried to quit in the previous year.

"This population is such a critical group," said Gary A. Giovino, PhD, director of the Tobacco Control Research Program at the institute. "They are very susceptible to the marketing of cigarettes through advertising. And once they start experimenting with tobacco, they become addicted very quickly."

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Tobacco close-up

Although the proportion of movies depicting tobacco use declined from 96% in 1996 to 77% in 2004, tobacco continued to have a presence in the majority of films. A survey examining the top 100 box office hits in those years and the influence on teens of on-screen smoking also found:

  • Tobacco use is still depicted in three-quarters of youth-rated movies and 90% of R-rated movies.
  • The amount of tobacco use or imagery (whether measured as a count of occurrences or as hours of screen time) in youth-rated movies has remained relatively stable since 1996. However, researchers noted that this may be explained by the downward ratings creep in which a higher percentage of movies each year were rated in the youth category.
  • In 2004, 74% of all top box office hits were youth-rated, compared with 51% in 1997. In 2004, 56% of smoking occurrences were portrayed in youth-rated movies, up from 31% in 1997.
  • Smoking in youth-rated movies reaches more adolescents because these are seen by three times as many young people as R-rated movies.

Source: "Trends in Top Box Office Movie Tobacco Use, 1996-2004," American Legacy Foundation

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External links

Smokefree Movies Action Network for Screen Out! guide (link)

American Legacy Foundation (link)

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