Clearing the on-screen air

What do movies like "Click," "X-men: The Last Stand" and "A Prairie Home Companion" have in common? They were all recently in theaters and are now finding an even bigger audience on DVD. They all feature Hollywood stars who appeal to young people -- between them these movies feature Adam Sandler, Halle Barry and Lindsay Lohan. They all are rated PG-13. And they all project images of cigarette smoking.

It's that last fact that public health officials and anti-tobacco advocates would like to reverse.

According to the Smokefree Movies Action Network, these are just a few recent examples -- 75%of PG-13 rated films and 40% of those rated G and PG include images of smoking.

The figures are particularly problematic when combined with other findings. Researchers from the Dartmouth Medical School and Norris Cotton Cancer Center conducted a landmark 2003 study and a follow-up that was published last year in Pediatrics and suggested that movie smoking accounts for smoking initiation among more than one-third of U.S. teens. They conclude that limiting the amount of such images seen by young people could have important public health implications. The World Health Organization also found a direct relationship between children's exposure to tobacco use via the big screen and lighting up for the first time. And of course, for some, this puff will become a habit.

That's where the Screen Out! campaign comes in. Launched in July, the initiative -- an effort of the Smokefree Movies Action Network -- is backed by the American Medical Association and a number of other public health organizations. Its goal is to eliminate smoking from youth-rated films. And physicians, both as health professionals and, often, as parents, should embrace it.

The campaign calls on the movie industry to take steps to ensure that films do not promote tobacco use. Among them is applying an "R" rating to any movie that shows or implies tobacco use without presenting its dangers. The AMA, a long-standing anti-smoking advocate, has policy that encourages such a rating.

But there is also an important role for parents and community groups. A Screen Out! guide is available to help them understand the influence of movies on kids' health decisions and provide tools to make the right entertainment choices. Moreover, the campaign includes information on its Web site that tells which current movies include smoking. It is not only a useful guide to parents, it puts the motion picture industry on notice that this issue isn't going away.

The AMA Alliance, a network of more than 25,000 spouses of physicians, has appropriately stepped forward to help advance the cause. It will not only be actively involved in the distribution of the guide but also in supporting the campaign's principles as they are further developed and implemented. And the importance of these tasks gained the Alliance a half-million-dollar check to assist in financing the effort. The grant, which was made by the American Legacy Foundation, an anti-tobacco organization formed in 1999 as a result of the Master Settlement Agreement between state attorneys general and the tobacco industry, was officially awarded to the Alliance last month.

A study published in the Nov. 7 Morbidity and Mortality Weekly Report underscores the urgency in reining in this, and any other, inducement to start smoking. These new data from the Centers for Disease Control and Prevention indicate that recent reductions in U.S. adult smoking rates might have stalled, illustrating the difficulties people face in trying to stop once they start.

Between 2004 and 2005, there was no observed change in U.S. adult smoking rates, and today 45.1 million people in the United States are current smokers.

It's not as though they haven't tried to overcome this addiction. Forty-two percent of them -- 19.2 million people -- stopped smoking for at least one day during the past year because they were trying to quit. One bright spot: Among those who had ever smoked, 50.8% -- 46.5 million people -- were able to quit. That percentage also is unchanged since 2004.

By now, most adults understand that tobacco use has serious consequences. Tobacco is the No. 1 preventable cause of death and disease in the United States.

But young people are often more likely to heed other messages -- especially when they are couched in an aura of hipness. That's why protecting these kids from the images that purvey such notions is critical.