Smoking in Top-Grossing Movies --- United States, 2010

The National Cancer Institute has concluded that studies indicate a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation (1). Adolescents in the top quartile of exposures to onscreen tobacco incidents have been found to be approximately twice as likely to begin smoking as those in the bottom quartile (2). The 2010 U.S. Department of Health and Human Services strategic plan to reduce tobacco use includes reducing youth exposure to onscreen smoking (3). To monitor tobacco use in movies, Thumbs Up! Thumbs Down! (TUTD), a project of Breathe California of Sacramento-Emigrant Trails, counts occurrences of tobacco incidents in U.S. top-grossing movies each year. This report updates a previous report (4) with the latest TUTD findings. In 2010, the number of onscreen tobacco incidents in youth-rated (G, PG, or PG-13) movies continued a downward trend, decreasing 71.6% from 2,093 incidents in 2005 to 595 in 2010. Similarly, the average number of incidents per youth-rated movie decreased 66.2%, from 20.1 in 2005 to 6.8 in 2010. The degree of decline, however, varied substantially by motion picture company. The three companies with published policies designed to reduce tobacco use in their movies had an average decrease in tobacco incidents of 95.8%, compared with an average decrease of 41.7% among the three major motion picture companies and independents without policies. This finding indicates that an enforceable policy aimed at reducing tobacco use in youth-rated movies can lead to substantially fewer tobacco incidents in movies and help prevent adolescent initiation of smoking.

TUTD uses persons trained as monitors to count all tobacco incidents in those movies that are among the 10 top-grossing movies in any calendar week. During 2002--2008, U.S. movies that ranked in the top 10 for at least 1 week accounted for 83% of all movies exhibited in the United States and 96% of ticket sales. For this analysis, TUTD defined a tobacco incident as the use or implied use of a tobacco product by an actor. A new incident occurred each time 1) a tobacco product went off screen and then back on screen, 2) a different actor was shown with a tobacco product, or 3) a scene changed, and the new scene contained the use or implied off-screen use of a tobacco product. The number of movies without tobacco incidents was divided by the total number of movies to calculate the percentage of movies with no incidents, and the average number of tobacco incidents per movie was calculated for each motion picture company. Results in 2010 were compared with 2005 and analyzed by motion picture company and by whether the company had a published policy aimed at decreasing the depiction of smoking in its movies.

In 2010, a total of 75 (54.7%) of 137 top-grossing movies had no tobacco incidents, compared with 49 (33.3%) of 147 in 2005; among R-rated movies, 14 (29.2%) of 48 had no tobacco incidents in 2010, compared with two (4.7%) of 43 in 2005. Among youth-rated movies (G, PG, or PG-13), 61 (69.3%) of 88 had no tobacco incidents in 2010 (Table), compared with 47 (45.2%) of 104 in 2005.

From 2005 to 2010, the total number of tobacco incidents in top-grossing movies decreased 56.0%, from 4,152 to 1,825. The total number of incidents in G or PG movies decreased 93.6%, from 472 to 30, whereas the number in PG-13 movies decreased 65.1%, from 1,621 to 565, and the number in R-rated movies decreased 40.5%, from 2,059 to 1,226 (Figure 1).

From 2005 to 2010, among the three major motion picture companies (half of the six members of the Motion Picture Association of America [MPAA]) with policies aimed at reducing tobacco use in their movies, the number of tobacco incidents per youth-rated movie decreased 95.8%, from an average of 23.1 incidents per movie to an average of 1.0 incident. For independent companies (which are not MPAA members) and the three MPAA members with no antitobacco policies, tobacco incidents decreased 41.7%, from an average of 17.9 incidents per youth-rated movie in 2005 to 10.4 in 2010, a 10-fold higher rate than the rate for the companies with policies (Table, Figure 2). Among the three companies with antitobacco policies, 88.2% of their top-grossing movies had no tobacco incidents, compared with 57.4% of movies among companies without policies (Table).

Reported by

Stanton A. Glantz, PhD, Univ of California, San Francisco; Shelley Mitchell, Kori Titus, Breathe California of Sacramento-Emigrant Trails; Jonathan R. Polansky, Onbeyond, Fairfax, California. Rachel B. Kaufmann, PhD, Ursula E. Bauer, PhD, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Stanton A. Glantz, glantz@medicine.ucsf.edu, 415-476-3893.

Editorial Note

The findings in this report indicate continuing progress toward the U.S. Department of Health and Human Services goal of reducing youth exposure to onscreen smoking (3). Across all MPAA rating categories, the percentages of 2010 top-grossing movies with no tobacco incidents were the highest observed in 2 decades (4). The decreased presence of onscreen smoking might have contributed to the decline in cigarette use among middle school and high school students (5,6). A 2010 meta-analysis of four studies attributed 44% of youth smoking initiation to viewing tobacco incidents in movies (2). Smoking and smokeless tobacco use usually are initiated during adolescence (7).

This report is the first to compare differences in onscreen tobacco incidents by major motion picture companies with and without published policies aimed at reducing tobacco use in their movies. These policies, adopted during 2004--2007 by three companies, provide for review of scripts, story boards, daily footage, rough cuts, and the final edited film by managers in each studio with the authority to implement the policies. However, although the three companies have eliminated depictions of tobacco use almost entirely from their G, PG, and PG-13 movies, as of June 2011 none of the three policies completely banned smoking or other tobacco imagery in the youth-rated films that they produced or distributed.

The findings in this report are subject to at least two limitations. First, the policies on smoking in movies took effect at different times for different motion picture companies. When the policies came into force, many movies were already in production, a process that typically takes several years. By 2010, all movies released by the three companies with published policies aimed at reducing tobacco use had entered production after the policies were promulgated. Second, motion picture companies were under growing antitobacco pressure from public health organizations, state health departments, and state attorneys general beginning in 2001, which might account, in part, for the decrease in onscreen tobacco incidents after 2005, even before two of the three major motion picture companies had adopted their policies.

This study demonstrates the practicality of enacting policies to reduce tobacco incidents in youth-rated movies. The findings also indicate that those major motion picture companies with antitobacco policies had the greatest success in reducing tobacco incidents in their movies.

The World Health Organization (8) and numerous public health and health professional organization have recommended giving movies with tobacco incidents an R rating, with two exceptions: those movies that portray a historical figure who smoked and those that portray the negative effects of tobacco use. Adoption of this policy could further reduce tobacco incidents in youth-rated movies. However, this policy would not affect youth exposure to older movies that have already been released and are available as downloads, rentals, and on television. Because of this and because youths do view some R-rated movies (9), removing tobacco incidents from youth-rated movies going forward will not completely eliminate youth exposure to smoking in movies. Therefore, antitobacco ads are recommended for showing before movies that depict smoking (3). Other recommended policies include certifying no payments for depicting tobacco use and ending depiction of tobacco brands (9).

Almost all states offer movie producers subsidies in the form of tax credits or cash rebates to attract movie production to their states, totaling approximately $1 billion annually. The 15 states subsidizing top-grossing movies with tobacco incidents spent more on these productions in 2010 ($288 million) than they budgeted for their state tobacco-control programs in 2011 ($280 million) (10). State and local health departments could work with state policy makers to harmonize their state movie subsidy programs with their tobacco-control programs by limiting eligibility for subsidies to tobacco-free movies.

More efforts are needed to reduce initiation of smoking among youths. Monitoring 1) the success of policies in reducing tobacco incidents in youth-rated movies and 2) the impact of incident reductions on youth smoking behavior helps assess and guide efforts to protect youths from tobacco addiction.

References

1. National Cancer Institute. Tobacco control monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2008. Available at http://www.cancercontrol.cancer.gov/tcrb/monographs/19/index.html. Accessed July 11, 2011.
2. Millett C, Glantz SA. Assigning an '18' rating to movies with tobacco imagery is essential to reduce youth smoking. Thorax 2010;65:377--8.
3. US Department of Health and Human Services. Ending the tobacco epidemic: a tobacco control strategic action plan for the U.S. Department of Health and Human Services. Washington, DC: US Department of Health and Human Services; 2010. Available at http://www.hhs.gov/ash/initiatives/tobacco/tobaccostrategicplan2010.pdf. Accessed July 11, 2011.
4. CDC. Smoking in top-grossing movies---United States, 1991--2009. MMWR 2010;59:1014--7.
5. CDC. Tobacco use among middle and high school students---United States, 2000--2009. MMWR 2010;59:1063--8.
6. CDC. Cigarette use among high school students---United States, 1991--2009. MMWR 2010;59:797--801>.
7. US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 1994. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/1994/index.htm. Accessed July 11, 2011.
8. World Health Organization. Smoke-free movies: from evidence to action. Geneva, Switzerland: World Health Organization; 2009. Available at http://www.who.int/tobacco/smoke_free_movies/en. Accessed July 11, 2011.
9. Sargent JD, Tanski SE, Gibson J. Exposure to movie smoking among US adolescents aged 10 to 14 years: a population estimate. Pediatrics 2007;119:e1167--76.
10. Millett C, Polansky J, Glantz S. Government inaction on ratings and government subsidies to the US film industry help promote youth smoking. PLoS Medicine. In press.