Where there’s smoke, there’s … probably a PG-13 rated movie.
A new study shows that tobacco incidents depicted in top-grossing movies in the United States are once again on the rise, breaking an earlier decline.
This is true despite public health efforts outside theaters to reduce smoking by children and teens.
“If the progress that we had seen between 2005 and 2010 had continued, all of the youth-rated films would have been smoke-free in 2015,” said study author Stanton Glantz, PhD, professor of medicine, and director of the University of California San Francisco (UCSF) Center for Tobacco Control Research and Education.
The July 7 study in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) found that the total number of tobacco incidents in top-grossing movies increased 72 percent between 2010 and 2016. It also increased 43 percent in PG-13 movies.
Tobacco incidents are defined as use or implied use, by an actor, of cigarettes, cigars, pipes, hookah, smokeless tobacco products, or electronic cigarettes.
This increase comes as the number of movies showing tobacco declined — meaning fewer movies account for a greater number of tobacco scenes.
In 2016, 41 percent of the top-grossing movies had tobacco incidents, down from 45 percent in 2010. In addition, 26 percent of youth-rated movies had tobacco incidents in 2016, a decline from 31 percent in 2010.
Tobacco incidents in top-grossing movies peaked in 2005. The lowest number of tobacco incidents on record occurred in 1998.
Tobacco depictions are now rare in PG and G movies — only four of these films in 2015 included tobacco use.
The study was a collaboration between UCSF, the Centers for Disease Control and Prevention (CDC), and Breathe California of Sacramento-Emigrant Trails, which provided the data.
The potential harm
Like on-screen violence, tobacco depicted in youth-rated movies can have a profound effect on children and teens.
“It’s very concerning because five years ago in 2012 the surgeon general concluded that exposure to smoking on-screen in movies causes kids to start smoking,” Glantz told Healthline.
There’s also a dose-response — the more often kids see tobacco use depicted in movies, the more likely they are to pick up the habit.
According a National Cancer Institute (NCI) report, youths who are heavily exposed to smoking depicted in movies are two to three times more likely to start, compared with kids who have little exposure.
“An increase in the amount of exposure means that more kids are going to be smoking and dying from tobacco-induced diseases,” said Glantz.
Tobacco use is linked to lung cancer, mouth cancer, emphysema, and other diseases.
The NCI report also cited studies showing that cigarette smoking in movies can influence adults’ and teens’ beliefs about smoking.
For example, when stars are shown smoking, or when the health consequences of tobacco don’t show up in the film, viewers may develop pro-smoking beliefs and intentions.
What’s causing the increase?
The increase in the number of on-screen tobacco incidents since 2010 runs counter to overall smoking trends in the United States.
According to the CDC, overall smoking rates in adults have been falling for decades, and in high school students since the late 1990s.
The researchers write that starting in 2001 public health officials became more concerned about tobacco use in movies. This might account for the decline of tobacco incidents in youth-rated movies between 2005 and 2010.
So what has shifted in recent years?
Some public health experts put the blame squarely on the motion picture companies that continue to produce youth movies depicting smoking.
“I think the [public health] messaging is fine,” said Glantz. “It’s been the recalcitrance on the part of the media companies to act responsibly and protect kids.”
The major studios have policies to help reduce the amount of smoking in movies that they release, but all of the polices have what Glantz calls “loopholes.”
Paramount Pictures “discourages” depiction of tobacco use in youth-rated films, but also takes into account the “creative vision of the filmmakers.”
Universal Pictures “presumes that no smoking incidents should appear” in youth-rated films, but leaves it as an option if there is a “substantial reason for doing so.”
Modernizing movie rating system
Currently, the Motion Picture Association of America (MPAA), which rates movies in the United States, has a smoking “rating descriptor” that is supposed to alert viewers and parents to tobacco use in a film.
However, this descriptor was missing from 89 percent of top-grossing, youth-rated movies that depicted tobacco use, according to a 2015 report by the UCSF Center for Tobacco Control Research and Education.
Public health experts are calling for a more consistent approach.
“The six studios that control the rating system through the MPAA need to modernize the rating system to reflect the science,” said Glantz, “and give an R-rating for smoking, which would get it out of all the youth-rated movies.”
A 2012 study in the journal Pediatrics estimated that this could reduce the number of teen smokers by 18 percent.
A related CDC fact sheet estimated that this change would save the lives of a million youth.
Advocacy group Smokefree Movies recently ran a two-page statement in The Hollywood Reporter and Variety demanding that MPAA update the rating system by June 1, 2018.
The statement was signed by the American Academy of Pediatrics, the American Heart Association, and other health organizations.
So far, the major studios have been unwilling to update the rating system to take into account on-screen tobacco use.
Some health experts have proposed running anti-smoking messages before movies to counteract the effect of on-screen tobacco use.
These are somewhat effective but would require much more effort than reducing children’s on-screen tobacco exposure.
“It would cost nothing to [update the rating system],” said Glantz. “There’s no public health intervention that would be cheaper and have a bigger effect.”