Smoking in Top-Grossing Movies --- United States, 1991--2009

Smoking in Top-Grossing Movies --- United States, 1991--2009
Weekly
August 20, 2010 / 59(32);1014-1017


Exposure to onscreen smoking in movies increases the probability that youths will start smoking. Youths who are heavily exposed to onscreen smoking are approximately two to three times more likely to begin smoking than youths who are lightly exposed (1); a similar, but smaller effect exists for young adults (2). To monitor the extent to which tobacco use is shown in popular movies, Thumbs Up! Thumbs Down! (TUTD), a project of Breathe California of Sacramento-Emigrant Trails, counted the occurrences of tobacco use (termed "incidents") shown in U.S. top-grossing movies during 1991--2009. This report summarizes the results of that study, which found that the number of tobacco incidents depicted in the movies during this period peaked in 2005 and then progressively declined. Top-grossing movies released in 2009 contained 49% of the number of onscreen smoking incidents as observed in 2005 (1,935 incidents in 2009 versus 3,967 incidents in 2005). Further reduction of tobacco use depicted in popular movies could lead to less initiation of smoking among adolescents. Effective methods to reduce the potential harmful influence of onscreen tobacco use should be implemented.

To conduct this analysis, TUTD counted the number of incidents of tobacco use in the 50 top-grossing movies each year during 1991--2001 and in all movies that were among the 10 top-grossing movies in any calendar week during 2002--2009. U.S. movies that rank in the top 10 for at least 1 week account for 83% of all movies released in U.S. theaters each year and 98% of all ticket sales (3). For each time frame, teams of trained observers reviewed each movie and counted tobacco incidents (3).* An incident was defined 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 in-theater impressions (one person seeing one tobacco incident one time) delivered in theatrical release was obtained by multiplying the number of incidents in each movie by the total number of tickets sold nationwide to the movie. The number of movies without any depiction of tobacco use also was counted.

Cumulatively, more movies qualify for the weekly top 10 category in a given year than for the annual top 50 category. Estimated counts of tobacco incidents for 1991--2001 were adjusted for the larger sampling frame used later, based on prior research on movie grosses and tobacco incidents for 2002--2007 (3). Approximately one third (34.5%) of 2002--2007 weekly top 10 movies also were included in the annual list of top 50 movies. Weekly top 10 movies that were not in the annual top 50 category had, on average, slightly fewer tobacco incidents than movies that were in the top 50 (21.5 incidents versus 23.0 incidents). To adjust for the difference in study methodology across the two periods so that results would be comparable, incident counts for 1991--2001 were inflated by a factor of 2.7 (calculated as [1/0.345] × [21.5/23.0]). The count of movies lacking tobacco depictions was inflated by 3.0 to maintain whole numbers.

The total number of incidents in the entire sample of top-grossing U.S. movies (Figure 1) ranged from 2,106 to 3,386 per year from 1991 to 1997, decreased to 1,612 in 1998, and then more than doubled to peak at 3,967 in 2005. From 2005 to 2009, the number of incidents dropped steadily, to 1,935 incidents in 2009. More than 99% of tobacco incidents related to smoking (versus smokeless tobacco use).

During 1991--2001, total in-theater impressions varied between 30 billion and 60 billion per year, then generally declined to a low of approximately 17 billion impressions in 2009 (Figure 2). The percentage of all top-grossing movies that did not show tobacco use exceeded 50% (51%; 74/145) for the first time in 2009 (Figure 3); similarly, the percentage of top-grossing, youth-rated movies (G/PG/PG-13) that did not show tobacco use generally has increased since 2003, reaching an all-time high of 61% (58/95) in 2009. Nonetheless, in 2009, more than half (54%; 32/59) of PG-13 movies contained incidents of tobacco use, down from 65% (133/205) during 2006--2008 and 80% (107/133) during 2002--2003.

Reported by
SA Glantz, PhD, Univ of California San Francisco, K Titus, MBA, S Mitchell, Breathe California of Sacramento-Emigrant Trails, J Polansky, Onbeyond LLC, Fairfax, California. RB Kaufmann, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note
The results of this analysis indicate that the number of tobacco incidents peaked in 2005, then declined by approximately half through 2009, representing the first time a decline of that duration and magnitude has been observed. However, nearly half of popular movies still contained tobacco imagery in 2009, including 54% of those rated PG-13, and the number of incidents remained higher in 2009 than in 1998. This analysis shows that the number of tobacco incidents increased steadily after the 1998 Master Settlement Agreement (MSA)† between the state attorneys general and the major cigarette companies, in which the companies agreed to end brand placement.

In 2001, the Smoke Free Movies campaign began to publicly link the tobacco content of movies to specific movie studios and their parent companies.§ Subsequently, several state and local tobacco control programs began efforts to raise awareness of the public health importance of reducing the amount of onscreen smoking. These efforts included activities such as engaging youth empowerment programs on the issue, media campaigns, and community outreach. Beginning in 2002, many state attorneys general also increased advocacy directed at the movie industry, and in May 2004 and May 2007, Congress held hearings on smoking in the movies.¶ In 2007, demands from state attorneys general led the Motion Picture Association of America (MPAA), which controls the movie rating system, to seek recommendations from the Harvard School of Public Health and to pledge their implementation. Harvard recommended that MPAA "take substantive and effective action to eliminate the depiction of smoking from movies accessible to children and youths" (4). MPAA's response was to attach smoking descriptors to the ratings for a fraction (12%) of nationally-released, youth-rated movies with smoking, beginning in May 2008 (5). Since 2007, several major studios adopted internal protocols for monitoring smoking content and promulgated corporate policies to discourage tobacco in their youth-rated movies. In 2009, Paramount (Viacom) became the first company whose youth-rated movies for the year contained no tobacco use incidents. In addition to other factors, these studio protocols might account for the some of the recent reduction in smoking incidents.

A meta-analysis of four studies estimated that 44% (95% confidence interval [CI] = 0.34--0.58) of the likelihood of youth trying smoking could be attributable to viewing smoking in the movies (6). Given the dose-response relationship between exposure to onscreen smoking and youth and young adult smoking, reductions in youth exposure to onscreen tobacco use since 2005 would be expected to have a beneficial effect on reducing smoking initiation (7). The national Youth Risk Behavior Survey** found that the national prevalence of ever having tried a cigarette declined significantly among high school students from 54.3% (95% CI: 51.2%--57.3%) in 2005 to 46.3% (95% CI: 43.7%--48.9%) in 2009. The reduction in smoking in movies might have been a contributing factor to this decline.

The findings in this report are subject to at least five limitations. First, the sample did not include all movies. However, an analysis of movies accounting for 96% of ticket sales during 2002--2008 suggested that movies that ranked in the top 10 for at least 1 week accounted for more than 95% of theater tobacco use impressions (3). Second, this analysis examined all tobacco use incidents rather than smoking alone. However, the majority of tobacco use incidents depict smoking, and exposure to both smoking and total tobacco use incidents are predictive of youth smoking initiation (1). Third, although theatrical tobacco impressions are down substantially, this measure must be interpreted cautiously because movies, including those containing incidents of tobacco use, can be viewed through many other channels (e.g., recorded media [DVDs], television, and the Internet), which do not factor into the calculation of movie theater impressions. Fourth, detailed audience composition data are not publicly available; therefore, the number of tobacco use impressions delivered by a particular movie to children and adolescents could not be determined. Finally, although this analysis shows the trends in movie tobacco depictions over time, it cannot definitively assess the reasons for those trends.

Effective methods to reduce the potential harmful influence of onscreen tobacco use should be implemented. Policies to decrease the negative effects on youths of onscreen depictions of smoking in movies have been recommended by the World Health Organization (8) and endorsed by a number of public health and health professional organizations.†† These include assigning R ratings to new movies that portray tobacco imagery. An R rating policy would create an economic incentive for producers to leave smoking out of movies that are marketed to youths. A 2005 study concluded that the return on investment for youth-rated movies was 70%, compared with 29% for R-rated movies (9). Reducing the number of movies containing tobacco incidents is expected to reduce the amount of onscreen smoking seen by youths and the associated likelihood that they will become smokers (10). Complementary recommended policies (8) include requiring strong antitobacco ads preceding movies that depict smoking, not allowing tobacco brand displays in movies, and requiring producers of movies depicting tobacco use to certify that no person or company associated with the production received any consideration for that depiction.

Acknowledgments
This analysis was funded, in part, through contributions by the American Legacy Foundation and the California Tobacco Control Program. The funding agencies played no role in the conduct of the research or preparation of the report.

References
1.National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco Control Monograph 19. Bethesda, MD: US National Cancer Institute; 2008.
2.Song AV, Ling PM, Neilands TB, et al. Smoking in movies and increased smoking among young adults. Am J Prev Med 2007;33:396--403.
3.Titus K, Polansky JR, Glantz S. Smoking presentation trends in U.S. movies 1991--2008. San Francisco, California: University of California San Francisco Center for Tobacco Control Research and Education; 2009. Available at http://escholarship.org/uc/item/30q9j424. Accessed February 14, 2010.
4.Harvard School of Public Health. Presentations to the Motion Picture Association of America on smoking in the movies. Boston, Massachusetts: Harvard University, School of Public Health; 2007. Available at www.hsph.harvard.edu/mpaa. Accessed August 12, 2010.
5.Polansky J, Mitchell S, Glantz S. Film-flam: how MPAA/NATO movie labels hide the biggest media risk to kids. San Francisco, CA: University of California San Francisco Center for Tobacco Control Research and Education; 2010. Available at http://escholarship.org/uc/item/8hn866tt. Accessed August 12, 2010.
6.Millett C, Glantz S. Assigning an 18 rating to movies with tobacco imagery is essential to reduce youth smoking. Thorax 2010;65:377--8.
7.Sargent JD, Beach ML, Dalton MA, et al. Effect of parental R-rated movie restriction on adolescent smoking initiation: a prospective study. Pediatrics 2004;114:149--56.
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 August 13, 2010.
9.Fuson B. Study: G-rated fare more profitable. The Hollywood Reporter. June 7, 2005. Available at www.hollywoodreporter.com/hr/search/article_display.jsp?vnu_content_id=1000947222. Accessed August 13, 2010.
10.Glantz S. Smoking in movies: A major problem and a real solution. Lancet 2003;362:281--5.


* The movie-by-movie results and an archive of all movies analyzed are available at http://www.scenesmoking.org.

† Master Settlement Agreement. Section III(e): prohibition on payments related to tobacco products and media. Full text available at http://www.naag.org/backpages/naag/tobacco/msa.

§ Additional information is available at www.smokefreemovies.ucsf.edu.

¶ Senate Subcommittee on Commerce, Science and Transportation, 108th Congress. Impact of smoking in the movies (May 11, 2004). Prepared testimony available at http://commerce.senate.gov/public/index.cfm?p=hearings&contentrecord_id=82d1efdc-6f24-4aa0-9ded-a66b60b2871c&contenttype_id=14f995b9-dfa5-407a-9d35-56cc7152a7ed&group_id=b06c39af-e033-4cba-9221-de668ca1978a&monthdisplay=5&yeardisplay=2004. House Subcommittee on Telecommunications and the Internet, 110th Congress. Images kids see on screen (June 22, 2007). Testimony and webcast (Panel 1) available at
http://energycommerce.house.gov/index.php?option=com_content&view=article&id=251&catid=32&itemid=58.

** Data available at http://apps.nccd.cdc.gov/youthonline/app.

†† A list of major endorsing organizations is available at http://www.smokefreemovies.ucsf.edu/solution

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Smoking in Top-Grossing Movies --- United States, 1991--2009