If Smoking Were Limited to R-Rated Movies, Teen Tobacco Use Would Decline

We know it's bad. But like many other attempts to improve human behavior, banning tobacco has run up against ingrained attitudes about what's acceptable and found the going tough.

In the case of tobacco, concerted efforts at promoting the deathly effects have dramatically reduced smoking. But not entirely eliminated them. And the movies share a large portion of the blame. The economics of tobacco product placement benefit film and tobacco companies. In return for having star actors smoke - or pretend to smoke in films, the film companies get an upfront payment to help defray the costs of production, thereby reducing their risk. The tobacco companies get a very effective advertisement for the essential coolness of smoking.

Aimed squarely at the most insecure and impressionable segment of the population - teens and tweens - movies starring heart-throb characters who smoke have now been causally linked to increased smoking. In effect, that means that smoking in movies statistically causes smoking in teens.

The powerful entertainment industry lobby has fought to protect smoking in movies as a cultural 'truth,' and even as 'free speech.' Those arguments have paled besides the money contributed to political campaigns, but they do provide public relations cover.

However, new studies and a new approach may chip away at the franchise: any movie with characters who smoke is automatically R-rated, which means no one under 17 may see it unless accompanied by a parent. Parents are busy these days and so more inclined to let younger teens go to the movies themselves. Insisting on an R-rating will cut the audience, thereby hurting movie revenues - and actor/actress tobacco use impact.

It is a brilliantly subversive strategy. The entertainment and tobacco lobbies will complain bitterly. But if enacted, it could cut youth tobacco use substantially. And given the cost to society of smoking-related disease at a time when people are struggling to pay rising medical costs, could have both an economic and socially beneficial impact. JL

Madeleine Kruhly reports in The Atlantic:

If smoking in a movie meant an R rating, it could reduce adolescent tobacco use by almost twenty percent.
Brad Pitt's character in Snatch, Mickey O'Neil, has all the elements of classic Hollywood James Dean cool. He moves with a quick confidence, he attacks with an incomparable sense of purpose, and -- like Al Pacino in Scarface, Renee Zellweger in Bridget Jones' Diary, and Ian McKellen as Gandalf in The Lord of the Rings -- he smokes.

Like it or not, kids emulate media. The Surgeon General has concluded that smoking in movies makes kids smoke. We can't smoke in TV commercials, so why can we smoke in movies? Even G-rated movies -- albeit a rare, curious occurrence.

Movements to ban cinematic smoking have been around for years, including efforts by numerous Attorneys General, but no formal policy is in place. A study published Tuesday in the journal Pediatrics may provide some substantive evidence in that debate.

James Sargent, MD, co-director of the Cancer Control Research Program at the Norris Cotton Cancer Center, began by exploring the consequences of exposing young viewers to any movie featuring tobacco usage. Accounting and adjusting for age, gender, and outside influences such as parents or friends who smoked, the researchers found that kids were twice as likely to start smoking.

There was clearly a link between the film industry's inclusion of smoking in movies and the prevalence of adolescents trying -- as well as regularly using -- tobacco. As Sargent remarked, "The results led to a policy question: what could you do about it?"

And after more intensive research, Sargent and his team found their answer: movie ratings.

Enlisting just over 6,500 adolescents, the researchers followed up with longitudinal surveys, checking in with the participants at eight month intervals, and using a survival model to estimate the length of time before an onset of smoking.

Movie smoking exposure (or MSE) was evaluated based upon the viewing of 532 recent box office hits. Each movie was categorized according to the respective ratings assigned by the Motion Picture Association of America: G/PG, PG-13, and R.

Although the median MSE was three times higher for PG-13 films compared to that of R-rated films, their relation to smoking was absolutely the same. These results lead to a surprising conclusion -- and one that effectively dismissed past research: it was the smoking itself that motivated adolescents to try tobacco, not the risky or flashy behaviors often included in and associated with adult movies. Or, as stated by the study:

The equivalent effect of PG-13-rated and R-rated MSE suggests that is the movie smoking that prompts adolescents to start smoking, not other characteristics of R-rated movies or adolescents drawn to them.

From this conclusion, Sargent and his colleagues were able to infer that giving an R rating for any movie showing smoking "could substantially reduce adolescent smoking." He proposes it might even reach an 18 percent decrease (a figure based off of risk estimations, probabilities of smoking onset, and the above MSE levels).

So, Sargent ultimately calls on the movie industry to take the same measures as they do in considering scenes of violence, sex, profanity, etc. That said, he still recognizes that the new implementation would "constrain the industry which looks to reach the largest audience possible."

Although this study offers valuable evidence as well a possible option for reducing adolescent smoking, it still leaves us with several notable uncertainties.

Sure, a new R rating might reduce smoking onset in adolescents, but wouldn't it simply postpone the eventual adoption of tobacco use? Or are adolescents that much more impressionable than their over-18 "adult" selves? The rating might forestall things, but it may be incapable of preventing the inevitable.

When asked about this possibility, Sargent agreed that this perspective could be a small glitch in the study's conclusions. But, he argued that older teenagers (17 and above) are "able to make more informed choices about what they're going to do." They would ideally have a higher maturity level and an improved capacity to make better decisions regarding health. "We don't hold kids at 12 or 13 entirely responsible for their decisions, but [with older teenagers], there's less of a chance of responding to stimuli in movies."

Conceding that logic, the Norris Center's study seems to provide a well-founded conclusion and a plausible recommendation. Your move, movies.