Those whose parents smoke are more likely to smoke, he said, but exposure to smoking in movies can overcome the benefit of having nonsmoking parents. In one study, the children of nonsmoking parents with heavy exposure to movie smoking were as likely to smoke as the children of smoking parents with heavy movie exposure.
To Dr. Glantz, and the other people who study this topic, that makes smoking in movies an “environmental toxin,” a factor endangering children.
“There’s no excuse for continuing to have smoking in movies that are rated to be sold to kids, and so the policy objective we have is there should be no smoking in movies that are rated for kids,” said Dr. Glantz, who maintains a website called Smoke Free Movies. “The studios have it in their power to fix this with a phone call.” The rating system needs to start treating smoking like a proscribed obscenity, he said; if it’s in the movie, the movie gets an R rating.
The Centers for Disease Control and Prevention’s fact sheet on smoking in the movies estimates that taking smoking out of films rated for children would save 18 percent of the 5.6 million young people alive today who will otherwise die of tobacco-related diseases – a million lives. “There’s nothing you could do that would be so cheap and save so many lives,” Dr. Glantz said.
This has been studied in 17 different countries, he said, and though policies vary widely and cultures are very different, the results are remarkably similar. “You consistently see this two to three times risk in kids who are exposed to a lot of onscreen smoking, all over the world.”
Five years ago, the people who worry about the impact on the young of seeing smoking in the movies thought things were looking good. In movies rated for a young audience (that is, G or PG or PG-13), there had been a steady drop in the number of “onscreen tobacco incidents.” Not only that, but in 2012, convinced by a heavy array of scientific evidence, the Surgeon General issued a report saying explicitly that seeing people smoke in movies caused kids to start smoking: “longitudinal studies have found that adolescents whose favorite movie stars smoke on screen or who are exposed to a large number of movies portraying smokers are at a high risk of smoking initiation.”
But after 2010, despite the accumulating evidence, the rate of cinematic smoking started to rise in those youth-rated movies, according to the new study, published this month in the C.D.C.’s Morbidity and Mortality Weekly Report, which looked at incidents of tobacco use in top-grossing movies from 2010 to 2016.
As far as movies rated G, PG, and PG-13, “When we compared 2010 to 2016, there was a slight decrease in the number of movies, but an increase in the number of incidents,” said Michael Tynan, a public health analyst in the office on smoking and health at the C.D.C., and the lead author of the new study. Dr. Glantz is also an author, and he and two of the four other authors have received grants from the Truth Initiative, an antismoking group.
The number of times that an actor used a tobacco product in a top-grossing movie “increased 72 percent among all movies and 43 percent among PG-13 movies,” Mr. Tynan said. In other words, he said, by 2016 there were “more tobacco incidents concentrated in fewer movies.”
One out of every four movies rated for youth today continues to feature tobacco use, Mr. Tynan said, “and we know this is harmful to youth and causes youth to start using tobacco.”
And the policies that the studios have in place, which seemed to be working as of 2012, are clearly not sufficient, Mr. Tynan said. “The frequency of tobacco use in PG-13 movies is a public health concern.” So what should be done? “One change is to rate movies with tobacco use with an R rating,” he suggested. Other steps that might help would be to have studios certify that there was no paid product placement, and to end the use of any actual tobacco brands on the screen. All of these strategies are supported by the American Academy of Pediatrics, which has issued a statement calling the new study “alarming.”
In a study done back in the ’90s, researchers pointed to some of the differences between who smokes on screen and who smokes in the real world. In the real world, smokers are likely to be “poor people, people with mental illness,” Dr. Glantz said. “If you look at the power players, the rich people, people who are in control, they’re not smoking.” But in movies, it tends to be more desirable or powerful characters, even if they’re the bad guys, and in that way, movie images may reinforce images in cigarette advertising.
And movie images are powerful. In one experiment, young people who were smokers were shown montages of clips from recent movies; the participants were randomized so that some saw clips with smoking in them and some did not. Then they were given a 10-minute break, and the people who saw the smoking images were significantly more likely to smoke during the break than the smokers who had not seen the images.
“Keeping smoking onscreen is like putting arsenic in the popcorn,” Dr. Glantz said. The new study “shows they’ve taken half of the arsenic out,” he said. “Now they need to take the rest out.”