Summary
What is already known about this topic?
The Surgeon General has concluded that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young persons. The more frequently youths see smoking on screen, the more likely they are to start smoking; youths who are heavily exposed to onscreen smoking imagery are approximately two to three times more likely to begin smoking than are youths who are less exposed.
What is added by this report?
Previously reported declines in number of top-grossing movies with tobacco use has continued; however, the decline in the total number of tobacco incidents has not progressed since 2010. From 2010 to 2016, the total number of tobacco incidents in top-grossing movies increased, with a 43% increase occurring among movies rated PG-13.
What are the implications for public health practice?
Although there were fewer youth-rated films with tobacco incidents in 2016 than in 2010, total depictions of tobacco use has remained stable, concentrating such exposure in fewer films. Reducing tobacco incidents that appear in youth-related movies would prevent the initiation of tobacco use among young persons. An R rating for movies with tobacco use could potentially reduce the number of teen smokers by 18% and prevent their premature deaths from tobacco-related diseases.
The Surgeon General has concluded that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young persons (1). The more youths see smoking on screen, the more likely they are to start smoking; youths who are heavily exposed to onscreen smoking imagery are approximately two to three times as likely to begin smoking as are youths who receive less exposure (1,2). A Healthy People 2020 objective is to reduce the proportion of youths exposed to onscreen tobacco marketing in movies and television (Tobacco Use Objective 18.3) (3). To assess the recent extent of tobacco use imagery in youth-rated movies (G, PG, PG-13*), 2010–2016 data from Thumbs Up! Thumbs Down! (TUTD), a project of Breathe California of Sacramento-Emigrant Trails were analyzed and compared with previous reports.† In 2016, 41% of movies that were among the 10 top-grossing movies in any calendar week included tobacco use, compared with 45% in 2010. Among youth-rated movies, 26% included tobacco use in 2016 (including 35% of PG-13 movies) compared with 31% in 2010 (including 43% of PG-13 movies). The steady decline in the number of tobacco incidents in youth-rated movies from 2005–2010 stopped after 2010. The total number of individual occurrences of tobacco use in a movie (tobacco incidents) in top-grossing movies increased 72%, from 1,824 in 2010 to 3,145 in 2016, with an increase of 43% (from 564 to 809) occurring among PG-13 rated movies. Reducing tobacco use in youth-related movies could help prevent the initiation of tobacco use among young persons.
TUTD counts occurrences of tobacco incidents, defined as the use or implied use of a tobacco product (cigarettes, cigars, pipes, hookah, smokeless tobacco products, and electronic cigarettes) by an actor, in U.S. top-grossing movies each year. Trained monitors count all tobacco incidents in those movies that are among the 10 top-grossing movies in any calendar week of the year. Previous reports have used this criterion because U.S. movies ranked in the 10 top-grossing movies for at least 1 week have accounted for 96% of U.S. ticket sales (4–6). At least two monitors independently evaluate each film; any differences are resolved by a supervisor who independently watches the film using the same protocol. Incidents of implied use have been rare and occur when a person is handed or is holding, but does not necessarily use, a tobacco product. A new incident was counted each time 1) a tobacco product went off screen and then came 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 use of a tobacco product.§
To calculate the percentage of movies with tobacco incidents, the number of movies with tobacco incidents was divided by the total number of movies, and the average number of tobacco incidents per movie was calculated for each motion picture company. For each year during 2010–2016, the number of top-grossing movies with tobacco incidents and overall number of tobacco incidents were calculated. Results were also analyzed by Motion Picture Association of America (MPAA) ratings (G, PG, PG-13, R). Findings were also compared with data from reports from 1991–2010 (4,5).
In 2016, among 143 top-grossing movies, 59 (41%) had tobacco incidents, compared with 62 (45%) of 137 in 2010; among top-grossing R-rated movies, 35 (67%) of 52 had tobacco incidents in 2016, compared with 35 (71%) of 49 in 2010 (Table 1). Among youth-rated movies (G, PG, or PG-13), 24 (26%) of 91 had tobacco incidents in 2016, compared with 27 (31%) of 88 in 2010. Overall, from 2010 to 2016, the number of top-grossing movies with tobacco incidents ranged from 58 in 2014 to 76 in 2013 (Table 1).
Although the percentage of top-grossing movies with tobacco incidence decreased during 2010–2016, the total number of tobacco incidents in top-grossing movies increased by 72%, from 1,824 to 3,145 (Table 2). The total number of incidents in G or PG movies decreased by 87% (from 30 to 4), whereas the number in PG-13 movies increased 43% (from 564 to 809), and the number in R-rated movies increased 90% (from 1,230 to 2,332). Compared with previous studies (4,5), smoking incidents had peaked at 3,962 incidents in 2005; the year with the lowest number of recorded smoking incidents (1,613) was 1998 (Figure). During 2010–2016, the lowest number of tobacco incidents (1,743) occurred in 2015; the highest number since 2010 (3,145) occurred in 2016, representing an 80% increase compared with the previous year.