Cumulative exposure to on-screen smoking is a major recruiter of new young smokers. Policy solutions—including R-rating films with tobacco imagery and making productions with tobacco ineligible for public subsidies—are backed by health authorities in California and worldwide.

Exposure to on-screen smoking accounts for nearly 100,000 current smokers in California aged 12-17. Total costs of medical services for this group, through age 50, are estimated at $1.6 billion (discounted present value). Two-thirds of the cost will be borne by government.

Top-grossing films made in California accounted for one-third of United States audience exposure to on-screen tobacco imagery 2002-11.

From mid-2009 through 2011, California approved $374 million in film and television production subsidies, in the form of tax credits. $128 million was approved for 27 feature films, released widely 2010-11, that achieved top-grossing status. Sixteen of these films featured tobacco imagery; $75 million was approved for these films, which made $1.1 billion at the box office.

More than two-thirds ($51 million) of California tax credits approved for top-grossing films with tobacco imagery went to PG-13 films. Nearly 80 percent (2 billion/2.5 billion) of in-theater tobacco impressions delivered in the US and Canada by California-subsidized, top-grossing films came from films rated PG-13. (The rest came from R-rated films.)

Tobacco content of top-grossing films varies by company. Forty-four percent of California subsidies approved for top-grossing feature were reserved for films released by Sony and Viacom (Paramount). Films from these two companies garnered 71 percent of California subsidies for films with tobacco and 83 percent of subsidies for youth-rated (PG-13) films with tobacco.

Of the $1.6 billion in costs of direct medical services that will be incurred for teen smokers in California recruited by their exposure to films with tobacco imagery, $510 million is attributable to adolescents’ exposure to films made in California.

If the California film subsidy program continues and the pattern of subsidies and smoking films remains the same as in the past, films containing tobacco and subsidized by California taxpayers will contribute an estimated 17,000 new 12-17 year old smokers among the next cohort of 12-17 year old smokers in California, who will incur an estimated $270 million in smoking-induced costs.

Public health authorities, including the US Centers for Disease Control and Prevention, the World Health Organization, the director of Los Angeles County’s Department of Public Health, and the chair of California’s Tobacco Education and Research Oversight Committee (TEROC) have highlighted the policy contradiction between state subsidies for films with tobacco imagery and state tobacco prevention programs.

The policy solution is to amend the California tax credit program statute, adding the following to the existing list of productions disqualified from eligibility for subsidy:

…any production that depicts or refers to any tobacco product or non-pharmaceutical nicotine delivery device or its use, associated paraphernalia or related trademarks or promotional material.

Such a change would end the practice of taxpayers paying for commercial films with tobacco imagery that subvert the important public goal of reducing youth smoking and its consequent health costs, many of which are borne by the public.

Smoking among American adults fell by half between 1950 and 2002, yet smoking on U.S. movie screens reached historic heights in 2002, topping levels observed a half century earlier. Tobacco’s comeback in movies has serious public health implications, because smoking on screen stimulates adolescents to start smoking,2,3 accounting for an estimated 52% of adolescent smoking initiation.

Equally important, researchers have observed a dose-response relationship between teens’ exposure to on-screen smoking and smoking initiation: the greater teens’ exposure to smoking in movies, the more likely they are to start smoking. Conversely, if their exposure to smoking in movies were reduced, proportionately fewer teens would likely start smoking.

To track smoking trends at the movies, previous analyses have studied the U.S. motion picture industry’s top-grossing films with the heaviest advertising support, deepest audience penetration, and highest box office earnings.4,5 This report is the first to examine the U.S. movie industry’s total output. It is also the first to identify smoking movies, tobacco incidents and tobacco impressions with the companies that produced and/or distributed the films — and with their parent corporations, which claim responsibility for tobacco content choices.† Examining Hollywood’s product line-up, before and after the public voted at the box office, sheds light on individual studios’ content decisions and industry-wide production patterns amenable to policy reform.

We surveyed all U.S.-produced live action films released to theaters in the five years between December 25, 1998, and December 24, 2003, and offer three different measures of smoking in movies:

1. INTENTION: Number of films that include smoking (and those smokefree) by year, Motion Picture Association of America (MPAA) age-classification, and corporation responsible;

2. PERFORMANCE: Number of smoking incidents in these films (an index of smoking intensity) by year, MPAA age-classification, and corporation responsible;

3. IMPACT: Number of smoking impressions (each film’s smoking incidents x tickets sold) delivered to theatrical audiences overall, to children aged 6-11 and to teens aged 12-17, by year, MPAA age-classification, and corporation responsible.

Because exposure to smoking in movies accounts for more than half of smoking initiation by U.S. adolescents, we pay particular attention to smoking in movies rated G/PG and PG-13 and to the effect of the proposed R-rating for tobacco use on screen.

KEY FINDINGS

Analysis of 776 U.S. movies released in the five years 1999-2003 established that:

• 80% of all films across the board included smoking — almost 90% of R-rated films, 80% of PG-13 movies and 50% of G/PG movies.

• Three media conglomerates — Time Warner, Disney and Sony — accounted for more than half of all movies with smoking and 55% of all tobacco impressions delivered to children and teens.

• The number of a studio’s releases ultimately determined its ranking in most tobacco dimensions. Companies with fewer releases tended to concentrate more of their tobacco incidents in films rated PG-13 but tobacco content patterns were otherwise remarkably uniform across major motion picture companies.

• Confirming past analyses, individual R-rated movies with smoking averaged twice as many tobacco incidents as youth-rated movies with smoking.

• The number of PG-13 releases with smoking has remained stable over five years. A five-year decline in R-rated releases and sharply lower ticket sales in 2003 has shifted the majority of tobacco incidents and impressions into movies rated G, PG and PG-13.

• The U.S. movie industry delivered an estimated 32.6 billion first-run theatrical tobacco impressions to audiences of all ages over the past five years. A quarter of these impressions — 8.3 billion evenly divided between youth-rated and R-rated movies — were delivered to children and teens. Time Warner alone delivered a quarter of child and teen tobacco impressions.

• More first-run tobacco impressions are delivered to teen moviegoers 12-17 than to children 6-11 or young adults 18-34 — 1,350 larger-than-life impressions per capita between 1999 and 2003. This estimate does not include the tobacco impressions delivered by a movie with smoking’s theatrical and on-air advertising trailers or from multiple viewings of the movie on pre-recorded video media and on cable, on-demand and broadcast television.

• By all measures, over the past five years rating on-screen smoking “R” would reduce children’s and teens’ first-run theatrical exposure to tobacco impressions, strongly associated with teens’ smoking initiation, by at least 50%.

Smoking among American adults fell by half between 1950 and 2002, yet smoking on U.S. movie screens reached historic heights in 2002, topping levels observed a half century earlier. Tobacco's comeback in movies has serious public health implications, because smoking on screen stimulates adolescents to start smoking, accounting for an estimated 52% of adolescent smoking initiation.

Equally important, researchers have observed a dose-response relationship between teens' exposure to on-screen smoking and smoking initiation: the greater teens' exposure to smoking in movies, the more likely they are to start smoking. Conversely, if their exposure to smoking in movies were reduced, proportionately fewer teens would likely start smoking.

To track smoking trends at the movies, previous analyses have studied the U.S. motion picture industry's top-grossing films with the heaviest advertising support, deepest audience penetration, and highest box office earnings. This report is unique in examining the U.S. movie industry's total output, and also in idnetifying smoking in movies, tobacco incidents, and tobacco impressions with the companies that produced and/or distributed the films - and with their parent corporations, which claim responsibility for tobacco content choices. Examining Hollywood's product line-up, before and after the public voted at the box office, sheds light on individual studios' content decisions and industry-wide production patterns amenable to policy reform.

We surveyed all U.S.-produced live action films released to theaters in the eight years between December 25, 1998, and December 24, 2006, and offer three different measures of smoking in movies:

1. INTENTION: Number of films that include smoking (and those smokefree) by year, Motion Picture Association of America (MPAA) age-classification, and the corporation responsible;

2. PERFORMANCE: Number of smoking incidents in these films (an index of smoking intensity) by year, MPAA age-classification, and corporation responsible;

3. IMPACT: Number of smoking impressions (each film's smoking incidents x tickets sold) delivered to theatrical audiences overall, to children aged 6-11, and to teens aged 12-17, by year, MPAA age-classification, and corporation reponsible.

Because exposure to smoking in movies accounts for about half of smoking initiation by U.S. adolescents, we pay particular attention to smoking in movies rated G/PG and PG-13 and to the effect of the proposed R-rating for tobacco use on screen.

Objective

Methods

Results

Conclusion