How Hollywood Hooks Kids: The Effects of Seeing Movies on Smoking

1. How Hollywood Hooks Kids:The Effects of Seeing Movies on Smoking James D. Sargent, M.D. This presentation summarizes a series of scientific studied done by Dr. James Sargent and his colleagues in the Department of Pediatrics at the Dartmouth Medical School. Before we begin to talk about the question posed in the title you need some background information. First we will examine how we view smoking behavior by age through a developmental model. After that we will talk about some recent data on just how big media figures into the lives of our children. Finally, we will examine the evidence that smoking in the movies is associated with more smoking by adolescents, even after taking into account other determinants of smoking, such as age, parenting style, and other factors.This presentation summarizes a series of scientific studied done by Dr. James Sargent and his colleagues in the Department of Pediatrics at the Dartmouth Medical School. Before we begin to talk about the question posed in the title you need some background information. First we will examine how we view smoking behavior by age through a developmental model. After that we will talk about some recent data on just how big media figures into the lives of our children. Finally, we will examine the evidence that smoking in the movies is associated with more smoking by adolescents, even after taking into account other determinants of smoking, such as age, parenting style, and other factors.

2. This is the basic question we asked in our research: Does seeing depictions of smoking in movies influence kids to smoke?This is the basic question we asked in our research: Does seeing depictions of smoking in movies influence kids to smoke?

3. �I believe films always mirror society; what film makers are trying to do is to document what�s happening in society�I think that if people are going to be influenced to start smoking or smoke cigarettes as a consequence of watching motion pictures or television, then they probably need more help than anyone can give them.�� Male, director/producer The motion picture industry generally denies the notion that their movies could influence behavior. But they don�t think about it very carefully. For example, this quote from a movie director might make sense for an adult, but makes very little sense from a child perspective. Children and adolescents are much more perceptive and much more clued in to what others are doing�they assimilate behavioral scripts from others (including their favorite movie stars) and adopt them.The motion picture industry generally denies the notion that their movies could influence behavior. But they don�t think about it very carefully. For example, this quote from a movie director might make sense for an adult, but makes very little sense from a child perspective. Children and adolescents are much more perceptive and much more clued in to what others are doing�they assimilate behavioral scripts from others (including their favorite movie stars) and adopt them.

4. �The medium is the message, and the message would be right � part of the show. How different from being the Corporate Moneybags or pushing samples in the lobby. It's the difference between B&W [Brown and Williamson Tobacco] doing commercials in movie houses and Marlboro turning up in the movies.�Pull, not push. Nobody tells them the 'answer,' they just know. Not 'why are you smoking that?' but 'I saw that video � can I try one?' If they feel like wearing the badge, they'll buy it. Like magic.� � RJR Marketing Executive The motion picture industry generally denies the notion that their movies could influence behavior. But they don�t think about it very carefully. For example, this quote from a movie director might make sense for an adult, but makes very little sense from a child perspective. Children and adolescents are much more perceptive and much more clued in to what others are doing�they assimilate behavioral scripts from others (including their favorite movie stars) and adopt them. However, the tobacco industry has thought very carefully about kid smoking. As shown by the second quote, movies and videos play heavily in their marketing strategies. Movies are used to �position� the product, making smoking look tough and glamorous.The motion picture industry generally denies the notion that their movies could influence behavior. But they don�t think about it very carefully. For example, this quote from a movie director might make sense for an adult, but makes very little sense from a child perspective. Children and adolescents are much more perceptive and much more clued in to what others are doing�they assimilate behavioral scripts from others (including their favorite movie stars) and adopt them. However, the tobacco industry has thought very carefully about kid smoking. As shown by the second quote, movies and videos play heavily in their marketing strategies. Movies are used to �position� the product, making smoking look tough and glamorous.

5. Goal of this Presentation This presentation will change the way you view and interpret movies

6. Content Analysis What can we say about tobacco use in movies? Dose Content Our goal is not only to quantify on screen-smoking behavior but also to examine background smoking. We determined how film makers use smoking to communicate character traits in order to better understand how this communication affects attitudes and expectations toward smoking. We also counted brand placement. Our goal is not only to quantify on screen-smoking behavior but also to examine background smoking. We determined how film makers use smoking to communicate character traits in order to better understand how this communication affects attitudes and expectations toward smoking. We also counted brand placement.

7. Smoking in Movies is Increasing This graph shows the number of tobacco events (such as appearance of smoking or cigarette advertising) per hour of screen time on a random sample of top-grossing films between 1960 and 2000. After falling through the 1960s, 1970s, and 1980s, it shot up starting around 1990. Despite the fact that smoking has dropped substantially in the population as a whole since 1960, the amount of smoking in the movies exceeds what existed in 1960. The tobacco industry amended its voluntary code of advertising to end paid product placement in 1989. We know from secret industry documents, however, that the industry continued using other devices, such as free cigarettes, to continue to encourage smoking in movies at least until the mid-1990s.This graph shows the number of tobacco events (such as appearance of smoking or cigarette advertising) per hour of screen time on a random sample of top-grossing films between 1960 and 2000. After falling through the 1960s, 1970s, and 1980s, it shot up starting around 1990. Despite the fact that smoking has dropped substantially in the population as a whole since 1960, the amount of smoking in the movies exceeds what existed in 1960. The tobacco industry amended its voluntary code of advertising to end paid product placement in 1989. We know from secret industry documents, however, that the industry continued using other devices, such as free cigarettes, to continue to encourage smoking in movies at least until the mid-1990s.

8. This slide shows how the amount of tobacco use varies by MPAA rating. The sample is the 601 popular contemporary movies from the 1990s. The vertical axis is the number of smoking occurrences in the movies. Notice that few of the movies Hollywood produces are intended for young kids (only 23 were rated G). Not surprisingly, median number of depictions of tobacco increased with MPAA rating. Even so, surprisingly, more than half of the G-rated films contained tobacco use. In addition, less than 10% of other films, regardless of rating DO NOT contain tobacco use. (This situation changed after 2000, when theaters started making it more difficult for teens to go to R rated movies. The MPAA rated fewer movies R and so PG13 movies now contain more smoking than R movies.) This is a box plot. The top and bottom of the box represent the 75th and 25th percentiles and the midline represents the median. The lines that extend from the box go from roughly the 5th to the 95th percentiles. The movies listed by name are the outliers with extremely high amounts of smoking. This slide shows how the amount of tobacco use varies by MPAA rating. The sample is the 601 popular contemporary movies from the 1990s. The vertical axis is the number of smoking occurrences in the movies. Notice that few of the movies Hollywood produces are intended for young kids (only 23 were rated G). Not surprisingly, median number of depictions of tobacco increased with MPAA rating. Even so, surprisingly, more than half of the G-rated films contained tobacco use. In addition, less than 10% of other films, regardless of rating DO NOT contain tobacco use. (This situation changed after 2000, when theaters started making it more difficult for teens to go to R rated movies. The MPAA rated fewer movies R and so PG13 movies now contain more smoking than R movies.) This is a box plot. The top and bottom of the box represent the 75th and 25th percentiles and the midline represents the median. The lines that extend from the box go from roughly the 5th to the 95th percentiles. The movies listed by name are the outliers with extremely high amounts of smoking.

9. Smoking in PG13 movies is increasing 82% of top 10 grossing PG13 films in theaters each week in May 2002-May 2003 included tobacco Half the tobacco shots were in G/PG/PG13 movies Two years before only 21% of tobacco occurrences were in G/PG/PG13 The amount of screen time devoted to smoking in PG 13 movies increased by 50% between 1996/7 and 1999/2000 Tobacco industry promised to stop product placement in 1998 Master Settlement Agreement Since the theaters started enforcing the R rating rule against children under 17 not being admitted without a parent, smoking in the movies has shifted down into PG13 movies. This effect may be due to the fact that the MPAA is rating movies more leniently, so films that would have received an R rating in the past are now being rated PG13. The tobacco industry (again) promised to stop doing product placement in movies when it signed the Master Settlement Agreement with the Attorneys General of 46 states in 1998 to end state lawsuits against the industry. Since then, the amount of screen time devoted to smoking in PG13 movies increased by 50%. (The fraction of PG13 movies that included smoking stayed constant at about 80%.)Since the theaters started enforcing the R rating rule against children under 17 not being admitted without a parent, smoking in the movies has shifted down into PG13 movies. This effect may be due to the fact that the MPAA is rating movies more leniently, so films that would have received an R rating in the past are now being rated PG13. The tobacco industry (again) promised to stop doing product placement in movies when it signed the Master Settlement Agreement with the Attorneys General of 46 states in 1998 to end state lawsuits against the industry. Since then, the amount of screen time devoted to smoking in PG13 movies increased by 50%. (The fraction of PG13 movies that included smoking stayed constant at about 80%.)

10. Screen Time Tobacco depictions take up less than 4 minutes of screen time in over 75% of movies This graph shows the distribution of movies with respect to the percent of the total run time that has smoking depicted. As you can see, tobacco use takes up less than 5 percent of most movies, suggesting it could be removed without affecting 95% of the movie in most cases.This graph shows the distribution of movies with respect to the percent of the total run time that has smoking depicted. As you can see, tobacco use takes up less than 5 percent of most movies, suggesting it could be removed without affecting 95% of the movie in most cases.

11. Conclusions Tobacco use occurs frequently It is widespread in youth-oriented films, and growing in PG13 Tobacco use takes up little screen time Removing it would affect only 5% of the movie

12. Teens and Movies:How much do they watch?

13. The question we are trying to answer is just how big a social influence to smoke is media viewing? We know from recent surveys that kids today watch an average of 2-3 hours of television programming per year. Almost 100% of households have a television and a VCR. Children also watch an average of 30 minutes per day of commercial videos and another 30 minutes per day of movies on TV. As a result, exposure to media that includes movies is very high, especially among the preadolescent and adolescent population, which is where the uptake of smoking is highest.The question we are trying to answer is just how big a social influence to smoke is media viewing? We know from recent surveys that kids today watch an average of 2-3 hours of television programming per year. Almost 100% of households have a television and a VCR. Children also watch an average of 30 minutes per day of commercial videos and another 30 minutes per day of movies on TV. As a result, exposure to media that includes movies is very high, especially among the preadolescent and adolescent population, which is where the uptake of smoking is highest.

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15. An R rating reduces the likelihood that a teen will see a movie � This slide shows the percentage of adolescents seeing movies of different MPAA ratings. Parents often think that an R-rating means that kids will seek out a movie because it is �forbidden�. But in fact, many fewer adolescents see R-rated movies compared to the other ratings. This sample included 5th through 8th graders. These are box plots. The line in the middle of the box plot represents the median, the top of the box is the 75th percentile and the bottom of the box is the 25th percentile. For R-rated movies, there were a few (the circles at the top of the plot) seen by two-thirds of adolescents, but for the most part only about 20 percent of adolescents had seen an R-rated movie. For G-rated movies, the majority of adolescents had seen them.This slide shows the percentage of adolescents seeing movies of different MPAA ratings. Parents often think that an R-rating means that kids will seek out a movie because it is �forbidden�. But in fact, many fewer adolescents see R-rated movies compared to the other ratings. This sample included 5th through 8th graders. These are box plots. The line in the middle of the box plot represents the median, the top of the box is the 75th percentile and the bottom of the box is the 25th percentile. For R-rated movies, there were a few (the circles at the top of the plot) seen by two-thirds of adolescents, but for the most part only about 20 percent of adolescents had seen an R-rated movie. For G-rated movies, the majority of adolescents had seen them.

16. � but Kids do see Lots of R rated Movies This information comes from a survey of about 5000 Northern New England 5-8th graders in 1999. In general, the R-rated movies were seen by a lower percentage of 5th vs 8th graders. But penetration was still high among the 5th graders. For example, about 2/3 of all kids in the sample had seen the movie �Scream� and 40% of 5th graders had seen it. This exposure is worrysome not only from the standpoint of tobacco but with respect to early exposure to violence, sexual acts, sex in the context of violence, depictions of alcohol use and other risky behaviors.This information comes from a survey of about 5000 Northern New England 5-8th graders in 1999. In general, the R-rated movies were seen by a lower percentage of 5th vs 8th graders. But penetration was still high among the 5th graders. For example, about 2/3 of all kids in the sample had seen the movie �Scream� and 40% of 5th graders had seen it. This exposure is worrysome not only from the standpoint of tobacco but with respect to early exposure to violence, sexual acts, sex in the context of violence, depictions of alcohol use and other risky behaviors.

17. Cigarette Brand Appearancesin Movies

18. This shows the percent of movies with brand depictions before and after a voluntary ban on product placements by the tobacco industry in 1989. The industry�s voluntary ban had no effect of cigarette brand depictions, which appeared in about one-third of movies. However, after the voluntary ban, actor endorsement of brands (where actors held up the brand when lighting up) increased dramatically. One way for the tobacco industry to get their brands into movies would be to pay movie stars to use their brand. As long as there is no quid-pro-quo, these payments would not be violations of the industry�s voluntary policy. Indeed, one of the approaches that the industry continued to use into the 1990s was providing free cigarettes to actors and other key people in Hollywood. And they would probably increase the chances the star would be brand loyal in a particular movie. This shows the percent of movies with brand depictions before and after a voluntary ban on product placements by the tobacco industry in 1989. The industry�s voluntary ban had no effect of cigarette brand depictions, which appeared in about one-third of movies. However, after the voluntary ban, actor endorsement of brands (where actors held up the brand when lighting up) increased dramatically. One way for the tobacco industry to get their brands into movies would be to pay movie stars to use their brand. As long as there is no quid-pro-quo, these payments would not be violations of the industry�s voluntary policy. Indeed, one of the approaches that the industry continued to use into the 1990s was providing free cigarettes to actors and other key people in Hollywood. And they would probably increase the chances the star would be brand loyal in a particular movie.

19. The most highly advertised brands are also the brands that show up in movies.The most highly advertised brands are also the brands that show up in movies.

20. Conclusions Tobacco use occurs frequently Tobacco use takes up little screen time Removing it would affect only 5% of the movie Cigarette brands appear often Increasingly endorsed by actors The most highly advertised brands account for most brand appearances (advertising motive)

21. Salience of Tobacco Use in Films

22. This slide outlines the structure of our scientific investigation of the link between seeing smoking in the movies and smoking behavior by adolescents.This slide outlines the structure of our scientific investigation of the link between seeing smoking in the movies and smoking behavior by adolescents.

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24. How Did We Measure Smoking? Ever tried smoking How many cigarettes have you smoked in your life? None Just a few puffs 1-19 cigarettes (less than a pack) 20-100 cigarettes (one to five packs) More than 100 cigarettes (more than five packs)

25. Since we could not ask everyone about all the movies, we gave each one a different random list of 50 movies from the 603 films we watched to measure the amount of smoking. We then added up the total amount of smoking that each adolescent saw in the 50 movies he or she had watched as our measure of �dose.�Since we could not ask everyone about all the movies, we gave each one a different random list of 50 movies from the 603 films we watched to measure the amount of smoking. We then added up the total amount of smoking that each adolescent saw in the 50 movies he or she had watched as our measure of �dose.�

26. This schematic shows the details of how we surveyed the kids to determine how much smoking they had seen. The top box shows what movies we selected to code for tobacco use. The left-hand side shows how we selected titles. Each kids was ask if they had seen each of 50 titles. On average, kids had seen 17 of the 50 movies we asked about. Some 25% had seen fewer than 11 and some 25% had seen more than 22. Based on the movies the kids had seen and the number of tobacco occurrences in each movie, we could create an exposure to movie score. From the movies they had seen, kids had seen an average of 91 smoking depictions. But 25% had seen fewer than 50 and 25% had seen more than 152.This schematic shows the details of how we surveyed the kids to determine how much smoking they had seen. The top box shows what movies we selected to code for tobacco use. The left-hand side shows how we selected titles. Each kids was ask if they had seen each of 50 titles. On average, kids had seen 17 of the 50 movies we asked about. Some 25% had seen fewer than 11 and some 25% had seen more than 22. Based on the movies the kids had seen and the number of tobacco occurrences in each movie, we could create an exposure to movie score. From the movies they had seen, kids had seen an average of 91 smoking depictions. But 25% had seen fewer than 50 and 25% had seen more than 152.

27. This graph shows how exposure to movie smoking varied in the sample. As you can see, most kids had seen fewer than 200 smoking depictions, but a few had seen upwards of 300. For the next analyses, exposure is divided into 4 categories, based on how much smoking kids had seen in movies. Comparisons will be against kids in the lowest exposure group (0-50 occurrances). We could not compare smoking behavior against kids who saw no smoking in movies because so few kids had not seen movies with smoking in them.This graph shows how exposure to movie smoking varied in the sample. As you can see, most kids had seen fewer than 200 smoking depictions, but a few had seen upwards of 300. For the next analyses, exposure is divided into 4 categories, based on how much smoking kids had seen in movies. Comparisons will be against kids in the lowest exposure group (0-50 occurrances). We could not compare smoking behavior against kids who saw no smoking in movies because so few kids had not seen movies with smoking in them.

28. Can we link what they viewwith what they do? Is higher exposure associated with a higher rate of smoking?

29. This is the relationship between exposure to movie smoking and adolescent smoking. As you can see, the more smoking in the movies kids saw, the more likely they were to have tried smoking. The next step is to show that exposure to movie smoking is not just a marker of some other factor that causes smoking.This is the relationship between exposure to movie smoking and adolescent smoking. As you can see, the more smoking in the movies kids saw, the more likely they were to have tried smoking. The next step is to show that exposure to movie smoking is not just a marker of some other factor that causes smoking.

30. For example, everyone knows that the older adolescents are, the more likely they are to smoke. And the older they are, the more likely they will have seen a lot of movies. So maybe seeing more smoking in movies is just a marker for older kids. And you can see when you compare these graphs that the relationships are similar. For example, everyone knows that the older adolescents are, the more likely they are to smoke. And the older they are, the more likely they will have seen a lot of movies. So maybe seeing more smoking in movies is just a marker for older kids. And you can see when you compare these graphs that the relationships are similar.

31. To test for this we �stratify� the analysis by breaking the sample into subgroups where the other important variables (such as age) are kept constant within each subgroup. For example, if the relationship we saw between amount of smoking in the movies and likelihood of smoking was just a reflection of the fact that older kids were more likely to try smoking rather than an independent effect of seeing smoking in the movies, breaking the students down by grade (�stratifying by grade�) would produce a graph like this. To test for this we �stratify� the analysis by breaking the sample into subgroups where the other important variables (such as age) are kept constant within each subgroup. For example, if the relationship we saw between amount of smoking in the movies and likelihood of smoking was just a reflection of the fact that older kids were more likely to try smoking rather than an independent effect of seeing smoking in the movies, breaking the students down by grade (�stratifying by grade�) would produce a graph like this.

32. Association is Independent of Grade But in fact, there is a very strong relationship within each grade. You can see from this graph that 5th graders with high exposure to movie smoking smoke at higher rates than 8th graders with low exposure.But in fact, there is a very strong relationship within each grade. You can see from this graph that 5th graders with high exposure to movie smoking smoke at higher rates than 8th graders with low exposure.

33. You can play this same game with other factors. We know that kids who like to take risks (we call them sensation seekers) also like to watch more movies and have a higher propensity to smoke. But low sensation seekers are just as responsive to seeing smoking in movies as high sensation seekers.You can play this same game with other factors. We know that kids who like to take risks (we call them sensation seekers) also like to watch more movies and have a higher propensity to smoke. But low sensation seekers are just as responsive to seeing smoking in movies as high sensation seekers.

34. Boys and girls respond the same to movie smoking.Boys and girls respond the same to movie smoking.

35. Kids who perform poorly in school see more moves. But even the kids with good grades are responsive to movie smoking.Kids who perform poorly in school see more moves. But even the kids with good grades are responsive to movie smoking.

36. But What About Parenting Style? What about parenting style? Are parents of kids who watch a lot of movies just neglectful? What about parenting style? Are parents of kids who watch a lot of movies just neglectful?

37. Parenting Style:Authoritative Parenting Responsive She listens to what I have to say She makes me feel better when I�m upset She wants to hear about my problems Demanding (rules/monitoring) She makes me follow her rules She tells me what time I have to be home She knows where I am after school We measure two elements of parenting. Responsiveness and demandingness Responsiveness is about whether your kid sees you as someone who listens to his or her point of view. Demandingness is about rule making, limit setting, and monitoring.We measure two elements of parenting. Responsiveness and demandingness Responsiveness is about whether your kid sees you as someone who listens to his or her point of view. Demandingness is about rule making, limit setting, and monitoring.

38. Parenting Style Based on their responses to these questions, mothers can be divide into the above 4 categories.Based on their responses to these questions, mothers can be divide into the above 4 categories.

39. Parenting style is related to adolescent smoking. Kids of neglectful parents smoke at the highest rates and kids of authoritative parents smoke at the lowest rates.Parenting style is related to adolescent smoking. Kids of neglectful parents smoke at the highest rates and kids of authoritative parents smoke at the lowest rates.

40. But parenting status is not strongly related to seeing smoking in movies, and kids of authoritative parents are just as responsive to seeing smoking in movies as kids of neglectful parents. But parenting status is not strongly related to seeing smoking in movies, and kids of authoritative parents are just as responsive to seeing smoking in movies as kids of neglectful parents.

41. All Else Being Equal: This slide shows the results of a statistical analysis of the risk of taking up smoking depending on how much smoking in the movies an adolescent sees after accounting for other things that could determine smoking. These results are presented as �odds ratios� compared to kids who saw 50 or fewer tobacco occurrences (the �reference� condition). For example, the crude odds ratio of 9 for kids who had seen more than 150 tobacco occurrences in movies (last number in the first column) indicates that they were 9 times as likely to have tried smoking than kids who had seen 50 or fewer occurrences. Some of this effect may be due to other factors, so we repeated the analysis taking into account more and more other factors that can predict smoking among adolescents. The three columns in the table to the right of the crude odds column show the results as we control for more and more other factors. Note that as we account for more other factors, the estimated effects of smoking in the movies falls. Nevertheless, even after controlling for grade in school, sex, parent education, friend sibling and parent smoking, exposure to tobacco promotions, sensation seeking, rebelliousness, self esteem, and parenting, kids with higher exposure to movie smoking are about two and a half times more likely to have tried smoking.This slide shows the results of a statistical analysis of the risk of taking up smoking depending on how much smoking in the movies an adolescent sees after accounting for other things that could determine smoking. These results are presented as �odds ratios� compared to kids who saw 50 or fewer tobacco occurrences (the �reference� condition). For example, the crude odds ratio of 9 for kids who had seen more than 150 tobacco occurrences in movies (last number in the first column) indicates that they were 9 times as likely to have tried smoking than kids who had seen 50 or fewer occurrences. Some of this effect may be due to other factors, so we repeated the analysis taking into account more and more other factors that can predict smoking among adolescents. The three columns in the table to the right of the crude odds column show the results as we control for more and more other factors. Note that as we account for more other factors, the estimated effects of smoking in the movies falls. Nevertheless, even after controlling for grade in school, sex, parent education, friend sibling and parent smoking, exposure to tobacco promotions, sensation seeking, rebelliousness, self esteem, and parenting, kids with higher exposure to movie smoking are about two and a half times more likely to have tried smoking.

42. What comes first? The previous study can be criticized for not demonstrating a temporal relationship If our hypothesis is correct, exposure to movie smoking should come before the adolescent starts to smoke

43. Cohort Study To answer that criticism, we conducted a study that began with kids who had never puffed on a cigarette We evaluated their exposure to movie smoking at the beginning of the study And contacted them one-two years later 10% tried smoking during that period of observation

44. Movie smoking exposure at baseline and smoking initiation over time

45. All Else Being Equal

46. The more smoking adolescents see in movies, the more more likely they are to start smoking. The effect is strongest for children of nonsmokers (blue bars). About 3% of adolescent children of nonsmoking parents who were in the lowest exposure group (the lowest 25% of exposure) started to smoke, after accounting for all other factors that contribute to smoking. The number of kids who started smoking was 12% in the highest exposure group (top 25% of exposure), almost as many as children of parents who smoked.The more smoking adolescents see in movies, the more more likely they are to start smoking. The effect is strongest for children of nonsmokers (blue bars). About 3% of adolescent children of nonsmoking parents who were in the lowest exposure group (the lowest 25% of exposure) started to smoke, after accounting for all other factors that contribute to smoking. The number of kids who started smoking was 12% in the highest exposure group (top 25% of exposure), almost as many as children of parents who smoked.

47. Attributable Risk A way of calculating what percent of adolescents in this study began smoking because of movie smoking Risk of smoking with movie smoking exposure = 10% Risk of smoking without movie smoking exposure = 5%. Therefore, half of the smoking we observed in this group of kids was due to seeing smoking in movies.

48. Conclusions Viewing tobacco use in movies is linked with higher rates of smoking among adolescents among never smokers: more positive attitudes toward smoking a higher risk of trying smoking later on because the association is strong and the exposure high in the general population of adolescents, movie smoking accounts for about 50% of adolescent smoking initiation

49. The Solution Certify no payoffs Require strong anti-smoking ads Stop identifying tobacco brands Rate new smoking movies �R� There are four simple steps that would drastically limit the value of movies as a promotional medium for Big Tobacco. All these recommendations are based in solid scientific evidence and can easily be implemented without affecting the content of films at all.There are four simple steps that would drastically limit the value of movies as a promotional medium for Big Tobacco. All these recommendations are based in solid scientific evidence and can easily be implemented without affecting the content of films at all.

50. The Solution Certify No Pay-OffsThe producers should post a certificate in the credits at the end of the movie declaring that nobody on the production received anything of value (cash money, free cigarettes or other gifts, free publicity, interest-free loans or anything else) from anyone in exchange for using or displaying tobacco. Everyone claims that Big Tobacco�s payoffs to Hollywood stopped long ago. (Few believe it.) Given this claim, it should not be a problem for producers to obtain written statements from everyone connected with a movie that includes smoking or other tobacco imagery certifying that they did not get anything from anybody to encourage them to put smoking in the movies. If they do so, they could just add a certification like this one at the end of the film, just as they do to assure the public that animals were not harmed in the making of a film. Hollywood should take protecting the kids in its audience as seriously as protecting animals.Everyone claims that Big Tobacco�s payoffs to Hollywood stopped long ago. (Few believe it.) Given this claim, it should not be a problem for producers to obtain written statements from everyone connected with a movie that includes smoking or other tobacco imagery certifying that they did not get anything from anybody to encourage them to put smoking in the movies. If they do so, they could just add a certification like this one at the end of the film, just as they do to assure the public that animals were not harmed in the making of a film. Hollywood should take protecting the kids in its audience as seriously as protecting animals.

51. The Solution Require Strong Anti-Smoking AdsStudios and theaters should require a genuinely strong anti-smoking ad (not one produced by a tobacco company) to run before any film with any tobacco presence, regardless of its MPAA rating. There is good evidence that a strong, high quality anti-smoking ad shown before a film with smoking neutralizes the pro-tobacco influence of the images in a film. There are hundreds of outstanding ads available from state tobacco control programs, such as this one (known as �Gala Event�) from the California Department of Health Services, and private groups like the American Legacy Foundation. Adding such an ad would not affect the content of the film at all. (Needless to say, we do not want a �youth smoking prevention� ad from a tobacco company. Those ads subtly promote smoking.) A strong ad makes the viewers aware of the possible subliminal advertising effects of smoking in the movies, which defeats its value in promoting tobacco. Most theaters now include advertisements so they certainly cannot object in principle. Theaters in Florida, Massachusetts, Vermont, and elsewhere have already run anti-smoking ads. Theaters in other places have refused. This is an area where local action can be most effective. Anti-smoking ads should be included on videos and DVD�s, too, since many kids see movies there, too.There is good evidence that a strong, high quality anti-smoking ad shown before a film with smoking neutralizes the pro-tobacco influence of the images in a film. There are hundreds of outstanding ads available from state tobacco control programs, such as this one (known as �Gala Event�) from the California Department of Health Services, and private groups like the American Legacy Foundation. Adding such an ad would not affect the content of the film at all. (Needless to say, we do not want a �youth smoking prevention� ad from a tobacco company. Those ads subtly promote smoking.) A strong ad makes the viewers aware of the possible subliminal advertising effects of smoking in the movies, which defeats its value in promoting tobacco. Most theaters now include advertisements so they certainly cannot object in principle. Theaters in Florida, Massachusetts, Vermont, and elsewhere have already run anti-smoking ads. Theaters in other places have refused. This is an area where local action can be most effective. Anti-smoking ads should be included on videos and DVD�s, too, since many kids see movies there, too.

52. The Solution Stop Identifying Tobacco BrandsThere should be no tobacco brand identification nor the presence of tobacco brand imagery (such as billboards) in the background of any movie scene. The most identified brands in movies area also the most smoked brands by kids, with Marlboro being the big leader in both, such as this display in Men in Black � and Men in Black II. And, since the �worm guys� in Men in Black were animated, director Barry Sonnenfeld and executive producer Steven Spielberg certainly cannot claim that the actors insisted in smoking Marlboros. Even if you accept that smoking is necessary for �artistic purposes,� there is no reason that specific brands need to be exhibited.The most identified brands in movies area also the most smoked brands by kids, with Marlboro being the big leader in both, such as this display in Men in Black � and Men in Black II. And, since the �worm guys� in Men in Black were animated, director Barry Sonnenfeld and executive producer Steven Spielberg certainly cannot claim that the actors insisted in smoking Marlboros. Even if you accept that smoking is necessary for �artistic purposes,� there is no reason that specific brands need to be exhibited.

53. The Solution Rate New Smoking Movies "R"Any film that shows or implies tobacco should be rated "R." The only exceptions should be when the presentation of tobacco clearly and unambiguously reflects the dangers and consequences of tobacco use or when it is necessary to represent accurately a real historical figure. The MPAA gives movies that use the F-word an R rating. Smoking should be treated just as seriously. An R rating would allow producers, directors, and actors the freedom to include smoking or other tobacco promotions if they felt it was necessary to tell the story � just as they now do with the F-word, sex, and violence. It is also important to emphasize that this recommendation applies to new movies. The goal is to reduce the amount of smoking and tobacco use in new films. No one is suggesting that old movies be re-rated.The MPAA gives movies that use the F-word an R rating. Smoking should be treated just as seriously. An R rating would allow producers, directors, and actors the freedom to include smoking or other tobacco promotions if they felt it was necessary to tell the story � just as they now do with the F-word, sex, and violence. It is also important to emphasize that this recommendation applies to new movies. The goal is to reduce the amount of smoking and tobacco use in new films. No one is suggesting that old movies be re-rated.

54. Everything you need to know, including copies of the scientific research papers summarized in this presentation � and links to others working on the issue -- is on the web site.Everything you need to know, including copies of the scientific research papers summarized in this presentation � and links to others working on the issue -- is on the web site.