Fighting Against Smoking in the Movies

Earlier this year, Stanton A. Glantz, professor of medicine at the University of California, San Francisco, and James Cameron, director of the science-fiction thriller Avatar, got into a public sparring match over Hollywood and cigarettes. Glantz, who has been furiously campaigning against smoking in PG-13 movies since he launched the Smoke Free Movies project in 2001, told The New York Times in January that scenes in Avatar depicting an environmental scientist puffing away on a cigarette were comparable to someone putting "a bunch of plutonium in the water supply." In an e-mailed statement to the Times, Cameron shot back that Grace Augustine, played by Sigourney Weaver, was never intended to be a role model for teenagers. Smoking is a filthy habit, he wrote, but "I don't believe in the dogmatic idea that no one in a movie should smoke. Movies should reflect reality."

Now, nearly eight months later, Glantz is back on the attack against Avatar and every other Hollywood flick showcasing cigarettes. And this time he's got the backing of the U.S. government. On Thursday, the Centers for Disease Control and Prevention published new data compiled by Glantz that tracks smoking in top-grossing movies between 1991 and 2009. The study, appearing in the CDC's Morbidity and Mortality Weekly Report (MMWR), shows that the number of tobacco incidents (defined as "the use or implied use of a tobacco product by an actor" onscreen) has dropped significantly in recent years—from a peak of almost 4,000 in 2005 to just under 2,000 last year. But 54 percent of PG-13 films released in 2009 still featured smoking. "We really need to fix this once and for all," says Glantz.

In a conference call with Glantz and the American Legacy Foundation, which helped fund the new research, the CDC's Ursula Bauer thanked him for keeping the subject at the forefront of the public-health conversation. Every day 4,000 Americans between the ages of 12 and 17 smoke their first cigarette, said Bauer, director of the CDC's National Health Center for Chronic Disease Prevention and Health Promotion. "We know that images of smoking in the media, including movies, have a strong pro-tobacco influence on youth." In the MMWR paper, the CDC said that "effective methods to reduce the potential harmful influence of onscreen tobacco use should be implemented." To Glantz, those words—especially the word "should"—add significant weight to his corner of the Hollywood-nicotine matchup. "This is the first time the CDC has weighed in at a policy level," he says. "To me, that's the real big news here."

Numerous studies, including a 2008 report by the National Cancer Institute, state that exposure to smoking on the big screen promotes smoking in young Americans. Congress has held hearings on the issue, and since 2007 several major studios have adopted internal policies to discourage anybody from lighting up in youth-rated movies. Those efforts may have contributed to the recent decline in onscreen smoking, says Glantz.

But what he and other public-health authorities—including the World Health Organization—really want is zero smoking in kid-rated movies, and an R rating if cigarettes do appear onscreen. "It's like frontal nudity or foul language," not an all-out ban on cinematic smoking, says Glantz. "You can do it, but not in movies for kids." If that standard were applied, movies like Eat Pray Love, Salt, and Dinner for Schmucks would shift from PG-13 to R. But the policy provides an exception for depictions of historical smokers, like Edward R. Murrow, who puffed away in the 2005 film Good Night, and Good Luck. Glantz says changing the rating system would cut total youth exposure to smoking in movies by about half. And there'd be an economic incentive not to feature cigarettes for the industry, too: a 2005 study on movie profitability found that the return on investment for R-rated movies is 29 percent, compared with 44 percent for PG-13 movies and 73 percent for PG movies.

The Motion Picture Association of America, which runs the rating system, issued a statement in response to the new CDC report saying that "there is broad awareness of smoking as a unique public health concern due to nicotine's highly addictive nature, and no parent wants their child to take up the habit." It went on to provide its own stats, saying that since May 2007, 73 percent of movies that contain "even the slightest bit of smoking" are in the R category, 21 percent are PG-13, and 6 percent are PG. Ultimately, the MPAA said, parents don't want the industry or the government to decide what's appropriate; they want to decide for themselves.

In the end, it's reality that matters most. Cameron says movies should reflect that. But as Glantz is quick to point out, the reality of smoking isn't its artsy portrayal of glamour, power, and sex appeal on the big screen. It's addiction, frustration, sickness, and death. Despite clear public-health messages about the perils of tobacco, smoking is still rampant in this country. A commentary published in July in The New England Journal of Medicine, aptly titled "Don't Forget Tobacco," calls for continued and urgent attention. And it bares the latest numbers: the prevalence of smoking hovers at 20 percent in the U.S.; more than 8 million people suffer tobacco's deleterious effects; and smoking kills 450,000 Americans annually. That is reality. And that has got to change.