Smoking in Top-grossing Movies — United States, 1991–2009

SA Glantz, PhD; K Titus, MBA; S Mitchell; J Polansky; RB Kaufmann, PhD


Morbidity and Mortality Weekly Report. 2010;59(32):1014-1017. 

In This Article

Editorial Note

The results of this analysis indicate that the number of tobacco incidents peaked in 2005, then declined by approximately half through 2009, representing the first time a decline of that duration and magnitude has been observed. However, nearly half of popular movies still contained tobacco imagery in 2009, including 54% of those rated PG-13, and the number of incidents remained higher in 2009 than in 1998. This analysis shows that the number of tobacco incidents increased steadily after the 1998 Master Settlement Agreement (MSA) between the state attorneys general and the major cigarette companies, in which the companies agreed to end brand placement.

In 2001, the Smoke Free Movies campaign began to publicly link the tobacco content of movies to specific movie studios and their parent companies.§ Subsequently, several state and local tobacco control programs began efforts to raise awareness of the public health importance of reducing the amount of onscreen smoking. These efforts included activities such as engaging youth empowerment programs on the issue, media campaigns, and community outreach. Beginning in 2002, many state attorneys general also increased advocacy directed at the movie industry, and in May 2004 and May 2007, Congress held hearings on smoking in the movies. In 2007, demands from state attorneys general led the Motion Picture Association of America (MPAA), which controls the movie rating system, to seek recommendations from the Harvard School of Public Health and to pledge their implementation. Harvard recommended that MPAA "take substantive and effective action to eliminate the depiction of smoking from movies accessible to children and youths".[4] MPAA's response was to attach smoking descriptors to the ratings for a fraction (12%) of nationally-released, youth-rated movies with smoking, beginning in May 2008.[5] Since 2007, several major studios adopted internal protocols for monitoring smoking content and promulgated corporate policies to discourage tobacco in their youth-rated movies. In 2009, Paramount (Viacom) became the first company whose youth-rated movies for the year contained no tobacco use incidents. In addition to other factors, these studio protocols might account for the some of the recent reduction in smoking incidents.

A meta-analysis of four studies estimated that 44% (95% confidence interval [CI] = 0.34–0.58) of the likelihood of youth trying smoking could be attributable to viewing smoking in the movies.[6] Given the dose-response relationship between exposure to onscreen smoking and youth and young adult smoking, reductions in youth exposure to onscreen tobacco use since 2005 would be expected to have a beneficial effect on reducing smoking initiation.[7] The national Youth Risk Behavior Survey** found that the national prevalence of ever having tried a cigarette declined significantly among high school students from 54.3% (95% CI: 51.2%–57.3%) in 2005 to 46.3% (95% CI: 43.7%–48.9%) in 2009. The reduction in smoking in movies might have been a contributing factor to this decline.

The findings in this report are subject to at least five limitations. First, the sample did not include all movies. However, an analysis of movies accounting for 96% of ticket sales during 2002–2008 suggested that movies that ranked in the top 10 for at least 1 week accounted for more than 95% of theater tobacco use impressions.[3] Second, this analysis examined all tobacco use incidents rather than smoking alone. However, the majority of tobacco use incidents depict smoking, and exposure to both smoking and total tobacco use incidents are predictive of youth smoking initiation.[1] Third, although theatrical tobacco impressions are down substantially, this measure must be interpreted cautiously because movies, including those containing incidents of tobacco use, can be viewed through many other channels (e.g., recorded media [DVDs], television, and the Internet), which do not factor into the calculation of movie theater impressions. Fourth, detailed audience composition data are not publicly available; therefore, the number of tobacco use impressions delivered by a particular movie to children and adolescents could not be determined. Finally, although this analysis shows the trends in movie tobacco depictions over time, it cannot definitively assess the reasons for those trends.

Effective methods to reduce the potential harmful influence of onscreen tobacco use should be implemented. Policies to decrease the negative effects on youths of onscreen depictions of smoking in movies have been recommended by the World Health Organization[8] and endorsed by a number of public health and health professional organizations.†† These include assigning R ratings to new movies that portray tobacco imagery. An R rating policy would create an economic incentive for producers to leave smoking out of movies that are marketed to youths. A 2005 study concluded that the return on investment for youth-rated movies was 70%, compared with 29% for R-rated movies.[9] Reducing the number of movies containing tobacco incidents is expected to reduce the amount of onscreen smoking seen by youths and the associated likelihood that they will become smokers.[10] Complementary recommended policies[8] include requiring strong antitobacco ads preceding movies that depict smoking, not allowing tobacco brand displays in movies, and requiring producers of movies depicting tobacco use to certify that no person or company associated with the production received any consideration for that depiction.

Master Settlement Agreement. Section III(e): prohibition on payments related to tobacco products and media. Full text available at
§ Additional information is available at
Senate Subcommittee on Commerce, Science and Transportation, 108th Congress. Impact of smoking in the movies (May 11, 2004). Prepared testimony available at House Subcommittee on Telecommunications and the Internet, 110th Congress. Images kids see on screen (June 22, 2007). Testimony and webcast (Panel 1) available at
** Data available at
†† A list of major endorsing organizations is available at


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