AAFP, Health Groups Demand 'R' Rating for Movies With Smoking

CDC Estimates Change Would Avert 1 Million Tobacco Deaths Among Children

August 30, 2017 01:28 pm News Staff

The AAFP recently joined 16 other health organizations to demand that movie producers, distributors and exhibitors meet a June 1, 2018, deadline to begin applying an "R" rating to any film that includes depictions of smoking or tobacco. Depiction of tobacco use in youth-rated movies must end, said the groups, because research showed these images are directly correlated with children becoming smokers.

[Two teens sitting in a movie theater]

The groups' Aug. 25 letter to film industry leaders(1 MB PDF) was spurred by a July 7 Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) from the CDC that examined tobacco use in top-grossing movies from 2010-2016. The MMWR concluded that a previous overall decline in individual occurrences of tobacco use in youth-rated movies stalled as of 2010, after which the total number of such tobacco incidents in top-grossing movies increased, with a 43 percent spike in movies rated "PG-13."

The CDC projected exposure to on-screen smoking would lead to more than 6 million U.S. children starting to smoke; of that total, 2 million would die prematurely from tobacco-induced cancer, heart disease, lung cancer or stroke. However, the agency said if the film industry voluntarily implemented policies to require "R" ratings for depiction of smoking, 1 million tobacco deaths among current children could be avoided.  

Story highlights
  • The AAFP joined 16 other health organizations to demand that movie producers, distributors and exhibitors meet a June 1, 2018, deadline to apply an "R" rating to all films that include depictions of smoking or tobacco.
  • The groups signed onto an Aug. 25 letter to film industry leaders that was spurred by a July 7 CDC Morbidity and Mortality Weekly Report highlighting tobacco use in top-grossing movies.
  • The goal of halting depictions of tobacco use in youth-rated movies is based on research that shows these images are directly correlated with children becoming smokers.  

"Today, the American Academy of Family Physicians is part of the more than 400,000 doctors and 17 public health and medical groups demanding the film industry take a very clear and necessary action to help protect one of our most vulnerable populations," said AAFP President John Meigs, M.D., of Centreville, Ala., in a joint news release(www.aap.org)

"Nicotine exposure harms children from conception onward, and tobacco continues to be a major health threat to both young people and adults. As family physicians, we see the dangerous effects of tobacco use in patients throughout the entire lifespan and will continue to work tirelessly to save lives by eliminating tobacco use and reducing the exposure to tobacco-related imagery that has been shown to increase the risk for tobacco use."

Tobacco industry documents have revealed that tobacco manufacturers and distributors collaborated with the movie industry for decades to promote smoking and specific tobacco brands -- both before and after the U.S. surgeon general's 1964 landmark report that causally connected smoking and cancer.

In March 2012, (then) Surgeon General and family physician Regina Benjamin, M.D., released a report(www.surgeongeneral.gov) in which she stated that "The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in movies and the initiation of smoking among young people." Shortly thereafter, a longitudinal cohort study(pediatrics.aappublications.org) published in the August 2012 issue of Pediatrics examined smoking onset in youths who viewed movies released during 1998-2003. It concluded that applying an "R" rating to movies that depict smoking could reduce the number of teen smokers by about 18 percent.

According to the groups' letter, since December 2003, the U.S. motion picture industry has reduced the annual number of top-grossing, youth-rated films with any tobacco imagery by 60 percent. In fact, in 2016, tobacco incidents in youth-rated (G/PG/PG-13) films were 35 percent below 2003 levels. However, as noted above, the overall trend of declining numbers of individual tobacco incidents among all top-grossing movies stalled in 2010 and then reversed.

"Since the industry's progress halted, major studios and independent producer-distributors have released 210 top-grossing, youth-rated U.S. films featuring more than 6,000 tobacco incidents, delivering 60.5 billion tobacco impressions to audiences in U.S. theaters alone," the letter said. "The average PG-13 film with any smoking is actually 30 percent smokier than a decade ago."

The letter further noted that if the industry had simply kept reducing tobacco content in youth-rated films at the pace during 2005-2010, all youth-rated films would have been entirely smoke-free by 2015.

The letter represented the largest-ever coalition of health care and medical organizations to speak out about this issue, with signatories that include -- in addition to the AAFP -- the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists and the American Medical Association.

The American Cancer Society, the American Heart Association, the American Lung Association, Campaign for Tobacco-Free Kids, the American Public Health Association, and the Association of State and Territorial Health Officials also signed on.

The correspondence was sent to the Motion Picture Association of America, as well as to large media companies such as Comcast, Disney, 21st Century Fox, Sony, Time Warner and Viacom. More than two dozen independent filmmakers, exhibitors and retailers also received the letter.

The coalition's letter called for the updated "R" rating guidelines to apply to all movies that depict smoking except those that "exclusively portray actual people who used tobacco (as in documentaries or biographical dramas) or that depict the serious health consequences of tobacco use."

"There is nothing that could be done that is so easy and cheap that would have such a big effect on youth smoking as making youth-rated films smokefree," said Stanton Glantz, a professor of medicine at the University of California, San Francisco, and director of the Smokefree Movies project, in the news release. "It's long past time for the motion picture industry to act."

Related AAFP News Coverage
AAFP Awards Third Round of Tobacco Control Mini-grants
Program Will Sunset After This Year
(8/8/2017)

CDC MMWR
Teen Tobacco Use Dropped Significantly From 2015 to 2016
(6/22/2017)

Leader Voices Blog: Not Blowing Smoke: FPs Can Make a Difference on Tobacco
(4/4/2017)