CDC estimates proposed R-rating would avert 1 million tobacco deaths among today’s children.
A coalition of the nation's most influential health organizations -- responding to a July 7 report by the U.S. Centers for Disease Control and Prevention -- have demanded that movie producers, distributors and exhibitors apply an R rating to all films that include depictions of smoking or tobacco.
Seventeen public health and medical groups signed a letter to film industry leaders in response to the CDC report, which showed that progress in reducing tobacco imagery in PG-13 movies stalled after 2010. The letter demands that the film industry meet a June 1, 2018, deadline to end its practice of using tobacco depictions in youth-rated movies that research has shown has a direct impact on children who go on to smoke.
The letter was signed by the largest-ever coalition of health leaders to unite behind this critical issue, including medical organizations that represent more than 630,000 doctors – the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, and the American Medical Association.
Signers also include the American Cancer Society, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, American Public Health Association, Association of State and Territorial Health Officials, Americans for Nonsmokers Rights, Breathe California Sacramento Region, Los Angeles County Health Agency, Smokefree Movies, Trinity Health, and Truth Initiative.
"As physicians and advocates, we are speaking with a unified voice: Filmmakers must stop enabling the tobacco industry to target our children." said Fernando Stein, MD, FAAP, president of the American Academy of Pediatrics. "The evidence is clear that when children see movie characters smoking, they are more likely to smoke. Ninety percent of smokers start smoking in their teen years, and many of them will battle a tobacco addiction that will eventually kill them. By rating movies appropriately, filmmakers can help protect the next generation from tobacco-related disease and death."
The CDC has projected that exposure to on-screen smoking will recruit more than 6 million U.S. children to smoke, of whom 2 million will die prematurely from tobacco-induced cancer, heart disease, lung disease or stroke. By voluntarily implementing policies that require R ratings for smoking, the film industry can avert 1 million tobacco deaths among today's children, according to estimates from the CDC.
Tobacco use continues to be the leading cause of preventable death in the U.S., responsible for nearly half a million adult deaths annually. Exposure to on-screen smoking recruits an estimated 37 percent of all new young smokers. The U.S. film industry has known about the risk from exposure and the public health value of the R rating since 2003. Under pressure from health groups and state attorneys general, some major studios reduced but did not end smoking in youth-rated films between 2005 and 2010, but then progress ceased. The smoking in PG-13 films is "of particular public health concern," said the CDC in its July 7 report.
"Cigarette smoking is the leading cause of cancer mortality, responsible for approximately 30 percent of all cancer deaths in America," said Gary Reedy, CEO of the American Cancer Society. "Most smokers are enticed into nicotine addiction as children, and the American film industry must take assertive action now to ensure that our kids are not lured into using this uniquely lethal product by depictions of smoking in major motion pictures."
The updated R rating guidelines, as described in the letter, would apply to all movies with 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."
The letter was sent Aug. 25 to the Motion Picture Association of America, Comcast, Disney, 21st Century Fox, Sony, Time Warner, Viacom; independents A24, Broad Green, Lionsgate, Open Rad, STX, The Weinstein Company; exhibitors National Association of Theatre Owners, AMC, Carmike, Cinemark, Marcus, Reading Int'l, Regal; retailers Amazon, Apple, AT&T, Best Buy, CinemaNow, Google, Hulu, Netflix, Redbox, Target, Verizon, Vudu and Walmart.
The Surgeon General notes that the magnitude of the effect of an R rating for smoking would be similar to increasing the price of cigarettes from $6.00 to $7.50 per pack.
"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. "It's long past time for the motion picture industry to act."
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"The Surgeon General recently concluded that there is a connection between youth seeing smoking onscreen and beginning to use tobacco. Today, the American Academy of Family Physicians is part of the more than 630,000 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. 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," said John Meigs, Jr., MD, President, The American Academy of Family Physicians.
"The American College of Physicians (ACP) calls attention to the data that demonstrate when children and adolescents are exposed to smoking on television and in the cinema they take up this lethal habit themselves. ACP members, as internists for adults, see all too frequently the ravages of nicotine addiction, and tobacco-related illness, including cancer, cardiovascular and cerebrovascular disease. Glamorizing smoking on television and in movies influences young persons to smoke and is at odds with anti-smoking efforts that are so critical for the health of our nation. ACP, therefore, encourages the television, motion picture and media industries to join with the medical community in recognizing this problem and taking whatever steps are needed to limit this hazardous exposure," said Jack Ende, president of the American College of Physicians.
"As the leading health care providers for women, ob-gyns see the deadly effects tobacco has on women through all stages of life. In recent years, many flavors of cigarettes, cigars and other forms of tobacco have been made available and marketed primarily to young and minority users. Compared with women who are nonsmokers, women who smoke cigarettes have greater risks of reproductive health problems, many forms of gynecologic cancer and other types of cancer, coronary and vascular disease, chronic obstructive lung disease, osteoporosis and possible poor future birth outcomes. We urge the motion picture industry to take smoking out of youth-related movies and stop targeting young people," said Haywood L. Brown, President, The American Congress on Obstetricians and Gynecologists.
"Approximately one third of deaths from heart disease in the U.S. can be traced to tobacco use and secondhand smoke exposure," said American Heart Association CEO Nancy Brown. "If the film industry insists on keeping this killer in movies, then they must make it more difficult for our kids to access and watch them. 'R' ratings on films that include tobacco depictions would go a long away in accomplishing this goal."
"The U.S. Surgeon General has concluded that exposure to onscreen smoking such as in movies causes young people to start smoking," said National President and CEO of the American Lung Association Harold P. Wimmer. "To help protect our youth from smoking-related disease and a lifetime of tobacco addiction, the American Lung Association supports giving an 'R' rating to all movies with instances of smoking in them. This is a commonsense step that will save lives."
"The AMA has long called on the entertainment industry to stop portraying the use of tobacco products as glamorous and sophisticated and de-emphasize the role of smoking on television and in the movies. We urge the motion picture industry to listen to the collective plea of the nation's physicians and once and for all apply an 'R' rating to films depicting cigarette smoking to help keep lethal, addictive tobacco products out of the hands of young people," said AMA President David O. Barbe, MD. "We will continue to advocate for more stringent policies and support efforts to protect our nation's youth from the dangers caused by tobacco use."
"Applying an R rating to films that show smoking is an important change that can have a big impact on the health of our nation. The role of entertainment in making tobacco use seem glamourous and carefree is undeniable, and it's time that the industry stops this practice to protect our youth," said Dr. Georges Benjamin, executive director, APHA.
Cynthia Hallett, President and CEO of Americans for Nonsmokers' Rights, noted that the movie industry has had more than 25 years to address public health concerns about smoking in films. Americans for Nonsmokers' Rights produced its "Hollywood on Tobacco" documentary and held the first summit on smoking in movies in 1991. "It's time for movie industry executives to stop dragging their feet and making excuses, and to adopt the R-rating to properly inform the viewing public and protect youth from unnecessary exposure to smoking in films," Hallett said.
"With the advancement of technology and the use of smart phones, entertainment is now available to us faster and easier than ever before. By giving an R rating to movies that depict smoking, fewer youth will see tobacco use as desirable. Cigarette smoking is the leading preventable cause of death in the United States and we need to use innovative ways to communicate the repercussions of tobacco use and its health effects to children while they are young. ASTHO is proud to support this initiative as our members—the leaders of our nation's state and territorial health departments—work tirelessly to create safe environments that promote the best possible health for all Americans," said Michael Fraser, executive director of ASTHO.
"There can be no neutrality when it comes to the issue of youth exposure to on-screen smoking. The health consequences are clear. Movie studios, other media producers, and retailers owe it to our children to stand on the right side of this fight," said David Modisette, CEO, Breathe California Sacramento Region.
"For the sake of our kids, it's time for the movies to end their long and harmful history of glamorizing smoking," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "By taking smoking out of youth-rated movies, the motion picture industry can help to save lives and to make the next generation tobacco-free."
"Hollywood can prevent these deaths," said Tonya Wells, Vice President, Public Policy & Federal Advocacy, Trinity Health. "If Hollywood fails to take action today, then years from now we will see the results of their inaction in our hospitals and clinics. Time is of the essence."
"We should not allow youth-rated movies to be advertising vehicles for the tobacco industry," said David Dobbins, Chief Operating Officer, Truth Initiative. "As smoking has become a less socially acceptable behavior, it continues to be portrayed positively in movies. We've made great strides in reducing the youth smoking rate to 6 percent but now is not the time to backslide."
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds