Tobacco Use in Top-Grossing Movies — United States, 2010–2018
Weekly / November 1, 2019 / 68(43);974–978
Michael A. Tynan1; Jonathan R. Polansky2; Danielle Driscoll3; Claire Garcia3; Stanton A. Glantz, PhD4 (View author affiliations)View suggested citation
What is already known about this topic?
The Surgeon General has concluded that there is a causal relationship between depictions of smoking in movies and the initiation of smoking among young persons.
What is added by this report?
From 2010 to 2018, tobacco incidents in top-grossing movies increased 57%, including a 120% increase in those rated PG-13. In 2018, biographical dramas accounted for most tobacco incidents, including 82% of those in PG-13 movies; 73% of characters who used tobacco in these biographical dramas were fictional.
What are the implications for public health practice?
Continued efforts are needed to reduce tobacco incidents in movies, particularly in PG-13–rated biographical dramas. Giving movies with tobacco incidents an R rating would eliminate tobacco product imagery from youth-rated films.
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The Surgeon General has concluded that there is a causal relationship between depictions of smoking in movies and initiation of smoking among young persons (1). Youths heavily exposed to onscreen smoking imagery are more likely to begin smoking than are those with minimal exposure (1,2). To assess tobacco-use imagery in top-grossing youth-rated movies (General Audiences [G], Parental Guidance [PG], and Parents Strongly Cautioned [PG-13]),* 2010–2018 data from the Breathe California Sacramento Region and University of California-San Francisco’s Onscreen Tobacco Database were analyzed.† The percentage of all top-grossing movies with tobacco incidents remained stable from 2010 (45%) to 2018 (46%), including youth-rated movies (31% both years). However, total tobacco incidents increased 57% from 2010 to 2018, with a 120% increase in PG-13 movies. Tobacco incidents in PG-13 fictional movies declined 57% from 511 in 2010 to an all-time low of 221 in 2018. Although the number of PG-13 fictional movies with tobacco incidents declined 40% during 2010–2018, the number of PG-13 biographical dramas with tobacco incidents increased 233%. In 2018, biographical dramas accounted for most tobacco incidents, including 82% of incidents in PG-13 movies; 73% of characters who used tobacco in these biographical dramas were fictional. Continued efforts could help reduce tobacco incidents in top-grossing movies, particularly in PG-13 biographical dramas, to help prevent youth smoking initiation.
Breathe California counts tobacco incidents, defined as the use or implied use of a tobacco product (i.e., cigarettes, cigars, pipes, hookahs, smokeless tobacco products, or electronic cigarettes), in U.S. top-grossing movies (movies ranking among the top 10 in theatrical gross receipts for at least 1 week), which account for 98% of U.S. movie ticket sales (3). Consistent with previous reports on this topic (3–5), this analysis is based upon assessments of movies for tobacco use by at least two independent monitors; any differences were resolved by a supervisor who independently assessed the movie using the same protocol.§
To calculate the percentage of movies with tobacco incidents, the number of movies with any tobacco incidents was divided by the total number of movies, and the average number of tobacco incidents per movie was calculated for each motion picture company. For each year during 2010–2018, the number of top-grossing movies with tobacco incidents and overall number of tobacco incidents were calculated. Results were also analyzed by Motion Picture Association of America ratings (G, PG, PG-13, and Restricted [R]). To identify movie type, production details in movie industry databases and trade publications were used to classify the top-grossing movies into three main genres: fiction, biographical dramas, and documentaries. The identity of each character using tobacco in biographical dramas was also examined to determine whether the character was fictional or an actual person.
In 2018, among the 139 top-grossing movies, 64 (46%) included tobacco incidents, compared with 62 (45%) of 137 in 2010. Among the 55 top-grossing R-rated movies, 38 (69%) had tobacco incidents in 2018, compared with 35 (71%) of 49 in 2010 (Table 1). Among youth-rated movies (G, PG, or PG-13), 26 (31%) of 84 had tobacco incidents in 2018, compared with 27 (31%) of 88 in 2010. During 2010–2018, the number of top-grossing movies with tobacco incidents was highest in 2013 (76) and lowest in 2014 (58).
The total number of tobacco incidents in top-grossing movies increased by 57%, from 1,824 in 2010 to 2,868 in 2018. The number of tobacco incidents reached a low of 1,743 in 2015 before increasing to a high of 3,163 in 2016. The total number of tobacco incidents in G- or PG-rated movies decreased from 30 in 2010 to 17 in 2018. In contrast, tobacco incidents increased from 564 to 1,241 (120%) in PG-13 movies and from 1,230 to 1,610 (31%) in R-rated movies, compared with those in 2010.
From 2010 to 2018, changes in the number of tobacco incidents in youth-rated movies varied by movie company. During this period, tobacco incidents dropped from 10 to zero in movies from Disney and from 115 to zero in Viacom movies and declined from 198 to 86 in Sony movies. Tobacco incidents increased approximately 2,900% in Comcast movies (from 19 to 573), 600% in Time Warner movies (from four to 29), 200% in Fox movies (from 96 to 327), and 60% in movies from independent companies (from 152 to 243).
Among the 1,239 top-grossing movies during 2010–2018, 1,110 (90%) were fictional, 114 (9%) were biographical dramas, and 15 (1%) were documentaries. During the same period, 83% of all movies with tobacco incidents were fictional, 16% were biographical dramas, and 1% were documentaries. The number of fictional PG-13 movies with tobacco incidents declined 40%, from 20 in 2010 to a low of 12 in 2018 (Figure). However, PG-13 biographical dramas with tobacco incidents increased 233% during this period, from three in 2010 (13% of PG-13 movies) to 10 in 2018 (43%). In 2018, among 1,241 tobacco incidents in PG-13 movies, biographical dramas accounted for 1,019 (82%).
During 2010–2018, across rating categories, most tobacco users in biographical dramas were fictional characters, including 60% (three of five) in G- or PG-rated movies, 70% (213 of 306) in PG-13–rated movies, and 78% (355 of 455) in R-rated movies (Table 2). Biographical dramas accounted for 31% (766 of 2,505) of all characters shown using tobacco; however, 75% (571 of 766) of tobacco users in biographical dramas were fictional characters. In 2018, 73% (82 of 112) of characters who used tobacco in biographical dramas were fictional.
The use of electronic cigarettes, or vaping, appeared in 19 top-grossing movies during 2010–2018 (i.e., 2% of all movies and 3% of movies with tobacco incidents). Among these 19 movies, 15 were R-rated, and four were PG-13–rated.
Although the number of movies with tobacco incidents remained stable during 2010–2018, the number of tobacco incidents within these movies increased, including a 120% increase in PG-13 movies. Although the number of PG-13 fictional movies with tobacco incidents declined substantially during 2010–2018, the number of PG-13 biographical dramas with tobacco incidents approximately tripled. The total number of PG-13 movies in both these genres with tobacco incidents approximately doubled since 2010; approximately 80% of all tobacco incidents in 2018 occurred in PG-13 biographical dramas. These findings suggest that the increasing number of youth-rated biographical dramas with tobacco incidents has negated previous progress made in reducing tobacco incidents in youth-rated fictional movies.
All major motion picture companies have policies to reduce tobacco depictions in youth-rated movies¶; however, Disney and Viacom were the only companies with no tobacco use in youth-rated movies in 2018. Paid placement of tobacco brands is prohibited in media such as movies, television, and video games by the 1998 Master Settlement Agreement between states and tobacco companies.** Public health groups have suggested interventions to reduce tobacco imagery in movies, such as the Motion Picture Association of America assigning an R rating to any movie with tobacco imagery, unless it portrays an actual historical figure who used tobacco or depicts the negative effects of tobacco use (6–8). Research suggests that such an R rating, in coordination with additional interventions, could help eliminate tobacco incidents in youth-rated movies (6–8) and reduce youth cigarette smoking by an estimated 18% (6,9).
Establishing the impact of youths’ exposure to tobacco imagery through movies (as well as original programming on television, streaming and on-demand services, and social media) and the effects of this exposure on youths’ tobacco use is important. A recent survey of streaming content popular with young persons and analysis of two full seasons of 14 programs identified at least one tobacco incident in 86% of programs (10), even as tobacco incidents have begun to decline in fictional theatrical feature films. Reducing the reach of tobacco incidents in streaming and other media platforms is essential to protect youths from exposures that can normalize tobacco use. Continued research will be necessary to understand how this exposure affects youth tobacco initiation and use (10).
The findings in this report are subject to at least two limitations. First, detailed audience composition data are not publicly available, so the number of tobacco-use impressions delivered by a particular movie to specific populations (e.g., children and adolescents) could not be determined. Second, the measure to assess tobacco exposure from movies should be interpreted cautiously because movies can be viewed through other media platforms that do not contribute to the calculation of in-theater impressions (e.g., physical discs, broadcast or cable television, and video-on-demand services).
Tobacco related incidents in youth-rated movies remained common, particularly in biographical dramas. The majority of persons using tobacco in these biographical dramas were fictional, not historical, figures. Studios could limit tobacco use in biographical dramas to real persons who actually used tobacco. Other evidence-based solutions could be implemented by producers and distributors of youth-rated entertainment to reduce the public health risk caused by exposure to on-screen tobacco imagery. For example, assigning all movies with tobacco incidents an R rating could eliminate tobacco product imagery from youth-rated films, which could further reduce initiation of tobacco product use among U.S. youths.
Corresponding author: Michael A. Tynan, email@example.com, 404-498-1202.
1Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Onbeyond LLC, Fairfax, California; 3Breathe California Sacramento Region, Sacramento, California; 4University of California, San Francisco.
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Jonathan Polansky, Danielle Driscoll, Claire Garcia, and Stanton Glantz report grants from Truth Initiative during the conduct of the study. Stanton Glantz also receives funding from the National Institutes of Health. No other potential conflicts of interest were disclosed.
* Ratings assigned by the Motion Picture Association of America (a trade organization that represents the major movie studios) include General Audiences (G): all ages admitted; Parental Guidance Suggested (PG): some material may not be suitable for children; Parents Strongly Cautioned (PG-13): some material may be inappropriate for children under 13; and Restricted (R): under 17 requires accompanying parent or adult guardian.
§ Two common methods used to count tobacco use incidents in movies are to count the number of scenes in which tobacco use occurs or to count the number of cuts in which tobacco use occurs. In the second method, a new incident is counted each time 1) a tobacco product went off screen and then came back on screen; 2) a different actor was shown with a tobacco product; or 3) a scene changed and the new scene contained the use or implied use of a tobacco product. Incidents of implied use are rare and occur when a person is handed or is holding, but not necessarily, using a tobacco product. Despite the difference in methods, both yield consistent results and are valid for comparing the results across ratings, years, companies, etc.
- US Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. https://www.cdc.gov/tobacco/data_statistics/sgr/2012/index.htm
- National Cancer Institute. Tobacco control monograph 19: the role of the media in promoting and reducing tobacco use. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2008. https://cancercontrol.cancer.gov/brp/tcrb/monographs/19/index.html
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- World Health Organization. Smoke-free movies: from evidence to action. Geneva, Switzerland: World Health Organization; 2009. https://apps.who.int/iris/handle/10665/44104
- Polansky JR, Titus K, Atayeva R, Glantz SA. Smoking in top-grossing US movies, 2014. San Francisco, CA: University of California, Center for Tobacco Control Research and Education; 2015. https://escholarship.org/uc/item/5d5348rs
- US Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm
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Abbreviation: PG-13 = Parents Strongly Cautioned (some material may be inappropriate for children under age 13 years).
* Ratings are assigned by the Motion Picture Association of America, the trade organization that represents the six major movie studios.
† Production details in movie industry databases and trade publications were used to classify the top-grossing movies as works of fiction or biographical dramas.
Suggested citation for this article: Tynan MA, Polansky JR, Driscoll D, Garcia C, Glantz SA. Tobacco Use in Top-Grossing Movies — United States, 2010–2018. MMWR Morb Mortal Wkly Rep 2019;68:974–978. DOI: http://dx.doi.org/10.15585/mmwr.mm6843a4.
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