January 14, 2009

Smoke Screens

In starring roles or cameos, cigarettes make frequent appearances in movies. What does it mean for the young people who watch?

By Julie Flaherty

Madeline Dalton, N88, N94, doesn’t consider movies the root of all evil. She and her twin 16-year-old sons can often be found in their Vermont home catching the latest Netflix arrival on their big-screen television. They devour everything from animated features to action thrillers. “Especially up here in the winter, we enjoy watching a lot of movies,” she says.

Madeline Dalton, N88, N94, enjoying a movie with her sons. Photo: John Sherman

So when Dalton, an epidemiologist, associate professor and director of the Hood Center for Children and Families at Dartmouth Medical School, set out some years ago to study how movies influence a child’s chances of taking up smoking, she had no grudge with Hollywood. She didn’t know her research eventually would make producers quake and force the movie industry to rethink its ratings system.  

Dalton started researching movies in 1996, when she and her colleagues at Dartmouth were working on a project to help children design their own tobacco-prevention programs. Because some 90 percent of adult smokers start smoking by age 18, preventing children from trying cigarettes has long been a public health goal.  

Talking to children at their schools, the researchers saw they were up against some powerful marketing. Back then it was still legal for cigarette companies to give out promotional items like hats and T-shirts, some of which parents passed on to their children.

“You could see the Marlboro backpacks sitting in the back of a third-grade classroom,” Dalton says. So she and her colleagues started thinking about some of the other media that might influence children to start smoking. They noticed that one thing the students talked about a lot—and could recount with amazing detail—was all the movies they watched.

No one had ever studied whether watching Gwyneth Paltrow light up in the Royal Tenenbaums could influence a youngster to do the same. “Now I know why,” Dalton says. “It is a very hard thing to measure. You can measure how many people smoke in movies—although that’s not easy either—but to tie that to what kids are watching and how strong their exposure is, that was really challenging.”

Just designing the study took almost two years, as their group, which included a pediatrician (James Sargent, M84, as primary investigator), two social psychologists and a statistician, hammered out all the factors they would have to measure. With the researchers’ varied backgrounds, “it was really difficult to come to a consensus,” Dalton says, “but it made for great discussions.”

First they had to figure out what movies the teens and tweens (ages 9 to 15) were watching. Through focus groups with children and interviews with video store owners, they narrowed their movie sample to box office hits from the previous 10 years, plus a handful of others that featured popular teen stars, for a total of roughly 600 films. (Yes, most great films of yesteryear are filled with scenes of smoking, but you won’t find many 12-year-olds standing in line at Blockbuster with a copy of Citizen Kane, so the classics were not included.)

They then hired a pair of movie aficionados to watch each film and mark down every time tobacco made an appearance. “The movie coders say it is a great job when it’s a good movie,” Dalton says. “But when it’s a bad movie with a lot of smoking, it’s tough.” This way, when they asked the nearly 5,000 children they were surveying about their movie-watching histories, they could tally the total puffs and drags each had seen on the screen.

At the same time, the researchers had to control for all the known risk factors for taking up smoking. There were the obvious ones: age, gender, ethnicity and parents’ education. Do their parents smoke? Their siblings? Their friends? How well do they do in school? The better the grades, the less likely the student will become a smoker.

They also looked at how closely the students’ parents—in this case, they focused on the mothers—supervised them and how approachable they were when their kids had concerns. Does your mom know what you do with your friends, they asked? Does she know where you are after school, or check to see that you do your homework? Does she want to know about your problems?

To make sure they weren’t comparing Sandra Dees to James Deans, they tried to get a feel for whether the children were sensation-seeking or rebellious. They also gauged self-esteem.

When the researchers completed the study, they found a link between the movies the children watched and their smoking experience that was so clear, even they were taken aback. All other things being equal, the children who saw the most smoking in movies were two and a half times more likely to have tried smoking than those who saw the least amount of on-screen light ups. “I don’t think any of us expected to see such a strong association,” Dalton says.

“We looked at the first analysis and said, ‘Nobody is going to believe that,’ ” Dalton says. They crunched and re-crunched the numbers, but the finding didn’t go away. The results were published in the British medical journal BMJ in 2001.

They followed the children for two more years, and their next paper, published in The Lancet in 2003, revealed something that non-smoking parents were surprised and perhaps alarmed to hear: it was their children who were most susceptible to the movie influence. In that group, children who saw the most on-screen smoking were four times more likely to light up than the ones who saw the fewest cigarette scenes.

“I’ve talked to parents who said, ‘Well, my kids watch the movies, but they are not going to be influenced by the smoking. We don’t smoke, and they hate smoking,’ ” Dalton says. “As a parent of teenagers, I can tell you, you never know what might influence your children.”

An Affair to Remember

Smoking and the movies have a long, tangled history. Decades after Bette Davis and Paul Henreid fell in love over plumes of smoke in Now, Voyager, and long after the dangers of smoking came into focus in the ’50s and ’60s, cigarettes continued to have a starring role in films.

Tobacco companies often paid to have their brands promoted on screen. See Superman II, where Philip Morris paid $42,000 for prominent placements of Marlboros, the brand name Lois Lane clearly prefers. One company, R.J. Reynolds, sent monthly supplies of free cigarettes to actors and directors. In 1983, Sylvester Stallone agreed to use Brown & Williamson tobacco products in five of his films in exchange for $500,000.

Tobacco companies, under pressure from the public, pledged voluntarily to end paid product placement in 1990, and it became official in 1998 as part of the companies’ master settlement agreement of lawsuits filed by state attorneys general over the health-care costs of tobacco-related illnesses.

Even so, tobacco depictions in movies, which declined through the 1970s and 1980s, actually increased after 1990, according to a 2002 report. The authors speculated that Hollywood was still influenced by Big Tobacco, although they could not prove it. And the smoking is not only in R-rated films. Researchers at Dartmouth found that the vast majority of on-screen smoking children see is in youth-rated movies, meaning G, PG and PG-13 films.

Armed with the research team’s findings, which were reiterated in several studies, public health advocates and state attorneys general began to push the film industry to make smoking part of the criteria for an R rating, just as nudity, sex, violence, drug use and bad language are taken into account. In 2004, Dalton was called to testify before a Senate hearing on the issue.

“From a researcher’s perspective, I think it’s important to understand what the risk factors are,” she says. “From a parenting standpoint, I just felt like parents needed to know. Many parents were unaware of the impact that movie smoking exposure could have on their children.”

Jack Valenti, then president of the Motion Picture Association of America (MPAA), the movie industry’s trade group, also spoke at the Senate hearing. Earlier he had revealed to Dalton that the MPAA had paid someone to go over her paper in The Lancet, looking for weaknesses, but could not find any. “Although he didn’t agree with our conclusions, he admitted that the study was methodologically sound,” she says.

Curiously, Dalton found that most of the film directors she spoke with didn’t parry her research with a freedom-of-expression argument. “Some had a more sympathetic view than many of the public,” she says. “I think that’s because their movies are rated based on all kinds of content that they decide to include. And they certainly are aware that movies impact kids. They are the first to tell you that it is a very powerful medium. The producers had a different take on it because they don’t gross as much from an R-rated movie as from a PG-13.”

The movie industry is beginning to make some changes. In May 2007, the MPAA announced it would consider tobacco use as a factor in its film ratings. In July 2008, six major movie studios said they would place anti-smoking public service announcements on DVDs of all movies with youth ratings that depict smoking. The industry could be under even more pressure with the recent release of a comprehensive report from the National Cancer Institute, a federal agency, which concluded that films have a powerful effect on adolescent tobacco use.

Still, many are reluctant to believe that letting little Jimmy kill time on a Sunday afternoon with Iron Man or Daredevil (two PG-13 films that received “black lung” designations from SceneSmoking.org) would be enough to get him to take up the habit.

After all, when Elvis Presley swiveled his hips, the rock-and-roll generation didn’t turn to lives of debauchery, as some predicted. “No, but a lot of people started dancing like that,” Dalton says. “And that’s the thing with the movies. How many people wanted to buy Mini Coopers after The Italian Job? Most of us are influenced in some way by what we see in movies.

“No one really has a problem talking about peer influences. If your friends smoke, you’re more likely to smoke—people take that as a given. The influence of movies is not that much different. It’s a social influence much the same as peers. It took us years to understand how peers influence children, and it will probably take us years to figure out how movies influence children.”

There is still a lot to make sense of. In a paper for the journal Preventive Medicine, Dalton points out that there is a limit to how well a researcher can convert “the contextual richness and nuances of movies” into survey data. She uses the example of a scene from Romeo & Juliet, when a pensive Leonardo DiCaprio smokes while writing in his diary.

A researcher simply ticking it off as a smoking instance on a data sheet “would not capture the fact that smoking followed a scene in which Romeo’s parents described his depression and alienation from them,” something many adolescents can identify with, she writes, emphasizing that adults—and scientists—can’t necessarily watch a film the way a teenager does. “Nor would it capture the almost sensual nature in which smoking was portrayed, which has to do with lighting, sound and other factors that simply cannot be coded in a large sample of movies.”

Some people say it should be acceptable for villains to smoke in movies, since it only underscores their wickedness. But Dalton points out that the characters that draw children in aren’t always the ones who wear white hats, and that it is too simplistic to characterize them as good versus bad.

She laughs when she thinks of her own sons, who as adolescents are drawn to the tough guys. “When they are watching The Godfather,” she says, “they want to be like members of the family, not the police who are after them.”

This story first appeared in the Fall 2008 issue of Tufts Nutrition magazine. Julie Flaherty can be reached at julie.flaherty@tufts.edu.

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