Smoking and the Movies

Jonathan M. Samet, MD, MS

MPAA, Hollywood, CaliforniaFebruary 23, 2007

Department of Epidemiology

1. Nearly all first use of tobacco occurs before

high school graduation; this finding

suggests that if adolescents can be kept tobacco-free,

most will never start using tobacco.

2. Most adolescent smokers are addicted to nicotine and report that they want to quit but are unable to do so; they experience relapse rates and

withdrawal symptoms similar to those

reported by adults.

3. Tobacco is often the first drug used by

those young people who use alcohol,

marijuana, and other drugs.

Major Conclusions of the 1994 U.S. Surgeon General’s Report

Major Conclusions of the 1994 U.S. Surgeon General’s Report, continued

4. Adolescents with lower levels of school achievement, with fewer skills to resist pervasive influences to use tobacco, with friends who use tobacco, and with lower self-images are more likely than their peers to use tobacco.5. Cigarette advertising appears to increase young people’s risk of smoking by affecting their perceptions of the pervasiveness, image, and function of smoking.6. Community wide efforts that include tobacco tax increases, enforcement of minors’ access laws, youth-oriented mass media campaigns, and school-based tobacco-use prevention programs are successful in reducing adolescent use of tobacco.

Children Smoke Around the World

Four Points

• Addiction to nicotine begins in adolescence.

• Smoking harms children and kills adults.

• Children who see smoking in movies are at increased risk to start smoking.

• Children are a target for the industry worldwide.

Tobacco Use Among Youth

•Approximately 80% of tobacco users initiate use before age 18 years.

•An estimated 6.4 million children aged <18 years who are living today will die prematurely as adults because they began to smoke cigarettes during adolescence.

•The annual health-related economic cost associated with tobacco use exceeds $167 billion.

Source: MMWR May 19, 2006 / 55(SS03);1-56

Percentage of all middle and high school students who first smoked a cigarette before age 11* years, National Youth

Tobacco Survey, US 2002

Source: MMWR May 19, 2006 / 55(SS03);1-56

Age of Initiation of Tobacco Use

Cigarettes

• Middle School. Nationally, 8.1% of students first smoked a whole cigarette before age 11 years, with male students (9.8%) significantly more likely than female students (6.5%) to have done so. Among the 30 states that asked this question, the percentage of students who first smoked a whole cigarette before age 11 years varied (range: 4.9% [Maryland]--14.3% [Louisiana]; median: 8.9%).

• High School. Nationally, 6.7% of students first smoked a whole cigarette before age 11 years, with male students (8.4%) significantly more likely than female students (5.0%) to have done so. Among the 24 states that asked this question, the percentage of students who first smoked a whole cigarette before age 11 years varied (range: 5.7% [Connecticut]--11.9% [Florida]; median: 9.0%).

Source: MMWR May 19, 2006 / 55(SS03);1-56

Percentage of all middle and high school students who were exposed to tobacco-related media and advertising, National Youth Tobacco

Survey, US 2002

Source: MMWR May 19, 2006 / 55(SS03);1-56

Larynx: 1980Esophagus: 1982

Kidney: 1982

Nasal & Oral pharynx: 1982

Coronary heart disease: 1979

Stomach: 2002

Cervix: 2002

Liver: 2002

Stroke: 1983

Aortic aneurysm: 1983Atherosclerotic peripheral vascular disease: 1983

Lung: 1964

Chronic obstructive pulmonary disease (COPD): 1964

Bladder: 1990

Pancreas: 1990

Leukemia: 2002

Ureter: 1990

Most Recent Scientific Evidence: Active Smoking

http://www.cdc.gov/tobacco/sgr/sgr_2004

Cataract: 2004

Diminished Health: 2004

Diseases and Adverse Health Effects Caused by Secondhand Smoke

Adults

Lung Cancer

Heart Disease

Children

SIDS

Exacerbation of Asthma

Chronic Respiratory Illness

Reduced Lung Function Growth

Middle Ear Disease

Acute Respiratory Illness

http://www.cdc.gov/tobacco/sgr/sgr_2004

Increased Risk of Smoking Initiation from Selected Factors

Characteristic Increased Risk

If either parent smokes 125%If any siblings smoke 91%If neither or one parent disapproves 53%Movie viewing: smoking exposure (2nd quartile compared to 1st quartile)

139%

Movie viewing: smoking exposure (3nd quartile compared to 1st quartile)

199%

Movie viewing: smoking exposure (4th level compared to 1st quartile)

331%

Source: Dalton et al. Lancet 2003

RR of Smoking Initiation

1

2.392.99

4.31

0

1

2

3

4

5

6

7

1 2 3 4

Movie Smoking Exposure Quartile

RR (95% CI)

Source: Dalton et al. Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet. 2003 Jul 26;362(9380):281-5.

Source: Dalton et al. Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet. 2003 Jul 26;362(9380):281-5.

RR of Smoking Initiation

1

2.84 2.32

4.77

2.64

4.64 4.084.74

0

2

4

6

8

10

NS S NS S NS S NS S

Movie Smoking Exposure Quartile by Parental Smoking

RR (95% CI)

Q1 Q2 Q3 Q4

Youth Smoking Worldwide: Japan