Harvard Public Health Review Winter 2007
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Hollywood Smokeout

Overwhelming Evidence
Fortunately, the MPAA’s Dan Glickman appears to have a fresh attitude. A former congressman, later secretary of Agriculture, Glickman is a former director of the Institute of Politics at Harvard’s Kennedy School of Government. As MPAA’s new leader, Glickman asked me to make a considered recommendation to the MPAA on smoking in the movies, with no preconditions. I was privileged in February to be able to bring two experts to present our views to senior representatives of the MPAA, the Guild of Directors, the Screen Actors Guild, and the National Organization of Theater Owners. These experts were HSPH’s Jay Winsten, associate dean for Public and Community Affairs, the Frank Stanton Director of the Center for Health Communication, and leader of the highly successful “Designated Driver” campaign; and Professor Jonathan Samet, chair of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, an author of the last five reports on smoking from U.S. surgeons general, and a national and international expert on smoking’s health effects.

Together we reviewed for film industry representatives the science demonstrating that nicotine is among the most addictive substances known—comparable to heroin and crack cocaine—and that smoking is harmful to the health of children, youths, and adults. Most significant, we pointed out that the mean age for initiating smoking in the United States is just 13 years, and that population studies indicate that if an individual does not start to smoke between ages 12 and 24, he or she runs only about a five to ten percent lifetime risk of ever smoking. Tellingly, about a third of all movie viewers are between the ages of 12 and 24. Thus the industry, and popular film stars who smoke, have the attention of young people at precisely the most crucial time in their lives for resisting tobacco initiation.

We reviewed, as well, the compelling body of evidence underlying our assertion that young people are influenced by television and movie images of smoking, and we explained the social-behavior theory behind changes in social norms. When industry spokespersons stated that directors’ depictions of smoking in the movies merely reflects “reality,” we responded that, in fact, widespread smoking expressly does not mirror reality. We pointed out that only about 21 percent of the U.S. population smokes, and that the highest proportion of smokers is among minority and disadvantaged socioeconomic groups. By contrast, in the movies, more than half of lead actors are depicted smoking, and the majority are white and well-off.

No Slippery Slope
We presented one final and, we believe, pivotal argument to urge the MPAA to take substantive action, by addressing the position held by some filmmakers that curtailing smoking in movies would compromise their artistic freedom or signal the beginning of a “slippery slope” toward censorship. Our argument regarding freedom of expression comes from experience: As a graduate faculty of Harvard University, we are acutely sensitive to potential infringements of academic freedom, the freedom to pursue our own ideas and scholarly inquiry into how to preserve and protect human life. But nearly a decade ago, the HSPH faculty began to recognize that accepting money from tobacco companies to do our scientific studies, no matter how worthy, would be antithetical to the mission of public health. The HSPH faculty debated intensively the implications of forswearing support from tobacco-related industries and their subsidiaries, and out of responsibility to our shared goals voted unanimously to forgo funding from them. Because tobacco, aside from guns, is the only product that, when used as directed, kills, no “slippery slope” issues have emerged since relating to any other products. HSPH was among the very first academic research institution in the nation to make such a formal policy. Many other schools have followed suit.

As deeply committed to academic freedom as our faculty researchers were, they believed that the higher value of taking responsibility for preventing the largest cause of death and disease in the world was sufficient for them to constrain that freedom, to say nothing of support for their research, even their ability to make a living. The film industry needs to take responsibility for the consequences of its actions, and to be creative in doing so.

With the greatest respect for the complexity and expense of making films, and for the creativity of the artists in all aspects of the industry, we made the following recommendation to Dan Glickman and the MPAA:

“Take substantive and effective action to eliminate the depiction of tobacco smoking from films accessible to children and youths, and take leadership and credit for doing so.” For industry leadership to have real impact, we said, we hoped the MPAA’s message would be clear, simple, and publicly accountable. And we asked all the major studios and guilds to use their leadership to make it a policy.

The May 10 announcement by the MPAA and Ratings Board, we believe, represents an historic and important step in the right direction by the leadership of the industry to recognize the dangers of smoking in movies. We hope it will be but one step of many undertaken by the motion picture and television industries toward a still more significant and impactful public health goal: eliminating the depiction of tobacco use from all youth-accessible films.

Barry R. Bloom

Dean Barry R. Bloom
Dean of the Faculty, HSPH
Joan L. and Julius H. Jacobson II Professor of Public Health

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Photos: top, ©Corbis; bottom,©Superstock

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