ACP American College of Physicians - Internal Medicine - Doctors for Adults

Effective Clinical Practice


Rate Movies with Smoking "R"

Effective Clinical Practice, January/February 2002

Stanton A. Glantz, PhD

For author affiliations, current addresses, and contributions, see end of text.

The major goal of the Motion Picture Association of America (MPAA), Hollywood's political arm, is to protect the movie studios and the multinational corporations that own them from anything that would restrict their activities or profits. In response to efforts by the government to censor the content of films, the MPAA instituted a voluntary system of rating films in 1968. (1) According to the MPAA, "The basic mission of the rating system is a simple one: to offer parents some advance information about movies so that parents can decide what movies they want their children to see or not to see." (1) Movies are rated on the basis of language, violence, sexual content, and drugs. Movies with explicit sexual material, explicative language, or drug use receive an R rating (restricted— no one under 17 admitted without a parent). The MPAA does not consider smoking—the most widely used addictive drug that kills the most people—in assigning ratings.

The fact that the MPAA does not consider smoking when rating a movie is very important to the tobacco industry because it recruits and retains new smokers—the children that the MPAA rating system is supposedly designed to protect—by associating its products with excitement, sex, wealth, rebellion, and independence. Movies are a powerful way to make this connection. The tobacco industry has built its alliance with Hollywood for decades by working at every level, from payments to studios to distributing free cigarettes to the people who make movies. (2, 3) And it has been a two-way street. For example, in 1972 the president of a production company wrote RJ Reynolds Tobacco reporting that all the characters in a suspense thriller they were producing smoked, then added, "Film is better than any commercial that has been run on television or any magazine, because the audience is totally unaware of any sponsor involvement." (4)

The paper by Dalton and colleagues (5) in this issue of ecp encourages taking smoking into account when rating a movie to provide a tool to help parents prevent their children from beginning to smoke. While the MPAA does not consider smoking in rating a film, there is generally more smoking in R-rated movies than in those rated G (general audience), PG (parental guidance suggested), or PG-13 (parents strongly cautioned; some material may be unsuitable for children under 13). Using a large sample of children in grades 5 through 8, they found that the more the children viewed R-rated films, the more likely they were to smoke and drink. Conversely, children whose parents restricted watching of R-rated films were less likely to smoke and drink. This effect persisted even after controlling for demographics and other aspects of parental restrictions. Compared with children who had no restrictions on viewing R-rated movies, children with restrictions had adjusted odds for having tried smoking reduced by half, and odds for children who were completely restricted were reduced by a factor of 5. Parents can help prevent their children from beginning to smoke by not allowing them to watch R-rated films whether in theaters, video, or television.

Dalton and colleagues' study adds to the already strong case that smoking in movies has a powerful impact on teen smoking. After a decline in the 1970s and 1980s, the amount of smoking in American movies began to increase dramatically in 1991 and now exceeds the amount present in 1960. (6) In contrast to reality, smoking in the movies is usually associated with high-profile, successful figures. (7) A teen going to the movies today will leave with the misimpression that smoking is widely accepted— that is, the "winners" smoke, and no health or social consequences are associated with smoking. Appearance of specific brands, with Philip Morris' Marlboro dominating during the 1990s, is high, and use of specific brands by actors on screen has increased dramatically. (8) Smoking by high-profile actors is associated with favorable attitudes toward smoking and actual smoking among teens. (9, 10) The more smoking that teens see on screen, the more likely they are to smoke. Compared with teens who had watched films with a total of 50 or fewer tobacco uses, watching movies with high tobacco use (more than 150 incidents) tripled the odds that the teens would try tobacco. (11)

Given the evidence that smoking in movies strongly impacts childhood and early smoking and claims by the MPAA that it created the ratings system to help parents protect their children, why has the MPAA consistently refused to include smoking when rating a movie? The MPAA has a long history of friendly relations with the tobacco industry; it has hosted meetings (12) of the tobacco industry's super-secret Committee of Counsel. (13) Similar to the tobacco industry, Hollywood has dealt with expressions of concern about smoking with rhetoric about "free expression" and denials that smoking in the movies actually contributes to smoking.

The MPAA's policy of protecting tobacco promotions in films by refusing to rate such films R under the guise of free expression is hypocritical in light of the fact that it rated the 1999 film The Insider R because of "language." The Insider, which described the struggle of former Brown and Williamson chief scientist Jeffrey Wigand and CBS 60 Minutes producer Lowell Bergman's efforts to tell the public the truth about big tobacco, is probably the most powerful educational film made about tobacco. It clearly demonstrates the industry's unscrupulous behavior and demonstrates how it has used its power to keep the truth away from the public. This message of truth versus lies is probably the most effective message that can be used to prevent teen smoking. (14, 15) The MPAA's R rating substantially reduced the number of teens that would see this film and virtually ensured that it would not be shown in schools. Quite a favor for the tobacco industry.

Of course, rating movies that contain smoking R has economic consequences for the studios because an R rating generally means less box office revenues and profits. In those cases where the producers, directors, actors, and writers think that smoking is crucial for dramatic effect, they would be free to include it, just as they can include graphic violence or sex. An R rating for smoking would, however, raise the cost of doing the tobacco industry's dirty work and would substantially reduce the number of films that promote smoking.

To achieve the maximum benefit of this policy, Hollywood would have to end the practice of promoting R-rated films to children and teens. (16) Theaters and video stores would have to take the R rating seriously and preclude children's access to these films unless they have expressed parental permission.

Rating films with smoking (or other pro-tobacco imagery) R is, of course, only one element of a program to prevent American films from being the tobacco industry's most powerful promotional device worldwide. To promote a discussion of these issues in Hollywood, I have been running an educational campaign based on full-page newspaper advertisements in the entertainment trade press (Figure 1). In addition to rating films with smoking R, this campaign advocates three other steps:

None of these measures will choke creativity or restrict content. They will, however, make movies less effective as promotional devices for the tobacco industry.

Jack Valenti, President of the MPAA, parroting tobacco industry logic, says that smoking is not considered in the ratings system because "Cigarettes are legal, so how could you have it affect the rating of a picture?" (Mr. Valenti seems to forget that the "f" word is legal, too.) He has also said that smoking is not considered in the ratings system because parents have not asked for it.

It is time to ask.


1. Motion Picture Association of America. Movie Ratings; 2001. s/about/index.htm. Accessed November 10, 2001.

2. Mekemson C, Glantz S. How the tobacco industry built its relationship with Hollywood. Tob Control: [In press].

3. Glantz S. Smoke Free Movies; 2001. Accessed September 29, 2001.

4. Richards R. We are about to go into production with the motion picture, "Run Sheep Run," a suspense thriller, set in Los Angeles. Accessed March 26, 2001. Bates Range 5002014

5. Dalton M, Sargent J, Mott L, et al. Correlation between use of tobacco and alcohol in adolescents and parental restrictions on movies. Eff Clin Pract 2002;5:1-10.

6. Kacirk K, Glantz S. Smoking in movies in 2001 exceeded rates in the 1960s. Tobacco Control 2001:10:397-8.

7. Hazan AR, Lipton HL, Glantz SA. Popular films do not reflect current tobacco use. Am J Public Health 1994;84:998-1000.

8. Sargent JD, Tickle JJ, Beach ML, Dalton MA, Ahrens MB, Heatherton TF. Brand appearances in contemporary cinema films and contribution to global marketing of cigarettes. Lancet 2001;357:29-32.

9. Distefan JM, Gilpin EA, Sargent JD, Pierce JP. Do movie stars encourage adolescents to start smoking? Evidence from California. Prev Med 1999;28:1-11.

10. Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton TF. Favourite movie stars, their tobacco use in contemporary movies and its association with adolescent smoking. Tob Control 2001;10:16-22.

11. Sargent J, Beach M, Dalton M, et al. Is viewing tobacco use in motion pictures associated with trying smoking? BMJ; 323:1394-7.

12. Stevens A. Letter regarding Committee of Counsel. Lorillard Tobacco; June 18, 1975. Accessed November 10, 2001. Bates Range 2025027391/7392

13. France M. Inside big tobacco's war room. Business Week 1998 June 15:134ff.

14. Goldman LK, Glantz SA. Evaluation of antismoking advertising campaigns [see comments]. JAMA 1998;279:772-7.

15. Healton C. Who's afraid of the truth? Am J Public Health 2001;91:554-8.

16. Federal Trade Commission. Marketing violent entertainment to children: a review of self-regulation and industry practices in the motion picture, music recording, and electronic game industries; 2000. tm#13. Accessed November 13, 2001.

17. Pechmann C, Shih C. Smoking in movies and antismoking advertisments before movies: effects on youth. J Marketing 1999;63:1-13.

Grant Support

This work was supported by the Robert Wood Johnson Foundation and Richard and Rhoda Goldman Fund.


Stanton A. Glantz, PhD, University of California, Box 0130, San Francisco, CA 94143-0130; telephone: 415-476-3893; fax: 415-476-2283; e-mail: