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

Effective Clinical Practice


Smoke-Free Movies: Sense or Censorship?

Effective Clinical Practice, January/February 2002

Steven Woloshin, MD, MS, Lisa M. Schwartz, MD, MS

In this issue we take on a controversial question: Do the movies bear some responsibility in popularizing smoking? Some health advocates are concerned that the portrayal of smoking in the movies contributes to the perception that cigarettes are glamorous, sexy, cool, etc. and may therefore lead some children to try smoking. The study by Dalton and colleagues (1) indirectly supports this contention. Their findings suggest that by limiting access to R-rated movies (which typically depict alcohol and cigarette use in a positive light), parents can reduce the chance that their children try cigarettes or alcohol.

We hoped to present a debate about the pros and cons of using the movie ratings system to help limit childrens' exposure to on-screen smoking. Specifically, a debate between a noted antismoking advocate who suggests that all films with smoking be rated R (to keep children from seeing the films) and the head of the Motion Picture Association of America (MPAA)—the organization that issues movie ratings—who has resisted this suggestion. Unfortunately, after an initial expression of interest, the MPAA decided against participating in the debate, leaving Professor Glantz's argument unopposed.

Needless to say, not everyone accepts the claim that movies are an important influence on children's smoking behaviors. Moreover, the evidence supporting this claim is limited to a few observational studies; and all such research faces the difficult challenge of disentangling the effect of movies from adolescent personalities and parenting characteristics. Some may feel that movies are simply the wrong battleground for the fight against tobacco and may view Professor Glantz's suggested remedies as a troubling call for censorship. In the interest of balance, we encourage readers to consider both sides of the argument.

The movies are not the only industry under pressure to quit smoking. At their recent Geneva meeting, the World Health Organization (WHO) announced its campaign against tobacco, joining with top athletes and sports organizations in an attempt to eliminate tobacco advertising in the sports world. They argued that such advertising creates a "positive association between tobacco and the strength, speed, grace, success, fun and excitement of sports". (2) WHO members failed to ratify a global antitobacco treaty that would ban tobacco advertising, with the main opposition coming from the United States delegation that felt that such a ban would breach laws on freedom of speech. (3) Antismoking advocates will undoubtedly push to have this issue revisited in the near future. Meanwhile, we hope to see more research about the extent to which positive images of smoking encourage tobacco use in our patients.

As always, we invite your opinion on these issues.


1. Dalton MA, Ahrens MB, Sargent JD, Mott LA, Beach ML, Tickle JJ, Heatherton TF. Correlation between use of tobacco and alcohol in adolescents and parental restrictions on movies. Eff Clin Pract. 2002;1:1-10.

2. Olson E. Health and sports officials join in world fight against smoking. New York Times;23 November. 2001:A8.

3. Olson E. After U.S. objects, World fails to agree to curb smoking ads. New York Times;28 November. 2001:A5.