When a group of Stanford pediatricians began a public campaign last fall against Hollywood’s depictions of cigarette smoking, some Palo Alto parents were caught off guard. “We’d get the reaction, ‘What are you talking about? Is there a lot of smoking in movies?’ ” says Lisa Chamberlain.
She and Seth Ammerman, both clinical assistant professors of pediatrics, direct the advocacy program, a required component for second-year residents at Lucile Packard Children’s Hospital. The idea is to involve physicians in public service projects that can make an impact on patients’ health outside hospital walls. Ammerman says he and Chamberlain assigned the anti-tobacco cause this year because “our residents recognize that tobacco is the No. 1 health problem in the country,” and the movement for smoke-free movies is getting stronger, armed with exhaustive statistics and a new landmark study.
For anyone skeptical of tobacco’s star billing in Hollywood, the Stanford group bolsters its case with evidence gathered by Smoke Free Movies, an organization run by UCSF professor of medicine Stanton Glantz, MS ’70, PhD ’73. In the year ending last May, 73 percent of the top-grossing movies featured smoking. (In the week of January 12 this year, nine of the top 10 did.) These weren’t cameo appearances: the films averaged 12 light-ups per hour (up from 7.7 in 2000-2001). And tobacco is gaining ground in the films kids watch: half the smoking scenes were in movies rated G, PG or PG-13, compared with 21 percent in 1999-2000. Interestingly, a higher percentage of PG-13 flicks than R-rated movies featured tobacco use.
But does that evidence amount to a smoking gun? Who can say that young people try cigarettes because they see the stars puffing away onscreen, as opposed to other influences?
As it happens, a group of Dartmouth physicians say they can, in a study published in the Lancet last June. Previous research associated movie smoking with adolescent experimentation, but this two-year study of more than 3,500 adolescents—controlled for variables such as personality traits, social influences and parental characteristics—demonstrated that exposure to onscreen smoking predicts whether adolescents will try cigarettes. Those with the greatest exposure were three times as likely to start smoking as those with the least, and children of nonsmokers were the most susceptible.
For Ammerman and Chamberlain, the Dartmouth study clinched their choice of this year’s advocacy project. If they could convince Hollywood to reduce the prevalence of smoking in movies, they could curb the number of children taking up the habit.
Over the course of the program, each of the 19 second-year residents will spend one month at work on public education and a letter-writing and petition-signing campaign. But with a difference: aided by a local supermarket, the group has amassed and flattened countless empty cigarette cartons, using the backs to collect signatures. They plan to feature the stack at a June press conference, then ship the letters and cartons to studio heads.
“Our goal is to get 1,000 names; so far we’ve got about 120,” says Patricia Fong, who spent her recent stint on the project talking to physicians, politicians, city councils, police and fire departments, schools and other groups in San Mateo and Santa Clara counties. “Everyone’s been really enthusiastic,” she says, when asked if anyone has raised arguments about filmmakers’ freedom of expression.
In fact, the Stanford pediatricians call for self-regulation in the industry, not legally imposed prohibitions. They support the recommendations of WHO and other health organizations: that films depicting tobacco use be rated R; that antismoking ads run before screenings; that credits include a declaration that nothing of value has been received in exchange for using or displaying tobacco; and that there be no identification of brands.
Talking of self-regulation, Ammerman has some plans for his own profession. “There’s a movement to document which magazines are taking cigarette ads—and we want to get physicians to stop taking those that do,” he explains. Tobacco advertising is prohibited in magazines if more than 15 percent of their readership is under 18, but defining readership can be slippery. And children, like everybody else, will kill time with what’s available in the doctor’s waiting room.
