2. Smoking and the Movies Jonathan M. Samet, MD, MS MPAA, Hollywood, California February 23, 2007 Department of Epidemiology

3. 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

4. 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.

5. Children Smoke Around the World

6. 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.

7. 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

8. 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

9. 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

10. 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

11. Larynx: 1980 Esophagus: 1982 Kidney: 1982 Nasal & Oral pharynx: 1982 Coronary heart disease: 1979 Stomach: 2002 Cervix: 2002 Liver: 2002 Stroke: 1983 Aortic aneurysm: 1983 Atherosclerotic 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

12. 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

13. Increased Risk of Smoking Initiation from Selected Factors CharacteristicIncreased Risk If either parent smokes 125% If any siblings smoke 91% If neither or one parent disapproves 53% Movie viewing: smoking exposure (2 nd quartile compared to 1 st quartile) 139% Movie viewing: smoking exposure (3 nd quartile compared to 1 st quartile) 199% Movie viewing: smoking exposure (4 th level compared to 1 st quartile) 331% Source: Dalton et al. Lancet 2003

14. 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.

15. Q1 Q2 Q3 Q4

16. Youth Smoking Worldwide: Japan