ASHES, Vol. 21(4) – Cigarette use in movies: Do U.S. adults support policy change?

In 2019, 51% of the top-grossing movies in the U.S. depicted tobacco use. Exposure to tobacco imagery could have considerable influence on adolescents’ decisions to initiate smoking, with one estimate suggesting that almost 90% of people who start smoking because of on-screen exposure to tobacco began smoking before the age of 18. Giving an R-rating for movies with tobacco imagery could reduce the number of adolescent smokers by 18%. This week, ASHES reviews a study by Nikhil Ahuja and colleagues that identified factors that influence U.S. adults’ opinions toward a policy that assigns R-ratings to movies depicting cigarette use.

What was the research question?
What factors influence U.S. adults’ opinions on a policy that assigns R-ratings for movies that depict cigarette use?

What did the researchers do?
The researchers used data from a nationally-representative, cross-sectional survey of 3,865 U.S. adults aged 18 and older. Participants were asked to what extent they would support or oppose a policy giving a default R-rating for movies depicting cigarette use. The researchers divided participants into three categories (support, neutral, and oppose) and compared these groups by variables like race/ethnicity, political viewpoints, and smoking status. Using logistic regressions, they investigated whether these variables predicted opinions toward the R-rating policy.

What did they find?
Almost half of participants (48.2%) supported the R-rating policy, while 31.1% were neutral and 20.7% were opposed. Minority participants–particularly non-Hispanic Asians–were significantly more likely than non-Hispanic Whites to support the policy than be neutral (see Figure). Older participants (65+) were more likely to support than oppose the policy, compared to the youngest participants (18-34). Individuals who held moderate political views (versus liberal views) were more likely to feel neutral about the policy than oppose it. Lastly, current/former e-cigarette users were less likely to support than oppose the policy, compared to participants who had never smoked. In contrast, being a former/current cigarette smoker was not a significant predictor of opinions toward the policy.

Figure. Odds ratios for factors that predict U.S. adults’ opinions toward a policy giving R-ratings for movies that depict cigarette smoking. Asterisks (*) mark the specific comparisons that were statistically significant. Click image to enlarge.

Why do these findings matter?
The majority of participants in this study were in favor of or neutral toward the R-rating policy. This suggests that U.S. adults might generally support policies that limit youth exposure to smoking in the media–including movies, television, and video games. These findings also give insight into the groups of people who favor or oppose such policies, making it easier for public health professionals to tailor their awareness campaigns. For example, e-cigarette users were less likely to support than oppose the R-rating policy, possibly because they are less concerned with the risks associated with cigarette smoking. This suggests a gap in understanding of the dangers of smoking and a need to educate e-cigarette users on the importance of policies, like the R-rating policy, that restrict exposure to smoking and prevent harms among youth.

Every study has limitations. What are the limitations in this study?
This study did not survey youth, a population that would be affected by the R-rating policy. It would be interesting to see how their opinions compared to other age groups. Additionally, the “neutral” response rating could indicate a number of things, including lack of knowledge of the topic, lack of interest, and social pressure. Longitudinal research is needed to determine the reasons behind the public’s attitudes, beliefs, and behaviors toward the R-rating policy.

For more information:
Individuals who want to reduce or stop vaping can find help resources on the CDC website. The American Lung Association and the Truth Initiative also provide helpful tips and strategies to quit nicotine. Additional resources can be found at the BASIS Addiction Resources page.

— Nakita Sconsoni, MSW

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