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Cheryl G. Healton Speaks at House of Representatives Subcommittee on Telecommunications and the Internet Hearing on "Images Kids See on the Screen"

6/22/2007

Testimony from Legacy president and CEO

 

 

Before the
Subcommittee on Telecommunications and
The Internet of the Committee on
Energy and Commerce of
The United States
House of Representatives

 

“Images Kids See on the Screen”

 

June 22, 2007

 
SUMMARY
STATEMENT OF CHERYL G. HEALTON, DR. P.H.
PRESIDENT AND CEO, AMERICAN LEGACY FOUNDATION
“IMAGES KIDS SEE ON THE SCREEN”

Smoking is the largest preventable cause of death in the U.S. with over 400,000 Americans dying every year from tobacco.  Approximately 8.6 million Americans suffer from tobacco-related disease. One of the most pernicious aspects of the smoking epidemic is its reliance on teen-agers.  Over 80% of all smokers start before their eighteenth birthdays and 90% start before they are twenty. The tobacco industry has chillingly referred to teen-agers as “replacement smokers” for its older customers who die or manage to quit.   Widespread images of smoking in the media are a major cause of youth smoking. Peer-reviewed research establishes that movie depictions of smoking recruit about 390,000 new youth smokers every year.  Smoking appears in approximately 75% of all movies and a clear majority of youth-rated movies.  Because youth-rated movies have much larger audiences than R-rated films, most smoking impressions come from G, PG and PG-13 movies. Movie smoking also reaches adolescents through smoking on trailers shown on television.  In addition, television shows popular with teens routinely depict smoking.   Along with other leading public health organizations including the World Health Organization, the American Medical Association and the American Academy of Pediatrics, the Foundation supports the following four principles to reduce the number of adolescents who begin smoking because of smoking in the movies:   • Rate new smoking movies “R”.  Because adolescents see significantly fewer R-rated movies, this will dramatically limit their exposure to movie smoking.
• Certify no pay-offs.  There is a long, well-documented history of tobacco product placement in the movies.  Current provisions addressing this practice, including the FTC’s tobacco marketing survey and provisions in the Master Settlement Agreement, are far from airtight and bear close examination.
• Require strong anti-smoking ads.  Research shows that strong anti-smoking advertisements shown immediately before a movie help counteract the effect of smoking images in the movie.
• Stop identifying tobacco brands.   While unbranded images of smoking are a powerful influence, branded images are nothing but a brand advertisement.    The American Legacy Foundation is on the front lines of the effort to prevent youth smoking. Our award-winning and proven effective youth tobacco countermarketing campaign, truth^®, communicates with teens in their own voice about the health effects, social costs and addictiveness of tobacco.  But with the continuing prevalence of smoking in the media, other trends in youth smoking, and our own declining budgets, we face major challenges in sustaining our past successes in saving young people’s lives.   Good morning.  I am Dr. Cheryl Healton, President and CEO of the American Legacy Foundation.  The Foundation, created as a result of the Master Settlement Agreement (MSA) between forty-six states and the tobacco companies, is the national public health foundation dedicated to building a world where young people reject tobacco and anyone can quit. I commend the Telecommunications and Internet Subcommittee for holding this important hearing and I very much appreciate the invitation to testify.   The media images children and teen-agers are exposed to exert a powerful, and all too often deeply negative, impact on their health.  My testimony today will address the devastating impact that the pervasive images of smoking in the media have on adolescent smoking initiation and the steps that must be taken to protect our children.  I will start by showing a short reel of images of smoking in recent PG-13 movies as well as images of smoking in movie trailers that have been shown on television.   Tobacco is one of the most significant public health challenges facing the United States and, indeed, the world.   It is the largest preventable cause of death in the U.S. with over 400,000 Americans dying every year from smoking.   Another 50,000 die as a result of second hand smoke.   Fully 63% of cancer deaths in the U.S. are attributable to tobacco.   Approximately 8.6 million Americans suffer from tobacco-related diseases.  Among many other diseases, smoking causes heart disease, cardiovascular disease, lung cancer and lung ailments, bronchitis, and asthma.   Smoking increases the risk of low birth weight babies, pre-term delivery and sudden infant death syndrome.   The Centers for Disease Control estimates that smoking costs the nation $75 billion in direct medical expenses  and $92 billion in lost productivity every year.   One of the most pernicious aspects of the smoking epidemic is that it depends on teen-agers; without teen-age smoking, it would soon run its course.  Over 80% of smokers start before their eighteenth birthday and 90% start before they turn twenty.    Every day, about 4,000 youth between the ages of twelve and seventeen try their first cigarette.   Every day, over 1,500 youth become daily smokers.  One in three teen smokers will die prematurely from tobacco-related disease.  The tobacco industry knows full well that teens are an essential element of its long term business plan; it has chillingly referred to teen-agers as “replacement smokers” for their older customers who die or manage to quit.    Because the vast majority of smokers start as teens, it is critically important to take action to prevent teens from starting to smoke in the first place.  The Foundation is probably best known for truth^®, the only non-tobacco industry sponsored national advertising, grassroots, and online countermarketing campaign designed to do just this:  prevent youth smoking.   Edgy, hard-hitting and unapologetic – and effective –, truth^® communicates with teens in their own voice about the health effects, addictiveness and social costs of tobacco.  It does not preach and never tells teens not to smoke.  Instead, with a special emphasis on exposing the marketing practices of the tobacco industry as revealed in the now-public tobacco documents, truth^® strives to make teens wary and educated consumers.   And it works.  Peer-reviewed research published in the American Journal of Public Health in 2005 found that in its first two years, from 2000 to 2002, truth^® was responsible for 22% of the overall decline in youth smoking, amounting to approximately 300,000 fewer youth smokers in 2002 because of truth^®.     But truth^® cannot do it alone, even when fully funded.  And that is no longer the case.  The Foundation’s major payments under the MSA ended in 2003 and will end altogether next year.  Due to declining resources, we have already had to substantially cut back on our media buy for truth^®. After another year or two the Foundation will no longer be able to continue truth^® on television without a major infusion of funds.  At the same time, recent reports suggest that the historic decade long decline in youth smoking that began in 1997 may be ending and youth smoking rates may even be trending back up.   We truly face a national crisis in the effort to prevent youth smoking.  It is more important than ever to address the known causes of youth smoking.   Peer-reviewed research establishes that one of the major causes of youth smoking is exposure to the widespread depiction of smoking in the movies.  Just last month, the Institute of Medicine of the National Academy of Sciences issued a major report including the conclusion that “Exposure to smoking in movies increases the risk for smoking initiation. . . . Furthermore, even after controlling for other factors known to be associated with adolescent smoking intention and tobacco use, studies show a clear dose effect, whereby greater exposure to smoking in the movies is associated with a greater chance of smoking.”   In particular, the research demonstrates that smoking on screen recruits about 390,000 new youth smokers every year . Two ground-breaking studies, published in Lancet  and Pediatrics, have found that youth exposure to movie smoking explains between one-third and one-half of all adolescent smoking initiation.  A third study published just this past May in Pediatrics sets out the extraordinary number of smoking images to which our children are exposed.  The 534 contemporary box-office hits analyzed in the study delivered, on average, 665 smoking impressions to each U.S. adolescent aged 10 to 14 years old .    Some of the additional key research findings from these studies include the following:
? Smoking in the movies has the greatest impact on youth who are normally the least likely to start smoking – those with non-smoking parents.
? Youth have a higher risk of trying cigarettes as their exposure to smoking in movies increases.  This is without regard to race/ethnicity or place of residence.
? Young people with the highest exposure to smoking in movies are nearly three times more likely to start smoking than those with the least exposure.   The Foundation’s published research shows that in 2004, tobacco was depicted in three quarters of youth-rated movies (G, PG and PG-13) and 90% of R-rated movies.   Because teens are less likely to see R-rated movies, about 60% of youth exposure comes from youth-rated movies. ,  A study analyzing tobacco use in movies from 1999 through 2006 found very similar results:  75% of all U.S. produced live action movies featured tobacco use, including 88% of R-rated movies, 75% of PG-13 movies and 36% PG and G-rated movies.   These percentages persist in the most recent movies.  According to data from the University of California-San Francisco’s Center for Tobacco Control Research, 72 % of all U.S. produced live action films that grossed at least $500,000 from 2004 to 2006 depicted smoking. Of these movies, 58% were youth-rated.   There is less research regarding the incidence of smoking on television; the Foundation is currently undertaking an analysis of the top ten network and cable television series viewed by youth to document the presence of tobacco use and brand imagery in these shows.  However, even a quick look at shows that are popular among teens, for example, Sex in the City, The Simpsons, Family Guy and The OC, demonstrates that there is also a great deal of smoking on television.  Shows no longer shown on television continue to be widely available through DVDs.   In addition, feature movies, many with smoking, are also shown on television.   To further highlight the cross-over between movie smoking and smoking on television, many movie trailers shown on television contain images of smoking.  The Foundation published research on this precise problem in The Archives of Pediatric Adolescent Medicine in 2006.  We analyzed all movie trailers shown on television from August 1, 2001 through July 31, 2002.  We found that 14.4% of these trailers included images of tobacco use and that nearly all U.S. youth between 12 and 17 years old saw at least one of these movie trailers during the study period, with 88.8% seeing at least one of these trailers three or more times.  Because television delivers images to young viewers just as movies do and portrays characters that are similarly aspirational to teens, there is no reason to think that the influence that depictions of smoking on television have on teens is any less than that of the movies.   The question, then, is what steps should be taken (1) to get smoking out of movies and television shows that are produced for and marketed to teens and children and (2) to the extent that smoking images remain in these media, counteract their effect on teens and children.    
 
The Foundation, along with leading public health organizations including the World Health Organization, the American Academy of Pediatrics, the American Medical Association, the American Lung Association and the American Heart Association,   supports the following principles which, if put into practice, will significantly reduce the number of adolescents who begin smoking because of smoking in the movies:   •  Rate new smoking movies "R".
Any film that shows or implies tobacco should be rated "R." The only exceptions should be when the presentation of tobacco clearly and unambiguously reflects the dangers and consequences of tobacco use or is necessary to represent the smoking of a real historical figure.
• Certify no pay-offs.
The producers should post a certificate in the closing credits declaring that nobody on the production received anything of value (cash money, free cigarettes or other gifts, free publicity, interest-free loans or anything else) from anyone in exchange for using or displaying tobacco.
• Require strong anti-smoking ads.
Studios and theaters should require a genuinely strong anti-smoking ad (not one produced by a tobacco company) to run before any film with any tobacco presence, in any distribution channel, regardless of its MPAA rating.
• Stop identifying tobacco brands.
There should be no tobacco brand identification or the presence of tobacco brand imagery (such as billboards) in the background of any movie scene.
In its just-released report, Ending the Tobacco Problem: A Blueprint for the Nation, the Institute of Medicine made similar policy recommendations:
• The Motion Picture Association of America (MPAA) should encourage and facilitate the showing of anti-smoking advertisements before any film in which smoking is depicted in more than an incidental manner.  The film rating board of the MPAA should consider the use of tobacco in the movies as a factor in assigning mature film ratings (e.g., an R-rating indicating Restricted: no one under age 17 admitted without parent or guardian) to films that depict tobacco use. (Recommendation 37).   • Congress should appropriate the necessary funds to enable the U.S. Department of Health and Human Services to conduct a periodic review of a representative sample of movies, television programs, and videos that are offered at times or in venues in which there is likely to be a significant youth audience (e.g., 15 percent) in order to ascertain the nature of and frequency of images portraying tobacco use.  The results of these reviews should be reported to Congress and to the public. (Recommendation 38)
Let me address a few key points in these recommendations in more detail. 
First, the R-rating is a necessary part of the solution.  As I have already discussed, most adolescent exposure to movie smoking is in youth-rated, not R-rated, movies.  Because adolescents see significantly fewer R-rated movies, their exposure to movie smoking will be dramatically decreased by instituting the R-rating requirement.  If movie producers want adolescents to be part of their audience, they only need remove depictions of smoking from their films.   In 2003, the Foundation conducted a series of surveys to measure public attitudes about the Smoke Free Movies Principles.  According to our data, in 2003, 46% of adults backed the R-rating for movies with smoking . Because of the increased understanding of what is at stake, there has been a dramatic increase in awareness and concern about smoking in the movies in the last few years. The results of a second national survey, released in February of 2007, shows that now 70% of adults support an R-rating for future movies that show smoking.   Second, the recommendation that movies must certify that there have been no pay-offs in return for showing tobacco images recognizes that there is a long and well-documented history of paid tobacco placement in the movies.  This history surely accounts for much of the tobacco imagery we see today in movies. The best source of information is the tobacco company’s own documents which were made public as a result of the Master Settlement Agreement and related state settlements with the tobacco industry.   Let me highlight just a few examples. In 1979, Philip Morris Europe reached an agreement with Pinewood Studios for the “exposure of the Marlboro brand name” in a “major [specified] scene” in Superman II in exchange for £20,000.  In that same year Philip Morris paid to have its product appear in the G-rated Muppet Movie.    In 1990 the American Tobacco Company signed an $89,000 “Advertising and Selling Authorization” for product placement in connection with its Carlton, Lucky Strike, Pall Mall and Malibu brands.  In 1988, Philip Morris supplied its products for films including Who Framed Roger Rabbit, Field of Dreams and Dream Team.   Since that time, certain steps have been taken in an effort to stop tobacco product placement.  In 1998 the Master Settlement Agreement included a provision barring the exchange of anything of value for the placement of tobacco brand imagery.  Since the 1990’s, the tobacco companies have consistently stated that they pay no funds for product placement in response to the Federal Trade Commission’s periodic survey of their marketing expenditures.   And, to be sure, the trail of documents ends in the early 1990’s.  However, none of this conclusively demonstrates that product placement is no longer a problem. To begin with, the MSA only binds the parties to it.  In the case of the Altria companies, for example, only Philip Morris USA is a party. Its corporate parent, Altria, is not bound by the MSA; nor are Kraft, Philip Morris International, or any other Altria subsidiaries.  I would note, for example, in the Superman II example I refer to earlier in my testimony, the dealmaker was Philip Morris Europe. Moreover, the FTC’s report does not require tobacco companies to report on the activities of their affiliates if the affiliate’s sale of cigarettes products and related merchandise constitutes less than 25% of its total retail sales.    This exception would apply, for example, to Kraft which is a non-tobacco subsidiary of Altria. The Foundation believes that it is very important to continue to shine a bright light on tobacco product placement.   Third, published research shows that strong anti-smoking advertisements shown immediately before a movie, with an emphasis on “strong”, can help counteract the impact of smoking images in the movie.   The Foundation, with its library of award-winning and effective truth^® ads, has endeavored to play a role in implementing this principle. We have worked closely with the state attorneys general, who have taken an active leadership role in the effort to protect youth from the effects of media images of smoking, to make available without charge truth^® ads to be included in DVD releases and other home viewing formats. Unfortunately, only one studio, the Weinstein Company, has agreed to include truth^® ads in DVDs such as School for Scoundrels, Clerks II and others. The Foundation has also provided public health organizations and states around the country with usage rights and accessibility to truth^® for their efforts to urge theaters to help protect teens from smoking images in the movies. In addition, we placed truth^® ads in movie theaters for airing in the first few months of 2007.  However, with the Foundation’s declining budgets, we cannot come even close to assuring that these ads are shown before every movie which depicts smoking.   Fourth, there is no place at all for tobacco brand imagery in the movies or other media.  While the research clearly shows that the depiction of smoking without an associated brand is a powerful influence on youth smoking initiation, the display of tobacco brands is tantamount to advertisements for those brands. Researchers at Dartmouth Medical School found that between 1996 and 2003 movies containing a tobacco brand appearance featured Marlboro 49% of the time.  As youth are particularly susceptible to advertising , it is not surprising to find that among youth smokers, 50% report that Marlboro is their usual brand.   Other research suggests that product placement, particularly when it includes an endorsement or use by an actor, effectively functions as advertising.   Studies consistently show that 75% of teens smoke the three most heavily promoted brands:  Marlboro, Camel and Newport.  
 
Finally, I recognize that after years of urging the MPAA to adopt the four principles and to keep smoking out of youth-rated movies, it has finally taken a hesitant half-step.  On May 10, 2007, the MPAA announced that it would “consider smoking” when rating movies.  In my view, this announcement, which contains no objective standards or commitment to actually do anything, is wholly inadequate.  Nonetheless we will monitor closely what steps the MPAA actually takes.  If this is to be at all effective, we would expect to start seeing a reduction in smoking in youth rated films no later than in the next month or so.   In conclusion, I would like to thank the Committee once more for holding this very important hearing.  Removing images of smoking from media produced for children and teens is an essential step toward stopping the deadly smoking epidemic.