Near majority of adults favor R ratings for films with smoking

Abstract

Study author Kelly D. Blake, ScD, director of the Health Information National Trends Survey (HINTS) and a health scientist in health communication and informatics research at the National Cancer Institute in Bethesda, Maryland, notes that it had been almost a decade since the last nationally representative assessment of public support for R rating designations by the Motion Picture Association (MPA) for movies with cigarette smoking. “Our study adds to prior assessments and suggests that public support among the general population of US adults is gradually trending upward, from 40% in 2003, to 45% in 2013, to 47% in 2020.”

The main goals of this study by National Cancer Institute researchers were to determine the proportion of adults who support, are ambivalent about, or oppose the depiction of smoking as a sufficient criterion for an R rating and to identify characteristics of study participants that were associated with their opinions on this issue.

The researchers used data from the 2020 HINTS, a National Institutes of Health–initiated national, cross-sectional postal survey of 3865 individuals at least 18 years old. This survey included an item that assessed support, opposition, and neutrality regarding the idea that “movies with cigarette smoking should be rated ‘R’ to protect children and youth from seeing cigarette smoking in movies.” Demographic data recorded in HINTS included each participant’s age, gender, and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, or non-Hispanic other); income; educational level; sexual orientation; geographic location; marital status; child status (whether a participant had children or not); and political leanings. They also asked participants about cigarette smoking and e-cigarette use (both classified as current, former, or never).

A slight majority of the participants were female (50.2%,), whereas more than half (58.7%) were non-Hispanic White. Current cigarette smokers and current e-cigarette users constituted 13.6% and 6.3% of the participants, respectively.

Overall, 20.3% strongly opposed or opposed a policy designating R ratings for movies containing cigarette smoking, 30.3% were neutral, and 47.0% supported or strongly supported this idea.

Using weighted, multivariable logistic regression models to identify characteristics associated with neutrality or opposition, with support as the referent category, the researchers found noteworthy differences by age and race/ethnicity. Older adults (at least 50 years old) were significantly less likely than the younger adults (18–34 years old) to be opposed to or neutral regarding smoking as an R rating criterion. For example, participants aged 50–64 years were only 56% as likely to be opposed to or neutral regarding this proposal, whereas those aged 65–74 years or older than 75 years were 39% and 27% as likely, respectively. The only significant difference by race/ethnicity was that non-Hispanic Asians, relative to non-Hispanic Whites, were only 46% as likely to be neutral to or oppose the policy.

The researchers found no significant associations with any of the other independent variables, including gender, income, education, sexual orientation, marital status, geography, children in the household, political views, and even cigarette or e-cigarette use.

There has been a long-running battle between the tobacco industry and health organizations about cigarette smoking in movies and on television and other media.

Although the effect of smoking in films on teens was not a part of this study, “There is compelling evidence of a causal relationship between depictions of cigarette smoking in movies and youth smoking initiation,” says Dr Blake. “Policies enacted by the MPA to curb youth exposure to cigarette smoking in films have been limited or have expired.” She also notes that current classification and rating rules do not include cigarette smoking.

“Demonstrating broad public support for an R rating policy for movies with smoking, may influence the MPA’s consideration of R ratings.

“Our study demonstrates near-majority support and only 20.3% opposition among adults in the United States for a policy that would give movies with cigarette smoking an R rating,” she continues. “There is also a sizable amount of neutrality toward such a policy, suggesting a need for efforts to raise awareness of the value of R ratings for reducing adolescent smoking initiation and smoking overall.”

Nigar Nargis, PhD, senior scientific director of tobacco control research at the ACS, says that because the study provides recent evidence of near-majority modest support (and minimal opposition) for designating an R rating to all movies that depict cigarette smoking and because there is evidence of a causal pathway between depictions of cigarette smoking in movies and youth smoking initiation, this could be an important step in reducing youth initiation. She notes, however, that “the effectiveness of R rating of movies has yet to be evaluated as a tobacco control measure.”

“Although there may be some net benefit from such a policy, this is but one type of media that youth consume, and moreover I suspect those younger than 17 years old use social media more often and are likely exposed to tobacco use more often there,” continues Dr Nargis. She points to recent results from a systematic review and meta-analysis in JAMA Pediatrics (doi:10.1001/jama pediatrics.2022.2223) showing the relationship between exposure to tobacco content on social media and tobacco use. Dr Nargis also wonders whether an R rating could serve as more of a magnet than a deterrent when films are viewed at home from streaming services, especially if parental controls are not activated.

Dr Blake suggests that future research could examine public opinion toward policies that would limit exposure to depictions of other forms of tobacco products among youth and also explore public opinion toward measures that would restrict exposure to tobacco use on additional media platforms, particularly those with a substantial youth audience.