Catch an R- or PG-13-rated movie these days, and you're practically guaranteed to see three things: sex, violence, and cigarettes. The villains smoke to look more villainous, the heroes smoke to look more heroic, and the extras smoke for "atmosphere." Cigarettes and cigarette advertising have even found their way into children's movies such as The Nutty Professor and Honey, I Shrunk the Kids. A 2007 study of top box office movie releases found that 39 percent of G- and PG-rated movies (and 65 percent of PG-13-rated movies) featured tobacco. One out of five movies aimed at kids depicts at least one cigarette logo, a recent survey reported. At a time when smoking is disappearing from most public places, it's making a major comeback on the big screen.

Gwyneth Paltrow and Gene Hackman relentlessly puff their way through The Royal Tenenbaums. Sissy Spacek, who stars in In the Bedroom, clouds her grief in smoke, and in A Beautiful Mind, Russell Crowe uses cigarettes as an emotional outlet. In the early 1980s, Hollywood seemed to respond to national anti-smoking campaigns by cutting the rate at which its stars lit up on-screen to just 4.9 times per hour, less than half the 1950s rate of 10.7. But recently, even though tobacco use is declining in the real world, the silver screen rate has shot back up to 10.9, according to a study published in the February 2004 American Journal of Public Health.

And cigarettes in movies are more than just props, says James Sargent, MD, an associate professor of medicine at Dartmouth College. When projected on the big screen, they are magnets for younger audiences. Every time Winona Ryder takes a drag in Girl Interrupted or Leonardo DiCaprio lights up in Romeo and Juliet, he says, another kid comes closer to taking up smoking.

Sargent and other experts have long suspected that smoking in the movies encourages smoking in real life. Now they have the numbers to back them up. In a study published in the December 15, 2001, issue of the British Medical Journal, Sargent and his colleagues found that kids who regularly see cigarettes in the movies are nearly three times as likely as other kids to take up smoking.

In the course of the study, the researchers sent surveys to nearly 5,000 schoolchildren age 9 to 15. Each survey contained questions about the child's smoking history as well as the smoking habits of parents and friends. Children were also asked to indicate which of 50 popular movies they'd seen, whether in theaters or on television. The researchers had already counted the number of smoking scenes in each film, making it possible to calculate the number of scenes viewed by each child.

Not surprisingly, all of the kids had seen cigarettes in the movies, some more than others. The real shock came when the numbers were put together: Compared with kids who rarely saw smoking in the movies, kids with the highest exposure were 2.7 times as likely to try smoking themselves. The trend held up even when researchers controlled for age, parental smoking, and other factors that might influence the decision to smoke.

"It's a very powerful study," says Stanton Glantz, MD, a professor of medicine at the University of California at San Francisco who has been tracking the portrayal of smoking in the movies for many years. Even before the Dartmouth study, he believed the smoke pouring out of Hollywood inspired many kids to take up the habit. "Their aspirations are up there on that screen," he says.

When it comes to smoking, actors and actresses may be more influential role models than anyone else, including parents and peers, Sargent says. "John Travolta is tough when he smokes. Are everyday smokers tough? Sharon Stone is sexy when she smokes. Are everyday smokers sexy? Smoking in movies associates the behavior with all the things adolescents want to be."

According to Glantz, on-screen smoking has increased steadily in the last decade, a time when smoking in the real world has actually declined. In his mind, the trend is no accident. Tobacco companies, desperate to attract new customers, Glantz says, are turning movies into commercials.

The tobacco industry didn't need a fancy study from Dartmouth to see the marketing potential of movies. In a 1983 speech to his marketing division, Hamish Maxwell, president of Phillip Morris International, put it bluntly: "I do feel heartened at the increasing number of occasions when I go to a movie and see a pack of cigarettes in the hands of the leading lady," Maxwell said. "We must continue to exploit new opportunities to get cigarettes on screen and into the hands of smokers."

In the past, tobacco companies openly paid movie studios and stars to feature their products. According to internal memos, Brown and Williamson alone -- makers of Kool and other brands -- spent $950,000 over four years to get their products on screen. After congressional hearings in 1989, the tobacco companies admitted to this covert form of advertising and publicly pledged to stop it. (At the time, none of the studios put such a policy into writing.) Ever since that pledge, however, smoking in the movies has actually increased, Glantz says. And filmmakers aren't just showing cigarettes. More than ever, he says, they are highlighting specific brands.

Sargent, for one, sees something fishy. "I wonder why brands appear on the screen if there is no quid pro quo," he says. "Does the movie industry also provide free advertising for BMW? For Nokia? For Heineken or Budweiser?"

The proliferation of cigarette packages and billboards in the movies definitely raises a red flag, says Glantz, who speculates that the movie studios and the tobacco companies are making deals. "Studios are very careful about what brands they use."

Some Hollywood insiders, even those like Larry Deutchman, who oppose on-screen smoking, dismiss such theories and point out that in recent years critics have failed to produce the proverbial smoking gun. "Just because a brand appears in a movie, you can't jump to the conclusion that somebody paid for it to be there," says Deutchman, senior vice president of marketing and industry relations for the Entertainment Industry Council. The EIC, a nonprofit organization formed by entertainment industry leaders, advises Hollywood on social and health issues.

An actor who clutches a pack of Marlboros is probably just trying to flesh out his character, not sell a product, Deutchman says. "The tobacco industry has done such a good job of presenting their brands, the brands have come to take on a certain meaning," he says. "If you're trying to show certain attributes, smoking a particular brand is one way to do it."

Deutchman says it's highly unlikely that movie studios are taking tobacco money through the back door. "It's important for the movie industry to be on good terms with the government, and they'd never risk it over something like this," he says. "[Payments from tobacco companies] would just be a drop in the bucket."

But even as Deutchman dismisses the conspiracy theory, he opposes smoking in films. In fact, curbing cigarette use in the movies is a key mission of the EIC. The council has called on filmmakers to reconsider their motives for displaying cigarettes. They urge filmmakers to consider whether smoking is really important to the story or just part of the scenery. The council has also pushed for more realistic portrayals of smoking. Movies that feature cigarettes should also feature stained teeth and nagging coughs, Deutchman insists.

Most significantly, the EIC has encouraged movie studios to take a clear, unambiguous stand against covert tobacco advertising. Several studios, including Fox, Warner Brothers, and MGM, now have written policies against accepting money or free cigarettes from tobacco companies.

Glantz seeks a more hard-line approach. In recent years, he's launched a campaign to dramatically change Hollywood's relationship with smoking. Through ads (in such publications as Variety magazine), newspaper editorials, and a Web site (http://SmokeFreeMovies.ucsf.edu), he calls for four major changes:

Glantz and Deutchman do agree that smoking on the big screen is out of hand. John Travolta doesn't need a cigarette to look tough, and Sharon Stone doesn't need to smoke to look sexy. Most important, kids shouldn't have to smoke to emulate their heroes.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

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Last updated June 11, 2009
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