The tobacco industry really took a beating in 1998. The Master Settlement Agreement (MSA) they signed with state attorneys general required them to give states $206 billion in compensation for the Medicaid and other costs of treating sick smokers. But the agreement also banned them from engaging in product placement deals for TV or movies. R.J. Reynolds couldn't pay to have George Clooney smoke Winstons anymore.

You'd expect to see fewer cigarettes in movies after a deal like that. But the size of the decline may surprise you. A new study in JAMA Pediatrics by Elaina Bergamini, Eugene Demidenko and James Sargent at the Norris Cotton Cancer Center and the Geisel School of Medicine at Dartmouth College* finds that the MSA led to an exponential decline in the appearance of tobacco brands in movies. Bergamini et al added up all the tobacco brand appearances in the top 100 grossing movies each year from 1996 to 2009. They find that the appearances dropped by about 7 percent every year, and then plateaued in 2006 at around 22 appearances a year:

They also found the length of smoking scenes decline. For example, between 1999 and 2000, when the MSA took effect, the number of minutes displaying smoking in adult-targeted movies fell by 85.4 percent. That's a huge one-year decline. The number of minutes in youth-oriented movies fell by less over that period, 42.3 percent, presumably because the number was lower to start with.

But the portrayal of alcohol didn't change much at all. The overall change in number of appearances wasn't statistically significant, nor was the slight decline in number of appearances in R-rated movies. But there was a significant increase in the number of alcohol appearances in PG-13 or lower-rated films

That matters. A number of studies, several by Sargent himself, suggest a causal relationship between adolescents' exposure to media portrayals of alcohol use and their subsequent use of alcohol. In other words, reducing media portrayals of alcohol use could prevent teen drinking, and thus teen drinking-related harms like car accidents. The evidence is perhaps stronger for portrayals of smoking. The authors quote a 2012 report by the Surgeon General which concludes, "The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people."

The authors note that no MSA-like agreement has been reached on alcohol, even though the costs of alcohol abuse for states are huge. Nor are there any federal regulations on alcohol product placement (and if there were, they would likely face First Amendment challenges). So they recommend industry self-regulation, such as voluntary reports of the amount spent on alcohol product placement, and a ban on such placements in G, PG, and PG-13 rated movies.

There's not a lot motivating the movie industry to adopt rules like that which involve foregoing a source of revenue, and even less in it for alcohol producers to comply with such bans. But if the experience with tobacco is any indication, such rules could make a big difference.


— Alyssa Rosenberg has an interesting post on how the social signals involved in portraying tobacco usage have changed since the MSA came into effect.

— Brad Plumer bemoaned our dangerous shortage of cool teen smokers.

* In Lebanon, N.H., and Hanover, N.H., respectively. Upper Valley, represent.