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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.

This recommendation urges the MPAA to take smoking into account “as a factor” in its rating system; it does not suggest, categorically, that all movies with smoking receive an R-rating. The objective is to encourage directors and producers to take into account the possible impact of displays of smoking on a teenage audience and give serious consideration whether depicting characters smoking contributes to the artistic aims of the film or is needed for historical or cultural accuracy.

Independent oversight of the industry’s standards and strategies is warranted. Such oversight of industry accountability should be facilitated through public monitoring and awareness of industry practices. Accordingly, the committee recommends that the U.S. Department of Health and Human Services be authorized and funded to monitor these media practices and report to Congress and the public. This approach echoes a similar recommendation made by the IOM Committee on Preventing and Reducing Underage Drinking in 2004 (IOM/NRC 2004).

Recommendation 38: 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 and frequency of images portraying tobacco use. The results of these reviews should be reported to Congress and to the public.


Central to successful tobacco control is surveillance for antismoking program design and outcomes. An in-depth discussion of the elements of surveillance for tobacco control is included in Clearing the Smoke (IOM 2001). CDC offers the following definition of surveillance: “Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know” (Thacker and Berkelman 1988). The extent of tobacco control activity surveillance depends on the goals of the program, the breadth of control activities and methods, the size of the geographic area being evaluated, the availability and accuracy of data

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