Hollywood's big screen has had a long love affair with the cigarette. Smoking in movies conveys a powerful image of "cool" and "sexy," which stays with moviegoers long after they have left the theater.

No movie going demographic is more susceptible to this image than children and teenagers.

The Harvard School of Public Health (HSPH) recently released the information presented to the Motion Picture Association of America (MPAA) during a scientific briefing in February.

The HSPH is leading the charge to influence how many actors light up while the cameras are rolling. During the February briefing, the HSPH was joined by Johns Hopkins Bloomberg School of Public Health, executives from the major studios, the National Association of Theater Owners, the Director's Guild of America and the Screen Actor's Guild to discuss with the MPAA what they see as excessive smoking on the big screen.

The call to end tobacco use in films comes at a critical juncture in the crusade to prevent smoking-related fatalities. Smoking is the largest preventable cause of death in the U.S.

The Centers for Disease Control and Prevention estimates 438,000 people in the U.S., and 5 million worldwide die prematurely each year from tobacco-related disease.

In a presentation demonstrating how pervasive the problem of smoking in the movies actually is, Dr. Jay A. Winsten, associate dean of HSPH, and director for Center for Health Communication, offered the following from the Sacramento Chapter of the American Lung Association:

-- In a 12-month period spanning 2004-2005, 66 percent of the top-50 grossing films showed characters smoking.

-- In that same time frame, 68 percent of all PG-13 films showed characters smoking.

-- There were 12.8 incidents of smoking per hour of running time for the top-50 grossing films.

-- There were 14.2 incidents of smoking per hour of running time for PG-13 films.

Dean Winsten went on to note that the average age of initiation of smoking is 13. "So imagine a 13-year-old child watching PG-13 films, and being bombarded 14 times per hour with powerfully seductive images of smoking by their favorite stars. There is no way that an anti-smoking public health campaign can possibly compete with Leonardo DiCaprio smoking on the big screen in Titanic [rated PG-13]."

Any conference concerning a ban on tobacco use in films would have to include a discussion of directorial freedom. This has been a long-standing issue since the 2004 Senate hearings on smoking in the movies when MPAA Director Jack Valenti cited directorial freedom as the chief reason why actors should continue to be permitted to smoke in movies.

In his presentation on the subject, Dr. Barry R. Bloom, dean of HSPH said that the academics from Harvard and Johns Hopkins respected the need for artistic freedom as much as they respected the need for academic freedom. However, both the HSPH and Johns Hopkins Bloomberg School of Public Health have chosen not to accept any funding for research from tobacco companies or related industries.

Bloom added that even though movies are "expensive, complex and demanding to make", smoking in movies is "both unnecessary and cliched and serves to make smoking socially acceptable to kids".

Anti-smoking groups and public health officials would like to see smoking tied to the movie ratings system. He challenged the leadership of the motion picture industry to take effective action to eliminate smoking in films accessible to young people and to send a "clear, simple and publicly accountable message" to industry members regarding such a policy.

Dr. Manny Alvarez reviewed this article.