Policy | Harm & costs by state

Select a US state to estimate the number of children alive today who will be recruited to smoke by movies with smoking, how many of this group will eventually die from tobacco-induced diseases, and the associated medical costs that will be incurred, both public and private.

STATE BY STATE | How many new young smokers do films recruit? At what cost?
Attributable to exposure to on-screen smoking
Projected smokers
(age 0-17)[1]
Projected smokers
(age 0-17)[2]
Estimated tobacco
deaths [3]
Lifetime medical
costs
(millions)[4]
Costs through age 50
(millions)[4]
Total US 17,371,900 6,428,000 2,057,000 $43,775 $67,100
-
-
-
-
-
Alabama 336,200 124,000 40,000 $850 $1,300
Alaska 43,600 16,000 5,000 $100 $175
Arizona 359,800 133,000 43,000 $900 $1,400
Arkansas 214,700 79,000 25,000 $550 $825
California 1,376,800 509,000 163,000 $3,475 $5,300
Colorado 283,200 105,000 34,000 $725 $1,100
Connecticut 175,400 65,000 21,000 $450 $675
DC 22,300 8,000 3,000 $50 $75
Delaware 53,700 20,000 6,000 $125 $200
Florida 844,500 312,000 100,000 $2,125 $3,250
Georgia 637,500 236,000 76,000 $1,600 $2,475
Hawaii 67,000 25,000 8,000 $175 $250
Idaho 94,300 35,000 11,000 $250 $375
Illinois 720,100 266,000 85,000 $1,800 $2,775
Indiana 471,100 174,000 56,000 $1,175 $1,825
Iowa 172,100 64,000 20,000 $425 $675
Kansas 191,200 71,000 23,000 $475 $750
Kentucky 371,700 138,000 44,000 $950 $1,450
Louisiana 307,400 114,000 36,000 $775 $1,200
Maine 84,300 31,000 10,000 $200 $325
Maryland 288,900 107,000 34,000 $725 $1,125
Massachusetts 322,300 119,000 38,000 $800 $1,250
Michigan 666,500 247,000 79,000 $1,675 $2,575
Minnesota 319,000 118,000 38,000 $800 $1,225
Mississippi 213,900 79,000 25,000 $550 $825
Missouri 398,600 147,000 47,000 $1,000 $1,525
Montana 59,000 22,000 7,000 $150 $225
Nebraska 118,600 44,000 14,000 $300 $450
Nevada 128,700 48,000 15,000 $325 $500
New Hampshire 67,900 25,000 8,000 $175 $250
New Jersey 445,800 165,000 53,000 $1,125 $1,725
New Mexico 124,500 46,000 15,000 $325 $475
New York 873,900 323,000 103,000 $2,200 $3,375
North Carolina 562,500 208,000 67,000 $1,425 $2,175
North Dakota 43,400 16,000 5,000 $100 $175
Ohio 809,800 300,000 96,000 $2,050 $3,125
Oklahoma 275,600 102,000 33,000 $700 $1,075
Oregon 213,400 79,000 25,000 $550 $825
Pennsylvania 761,500 282,000 90,000 $1,925 $2,950
Rhode Island 48,700 18,000 6,000 $125 $200
South Carolina 322,900 119,000 38,000 $800 $1,250
South Dakota 65,700 24,000 8,000 $175 $250
Tennessee 391,400 145,000 46,000 $975 $1,525
Texas 1,557,800 576,000 184,000 $3,925 $6,000
Utah 120,800 45,000 14,000 $300 $475
Vermont 31,500 12,000 4,000 $75 $125
Virginia 469,800 174,000 56,000 $1,175 $1,825
Washington 324,900 120,000 38,000 $825 $1,250
West Virginia 147,900 55,000 18,000 $375 $575
Wisconsin 332,000 123,000 39,000 $850 $1,275
Wyoming 37,800 14,000 4,000 $100 $150

 

Evidence behind these results | “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.” — US Surgeon General, 2012.

Longitudinal studies | In 2003, in a landmark longitudinal study, Dartmouth University researchers followed more than 2,600 adolescents for up to two years. After controlling for all the other factors bearing on smoking initiation, they found that the more smoking in movies kids saw, the more likely they were to smoke: a dose-response effect. The kids who saw the most smoking in movies were nearly three times more likely to have started smoking than kids who saw the least. Since then, studies from a dozen countries have confirmed the dose-response effect.

Based on all US longitudinal studies through 2012, exposure to on-screen smoking accounts for 37 percent of US smokers younger than eighteen (95% CI 0.25 - 0.52). The US Surgeon General (2014) has concluded that R-rating future movies with smoking would reduce the youth smoking rate by 18 percent.

Surveys | Complementing such experiments, cross-sectional surveys have asked large numbers of children whether or not they smoke and also what movies they have seen or who are their favorite stars. After accounting for other factors known to determine smoking, such as school performance and whether their parents smoke, the surveys find that kids who have seen a lot of smoking in the movies or have favorite stars that smoke are more likely to be smokers. These snapshots offer strong evidence. But to be certain of cause-and-effect, researchers follow kids' exposure to movies and their smoking behavior over time, in longitudinal studies.

Experimental evidence | Other scientific studies consistently demonstrate that smoking in movies stimulates kids to smoke. For example, it has been demonstrated that watching a movie with smoking moves kids' attitudes in a pro-smoking direction.

Notes

Note 1 The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Table 12.2.1 Prevalence of current smoking among adults, 18–30 years of age, and projected number of persons, 0–17 years of age, who will become smokers and die prematurely as adults because of a smoking-related illness, by state — United States, 2012 (pp. 693-695)17 January 2014. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, Ga.

Note 2Attributable risk 0.37 (95% CI 0.25-0.52). Glantz SA. Updated attributable risk for smoking due to movies: 37%. Blog entry 19 August 2012. UCSF Center for Tobacco Control Research and Education. 

Note 3Probability of smoking-attributable mortality = 0.32. Centers for Disease Control and Prevention. Projected smoking-related deaths among youth—United States. Morbidity and Mortality Weekly Report 1996;45(44): 971–4.

Note 4 $6,810 total additional medical cost per new smoker. $10,437 additional medical cost through age 50 per new smoker (because smokers die younger). Glantz SA. Costs of a new smoker. 1 October 2016. Discounted present value of future medical costs of a 24 year old smoker based on values in Tables 5.6 and 11.2 of The Price of Smoking, by Frank Sloan, et al. (Cambridge, MA, MIT Press, 2004) adjusted to August 2016 prices using the Medical CPI. See also: Sloan FA, Ostermann J, Conover C, Taylor DH, Picone G. The price of smoking. November 2004. MIT Press, Boston.