As a kid growing up in the sixties, Robin Koval made a school art project for her parents: A handmade ceramic ashtray.

Back then, making tobacco accessories in an art class was common. Today, as the president and CEO of public health foundation Legacy, Koval uses the ashtray she made for her parents as an example of shifting attitudes about smoking.

“A child making something like that today in school — can you imagine?” Koval said. “It really shows just how far we’ve come.”

Since Legacy opened its doors in 1999 following the historic 1998 Master Settlement Agreement between 46 U.S. states and the tobacco industry, smoking among teens has declined dramatically since the mid 1990s.

The agreement changed the rules about how tobacco could be marketed — forbidding billboard advertisement and tobacco merchandising, along with any advertising aimed at minors. But Koval also credits much of the decline to Hollywood voluntarily scaling back smoking in film and on TV, which even the Centers for Disease Control has linked to youth smoking.

“While there’s still a lot of work to be done, the portrayal of smoking has fallen by nearly half as of 2014,” Koval said.

Even as smoking rates and depictions in entertainment have fallen, another problem has risen to take tobacco’s place on the silver screen: Alcohol.

Dr. James Sargent of Dartmouth University’s Geisel School of Medicine released a study in 2013 that found that, since the 1998 settlement agreement, appearances of tobacco fell 42 percent in movies rated for children and 85 percent for films intended for adults.

At the same time, Sargent’s study found that alcohol placements on film increased from 80 appearances per year to 140 in movies intended for children, or an annual increase of about 5 percent from 1996 to 2009.

“The new frontier for us is alcohol in movies and TV,” Sargent said. “We’re in the same position today with alcohol as we once were with smoking.”

More research needed

Koval says it has taken medical professionals longer to talk about the influence of alcohol in the movies partially because there’s much less research behind it than smoking depictions.

“We have to remember that tobacco has just been studied for so long,” Koval said. “It’s one of the most well-documented and studied substances that the conclusions (about how media depictions encourage smoking) are very clear.”

Sargent said that because individual studies couldn't directly link media depictions as a cause of smoking in kids, the alternative was to study decades of research that came to the same conclusion. The amount of research behind smoking was crucial to getting high-level public health figures like the surgeon general and organizations like the Centers for Disease Control to advocate against portrayals of smoking — something that hasn’t happened to the same extent with alcohol.

“Alcohol depictions in movies have always been a problem, but the public health community hasn’t articulated what should be done about it,” Sargent said.

University of New Mexico pediatrics professor Dr. Victor Strasburger says the American public has a different relationship with alcohol because it won’t kill anyone unless it’s abused.

“It’s easier to condemn smoking because when used as directed, tobacco will kill you. But alcohol, when used in moderation, is fine and dandy,” Strasburger said. “Challenge alcohol and you’re now challenging one of the fundamentals of adult society.”

The evidence is that media depictions of alcohol use is mounting. A British study that Sargent published this spring found that the more often 15-year-olds in the United Kingdom were exposed to drinking in movies, the more likely they were to have tried alcohol or engaged in binge drinking.

The study also found that teen drinking increased even when the researchers controlled for other variables like drinking among family members or whether or not the child had adult supervision. Dr. David Jernigan, director of the Center on Alcohol Marketing and Youth at Johns Hopkins University, argues that kind of evidence points to how alcohol can be more damaging to youths than smoking.

“What tobacco and alcohol have in common is that addiction to both begins in adolescence, but in terms of prevalence and immediate damage, alcohol is worse,” Jernigan said. "The negative effects of alcohol can happen much more quickly. You’re not going to kill someone driving a car because you smoked a cigarette before you got behind the wheel.”

Sargent says the fallout of alcohol abuse is also much harder to limit.

“Secondhand smoke harms others when they breathe it, so we can limit it through smoke-free laws,” Sargent said. “Alcohol harms those that end up injured or killed in drunk driving, fights, lose their jobs or leave their families. It’s harder to limit those secondary effects.”

The imbalanced picture

Jernigan said that young people are mostly swayed by alcohol depictions in movies because the depictions are seldom realistic.

“So much of what they see is an imbalanced picture that makes being drunk into a positive experience,” Jernigan said. “You have films like ‘The Hangover,’ which just make light of the whole thing, but repeated exposures to that kind of attitude normalizes the abuse.”

Strasburger says movies casting alcohol as a way of dealing with emotions are also a big problem.

“The message has long been, if you’re conflicted, have a drink. If you’re sad or angry, have a drink. If you’re celebrating, have a drink,” Strasburger said. “If they instead portrayed the negative consequences of alcohol use — the rapes, domestic abuse, car wrecks, deaths — that wouldn’t be conducive to encouraging teens to drink.”

Because the brain’s centers for impulse and behavior control aren’t fully developed until around age 25, Sargent and Strasburger say young viewers aren’t equipped to equate Hollywood’s depictions of alcohol with reality.

“The more they admire the people they’re watching, the more they’re likely to emulate what they’re doing,” Sargent said. “What happens is, if they watch a lot of movies portraying the activity, it changes how they think about that activity, like smoking.”

By the time they’re 25, however, many kids already have experience with alcohol. According to the 2014 Monitoring the Future poll, 60 percent of American high school students said they drank and 20 percent of high school seniors participated in binge drinking (which is defined as five or more drinks in a row).

Strasburger says more studies with long-term analyses of content is imperative to making a real difference. Until more research is done, Sargent and Jernigan say R ratings for films that include alcohol or drinking would be a big help.

“When Hollywood is making millions on these movies, they have a public health responsibility and some of them do take it seriously,” Strasburger said. “A young mind that’s not fully matured is a recipe for disaster if mixed with alcohol.”


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