The U.S. surgeon general is calling on Hollywood to kick the tobacco habit, saying too many youth-rated films contain harmful images of tobacco use.
In a new report on smoking released Friday, acting Surgeon General Boris Lushniak and other U.S. health officials greatly expanded the list of tobacco's damaging health effects and urged renewed focus on reducing national smoking rates.
Among dozens of findings and recommendations, the report found that media images of smoking had become more common in the last two years, with young people being exposed to almost 15 billion impressions of tobacco use in youth-rated films.
"Anything that can be done to help reduce that imagery, to reduce that sense that smoking is a norm, is helpful," Lushniak said, before attending a White House conference on the report. "We would like to partner with the film industry to realize this has an effect on the health of our nation."
The report marks the 50th anniversary of the first surgeon general's report on smoking, a landmark event that triggered sustained government efforts to reduce smoking rates.
Since 1964, smoking prevalence has dropped from roughly 43% to 18% in 2012. However, health officials say the declines have slowed in the last several years, and it now appears as if the U.S. will fail to meet a goal of 12% by 2020.
"The current rate of progress in tobacco control is not fast enough, and more needs to be done to end the tobacco epidemic," the report said.
Particularly alarming, officials said, was the finding that more youths and young adults are picking up the habit. The total number of youths and young adults who smoke increased from 1.9 million in 2002 to 2.3 million in 2012, according to the report.
"Youth who are exposed to images of smoking in the movies are more likely to smoke; those who get the most exposure to onscreen smoking are about twice as likely to begin smoking as those who get the least exposure," the report said.
"Actions that would eliminate the depiction of tobacco use in movies, which are produced and rated as appropriate for children and adolescents, could have a significant effect on preventing youth from becoming tobacco users."
The report outlines a number of new findings regarding tobacco's damaging health effects. Smoking, authors wrote, can cause diabetes, colorectal cancer, erectile dysfunction and birth defects. Also, exposure to secondhand smoke was found to be a cause of stroke.
"As inconceivable as it is, tobacco is even worse than we knew," said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. "It appears cigarettes are getting more lethal. If you look at smokers over the years, even though they're smoking less, they're dying more."
Smoking and exposure to tobacco smoke cause almost 500,000 premature deaths each year. If current trends continue, roughly 5.6 million Americans now younger than 18 will die prematurely as adults due to smoking, health officials say.
The surgeon general's report also outlined new hazards posed by nicotine, a powerfully addictive substance in cigarettes. Not only was nicotine exposure linked to problems of brain development in fetuses, it also appears to cause cognitive problems in teens.
"The evidence is suggestive that nicotine exposure during adolescence ... may have lasting adverse consequences for brain development," the report said.
The call for Hollywood's cooperation in helping to reduce smoking rates is only one of a number of steps health officials are urging.
They also recommend raising taxes on cigarettes, raising the purchasing age to 21 nationwide, expanding smoke-free area laws across the country, enlarging cigarette pack warning labels so they include graphic images and imposing new regulations on cigarette manufacturing.
Still, Frieden said that images of smoking in the media carried great influence. He said he learned this firsthand when he served as New York City health commissioner.
After implementing numerous steps to reduce smoking in the city, smoking rates dropped 50% in just a few years. However, he and his staff were perplexed to discover that rates had not fallen for one group -- white females.
"We didn't know why," Frieden said. "So we hired an anthropologist and had them do a series of focus groups with white girls to find out why."
Frieden said every focus group gave the same answer. Smoking was due to a popular television show that featured a white female character who smoked.
"It was because of 'Sex and The City,'" Frieden said. "It had a huge impact."
[Updated 2:22 p.m. PST Jan. 21: An earlier version of this post, citing the executive summary of the surgeon general's report, stated that young people had been exposed to almost 15 million impressions of tobacco use in youth-rated films. The report summary has been revised to correct the number of impressions: 15 billion.]