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Research Shows New Risks From Movie Smoking Exposure

September 3, 2007

Exposure to smoking in movies is not only likely to influence adolescents to start smoking, it also appears to be closely associated with adolescents' risk of becoming established smokers according to a new study by researchers at Dartmouth Medical School and Dartmouth-Hitchcock Medical Center.

"Established smokers" are defined as those who have used at least 100 cigarettes in their lifetimes. Youths who become established smokers are very likely to go on to addicted adult smoking.

Dr. James D. Sargent, M.D., Director of the Cancer Control Research Program at Norris Cotton Cancer Center and colleagues surveyed 6,522 U.S. adolescents age 10 - 14 about smoking in 2003. The researchers also assessed exposure to over 500 popular movies released in the 5 years prior to 2003. Follow-up interviews were conducted to reassess smoking status eight months, 16 months, and two years after the initial interview.

At the beginning of the study, 5,637 (90 percent) of the teens had never smoked, while 33 (0.5 percent) had smoked more than 100 cigarettes. Most of those who smoked more than 100 cigarettes had symptoms of addiction to nicotine and considered themselves smokers. By the two-year follow-up survey, 125 of the participants had become newly established smokers. Adolescents who were below the midpoint of movie smoking exposure were 6-12 times less likely to become established smokers than teens who were above the midpoint. The association remained significant after the researchers considered other factors related to teen smoking, including age, smoking by a parent or friend and sensation-seeking qualities.

Although the exact mechanism for this link is unclear, the authors note a plausible explanation, that frequent exposure to smoking cues in movies may lead to: more positive notions about how the use of cigarettes could affect them, more favorable perceptions of smokers, and a greater tendency to associate with teens who smoke. These are all factors known to increase risk for smoking.

While earlier research has found that higher exposure to movie smoking increases teens' risk of starting to smoke, Sargent says more research is needed to understand other aspects of the issue. For example, not all adolescents who try smoking go on to become dependent smokers. Although half of high school seniors have tried smoking at some time, only seven percent are current daily smokers of half a pack or more. Little is known about which factors differentiate adolescents who progress to being dependent smokers from those who do not, and this study starts to address that question.

"Taken with the results of previous studies showing that smoking in movies prompts adolescents to try smoking, the present findings further heighten concern about the public health implications of movie-smoking exposure," said Sargent, who is also a physician at the Children's Hospital at Dartmouth-Hitchcock (CHaD), part of Dartmouth-Hitchcock Medical Center. This link between movie smoking and established smoking - an outcome that predicts regular adult smoking and smoking-related morbidity and mortality in the future - adds strong support for the public health program Smoke Free Movies. The Smoke Free Movies program aims to reduce adolescent exposure to movie smoking through voluntary changes in how movies are distributed and rated, and has been endorsed by the American Academy of Pediatrics.

Sargent said investigators offer the following recommendations for parents:

  • Limit movie viewing to no more than 2 movies per week
  • Adhere to the motion picture ratings guidelines: Children age 12 and under should not watch PG-13 movies, and young adolescents (12-16) should be restricted from seeing R-rated movies.