The portrayal of smoking in movies projects the images of toughness, rebellion, and sex appeal—the same messages that tobacco companies use to advertise their products. Smoking in movies is not processed by the viewer as an advertisement for tobacco, however, which limits the viewers' skepticism of tobacco use. Studies have shown that adolescents who view smoking in movies have a more positive attitude toward tobacco use, and that those who identify with stars who smoke are more likely to take up smoking. Adolescents who never smoked but who had higher exposure to smoking in movies developed more positive attitudes toward smoking and were at a higher risk for starting smoking compared with teenagers who had less exposure to smoking in movies. This factor was independent of other social influences, personality traits of the adolescent, or parenting. One prevention strategy for reducing adolescent smoking could be to reduce teen exposure to movie smoking. Unfortunately, the movie industry is unwilling to restrict smoking in movies. Sargent and associates examined adolescents' exposure to smoking in movies and factors that may modify this exposure.

The study was a survey of exposure to smoking in movies among a group of New England middle-school students. Exposure to smoking in films was determined by selecting 601 popular contemporary movies. Students were asked if they had seen a random selection of 50 of the 601 movies. The researchers counted the numbers of smoking occurrences in each movie. They also determined other factors concerning each adolescent, including movie access, personal characteristics, and parenting factors. Movie access included information about the number of home movie channels, videotape use, and movie theater outings. Personal characteristics included age, sex, self-reported school performance, sensation-seeking propensity, rebelliousness, and self-esteem. Parental factors included information about restriction of viewing R-rated movies, restriction of television viewing time, and presence of an authoritative parenting style.

There were 4,910 participants in the study. On average, they had seen 30 percent of the movie sample, from which they were exposed to 1,160 occurrences of smoking. Exposure to movie smoking increased by approximately 10 percent for each additional movie channel available at home and each additional video watched per week. Participants who went to a movie theater more than once per month were exposed to an average increase of 300 movie-smoking occurrences compared with those who did not go to movie theaters.

Parental restriction of viewing R-rated movies reduced smoking exposure by 50 percent compared with those who had no such restriction. These R-rated movies contained twice the number of smoking exposures as movies in the other rating categories. Parenting styles did not have any impact on the amount of smoking viewed in movies. Parental restrictions for viewing R-rated movies and exposure to movie smoking were strongly associated with the adolescent trying smoking.

The authors conclude that adolescents view a substantial number of smoking depictions in movies that can influence their attitudes and behaviors toward this habit. Parental limitations to these movies can reduce adolescent exposures to smoking in movies. They add that physicians can teach parents to monitor and enforce movie access guidelines that, in turn, can reduce adolescent smoking.

editor's note: When dealing with adolescents and the pressures they face with regard to smoking and tobacco use, physicians must be aware of where the adolescents are receiving information about these habits. Results of the study by Sargent and associates demonstrate the impact that a simple intervention can have on reducing the risk of adolescent smoking. By limiting exposure to R-rated movies, parents can greatly reduce their adolescent's exposure to smoking in the movies. This step can reduce the impact of cinematic smoking on adolescents. This step also gives physicians another way to assist parents in preventing smoking before it starts.—K.E.M.