Adolescents who see smoking depicted in movies are more likely to become established smokers, according to a study funded by the National Cancer Institute (NCI), part of the National Institutes of Health. The study, which could have broad implications for efforts to reduce smoking among youth, appears in the November 2005 issue of the journal Pediatrics and was updated in the September 4, 2007 issue of Archives of Pediatric Adolescent Medicine. James Sargent, M.D., of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues are the first to utilize a nationally representative sample of youth in the United States to examine the influence of adolescents' exposure to movie smoking on their smoking behavior.

Prior research has established that social influences, such as family and peer smoking and tobacco advertising, are important determinants of smoking in adolescents. More recently, research has focused on the impact of smoking in entertainment -- including the effect of celebrities who smoke -- on youth smoking.

Sargent and his team studied adolescents ages 10 to 14 and found in their earlier study that youth had a higher risk of smoking initiation as their exposure to movie smoking increased, with those youth most exposed to movie smoking being most at risk. Adolescents with the greatest exposure to movie smoking were 2.6 times more likely to try smoking than their peers in the least exposed group, after controlling for other factors. The increased risk of smoking initiation associated with exposure to smoking in the movies was similar to that of other well-known risk factors, such as having a parent or sibling who smokes. This increased risk was seen across youth of all racial and ethnic groups, in all geographic regions of the country.

The investigator's latest study examines a more serious behavior outcome -- established smoking. Established smokers have smoked more than 100 cigarettes in their lifetimes and most reported symptoms of tobacco addiction and considered themselves smokers. The new study found that teens who had the greatest exposure to smoking in movies were twice as likely to become established smokers, compared with those who had the least exposure. This effect was independent of age, parent, sibling, or friend smoking.

The latest research finding from 2007 also shows that teens who were not sensation-seekers were more responsive to smoking in movies compared with teens who were sensation-seekers. Thus, the effect of movies on behavior may be particularly strong for teens who tend to avoid risk-taking.

"These studies highlight the significant association between smoking in the movies and youth smoking," said Cathy Backinger, Ph.D., acting chief of NCI's Tobacco Control Research Branch. "These studies reaffirm the need to continue to address the full range of influences on adolescent smoking."

According to the Centers for Disease Control and Prevention, the majority of adult smokers started smoking before the age of 18, and, each day, nearly 4,000 young people try their first cigarette. "More than 6.4 million children living today will die prematurely because they started smoking as an adolescent," said Backinger. "These statistics demonstrate how crucial it is to address the issue of adolescent smoking."

For this research, Sargent and colleagues first analyzed the amount of smoking depicted in the 500 most popular movies released between 1998 and 2002, as well as 32 high-grossing movies released in the first four months of 2003. A "smoking occurrence" was noted when tobacco use was depicted, either by a major or minor character or in the background. By this standard, smoking occurred in 74 percent of the movies studied. Researchers then conducted a random telephone survey of 6,522 U.S. adolescents ages 10 to 14. Participants were asked whether they had seen a random selection of 50 of the 532 analyzed films. The study participants were also asked, "Have you ever tried smoking a cigarette, even just a puff?" and those who answered "yes" were classified as having tried smoking. The adolescents who participated in the study reported having seen an average of 13 movies, leading to an average exposure to 61 smoking occurrences. Exposure to smoking in movies was significantly higher among Hispanic and black adolescents than among whites.

"Our findings indicate that all U.S. adolescents, regardless of race or place of residence, have a higher risk of trying smoking as their exposure to movie smoking increases," said Sargent. Sargent and his coauthors suggest various approaches to curbing adolescent exposure to movie smoking, including persuading the movie industry to voluntarily reduce depictions of smoking and cigarette brands; incorporating smoking into the movie ratings system to make parents aware of the risks a movie with smoking poses to the adolescent viewer; and encouraging parents to more strongly enforce restrictions on youths' viewing of R-rated movies, which contain the highest amounts of smoking.

"The findings from this national survey complement other studies that showed that exposure to smoking in the movies predicts later youth smoking," said Robert T. Croyle, Ph.D., director of NCI's Division of Cancer Control and Population Sciences. "Now we need to consider effective ways to reduce youths' exposure to this preventable risk factor."

To learn more about tobacco control programs at NCI, please visit NCI's Tobacco Control Research Branch Web site at http://cancercontrol.cancer.gov/tcrb/.

For more information about cancer, visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4 CANCER (1-800-422-6237).

Sargent JD, Beach ML, et al. "Exposure to Movie Smoking: Its Relation to Smoking Initiation among U.S. Adolescents." Pediatrics 2005; 116: 1183-1191.

Sargent JD, Stoolmiller M, Worth KA, Cin SD, Wills TA, Gibbons FX, Gerrard M, Tanski S. "Exposure to Smoking Depictions in Movies: Its Association With Established Adolescent Smoking". Arch Pediatr Adolesc Med. 2007;161:849-856.

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