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 June 14, 2003
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By Adam Marcus, HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

MONDAY, June 9 (HealthDayNews) -- Smoking on the silver screen strongly encourages adolescents to start puffing themselves, new research says.

The study finds that adolescents exposed to more smoke-filled films are far more likely to take up smoking over the next two years than their peers who don't watch such movies.

"Smoking in the movies is associated with about 125,000 children a year dying prematurely," says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

A report on the study appears in the June 10 issue of The Lancet online.

Making smoking on screen a trigger for an "R" rating would cut that 125,000 figure in half, says Glantz, author of an editorial accompanying the journal article. "The question is, does the Motion Picture Association of America [MPAA] want to save 63,000 lives a year with appropriate ratings?" he says.

Many previous studies have suggested that depictions of smoking on screen encourage teens to smoke. Indeed, the World Health Organization declared "tobacco-free films" a theme of this year's World No Tobacco Day.

Harder to prove, however, is a direct connection between a teen seeing smoking in a movie and his or her decision to pick up the habit. The latest study sought to determine how often that happened.

A research team led by Madeline Dalton, a professor of pediatrics at Dartmouth Medical School, followed 2,603 boys and girls, ages 10 to 14, who said at the beginning of the study that they'd never smoked. They were asked if they'd seen any of 50 popular films -- out of a possible 601 -- with varying amounts of smoking. Titles ranged from action blockbusters like Die Hard and True Lies to children's movies, including 101 Dalmatians (the live-action version), Free Willy, and The Little Mermaid.

"We picked them based on box office receipts, not on whether they had smoking," Dalton says.

Over the next 13 to 26 months, 259 (about 10 percent) of the boys and girls reported smoking at least once. But while 17 percent of those in the group that saw the most movies with smoking tried tobacco, only 3 percent in the group that saw the fewest such films did so.

Risk-seeking behavior, rebelliousness, self-esteem, parental history of smoking, and other personality and parenting factors affected the chances that a child would start smoking. After weighing these factors, the researchers determined that seeing smoky movies still nearly tripled the odds a youth would experiment with tobacco -- a greater effect even than cigarette advertising, Glantz says.

"We found that of the children who tried smoking, half of them did so based on what they saw in the movies," Dalton says.

Dalton, like Glantz, believes the film rating system needs to start considering smoking. "The current intent of the ratings system is to notify parents of content that is thought to be inappropriate for children," she says. "Now we have evidence that smoking in movies is inappropriate for children and the message needs to be put out there."

Since smoking is rarely integral to movie plots, Glantz says, people should wonder why characters are often lighting up. "Sex and violence sell tickets. Smoking doesn't. Why are [movie studios] clinging to it?"

The MPAA did not return calls seeking comment.

Tobacco industry documents reveal that cigarette makers in the past have forged deals with Hollywood studios to feature certain brands in films -- despite denials by both sides. And while scripts may not call for a character to smoke, actors and directors often decide a scene calls for cigarettes anyway.

Kimberly Thompson, a Harvard epidemiologist who has studied tobacco use and movies, calls the new study "important" because it's the first thorough attempt to put a time-frame around youth smoking and exposure to the habit on film. However, she says, the researchers fall short of sealing their case.

"A strong correlation still doesn't get you to causation. This is good and strong evidence, but it's still a correlation," Thompson says.

More information

For more on smoking and movies, visit this Web site from the University of California, San Francisco.

Kids-In-Mind and Screen It! offer movie reviews for parents, including information on whether the characters smoke.

SOURCES: Madeline Dalton, Ph.D., research assistant professor of pediatrics, Dartmouth Medical School, Lebanon, N.H.; Stanton Glantz, Ph.D., professor of medicine, University of California, San Francisco; Kimberly Thompson, Sc.D., associate professor, Harvard School of Public Health, Boston; June 10, 2003, The Lancet online

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