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Silver screen is a smoking gun for adolescents

Young adolescents who watch a lot of R-rated movies are up to three times more likely to start smoking than peers whose viewing habits are restricted by their parents, according to a DMS research group that has studied many aspects of teen smoking.

Exposure: James Sargent, M.D., a professor of pediatrics, and Madeline Dalton, Ph.D., a research associate professor of pediatrics, both published recent articles on the link between teens' exposure to smoking in the movies and their adoption of the habit. The studies were based on surveys in which 10- to 14- year-olds were asked which of a random set of 50 R-rated movies (from a total of 601 box-office hits) they'd seen.

According to Sargent's article, which was published in the July Archives of Pediatrics and Adolescent Medicine, the study participants had been exposed to an average of more than 1,000 depictions of smoking. For some, the number was over 4,000. The total number of smoking occurrences in all 601 movies was 5,335. Not surprisingly, the most relevant factor in reducing a teen's number of exposures was parental restrictions on movieviewing.

Dalton then conducted a longitudinal study of 3,547 adolescents who, according to their initial surveys, had never smoked. She was able to follow up a year or two later with 2,603 of these respondents to determine how many had since taken up smoking. Her article, published in the June 10 online edition of Lancet, states that "even after controlling for all other covariates, 52.2% of smoking initiation in this cohort can be attributed to exposure to smoking in movies." Those teens who had the greatest exposure to smoking in movies were nearly three times as likely to have started smoking as those with the least exposure.

Sargent says that Dalton's study "is really powerful evidence that seeing smoking in movies is a causal element of smoking." However, he acknowledges a need to confirm the finding in additional population samples; they are currently conducting a national survey of 6,000 adolescents. The just-published work involved only white adolescents from northern New England, while the follow-up study will survey various ethnic and racial groups in both urban and rural settings.

Restrictions: At the same time, Dalton is looking at how restricted movie-viewing fits with other restrictions set by parents. "Watching movies influences behaviors," says Dalton. "We want to know what would motivate parents to restrict" their children's viewing habits.

Wonders Sargent, "Is it the violence, the sex, the bad language? It's not smoking," he believes. "Smoking is the last thing [parents] think about. We need to figure out what's the lever that will get their attention."

Movies that glamorize smoking—as illustrated by this scene of Renee Zellweger in Bridget Jones's Diary—are coming under increasing fire, as a result of the continued productivity of a research group in the Dartmouth Department of Pediatrics.

But it may be all those things in combination that incite adolescents to smoke. "Watching smoking in the context of other adult behaviors makes it more salient to the kids than watching smoking in a G-rated movie," says Dalton. "I don't think a lot of kids are setting out to emulate Cruella DeVille," the chainsmoking cartoon villainess in Disney's 101 Dalmations.

Best medicine: Having parents who don't smoke, and who restrict their kids' movie-viewing, is the best medicine for teens, the DMS team has determined. According to Sargent, "Of 400 kids who had low exposure to smoking in the movies due to parental restriction [and] whose parents didn't smoke, over a twoyear period only three . . . tried smoking."

Without any restrictions on movie-viewing, he adds, kids whose parents (and friends) don't smoke are most affected by seeing smoking in the movies. In other words, the impact of smoking in the movies on adolescents whose parents smoke is lower— perhaps because they have a more realistic view of smoking so are less easily influenced by the glamorized smoking in films. "Seeing your mother smoke is definitely different than seeing Cameron Diaz smoke on screen," says Dalton.

She adds that reaction to the study has generally been positive, noting that schools and principals where the study was conducted were helpful, and participating children and their parents very supportive. But the publication of their articles did elicit some mixed reactions, generally from people worried about censorship. (See page 22 for media coverage of the studies.)

The team is now looking for effective techniques to motivate parents to restrict their kids' viewing habits. It's a highly charged issue, however, and Sargent and Dalton know they must proceed with care.

Message: "For now," concludes Sargent, "what we're trying to do is get pediatricians to start to communicate that media restriction is every bit as important as knowing where your kid is after school."

Katharine Fisher Britton

If you would like to offer any feedback about this article, we would welcome getting your comments at DartMed@Dartmouth.edu.

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