The more teenagers see actors smoking in films, the more likely they are to try cigarettes, reports the December 15 issue of the British Medical Journal. A study of nearly 5,000 rural middle school students (ages 9 to 15) in Vermont and New Hampshire shows a strong association between the number of times adolescents view actors using tobacco in movies and the likelihood of trying cigarettes.

Dartmouth Medical School investigators gave teens a list of 50 recent popular films-selected randomly from a pool of 600 recent popular films that the researchers had analyzed for tobacco depictions. Based on the films each student reported seeing from the list of 50, the researchers tallied the total number of times that teen would have been exposed to smoking or other tobacco use.

More than 31 percent of teenagers who saw 150 or more instances of actors smoking on film tried smoking themselves, as compared to about 5 percent of teens who saw 50 or less tobacco-related scenes, report James Sargent, M.D., and his colleagues. This study represents the first broad survey of teen exposure to tobacco use in motion pictures.

"This important research shows a clear association between smoking by adolescents and watching smoking in movies," said Cathy Backinger, Ph.D., National Cancer Institute (NCI), who oversees a program on youth tobacco research that funded the current study. "This work highlights the need for attention to the full range of influences on smoking. NCI is committed to understanding why kids smoke in order to develop effective tobacco prevention and cessation programs."

The typical teen in this study had seen at least 17 of the 50 listed films, either in the theater or at home on television via movie channels or video. Teens' actual exposure to tobacco use is most likely even higher than that seen in the study because surveys show that, on average, this age group watches about 150 films per year. So, the adolescent with common movie-watching habits will be exposed to about 800 tobacco use depictions each year, said Sargent. "Given this high level of movie exposure, the typical teen could see more smoking in films than in the real world," Sargent said. He noted that nearly all of the R-rated films distributed over the past decade contain smoking scenes.

The researchers analyzed several other strong influences on teens' decision to smoke, including school performance; personality traits, such as rebelliousness or the tendency to seek out scary or dangerous activities; and smoking habits of friends, siblings and parents. But it was the number of viewed movie scenes with tobacco use that correlated most strongly with initial use of cigarettes-supporting the hypothesis that films play a role in the initiation of smoking.

"This study should not be interpreted by itself as evidence that watching tobacco use in films causes smoking," Sargent said. "Instead, the results are the first step toward determining causation." Other studies are needed to show whether viewing tobacco use in films precedes smoking.

Sargent is an associate professor in the Department of Pediatrics at Dartmouth-Hitchcock Medical Center. His research is a direct result of a recent NCI initiative designed to encourage innovative research in prevention and cessation of tobacco use by youths in the United States.

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

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