The review concludes that eliminating scenes of smoking in new youth-rated films should substantially reduce smoking initiation in the adolescent years, when the vast majority of smokers start.
"The weight of dozens of studies, after controlling for all other known influences, shows the more smoking that kids see on screen, the more likely they are to smoke," said lead author Annemarie Charlesworth, a research specialist at the University of California, San Francisco Institute for Health Policy Studies. "This strong empirical evidence affects hundreds of thousands of families."
The research review, published in the December issue of Pediatrics, a peer-reviewed publication of the American Academy of Pediatrics, examined the findings of 42 studies on how viewing on-screen smoking affects adolescent and teen smoking behavior.
Among the conclusions:
- U.S. movies again show as much smoking as they did in 1950. The balance of smoking has swung toward youth-rated (G/PG/PG-13) films.
- Films very rarely depict negative consequences of smoking. They depict smoking as "adult" and skew smoking unrealistically toward higher status characters.
- For teen audiences, anti-tobacco spots shown before movies with on-screen smoking countered much of the promotional effect of smoking in the movies.
- A simple "dose-response" relationship describes the impact of movie smoking on teen audiences: those who see the highest number of smoking scenes are almost three times as likely to start smoking (after adjusting for other factors) as those who see the lowest number.
The study found that adolescents and teens who received less exposure to on-screen smoking because their parents consistently limited their viewing of R-rated films were less likely to start smoking (after adjusting for all other influences) than those who saw more.
"This result indicates that lowering exposure by removing smoking from youth-marketed films will reduce the number of kids who start smoking," said Stanton Glantz, PhD, UCSF professor of medicine, director of the Center for Tobacco Control Research and Education at UCSF and the paper's senior author.
"More than a decade of independent experimental and epidemiological research shows that the tobacco industry was smart, from a marketing point of view, in investing millions of dollars to put smoking on the American screen," Glantz said.
"This strong and consistent scientific evidence has major implications for the current policy debate between the pediatricians and parents, on one side, and a handful of media companies on the other. The science is in; getting smoking out of youth rated movies is the simplest and least expensive thing that can be done to reduce adolescent smoking."
This work was supported by the National Cancer Institute.
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