Influence of motion picture rating on adolescent response to movie smoking.
OBJECTIVE
To examine the association between movie smoking exposure (MSE) and adolescent smoking according to rating category.


METHODS
A total of 6522 US adolescents were enrolled in a longitudinal survey conducted at 8-month intervals; 5503 subjects were followed up at 8 months, 5019 subjects at 16 months, and 4575 subjects at 24 months. MSE was estimated from 532 recent box-office hits, blocked into 3 Motion Picture Association of America rating categories: G/PG, PG-13, and R. A survival model evaluated time to smoking onset.


RESULTS
Median MSE in PG-13-rated movies was ∼3 times higher than median MSE from R-rated movies, but their relation with smoking was essentially the same, with adjusted hazard ratios of 1.49 (95% confidence interval [CI]: 1.23-1.81) and 1.33 (95% CI: 1.23-1.81) for each additional 500 occurrences of MSE respectively. MSE from G/PG-rated movies was small and had no significant relationship with adolescent smoking. Attributable risk estimates showed that adolescent smoking would be reduced by 18% (95% CI: 14-21) if smoking in PG-13-rated movies was reduced to the fifth percentile. In comparison, making all parents maximally authoritative in their parenting would reduce adolescent smoking by 16% (95% CI: 12-19).


CONCLUSIONS
The equivalent effect of PG-13-rated and R-rated MSE suggests it is the movie smoking that prompts adolescents to smoke, not other characteristics of R-rated movies or adolescents drawn to them. An R rating for movie smoking could substantially reduce adolescent smoking by eliminating smoking from PG-13 movies.
Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA. james.d.sargent@dartmouth.edu
James D
JD
Sargent
Susanne
S
Tanski
Mike
M
Stoolmiller
D000293:Adolescent; D001290:Attitude; D001318:Authoritarianism; D002648:Child; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006801:Humans; D007100:Imitative Behavior; D008137:Longitudinal Studies; D008297:Male; D009040:Motion Pictures; D016487:Parenting / Q000523:psychology; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D000074606:Smoking Prevention; D012951:Socialization