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Teenagers are significantly more likely to start smoking if they watch movies featuring stars who smoke cigarettes, and teens whose parents don't smoke are the most likely to be swayed by actors lighting up onscreen.

According to a study released yesterday in the journal Lancet, teens who watched the most movies with smoking were almost three times more likely to start smoking than those who watched the fewest number of movies with smoking.

"The study provides the strongest evidence to date that smoking in movies encourages adolescents to start smoking," said Madeline Dalton of the Dartmouth Medical School, lead author on the study. "We found that half the kids who started smoking did so because of seeing it in the movies."

Dalton said she was surprised by the strength of the connection between movies and teen smoking, which she found to be a stronger influence on behavior than even peer smoking. She also found a "dose response" present -- that the more movies with smoking they saw, the more likely that the teens would start smoking themselves -- indicating that a reduction in movie smoking would likely result in a decrease in teen smoking.

The study, which was funded by the National Cancer Institute, is the broadest on the controversial subject of smoking in movies. The researchers followed about 2,600 Vermont and New Hampshire children ages 10 to 14 for two years, and plan to follow up with a larger national study also funded by the institute.

The study was accompanied by a commentary in Lancet from anti-tobacco activist Stanton A. Glantz of the University of California at San Francisco that recommends that the movie industry consider the presence of smoking as "adult content" that would lead to an "R" rating.

He wrote that the new study indicates that "pushing for policy changes to reduce youth exposure to smoking in movies will have a rapid and substantial effect on youth smoking. . . . Every day of delay means more unnecessary addiction and death because of Hollywood's love affair with the tobacco industry."

Cigarette makers used to pay to have their products appear in movies, but that practice was banned by the national tobacco settlement with the states in 1998. Nonetheless, Dalton and Glantz said the prevalence of smoking on the screen has increased since the settlement was signed, and Glantz wrote that it has about doubled since 1990.

Dalton said that her research found that cigarette smoking in movies is generally shown in a positive or neutral light, with only 5.9 percent of instances classified as negative. She said that many of the smokers onscreen were rebellious or tough -- exactly the kind of characters that teens traditionally find appealing.

Because the study looked at young adolescents, it did not establish a direct connection between movie smoking and actual habitual smoking by children. Rather, it found that the movies encouraged teens to try smoking, and that more than 50 percent of teens who tried smoking did so after seeing smoking in movies.

A particularly strong correlation existed for children of non-smokers. According to Dalton, those teens were four times more likely to start smoking if they were in the group that saw many movies with smoking than those in the group that saw the fewest movies with smoking.

Richard Taylor, spokesman for the Motion Picture Association of America, said his organization had no comment on the study or on the reportedly increasing prevalence of smoking in movies.

Overall, about 10 percent of the teens tried smoking during the two years of the study. In his commentary, Glantz wrote that federal statistics show that every day, about 2,050 teens ages 12 to 17 start smoking, and that about one-third of them will die prematurely because of smoking-related diseases

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