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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 149-156

Effect of Parental R-Rated Movie Restriction on Adolescent Smoking Initiation

A Prospective Study

James D. Sargent, MD*,{ddagger},§, Michael L. Beach, MD, PhD§,||, Madeline A. Dalton, PhD*,§, Linda Titus Ernstoff, PhD{ddagger},§, Jennifer J. Gibson, MA{ddagger},§, Jennifer J. Tickle, PhD and Todd F. Heatherton, PhD

* Departments of Pediatrics
{ddagger} Community and Family Medicine
§ Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire
|| Department of Anesthesiology, Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire
Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire

Objective. To determine if young adolescents who report that their parents restrict viewing R-rated movies have a lower risk of trying smoking in the future.

Design. Prospective observational study. Students from 15 schools in New Hampshire and Vermont, randomly selected from all middle schools with >150 students, were surveyed in 1999. Baseline never-smokers were surveyed again by telephone 13 to 26 months later to determine smoking status.

Outcome Measure. Trying smoking during the follow-up period.

Results. The majority of the 2596 students were white, with ages ranging from 10 to 14 years. Nineteen percent reported that their parents never allowed them to view R-rated movies, 29% were allowed once in a while, and 52% were allowed sometimes or all the time. Ten percent of students tried smoking during the follow-up period. Smoking-initiation rates increased as parental restriction of R-rated movies decreased (2.9% for adolescents reporting that their parents never allowed them to view R-rated movies, 7.0% for those allowed to view them once in a while, and 14.3% for those allowed to view them sometimes or all the time). There was a strong and statistically significant effect of parental R-rated movie restriction on adolescent smoking even after controlling for sociodemographics, social influences (friend smoking, receptivity to tobacco promotions), parenting style (maternal support and control, parental disapproval of smoking), and characteristics of the adolescent (school performance, sensation seeking, rebelliousness, self-esteem). Compared with adolescents whose parents never allowed them to view R-rated movies, the adjusted relative risk for trying smoking was 1.8 (95% confidence interval [CI]: 1.1, 3.1) for those allowed to watch them once in a while and 2.8 (95% CI: 1.6, 4.7) for those allowed to watch them sometimes or all the time. The effect was especially strong among adolescents not exposed to family (parent or sibling) smoking, among whom the adjusted relative risk for smoking was 4.3 (95% CI: 1.4, 13) for those allowed to view R-rated movies once in a while and 10.0 (95% CI: 3.6, 31) for those allowed to view them sometimes or all the time.

Conclusions. Parental restriction from watching R-rated movies strongly predicts a lower risk of trying smoking in the future. The effect is largest among adolescents not exposed to family smoking. By exerting control over media choices and by not smoking themselves, parents may be able to prevent or delay smoking in their children.

Key Words: smoking • mass media • parenting • movies

Abbreviations: RR, relative risk • CI, confidence interval

Received for publication Sep 19, 2003; Accepted Mar 2, 2004.




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