A new study published in the American Journal of Preventive Medicine reports that youths whose parents allow them to view R-rated movies and videos are more likely to start smoking.
The study was a longitudinal one: approximately 1,200 Massachusetts youths were followed for four years, from the sixth grade through the ninth grade. At baseline, youths were asked whether their parents allow them to watch R-rated movies. Rates of smoking initiation in the subsequent four years were compared between youths who reported that they were or were not allowed to watch such movies.
The study found that: "Among those who were allowed to watch R-rated movies, smokers were nearly three times as likely and nonsmokers were almost twice as likely to say it would be easy for them to get cigarettes, compared to youngsters who weren't allowed to watch R-rated movies."
According to the study's lead author: "the study shows that parental permission to watch R-rated movies is one of the strongest predictors of children's belief that cigarettes are easily available, about as strong as having friends that smoke. 'We do know that kids who believe it is easy to get a cigarette are at risk of smoking,' Doubeni said. 'Our prior research has already shown that kids who perceive cigarettes as readily accessible are more likely to end up as regular smokers.'"
The researchers offer two potential explanations for the study findings: "It may have to do with a parenting style that is permissive of activities that are not age-appropriate. Or it may be an outcome of all the smoking scenes in R-rated movies."
The Rest of the Story
This study is important because casts some doubt on the conclusion of previous studies that viewing smoking in movies is strongly causally associated with smoking initiation. The present study offers a potential alternative hypothesis: it may be that youths who are allowed to watch movies that have more smoking in them are different than youths who are not allowed to watch these movies, and that those differences (having something to do with parental permissiveness) are related to factors that influence smoking initiation.
If allowing children to watch R-rated movies is a proxy for a general parental permissiveness that relates to higher risk-taking behaviors among children, then it is possible that part of the effect that has been attributed to the viewing of smoking in films is actually due to other variables than the smoking itself.
Most importantly, this study casts serious doubt on the claim by anti-smoking groups that requiring an R-rating for movies that depict smoking would avert 60,000 tobacco deaths per year in the U.S. There are two reasons for this.
First, if the causal relationship between seeing smoking in films and starting smoking has been overestimated, then so too has the estimate of the number of lives that would be saved.
Second, viewing R-rated films has now been shown to predict smoking initiation. Requiring an R-rating for movies that depict smoking might alter parents' approach to allowing their kids to view movies. More youths might end up seeing R-rated movies, resulting in more smoking initiation. In addition, even if the same number of kids continue to see R-rated movies, one would expect the frequency of smoking depiction in such movies to drastically increase, thus leading to increased smoking initiation among those youths (based on the public health groups' own conclusions).
The movement to require R-ratings in all films that depict any fleeting amount of smoking is yet another example of how the tobacco control movement is losing its science base. The movement is making wild, premature claims that are not adequately supported by solid data. Alternative hypotheses have not been adequately considered.
This is, in fact, where disallowing dissent in the movement is hurting it. Anyone who dissents from the dogma - anyone who challenges the strength of the causal conclusion that viewing smoking in movies causes 100,000 kids to start smoking each year - is accused of being a denialist or a tobacco mole. Thus, there is no chance for reasonable alternative hypotheses - such as the one suggested by the authors of the present study - to be seriously considered in the discourse of the movement.
This leaves the more extreme claims to be unchallenged and therefore accepted as the de facto consensus of the movement.
But here we have a situation where tobacco control researchers have published a paper noting that one of two equally plausible hypotheses is that levels of parental permissiveness may explain the relationship between watching R-rated movies and smoking initiation, rather than exposure to the smoking itself.
Finally, I should note that my personal opinion is that viewing smoking in movies has some effect on smoking initiation. However, I believe the magnitude of the effect has been greatly overestimated. And most importantly, I believe that the magnitude of the effect of requiring an R-rating for movies that depict smoking has been vastly overestimated. I do not believe for a moment that such a measure would prevent 60,000 deaths per year.