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To the Editor: The National Cancer Institute reported that "the total weight of evidence from cross-sectional, longitudinal, and experimental studies indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation."¹ Attributable risk estimates suggest that movie smoking accounts for one-third to one-half of adolescent smoking onset,^2-3 raising the possibility that trends in movie smoking could influence trends in adolescent smoking. We compared current (past 30-day) smoking among US eighth-grade adolescents with smoking in popular movies.

Methods

Each year from 1990 to 2007, the 25 movies with highest US box-office gross revenues⁴ were content coded for tobacco use by 2 coders. Only tobacco use was coded (>90% was cigarette or cigar smoking). A smoking occurrence was counted whenever a movie character handled or used tobacco or when tobacco use was depicted in the background. A 10% subsample of movies was double-coded (interrater correlation = 0.96 for this outcome).

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James D. Sargent, MD
james.d.sargent@dartmouth.edu
Norris Cotton Cancer Center
Dartmouth Medical School
Hanover, New Hampshire

Todd F. Heatherton, PhD
Psychological and Brain Sciences
Dartmouth College
Lebanon, New Hampshire

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