According to the American Lung Association, each day nearly 6000 children under the age of 18 years start smoking. Smoking in adolescence leads to more frequent and more severe respiratory illness, worsening of asthmatic symptoms, and a decrease in ability to participate in physical fitness activities. It also has the potential to decrease lung growth and impair the achievement of full adult lung function.

Keeping teens from starting smoking is critical. Quitting is just as hard for adolescents as adults. To prevent them from starting, it helps to understand why they start. Researchers have studied which teens are at risk for starting to smoke, and the kinds of influences that lead them to smoke. They have also looked at non−smokers to see the sorts of personal qualities and situations that have helped them resist the temptation.

Most movies tend to omit sallow−skinned, yellow−toothed, tobacco−stained, coughing, wheezing, and ultimately, dying smokers from the silver screen.

It turns out that there is a direct association between how much a teen is exposed to smoking through watching movies. As much as 30−50% of adolescent smoking appears to be related to seeing actors smoking on the screen. The typical Hollywood smoker is an appealing character who may be charming and socially confident, or a daring and devil−may−care rebel. Most movies tend to omit sallow−skinned, yellow−toothed, tobacco−stained, coughing, wheezing, and ultimately, dying smokers from the silver screen.

So what qualities or situations help teens resist the temptation to smoke? Being on a sports team helps. This influence is probably due to a number of factors, including the fact that team members often have both professional athletic role models who portray healthy habits and an increased concern for their own bodies and their ability to perform athletically. Additionally, athletic teens are more likely to have a peer group who finds it more socially acceptable not to smoke.

A recent study, published in the Archives of Pediatric and Adolescent Medicine in July 2009, looked at the interaction between the protective impact of team sport participation and the negative impact of exposure to movie smoking. They wondered whether sports participation would outweigh the strong negative influence of movies.

Researchers studied 2048 teens that were not smokers at start of the study. They interviewed them when they were between 9− to 14− years−old and again about six−and−a−half− years later when they were 16− to 21− years old. To determine how much movie smoking the teens had been exposed to , the researchers viewed popular movies in a variety of rating categories (PG, R etc) and counted the number of incidents of smoking during the film. They then asked the teens how many, out of a 50−movie list, they had seen. From this information, they calculated the total number of smoking incidents witnessed by the student. The average student had seen 16 of the 50 movies and had viewed an average of 1200 smoking incidents. There was no difference in the number of incidents witnessed by the athletes and non−athletes.

At the follow up interview, students were asked about whether they had started smoking since the first interview. Established smoking was defined as having smoked 100 or more cigarettes. They were also asked how many sports teams they had been on in the preceding 12 months.

Seventeen percent of the students had become established smokers by the second interview. The established smokers were more likely to be male and older than their non−smoking peers. Their parents had lower levels of education and smoked themselves. They had poorer school performance and had rebellious and thrill−seeking temperaments. Smokers were less likely to have participated in team sports. In fact, students who did not participate in sports were twice as likely to be established smokers at the follow up interview.

But even among the students who participated in team sports, the likelihood of initiating smoking was increased by exposure to movie smoking. The more movie smoking they had watched, the more likely they were to begin smoking, but it took a much higher level of movie exposure to cause them to start. So, sports was still seen to be protective against being influenced by movie smoking.

In addition to recommending that team sports participation be strongly encouraged, researchers also endorsed developing policies to decrease children's and teens' exposure to movie smoking. These might include eliminating smoking from youth rated movies, or requiring an R rating for movies with smoking incidents.

Doctors, coaches, parents, and teachers should all be aware of the influence that seeing actors smoke in films has on teens and should point out the distorted representations of the positive social, financial, and personal benefits of smoking. Teens and preteens need ongoing, developmentally appropriate anti−smoking teaching in school, and even in clubs and social organizations. For parents who want to monitor their children’s movie smoking exposure, the authors suggest two websites that can tell a parent the amount of smoking in a given movie: http://www.screenit.com and http://www.commonsensemedia.org.