NEW YORK (Reuters Health) - Seeing their movie idols light up on-screen may help convince children and teens that smoking is just fine, a study of US middle-school students suggests.

Researchers found that students who had seen relatively more films featuring smoking also had more positive attitudes toward the habit. This, they say, suggests that on-screen tobacco use can help shape children's views on smoking. "It suggests that the movie influence may start long before they ever puff on a cigarette," the study's lead author, Dr. James D. Sargent of Dartmouth Medical School in Hanover, New Hampshire, told Reuters Health. In an earlier study, Sargent's team had found a relationship between adolescent smoking rates and exposure to smoking in movies. However, the investigators could not tell whether the film images actually moved kids to see smoking in a positive light. This study now suggests that may be the case, according to Sargent. "Kids don't just start smoking for other reasons then go to the movies to validate their new self-image," he said. The study looked at nearly 3,800 students in grades 5 to 8 in schools in Vermont and New Hampshire. The children were asked to identify which movies they had seen from a list of 50 recent films that the researchers had analyzed for smoking content. The movies were randomly pulled from a list of 601 films ranging from "G"- to "R"-rated. The vast majority of "PG," "PG-13" and "R" movies contained tobacco use. The students were also asked about their views on smoking and whether they would consider taking up the habit. Sargent and colleagues also looked at factors that could affect kids' smoking attitudes--such as their school performance, their parents' strictness, their own propensity toward "rebelliousness" and whether their parents, siblings and friends smoked. Overall, nearly one quarter of the students were considered "susceptible" to smoking based on their responses, and about 20% saw adolescent smoking as a normal behavior, according to findings published in the April issue of the American Journal of Preventive Medicine. Moreover, the students' susceptibility to smoking rose in tandem with their exposure to on-screen smoking, regardless of other influences, the team found. Children who saw relatively more smoking in films were also more likely to view adult smoking as normal, the findings show. According to Sargent, this study offers "an important piece in developing the argument that exposure to movie smoking is one of the causes of adolescent smoking."

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