There is a new push to give an "R" rating to all movies that depict smoking.

Why? Every year, nearly 400,000 kids start smoking due to the influence of movies. The finding was highlighted at this week's meeting of the American Academy of Pediatrics, held Oct. 7-10 in Atlanta.

Can you really tell whether smoking portrayed in movies makes kids start smoking? Yes, says James Sargent, MD, director of the Cancer Prevention Research Program at Dartmouth Medical School in Lebanon, N.H.

Since 1996, Sargent and colleagues have analyzed movies for smoking content. They've also been finding out which movies kids have seen, and whether they smoke.

After accounting for factors linked to smoking behavior and moviegoing frequency, they find that kids who see the most onscreen smoking are more than 2.5 times more likely to start smoking than kids who see the least onscreen smoking.

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The numbers are striking. Kids who watched very few movies hardly smoked at all. But among the 5 percent of kids who saw the most onscreen smoking, 40 percent had started smoking themselves.

There's less smoking in movies than there used to be. But this is mostly due to less smoking in movies already rated "R" or higher. In youth-rated movies, there's been no less smoking.

Sargent -- backed by the American Academy of Pediatrics -- strongly urges the film industry to adopt four rules proposed by the University of California, San Francisco "Smokefreemovies" campaign:

--Movies that portray smoking should be rated "R."

--Movies should certify that they received nothing of value from anyone in exchange for portraying tobacco use or tobacco products.

--Movies should run strong antismoking ads before any film that portrays smoking or tobacco products.

--Movies should ban the display of any brand of tobacco.

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By Daniel J. DeNoon, reviewed by Louise Chang, MD

SOURCES: Sargent, J. AAP Handout, October 2006. News release, American Academy of Pediatrics.