Madeline Dalton

In 1996, when Madeline Dalton, N88, N94, began working on a project to help children design their own smoking prevention programs, she quickly realized that any such program would be up against some Madeline Dalton with sonspowerful marketing. “You could see the Marlboro backpacks sitting in the back of a third-grade classroom,” she says. So Dalton, who is an epidemiologist at Dartmouth Medical School’s Hood Center for Children and Families, of which she is now director, set out on a research path that has made her a key figure in the fight to keep children from smoking. She and some Dartmouth colleagues examined the wide range of media that might influence the way children view tobacco. And they noticed that one thing young people talked about a lot was the movies they watched.

The researchers went on to conduct a study of how on-screen smoking might affect young people. When it was completed, they found that the children who saw the most smoking in movies were two and a half times as likely to have lit up as those who saw the least. “We looked at the first analysis and said, ‘Nobody is going to believe that,’ ” Dalton says. They crunched and recrunched the numbers, but the finding didn’t go away. The results were published in the British medical journal BMJ in 2001.

The group’s next paper, published in The Lancet in 2003 after they followed the same kids for two more years, reported another shocker: it was the children of nonsmokers who were most susceptible to the movie influence. In that group, those who saw the most on-screen smoking were four times as likely to light up as those who saw the fewest cigarette scenes.

Armed with these results, which were reiterated in several other studies, public health advocates and state attorneys general began to lobby the film industry. They proposed that one of the criteria for giving a movie an R rating–along with nudity, sex, violence, drug use, and bad language–should be whether characters smoked.

In 2004, Dalton was called to testify at a Senate hearing on the issue. Jack Valenti, then president of the Motion Picture Association of America (MPAA), the movie industry’s trade group, spoke at the hearing as well. Having paid an expert to scour her paper in The Lancet for weaknesses, Valenti “admitted that the study was methodologically sound,” Dalton says–although he didn’t agree with her conclusions. Curiously, Dalton found that most film directors she spoke with didn’t counter her research with a freedom-of-expression argument. “Some had a more sympathetic view than many of the public,” she says.

Recently, the movie industry has begun to make changes. In May 2007, the MPAA announced it would consider tobacco use as a factor in its film ratings. In July 2008, six major movie studios said they would place antismoking public service announcements on the DVDs of all G, PG, and PG-13 movies that depict smoking. The industry could be under even more pressure with the recent release of a comprehensive report from the National Cancer Institute showing that films have a powerful effect on adolescent tobacco use.

Meanwhile, Dalton says, researchers can hone their techniques for judging smoking scenes. As she noted in a study published in Preventive Medicine, there is a limit to how well a researcher can convert “the contextual richness and nuances of movies” into survey data. She points out a scene from Romeo and Juliet in which a brooding Leonardo DiCaprio smokes while writing in his diary. Simply noting it as “a pensive moment with negative affect” in the character’s smoking tally–the current methodology–”would not capture the fact that smoking followed a scene in which Romeo’s parents described his depression and alienation from them,” something many adolescents can identify with, she writes. “Nor would it capture the almost sensual nature in which smoking was portrayed, which has to do with lighting, sound, and other factors that simply cannot be coded in a large sample of movies.”

A lot depends on teen psychology. Some argue that villains should be allowed to smoke because it only underscores their wickedness. But Dalton notes that the characters who draw children in aren’t always the ones who wear white hats. She laughs, thinking of her own adolescent sons. “When they are watching The Godfather,” she says, “they want to be like members of the family, not the police who are after them.”