{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:37:28Z","timestamp":1777664248438,"version":"3.51.4"},"reference-count":51,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Educ Behav"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>\n                    Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults\u2019 opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged \u2265 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28,\n                    <jats:italic>p<\/jats:italic>\n                    = .008) and \u226565 years (aOR = 4.54,\n                    <jats:italic>p<\/jats:italic>\n                    &lt;.001) (vs. 18\u201334 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74,\n                    <jats:italic>p<\/jats:italic>\n                    = .04), whereas adults with a household annual income of US$75,000 or more (vs. &lt;$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race\/ethnicity, household income, e-cigarette usage, and political ideologies.\n                  <\/jats:p>","DOI":"10.1177\/10901981241239933","type":"journal-article","created":{"date-parts":[[2024,3,23]],"date-time":"2024-03-23T00:38:20Z","timestamp":1711154300000},"page":"573-582","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of U.S. Adults\u2019 Opinion Toward an R-Rating Policy for Movies With Cigarette Smoking"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1672-9248","authenticated-orcid":false,"given":"Nikhil","family":"Ahuja","sequence":"first","affiliation":[{"name":"Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asos","family":"Mahmood","sequence":"additional","affiliation":[{"name":"The University of Tennessee Health Science Center, Memphis, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satish","family":"Kedia","sequence":"additional","affiliation":[{"name":"The University of Memphis School of Public Health, Memphis, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Dillon","sequence":"additional","affiliation":[{"name":"Kent State University at Stark, North Canton, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,3,22]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"American Lung Association. (2019). Leading health groups demand film industry give R rating to movies that depict smoking. https:\/\/www.lung.org\/media\/press-releases\/leading-health-groups-demand-r-rating-for-tobacco"},{"key":"e_1_3_2_3_1","doi-asserted-by":"crossref","unstructured":"Blake K. D. Gaysynsky A. Mayne R. G. Seidenberg A. B. Kaufman A. D\u2019Angelo H. Roditis M. Vollinger R. E. (2022). U.S. public opinion toward policy restrictions to limit tobacco product placement and advertising at point-of-sale and on social media. Preventive Medicine 155 Article 106930. https:\/\/doi.org\/10.1016\/j.ypmed.2021.106930","DOI":"10.1016\/j.ypmed.2021.106930"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"Blake K. D. Viswanath K. Blendon R. J. Vallone D. (2010). The role of reported tobacco-specific media exposure on adult attitudes towards proposed policies to limit the portrayal of smoking in movies. Tobacco Control 19(3) 191\u2013196. https:\/\/doi.org\/10.1136\/tc.2009.031260","DOI":"10.1136\/tc.2009.031260"},{"key":"e_1_3_2_5_1","doi-asserted-by":"crossref","unstructured":"Blendon R. J. Benson J. M. Schneider E. C. (2021). The future of health policy in a partisan United States: Insights from public opinion polls. Journal of the American Medical Association 325(13) 1253\u20131254. https:\/\/doi.org\/10.1001\/jama.2021.1147","DOI":"10.1001\/jama.2021.1147"},{"key":"e_1_3_2_6_1","doi-asserted-by":"crossref","unstructured":"Blendon R. J. Young J. T. (1998). The public and the comprehensive tobacco bill. Journal of the American Medical Association 280(14) 1279\u20131284. https:\/\/doi.org\/10.1001\/jama.280.14.1279","DOI":"10.1001\/jama.280.14.1279"},{"key":"e_1_3_2_7_1","unstructured":"Centers for Disease Control and Prevention. (2022 August 22). Smoking in the movies. https:\/\/www.cdc.gov\/tobacco\/data_statistics\/fact_sheets\/youth_data\/movies\/index.htm"},{"key":"e_1_3_2_8_1","doi-asserted-by":"crossref","unstructured":"Charlesworth A. Glantz S. A. (2005). Smoking in the movies increases adolescent smoking: A review. Pediatrics 116(6) 1516\u20131528. https:\/\/doi.org\/10.1542\/peds.2005-0141","DOI":"10.1542\/peds.2005-0141"},{"key":"e_1_3_2_9_1","doi-asserted-by":"crossref","unstructured":"Cohen J. E. (2000). Political ideology and tobacco control. Tobacco Control 9(3) 263\u2013267. https:\/\/doi.org\/10.1136\/tc.9.3.263","DOI":"10.1136\/tc.9.3.263"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03404302"},{"key":"e_1_3_2_11_1","doi-asserted-by":"crossref","unstructured":"Dalton M. A. Adachi-Mejia A. M. Longacre M. R. Titus-Ernstoff L. T. Gibson J. J. Martin S. K. Sargent J. D. Beach M. L. (2006). Parental rules and monitoring of children\u2019s movie viewing associated with children\u2019s risk for smoking and drinking. Pediatrics 118(5) 1932\u20131942. https:\/\/doi.org\/10.1542\/peds.2005-3082","DOI":"10.1542\/peds.2005-3082"},{"key":"e_1_3_2_12_1","doi-asserted-by":"crossref","unstructured":"de Leeuw R. N. H. Sargent J. D. Stoolmiller M. Scholte R. H. J. Engels R. C. M. E. Tanski S. E. (2011). Association of smoking onset with R-rated movie restrictions and adolescent sensation seeking. Pediatrics 127(1) e96\u2013e105. https:\/\/doi.org\/10.1542\/peds.2009-3443","DOI":"10.1542\/peds.2009-3443"},{"key":"e_1_3_2_13_1","doi-asserted-by":"crossref","unstructured":"Diepeveen S. Ling T. Suhrcke M. Roland M. Marteau T. M. (2013). Public acceptability of government intervention to change health-related behaviours: A systematic review and narrative synthesis. BMC Public Health 13(1) Article 756. https:\/\/doi.org\/10.1186\/1471-2458-13-756","DOI":"10.1186\/1471-2458-13-756"},{"key":"e_1_3_2_14_1","doi-asserted-by":"crossref","unstructured":"Filippidis F. T. Girvalaki C. Mechili E.-A. Vardavas C. I. (2017). Are political views related to smoking and support for tobacco control policies? A survey across 28 European countries. Tobacco Induced Diseases 15(1) Article 45. https:\/\/doi.org\/10.1186\/s12971-017-0151-x","DOI":"10.1186\/s12971-017-0151-x"},{"key":"e_1_3_2_15_1","doi-asserted-by":"crossref","unstructured":"Fillon M. (2023). Near majority of adults favor R ratings for films with smoking. CA: A Cancer Journal for Clinicians 73(2) 118\u2013119. https:\/\/doi.org\/10.3322\/caac.21776","DOI":"10.3322\/caac.21776"},{"key":"e_1_3_2_16_1","doi-asserted-by":"crossref","unstructured":"Fox A. M. Feng W. Yumkham R. (2017). State political ideology policies and health behaviors: The case of tobacco. Social Science & Medicine 181 139\u2013147. https:\/\/doi.org\/10.1016\/j.socscimed.2017.03.056","DOI":"10.1016\/j.socscimed.2017.03.056"},{"key":"e_1_3_2_17_1","doi-asserted-by":"crossref","unstructured":"Gentile D. A. (2010). Are motion picture ratings reliable and valid? Journal of Adolescent Health 47(5) 423\u2013424. https:\/\/doi.org\/10.1016\/j.jadohealth.2010.08.016","DOI":"10.1016\/j.jadohealth.2010.08.016"},{"key":"e_1_3_2_18_1","doi-asserted-by":"crossref","unstructured":"Gentzke A. S. Glover-Kudon R. Tynan M. Jamal A. (2020). Adults\u2019 attitudes toward raising the minimum age of sale for tobacco products to 21 years United States 2014\u20132017. Preventive Medicine 133 Article 106012. https:\/\/doi.org\/10.1016\/j.ypmed.2020.106012","DOI":"10.1016\/j.ypmed.2020.106012"},{"key":"e_1_3_2_19_1","doi-asserted-by":"crossref","unstructured":"Heatherton T. F. Sargent J. D. (2009). Does watching smoking in movies promote teenage smoking? Current Directions in Psychological Science 18(2) 63\u201367. https:\/\/doi.org\/10.1111\/j.1467-8721.2009.01610.x","DOI":"10.1111\/j.1467-8721.2009.01610.x"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)31039-0"},{"key":"e_1_3_2_21_1","unstructured":"Kunkel D. Farinola W. J. M. Cope K. M. Donnerstein E. Biely E. Zwarun L. (1998). Rating the TV ratings\u2014One year out: An assessment of the television industry\u2019s use of V-chip ratings. report. https:\/\/eric.ed.gov\/?id=ED445367"},{"key":"e_1_3_2_22_1","doi-asserted-by":"crossref","unstructured":"Lama Y. Gaysynsky A. Mayne R. G. Blake K. D. (2022). U.S. adults\u2019 public opinion toward R-rating labels for movies with cigarette smoking. American Journal of Preventive Medicine 64(2). 265\u2013269. https:\/\/doi.org\/10.1016\/j.amepre.2022.08.017","DOI":"10.1016\/j.amepre.2022.08.017"},{"key":"e_1_3_2_23_1","doi-asserted-by":"crossref","unstructured":"Lee J. G. L. Henriksen L. Rose S. W. Moreland-Russell S. Ribisl K. M. (2015). A systematic review of neighborhood disparities in point-of-sale tobacco marketing. American Journal of Public Health 105(9) e8\u2013e18. https:\/\/doi.org\/10.2105\/AJPH.2015.302777","DOI":"10.2105\/AJPH.2015.302777"},{"key":"e_1_3_2_24_1","doi-asserted-by":"crossref","unstructured":"Longacre M. R. Adachi-Mejia A. M. Titus-Ernstoff L. Gibson J. J. Beach M. L. Dalton M. A. (2009). Parental attitudes about cigarette smoking and alcohol use in the motion picture association of America rating system. Archives of Pediatrics & Adolescent Medicine 163(3) 218\u2013224. https:\/\/doi.org\/10.1001\/archpediatrics.2008.550","DOI":"10.1001\/archpediatrics.2008.550"},{"key":"e_1_3_2_25_1","doi-asserted-by":"crossref","unstructured":"Malt L. Verron T. Cahours X. Guo M. Weaver S. Walele T. O\u2019Connell G. (2020). Perception of the relative harm of electronic cigarettes compared to cigarettes amongst U.S adults from 2013 to 2016: Analysis of the Population Assessment of Tobacco and Health (PATH) study data. Harm Reduction Journal 17 Article 65. https:\/\/doi.org\/10.1186\/s12954-020-00410-2","DOI":"10.1186\/s12954-020-00410-2"},{"key":"e_1_3_2_26_1","doi-asserted-by":"crossref","unstructured":"McAfee T. Tynan M. (2012). Smoking in movies: A new centers for disease control and prevention core surveillance indicator. Preventing Chronic Disease 9 Article E162. https:\/\/doi.org\/10.5888\/pcd9.120261","DOI":"10.5888\/pcd9.120261"},{"key":"e_1_3_2_27_1","unstructured":"McMillen R. (2020). Attitudes about smoking in the movies. Smoke Free Media; University of California San Francisco. https:\/\/smokefreemedia.ucsf.edu\/sites\/default\/files\/2020-09\/Polling%20-%20US%20Social%20Climate%202004-13.pdf"},{"key":"e_1_3_2_28_1","doi-asserted-by":"crossref","unstructured":"Mekemson C. (2004). Tobacco use in popular movies during the past decade. Tobacco Control 13(4) 400\u2013402. https:\/\/doi.org\/10.1136\/tc.2003.007211","DOI":"10.1136\/tc.2003.007211"},{"key":"e_1_3_2_29_1","doi-asserted-by":"crossref","unstructured":"Mekemson C. Glantz S. A. (2002). How the tobacco industry built its relationship with Hollywood. Tobacco Control 11(Suppl. 1) i81\u2013i91. https:\/\/doi.org\/10.1136\/tc.11.suppl_1.i81","DOI":"10.1136\/tc.11.suppl_1.i81"},{"key":"e_1_3_2_30_1","volume-title":"Classification and rating rules","author":"Motion Picture Association","year":"2020","unstructured":"Motion Picture Association. (2020). Classification and rating rules. Motion Picture Association."},{"key":"e_1_3_2_31_1","doi-asserted-by":"crossref","unstructured":"Nalkur P. G. Jamieson P. E. Romer D. (2010). The effectiveness of the motion picture association of America\u2019s rating system in screening explicit violence and sex in top-ranked movies from 1950 to 2006. Journal of Adolescent Health 47(5) 440\u2013447. https:\/\/doi.org\/10.1016\/j.jadohealth.2010.01.019","DOI":"10.1016\/j.jadohealth.2010.01.019"},{"key":"e_1_3_2_32_1","unstructured":"National Cancer Institute NIH. (2020). Health information national trends survey 5 (HINTS 5) cycle 4 methodology report. https:\/\/hints.cancer.gov\/data\/methodology-reports.aspx"},{"key":"e_1_3_2_33_1","doi-asserted-by":"crossref","unstructured":"Nelson D. E. Kreps G. L. Hesse B. W. Croyle R. T. Willis G. Arora N. K. Rimer B. K. Viswanath K. V. Weinstein N. Alden S. (2004). The Health Information National Trends Survey (HINTS): Development design and dissemination. Journal of Health Communication 9(5) 443\u2013460. https:\/\/doi.org\/10.1080\/10810730490504233","DOI":"10.1080\/10810730490504233"},{"key":"e_1_3_2_34_1","doi-asserted-by":"crossref","unstructured":"Oghenetega E. Kekere V. Enosolease U. Eche V. Reng G. Sonola O. Ezema E. Busari R. Adegbite O. Muoghalu C. Ikekwere J. Emenuga I. Jawla M. Onyeaka H. (2022). Prevalence and correlates of U.S adult opinions on restricting exposure of children to smoking in movies: The 2020 Health Information National Trends Survey. Population Medicine 4 1\u20138. https:\/\/doi.org\/10.18332\/popmed\/150644","DOI":"10.18332\/popmed\/150644"},{"key":"e_1_3_2_35_1","volume-title":"Smoking in top-grossing U.S movies: 2019","author":"Polansky J.","year":"2020","unstructured":"Polansky J., Driscoll G., Glantz S. (2020). Smoking in top-grossing U.S movies: 2019. University of California, San Francisco, Center for Tobacco Control Research and Education."},{"key":"e_1_3_2_36_1","volume-title":"Six months later: Are MPAA\u2019s tobacco ratings protecting movie audiences?","author":"Polansky J. R.","year":"2007","unstructured":"Polansky J. R., Glantz S., Titus K. (2007). Six months later: Are MPAA\u2019s tobacco ratings protecting movie audiences? University of California, San Francisco."},{"key":"e_1_3_2_37_1","doi-asserted-by":"crossref","unstructured":"Sargent J. D. Beach M. L. Dalton M. A. Ernstoff L. T. Gibson J. J. Tickle J. J. Heatherton T. F. (2004). Effect of parental R-rated movie restriction on adolescent smoking initiation: A prospective Study. Pediatrics 114(1) 149\u2013156. https:\/\/doi.org\/10.1542\/peds.114.1.149","DOI":"10.1542\/peds.114.1.149"},{"key":"e_1_3_2_38_1","doi-asserted-by":"crossref","unstructured":"Sargent J. D. Dalton M. A. Beach M. L. Mott L. A. Tickle J. J. Ahrens M. B. Heatherton T. F. (2002). Viewing tobacco use in movies: Does it shape attitudes that mediate adolescent smoking?. American Journal of Preventive Medicine 22(3) 137\u2013145. https:\/\/doi.org\/10.1016\/S0749-3797(01)00434-2","DOI":"10.1016\/S0749-3797(01)00434-2"},{"key":"e_1_3_2_39_1","doi-asserted-by":"crossref","unstructured":"Sargent J. D. Hanewinkel R. (2015). Impact of media movies and TV on tobacco use in the youth. The Tobacco Epidemic 42 171\u2013180. https:\/\/doi.org\/10.1159\/000369482","DOI":"10.1159\/000369482"},{"key":"e_1_3_2_40_1","doi-asserted-by":"crossref","unstructured":"Sargent J. D. Tanski S. Stoolmiller M. (2012). Influence of motion picture rating on adolescent response to movie smoking. Pediatrics 130(2) 228\u2013236. https:\/\/doi.org\/10.1542\/peds.2011-1787","DOI":"10.1542\/peds.2011-1787"},{"key":"e_1_3_2_41_1","doi-asserted-by":"crossref","unstructured":"Schmidt A. M. Kowitt S. D. Myers A. E. Goldstein A. O. (2018). Attitudes towards potential new tobacco control regulations among U.S. adults. International Journal of Environmental Research and Public Health 15(1) Article 72. https:\/\/doi.org\/10.3390\/ijerph15010072","DOI":"10.3390\/ijerph15010072"},{"key":"e_1_3_2_42_1","doi-asserted-by":"crossref","unstructured":"Shete S. S. Yu R. Shete S. (2021). Political ideology and the support or opposition to United States tobacco control policies. Journal of the American Medical Association Network Open 4(9) Article e2125385. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.25385","DOI":"10.1001\/jamanetworkopen.2021.25385"},{"key":"e_1_3_2_43_1","doi-asserted-by":"crossref","unstructured":"Smith E. P. Witherspoon D. P. Bhargava S. Bermudez J. M. (2019). Cultural values and behavior among African American and European American children. Journal of Child and Family Studies 28 1236\u20131249. https:\/\/doi.org\/10.1007\/s10826-019-01367-y","DOI":"10.1007\/s10826-019-01367-y"},{"key":"e_1_3_2_44_1","doi-asserted-by":"crossref","unstructured":"Stuber J. Galea S. Link B. G. (2008). Smoking and the emergence of a stigmatized social status. Social Science & Medicine 67(3) 420\u2013430. https:\/\/doi.org\/10.1016\/j.socscimed.2008.03.010","DOI":"10.1016\/j.socscimed.2008.03.010"},{"key":"e_1_3_2_45_1","doi-asserted-by":"crossref","unstructured":"Thompson E. M. Gunther A. C. (2007). Cigarettes and cinema: Does parental restriction of R-rated movie viewing reduce adolescent smoking susceptibility? Journal of Adolescent Health 40(2) 181e1\u2013181e6. https:\/\/doi.org\/10.1016\/j.jadohealth.2006.09.017","DOI":"10.1016\/j.jadohealth.2006.09.017"},{"key":"e_1_3_2_46_1","unstructured":"Truth Initiative. (2020). Smoking in movies: 2020. https:\/\/truthinitiative.org\/research-resources\/tobacco-pop-culture\/smoking-movies-2020"},{"key":"e_1_3_2_47_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6843a4"},{"key":"e_1_3_2_48_1","unstructured":"University of California San Francisco. (2021). R-rate films with tobacco. Smoke Free Media. https:\/\/smokefreemedia.ucsf.edu\/policy-solutions\/r-rate"},{"key":"e_1_3_2_49_1","doi-asserted-by":"crossref","unstructured":"U.S. Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults: A report of the surgeon general: (603152012-001) [dataset]. American Psychological Association. https:\/\/doi.org\/10.1037\/e603152012-001","DOI":"10.1037\/e603152012-001"},{"key":"e_1_3_2_50_1","doi-asserted-by":"crossref","unstructured":"U.S. Department of Health and Human Services. (2014). The health consequences of smoking\u201450 years of progress: A report of the surgeon general: (510072014-001) [dataset]. American Psychological Association. https:\/\/doi.org\/10.1037\/e510072014-001","DOI":"10.1037\/e510072014-001"},{"key":"e_1_3_2_51_1","unstructured":"World Health Organization. (2016). Films showing smoking scenes should be rated to protect children from tobacco addiction. https:\/\/www.who.int\/news\/item\/01-02-2016-films-showing-smoking-scenes-should-be-rated-to-protect-children-from-tobacco-addiction"},{"key":"e_1_3_2_52_1","unstructured":"World Health Organization. (2009). Smoke-free movies: From evidence to action. https:\/\/apps.who.int\/iris\/handle\/10665\/44104"}],"container-title":["Health Education &amp; Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10901981241239933","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10901981241239933","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10901981241239933","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:35:24Z","timestamp":1777448124000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10901981241239933"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,22]]},"references-count":51,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1177\/10901981241239933"],"URL":"https:\/\/doi.org\/10.1177\/10901981241239933","relation":{},"ISSN":["1090-1981","1552-6127"],"issn-type":[{"value":"1090-1981","type":"print"},{"value":"1552-6127","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,22]]}}}