Purpose: To determine exposure of young adolescents to extremely violent movies. Design: Cross-sectional school-based survey of middle school students at 15 randomly selected New Hampshire and Vermont middle schools. Each survey contained a unique list of 50 movies, randomly selected from 603 top box office hits from 1988 to 1999, 51 of which were determined by content analysis to contain extremely violent material. Movie titles only were listed, and adolescents were asked to indicate which ones they had seen. Each movie appeared on approximately 470 surveys. We calculated the percentage of students who had seen each movie for a representative subsample of the student population. We also examined characteristics associated with seeing at least one extremely violent movie. Complete survey information was obtained from 5456 students. The sample was primarily white and equally distributed by gender. Results: On average, extremely violent movies were seen by 28% of the students in the sample (range 4% to 66%). The most popular movie, Scream, was seen by two-thirds of students overall and over 40% of fifth-graders. Other movies with sexualized violent content were seen by many of these adolescents. Examples include The General's Daughter (rated R for "graphic images related to sexual violence including a rape scene and perverse sexuality") and Natural Born Killers (rated R for extreme violence and graphic carnage, shocking images, language, and sexuality"), seen by 27% and 20%, respectively. Older students, males, those of lower socioeconomic status, and those with poorer school performance were all significantly more likely to have seen at least one extremely violent movie. Conclusion: This study documents widespread exposure of young adolescents to movies with brutal, and often sexualized, violence. Given that many of these films were marketed to teens, better oversight of the marketing practices of the film industry may be warranted. (C) Society for Adolescent Medicine, 2002.