Research article
Viewing tobacco use in movies: Does it shape attitudes that mediate adolescent smoking?1

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Abstract

Background: Social cognitive theory posits that children develop intentions and positive expectations (utilities) about smoking prior to initiation. These attitudes and values result, in part, from observing others modeling the behavior. This study examines, for the first time, the association between viewing tobacco use in movies and attitudes toward smoking among children who have never smoked a cigarette.

Design/ Setting: Cross-sectional school-based survey was used among randomly selected Vermont and New Hampshire middle schools. The sample consisted of 3766 middle school students (grades 5–8). The sample was primarily white and equally distributed by gender. The primary exposure was number of movie tobacco-use occurrences viewed. We first counted occurrences of tobacco use in each of 601 recent popular motion pictures. Each student was asked to select movies they had seen from a random subset of 50 movies. Based on movies the adolescent had seen, movie tobacco-use occurrences were summed to determine exposure.The outcome was susceptibility to smoking, positive expectations, and perceptions of smoking as normative behavior for adolescents or adults.

Results: The movies in this sample contained a median of five occurrences of tobacco use (interquartile range=1, 12). The typical adolescent never-smoker had viewed 15 of the 50 movies on his/her list. From movies adolescents reported seeing, exposure to movie tobacco-use occurrences varied widely: median=80, and interquartile range 44 to 136. The prevalence of susceptibility to smoking increased with higher categories of exposure: 16% among students who viewed 0 to 50 movie tobacco occurrences; 21% (51 to 100); 28% (101 to 150); and 36% (>150). The association remained statistically significant after controlling for gender, grade in school, school performance, school, friend, sibling and parent smoking, sensation-seeking, rebelliousness, and self-esteem. Compared with adolescents exposed to ≤50 occurrences of tobacco use, the adjusted odds ratio of susceptibility to smoking for each higher category was 1.2 (95% confidence interval 0.9, 1.5), 1.4 (1.1, 1.9), and 1.6 (1.3, 2.1), respectively. Similarly, higher exposure to tobacco use in movies significantly increased the number of positive expectations endorsed by the adolescent and the perception that most adults smoke, but not the perception that most peers smoke.

Conclusions: This study provides empirical evidence that viewing movie depictions of tobacco use is associated with higher receptivity to smoking prior to trying the behavior.

Introduction

Although extensive research has demonstrated the importance of some social factors—peer smoking, family smoking, school smoking rates, and print advertising—on adolescent smoking, little attention has been given to movie influences. Movies are a powerful socializing force for contemporary adolescents, shaping views of what is “cool,” attractive, and grown-up—all things that adolescents try to be. Adolescents may perceive relationships between these desired characteristics and behaviors (e.g., tobacco use) that might help establish this identity. To the extent that smoking portrayals are consistent with adolescents’ actual or ideal self-images or prototypes of the ideal group member, adolescents will be motivated to smoke to align self-perceptions with personal ideals.1, 2, 3, 4

In 1998, the Kaiser Family Foundation conducted a survey of the media habits of a nationally representative sample of American children.5 The survey found that adolescents aged 8 to 13 years are exposed to an average of two to three movies per week, with some seeing as many as five. This amounts to an average of 100 to 150 movies per year. At the same time, greater restrictions on public tobacco use have limited adolescents’ exposure to this social influence, making movies a key way that adolescents learn about the stylistic elements and social context of tobacco use. Furthermore, smoking in movies is modeled by popular stars and often associated with other adult behaviors, so the exposure is likely to be more salient to adolescents than smoking in the community.

Adolescent smoking is a multiply determined behavior influenced by cultural, interpersonal, and intrapersonal factors.6 Our theoretical model integrates what is known about various risk factors that predict smoking initiation, including individual factors (e.g., temperament, socioeconomic status, and gender), peer factors (e.g., influence and self-selection), parental involvement (e.g., control and support), and media influence. Our model, which has as its basis social cognitive theory,7 dictates that there are multiple reciprocal interactions among these risk factors that lead to attitudinal susceptibility to smoking (Figure 1). The putative social cognitive mechanisms that render adolescents susceptible include normative beliefs about smoking, self-identification processes, and learned expectations. These processes are implicit and shaped by the social context, such as exposure to smoking behavior in movies.

In a recent cross-sectional study, we demonstrated that exposure to tobacco use in movies is associated with adolescent smoking behavior.8 Although the finding is suggestive, the study does not show that exposure to movie tobacco use precedes smoking initiation. Another plausible explanation is that adolescents who begin smoking for other reasons seek out movies that depict risk-taking behaviors in order to further consolidate their identities as smokers. However, this cross-sectional study also included many who had never tried a cigarette. Our theoretical model postulates that movie portrayals shape mediating attitudes that precede smoking initiation. Therefore, we predict that higher exposure to tobacco use among never-smokers will be associated with more favorable attitudes toward taking up smoking.

Section snippets

Overview

We recruited a representative adolescent sample from New Hampshire and Vermont middle schools and conducted a cross-sectional survey to determine smoking status and exposure to tobacco use in movies.

Sample recruitment

We identified all schools in New Hampshire and Vermont with at least 150 students (N=154). We then randomly selected 30 schools (15 from each state) and approached them for participation in the study. Fifty percent of the schools agreed to participate within 30 days of the offer (seven from New

Characteristics of the sample

The 3766 adolescents ranged in age from 9 to 15 years; fifth graders were under-represented because some of the junior high schools did not include that grade (Table 1). The students were primarily white and equally distributed by gender, with most reporting that both parents had graduated from high school. Thirty-three percent reported having at least one parent who smoked, 12% had a sibling that smoked, and 27% had friends who smoked.

Attitudes toward smoking

Approximately 20% of the adolescents were susceptible to

Discussion

Our research documents a strong relationship between viewing tobacco use in movies and more positive attitudes toward smoking among adolescent never-smokers. This extends research already published showing a cross-sectional association between exposure to movie depictions of tobacco use and adolescent smoking behavior.8 The previous finding is subject to the interpretation that adolescents begin smoking for other reasons and then seek out the types of movies that depict smoking in order to

Acknowledgements

This work was supported by National Cancer Institute grant CA-77026. We are grateful to Susan Martin for editorial assistance, and to Dan Nassau and Ezra Hays for coding the movies.

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