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High youth access to movies that contain smoking in Europe compared with the USA
  1. Reiner Hanewinkel1,2,
  2. James D Sargent3,
  3. Sólveig Karlsdóttir4,
  4. Stefán Hrafn Jónsson4,5,
  5. Federica Mathis6,
  6. Fabrizio Faggiano6,7,
  7. Evelien A P Poelen8,
  8. Ron Scholte8,
  9. Ewa Florek9,
  10. Helen Sweeting10,
  11. Kate Hunt10,
  12. Matthis Morgenstern1,2
  1. 1Institute for Therapy and Health Research, Kiel, Germany
  2. 2Institute for Medical Psychology and Medical Sociology, University Hospital Schleswig-Holstein, Kiel, Germany
  3. 3Dartmouth Medical School, Lebanon, New Hampshire, USA
  4. 4Directorate of Health, Reykjavik, Iceland
  5. 5University of Iceland, Reykjavik, Iceland
  6. 6Piedmont Centre for Drug Addiction Epidemiology, A.S.L. TO3, Grugliasco (TO), Italy
  7. 7Avogadro University, Novara, Italy
  8. 8Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
  9. 9Laboratory of Environmental Research, Department of Toxicology, University of Medical Sciences, Poznan, Poland
  10. 10Medical Research Council (MRC) Social and Public Health Sciences Unit, Glasgow, UK
  1. Correspondence to Dr Reiner Hanewinkel, Institute for Therapy and Health Research (IFT-Nord), Harmsstrasse 2, 24114 Kiel, Germany; hanewinkel{at}


Background Based on evidence that exposure to smoking in movies is associated with adolescent smoking, the WHO has called on countries to assign a rating that restricts youth access to such movies.

Objective To evaluate youth access to movies that portray smoking in European countries and compare with that in the USA.

Methods The authors identified the most commercially successful movies screened in six European countries (Germany, Iceland, Italy, the Netherlands, Poland and UK) and the USA between 2004 and 2009. The authors coded the 464 movies that were screened in both Europe and the USA according to whether or not they portrayed smoking.

Results 87% of the movies were ‘youth’ rated in Europe (ratings board classification as suitable for those younger than 16 years) compared to only 67% in the USA (suitable for those younger than 17 years). Smoking was portrayed in 319 (69%) movies. 85% of the movies that portrayed smoking were ‘youth’ rated in Europe compared with only 59% in the USA (p<0.001).

Conclusions Tobacco imagery is still common in popular films shown in European countries and the USA. None of the seven countries examined followed the WHO recommendations on restricting youth access to movies that portray smoking. Compared to the USA, European youths have access to substantially more movies in general, and this gives them access to more movies that portray smoking in particular.

  • Media
  • movies
  • smoking initiation
  • youth protection
  • Europe
  • packaging and labelling
  • prevalence
  • smuggling
  • taxation and price
  • primary healthcare
  • smoking onset
  • advertising and promotion
  • addiction
  • denormalization
  • harm reduction
  • prevention
  • cotinine
  • secondhand smoke
  • toxicology
  • adolescence
  • young people
  • lifestyle
  • health

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  • Funding The study was supported by European Commission and Ministry of Health of the Federal Republic of Germany. KH and HS are funded by the UK Medical Research Council (MC_US_A540_0041). The coding of the US movies was supported by the National Institutes of Health (grant NIH CA 077028).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.