ArticlesEffect of viewing smoking in movies on adolescent smoking initiation: a cohort study
Introduction
Many studies have linked tobacco marketing with an increased risk of smoking uptake in adolescents.1, 2, 3, 4, 5, 6, 7 For example, owning tobacco promotional items and being able to recall cigarette advertisements can double the odds that an adolescent will become an established smoker.3 Movie images, like commercial advertising, associate smoking with celebrities and depict it as an attractive behaviour.8 In popular contemporary movies, smoking is frequently associated with characteristics many adolescents find appealing-such as toughness, sexiness, and rebelliousness.9 Endorsement of cigarette brands in movies by actors has also increased substantially over the past decade.10
Several studies have described how smoking is portrayed in movies,9, 11, 12, 13, 14, 15, 16 but only a few have specifically assessed whether viewing smoking in movies affects adolescent smoking behaviour. In an experimental study, Pechmann and Shih17 showed that adolescents were more likely to report positive attitudes toward smoking after seeing smoking portrayed in movies. Results of two crosssectional studies18, 19 indicated that adolescents were more likely to have tried smoking if their favourite movie stars smoked on screen. In our previous study of adolescents in New England, USA, exposure to smoking in movies was associated with smoking experimentation, even after controlling for the effects of other social influences, parenting, and personality characteristics of the child.20
Collectively, these results suggest that movie smoking influences adolescent smoking behaviour. However, the cross-sectional design of these studies precludes establishment of a temporal relation. To determine whether exposure to movie smoking predicts smoking initiation in adolescents, we did a longitudinal study of adolescents in New England, USA, who had never previously tried smoking.
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Participants
In 1999, we distributed a self-administered written survey to adolescents (aged 10–14 years) enrolled in grades 5 through 8 at 14 schools in Vermont and New Hampshire, USA. The purpose of this baseline survey was to assess exposure to smoking in movies and investigate its association with lifetime smoking experience. Details of the methods for the survey have been published previously.20
Through the baseline survey, we identified 3547 adolescents who had never tried smoking cigarettes and were
Procedures
We assessed lifetime smoking experience at baseline and follow-up by asking “How many cigarettes have you smoked in your life?”, to which respondents could answer “none”, “just a few puffs”, “one to 19 cigarettes”, “20 to 100 cigarettes”, or “more than 100 cigarettes”. Only students who answered “none” at baseline were eligible for follow-up. Students who reported any cigarette smoking (just a few puffs, one to 100 cigarettes, more than 100 cigarettes) on the follow-up survey were classified as
Statistical analysis
Preliminary analyses consisted of descriptive frequencies, χ2 tests to compare differences in proportions, and t tests to compare mean differences by group. We used generalised linear models28 to assess smoking initiation as a function of both movie exposure and baseline covariates. We used a log link, rather than a logistic regression, so that relative risks could be estimated directly. An overdispersion variable was used to account for possible clustering by schools. Exposure to movie smoking
Role of the funding source
The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Results
Our final sample of 2603 adolescents was mainly white (94%, n=2392), as was the underlying population (96%); equally distributed by sex; with a mean age at baseline of 12 years (SD 1.1). Participants who were followed up were much the same as non-participants in age, sex, grade, and exposure to movie smoking, but nonparticipants were more likely than participants to have parents who smoke (41% [383] vs 30% [773], respectively) and slightly more likely to be susceptible to smoking30 at baseline (
Discussion
Our results suggest that viewing smoking in movies strongly predicts whether or not adolescents initiate smoking, and the effect increases significantly with greater exposure. Adolescents who viewed the most smoking in movies were almost three times more likely to initiate smoking than those with the least amount of exposure. The magnitude of this association is consistent with the results of our cross-sectional study of adolescents in New England, USA.20 It is also consistent with the results
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