Elsevier

Preventive Medicine

Volume 39, Issue 6, December 2004, Pages 1093-1098
Preventive Medicine

Television viewing and smoking volume in adolescent smokers: a cross-sectional study

https://doi.org/10.1016/j.ypmed.2004.04.019Get rights and content

Abstract

Background. Previous research has shown a relationship between television viewing and smoking initiation. The relationship between television viewing and the amount of cigarettes consumed by adolescent smokers per time unit (day, week, month…) has not yet been studied.

Methods. A cross-sectional sample of children by means of self-reports administered by research assistants in schools was obtained. Participants were 421 smokers in a random sample of 4th year students in 15 secondary schools in Flanders, Belgium. Main outcome measures were quantifiable, closed survey questions about smoking volume, whether or not parents and friends smoked, frequency of going out and average weekly TV viewing volume.

Results. Television viewing was a significant predictor of smoking volume. Smokers who watch more TV smoke more. The relationship was curvilinear (quadratic). The relationship becomes stronger (curves upward) for higher levels of viewing. Those who watch 5 or more hours a day smoke between 60 and 147 cigarettes more per week than those who watch 1 h or less.

Conclusions. Television viewing is significantly related to smoking volume. The content of television may glamorize smoking. Children may learn to associate smoking with viewing regardless of content. It is also possible that heavier smoking leads to more viewing or that a third variable influences both smoking volume and viewing. Regardless of the causal direction of the relationship television viewing appears to be an indicator or predictor of smoking volume. The curvilinear nature of the relationship deserves further attention.

Introduction

Studies have shown that it is still very common to see characters smoke in movies or television drama [1], [2], [3], [4], [5], [6], [7], [8]. While the prevalence of smoking in movies decreased from the 1960s through the 1980s, it increased again in the 1990s. A recent study by Glantz et al. [6] even found that smoking in movies was more prevalent in the year 2002 than it was in the 1950s. Smoking in movies or on television is often depicted in a positive way. One study showed that smokers are portrayed as attractive and successful individuals. Men are depicted as smokers more often than women are [7]. The authors analyzed a random sample of 62 of the top grossing US films between 1960 and 1990 and concluded that films consistently portray smokers as successful, attractive white males. In a similar analysis, McIntosh et al. [9] concluded that smokers in movies are sexier and more romantic than nonsmokers are. Others have found that even modest levels of viewing music videos may result in substantial exposure to glamorized depictions of tobacco [1]. The authors compared the percentage of music videos showing smoking behaviors on four different US music video networks. Their analysis indicated that between 11.9% and 25.7% of all music videos depicted on these networks showed smoking behavior.

While much of the research about the content of audiovisual media has been conducted in the United States of America, it is important to note that in many countries, a large portion of what is broadcast on television is American fiction. In Flanders, Belgium, during prime time, 38.3% of fiction on public channels and 82.3% of fiction on commercial channels is American. 87.5% of the movies shown on public channels and 96.3% of the movies shown on commercial channels are from the United States [10]. It seems reasonable therefore to hypothesize that much of what has been shown for the treatment of tobacco in American fiction can be extrapolated to Flemish viewers. It is also interesting to note that in Belgium, all cigarette advertising, including televised commercials, is illegal. On Belgian television, smoking is shown only in entertainment programs. There are no commercial messages promoting smoking behaviors.

Watching people consume tobacco in movies or on TV may not be harmless. Some studies have found that positive depictions of tobacco consumption in movies or on television were related to taking up smoking by teenagers [11], [12], [13]. One study tested the hypothesis that greater exposure to smoking in films is associated with experimenting with smoking by adolescents [13]. The authors reported that the prevalence of trying smoking increased with higher levels of exposure to smoking-related scenes in movies. At the starting point of their analysis, the authors divided all respondents into four different groups, based on the number of smoking-related scenes that they had seen (0–50, 51–100, 101–150, >150). They then calculated the odds ratio of ever having tried smoking for all groups compared to the lowest group. The odds ratios were 1.7 for the second group, 2.4 for the third group and 2.7 for the highest group. On the basis of these results, the authors [13] concluded that there was a strong, direct and independent association between seeing tobacco use in films and trying cigarettes. Others found that smoking scenes in movies “positively aroused viewers, enhanced their perceptions of smokers' social stature and increased their intent to smoke” [11]. An often quoted study by Gidwani et al. [12] tested the relationship between television viewing and initiation of smoking among young people and found that those who watched television for 5 or more hours per day were 5.99 times more likely to initiate smoking than those who watched less than 2 h per day.

If television viewing is effective in motivating teenagers to start smoking, it may also motivate those who already smoke to increase their cigarette consumption. There do not appear to be any studies looking into the relationship between television viewing and the amount of cigarettes consumed by adolescent smokers per time unit (day, week, month…). The present article will try to assess whether or not a significant relationship exists between television viewing and smoking volume in adolescent smokers. If glamorized depictions make smoking seem “cool” and interesting enough to try, then those depictions may induce smokers to smoke more than they already do. This article therefore looks at the hypothesis that watching television is related to higher levels of smoking volume.

Section snippets

Subjects

We used data from the first wave of the Leuven Study on Media and Adolescent Health (SOMAH). These data were collected in February 2003 by means of a standardized, self-administered questionnaire including measures of television viewing and smoking behavior. Respondents were selected from a sample of 1st and 4th year students in 15 secondary schools in the Flemish Community of Belgium. First, schools were selected randomly from a list of secondary schools in Flanders and were contacted with the

Television viewing

The smokers in our sample (N = 421) watched television for an average of 3:04 h per day (SD = 1:41). Independent samples t tests showed that males (M = 3:14; SD = 1:44) watch more TV than females (M = 2:48; SD = 1:35) do (t = 2.648; df = 415; P = 0.008). A one-way ANOVA with post hoc Tukey test showed that smokers in the highest educational level (M = 2:32; SD = 1:17) watched significantly less TV than smokers in the technical (M = 3:09; SD = 1:42) and vocational (M = 3:32; SD = 1:52) levels

Discussion

Previous research has suggested that television viewing is related to smoking initiation in adolescents [11], [12], [13]. The present study suggests that a television effect may also occur in those who already smoke. Our data suggest that a quadratic relationship exists between television viewing and smoking volume. The smokers in our sample smoked more if they watched more TV. Smoking increased more as viewers watched more. In heavier viewers, watching more TV is related to a greater increase

Acknowledgements

This study was funded by a subsidy from the Ministry of Welfare of the Flemish Government and the Flemish Fund for Scientific Research (FWO).

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