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2013, American Journal of Preventive Medicine
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Background: Longitudinal studies from the U.S. suggest a causal relationship between exposure to images of smoking in movies and adolescent smoking onset. Purpose: This study investigates whether adolescent smoking onset is predicted by the amount of exposure to smoking in movies across six European countries with various cultural and regulatory approaches to tobacco. Methods: Longitudinal survey of 9987 adolescent never-smokers recruited in the years 2009-2010 (mean age_13.2 years) in 112 state-funded schools from Germany, Iceland, Italy, The Netherlands, Poland, and the United Kingdom (UK), and followed up in 2011. Exposure to movie smoking was estimated from 250 top-grossing movies in each country. Multilevel mixed-effects Poisson regressions were performed in 2012 to assess the relationship between exposure at baseline and smoking status at follow-up. Results: During the observation period (M_12 months), 17% of the sample initiated smoking. The estimated mean exposure to onscreen tobacco was1560 occurrences. Overall, and after controlling for age; gender; family affluence; school performance; TV screen time; personality characteristics; and smoking status of peers, parents, and siblings, exposure to each additional 1000 tobacco occurrences increased the adjusted relative risk for smoking onset by 13% (95% CI_8%, 17%, p_0.001). The crude relationship between movie smoking exposure and smoking initiation was signifıcant in all countries; after covariate adjustment, the relationship remained signifıcant in Germany,
2011
Aim To investigate whether the association between exposure to smoking in movies and smoking among youth is independent of cultural context. Method Cross-sectional survey of 16 551 pupils recruited in Germany, Iceland, Italy, the Netherlands, Poland and Scotland with a mean age of 13.4 years (SD¼1.18) and an equal gender distribution. Schoolbased surveys were conducted between November 2009 and June 2010. Using previously validated methods, exposure to movie smoking was estimated from the 250 top-grossing movies of each country (years 2004e2009) and related to ever smoking. Results Overall, 29% of the sample had tried smoking. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of ever smoking: 14% of adolescents in Q1 had tried smoking, 21% in Q2, 29% in Q3 and 36% in Q4. After controlling for age, gender, family affluence, school performance, television screen time, number of movies seen, sensation seeking and rebelliousness and smoking within the social environment (peers, parents and siblings), the adjusted ORs for having tried smoking in the entire sample were 1.3 (95% CI 1.1 to 1.5) for adolescents in Q2, 1.6 (95% CI 1.4 to 1.9) for Q3 and 1.7 (95% CI 1.4 to 2.0) for Q4 compared with Q1. The adjusted relationship between ever smoking and higher movie smoking exposure levels was significant in all countries with a non-linear association in Italy and Poland. Conclusions The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Limiting young people's exposure to movie smoking could have important public health implications.
American Journal of Preventive Medicine, 2007
Background-Studies have linked exposure to movie smoking and smoking initiation among U.S. adolescents, but there has been only one published study of adolescents outside the U.S.
The Lancet, 2003
Journal of Health Communication, 2012
The authors investigated the association between exposure to smoking in movies and the initiation and progression of adolescent smoking over time among 6,522 U.S. adolescents (between the ages of 10 and 14 years, at baseline) in a nationally representative, 4-wave random-digit-dial telephone survey. They conducted a hazard (survival) analysis testing whether exposure to movie smoking and demographic, personality, social, and structural factors predict (a) earlier smoking onset and (b) faster transition to experimental (1-99 cigarettes/lifetime) and established smoking (>100 cigarettes/lifetime). Results suggest that higher exposure to movie smoking is associated with less time to trying cigarettes for the first time (adjusted hazard ratio = 1.66; 95% CI [1.37, 2.01]) but not with faster escalation of smoking behavior following initiation (adjusted hazard ratio = 1.53; 95% CI [0.84, 2.79]). In contrast, age, peer smoking, parenting style, and availability of cigarettes in the home were predictors of earlier onset and faster transition to established smoking. Thus, the authors concluded that the effect of exposure to mass-mediated images of smoking in movies may decline once adolescents have started to smoke, whereas peers and access to tobacco remain influential.
PEDIATRICS, 2009
OBJECTIVE-Movie smoking exposure is a strong predictor of smoking initiation by adolescents; however, we do not know whether it is a long-term predictor of established smoking. We conducted a prospective study to determine whether movie smoking exposure during early adolescence predicts established smoking in older teens and young adults.
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