National Academies Press: OpenBook

Ending the Tobacco Problem: A Blueprint for the Nation (2007)

Chapter: Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking

« Previous: Appendix G: Reducing and Preventing Tobacco Use Among Pregnant Women, Parents, and Families
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

H
Smoking in the Movies: Its Impact on Youth and Youth Smoking

Bonnie L. Halpern-Felsher

Department of Pediatrics

University of California, San Francisco


Jodi L. Cornell

Department of Pediatrics

University of California, San Francisco1

INTRODUCTION

Smoking in the movies doubled in the 1990s, bringing exposure rates closer to those observed in the 1950s (Glantz et al. 2004). While recent data suggest that depictions of smoking in the movies have declined from 2000–2004 (Worth et al. 2006), youth exposure to smoking in the movies remains high. In addition to its inclusion in R-rated movies, smoking can be observed readily in many youth-rated movies, including movies rated G, PG, and PG-13 (Charlesworth and Glantz 2005). Studies employing content analysis have documented that smoking is portrayed in approximately 87 percent of movies produced from 1988 to 1997 (Dalton et al. 2002b), in 77 percent of movies in 2004 (Worth et al. 2006) and in more than 66 percent of children’s animated movies released between 1937 and 1997 (Goldstein et al. 1999). Health professionals and tobacco control advocates are concerned that youth exposure to smoking in the movies will have an impact on adolescents’ attitudes toward smoking as well as smoking behavior itself (Charlesworth and Glantz 2005; Sargent 2005; Worth et al. 2006). These concerns are consistent with social cognitive theory indicating that adolescents are especially vulnerable to social modeling influences on behavior, including risky behavior such as tobacco and other drug use (Akers and Lee 1996; Bandura 1986).

It has been shown that the tobacco industry has done extensive research to determine how and when to best influence older adolescents’ and young adults’ initiation and continuation of tobacco use (Ling and Glantz 2002). Clearly, there is a strong relationship between exposure to pro-tobacco campaigns and tobacco advertising and adolescent uptake of smoking and age of initiation of smoking ( Biener and Siegel 2000; Biener and Siegel 2001; Pierce et al. 1998; Pierce et al. 1999; Pierce et al. 2002). Pierce and colleagues (1998) found that adolescents in California who were able to describe a favorite tobacco advertisement were twice as likely to start smoking, and adolescents who used a tobacco-promotional product were three times as likely to begin. Sargent and colleagues (2000) also found that smoking uptake is more likely among adolescents who posses tobacco-promotional items, such as a T-shirt (Sargent et al. 2000; see also Pierce et al. 1999). Longitudinal research indicates that approximately 34 percent of all new tobacco ex-

1

This research was supported in part by grants awarded to Dr. Halpern-Felsher from the Tobacco-Related Disease Research Program, Office of the President, University of California (#9K-0072 and #14RT-0010)

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

perimentation occurs as a result of tobacco advertising and promotions (Pierce et al. 1999). Emery and colleagues (1999) estimated that each year, tobacco-marketing efforts generate approximately 193,000 additional adult smokers who began smoking as adolescents because of such marketing (Emery et al. 1999). The influence of these pro-tobacco campaigns has been shown to be stronger than the presence of antismoking messages (Straub et al. 2003).

The body of research linking pro-tobacco campaigns to the initiation of youth smoking is alarming, especially given studies indicating that approximately one-third of adolescents who initiate smoking progress into addicted smoking (Anthony et al. 1994; Choi et al. 1997). It is thus important to explore whether and to what extent exposure to smoking in movies has a similar influence on adolescent tobacco use and whether such influence varies by age, gender, and parental influences. In this appendix, we provide a comprehensive review of empirical research investigating the relationship between exposure to smoking depictions in movies, adolescent smoking-related attitudes, and adolescent smoking behavior. We begin with some theoretical bases underlying the links between exposure to tobacco use in the movies and youth behavior.

THEORIES OF MOVIES AS SOCIAL MODELING INFLUENCES ON ADOLESCENT TOBACCO USE

The theoretical basis for the important role of social constructs in shaping smoking behaviors stems largely from Social Cognitive Theory (e.g., Akers and Lee 1996; Bandura 1986), Social Norms Theory, and Social Marketing Theory, which are also the basis for much of the health research investigating the relationship between exposure to smoking in movies and adolescent smoking behavior. These theories posit that social modeling (observing others perform a behavior and reaping the rewards of that behavior [Bandura 1986]) and social norms (believing that a given behavior is normative and frequent [Wakefield et al. 2003]) are powerful influences on teaching adolescents about behavior in social contexts and are strongly related to adolescents’ behavior. Applied to smoking, depictions of smoking in the movies often serve to influence or change youth’s attitudes about smoking, in part by glamorizing smoking and the smoker him or herself. Often the smoker is portrayed positively—attractive, slim, wealthy, and sexy. Smokers are often shown reaping smoking-related benefits (e.g., coping, relaxation), yet rarely are they seen experiencing any harm or negative stigma from smoking. Depictions of smoking in the movies are also expected to increase the perception that smoking is normative.

Current opinion about adolescent smoking largely considers social factors to be the main set of variables influencing experimental smoking (Lynch and Bonnie 1994; Sargent 2005), including peers and family, which are also key influences on the development of social norms. Adolescents are particularly cued into the social context around them, including media influences on depictions of various behaviors and related positive and negative outcomes. Parallel with physical and cognitive maturation, important social changes take place in adolescence that shift the focus of affiliation gradually from parents to peers and from group relations to intimate relations with individuals outside the family. These expanding social relationships from adolescence through young adulthood broaden adolescents’ sense of extrafamilial reality and reinforce their increasing sense of individuality and need for autonomy. Adolescents’ newly acquired ability to think abstractly and to take a third person’s perspective is an important prerequisite for successful socialization and is tied to new responsibilities and freedom, including trying new and risky behavior such as drinking alcohol, having sex, and smoking cigarettes (e.g., Steinberg and Cauffman 1996). This sets the stage for a variety of social factors to influence adolescents’ attitudes and beliefs for numerous behaviors, including movies and television depictions of behav-

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

ior, and since adolescents have increased power over their own choices about what media and movies they expose themselves to, the extent to which these media influence their socialization is worthy of attention (Arnett 1995).

RESEARCH ON SMOKING IN THE MOVIES AND YOUTH PERCEPTIONS AND BEHAVIOR

Research investigating the impact of youth exposure to smoking in movies has yielded three important findings: (1) exposure to smoking depictions in movies influences perceptions of smoking, (2) exposure to smoking in movies increases the risk for smoking initiation, and (3) the increased risk for smoking initiation from exposure to smoking in movies can be reduced by antismoking advertisements and parental restriction of movies. A review of the scientific evidence for these three findings is summarized next (see also Tables H-1, H-2, and H-3). The current review includes only published scientific research articles specifically investigating the relationship between smoking in the movies and adolescent attitudes and tobacco use (see also Charlesworth and Glantz 2005; Worth et al. 2006).

Exposure to Smoking Depictions in Movies Influences Adolescent Perceptions of Smoking

A small set of literature has addressed the extent to which youth are exposed to smoking in the movies and whether such exposure has an effect on youth perceptions of smoking images (Table H-1). Sargent and colleagues (2003) provided evidence for a dose effect between access to movies and increased exposure to smoking in movies (Sargent et al. 2003). Access to cable movie channels and videotapes and number of movie outings per month were strongly associated with adolescents’ increased exposure to smoking in the movies (F = 63.4, adjusted R2 = .34). Exposure to smoking increased by 10 percent (150 occurrences) for each additional movie channel and video watched per week. Movie theater outings more than once a month were associated with a 20 percent (300 occurrences) increase in movie smoking exposure.

A qualitative study conducted by Watson and colleagues (2003) sheds light on the content of media attended to by adolescents. This study examined perceptions of smoking images in television, movies, newspapers, and magazines to gauge the extent to which adolescents notice smoking in the media and how they interpret social acceptability of smoking through visual cues. Their findings showed that 78 percent of their sample noticed and commented on the smoking images unprompted by the facilitator and 64 percent of responses were positive for social acceptability, especially the social benefits of smoking. Negative physical health responses were 46 percent, and positive ratings were 33 percent, but there was rarely sufficient information to rate the media item on physical health effects. Alarmingly, 65 percent of mood ratings were positive, especially issues of stress relief and emotional control, 39 percent of ratings were positive and 44 percent were negative for appearance effects. Most positive ratings were from depictions of physically attractive persons. Finally, 52 percent of the sample rated smoking as a good thing to do, whereas 48 percent rated it as a bad thing (Watson et al. 2003). Clearly adolescents are aware of the conflicting messages conveyed through the media; alarmingly, these results indicate that the social desirability effects are also functioning. Unfortunately, these results were not linked to behavior or intentions to smoke.

McCool and colleagues (2004) have conducted a number of studies examining adolescent perceptions and smoking depictions in film. McCool and colleagues (2004) also found support

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

that image concerns influence adolescent perceptions of smoking in films and that these perceptions differed by gender (McCool et al. 2004). Further, “sexy” and “stylish” were stereotypes significantly associated with smoking susceptibility (p < .01) for both female and male smokers in films. However, a serious limitation of this study was that the measure of stereotypes was linguistically trait-based with matching from a generalized question rather than based on specific actors or viewed images. Thus, although these results point to general adolescent perceptions of male and female smokers on film, they do not capture information about the specific actors that are viewed most favorably by adolescents themselves and thus might have a more profound impact on adolescents’ attitudes and perceptions of smoking.

In their 2001 and 2003 studies utilizing focus groups, McCool and colleagues (2001; 2003) examined how smoking depictions are related to adolescent smoking perceptions. McCool and colleagues (2001) showed that young adolescents from New Zealand perceived smoking depictions in movies as very prevalent and recognizable and they regarded these depictions as a reflection of reality. The adolescents had nonchalant attitudes toward inclusion of smoking depictions in movies, and these attitudes were linked to the perception that smoking prevalence is high among peers and adults (McCool et al. 2001). The authors suggest that smoking imagery in film may reinforce perceptions of smoking as a way to reduce stress and to develop self-image, and to serve as a marker of adult independence. In their study with older adolescents, McCool and colleagues (2003) showed that adolescents were receptive to smoking depictions when used in a credible way to portray an emotional state, subculture affiliation, and life-style. Experience as a smoker appeared to inflate credibility of depictions of smoking, particularly in gritty realism or drama. Stereotypical images were readily recalled and appeared to support misconceptions of smoking, and recall of images was associated with stress, anxiety, drug use, and seduction (McCool et al. 2003). The results suggest that pervasive and credible smoking scenes may offer support and reassurance to smokers or teens who are ambivalent about smoking.

Taken together, these studies demonstrate that youth are exposed to a vast amount of smoking in the movies and that such depictions are associated with more favorable attitudes toward smoking and smoking characters. These positive views are particularly prevalent among youth who themselves smoke.

Exposure to Smoking Depictions in Movies Increases Risk for Smoking Initiation

As the above section demonstrates, there is little doubt that youth are being exposed to smoking in the media—including through movies, television, magazines, and newspapers—and that such exposure influences smoking-related perceptions. The question then becomes whether such exposure creates a heightened risk for youth’s own smoking. A number of studies employing different methodology have addressed this concern (see Table H-2). These studies, reviewed next, suggest a relationship between exposure to smoking in the movies and smoking initiation. However, studies have not yet been conducted to determine whether such a relationship between viewing smoking in the movies and tobacco use continues after initial tobacco use.

Favorite Movie Stars’ Use of Tobacco in Movies

Several studies have examined whether and to what extent viewing movies in which popular or favorite movie stars smoke on-screen has an effect on youth smoking. After controlling for other variables associated with adolescent smoking (e.g., parent and friend smoking, receptivity to tobacco ads; see Table H-2). Distefan and colleagues (1999) showed that adolescent never-

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

smokers who shared favorite stars with adolescent ever-smokers were more likely to be susceptible to smoking than adolescent never smokers who did not share stars with adolescent ever-smokers (OR = 1.35, 95 percent confidence interval 1.12–1.62; p < .01) (Distefan et al. 1999).

Similarly, Tickle and colleagues (2001) provided some support that smoking by movie stars is associated with greater risk of smoking initiation among adolescents. For youth with smoking experience, after controlling for possible confounds, the odds of having a higher smoking status (ranging from nonsusceptible never-smoker to smoker, see Table H-2) increased with their favorite stars’ on-screen smoking. For adolescents whose star smoked in one film, the odds of being higher in smoking status were 0.78 (0.53–1.15, 95 percent confidence interval [CI]). For adolescents whose stars smoked in two films, odds increased to 1.53 (1.01–2.32, 95 percent CI), and whose stars smoked in three or more films, the odds of being higher in smoking status increased to 3.1 (1.34–7.12, 95 percent CI). The same pattern was found for never-smokers, that is susceptibility to smoking increased as their favorite stars’ smoking increased. Specifically, for adolescents whose star smoked in one film, the odds of being higher in smoking status were 2.16 (0.86–5.45, 95 percent CI). For those whose stars smoked in two films, 4.78 (95 percent CI, 1.60–14.23), and for those whose stars smoked in three or more films, the risk increased to 16.18 (95 percent CI, 2.33–112.61). However, no effects were found for adolescents in other stages of smoking initiation or for current smokers. Thus, the direction of influence between exposure to smoking in movies and adolescent smoking status was not determined (Tickle et al. 2001).

Unfortunately, since both the Distefan and colleagues (1999) and the Tickle and colleagues (2001) studies used a cross-sectional design, it is impossible to determine whether adolescents who were more susceptible to smoking paid more attention to smoking in films or whether they were truly influenced by smoking images (Distefan et al. 1999; Tickle et al. 2001). Using a longitudinal design, Distefan and colleagues (2004) shed further light on the relationship between exposure to favorite movie stars’ smoking on-screen and tobacco use among adolescents. They showed that adolescents with a favorite star who smoked on-screen were more likely to have smoked at follow-up 3 years later (odds ratio [OR] = 1.36; 95 percent CI 1.02–1.82). For adolescent females, the corresponding values were strong (OR = 1.86; 95 percent CI 1.26–2.73) when all other variables were controlled (including receptivity to tobacco advertising). For adolescent males, smoking initiation at follow-up was associated only with receptivity to tobacco advertising and promotions but not with having a favorite star smoke on-screen (Distefan et al. 2004).

Finally, using a controlled experimental design in which adolescents were exposed to a film clip depicting either smoking or nonsmoking by popular male and female actresses, adolescents were asked to rate character attractiveness and similarity to themselves (Hines and Saris 2000). Adolescents who viewed the smoking clips reported a greater likelihood of smoking (mean = 2.5, standard deviation [SD] = 1.6) than participants who viewed the nonsmoking clips (mean = 2.2, SD = 1.5; F(1,135) = 7.44, p = .007). This effect accounted for 5.2 percent of the variance. Adolescents’ current smoking status also had a significant relationship with adolescents’ report of their likelihood to smoke in the future (F(2,135) = 446.75, p < .001), with regular smokers (mean = 4.7, SD = 0.5) more likely to smoke than occasional smokers (mean = 3.3, SD = 1), who in turn were more likely to smoke than nonsmokers (mean = 1.3, SD = 0.4). This effect accounted for 86.7 percent of the variance. Thus, these results indicate that smoking status has a much stronger effect on likelihood of smoking than viewing smoking depictions in film clips.

Although these studies were modest in size and scope, they do provide evidence that adolescents are more susceptible to initiating tobacco use if they have observed their favorite movie

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

star smoke on-screen. However, given the limited experimental and longitudinal data available to date, caution must be exercised in interpreting these findings.

Exposure to Smoking Depictions in Movies and Television

A number of studies have questioned whether exposure to smoking in the movies more generally, not just by one’s favorite actor or actress, has an influence on youth smoking. The majority of the research on movie smoking exposure and adolescent smoking initiation has been conducted by Sargent and colleagues (2001) and has employed both cross-sectional and longitudinal designs. Using quartiles of smoking exposure in movies in a cross-sectional study, Sargent and colleagues (2001) showed that increased exposure to smoking in movies was associated with greater risk of trying smoking (Sargent et al. 2001). Further, this relationship was demonstrated among a nationally representative sample including adolescents from broad geographic regions of the United States and among different racial and ethnic groups (Sargent et al. 2005). Sargent and colleagues (2005) estimated that exposure to smoking in movies is an independent, primary risk factor for smoking initiation among 38 percent of the adolescents who tried smoking in the study sample (0.10 ever tried smoking prevalence in overall study sample of 6,522) (Sargent et al. 2005). It was also shown that higher exposure to smoking in movies and increased smoking susceptibility (OR = 1.60; 95 percent CI, 1.24–2.07), more normative views of adult smoking (OR = 1.37; 95 percent CI 1.09–1.71), and more positive expectations from smoking (OR = 1.38; 95 percent CI 1.13–1.70) were related to adolescent smoking initiation (Sargent et al. 2002).

These results also showed that exposure to 50 occurrences of smoking in movies (about five R-rated movies) has a moderate effect on smoking attitudes similar to other social influences, such as having family members or friends who smoke (Sargent et al. 2002). No association was found between more exposure to smoking in movies and peer norms of smoking when controlling for sociodemographics, social influences, and personality factors.

Using a longitudinal design, Dalton and colleagues (2003) provided support for a clear dose effect between movie exposure and initiation, with greater exposure to smoking in the movies associated with a greater likelihood of tobacco initiation, particularly in participants with nonsmoking parents. The dose effect size ranged from 2.0 to 2.7, even when controlling for a number of covariates including demographics; school achievement; parent, sibling, and friend smoking; receptivity to tobacco promotions; parental education; parenting styles; and perception of parental disapproval of smoking. However, only a small proportion of the sample (10 percent) initiated smoking, and a positive relationship was found between exposure and personal characteristics of adolescents such as sensation seeking, rebelliousness, or a negative association with school performance and parenting styles, suggesting that these results may reflect only a particular subset of adolescents (Dalton et al. 2003). An alternate view of these data is that a small subset of adolescents who already have many variables that contribute to a higher likelihood of smoking initiation, such as personality traits and parenting factors, could pay more attention to depictions of smoking than adolescents in general. Dalton and colleagues (2003) acknowledged that some aspects of R-rated movies other than smoking could conceivably contribute to smoking initiation and that further research is needed to determine other possible aspects.

Two studies examined whether there is a similar relationship between television and smoking behavior. Gutschoven and Van den Bulck (2004) examined the relationship between television viewing and the amount of cigarettes smoked by adolescent smokers per unit time of television. Smoking volume was correlated with self-assessed health, even when controlling for level of education and age (r = −0.11, p = .03), with heavier smokers feeling less healthy. Television

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

viewing was a significant predictor of smoking volume, with smokers who watch 5 or more hours a day reporting smoking between 60 and 147 more cigarettes per week than those who watch an hour or less a day. Television viewing explained an additional 3 percent of the variance (F(8,399) = 30.975, model R2 = .383, p < .0001) when gender, educational level, parental and peer smoking, and frequency of going out were accounted for in the model. Using longitudinal data from the National Longitudinal Survey of Youth, Gidwani and colleagues (2002) examined whether youth with greater exposure to television exhibited higher rates of smoking initiation. They found a dose–response relation between amount of TV viewing and smoking initiation when taking control variables into account; specifically, adolescents who watched more than 5 hours of TV per day were 5.99 times more likely to initiate smoking than adolescents who watched 0–2 hours a day (p = .02; 95 percent CI 1.39–25.71) (Gidwani et al. 2002). Similarly, adolescents who watched more than 4 to 5 hours per day were 5.24 times more likely to initiate smoking than adolescents who watched 0–2 hours per day (p = .03; 95 percent CI 1.19–23.10) (Gutschoven and Van den Bulck 2004).

These cross-sectional and longitudinal studies provide clear support that youth report greater susceptibility and intentions to smoke and are more likely to actually try smoking following exposure to smoking in the movies and on television. Further, even after controlling for other factors known to be associated with adolescent tobacco intention and use, studies show a clear dose effect, whereby greater exposure to smoking in the movies is associated with a greater chance of smoking. Studies have not yet been conducted to determine whether such a relationship between viewing smoking in the movies and tobacco use continues after initial tobacco use (Sargent 2005).

The Effects of Smoking in Movies Can Be Reduced by Antismoking Advertisements and Parental Restriction of R-Rated Movies

As shown in Table H-3, a small number of studies have investigated whether antismoking advertisements can ameliorate the influence that exposure to smoking in the movies has on youth tobacco use. Pechmann and Shih (1999) conducted the first experimental study addressing this question, with results yielding significant interactions between viewing or not viewing an anti-smoking advertisement on the level of positive arousal (F[1227] = 6.91, p < .01), perceptions of a smoker’s stature (F[1228] = 4.82, p < .05), smoker’s perception of their own stature (F[1228] = 4.88, p < .05), and participants’ intent to smoke (F[1203] = 4.88, p < .05). Further, when viewing an antismoking advertisement, more negative thoughts were generated about the lead characters when the character was a smoker as compared to not being a smoker (2.37 vs. 1.31, t = 2.70, p < .01). This effect was not found if an antismoking ad was not viewed (F[1188] = 6.98, p < .01). A limitation of this study is that the outcome measure was not related to actual smoking behavior of adolescents. Nevertheless, the study provides evidence that antismoking advertisements may help to combat the positive associations that smoking in movies may foster (Pechmann and Shih 1999).

Edwards and colleagues (2004) attempted to replicate and expand on Pechmann and Shih’s results by using the “real-world” environment of actual movie theaters to evaluate the effect of antismoking advertisement on women’s perceptions of smoking in movies and their intentions to smoke. Nonsmokers who saw the ad were more likely to perceive smoking as “not ok” (48.2 percent) compared to nonsmokers who did not view the ad (25.2 percent, X2=83.11, df = 3, p = .0001). This difference was maintained when age and movie exposure differences were adjusted (Wald X2 = 75.784, df = 1, p = .0001). However, no effect was found for smokers, even when

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

age and movie were accounted for, and no overall effect was found for the antismoking ad on intentions to smoke. When smokers and nonsmokers were analyzed separately, smokers were more likely to have lower intentions to smoke (31.9 percent versus 47.8 percent; X2 = 9.03, df = 2, p = .01), and when age and movie were accounted for the group of smokers who saw the ad continued to have lower intentions to smoke (Wald X2 = 4.59, df = 1, p = .03). No effect was found for nonsmokers (X2 = .97, df = 2, p = .62), even when age and movie were accounted for (Wald X2 = 1.25, df = 1, p = .263). These results may indicate that antismoking advertisements may have only a small effect upon intention to smoke and that other factors may play a role in adolescents’ intentions to smoke (Edwards et al. 2004).

Dixon and colleagues (2001) also found similar results in their quasi-experimental study investigating the effects of viewing a movie with anti-tobacco content. Theater patrons were surveyed before and after viewing the film The Insider, with results indicating that their perceptions of the business conduct of the tobacco industry were more negative than perceptions held by theater patrons who saw a control movie without anti-tobacco content. Further, viewing the anti-tobacco industry content also appeared to promote a short-term reduction in intentions to smoke (Dixon et al. 2001).

In a study examining the effect of parental restriction of R-rated movies on adolescent smoking initiation, Sargent and colleagues (2004) found that decreased parental restriction was associated with higher risk of smoking initiation. They also found a reverse effect, where increased parental restriction was associated with decreased risk, compared to adolescents reporting no change (Sargent et al. 2004). This pattern was even more pronounced for adolescents from nonsmoking families compared to adolescents from families that smoke. Similarly, Dalton and colleagues (2002a) found higher levels of trying smoking and drinking alcohol among adolescents with no parental restriction of R-rated movies compared to adolescents whose parents did not allow them to view any R-rated movies (Dalton et al. 2002a).

Although limited in scope and methodology, the results from this set of studies provide evidence that viewing antismoking advertising and parental restrictions limiting youth exposure to R-rated movies can ameliorate the effect that smoking in the movies has on youth.

SUMMARY AND RECOMMENDATIONS

Portrayals of smoking in the movies, especially images that put smoking in a positive or sexy vein, are likely to alter perceived norms about smoking, resulting in smoking being viewed as more normative, positive and socially acceptable. Indeed, the convergence of study results provides persuasive evidence of a relationship between exposure to smoking in the movies and adolescent perceptions of tobacco, as well as actual tobacco use, and that the effects are at least comparable to those of pro-tobacco advertisements. It is clear that youth’s exposure to smoking in movies, including but not limited to tobacco use among the more popular youth film stars, has an effect on youth initiation. Research provides evidence for a relationship between smoking exposure in movies and adolescent smoking behavior, but it also indicates avenues by which this risk of smoking initiation from exposure to smoking in movies can be reduced.

Given the serious public health concern, action to closely monitor and limit adolescent exposure to smoking in the movies is warranted. A number of recommendations can guide engaging the movie industry in a discussion and educating the many decision makers in the industry about the issue of smoking in the movies and adolescent tobacco use.

We recommend two strategies that the movie industry should consider to reduce smoking in the movies and combat the effect tobacco exposure has on youth.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Recommendation 1: First and foremost, we encourage the entertainment industries to create a set of self-regulatory strategies that closely limit and monitor youth exposure to smoking in the movies, television programming, and videos that combat the effect tobacco exposure has on youth’s smoking attitudes and behavior. These strategies should both guide and educate the movie industry about the evidence linking smoking in the movies and adolescent tobacco use (e.g., Dalton et al. 2003; Sargent et al. 2005), as well as spark a cogent discussion within the industry and between the industry and policy makers.

We recommend a number of strategies and a range of options that the entertainment industries, and in particular the Motion Picture Association of America (MPAA), should adopt to reduce smoking in the movies. The industries’ self-regulation should include but not be limited to the following possible options:

Recommendation 1a: The film rating board of the MPAA should consider the use of tobacco in the movies as a criterion in assigning mature film ratings (e.g., an R-rating indicating Restricted: no one under age 17 admitted without parent or guardian) to films that depict tobacco use.

A Ratings Board, which is appointed by the president of the MPAA, decides on ratings assigned to each movie. Currently, such ratings are based on the extent to which there is violence, language, nudity, sensuality, and drug abuse in the film. Tobacco use is not a criterion by which ratings are assigned. Assigning films with tobacco use a mature rating (R-rating) increases the likelihood that parents will restrict youth access to such films, a strategy that has been shown to reduce smoking initiation (Dalton et al. 2002a; Sargent et al. 2003; Sargent et al. 2004).

Recommendation 1b: The MPAA should encourage the use of antismoking advertisements before the film. As reviewed above, the effects of youth viewing smoking in the movies is reduced among youth who first viewed an antismoking advertisement (e.g., Edwards et al. 2004; Pechmann and Shih 1999).

Investigations of the effectiveness of antismoking advertisements with adolescents indicate strategies that are effective in reducing the influence of viewing smoking depictions in the media in general and can be applied to smoking depictions in the movies as well. Goldman and Glantz (1998) showed that messages that are aggressive, delegitimize the tobacco industry, deglamorize smoking, and portray the negative effects of secondhand smoke were the most effective messages for changing perceptions about the normality of smoking and reducing cigarette consumption (Goldman and Glantz 1998). A recent study of a specific antismoking advertising campaign (the Truth campaign) echoes the same results and found this counter-industry media campaign to be effective in increasing negative beliefs and attitudes about the tobacco industry and associated with lower receptivity to pro-tobacco advertising and less progression of smoking intention and behavior (Hershey et al. 2005).

Recommendation 1c: The MPAA should regulate smoking on all movie and television sets so as to minimize exposure to smoke among actors and crewmembers. Emphasis should also be given to banning smoking on all sets in which children, including child actors, are present.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Findings from the Environmental Protection Agency (EPA) and other studies showing the adverse health effects of secondhand smoke led the EPA to classify secondhand smoke as a human carcinogen (DHHS 2002a). The findings also led several states and municipalities to create laws restricting smoking in workplaces and other public places. Further, the Healthy People 2010 objectives included a goal to reduce the percentage of nonsmokers exposed to secondhand smoke by 45 percent (DHHS 2000; DHHS 2002b). Reducing one’s exposure to secondhand smoke should be applied to all individuals, but especially to infants, children, and youth for whom secondhand smoke has been shown to cause sudden infant death syndrome, low birth weight, chronic middle ear infections, and respiratory illnesses including asthma, bronchitis, and pneumonia (DHHS 1999). Many of these adverse health effects linked to secondhand smoke are expected to continue into adulthood, including increasing one’s chance of developing lung cancer (Janerich et al. 1990).

Given that movie sets are workplaces, they should fall under similar regulations that restrict exposure to secondhand smoke among employees in other work settings. Further, the evidence summarized in this report strongly suggest that the MPAA, film directors, and other film producers should create extensive strategies to ensure that youth have limited exposure to tobacco smoke while on the movie and television sets. Such strategies adopted by the MPAA should include restricting the use of tobacco on the set unless absolutely necessary, reducing the number of times a scene that includes smoking is filmed, and creating as many outdoor scenes as possible.

Recommendation 2: Congress should appropriate the necessary funds to enable the U.S. Department of Health and Human Services to conduct a periodic review of a representative sample of movies, television programs, and videos that are offered at times or in venues in which there is likely to be a significant youth audience (e.g., 15 percent) in order to ascertain the nature and frequency of images portraying tobacco use. The results of these reviews should be reported to Congress and to the public.

Despite our overall recommendation that strategies to reduce youth exposure to the portrayal of tobacco use in movies, television, and videos should be implemented on a voluntary basis by the relevant entertainment industry and related trade associations, some independent oversight of these standards and strategies is warranted. Such oversight of industry accountability should be facilitated through public monitoring and awareness of industry practices. Accordingly, we recommend that the U.S. Department of Health and Human Services be authorized and funded to monitor these media practices and report to Congress and the public.

Recommendation 3: Finally, we encourage additional research on the effects of smoking in the movies on adolescent tobacco use. The research on how and the extent to which exposure to smoking in the movies influences adolescent tobacco use is still nascent and thus should be replicated and expanded. Current studies are a key step in the right direction, but there are questions that still must be addressed. For example, Dalton and colleagues’ (2003) longitudinal study provided the most persuasive evidence that smoking depictions in movies influence adolescent smoking initiation (Dalton et al. 2003). However, the sample was predominately comprised of white, rural, nonsmoking youth and therefore should be replicated with a more diverse sample. Further, it is not clear how to measure cumulative effects of repeated exposure to smoking depictions from not only movies but also the combination of various media outlets. Sargent and colleagues’ (2005) study provided the most comprehensive study

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

of a large, diverse group of adolescents and includes an impressive list of control variables, but the study’s cross-sectional design still leaves unanswered questions (Sargent et al. 2005).

Measures of adolescent smoking in current research are also limited, with most studies focusing on smoking initiation (Dalton et al. 2003; Distefan et al. 2004; Sargent et al. 2004; Sargent et al. 2001; Sargent et al. 2002) or other factors such as intentions to smoke, susceptibility to smoking (Edwards et al. 2004; Hines and Saris 2000; McCool et al. 2004) or perceptions of smoking (Pechmann and Shih 1999; Watson et al. 2003). No information is available to date that indicates effects of smoking depictions in movies on long-term or addicted smoking. Another related issue is the lack of information about possible effects of exposure to smoking in movies depending upon different smoking status and experience of the adolescent. For example, results from Hines and Saris (2000) indicate that smoking status has a much stronger effect on likelihood of smoking than viewing smoking depictions in film clips. Additional prospective research is needed with nonsmokers to establish predictive relationships.

Another limitation of current research is determining whether adolescents with an interest in tobacco or with greater intentions to try cigarettes are more likely to attend to or notice smoking in movies. Adolescents who are more susceptible to smoking may pay more attention to smoking in films or admire stars who smoke more than less susceptible adolescents; the direction of this relationship is yet to be clearly answered. Although the Dalton and colleagues (2003) study provided evidence that movie exposure is predictive of initiation, the limitations of the study prevent definitive conclusions about causal relationships. Finally, finer-tuned measures of smoking exposure in movies are needed (Dalton et al. 2003). The specific factors of smoking depictions in movies that influence behavior must be identified, including possible genre-specific smoking depictions, smoking by actors with different character traits, and smoking in contexts with different situational and affective variables, and the way the gender and ethnicity of both actors and viewers influence interpretation of depictions, must be determined.

We thus recommend that further research be conducted in a number of areas. One question that remains to be answered by research is how the movies influence actual smoking behavior and whether viewing smoking depictions in the movies and other media has a lasting effect on continued smoking, since the crucial health issue of concern is adolescent smoking that results in health problems. Further, research on identifying the cumulative effect of advertising and other media depictions of smoking and movies is needed in order to gauge appropriate public health measures to address smoking in the movies. Finally, effects of exposure to smoking in the movies and other media must be considered within the entire context of variables that influences adolescent smoking, including parents, peers, and individual-level variables.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-1 Exposure to Smoking Depictions in Movies Influences Adolescent Perceptions of Smoking (Sargent et al. 2003)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Sargent et al., 2003

Describe adolescents’ exposure to smoking and examines how access to movies, parenting, and characteristics of the adolescent are associated with exposure to movie smoking

Cross sectional

School based survey

List of specific movies with smoking occurrences measured for each

Adolescents aged 9-15 years in grades 5-8 at 14 schools in New England, USA

Mainly white rural population

N=4919

Exposure to smoking in films: Ratio of total number of smoking occurrences viewed by total possible number of smoking occurrences in a subset of 50 movies (median=436; interquartile range=387-492)

Exposure to smoking in popular contemporary movies: the ratio of individual participant exposure multiplied by total possible occurrences on the entire sample of 601 movies shown in box offices from years 1988-99

Movie access: cable movie channels at home, videotapes viewed in a week, and movie theater outings in a month

Parenting factors: Restriction of R-rated movies, TV restriction, authoritative parenting measure

Characteristics of Adolescent: age, sex, school performance, sensation seeking, rebelliousness, and self esteem

Participants had seen 30% of the movie sample (interquartile range=20-44%) which contained 1160 (640-1970) occurrences of movie smoking

All movie access factors were strongly associated with exposure to adolescent exposure to movie smoking (F=63.4, adjusted R2= 0.34). Exposure increased by 10% (150 occurrences) for each additional movie channel and video watched per week. Movie theater outings more than once a month were associated witha 20% (300 occurrences) increase in movie smoking exposure.

Adolescents who reported no parental restriction of R-rated movies had seen about 50% (650) more smoking occurrences, and those with partial restriction saw 260 additional occurrences, than adolescents with full restriction of R-rated movies. An effect was not found for parenting style on exposure to movie smoking.

Lower exposure to movie smoking mediated the effect of little or no R-rated movie restriction on risk of trying smoking which dropped from OR 8.8 (5.6-13.9) to 5.4 (3.3-8.7), 95%CI when exposure was included in thelogistic regression model.

Adolescents with no TV restrictions saw 140 more occurrences of smoking than those with full TV restriction.

Participants who rated above the median for sensation seeking and rebelliousness had seen respectively 200 and 120 more occurrences of smoking in movies.

Finer tuned measures of smoking exposure in movies is needed, including measuring the effects of lifetime exposure, and of different depictions of smoking that include different character traits and contextual variables.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-1. Exposure to Smoking Depictions in Movies Influences Adolescent Perceptions of Smoking (Watson et al. 2003)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Watson et al., 2003

Examined perceptions of smoking images in TV, movies, newspapers, and magazines to gauge the extent that adolescents notice smoking in the media, and how adolescents interpret social acceptability of smoking through visual cues

Focus groups

Metropolitan high school based focus groups, 4 groups of each age: 13,14, 15, and 16

Participant pool divided into smoker and nonsmoker groups and then randomly Selected

Media clips shown to the groups, each was rated and then discussed

Preliminary focus groups used to develop semantic scales used in subsequent groups to rate the media items

High school students aged 13-16 years old from schools selected for a range of socioeconomic backgrounds

N=117

Media items: a media placement company provided movie and TV segments, magazine photos, newspaper articles, and cartoons for popularity among 13-16 year olds that all depicted smoking by people ranging in physical characteristics such as age, sex, appearance, and clothing

Questionnaires to guide group discussion: Semantic scales: Social acceptability (cool, normal, rewarding), physical health effects (addictive, unhealthy), mental health effects (relaxing, exiting, happy), cosmetic/body image effects (attractive, classy) Indicate overall if the clip represented smoking as a good or bad thing to do

78% of the sample noticed and commented on the smoking images unprompted by facilitator

64% of responses were positive for social acceptability, especially the social benefits of smoking

negative physical health responses were46%, and positive ratings were 33%, rarely sufficient information to rate the media item on physical health effects

65% of mood ratings were positive, especially issues of stress relief and emotional control

39% of ratings were positive and 44% were negative for appearance effects, most positive ratings were from depictions of physically attractive persons

52% of the sample rated smoking as a good thing to do, 48% rated it as a bad thing

Not linked to behavior or intentions to smoke

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-1. Exposure to Smoking Depictions in Movies Influences Adolescent Perceptions of Smoking (McCool et al . 2004)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

McCool et al., 2004

To assess the effects of age, sex, smoking susceptibility, and ethnicity on smoking stereotypes, and the influence of emotional and image of smoking stereotypes on smoking susceptibility in adolescents

Cross sectional

School-based survey

List of possible image and emotional traits of general female and male smokers presented and rated

2 samples of adolescents from schools in Auckland, New Zealand

N=3041

Young adolescents: Mean age 12 yrs, 52.7% male, 55.5% European, 12.9% Maori, 13.5% Pacific island, 17% Asian, 5.7% other

Older adolescents: mean age 18 yrs, 57.6% male, 53.9% European, 10.2% Maori, 19.5% Pacific Island, 19.3% Asian, 6% other

Smoking Susceptibility: How likely to try a cigarette in the next year, how likely to be a smoker in the future on five point likert scale, all non-smokers who responded “probably” or “definitely” for both questions were defined as susceptible smokers

Smoker Stereotypes: “In general, do you think female (male) smokers in films tend to be…” range of actor traits presented on dichotomous yes/no scale,

Stereotype data presented by category: Emotional sensitivity stereotype: depressed, bored, stressed,weak, angry and Image stereotype: stylish, tough smart, sexy, hard, healthy, intelligent

Age:

Female smokers in film: Younger adolescents were less likely than older adolescents to report female smokers as healthy and stressed but more likely to report female smokers in film to be angry

Male smokers in film:

Younger adolescents more likely than older adolescents to perceive male smokers as angry and depressed

Gender:

Female smokers in film: Males more likely than females to perceive female smokers as sexy, intelligent, and healthy. Females more likely than males to perceive female smokers as stressed, bored, angry and depressed

Male smokers in film: Females more likely than males to perceive male smokers as sexy, stressed, bored, angry, and depressed. Males more likely than females to perceive male smokers as stylish, intelligent, and healthy.

Ethnicity:

Female smokers in film: Pacific more likely than European group to perceive female smokers as sexy, stylish, and intelligent.

Male smokers in film: Pacific more likely to perceive male smokers as sexy, stylish, intelligent, bored, and depressed. Asian adolescents more likely to perceive male smokers as stylish and intelligent compared to other ethnic groups.

Smoking Susceptibility:

Sexy and stylish were significantly associated with smoking susceptibility (p’s<.01) for both female and male smokers in film.

Stereotypes measure based on linguistic trait matching from a generalized question rather than based on specific actors or viewed images

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-1. Exposure to Smoking Depictions in Movies Influences Adolescent Perceptions of Smoking (McCool et al. 2001)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

McCool et al., 2001

To explore how adolescents interpret smoking depictions in movies, whether they were aware of media tactics, and how smoking depictions relate to their surrounding culture

Qualitative focus groups conducted at school

Grounded theory analysis of same gendered focus group discussions

Adolescents from schools in Auckland, New Zealand

N=76

Young adolescents: Age 12 & 13 yrs, 50% male, 615% European, 14% Maori, 9% Pacific island, 11% Asian, 5% other

List of themes to discuss: centered around experiences and attitudes of media imagery, desired images, self-image, recall of smoking images, images of smokers, perceptions of smoking among peers and adults, weight and stress factors in smoking

Participants perceived smoking depictions in movies as very prevalent and recognizable and regarded smoking depictions as a reflection of reality

Nonchalant attitude towards inclusion of smoking depictions in movies and linked to the perception that smoking prevalence is high among peers and adults

Smoking imagery in film may reinforce perceptions of smoking as stress relief, development of self-image, and a marker of adult independence

Relatively young adolescents and no systematic measure of smoking status of participants

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-1. Exposure to Smoking Depictions in Movies Influences Adolescent Perceptions of Smoking (McCool et al. 2003)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

McCool et al., 2003

To explore how older adolescents respond to smoking imagery in film and meanings and relevance to their beliefs about smoking

Qualitative focus groups conducted at school

Grounded theory analysis of same gendered focus group discussions

Adolescents from schools in Auckland, New Zealand

N=88

Young adolescents: Average age 16 yrs, 46.6% male, 41% European, 29% Maori, 19% Pacific island, 8% Asian, 3% other

List of themes to discuss: centered around self-image, ideal images in popular culture, sub-culture affiliation and awareness, awareness and interpretation of smoking depiction in movies, symbolic significance of smoking images, media analysis skills, attitudes toward inclusion of smoking in media, media ‘immunity’ and perceived prevalence of smoking in reality

Participants were receptive to smaoking depictions when used in a credible way to portray an emotional state, subculture affiliation, and lifestyle

Experience as a smoker appeared to inflate credibility of depictions of smoking, particularly in gritty realism or drama

Stereotypical images were readily recalled and appeared to support misconceptions of smoking, recall of images were associated with stress, anxiety, drug use, and seduction

Smoking depictions in specific contexts hold specific meanings, realistic images were seen as salient representations of reality

Pervasive and credible smoking scenes may offer support and reassurance to smokers or teens who are ambivalent about smoking

Most responses were nonchalant about smoking depictions in film, indicating the pervasiveness of smoking

Older teens tended to draw upon their own experience with tobacco use when interpreting smoking depictions in film

Unclear how the views expressed are shared among a larger sample of adolescents and how these influence smoking behavior

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Distefan et al. 1999)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Distefan et al., 1999

Examine the relationship between adolescents’ favorite movie stars and smoking status while controlling for variables associated with smoking initiation

Cross-sectional

Telephone surveys in English and Spanish

Favorite actors elicited from participants and then ranked into the top ten mentioned, differences between non-smoker and smoker adolescents in their nominations examined

Adolescents aged 1217 years from a random digit-dialing telephone survey of households in California

N=6252 (71.2% of original sample of 8778)

51.% male, 54.8% Caucasian, 25.2% Hispanic, 9.3% Asian, 7% African American, 3.4% other

Smoking status of favorite star: Participants at baseline were asked to list their 2 favorite male and female movie stars. The top 10 stars listed by gender of participant determined and 50 films in the 3 years before the study (1994-96) were viewed to rate whether or not the star smoked onscreen in at least 2 of these films; smoking status of star in real life determined byprint media coverage

Smoking status of adolescent: Positive responses to both, “Have you ever smoked a cigarette?” and “Have you ever tried or experimented with cigarette smoking, even a few puffs?”

Control variables: Exposure to parental and friend smoking, perceived safety of experimenting with cigarettes, rebelliousness, and receptivity to tobacco advertising and promotions

5 of the 6 favorite stars of adolescent smokers smoked in real life, compared to 1 of the4 stars preferred by never smokers

After controlling for other variables associated with adolescent smoking, adolescent never smokers who shared favorite stars with adolescent ever smokers were more likely to be susceptible to smoking than those who did not share stars with adolescent ever smokers (OR=1.35, 95%CI 1.12, 1.62; p<.01)

No link to actual smoking behavior

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Tickle et al. 2001)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Tickle et al., 2001

Assess relation between adolescents’ favorite movie stars smoking on screen and adolescent smoking status

Cross sectional

School based survey

Open-ended question elicited adolescents’ favorite movie stars, list condensed to 43 film stars whose films between 1994-96 were evaluated for the star’s smoking

Adolescents aged 10-19 years in grades 6-12 at 5 schools in New England, USA

Mainly white rural population

N=632 who had selected one of the 43 film stars identified for analysis

Out of 1236 responses to open ended question to name favorite movie/film star, 228 stars named and analysis restricted to 43 stars who were named by at least 5 adolescents that had appeared in films within 3 precious years of study (1994-96)

Smoking status:

“Have you ever tried smoking cigarettes, even afew puffs?” and How many cigarettes have you smoked in your whole life?”

Never: answered “no” and “none” to both q

Experimental: smoked fewer than 100 cigarettes, and whether they had smoked in the last 30 days

Smokers: smoked 100 or more cigarettes

(Bogus pipeline procedure using saliva sample to increase validity of smoking reports)

Smoking status index: non-susceptible never smokers, susceptible never smokers, non-current experimenters, current experimenters, smokers

Star tobacco use index:

Number of movies in sampling frame in which star smoked more than 2 times

Control variables:

Family and friend smoking, receptivity to tobacco promotions, grade, sex, school performance

53% of adolescents selected stars who did not smoke on-screen

After controlling for possible confounds, the odds of having a higher smoking status increased with higher number of incidence of on screen star smoking, for adolescents whose star smoked in 1 film, the odds of being higher in smoking status was 0.78 (95%CI, 0.53-1.15), for stars who smoked in 2 films, 1.53 (95%CI, 1.01-2.32), for stars who smoked in 3 or more films, 3.1 (95%CI 1.34-7.12)

For never smokers, the same pattern was found in susceptibility to smoking, for adolescents whose star smoked in 1 film, the odds of being higher in smoking status was 2.16 (95%CI, 0.86-5.45), for stars who smoked in 2 films, 4.78 (95%CI, 1.60-14.23), for stars who smoked in 3 or more films, 16.18 (95%CI 2.33-112.61)

Cross sectional nature of study cannot determine whether adolescents who are more susceptible to smoking may pay more attention to smoking in films or admire stars who smoke more than less susceptible adolescents

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Distefan et al. 2004)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Distefan et al., 2004

Adolescents whose favorite movie stars smoke on-screen have a higher risk of smoking

Longitudinal

Baseline telephone surveys in 1996 with follow up telephone surveys in 1999

Male and female actors elicited from participants, their on-screen smoking rated and then compared to other variables related to adolescent smoking

Adolescents aged 12-15 years from a random digit-dialing telephone surveyof households in California

N=2084 (67% of original sample of 3104)

Never smokers from baseline sample used

Non-participants more likely tobe non-White, report average or below average school performance, and to have family members who were smokers

Smoking status of favorite star: Participants at baseline were asked to list their 2 favorite male and female movie stars. The top 10 stars listed by gender of participant determined and 50 films in the 3 years before the study (1994-96) were viewed to rate whether or not the star smoked on-screen in at least 2 of these films

Smoking status by followup survey: Positive responses to both, “Have you ever smoked a cigarette?” and “Have you ever tried or experimented with cigarette smoking, even a few puffs?”

Control variables: Receptivity to tobacco advertising and promotions: “Have you ever bought or received for free any product which promotes a tobacco brand or distributed by a company?” and “Do you think you would ever use a tobacco industry promotional item, suchas a t-shirt?” yes to either has high receptivity, low receptivity was unable to recall unaided a tobacco advertising brand or not having a favorite advertisement but able to name a brand most advertised, intermediate receptivity measured by having a favorite advertisement

Exposure to parental and friend smoking, parental disapproval of smoking, school performance

34.5% of participants had favorite stars that smoked on-screen and the participants with smoking stars were more likely to be female (39.2% vs. 29.9%) and aged 14-15 years (40.7% vs. 29.5% aged 12-13 years at baseline)

Adolescents with a favorite star who smoked on-screen were more likely to have smoked at follow up (OR=1.36; 95% CI=1.02-1.82)

For adolescent females, having a favorite star who smoked on-screen increased the risk of smoking at follow up (OR=1.86;95% CI=1.26-2.73) when all other variables were controlled.

When receptivity to tobacco advertising and gender was taken into account, an effect was found for adolescent females: 20% initiated smoking if at baseline they were minimally receptive and their favorite star did not smoke on-screen, compared to more than 50% of females who initiated smoking when at baseline they were highly receptive to advertising and had a favorite star who did smoke on-screen. For adolescent males, smoking initiation at follow up was only associated with receptivity to tobacco advertising and promotions but not to having a favorite star smoke on-screen

Only measures smoking initiation, no indication of continued or addicted smoking

Further research needed to determine possible genre specific smoking depictions and how gender influences interpretation of depictions

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Hines et al. 2000)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Hines et al., 2000

To determine the effect of exposure to smoking in the movies on attractiveness of the character, urge to smoke, and likelihood of smoking in certain situations by smoking status and gender.

Controlled Experiments

School based surveys and film showings during class

Film clips depicting both smoking and non smoking by popular male and female actresses

Ratings of character attractiveness and similarity elicited after each clip

College students at a Midwestern university in the United States as part of general psychology course requirement

N=151

64 females, 84 males aged 17-41 years (x=20.08), 87% Caucasian, 9% African American, 2% Asian American, 1% Hispanic

Exposure to smoking in the movies: Film actors who were attractive and popular to 160 General psychology students. Eight 3-minute film segments depicting 4 male and 4 female actors smoking (experimental condition) and not smoking (control condition). Distractor clips depicting different actors not smoking were also included.

Rating of character attractiveness: physically attractive, sexy, inshape, sophisticated, wise, adventurous, cool, sociable, popular, desirable for a date, feminine, and masculine (5-point Likert scale)

Rating of perceived similarity to character: how much the character is “like me”.

Smoking status: smoking history and current smoking status elicited and participants categorized as regular (smoking every day and at least 100 cigarettes in lifetime), some-day (some days of the week and at least 100 cigarettes in lifetime),or nonsmokers (participants who did not meet above criteria)

Desire to smoke: 7-point Likert scale

Smoking scenarios: 18 scenarios of 3 different levels of cigarette availability (cigarette must be purchased or requested, cigarette is offered or pack is available, cigarette is being pushed by friends) rated likelihood of smoking on a 5-point Likert scale.

n.s. main effects and interactions found for ratings of the male actor attractiveness by the experimental condition and participant smoking status

The effect of the experimental condition accounted for 9.3% of the variance in ratings of attractiveness, the interaction between the experimental condition and smoking status accounted for anadditional 4.5% of the variance

The experimental condition by gender by smoking status interaction for desire to smoke was significant F(2, 143)=3.46, p=.03 and accounted for 5% of the variance

The main effect of experimental condition on likelihood of smoking was significant (F(1,135)=7.44, p=.007), with those who viewed the smoking clips (x=2.5, SD=1.6) reporting a greater likelihood of smoking than participants who viewed the nonsmoking clips (x=2.2, SD=1.5). This effect accounted for 5.2% of the variance

The main effect of smoking status of participant on likelihood of smoking was also significant (F(2,135)=446.75, p<.001) with regular smokers (x=4.7, SD=.5) more likely to smoke than occasional smokers (x=3.3, SD=1) who were more likely to smoke than nonsmokers (x=1.3, SD=.4). This effect accounted for 86.7% of the variance

The results indicate that smoking status has a much stronger effect on likelihood of smoking than viewing smoking depictions in film clips. Further prospective research is needed with nonsmokers to establish predictive relationships

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Sargent et al. 2005)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Sargent, et al., 2005

Measure exposure to movie smoking in a nationally repreentative sample and determine whether exposure is associated with smoking initiation in adolescents

Cross-sectional

Telephone based survey

List of specific movies with smoking occurrences measured for each

Adolescents aged 10-14 years randomly selected across the USA

Broad geographic regions across USA and different ethnic and racial groups

N=6522

Exposure to smoking in movies: Total number of smoking occurrences viewed in a random subset of 50 movies selected from 500 movies from 1998-2002 and 32 movies during 2003; categorized into quartiles based on median number of smoking occurrences (46, interquartile range 19,88) for analysis.

Smoking Initiation:

Any lifetime cigarette smoking by answering yes to the question,” Have you ever tried smoking a cigarette, even just a puff?”

Controlled variables: age, sex, parent education, self-reported school performance, sensation seeking, rebelliousness, self esteem, parent, sibling, friend smoking, parenting style, weekly spendable income, access to cigarettes in the home, extracurricular activities, weekday TV watching, weekday videogame use, self regulation, parental oversight of smoking behavior, and parent report of household income.

Exposure to smoking in movies was an average of 61 occurrences (mean number of 13 (SE:0.11) movies seen by participants from the randomized list of 50).

Exposure was higher among Hispanic (65 occurrences; SE: 2.1) and black (74 occurrences; SE: 2.7) adolescents compared to white adolescents (57 occurrences; SE: 0.9; p<.001)

The proportion of adolescents who tried smoking increased with each quartile of exposure to smoking in movies: quartile 1=0.02, quartile 2= 0.06, quartile 3= 0.11& quartile 4= 0.22, consistent across racial/ethnic groups and no difference between region of the country

In addition, when controlling for all possible confounding variables, adolescents with higher exposure to smoking in movies had significantly higher odds of trying smoking when compared to quartile 1: quartile 2= OR 1.7 (1.1-2.7) CI 95%; quartile 3= OR 2.0 (1.2-3.1); and quartile 4= OR 2.7 (1.7-4.2).

Attributable risk, determined by setting movie smoking to quartile 1 for adolescents in higher quartiles and holding other risk factors constant, was 0.38 (0.20-0.56) CI 95%. Thus, exposure to smoking depictions in movies is an independent, primary risk factor for smoking initiation in 38% of adolescents in the sample who tried smoking.

Not longitudinal and therefore cannot assess temporal sequence or causation

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Sargent et al. 2001)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Sargent et al., 2001

Exposure to movie smoking associated with smoking initiation in adolescents

Cross- sectional

School based survey

List of specific movies with smoking instances measured for each

Adolescents aged 9-15 years in grades 5-8 at 14 schools in New England, USA

Mainly white rural population

N=4919

Exposure to smoking in movies: Total number of smoking occurrences viewed in a random subset of 50 movies selected from 601 movies from 1988-99, categorized into 4 groups for analysis 0-50 (26.4% of sample), 51-100 (28.7%), 101-150 (19.5%), and >150 (25.4%).

Smoking Initiation:

Any lifetime cigarette smoking

Controlled variables: age, sex, school, parent education, self-reported school performance, sensation seeking, rebelliousness, self esteem, receptivity to tobacco advertising, authoritative parenting, parental disapproval of smoking, and parent, sibling, friend smoking

Exposure to smoking in movies increased with age, lower school performance, and higher levels of sensation seeking and rebelliousness

More males than females had exposure to smoking in movies (mean=126 SD: 88 vs. mean= 95 SD: 72, p<.0001)

The proportion of adolescents who tried smoking increased with more exposure to smoking in movies as follows, 0-50 occurrences 4.9% (64) tried smoking, 51-100 occurrences 13.7% (194), 101-150 occurrences 22.1% (212), >150 31.3% (391), independent of age p<.0001

In addition, when controlling for possible confounding variables, adolescents with higher exposure to smoking in movies had significantly higher odds of trying smoking: 51-100 occurrences OR 1.9 (1.3-2.7) CI 95%, 101-150 occurrences OR 2.6 (1.8-3.7), >150 occurrences OR 2.5 (1.7-3.5)

Sample mainly white rural population of nonsmokers

Smoking occurrence is so prevalent in R-rated films, may not be able to determine independent effect of exposure to smoking from other R-rated movie content

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Sargent et al. 2002)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Sargent et al., 2002

Higher exposure to smoking in movies among never smokers will be associated with more favorable attitudes toward smoking initiation

Cross sectional

School based survey

List of specific movies with smoking occurrences measured for each

Adolescents aged 9-15 years in grades 5-8 at 14 schools in New England, USA

Mainly white rural population

N=3702

Only participants who reported no lifetime smoking experience were eligible

Non-participants were more likely to be in 5th and 6th grade, to have parents, siblings, and friends who smoke; and have lower school performance compared with participants. No differences in attitudes toward smoking were found, except more likely to view adult smoking as normative than participants

Exposure to smoking in movies: Total number of smoking occurrences viewed in a random subset of 50 movies selected from 601 movies from 1988-99, categorized into 4 groups for analysis: 0-50 (30% of sample), 51-100 (30%), 101-150 (19%), and >150 (21%).

Smoking susceptibility: intentions: “Do you think you will smoke a cigarette in the next 6 months?” and resistance to peer smoking: “Would you smoke a cigarette if your best friend offered you one?”

Normative peer smoking: “I think most kids in my school smoke”

Normative adult smoking: “I think most adults smoke”

Positive expectations of smoking: enjoyment, something to do when bored, deal with problems or stress, stay thin, feel more comfortable at parties, relaxing, look older dichotomized y/n and then summed into an index ranging from 0 to 7

Controlled variables: grade, school, self-reported school performance, sensation seeking, rebelliousness, self esteem, receptivity to tobacco advertising, parent education, authoritative parenting, and parent, sibling, friend smoking

Exposure to smoking in movies increased with higher grade in school, lower school performance, higher levels of sensation seeking and rebelliousness, and lower levels of self esteem.

More males than females had exposure to smoking in movies (mean=115, SD: 84 vs. mean= 87, SD: 68)

Positive attitudes increased with more exposure to smoking in movies: 14% of never smokers in lowest quartile of exposure were susceptible to smoking vs. 36% who were in the highest quartile (p<.001)

14% in the lowest category of exposure endorsed >2 positive expectations compared to 31% in the highest category of exposure (p<.0001)

Associations were found between higher exposure to smoking in movies and smoking susceptibility (OR 1.60, 95%CI 1.24-2.07), normative adult smoking (OR 1.37, 95CI 1.09-1.71), and positive expectations from smoking (OR 1.38, 95% CI 1.13-1.70)

Exposure to 50 occurrences of smoking in movies (about 5 R-rated movies) has a moderate effect on attitudes, similar to other social influences such as having family members or friends who smoke (OR 1.16 (.97-1.39) 95% CI) for 0-50 occurrences vs. (OR 1.31 (1.05-1.62) 95% CI) for 51-100 occurrences

No association was found between higher exposure to smoking in movies and peer norms of smoking when controlling for sociodemographics, social influences, and personality factors

Sample mainly white rural population of nonsmokers

Cannot determine if positive smoking attitudes are due to another unknown variable which in turn leads adolescents to seek out movies with smoking or other adult behaviors

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Dalton et al. 2003)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Dalton et al., 2003

Exposure to movie smoking predicts smoking initiation in adolescents

Longitudinal

Baseline school-based surveys and follow up phone interviews 13-26 months later

List of specific movies with smoking occurrences measured for each

Adolescents aged 10-14 years in grades 5-8 at 14 schools in New England, USA

N=2603

Only participants who reported no lifetime smoking experience on baseline were eligible for follow up interviews

Non-participants comparable to participants in age, sex, grade, and exposure to movie smoking but were more susceptible to smoking at baseline; were more likely to have parents, siblings, and friends who smoke; and were more likely to have lower school performance

Exposure to smoking in movies: Ratio of total number of smoking occurrences viewed by total possible number of smoking occurrences in a subset of 50 movies selected from 601 movies from 1988-99, classified into quartiles (0-531, 532-960, 961-1664, 1665-5308)

Child characteristics: sex, age, school, self-reported school performance, sensation seeking, rebelliousness, self esteem

Social influences on smoking initiation:

Parent, sibling, friend smoking, receptivity to tobacco advertising

Parenting characteristics: parent education, authoritative parenting, and adolescent perceptions of parental disapproval of smoking

Smoking Initiation:

Any lifetime cigarette smoking reported on follow up survey

Participants saw 32% (n=16) of the 50 movies on the survey for a total mean of 98.5 (SD=75.1) smoking occurrences

Females saw a mean of 14.6 (SD=7.4) movies with a mean of 85.1 (SD=66.4) occurrences vs. Males saw a mean of 17.1 (SD=8.2) movies and a mean of 113.5 (SD=81.2) smoking occurrences

Smoking in movie exposure was positively associated with sensation seeking and rebelliousness and negatively associated with school performance and measures of authoritative parenting

10% (259) of participants initiated smoking and of those 208 reported “just a few puffs” and 6 reported more than 100 cigarettes

After controlling for age, sex, and school adolescents with the highest exposure to smoking in the movies were 2.71 (95%, CI 1.73-4.25) times more likely to initiate smoking compared to adolescents with the lowest exposure

The effect of exposure to smoking in movies was stronger for adolescents whose parents did not smoke than for adolescents whose parents smoked

52.2% of smoking initiation was attributed to smoking in movies exposure

Sample mainly white rural population of nonsmokers

Did not control for age, as increase in age also increase in exposure to smoking, how to measure the cumulative exposure?

Unable to separate out effects of R-rating and smoking content of movies since many R-rated movies contain smoking thus another aspect of R-rated movies may influence smoking initiation

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Gutschoven and Van den Bulck 2004)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Gutschoven & Van den Bulck, 2004

Examining the relationship between television viewing and the amount of cigarettes smoked by adolescent smokers per time unit

Cross-sectional

School bases survey conducted in assembly setting

Adolescents average age 16.51 (SD=.81) in schools in Flanders, Belgium

N=421

Only participants who reported smoking at least one cigarette in the past year were used for analysis

Television viewing time: total television viewing in hours per week

Cigarette smoking: variable calculated into number of cigarettes smoked per week

Self-assessed health: How healthy you feel and how many days in the past year unable to attend school because of sickness

Control variables: sex, educational level (general, technical, and vocational), peer smoking, frequency of going out to taverns, pubs, bars, discos, parties, etc., parental smoking

Smokers watched an average of 3.04 hours a day of television

Males (3.14, SD=1.44) watched more TV than females (2.48, SD=1.35; t=2.648, df=415, p=.0008)

Smokers of the highest (general) educational level (2.32m SD=1.17) watched significantly less TV than smokers in the technical (3.09,SD=1.42) and vocational levels (3.32, SD=1.52; F (2416)=64.821, p=.0001)

Smoking volume was correlated with self-assessed health, even when controlling for level of education and age (r = −0.11, p=.03) with heavier smokers feeling less healthy and this was also found between volume and days off sick (r = .28, p<.0001).

Television viewing was a significant predictor of smoking volume, with smokers who watch 5 or more hours a day smoke between 60 and 147 more cigarettes per week than those who watch 1 hour or less a day. Television viewing explained an additional 3% of the variance (F(8399)= 30.975, Model R2 = .383, p<.0001) when gender, educational level, parental and peer smoking, and frequency of going out was accounted for in the model.

Definition of smokers for sample inclusion was unclear, not well defined

Unable to separate out direction of the relationship, smokers may watch more TV due to an unmeasured variable.

School performance was not measured

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Gidwani et al. 2002)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Gidwani et al., 2002

Determine whether youth with greater exposure to television exhibit higher rates of smoking initiation

Longitudinal

Annual interviews from the National Longitudinal Survey of Youth (NLSY) compared between 1990-1992

Adolescents from 10 to 15 years old mean age 11.5 years from the NLSY nationally representative sample of youth which was over sampled for African American, Hispanic American, and poor non-Hispanic white populations

N=592

Only participants who had completed reports of television viewing and no smoking before 1990

Television viewing time: average television viewing in hours per day categorized into 0-2, >2-3, >3-4, >4-5, and >5 hours per day

Initiation of smoking: self-reported smoking in the last 3 months

Control variables: ethnicity, household poverty, marital status, number of children in household, maternal education, intelligence, employment, gender, baseline aptitude scores

Smoking increased from 4.8% in 1990 to 12.3% in 1992

Average hours of television viewing was 4.8 hours in 1990, of the participants who initiated smoking in 1992, 42% viewed >5 hours of television per day

Dose-response relation was found between amount of TV viewing and smoking initiation when taking control variables into account: adolescents who watch >5 hours of TV per day were 5.99 times more likely to initiate smoking (P=.02; 95%CI:1.39-25.71) than adolescents who watched 0-2 hours a day.

Similarly, adolescents who watched >4-5 hours per day were 5.24 times more likely to initiate smoking than adolescents who watched 0-2 hours per day (P=.03; 95% CI: 1.19-23.10)

Content of TV viewing, peer smoking, and exposure to other media were not measured

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (McCool et al. 2005)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

McCool et al., 2005

To assess the media interpretation model of adolescents’ exposure to smoking in film, perceptions of smoking imagery in film, and smoking intentions

Cross-sectional

School based surveys during required class or after-school assembly

Two samples of adolescents median age 12 and median age16 years from schools in Auckland, New Zealand

N=3041

Ever smoker 12 yrs cohort: 28.8% and 16 yrs cohort: 66.4%

Film experiences: film exposure, perception of smoking depiction frequency, nonchalant attitudes toward smoking in movies, positive stereotypes of smokers in movies

Smoking beliefs and intentions: perceptions of smoking prevalence, attitudes towards smokers, intentions to smoke

Film exposure predicted higher levels of perceived smoking frequency and nonchalant attitudes about smoking imagery

24% of the variance of smoking intentions was accounted for by the media interpretation model

Perceptions of smoking were prevalent, non-judgmental attitudes toward smoking and positive smoker stereotypes independently accounted for variance within smoking intentions

Direction of influence of noticing smoking depictions and perceptions of smoking frequency is unclear

Smoking experience was not taken into account

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-2. Exposure To Smoking Depictions In Movies Increases Risk For Smoking Initiation (Goldberg 2003)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Goldberg, 2003

Examine the relationship between level of exposure to American movies and videos, exposure to American cigarette advertising and access to promotional products for cigarettes,and smoking behavior including exploratory puffing, cigarettes smoked in the last week, and intentions to smoke in the future

Cross-sectional

School based surveys during free class time

Adolescents aged between 14 and 16 years from schools in Hong Kong

N=3041

Ever smoker 12 yrs cohort: 28.8% and 16 yrs cohort: 66.4%

Film exposure: Number of American movies and videos seen over the past 2 months

Smoking behavior and intentions: ever puffed a cigarette, smoked in the last 7 days, expectations of smoking cigarettes one year from now

Brand of cigarette smoked and brand of cigarette advertising recalled

Number of cigarette promotional products owned

Adolescents had seen an average of 1.4 American movies and 1.2 American videos

Significant differences in smoking experience and intentions found between adolescents who saw 0-1 movies vs. 4 or more movies (34% vs. 47% and 21% vs. 30%, p<.01, Chi square values not reported)

Significant differences in smoking experience, current smoking, and intentions to smoke found between adolescents who reported seeing 0-5 cigarette advertising products vs. 9 or more products (28% vs. 50%; 13% vs. 27%; 16% vs. 34%, p,.001)

Significant differences in smoking experience, current smoking, and intentions to smoke found between adolescents who reported owing no vs. 2 or more cigarette promotional products (34% v.71%, 16% vs. 44%, 22% vs.58%; p<.001)

Depictions of smoking in movies not measured

Direction of influence not discernable

No other variables controlled for or measured

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-3. The Effects of Smoking in Movies Can Be Reduced by Anti-Smoking Advertisements and Parental Restriction of R-Rated Movies (Pechmann and Shih, 1999)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Pechmann and Shih, 1999

Experimental design to test rival theses about the effects of smoking in movies on adolescents and whether these effects can be nullified with antismoking advertising

Pechmann and Shih,

Controlled Experiments

School based surveys and film showings during class

Study 1: Clips of 2 films with smoking either present or professionally edited out

Study 2: Entire feature length film with smoking present or edited out

Ratings of arousal and smoking perceptions elicited after each scene in both studies

9th graders aged 14-15 years from southern California

Non smokers, half female

Study 1: N= 607; 75% Caucasian

Study 2: N= 232; 50% Caucasian, screened out if already seen stimulus movie

Study 1:

Smoking in Movies: 14 scenes from 2 feature films (16 minutes of total footage) that included high and low positive arousal scenes with a female and a male star who either originally smoke in the scene or the smoking is professionally edited out of the scene

Positive arousal: Each scene rated sad vs. happy and boring vs. exciting

Perceptions of Smokers: “How does a teenager who smokes cigarettes look to you?” (1-9 , 9= most favorable), rating teenage smokers on 4 factors: stature (intelligent, smart, rich, successful), vitality (healthy, well, fit, athletic, clean, good-smelling), popularity (well-liked, fun to be with, desirable to date, sexy, cute, good-looking), and poise (confident, comfortable around others, own person, free to make own decisions, contented, relaxed), and “If you were to smoke a cigarette, how do you think it would make you feel?”, rating on same 4 factors

Study 2:

Smoking in Movies: original version of feature film Reality Bites, 12 (30%) out of 40 scenes depicted smoking, a total of99 minutes of footage, and version of same film with smoking, cigarettes, ash trays,

Study 1: The smoking vs. nonsmoking scenes elicited more positive arousal (x=3.42 vs. 3.19; F(1596)=10.06, p<.01); more positive perceptions of how smokers are perceived by others in stature (3.58 vs. 3.13, F(1601)=7.49, p<.01) and vitality (3.16 vs. 2.76, F(1601)=4.86, p<.01); and more positive perceptions about how a smoker perceives their own stature (3.63 vs. 3.27, F(1601)=5.85, p<.01)

Study 2: In control ad condition, the smoking vs. nonsmoking scenes elicited more positive arousal (x=4.35 vs. 4.03, t=2.19, p<.05); more positive perceptions of how smokers are perceived by others in stature (3.91 vs. 3.13, t=2.33, p<.05); more positive perceptions of smoker self-perception of stature (3.80 vs. 2.96, t= 2.32, p<.05); and more intentions to smoke (1.91 vs. 1.59, t=1.88, p<.05). In the antismoking ad condition, the smoking scenes did not differ from the other scenes (p<.05)

Significant interactions were found between the ad conditions and smoking depictions with the level of positive arousal (F(1227)=6.91,p<.01); other’s perceptions of a smoker’s stature (F(1228)=4.82,p<.05); smoker’s perception of their own stature (F(1228)=4.88, p<.05); and participants’ intent to smoke (F(1203)=4.88, p<.05)

In the antismoking ad, more negative thoughts were generated when the lead characters were smokers vs. nonsmokers (2.37 vs.1.31, t=2.70,

Outcome measure was not actual smoking behavior

Reactions were measured after each scene which could have influenced results

Smoking depictions limited to one movie, further research is needed with more smoking depictions in movies

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-3. The Effects of Smoking in Movies Can Be Reduced by Anti-Smoking Advertisements and Parental Restriction of R-Rated Movies (Pechmann and Shih, 1999)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

1999

 

 

and secondhand smoke professionally edited out

Positive arousal and Perceptions of Smokers:

Same as above

Anti-Smoking Advertisement: 30-second television spot of negative caricatures of a smoker vs. control advertisement on AIDS with same length and format of caricatures

Intentions to Smoke: “Do you think that you will smoke at any time during the next year? and Would you smoke if your best friend dared you?” (1=definitely not, 4=definitely yes)

Ad-induced increases in negative smoker-related thoughts (positive, negative, or neutral)

Extensive manipulation and suspicion checks also included

p<.01), this was not found in the control ad condition. Significant interaction between the ad conditions and smoking depictions with the number of negative thoughts about the lead characters (F(1188)=6.98, p<.01)

 

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-3. The Effects of Smoking in Movies Can Be Reduced by Anti-Smoking Advertisements and Parental Restriction of R-Rated Movies (Edwards et al. 2004)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Edwards, et al., 2004

Evaluate the effect of anti-smoking advertisement on women’s perceptions of smoking in movies and their intentions to smoke

Quasi-experimental

Surveys administered after viewing movies in movie theater to patrons who looked between 12 and 17 years old

Five movies with various amounts of smoking viewed in ‘real-world’ movie theaters

Control condition: no ad was shown before the movie (week 1)

Experimental condition: Anti-smoking advertisement shown before the movie (week 2)

Female movie theater patrons aged 12-17 years in Sydney, Australia

N=2038

Mean age=13.9 years (SD=1.58) Age not evenly distributed for 16 and 17 year olds

9.2% reported smoking cigarettes in the previous 4 weeks

Movie exposure to smoking:

5 movies on “Screenit”, an internet film review site were identified for varying levels of smoking depiction

Perceptions of smoking in movies:

whether smoking was present in the movie seen and which characters smoked, answer to question: “was it perok the characters were smoking?” 5-point Likert scale responses

Smoking history and intentions:

“have you smoked cigarettes in the last 4 weeks?” and “do you think you will be smoking cigarettes this time next year?” 7-point Likert scale

Anti-smoking advertisement:

A national anti-tobacco campaigns’s ad was modified with an anti-smoking voice-over by a popular female teen star was shown before the movie

Nonsmokers who saw the ad were more likely to see smoking as “not ok” (48.2%) vs. nonsmokers who did not see the ad (25.2%, X2=83.11, df=3, p=.0001); this difference was maintained when age and movie exposure differences were adjusted for (Wald X2=75.784, df=1, p=.0001).

No effect was found for smokers (X2=2.52, df=2, p=.28), even when age and movie were accounted for (Wald X2=1.37, df=1, p=.242).

No overall effect was found for the intervention on intentions to smoke (X2=3.26, df=2, p=.196).

When smokers and nonsmokers were analyzed sepamovie rately, smokers were more likely to not intend to smoke (31.9% vs. 47.8%; X2=9.03, df=2, p=.01), and campaign’s when age and movie were accounted for the intervention group of smokers continued to have lower intentions to smoke (Wald X2=4.59, df=1, p=.03).

No effect was found for nonsmokers (X2=.97, df=2, p=.62), even when age and movie were accounted for (Wald X2=1.25, df=1, p=.263).

No baseline information about perceptions of smoking or intentions to smoke.

Sampling strategy open to researcher bias and may not be representative.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-3. The Effects of Smoking in Movies Can Be Reduced by Anti-Smoking Advertisements and Parental Restriction of R-Rated Movies (Dixon 2001)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Dixon, 2001

Assess public perceptions of the tobacco industry and tobacco use intentions after watching the movie The Insider

Quasi-experimental

Surveys administered before and 2 weeks after viewing movies in a movie theater for a free movie pass

Control movie: Erin Brockovich

Commercial theater patrons between ages 15-60+ years (majority between 20-39 years) in Melbourne,Australia

N=322, Insider viewers =182 Brokovich viewers=141

Only participants who had not seen either movie were included in the sample

Both sets of viewers had comparable smoking status (majority nonsmoker) and education.

Film conditions: both rated “M15+” which means viewers 15 year or under not admitted unless with a parent or adult guardian

The Insider was a tale of a whistle-blower of the tobacco industry cover up of the harmful health effects of their products. Erin Brokovich which had an analogous plot but without the tobacco industry content.

Perceptions of different professions: List of professions were presented and rating on “ethics and honest” and “power” elicited. Statements of agreement presented about business conduct of tobacco industry and other industries.

Intentions to smoke: “Do you think you will be smoking cigarettes this time next year?”

Perception of smoking prevalence: in real life and in movies compared to real life

Patrons who viewed The Insider held more negative views of the tobacco industry business conduct than those who saw the control movie, even when preexisting attitudes were controlled for (pre-film means = 1.68 vs. 1.78, post-film means = 1.63 vs. 1.90, F(1, 242)= 3.09, p=.0004)

Viewing The Insider was also associated with short term reductions in intentions to smoke (pre-film mean = 1.97 (SD: 1.57) vs. post-film mean = 1.76 (SD: 1.44) F(4,188)=114.97, p<.001).

No baseline information about perceptions of smoking or intentions to smoke.

Self-selection bias of viewing The Insider and nonequivalent control movie make the intentions finding difficult to interpret.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-3. The Effects of Smoking in Movies Can Be Reduced by Anti-Smoking Advertisements and Parental Restriction of R-Rated Movies (Sargent et al. 2004)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Sargent, et al., 2004

Examine the effect of parental R-rated movie restriction on adolescent smoking initiation

Longitudinal

School-based surveys at baseline and follow up phone interviews 13-26 months later

List of specific R-rated movies with smoking occurrences measured for each

Adolescents aged 10-14 years at 14 schools in New England, USA

N=2596

Only participants who reported no lifetime smoking experience on baseline were eligible for follow up interviews

Non-participants comparable to participants in age, sex, grade, and parental R-rated movie restriction but were more slightly more susceptible to smoking at baseline; were more likely to have parents, and friends who smoke; have parents who did not complete high school and were more likely to have lower school performance

Exposure to smoking in R-rated movies: Ratio of total number of smoking occurrences viewed by total possible number of smoking occurrences in a subset of 50 movies selected from 601 movies from 1988-99, adolescents classified into 3 categories of R-rated movie exposure: no exposure (n=594), low (n=1109, exposure to 1-499 occurrences of R-rated movie smoking), and high (n=893, exposure to 500-3376 occurrences)

Parental Restriction of R-rated movies: ”How often do your parents let you watch movies or videos that are rated R?” responses ranged from “never” to “all the time” and then coded into 3 categories: greater strictness (score moved to more restrictive category during follow up), greater leniency (score moved to a less restrictive category) , or no change

Confound variables: sex, age, school, self-reported school performance, sensation seeking, rebelliousness, self esteem; Parent, sibling, friend smoking, receptivity to tobacco advertising; parent education, authoritative parenting, and adolescent perceptions of parental disapproval of smoking

Smoking Initiation:

Any lifetime cigarette smoking reported on follow up survey

Exposure to R-rated movie smoking decreased significantly (p<.001) with increasing parental restriction, adolescents who were “never” allowed to view R-rated movies had low exposure to R-rated movie smoking (4.9%), compared to 20% for adolescents allowed to watch them “once in while”, and 54% for adolescent allowed to “sometimes/all the time”

After controlling for confound variables, risk of smoking initiation increased with decreased parental restriction from viewing R-rated movies RR 1.8(95% CI 1.1-3.1) for “once in a while” vs. RR 2.8 (95%CI 1.6-4.7) for “sometimes” or “all the time”

This pattern was even more pronounced for adolescents from non-smoking families (RR 4.3 (95% CI, 1.4-13) when “once in while” vs. “sometimes, all the time” RR 10 (95%CI 3.6-31) compared to adolescents from families that smoke (RR 12 (4.1-37) for “once in a while” vs. “sometimes, all the time” RR 13 (4.4-38)

Decreased parental restriction was associated with higher risk of smoking initiation and increased restriction with decreased risk, compared with adolescents reporting no change.

Only measures smoking initiation, no indication of continued or addicted smoking

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Table H-3. The Effects of Smoking in Movies Can Be Reduced by Anti-Smoking Advertisements and Parental Restriction of R-Rated Movies (Dalton et al. 2002)

Authors and Research Question

Methods

Sample

Measures

Findings

Limitations

Dalton et al., 2002

Examine the effect of parental R-rated movie restriction on adolescent smoking and alcohol use

Cross-sectional

School-based surveys

List of specific R-rated movies elicited whether student had seen or not

Primarily White (93%) adolescents average age 12 years at 30 schools in New England, USA

N=4544

Exposure to smoking in R-rated movies: List of a subset of 50 movies selected from 603 movies from 1988-99 rated on whether participant saw movie or not

Parental Restriction of R-rated movies: ”How often do your parents let you watch movies or videos that are rated R?” responses ranged from “never” to “all the time”

Confound variables: sex, school, grade, school performance, sensation seeking, rebelliousness, self esteem; parent education, parental disapproval of smoking, maternal supervision and responsiveness

Whether participant ever tried smoking or alcohol: “How many cigarettes have you smoked in your life?” any answer of “just a few puffs” or more coded as tried smoking. “Have you ever had beer, wine, or other drink with alcohol that your parents didn’t know about?” yes or no.

Trying smoking prevalence was 35% for no restriction of R-rated movies, 12% for partial restrictions, and 2% with complete restrictions.

Trying alcohol prevalence was 46% for no restrictions, 16% for partial restriction, and 4% with complete restriction.

When R-rated movies were completed restricted, adolescents were less likely to smoke (Relative Risk 0.29, 95% CI, 0.19-0.45) and drink alcohol (Relative Risk 0.30, CI, 0.21- 0.42) compared with no restrictions of R-rated movies, even after controlling for confound variables.

Not a clear measure of smoking depiction exposure

Only measures trying behavior, not continued use

Not clear that other variables associated with smoking and drinking behavior, e.g. peer behaviors, account for findings

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

REFERENCES

Akers RL , Lee G. 1996. A longitudinal test of social learning theory: adolescent smoking. Journal of Drug Issues 26(2):317-343.

Anthony JC, Warner LA, Kessler RC. 1994. Comparitive epidemiology of dependence on tobacco, alcohol, controlled subtrances, and inhalants: basic findings from the national comorbidity survey. Experimental and Clinical Psychology 2:244-268.

Arnett JJ. 1995. Adolescents' uses of the media for self-socialization. Journal of Youth and Adolescence 24(5):519-533.

Bandura A. 1986. Social Foundations for Thought and Action: A Social-Cognitive Model. Englewood Cliffs, NJ: Prentice Hall.

Biener L, Siegel M. 2000. Tobacco marketing and adolescent smoking: more support for a causal inference. American Journal of Public Health 90(3):407-411.

Biener L, Siegel M. 2001. The Role of Tobacco Advertising and Promotion in Smoking Initiation. Bethesda, MD.

Charlesworth A , Glantz SA. 2005. Smoking in the movies increases adolescent smoking: a review. Pediatrics 116(6):1516-1528.

Choi WS, Pierce JP, Gilpin EA, Farkas AJ, Berry CC. 1997. Which adolescent experimenters progress to established smoking in the United States. American Journal of Preventive Medicine 13(5):385-391.

Dalton MA, Ahrens MB, Sargent JD, Mott LA, Beach ML, Tickle JJ, Heatherton TF. 2002a. Relation between parental restrictions on movies and adolescent use of tobacco and alcohol. Effective Clinical Practice 5(1):1-10.

Dalton MA, Tickle JJ, Sargent JD, Beach ML, Ahrens MB, Heatherton TF. 2002b. The incidence and context of tobacco use in popular movies from 1988 to 1997. Preventive Medicine. 34(5):516-523.

Dalton MA, Sargent JD, Beach ML, Titus-Ernstoff L, Gibson JJ, Ahrens MB, Tickle JJ, Heatherton TF. 2003. Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet 362(9380):281-285.

DHHS (U.S. Department of Health and Human Services). 1999. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA:DHHS.

DHHS. 2000. Healthy People 2010 (2nd Ed). With Understanding and Improving Health and Objectives for Improving Health. Washington DC: U.S. Government Printing Office.

DHHS. 2002a. Report on Carcinogens (10 ed). Public Health Service, National Toxicology Program.

DHHS. 2002b. Healthy People 2010: Understanding and Improving Health. Washington, DC: U.S. Government Printing Office.

Distefan JM, Gilpin EA, Sargent JD, Pierce JP. 1999. Do movie stars encourage adolescents to start smoking? Evidence from California. Preventive Medicine 28(1):1-11.

Distefan JM, Pierce JP, Gilpin EA. 2004. Do favorite movie stars influence adolescent smoking initiation? American Journal of Public Health 94(7):1239-1244.

Dixon HG, Hill DJ, Borland R, Paxton SJ. 2001. Public reaction to the portrayal of the tobacco industry in the film The Insider. Tobacco Control 10(3):285-291.

Edwards CA, Harris WC, Cook DR, Bedford KF, Zuo Y. 2004. Out of the smokescreen: does an anti-smoking advertisement affect young women's perception of smoking in movies and their intention to smoke? Tobacco Control 13(3):277-282.

Emery S, Choi WS, Pierce JP. 1999. The social costs of tobacco advertising and promotions. Nicotine and Tobacco Research 1 (Suppl 2):S83-91.

Gidwani PP, Sobol A, DeJong W, Perrin JM, Gortmaker SL. 2002. Television viewing and initiation of smoking among youth. Pediatrics 110:505-508.

Glantz SA, Kacirk KW, McCulloch C. 2004. Back to the future: smoking in movies in 2002 compared with 1950 levels. American Journal of Public Health. 94(2):261-263.

Goldman LK , Glantz SA. 1998. Evaluation of antismoking advertising campaigns. Journal of the American Medical Association 279(10):772-777.

Goldstein AO, Sobel RA, Newman GR. 1999. Tobacco and alcohol use in G-rated children's animated films. Journal of the American Medical Association. 281 (12):1131-1136.

Gutschoven K , Van den Bulck J. 2004. Television viewing and smoking volume in adolescent smokers: a cross-sectional study. Preventive Medicine 39(6):1093-1098.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Hershey JC, Niederdeppe J, Evans WD, Nonnemaker J, Blahut S, Holden D, Messeri P, Haviland ML. 2005. The theory of “truth”: how counterindustry campaigns affect smoking behavior among teens. Health Psychology 24(1):22-31.

Hines D, Saris RN. 2000. Cigarette smoking in popular films: does it increase viewers’ likelihood to smoke? Journal of Applied Social Psychology 30(11):2246-2269.

Janerich DT, Thompson WD, Varela LR, Greenwald P, Chorost S, Tucci C, Zaman MB, Melamed MR, Kiely M, McKneally MF. 1990. Lung cancer and exposure to tobacco smoke in the household. New England Journal of Medicine 323(10):632-636.

Ling PM , Glantz SA. 2002. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. American Journal of Public Health 92(6):908-916.

Lynch BS, Bonnie RJ. 1994. Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths. Washington DC: The National Academies Press.

McCool JP, Cameron L, Petrie K. 2004. Stereotyping the smoker: adolescents’ appraisals of smokers in film. Tobacco Control 13(3):308-314.

McCool JP, Cameron LD, Petrie KJ. 2001. Adolescent perceptions of smoking imagery in film. Social Science and Medicine 52(10):1577-1587.

McCool JP, Cameron LD, Petrie KJ. 2003. Interpretations of smoking in film by older teenagers. Social Science and Medicine. 56(5):1023-1032.

Pechmann C , Shih CF. 1999. Smoking scenes in movies and antismoking advertisements before movies: effects on youth. Journal of Marketing 63:1-13.

Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Berry CC. 1998. Tobacco industry promotion of cigarettes and adolescent smoking. Journal of the American Medical Association 279(7):511-515.

Pierce JP, Distefan JM, Jackson C, White MM, Gilpin EA. 2002. Does tobacco marketing undermine the influence of recommended parenting in discouraging adolescents from smoking? American Journal of Preventive Medicine 23(2):73-81.

Pierce JP, Gilpin EA, Choi WS. 1999. Sharing the blame: smoking experimentation and future smoking-attributable mortality due to Joe Camel and Marlboro advertising and promotions. Tobacco Control 8(1):37-44.

Sargent JD. 2005. Smoking in movies: impact on adolescent smoking. Adolescent Medicine Clinics 16(2):345-370.

Sargent JD, Beach ML, Adachi-Mejia AM, Gibson JJ, Titus-Ernstoff LT, Carusi CP, Swain SD, Heatherton TF, Dalton MA. 2005. Exposure to movie smoking: its relation to smoking initiation among US adolescents. Pediatrics 116(5):1183-1191.

Sargent JD, Beach ML, Dalton MA, Ernstoff LT, Gibson JJ, Tickle JJ, Heatherton TF. 2004. Effect of parental R-rated movie restriction on adolescent smoking initiation: a prospective study. Pediatrics 114(1):149-156.

Sargent JD, Beach ML, Dalton MA, Mott LA, Tickle JJ, Ahrens MB, Heatherton TF. 2001. Effect of seeing tobacco use in films on trying smoking among adolescents: cross sectional study. British Medical Journal 323(7326):1394-1397.

Sargent JD, Dalton M, Beach M, Bernhardt A, Heatherton T, Stevens M. 2000. Effect of cigarette promotions on smoking uptake among adolescents. Preventive Medicine 30(4):320-327.

Sargent JD, Dalton MA, Beach ML, Mott LA, Tickle JJ, Ahrens MB, Heatherton TF. 2002. Viewing tobacco use in movies: does it shape attitudes that mediate adolescent smoking? American Journal of Preventive Medicine. 22(3):137-145.

Sargent JD, Dalton MA, Heatherton T, Beach M. 2003. Modifying exposure to smoking depicted in movies: a novel approach to preventing adolescent smoking. Archives of Pediatric and Adolescent Medicine 157(7):643-648.

Steinberg L, Cauffman E. 1996. Maturity of judgment in adolescence: psychosocial factors in adolescent decision making. Law and Human Behavior 20:249-272.

Straub DM, Hills NK, Thompson PJ, Moscicki AB. 2003. Effects of pro- and anti-tobacco advertising on nonsmoking adolescents' intentions to smoke. Journal of Adolescent Health 32(1):36-43.

Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton TF. 2001. Favourite movie stars, their tobacco use in contemporary movies, and its association with adolescent smoking. Tobacco Control 10(1):16-22.

Wakefield M, Flay B, Nichter M, Giovino G. 2003. Role of the media in influencing trajectories of youth smoking. Addiction 98 (Suppl 1):79-103.

Watson NA, Clarkson JP, Donovan RJ, Giles-Corti B. 2003. Filthy or fashionable? Young people's perceptions of smoking in the media. Health Education Research 18(5):554-567.

Worth K, Tanski S, Sargent J. 2006. Trends in Top Box Office Movie Tobacco Use, 1996-2004. First Look Report. Washington, DC: American Legacy Foundation.

Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 516
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 517
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 518
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 519
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 520
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 521
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 522
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 523
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 524
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 525
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 526
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 527
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 528
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 529
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 530
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 531
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 532
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 533
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 534
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 535
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 536
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 537
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 538
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 539
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 540
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 541
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 542
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 543
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 544
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 545
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 546
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 547
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 548
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 549
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 550
Suggested Citation:"Appendix H:Smoking in the Movies: Its Impact on Youth and Youth Smoking." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 551
Next: Appendix I: State Statutes Governing Direct Shipment of Alcoholic Beverages to Consumers: Precedents for Regulating Tobacco Retail Shipments »
Ending the Tobacco Problem: A Blueprint for the Nation Get This Book
×
Buy Hardback | $68.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The nation has made tremendous progress in reducing tobacco use during the past 40 years. Despite extensive knowledge about successful interventions, however, approximately one-quarter of American adults still smoke. Tobacco-related illnesses and death place a huge burden on our society.

Ending the Tobacco Problem generates a blueprint for the nation in the struggle to reduce tobacco use. The report reviews effective prevention and treatment interventions and considers a set of new tobacco control policies for adoption by federal and state governments. Carefully constructed with two distinct parts, the book first provides background information on the history and nature of tobacco use, developing the context for the policy blueprint proposed in the second half of the report. The report documents the extraordinary growth of tobacco use during the first half of the 20th century as well as its subsequent reversal in the mid-1960s (in the wake of findings from the Surgeon General). It also reviews the addictive properties of nicotine, delving into the factors that make it so difficult for people to quit and examines recent trends in tobacco use. In addition, an overview of the development of governmental and nongovernmental tobacco control efforts is provided.

After reviewing the ethical grounding of tobacco control, the second half of the book sets forth to present a blueprint for ending the tobacco problem. The book offers broad-reaching recommendations targeting federal, state, local, nonprofit and for-profit entities. This book also identifies the benefits to society when fully implementing effective tobacco control interventions and policies.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!