When Movies Matter: Exposure to Smoking in Movies and Changes in Smoking Behavior

Abstract

The authors investigated the association between exposure to smoking in movies and the initiation and progression of adolescent smoking over time among 6,522 U.S. adolescents (between the ages of 10 and 14 years, at baseline) in a nationally representative, 4-wave random-digit-dial telephone survey. They conducted a hazard (survival) analysis testing whether exposure to movie smoking and demographic, personality, social, and structural factors predict (a) earlier smoking onset and (b) faster transition to experimental (1–99 cigarettes/lifetime) and established smoking (>100 cigarettes/lifetime). Results suggest that higher exposure to movie smoking is associated with less time to trying cigarettes for the first time (adjusted hazard ratio = 1.66; 95% CI [1.37, 2.01]) but not with faster escalation of smoking behavior following initiation (adjusted hazard ratio = 1.53; 95% CI [0.84, 2.79]). In contrast, age, peer smoking, parenting style, and availability of cigarettes in the home were predictors of earlier onset and faster transition to established smoking. Thus, the authors concluded that the effect of exposure to mass-mediated images of smoking in movies may decline once adolescents have started to smoke, whereas peers and access to tobacco remain influential.

Acknowledgments

The research reported has been funded by the U.S. National Institutes of Health: National Cancer Institute (CA77026) and National Institute on Alcohol Abuse and Alcoholism (AA015591). The survey project has also received support from the American Legacy Foundation, a U.S. nonprofit, independent, public health foundation. The authors thank Nicholas Valentino and L. Rowell Huesmann for their helpful comments on a previous version of this manuscript. None of the authors has connections with the tobacco industry. There are no contractual constraints on publishing the research being reported.

Notes

Note. Total N of imputed data is 6,522 at all waves.

¹Previously published sensitivity analyses using these (Sargent, et al., 2007) and similar (Dalton, et al., 2003) data reveal that despite the use of single item measures and scales with moderate reliability coefficients, there is little evidence that effects of movie smoking exposure can be attributed to unmeasured confounding variables.

Note. IQR = interquartile range.

Note. A hazard rate of 1.0 indicates “no effect”; thus, confidence intervals not including 1.0 indicate significant effects.