Cigarettes in Movies Turns Teens into Active Smokers

LEBANON, N.H., Sept. 4 -- Teens who see more smoking in movies may be more likely to get hooked themselves.

So found researchers who surveyed 6,522 children and adolescents ages 10 to 14 about their smoking and movie-watching habits in 2003, reported James D. Sargent, M.D., of Dartmouth, and colleagues, in the September issue of Archives of Pediatrics & Adolescent Medicine.

They selected the top U.S. box-office hits per year for 1998 to 2002 as well as 34 movies that grossed at least million at the box office in the first four months of 2003. A computer then randomly selected 50 movies for inclusion in the telephone interviews.

At the beginning of the study, 5,637 (90%) of the teens had never smoked, while 33 (0.5%) had smoked more than 100 cigarettes. By the two-year follow-up, 125 teens had become established smokers. Those who were below the midpoint of movie smoking exposure were less likely than teens who were above the midpoint to have smoked more than 100 cigarettes, the study showed.

Of the 125 participants who had become established smokers, 85% were current (30-day) smokers and 51% smoked daily. In addition, 83% of these teens showed at least one sign of addiction to smoking and 53% had all four of the addiction symptoms that were included in the interview.

"This is the first study to link viewing smoking in movies with established adolescent smoking," concluded Dr. Sargent and colleagues. "The present findings heighten concern about the public health implications of movie-smoking exposure by linking it with an outcome that predicts smoking-related morbidity and mortality in the future." Established smoking was defined as having smoked more than 100 cigarettes over a lifetime.

Exactly why teens who are exposed to more smoking in the movies are at higher risk for becoming established smokers is unclear, but the researchers suggested that it may be because of "more positive expectancies about effects of smoking, more favorable perceptions of smokers and a greater tendency to affiliate with teens who smoke."

Smoking occurrence in a movie was defined as whenever a major or minor character handled or used tobacco in a scene or when it was used by an extra in the background. A smoking occurrence was unrelated to how long the scene was or how many times the tobacco product was shown during said scene.

Overall, there was smoking in 74% of the 532 movies. These movies contained a total of 3,795 smoking occurrences. The researchers designed a measure of smoking exposure by adding the number of smoking occurrences in the portion of those 50 movies that the participant had seen, dividing by the number of occurrences in the 50 movies, and multiplying that by the number of smoking episodes in all 532 movies. They also conducted follow-up interviews to reassess smoking status after eight months, 16 months and 24 months.

Established smoking incidence was 7.4 per 1,000 person years of observation for the baseline to eight-month period and 15.8 per 1,000 person years of observation from eight months to 16 months. From 16 months to 24 months, the established smoking incidence was 19.7 per 1,000 person years of observation.

The risk of becoming an established smoker was predicted by baseline exposure to smoking in the movies. The hazard ratio was 2.04 (95% CI, 1.01-4.12).

In the study, those adolescents who were not thrill-seekers were among the most likely to become established smokers on the basis of their exposure to smoking in movies. Those teens who were high on the sensation seeking scale were less likely to get hooked by movie exposure to smoking, the study found.

"It is possible that low sensation seekers have relatively little exposure to risky behavior, hence are more influenced by viewings smoking models in movie situations," the researchers write. The new study does have some limitations namely that the findings are based on self-reports, not biochemical markers of nicotine exposure.