Exposure to smoking depictions in movies: its association with established adolescent smoking.

OBJECTIVE

To assess the association between exposure to movie smoking and established adolescent smoking.

DESIGN

Longitudinal survey of a representative US adolescent sample.

SETTING

Adolescents were surveyed by telephone in their homes.

PARTICIPANTS

Sixty-five hundred twenty-two US adolescents aged 10 to 14 years at baseline, resurveyed at 8 months (8M) (n = 5503), 16 months (16M) (n = 5019), and 24 months (24M) (n = 4575). Main Exposure Exposure to smoking in 532 box-office hits released in the 5 years prior to the baseline survey. Outcome Measure Established smoking (having smoked more than 100 cigarettes during lifetime).

RESULTS

Of 108 incident established smokers with data at the 24M survey, 85% were current (30-day smokers) and 83% endorsed at least 1 addiction symptom. Established smoking incidence was 7.4, 15.8, and 19.7 per 1000 person-years of observation for the baseline-to-8M, 8M-to-16M, and 16M-to-24M observation periods, respectively. In a multivariate survival model, risk of established smoking was predicted by baseline exposure to smoking in movies with an adjusted overall hazard ratio of 2.04 (95% confidence interval, 1.01-4.12) for teens in the 95th percentile of movie-smoking exposure compared with the 5th percentile. This effect was independent of age; parent, sibling, or friend smoking; and sensation seeking. Teens low on sensation seeking were more responsive to the movie-smoking effect (hazard ratio, 12.7; 95% confidence interval, 2.0-80.6) compared with teens who were high on sensation seeking (hazard ratio, 1.01; 95% confidence interval, 0.4-2.6).

CONCLUSION

In this national US adolescent sample, exposure to smoking in movies predicted risk of becoming an established smoker, an outcome linked with adult dependent smoking and its associated morbidity and mortality.