Titus-Ernstoff Linda, Dalton Madeline A, Adachi-Mejia Anna M, Longacre Meghan R, Beach Michael L
Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USA.
Pediatrics. 2008 Jan;121(1):15-21. doi: 10.1542/peds.2007-0051.
Previous studies showed an association between viewing of smoking in movies and initiation of smoking among adolescents. However, all studies except one were cross-sectional, and none updated movie smoking exposure prospectively or assessed its influence on children.
We enrolled elementary school students, 9 to 12 years of age, in a longitudinal study to assess the influence of movie smoking exposure on smoking initiation among children. Movie smoking content was coded for the most popular movie releases; exposure was assessed by asking children which movies they had seen, on the basis of unique lists of 50 movies sampled randomly from top box office hits and video rentals. Data collection occurred in 3 waves (the baseline survey and 2 follow-up surveys), approximately 1 year apart. Movie lists were updated for each data collection wave, to reflect recent releases. Movie smoking exposure was analyzed in relation to smoking initiation by the end of the study period.
Approximately 80% of the children's smoking exposure occurred through movies rated G, PG, or PG-13. Children's movie smoking exposure predicted smoking initiation significantly, after adjustment for multiple covariates including child and parent characteristics. The relative risks were 1.09, 1.09, and 1.07 for a 1-decile increase of movie smoking exposure measured at the baseline, second, and third data collection waves, respectively. The adjusted attributable risk of smoking initiation attributable to movie smoking exposure was 0.35.
Our study, which is the first to enroll children in elementary school and to update movie smoking exposure longitudinally, indicates that early exposure has as much influence on smoking risk as does exposure nearer the outcome. Overall, movie smoking may be responsible for at least one third of smoking initiation for children in this age group.
先前的研究表明，青少年观看电影中的吸烟镜头与开始吸烟之间存在关联。然而，除一项研究外，所有研究均为横断面研究，没有一项对电影吸烟暴露情况进行前瞻性更新，也没有评估其对儿童的影响。
我们招募了9至12岁的小学生参与一项纵向研究，以评估电影吸烟暴露对儿童开始吸烟的影响。对最受欢迎的电影发行版本中的吸烟内容进行编码；通过询问儿童看过哪些电影来评估暴露情况，这些电影是从票房热门影片和视频租赁中随机抽取的50部电影的独特列表中选取的。数据收集分3个阶段进行（基线调查和2次随访调查），相隔约1年。每次数据收集阶段都会更新电影列表，以反映最新发行的影片。在研究期结束时，分析电影吸烟暴露与开始吸烟之间的关系。
大约80%的儿童吸烟暴露是通过G级、PG级或PG - 13级电影发生的。在对包括儿童和家长特征在内的多个协变量进行调整后，儿童的电影吸烟暴露显著预测了开始吸烟的情况。在基线、第二次和第三次数据收集阶段，电影吸烟暴露每增加1个十分位数，相对风险分别为1.09、1.09和1.07。电影吸烟暴露导致开始吸烟的调整后归因风险为0.35。
我们的研究首次招募小学生并纵向更新电影吸烟暴露情况，表明早期暴露对吸烟风险的影响与接近结果时的暴露影响一样大。总体而言，电影吸烟可能至少导致该年龄组儿童三分之一的吸烟行为。
