Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1183-1191 (doi:10.1542/10.1542/peds.2005-0714)
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Exposure to Movie Smoking: Its Relation to Smoking Initiation Among US Adolescents

James D. Sargent, MD*,{ddagger},§, Michael L. Beach, MD, PhD{ddagger},§,||, Anna M. Adachi-Mejia, PhD*,§, Jennifer J. Gibson, MS{ddagger},§, Linda T. Titus-Ernstoff, PhD{ddagger},§, Charles P. Carusi, PhD, Susan D. Swain, MA, Todd F. Heatherton, PhD# and Madeline A. Dalton, PhD*,§

* Departments of Pediatrics
{ddagger} Community and Family Medicine
|| Anesthesia
§ Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire
# Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
Westat, Rockville, Maryland

Objective. Regional studies have linked exposure to movie smoking with adolescent smoking. We examined this association in a representative US sample.

Design/Methods. We conducted a random-digit-dial survey of 6522 US adolescents aged 10 to 14 years. Using previously validated methods, we estimated exposure to movie smoking, in 532 recent box-office hits, and examined its relation with adolescents having ever tried smoking a cigarette.

Results. The distributions of demographics and census region in the unweighted sample were almost identical to 2000 US Census estimates, confirming representativeness. Overall, 10% of the population had tried smoking. Quartile (Q) of movie smoking exposure was significantly associated with the prevalence of smoking initiation: 0.02 of adolescents in Q1 had tried smoking; 0.06 in Q2; 0.11 in Q3; and 0.22 in Q4. This association did not differ significantly by race/ethnicity or census region. After controlling for sociodemographics, friend/sibling/parent smoking, school performance, personality characteristics, and parenting style, the adjusted odds ratio for having tried smoking were 1.7 (95% confidence interval [CI]: 1.1, 2.7) for Q2, 1.8 (95% CI: 1.2, 2.9) for Q3, and 2.6 (95% CI: 1.7, 4.1) for Q4 compared with adolescents in Q1. The covariate-adjusted attributable fraction was 0.38 (95% CI: 0.20, 0.56), suggesting that exposure to movie smoking is the primary independent risk factor for smoking initiation in US adolescents in this age group.

Conclusions. Smoking in movies is a risk factor for smoking initiation among US adolescents. Limiting exposure of young adolescents to movie smoking could have important public health implications.


Key Words: adolescent smoking • media impact

Abbreviations: RDD, random-digit-dial • OR, odds ratio • CI, confidence interval


Accepted May 3, 2005.


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eLetters:

Read all eLetters

Alternative explanation for the association between movie-smoking exposure and smoking initiation
Joel M. Moskowitz, Ph.D.
Pediatrics Online, 18 Nov 2005 [Full text]
Response to Dr Moskowitz
James D. Sargent, et al.
Pediatrics Online, 6 Apr 2006 [Full text]