# Presentation: 524083

## Media Influences on Adolescent Smoking Behavior

**James Sargent, M.D.**
**Director of Cancer Prevention Research**
**Norris Cotton Cancer Center**
**Dartmouth Medical School**
*Supported by National Institutes of Health (CA077026, AA015591)*

## Mass Communication

**Mass Communication**

*Source*

*Receiver*

*Medium*

*Simple one-way communication*

## Media Influences on Adolescent Smoking Behavior

_**AIMS**_
**• ****Describe smoking in popular contemporary movies**
**• ****Assess exposure to movie smoking among adolescents**
**• ****Determine if movie smoking exposure is linked with adolescent smoking**

*Supported since 1997 by National Institutes of Health (CA-77026)*

- Johnny Depp: “Blow”

**Notes:**
A lot of research has investigated predictors and risk factors for smoking, but only recently have we begun to look at movies.  Why?  

## Content Analysis

**Notes:**
A lot of research has investigated predictors and risk factors for smoking, but only recently have we begun to look at movies.  Why?  

## Smoking Episodes in 532 Box Office Hits

**0**

**4**

**16**

**36**

**64**

**G**

**PG**

**PG-13**

**R**

**28 (25%)**

**71 (44%)**

**220 (76%)**

**215 (87%)**

**Number of Movie Smoking Episodes**

**Smoking Episodes in 532 Box Office Hits**

**N - Movies (% w smk)**

**MPAA Rating**

**0**

**0**

**4**

**7**

## Percent of Movies

**0**

**20**

**40**

**60**

**80**

**Percent of Movies**

**0**

**5**

**10**

**15**

**20**

**25**

**Minutes of Screen Smoking**

**Smoking Screentime in 532 Box office hits**

## Linking Smoking in Movies with Adolescent Smoking

- Jeff Bridges: “Seabiscuit”

## BMJ 2001;323(7326):1394-7

**BMJ 2001;323(7326):1394-7**

## Chicken and the Egg:Longitudinal Study of Never Smokers

## Findings Generalizable?

- Could this just be a regional finding?
- Can the findings be replicated?
- Do they hold across race/ethnicity?

## Study Design

**Study Design**

- Random digit dial telephone (RDD) survey
- Telephone protocol identified U.S. households with 10-14 year-old adolescents (N = 6522)
- Major undertaking, 400,000 RDD numbers
- Could never have been accomplished without NIH funding

## Exposure Measurement

**Exposure Measurement**

## Select Popular Movies

**• ****Box office hits**

** **

** **

**                  ****N**

**      ****Top 100, 1998-2002                         500**

**      ****> $10mil revenues, 2003                   32  **

**  • ****Count the tobacco use occurrences**
**   ****in each movie**

**Content Analysis**

## Generate Movie Lists

**Generate Movie Lists**

**Select Popular Movies**

**• ****Box office hits**

** **

** **

**                  ****N**

**      ****Top 100, 1998-2002                         500**

**      ****> $10mil revenues, 2003                   32  **

**• ****Questionnaire assesses which of the**

**   ****50 movies the adolescent has ever seen**

**Survey Adolescents (Sep 2003)**

**    • ****Randomly select 50 movies for each survey**

**    • ****Use stratified sampling to ensure**

**       ****representative distribution by rating**

**       ****(R, PG 13, PG, G)**

** **

**  • ****Count the tobacco use occurrences**
**   ****in each movie**

**Content Analysis**

## Generate Movie Lists

**Generate Movie Lists**

**Select Popular Movies**

**• ****Box office hits**

** **

** **

**                  ****N**

**      ****Top 100, 1998-2002                         500**

**      ****> $10mil revenues, 2003                   32  **

**• ****Questionnaire assesses which of the**

**   ****50 movies the adolescent has ever seen**

**Survey Adolescents (Sep 2003)**

**    • ****Randomly select 50 movies for each survey**

**    • ****Use stratified sampling to ensure**

**       ****representative distribution by rating**

**       ****(R, PG 13, PG, G)**

** **

**  • ****Count the tobacco use occurrences**
**   ****in each movie**

**Content Analysis**

**Number movie tobacco use occurrences seen**

**Movie Smoking Exposure Variable**

**Merge**

## Exposure to Movie Smoking and Adolescent

**Exposure to Movie Smoking and Adolescent**
**Smoking by Race/Ethnicity**

*Overall Smoking Prevalence*

## Controlling for Covariates

***Sociodemographics***
- Grade in school
- Gender
- Parent Education
***Social Influences***
- Parent smoking
- Sibling smoking
- Friend smoking

***Personality Characteristics***
- Self esteem
- Sensation seeking
- Rebelliousness
***Parenting***
- Maternal responsiveness
- Maternal supervision
- Parental disapproval of smoking

## Multivariate Analyses

## Promoting Change within the Movie Industry

**Notes:**
A lot of research has investigated predictors and risk factors for smoking, but only recently have we begun to look at movies.  Why?  

## Movie Character Smoking Trends

## Movie Character Smoking--Adolescents

- † p-value < 0.01 for downward trend among teen movie characters

- 0

- 2

- 4

- 6

- 8

- 10

- 12

- 14

- 16

- 18

- 20

- 1996

- 1997

- 1998

- 1999

- 2000

- 2001

- 2002

- 2003

**Year**

**Percent of Adolescent Smokers**

- Daily

- smoking,

- 10th

- graders,

- MTFS*

- Adolescent

- movie

- characters†

## What’s in Store?

- Reach—Gross impressions
- U.S. adolescents 10-14: 2003

## Adolescent   ←   randomly assigned to   ←    Movie

**Generate movie lists**

**Select Popular Movies**

**• ****Box office hits**

** **

** **

**                  ****N**

**      ****Top 100, 1999-2003                         500**

**      ****Top   50, 2003 (assessed 5/03)        32  **

**• ****Questionnaire assesses which of the**

**   ****50 movies the adolescent has ever seen**

**Survey Students**

**    • ****Randomly select 50 movies for each survey**

**    • ****Use stratified sampling to ensure**

**       ****representative distribution by rating**

**       ****(R, PG 13, PG, G)**

** **

***Adolescent   ******←******   randomly assigned to   ←    Movie***

***So a representative sample of about  550 U.S. adolescents***
***responded to each movie***

## Lifetime Smoking ImpressionsUS Adolescents 10-14 in 2003,532 Popular Contemporary Movies

-  Impression: each time an adolescent saw a smoking scene
- These movies delivered:
- 13.8 billion lifetime smoking impressions
- Does not count repetitive viewing

## Smoking

**Smoking**

## What’s in Store?

- Reach—Gross impressions
- Contextualized smoking
- Movie industry response
- Eliminate G and PG smoking

## Movie smoking – Kid smoking relation

- 0

- .1

- .2

- .3

- .4

- 0

- 50

- 100

- 150

- 200

**GPG movie smoking**

**PG-13 movie smoking**

**R movie smoking**

**Episodes of Movie Smoking Exposure**

**Proportion of Adolescent Ever Smokers**

**Movie smoking – Kid smoking relation**
**by smoking rating**

## What’s in Store?

- Reach—Gross impressions
- Contextualized smoking
- Movie industry response
- Eliminate G and PG smoking
- “Most smoking is bad guy smoking”

## Movie smoking – Kid smoking relation

- 0

- .1

- .2

- .3

- .4

- .5

- 0

- 50

- 100

- 150

**Bad Guy Smoking**

**Good Guy Smoking**

**Mixed Character**

**Episodes of Movie Smoking Exposure**

**Proportion of Adolescent Ever Smokers**

**Movie smoking – Kid smoking relation**
**by character type**