Exposure to Smoking in Internationally Distributed American Movies and Youth Smoking in Germany: A Cross-Cultural Cohort Study

"Tobacco industry documents indicate awareness of leadership and marketing executives regarding the importance of cinema in communicating strong, positive images for cigarettes and smoking to position the behavior as something to which people aspire..."

This 12-page article details research to investigate whether exposure to tobacco imagery in internationally distributed American movies is linked to smoking behaviour amongst German never-smokers (aged 10 to 16 years). The longitudinal study estimated movie smoking exposure by asking adolescents if they had seen movies from a list of 50 movie titles, randomly selected for each adolescent from 398 internationally distributed movies released between 1994 and 2004 that became box-office hits in Germany. These films were reviewed for smoking content. Adolescents were re-surveyed 12 to 13 months later to determine smoking status, and results were compared with a similarly designed survey of 2,603 white United States (US) adolescents.

The 398 internationally distributed movies represented 80% of the German box-office hits within this time frame, with the majority (388) produced and/or distributed internationally by US companies. Smoking was present in 74% of the movies. Overall, 503 (19%) of the students tried smoking during the follow-up period. The incidence of trying smoking was associated with increased exposure to movie smoking. Researchers controlled for a number of covariates that could confound the relation between exposure to smoking in movies and trying smoking, including characteristics of the adolescent, specific social influences, and parenting style. The assessment of the covariates mirrored that of the US study, with the exception of controls for socioeconomic status (SES) and tobacco marketing receptivity. The researchers found that the form of the dose-response was similar to the US sample, with the strongest response to movies seen in the lower 2 quartiles of exposure. In short, after controlling for baseline covariates, exposure to movie smoking remained a significant predictor of trying smoking in German adolescents, and the effect was significantly stronger in adolescents whose parents did not smoke.

An excerpt from the Discussion section follows:

"In this prospective study of German adolescents, we observed a two-fold increased risk for trying smoking with higher exposure to smoking in internationally distributed American movies, independent of other risk factors for smoking, and replicating the main effect results for another cohort study of US adolescents....The cross-cultural replication of a movie smoking effect on smoking among German children is notable not only for its similarity to the US findings but also because these 2 cultures treat smoking differently, with smoking being more socially acceptable to Germans and tobacco companies enjoying fewer restrictions in Germany...

The finding that exposure to internationally marketed movies predicts smoking across cultures could have important public health implications. The majority of movies in the German movie market are produced and distributed by US companies; therefore, most movie smoking exposure comes from these movies. If one accepts a causal interpretation, then this suggests that reductions in the prevalence of smoking in US-produced movies could affect youth smoking outside the United States....A number of policy considerations could, in theory, affect adolescent exposure to smoking in movies. Specifically, movie rating boards could rate smoking just as they rate violence for public health reasons."