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Its Association With Established Adolescent Smoking

James D. Sargent, MD; Mike Stoolmiller, PhD; Keilah A. Worth, PhD; Sonya Dal Cin, PhD; Thomas A. Wills, PhD; Frederick X. Gibbons, PhD; Meg Gerrard, PhD; Susanne Tanski, MD

Arch Pediatr Adolesc Med. 2007;161(9):849-856.

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.

Author Affiliations: Department of Pediatrics (Drs Sargent and Tanski) and Norris Cotton Cancer Center (Drs Sargent, Worth, Dal Cin, and Tanski), Dartmouth Medical School, Lebanon, New Hampshire; University of Oregon, Eugene (Dr Stoolmiller); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (Dr Wills); and Iowa State University, Ames (Drs Gibbons and Gerrard).

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