The Association Between Smoking Depictions in Films and Tobacco use in British Adolescents: A Cross-Sectional Cohort Study

Abstract

Background and aims: Research has shown that adolescents with high exposure to smoking depictions in films are two to three times more likely to start smoking compared to others, even after adjustment for confounders. We aimed to assess the association between exposure to smoking depictions in films and adolescent tobacco use in a British population cohort. Methods: Data about exposure to smoking depictions in films and own smoking behaviour were collected from 5166 15 year olds in South-West England. Main outcome measures were smoking initiation (ever tried a cigarette?) and current smoking status (do you smoke every week?). Social, family and behavioural factors were adjusted for together with alcohol use and peer smoking behaviour as mediators. Results: Higher exposure to smoking depictions in films was associated with a dose response increase in risk of smoking initiation in adolescence even after adjusting for social, familial and behavioural confounders. Adolescents in the highest quartile of exposure were 1.73 (1.55 to 1.93) times more likely to initiate smoking compared with those in the lowest quartile. They were more likely to report being current smokers after adjusting for social and familial factors (RR 1.47 (1.07 to 2.02)) but the association attenuated after including behavioural factors in the model. Conclusions: This study provides evidence that adolescents in the UK exposed to smoking depictions in films are more likely to initiate smoking. Given the association between smoking and poor health outcomes these data justify a review of film ratings in the UK.