Cigarette Smoking and Perception of a Movie Character in a Film Trailer

ARTICLE Cigarette Smoking and Perception of a Movie Character in a Film Trailer

Reiner Hanewinkel, PhD

Objective: To study the effects of smoking in a film named “attractiveness.” The Cronbach ␣ for the attrac- trailer. tiveness rating was 0.85.

Design: Experimental study. Results: Multilevel mixed-effects linear regression was used to test the effect of smoking in a film trailer. Smoking in the Setting: Ten secondary schools in Northern Germany. film trailer did not reach significance in the linear regression model (z=0.73; P=.47). Smoking status of the recipi- Participants: A sample of 1051 adolescents with a mean ent (z=3.81; PϽ.001) and the interaction between smok- (SD) age of 14.2 (1.8) years. ing in the film trailer and smoking status of the recipient (z=2.21; P=.03) both reached statistical significance. Ever Main Exposures: Participants were randomized to smokers and never smokers did not differ in their percep- view a 42-second film trailer in which the attractive tion of the female character in the nonsmoking film trailer. female character either smoked for about 3 seconds or In the smoking film trailer, ever smokers judged the char- did not smoke. acter significantly more attractive than never smokers.

Main Outcome Measures: Perception of the charac- Conclusion: Even incidental smoking in a very short film ter was measured via an 8-item semantic differential scale. trailer might strengthen the attractiveness of smokers in Each item consisted of a polar-opposite pair (eg, “sexy/ youth who have already tried their first cigarettes. unsexy”) divided on a 7-point scale. Responses to individual items were summed and averaged. This scale was Arch Pediatr Adolesc Med. 2009;163(1):15-18

MOKING IS A LEADING PRE- school students12 and young adults.13 A re- ventable risk factor for many cent study shows that exposure to smok- chronic disorders that are ex- ing in movies predicts also the risk of be- pected to account for an in- coming an established smoker.14 creasing share of the global Studies consistently suggest that the diseaseS burden.1 Current global patterns majority of smoking depictions in mov- of youth smoking suggest little abate- ies are associated with popular and desir- ment of cigarette use.2 One way of con- able role models with positive attributes, trolling the smoking epidemic is to pre- such as fame, attractiveness, sexiness, so- vent youth from taking up the behavior. phistication, and glamour.15,16 Results from The epidemiology of smoking in youth has experimental studies suggest that expo- identified a number of factors that may pre- sure to movies in which smoking takes dict future tobacco use, among them so- place predicts more favorable attitudes to- cial factors like friend, sibling, and par- ward smokers17 and increased self- ent smoking.3 In recent years, attention has reported likelihood of smoking.18,19 shifted toward assessing the impact of Smoking occurs frequently in Holly- smoking imagery in popular media as an wood blockbusters.20-22 Although to- important factor in establishing and main- bacco advertising was banned from tele- taining prosmoking attitudes.4 Cross- vision in many countries years ago (for sectional5-8 and longitudinal9-11 surveys instance, in 1971 in the United States and have shown that greater exposure to smok- in 1975 in Germany), tobacco use can still ing in movies predicts increased likeli- be seen across a spectrum of television pro- hood of trying smoking, even after tak- gramming.23-26 A recent study suggests that Author Affiliation: Institute for ing into account a number of confounding nearly all US youth aged 12 to 17 years Therapy and Health Research, factors. Smoking in motion pictures af- were exposed to images of tobacco use on IFT-Nord, Kiel, Germany. fects not only teens but also elementary television in the context of a movie trailer

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 163 (NO. 1), JAN 2009 WWW.ARCHPEDIATRICS.COM 15

©2009 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 during a 1-year observational period.27 To my knowl- rettes have you smoked in your life?” The response “none” was edge, the effects of such an exposure have not been stud- categorized as “never smoked” and all other responses (just a ied. The experimental data reported in this article are the few puffs, 1-19 cigarettes, 20-100 cigarettes, Ͼ100 cigarettes), 28 first to show the effects that smoking in a film trailer might as “ever smoked.” have on youth. SEMANTIC DIFFERENTIAL SCALE

METHODS To measure the perception of the character, a semantic differential scale was used.29 Semantic differential scales are fre- OVERALL DESIGN quently used to measure explicit attitudes and opinions.30,31 Each item consisted of a polar-opposite pair divided on a 7-point scale. The study design was a 2 (character smoking in a film trailer The pairs were “boring/exciting”; “well/bad”; “friendly/ vs nonsmoking) ϫ2 (smoking status of the subjects) between- unfriendly”; “social/antisocial”; “beautiful/ugly”; “cool/ subjects experimental design with random assignment of groups uncool”; “young/old”; and “sexy/unsexy.” Items were derived (school classes) to film condition. The second factor (smok- from previous research on perceptions of smoking in films.32-35 ing status of the participants) was introduced into the design For the analysis, items were (re)coded to indicate that higher because previous studies have shown that smoking in movies values reflect a more positive view of the character. Responses could affect adolescent never smokers9-12 as well as teens who to individual items were summed up and averaged. This scale have already tried smoking.14 was named “attractiveness.” The Cronbach ␣ for the attractiveness rating was 0.85. STIMULUS MATERIAL CONTROLLING FOR CONFOUNDING To assess the impact of smoking images in a film trailer, Nord- deutscher Rundfunk (NDR) (Northern German Broadcast), one A number of covariates that could confound the relation be- of the national public television channels in Germany, pro- tween exposure to smoking in a film trailer and the percep- duced 2 versions of a film trailer, which both lasted 42 sec- tion of the character were controlled. Sensation seeking and onds. The trailer consisted of 6 scenes. In one of the scenes, rebelliousness of the recipients were measured with the fol- the attractive, 34-year-old, well-known German female actor lowing 12 items: “I like to do scary things”; “I get bored being (Meret Becker, http://www.meretbecker.de/) smoked or did not with the same friends all the time”; “I like to do dangerous smoke for about 3 seconds. Within the smoking scene, the ac- things”; “I often think there is nothing to do”; “I like to listen tor was alone and relaxed. No adverse effects of smoking were to loud music”; “I get in trouble in school”; “I argue a lot with shown. With the exception of this one scene, there was no dif- other kids”; “I do things my parents wouldn’t want me to do”; ference between the 2 trailers. The whole format of the trailer “I do what my teachers tell me to do”; “I sometimes take things was identical to the format of a film trailer frequently shown that don’t belong to me”; “I argue with my teachers”; and “I on NDR. like to break the rules.” Response categories for these items were “not like me,” “sort of like me,” “a lot like me,” and “just like PARTICIPANTS me.” For the analysis, responses to individual items measur- ing students’ personality were summed, such that higher scores ␣ Participants were recruited from 45 classes from 10 secondary signified more of each characteristic (Cronbach of the 12- schools in Schleswig-Holstein, a state of Germany. Parental writ- item index=0.76). In addition, social influences toward smok- ten permission and student assent were required for participa- ing (mother and father smoking, sibling smoking, friend smok- tion in the survey. The study was approved by the Ministry of ing) were assessed. Cultural Affairs of the Bundesland Schleswig-Holstein. The sample consisted of 1051 pupils, 490 boys (47%) and STATISTICAL ANALYSIS 559 girls (53%) (there were 2 missing sex values) with a mean (SD) age of 14.2 (1.8) years (median, 14 years; range, 10-18 Multilevel mixed-effects linear regression, implemented in Stata years). The majority of 620 pupils (59%) never tried smoking. 10.0 (StataCorp, College Station, Texas), was used to test the effect of smoking in a film trailer. In the models, the outcome variable PROCEDURE (ie, the perception of the character) was regressed on the experimental conditions “smoking in the film trailer” (smoking vs non- The experiment was conducted by trained research staff who smoking), “smoking status of the recipient” (never smoked vs ever also carried out the data collection in the 10 schools. The 45 smoked), and the interaction between these 2 variables with a ran- classes were randomly assigned to 1 of the 2 conditions (smok- dom effect for class, since students were nested in classes. Sex, ing vs nonsmoking of the main character). Randomization was age, sensation seeking, and rebelliousness and friend, sibling, and stratified by grade. The pupils were guided classwise to one me- parent smoking served as covariates. dia room in the school, in which the trailer was projected via a laptop and a projector. After the pupils entered the media room, RESULTS they watched the trailer. Then the questionnaires were distributed by the research staff. The survey was anonymous, and the questionnaires were collected by the research staff, placed in Smoking in the film trailer did not reach significance in an envelope, and sealed in front of the class. the linear regression model (z=0.73; P=.47). Smoking status of the recipient (z=3.81; PϽ.001) and the inter- MEASURES action between smoking in the film trailer and smoking status of the recipient (z=2.21; P=.03) both reached sta- Demographics included age (“How old are you?”) and sex (“Are tistical significance. you a girl or a boy?”) of the pupils. Smoking status of the sub- Adjusted means of the outcome variable stratified by jects was determined by asking the question “How many ciga- experimental conditions are shown in the Figure. Ever

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 163 (NO. 1), JAN 2009 WWW.ARCHPEDIATRICS.COM 16

©2009 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 smokers and never smokers did not differ in the perception of the female character in the nonsmoking film trailer. 4.0 Never smokers Ever smokers In the smoking film trailer, ever smokers judged the char- 3.9

acter significantly more positive than never smokers. 3.8 P < .001 3.7 COMMENT 3.6 P = .41 3.5

3.4 Data from this experimental study indicate that inciden- 3.70

Attractiveness Rating 3.3 tal smoking of only 3 seconds in a short film trailer of 3.50 3.2 3.43 42 seconds could have an effect on the perception of the 3.34 female character. A large sample of young German ado- 3.1 lescents judged the character quite differently depend- 3.0 ing on their own smoking experience. Never smokers and Nonsmoking Smoking ever smokers did not differ in their perception of a non- Behavior of the Character in the Trailer smoking attractive female actor, but ever smokers judged Figure. Adjusted means for the attractiveness rating of the female character the same character more positively when the character stratified by experimental condition and smoking status of the recipient. smoked compared with never smokers. Means are adjusted for sex, age, sensation seeking, and rebelliousness and When depicted in movies, smoking sends a powerful friend, sibling, and parent smoking. Higher values reflect a higher and enticing message to the adolescent viewer. Movie di- attractiveness rating of the character. rectors and actors use smoking to project character traits typically seen in tobacco advertising: toughness, rebel- dissonance has been resolved by changing their cognitions. liousness, and sexiness.36 Results from focus groups and In contrast, those adolescents who have never smoked surveys indicate that these stereotype messages are well should not have built up cognitive dissonance. Therefore, received by teens.33,34,37 they do not have any motivation to resolve dissonance. A recent published study indicates that a sample of Theories describing attitude and persuasion have been more than 500 contemporary box-office hits delivered applied to explain the process of smoking initiation, re- billions of smoking impressions to American youth dur- duction, continuation, and progression. Recent re- ing a period when they are susceptible to social influ- search on the theory of planned behavior, which in- ences to smoke.38 Not surprisingly, previous literature cludes prosmoking attitudes, perceived social norms showed consistently that exposure to smoking on- regarding smoking, and self-efficacy to resist smoking, screen increases the odds of smoking in children,12 ado- reveals that these cognitions may play a relevant role in lescents,5,6,8-11,14 and young adults.13 These studies show progression in smoking after experimentation or recent in general a clear dose-response relationship between ex- onset.41 The current research reveals that even inciden- posure to movie smoking and smoking initiation. Com- tal smoking in a film trailer could have an effect on at- pared with billions of smoking impressions that Ameri- titudes in those adolescents after experimenting with can and German teens are exposed to, the exposure to a smoking. By facilitating prosmoking attitudes, smoking 3-second smoking scene is marginal. Therefore, one could in movie trailers may contribute to adolescent smoking have expected that this exposure might not have an effect progression. at all. The present investigation contradicts this expec- The study has some strengths and weaknesses that tation by showing that even very brief exposures in trail- should be taken into account. The strengths are the ex- ers could have different effects on smokers and non- perimental design, the professional stimulus material, and smokers. the high number of participants in the study. Neverthe- How can these results be explained? One possibility is less, weaknesses are that teens entered the study as never the Festinger theory of cognitive dissonance.39,40 Accord- or ever smokers and the regional sample drawn does not ing to this theory, the possession of inconsistent cogni- allow generalizing the results to the whole population tions creates psychological discomfort, which motivates of German adolescents. people to alter their cognitions (beliefs, attitudes) and/or Taken together, this experimental study presents data behaviors to restore consistency. The emotional state of suggesting that even incidental smoking in a very short dissonance may occur when there is inconsistency between trailer might strengthen the attractiveness of smokers in 2 beliefs or between a belief and a behavior. The individual youth who have already tried their first cigarettes. Fu- will try to resolve the unpleasant dissonance by changing ture experimental studies should also address possible the belief, changing the action, or “rationalizing” the ac- sex effects; thus, the stimulus material should consist of tion. Few, if any, German adolescents could have avoided male and female smoking and nonsmoking characters. exposure to information designed to persuade them that Given the evidence that smoking in movies strongly smoking is harmful. Such exposure, dissonance theory ar- impacts childhood and early smoking initiation in the gues, creates an unpleasant tension for those adolescents United States and Germany, leading US advocates pro- who have already tried smoking, which might be relieved mote an R rating (no cinema admission to persons younger through selective information processing. A smoking film than 17 years without a parent or guardian) for all mov- character might therefore be perceived as “sexy,” “cool,” ies portraying smoking.42,43 The expectation is that an R and “exciting” by teens who have already smoked. Accord- rating would substantially reduce exposure and subse- ing to the theory of cognitive dissonance, the unpleasant quent adolescent smoking initiation. This study sug-

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 163 (NO. 1), JAN 2009 WWW.ARCHPEDIATRICS.COM 17

©2009 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 gests that health advocates should not only focus on mo- 15. Dozier DM, Lauzen MM, Day CA, Payne SM, Tafoya MR. Leaders and elites: por- tion pictures. Instead, policies to prevent youth from being trayals of smoking in popular films. Tob Control. 2005;14(1):7-9. 16. McIntosh WD, Bazzini DG, Smith SM, Wayne SM. Who smokes in Hollywood? exposed to tobacco images should ultimately include film Characteristics of smokers in popular films from 1940 to 1989. Addict Behav. trailers and all relevant television programming. 1998;23(3):395-398. 17. Gibson B, Maurer J. Cigarette smoking in the movies: the influence of product Accepted for Publication: May 22, 2008. placement in attitudes toward smoking and smokers. J Appl Soc Psychol. 2000; 30(7):1457-1473. Correspondence: Reiner Hanewinkel, PhD, Institute for 18. Hines D, Saris R, Throckmorton-Belzer L. Cigarette smoking in popular films: Therapy and Health Research, IFT-Nord, Harmsstrasse does it increase viewers’ likelihood to smoke? J Appl Soc Psychol. 2000;30 2, 24114 Kiel, Germany ([email protected]). (11):2246-2269. Financial Disclosure: None reported. 19. Pechmann C, Shih C-F. Smoking scenes in movies and antismoking advertise- Funding/Support: This study was financed by the Min- ments before movies: effects on youth. J Mark. 1999;63(3):1-13. 20. Dalton MA, Tickle JJ, Sargent JD, Beach ML, Ahrens MB, Heatherton TF. The istry of Health of the Federal Republic of Germany. NDR incidence and context of tobacco use in popular movies from 1988 to 1997. Prev generously produced and provided us with the trailers Med. 2002;34(5):516-523. used in this study. 21. Everett SA, Schnuth RL, Tribble JL. Tobacco and alcohol use in top-grossing Role of the Sponsor: The funder had no role in the de- American films. J Community Health. 1998;23(4):317-324. 22. Glantz SA, Kacirk KW, McCulloch C. Back to the future: smoking in movies in sign or conduct of the study; collection, analysis, or in- 2002 compared with 1950 levels. Am J Public Health. 2004;94(2):261-263. terpretation of the data; or preparation, review, or ap- 23. Christenson PG, Henriksen L, Roberts DF. Substance Use in Popular Prime- proval of the manuscript. Time Television. Washington, DC: Office of National Drug Control Policy; 2000. Additional Contributions: Matthis Morgenstern, PhD, 24. Hazan AR, Glantz SA. Current trends in tobacco use on prime-time fictional provided statistical advice. I thank Nicola Alcaide, MA, television. Am J Public Health. 1995;85(1):116-117. 25. Hanewinkel R, Wiborg G. Smoking in contemporary German television and Lars Grabbe, MA, for their support in data collec- programming. Int J Public Health. 2007;52(5):308-312. tion. 26. Hanewinkel R, Wiborg G. Smoking in a popular German television crime series 1985-2004 Prev Med. 2008;46(6):596-598. 27. Healton CG, Watson-Stryker ES, Allen JA, et al. Televised movie trailers: under- REFERENCES mining restrictions on advertising tobacco to youth. Arch Pediatr Adolesc Med. 2006;160(9):885-888. 1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 28. World Health Organization. Guidelines for Controlling and Monitoring the To- 2002 to 2030. PLoS Med. 2006;3(11):e442. http://medicine.plosjournals.org/ bacco Epidemic. Geneva, Switzerland: World Health Organization; 1998. perlserv/?request=get-document&doi=10.1371/journal.pmed.0030442. Ac- 29. Osgood CE. The nature and measurement of meaning. Psychol Bull. 1952;49(3): cessed May 13, 2008. 197-237. 2. Warren CW, Jones NR, Eriksen MP, Asma S. Patterns of global tobacco use in 30. Henriksen L, Fortmann SP. Young adults’ opinions of Philip Morris and its tele- young people and implications for future chronic disease burden in adults. Lancet. vision advertising. Tob Control. 2002;11(3):236-240. 2006;367(9512):749-753. 31. Huijding J, de Jong PJ, Wiers RW, Verkooijen K. Implicit and explicit attitudes 3. Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: a toward smoking in a smoking and a nonsmoking setting. Addict Behav. 2005; critical review of the literature. Tob Control. 1998;7(4):409-420. 30(5):949-961. 4. Wakefield M, Flay B, Nichter M, Giovino G. Role of the media in influencing tra- 32. Dal Cin S, Gibson B, Zanna MP, Shumate R, Fong GT. Smoking in movies, im- jectories of youth smoking. Addiction. 2003;98(suppl 1):79-103. plicit associations of smoking with the self, and intentions to smoke. Psychol 5. Sargent JD, Beach ML, Dalton MA, et al. Effect of seeing tobacco use in films on Sci. 2007;18(7):559-563. trying smoking among adolescents: cross sectional study. BMJ. 2001;323 33. McCool JP, Cameron LD, Petrie KJ. Interpretations of smoking in film by older (7326):1394-1397. teenagers. Soc Sci Med. 2003;56(5):1023-1032. 6. Hanewinkel R, Sargent JD. Exposure to smoking in popular contemporary mov- 34. McCool JP, Cameron L, Petrie K. Stereotyping the smoker: adolescents’ apprais- ies and youth smoking in Germany. AmJPrevMed. 2007;32(6):466-473. als of smokers in film. Tob Control. 2004;13(3):308-314. 7. Laugesen M, Scragg R, Wellman RJ, DiFranza JR. R-rated film viewing and ado- 35. Watson NA, Clarkson JP, Donovan RJ, Giles-Corti B. Filthy or fashionable? Young lescent smoking. Prev Med. 2007;45(6):454-459. people’s perceptions of smoking in the media. Health Educ Res. 2003;18(5): 8. Sargent JD, Beach ML, Adachi-Mejia AM, et al. Exposure to movie smoking: its 554-567. relation to smoking initiation among US adolescents. Pediatrics. 2005;116 36. Sargent JD, Dalton MA, Heatherton T, Beach M. Modifying exposure to smoking (5):1183-1191. depicted in movies: a novel approach to preventing adolescent smoking. Arch 9. Hanewinkel R, Sargent JD. Exposure to smoking in internationally distributed Pediatr Adolesc Med. 2003;157(7):643-648. American movies and youth smoking in Germany: a cross-cultural cohort study. 37. McCool JP, Cameron LD, Petrie KJ. Adolescent perceptions of smoking imag- Pediatrics. 2008;121(1):e108-e117. http://pediatrics.aappublications.org/cgi/ ery in film. Soc Sci Med. 2001;52(10):1577-1587. content/full/121/1/e108. Accessed May 13, 2008. 38. Sargent JD, Tanski SE, Gibson J. Exposure to movie smoking among US ado- 10. Dalton MA, Sargent JD, Beach ML, et al. Effect of viewing smoking in movies on lescents aged 10 to 14 years: a population estimate. Pediatrics. 2007;119(5): adolescent smoking initiation: a cohort study. Lancet. 2003;362(9380):281- e1167-e1176. http://pediatrics.aappublications.org/cgi/content/full/119/5/ 285. e1167. Accessed May 13, 2008. 11. Jackson C, Brown JD, L’Engle KL. R-rated movies, bedroom televisions, and ini- 39. Crano WD, Prislin R. Attitudes and persuasion. Annu Rev Psychol. 2006;57:345- tiation of smoking by white and black adolescents. Arch Pediatr Adolesc Med. 374. 2007;161(3):260-268. 40. Festinger L. Cognitive dissonance. Sci Am. 1962;207(10):93-102. 12. Titus-Ernstoff L, Dalton MA, Adachi-Mejia AM, Longacre MR, Beach ML. Lon- 41. Van Zundert RM, Engels RC, Van Den Eijnden RJ. Adolescent smoking continu- gitudinal study of viewing smoking in movies and initiation of smoking by children. ation: reduction and progression in smoking after experimentation and recent Pediatrics. 2008;121(1):15-21. onset. J Behav Med. 2006;29(5):435-447. 13. Song AV, Ling PM, Neilands TB, Glantz SA. Smoking in movies and increased 42. Glantz SA. Smoking in movies: a major problem and a real solution. Lancet. 2003; smoking among young adults. AmJPrevMed. 2007;33(5):396-403. 362(9380):258-259. 14. Sargent JD, Stoolmiller M, Worth KA, et al. Exposure to smoking depictions in 43. Kachroo S, Etzel CJ, Wilkinson AV. Do current government policies sufficiently movies: its association with established adolescent smoking. Arch Pediatr Ado- regulate the interaction between viewing smoking in movies and adolescent smok- lesc Med. 2007;161(9):849-856. ing behavior? Am J Addict. 2007;16(6):532-533.

(REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 163 (NO. 1), JAN 2009 WWW.ARCHPEDIATRICS.COM 18