16 Tobacco Control 2001;10:16–22 Tob Control: first published as 10.1136/tc.10.1.16 on 1 March 2001. Downloaded from Favourite movie stars, their tobacco use in contemporary movies, and its association with adolescent smoking Jennifer J Tickle, James D Sargent, Madeline A Dalton, Michael L Beach, Todd F Heatherton Abstract favourable attitudes toward smoking than Objective—To assess the relation between adolescents who choose non-smoking adolescents’ favourite movie stars, the stars. This finding supports the proposi- portrayal of tobacco use by those stars in tion that the portrayal of tobacco use in contemporary motion pictures, and contemporary motion pictures, particu- adolescent smoking. larly by stars who are admired by adoles- Design and setting—632 students (sixth to cents, contributes to adolescent smoking. 12th grade, ages 10–19 years) from five (Tobacco Control 2001;10:16–22) rural New England public schools Keywords: adolescent smoking; movies; media completed a voluntary, self administered influences survey in October 1996. The survey assessed tobacco use, other variables Understanding factors that contribute to the associated with adolescent smoking, and adoption of smoking by youth is an essential favourite movie star. In addition, tobacco element of tobacco control. A variety of theories have been proposed to explain tobacco use by 43 selected movie stars was use among adolescents. One of the most popu- measured in films between 1994 and 1996. lar is social learning theory,1 which emphasises Outcome measures—Students were cat- the importance of the interplay between egorised into an ordinal five point index individual traits and the environment. (tobacco status) based on their smoking Important social learning factors in children Department of behaviour and their smoking susceptibil- Psychological and include parents and peers, but also http://tobaccocontrol.bmj.com/ Brain Sciences, ity: non-susceptible never smokers, socialisation by mass media. The view that Dartmouth College, susceptible never smokers, non-current Hanover, New exposure to smoking in mass media can have Hampshire, USA experimenters, current experimenters, an impact on tobacco related attitudes and J J Tickle and smokers. We determined the adjusted behaviours is articulated in the Institute of T F Heatherton cumulative odds of having advanced Medicine document, “Growing up tobacco smoking status based on the amount of 2 Departments of free” : “In developing norms, adolescents look Pediatrics and on-screen tobacco use by their favourite to the greater social environment for concepts Community & Family film star. of adult identity, particularly the behaviour of Medicine, and the Results—Of the 43 stars, 65% used Norris Cotton Cancer leaders, heroes, and film stars, and in the Center, Dartmouth tobacco at least once, and 42% portrayed media.” Medical School, smoking as an essential character trait in Despite the popularity of the idea that smok- Hanover one or more films. Stars who smoked ing in movies could be a significant social J D Sargent on September 24, 2021 by guest. Protected copyright. Department of more than twice in a film were considered learning factor in adolescents, there has been Pediatrics, and the smokers. For adolescents whose favourite little empirical study of this notion. Norris Cotton Cancer stars smoked in only one film, the odds of Center, Dartmouth Adolescents’ exposure to motion pictures has Medical School, being higher on the smoking index was increased in the past two decades. Most Hanover 0.78 (95% confidence interval (CI) 0.53 to Americans now have access to movies on video- M A Dalton 1.15). For adolescents whose favourite tape, and adolescents today view an average of 3 Department of stars smoked in two films, the odds of two movies per week. In addition, smoking in Community & Family being higher on the smoking index was 1.5 movies is prevalent; a recent study of films Medicine, Dartmouth (95% CI 1.01 to 2.32). For adolescents released between 1990 and 1996 found that Medical School, and 4 Veterans’ AVairs whose favourite stars smoked in three or 57% of major movie characters used tobacco. Medical Center, White more films (Leonardo DiCaprio, Sharon Smoking is common even in G (general River Junction, Stone, John Travolta), the odds of being viewing audience) rated films.5 Given access to Vermont, USA M L Beach higher on the smoking index was 3.1 (95% video rentals, cable television, and traditional CI 1.34 to 7.12). Among never smokers movie theatres, it is likely that adolescents are Correspondence to: (n = 281), those who chose stars who were exposed to a great deal of smoking in movies. Jennifer J Tickle, 6207 6 Moore Hall, Department of smokers in three or more films were much Recently, Distefan and colleagues reported Psychological and Brain more likely to have favourable attitudes a relation between preference for particular Sciences, Dartmouth College Hanover, NH 03755, USA toward smoking (adjusted odds ratio 16.2, stars and susceptibility to smoking in a sample Jennifer.Tickle@ 95% CI 2.3 to 112). of California adolescents. They found that Dartmouth.edu Conclusions—Adolescents who choose adolescent tobacco users diVered from never Received 27 January 2000 movie stars who use tobacco on-screen smokers in their choice of favourite stars, and and in revised form 2 June 2000 are significantly more likely to have an that many of the stars selected by tobacco users Accepted 23 June 2000 advanced smoking status and more were smokers in real life or portrayed www.tobaccocontrol.com Movie stars and adolescent smoking 17 Tob Control: first published as 10.1136/tc.10.1.16 on 1 March 2001. Downloaded from characters who used tobacco in films. In addi- incomplete data on the variables examined in tion, adolescent never smokers who chose a this report. Completed surveys were obtained favourite star of adolescent smokers were from 1265 students. Each student’s favourite almost 1.5 times more likely to be susceptible star was surveyed in the sample by asking the to smoking. The risk variable in the Distefan following open ended question: “Who is your study—choice of a favourite star of smokers— favourite movie/film star?” Of 1236 respond- was whether the star was chosen by adolescent ents to this question, 79% were able to identify smokers, not whether the star actually used a favourite actor/actress, 7.9% mentioned a tobacco in movies. movie title or cartoon (coded non-response), In this study we assess directly the on-screen and 13.2% did not name a favourite smoking behaviour of movie stars favoured by actor/actress. Because the question was open a sample of adolescents, independent of the ended, 228 stars were named in response to the adolescent’s smoking status, and then evaluate question. Evaluation of smoking status for all the association between whether the actor movies for each of these stars would have smokes in movies and adolescent smoking. Our required us to view some 2000 movies. In order hypothesis is that adolescents who choose to reduce the number of movies in the sample, favourite stars who display higher levels of we restricted our analysis of star smoking smoking in film will be further along in their behaviour to actors and actresses who were acquisition of smoking behaviour than selected by at least five students in the sample adolescents who select stars who smoke less. and who had appeared in films within the three years before the study (1994 to 1996). We Methods excluded one further actress, Pamela Five rural schools in Vermont and New Hamp- Anderson, who was likely selected by students shire participated in a survey that was who knew of her from television rather than conducted for a separate purpose but film. These criteria resulted in a sample of 632 contained items relevant to the current students who had selected one of 43 film stars. hypothesis. A detailed description of the Retained students did not diVer from those sample and survey methods has been who were excluded with respect to smoking published.7 Briefly, school selection was based status, grade in school, or exposure to tobacco on the following criteria: (1) schools enrolled advertising. They were significantly less likely students in grades 6 through 12 (ages 10–19 to have family members who smoked and were years); (2) schools were located in rural significantly more likely to be male and have communities in Vermont or New Hampshire, below average grades. within a two hour driving distance from Leba- non, New Hampshire; (3) schools served com- VALIDITY AND RELIABILITY http://tobaccocontrol.bmj.com/ munities that were in the lowest quartiles for Details of the procedures used to increase the median household income and percent of validity and reliability of the self reports have adults who completed high school for each been published.7 We assured anonymity8 and state. Of 13 schools initially contacted and employed a bogus pipeline procedure (using a asked to participate, five were surveyed in saliva sample)9 to increase the validity of October 1996: three in New Hampshire reports of smoking. In addition, self reports of (school A, grades 9–12, 469 students; school B, tobacco use by eighth, 10th, and 12th graders grades 6–7, 169 students; school C, grades were similar to those of the nationally 8–12, 378 students) and two in Vermont representative sample of students surveyed in (school D, grades 7–12, 288 students; school the 1996 “Monitoring of the future survey” E, grades 7–12, 543 students). The (MTFS).710 The test-retest reliability of all populations served by participating schools covariates was evaluated in a separate survey of on September 24, 2021 by guest. Protected copyright. were not diVerent from non-participating 114 students who completed the questionnaire schools.