ARTICLE Portrayal of Alcohol Consumption in Movies and Drinking Initiation in Low-Risk Adolescents AUTHORS: Reiner Hanewinkel, PhD,a,b James D. Sargent, WHAT’S KNOWN ON THIS SUBJECT: Several experimental and MD,c Kate Hunt, PhD,d Helen Sweeting, PhD,d Rutger C.M.E. observational studies reveal an association between exposure to Engels, PhD,e Ron H.J. Scholte, PhD,e Federica Mathis, BSc,f alcohol consumption in movies and youth drinking, but little is Ewa Florek, MD,g and Matthis Morgenstern, PhDa,b known about the effect of such exposure on drinking onset among aInstitute for Therapy and Health Research (IFT-Nord), Kiel, low-risk adolescents. Germany; bInstitute for Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel, WHAT THIS STUDY ADDS: In a longitudinal study, exposure to Germany; cGeisel School of Medicine at Dartmouth, Lebanon, New Hampshire; dMRC/CSI Social & Public Health Sciences Unit, alcohol consumption in movies was associated with drinking University of Glasgow, Scotland; eBehavioural Science Institute, initiation in a sample of adolescents from 6 European countries Radboud University, Nijmegen, Netherlands; fPiedmont Centre for who had never drunk alcohol and were attitudinally Drug Addiction Epidemiology, ASL TO3, Grugliasco, Italy; and nonsusceptible to future use at the time of exposure. gLaboratory of Environmental Research, Department of Toxicology, University of Medical Sciences, Poznan, Poland KEY WORDS alcohol imagery, movies, binge drinking, young people, Europe ABBREVIATIONS CI—confidence interval abstract IRR—incidence rate ratio OBJECTIVES: To investigate the hypothesis that exposure to alcohol Dr Hanewinkel designed the study, contributed to data consumption in movies affects the likelihood that low-risk adolescents acquisition in Germany, carried out the statistical analysis, and drafted the article; Dr Sargent designed the study, contributed will start to drink alcohol. to data acquisition (alcohol occurrences in movies), and revised METHODS: Longitudinal study of 2346 adolescent never drinkers who the manuscript critically for important intellectual content; Dr also reported at baseline intent to not to do so in the next 12 months Hunt contributed to data acquisition in Scotland and revised the manuscript critically for important intellectual content; Dr (mean age 12.9 years, SD = 1.08). Recruitment was carried out in 2009 Sweeting contributed to data acquisition in Scotland and revised and 2010 in 112 state-funded schools in Germany, Iceland, Italy, the manuscript critically for important intellectual content; Dr Netherlands, Poland, and Scotland. Exposure to movie alcohol Engels contributed to data acquisition in the Netherlands and revised the manuscript critically for important intellectual consumption was estimated from 250 top-grossing movies in each content; Dr Scholte contributed to data acquisition in The country in the years 2004 to 2009. Multilevel mixed-effects Poisson Netherlands and revised the manuscript critically for important regressions assessed the relationship between baseline exposure intellectual content; Ms Mathis contributed to data acquisition in Italy and revised the manuscript critically for important to movie alcohol consumption and initiation of trying alcohol, and intellectual content; Dr Florek contributed to data acquisition in binge drinking ($ 5 consecutive drinks) at follow-up. Poland and revised the manuscript critically for important RESULTS: Overall, 40% of the sample initiated alcohol use and 6% ini- intellectual content; Dr Morgenstern designed the study, contributed to data acquisition in Germany, carried out the tiated binge drinking by follow-up. Estimated mean exposure to movie statistical analysis, and revised the manuscript critically for alcohol consumption was 3653 (SD = 2448) occurrences. After age, important intellectual content; and all authors agreed to be gender, family affluence, school performance, TV screen time, person- accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the ality characteristics, and drinking behavior of peers, parents, and work were appropriately investigated and resolved and siblings were controlled for, exposure to each additional 1000 movie approved the final manuscript as submitted. alcohol occurrences was significantly associated with increased relative www.pediatrics.org/cgi/doi/10.1542/peds.2013-3880 risk for trying alcohol, incidence rate ratio = 1.05 (95% confidence doi:10.1542/peds.2013-3880 interval, 1.02–1.08; P = .003), and for binge drinking, incidence rate Accepted for publication Feb 20, 2014 ratio = 1.13 (95% confidence interval, 1.06–1.20; P , .001). Address correspondence to Reiner Hanewinkel, PhD, Institute for CONCLUSIONS: Seeing alcohol depictions in movies is an independent Therapy and Health Research (IFT-Nord), Harmsstrasse 2, 24114 predictor of drinking initiation, particularly for more risky patterns of Kiel, Germany. E-mail: [email protected] drinking. This result was shown in a heterogeneous sample of Euro- (Continued on last page) pean youths who had a low affinity for drinking alcohol at the time of exposure. Pediatrics 2014;133:973–982 PEDIATRICS Volume 133, Number 6, June 2014 973 Downloaded from www.aappublications.org/news by guest on September 26, 2021 The causes of alcohol use and misuse in future use. Conceptually, this is a very and indicated at baseline that they young people are multifactorial and important group, because they can would “definitely not” drink alcohol in include cultural norms, parental and shed more light on the temporal se- the next year and “definitely not” drink peer influences, personality traits, al- quence of the exposure–behavior link alcohol offered by friends. As primary cohol use expectancies, and hereditary (it is hard to imagine how they could be outcomes we studied the initiation of factors.1 In the last decade some at- drawn to movies with alcohol because ever drinking and binge drinking. tention has been given to the question of favorable attitudes toward drinking of whether alcohol exposure in the at baseline). Empirically, they are ex- METHODS media might also account for variance tremely difficult to study, because Design, Procedure, and Study in young people’s alcohol consumption. usually only a small proportion of an Sample The theoretical background for these early- to mid-adolescent sample A school-based longitudinal study was studies is social learning theory, which belongs to this group, and analyses fail conducted in 6 European countries by suggests that behavior is learned from because of a lack of statistical power. research centers in Germany (Kiel), the environment as people observe and One could solve these sample size Iceland (Reykjavik), Italy (Turin and then imitate the actions of influential problems by studying younger age Novara), Poland (Poznan), Netherlands others.2 Such models include parents, groups (eg, 6- to 10-year-olds). How- (Nijmegen), and Scotland (Glasgow). friends, teachers, and characters ever, the central behavioral outcomes Study samples were all recruited depicted in the media or advertising. under question are alcohol use and from state-funded schools, with data For example, given access to cigarettes misuse initiation, and this cannot be collected through self-completion and alcohol in a Barbie play scenario, realistically studied in young children questionnaires overseen by trained preschool children will enact smoking or requires a long follow-up period. research staff. Participants were given and alcohol scripts in their play, scripts From 2009 to 2011 we conducted a large assurances about confidentiality and they have learned from watching their European study on the effects of movies anonymity, and each completed ques- 3 parents. on smoking and drinking behavior of tionnairewasplacedinanenvelopeand Alcohol portrayals are widespread in young people.12,19,20 In this study, 16 551 sealed in front of participants to re- the mass media. A recent content adolescents from 6 countries (from assure them that teachers, peers, or analysis of popularly viewed television Germany, Iceland, Italy, Poland, Neth- family members would not see them. To in the United Kingdom found that al- erlands, and Scotland) were inter- permit linking of the baseline and cohol imagery occurred in .40% of viewed at baseline, and .80% of these follow-up surveys, identical question- broadcasts.4 In movies, alcohol use and were followed up 12 months later. The naire front sheets allowed participants brand appearances are even more sample size of this study provides togenerate individual 7-charactercodes prevalent: Some 86% of movies popular a unique opportunity to perform sub- (based on prespecified digits or let- in the United Kingdom5 and 83% of sample analyses such as the one out- ters from memorable names and Hollywood blockbusters6 depicted al- lined earlier. In addition, it is one of the dates, including date of birth and cohol use. More importantly, results few longitudinal studies on alcohol use mother’s first name). This procedure from experimental7–9 and cross-sectional in movies and only the second ever has been tested in previous studies.23 observational studies10–12 have shown a conducted outside the United States. Ethical approval for the research was consistent link between exposure to The 6 European countries involved in gained from the relevant body in each alcohol use in movies and drinking the study show variation in