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 regres- sion 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 indi- vidual 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 Sdisease 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 differ- ential 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 attrac- tiveness 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 experi- mental 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 distrib- uted 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.