Smoking in film and impact on adolescent smoking: with special reference to European adolescents.

This review examines the evidence supporting an association between seeing smoking depictions in movies and adolescent smoking. The portrayal of tobacco use is common in movies and often modeled by movie stars who, from a social influences standpoint, should be powerful behavior change agents. The results of studies assessing audience responses to tobacco portrayal in movies are remarkably consistent in showing a moderate to strong association between seeing movie smoking and more positive attitudes toward smoking and adolescent smoking initiation. The population-based data include cross sectional samples from different regions of the United States, all supporting a movie smoking-teen smoking link. The 2 published longitudinal studies show an independent link between exposure to movie smoking at baseline and initiation in the future, with estimates of the effect size being remarkably consistent with their cross-sectional counterparts. Experimental research adds support by showing that scene depictions of smoking enhance positive views of smokers and increase intent to smoke in the future. Taken as a whole, this rich research base provides very strong support for the notion that movie smoking plays a role in smoking initiation among adolescents that warrants action at the individual and societal level. A major gap in our understanding is the impact of Hollywood movies on adolescents outside the United States. There is a real need for studies to be conducted in European and other populations to better understand the global reach of smoking in American film, since over half of box office revenues come from outside the United States.