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Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study

ABSTRACT
Objective To assess associations between exposure to
smoking depictions in films and adolescent tobacco use
in a British population cohort.
Methods Data on exposure to smoking in films and
smoking behaviour were collected from 5166 15-year-old
adolescents in the UK. Main outcome measures were
smoking initiation (ever tried a cigarette) and current
smoking status. Social, family and behavioural factors
were adjusted for, together with alcohol use and peer
smoking as potential mediators. Data from all existing
cross-sectional studies examining the effects of exposure
to smoking in films were summarised in a meta-analysis.
Results Higher exposure to smoking in films was
associated with a dose-response increase in the risk of
smoking initiation even after adjusting for confounders.
Adolescents in the highest exposure quartile were 1.73
(95% CI 1.55 to 1.93) times (RR) more likely to initiate
smoking than those in the lowest quartile. They were more
likely to report current smoking after adjusting for social and
familial factors (RR 1.47 (95% CI 1.07 to 2.02)), but the
association attenuated after including behavioural factors
(RR 1.34 (95% CI 0.95 to 1.87)). The meta-analysis shows
that, after aggregation of all relevant data, viewing smoking
in films increases the risk of smoking onset by over 100%
(combined RR 2.13 (95% CI 1.76 to 2.57)) and the risk of
current or established smoking behaviour by 68%
(combined RR 1.68 (95% CI 0.40 to 2.01)).
Conclusions This study provides evidence that
adolescents in the UK and elsewhere who are exposed to
smoking depictions in films are more likely to initiate
smoking. Given the association between smoking and poor
health outcomes, these data justify a review of film ratings

ABSTRACTObjective To assess associations between exposure tosmoking depictions in films and adolescent tobacco usein a British population cohort.Methods Data on exposure to smoking in films andsmoking behaviour were collected from 5166 15-year-oldadolescents in the UK. Main outcome measures weresmoking initiation (ever tried a cigarette) and currentsmoking status. Social, family and behavioural factorswere adjusted for, together with alcohol use and peersmoking as potential mediators. Data from all existingcross-sectional studies examining the effects of exposureto smoking in films were summarised in a meta-analysis.Results Higher exposure to smoking in films wasassociated with a dose-response increase in the risk ofsmoking initiation even after adjusting for confounders.Adolescents in the highest exposure quartile were 1.73(95% CI 1.55 to 1.93) times (RR) more likely to initiatesmoking than those in the lowest quartile. They were morelikely to report current smoking after adjusting for social andfamilial factors (RR 1.47 (95% CI 1.07 to 2.02)), but theassociation attenuated after including behavioural factors(RR 1.34 (95% CI 0.95 to 1.87)). The meta-analysis showsthat, after aggregation of all relevant data, viewing smokingin films increases the risk of smoking onset by over 100%(combined RR 2.13 (95% CI 1.76 to 2.57)) and the risk ofcurrent or established smoking behaviour by 68%(combined RR 1.68 (95% CI 0.40 to 2.01)).Conclusions This study provides evidence thatadolescents in the UK and elsewhere who are exposed tosmoking depictions in films are more likely to initiatesmoking. Given the association between smoking and poorhealth outcomes, these data justify a review of film ratings

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