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Effect of seeing tobacco use in films on trying smoking among adolescents: cross sectional study

BMJ 2001; 323 doi: (Published 15 December 2001) Cite this as: BMJ 2001;323:1394
  1. James D Sargent, associate professor (James.D.Sargent{at},
  2. Michael L Beach, associate professorb,
  3. Madeline A Dalton, research assistant professora,
  4. Leila A Mott, senior analystc,
  5. Jennifer J Tickle, program managerd,
  6. M Bridget Ahrens, program managera,
  7. Todd F Heathertond, professor
  1. a Department of Pediatrics, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA
  2. b Department of Anesthesia, Dartmouth Medical School
  3. c Department of Community and Family Medicine, Dartmouth Medical School
  4. d Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA
  1. Correspondence to: J D Sargent
  • Accepted 29 August 2001


Objective: To test the hypothesis that greater exposure to smoking in films is associated with trying smoking among adolescents.

Design: Cross sectional survey of 4919 schoolchildren aged 9–15 years, and assessment of occurrence of smoking in 601 films.

Setting: Randomly selected middle schools in Vermont and New Hampshire, USA.

Main outcome measure: Number of schoolchildren who had ever tried smoking a cigarette.

Results: The films contained a median of 5 (interquartile range 1-12) occurrences of smoking. The typical adolescent had seen 17 of 50 films listed. Exposure to smoking in films varied widely: median 91 (49–152) occurrences. The prevalence of ever trying smoking increased with higher categories of exposure: 4.9% among students who saw 0–50 occurrences of smoking, 13.7% for 51–100 occurrences, 22.1% for 101-150, and 31.3% for >150. The association remained significant after adjustment for age; sex; school performance; school; parents' education; smoking by friend, sibling, or parent; and receptivity to tobacco promotions. The adjusted odds ratios of ever trying smoking for students in the higher categories of exposure, compared with students exposed to 0–50 occurrences of smoking in films, were 1.7 (95% confidence interval 1.2 to 2.4), 2.4 (1.7 to 3.4), and 2.7 (2.0 to 3.8). These odds ratios were not substantially affected by adjustment for parenting style or for personality traits of the adolescent.

Conclusion: In this sample of adolescents there was a strong, direct, and independent association between seeing tobacco use in films and trying cigarettes, a finding that supports the hypothesis that smoking in films has a role in the initiation of smoking in adolescents.

What is already known on this topic

What is already known on this topic Smoking is often depicted in films, and watching films is a favourite activity of adolescents

Adolescents whose favourite actors smoke in films are more likely to have tried smoking

What this study adds

What this study adds Adolescents' exposure to smoking in films varies widely

Adolescents with higher exposure are significantly more likely to have tried smoking, even when other factors linked with adolescent smoking have been taken into account

This study supports the hypothesis that depictions of smoking in films influence adolescents to smoke


  • Funding National Cancer Institute grant CA-77026.

  • Competing interests None declared.

  • Accepted 29 August 2001
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