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Testimony of Madeline A. Dalton, Ph.D.

Before the Committee on Commerce, Science, and Transportation

May 11, 2004

Good afternoon. My name is Madeline Dalton. I’m an Associate Professor in the Department of Pediatrics and the Norris Cotton Cancer Center at Dartmouth Medical School. For the past 9 years, I’ve worked with a multi-disciplinary team of investigators studying the influence of behavioral and social risk factors for adolescent smoking. I’m honored to be here today and appreciate the opportunity to share with you the results of our most recent study, which looked at the influence of movies on adolescent smoking behavior.

Adolescents engage in a number of high risk health behaviors, but smoking is of particular concern because it is the leading cause of preventable death in our country. Smoking kills over 400,000 people in the US each year, which is more than the number of deaths caused by alcohol, illicit drugs, motor vehicles, sexual activity and firearms combined. 1 The period of greatest risk for smoking initiation is during childhood, particularly between 10 and 15 years of age. If we can prevent children from smoking until they reach their 18 th birthday, then their chance of becoming an addicted smoker is very low. This is the primary reason why we study, and try to prevent, risk factors for smoking initiation during adolescence.

Movies are potentially a very important social influence on adolescent smoking. Movies not only depict modern societal norms and styles, they help to define them. In popular contemporary movies, smoking is commonly associated with characteristics many adolescents find appealing, such as toughness, sexiness, and rebelliousness. 2 Cigarette brand appearances and smoking portrayals in movies endorse smoking behavior by associating it with larger-than-life actors, many of whom are social icons for adolescents. Adolescents are vulnerable to these portrayals, as they look to movie stars to help form their own identity and self-image.

In our study, we analyzed the smoking content of 600 top box-office hits released over the past decade. Eighty-five percent of these movies portrayed smoking. Movies were more likely to have smoking as the rating increased. For example, smoking was portrayed in approximately half of G-rated movies compared to 90% of R-rated movies. More than three quarters of PG and PG-13 movies, which are generally considered appropriate for adolescent audiences, featured smoking.

Prior research has shown that adolescents are more likely to smoke if their favorite movie stars smoke on-screen. 3,4 Experimental studies of adolescents suggest that viewing smoking in movies is associated with more positive attitudes toward smoking. 5 Our cross-sectional survey of almost 5000 adolescents showed that the more smoking adolescents viewed in movies, the more likely they were to have tried smoking themselves. 6 To validate these findings, we initiated a prospective follow-up study in 2000. 7 The goal of the prospective study was to determine if viewing smoking in movies predicted smoking initiation among adolescent never smokers.

The prospective study surveyed adolescents, 10-14 years of age, at 14 middle schools in Northern New England. We asked the students about their movie viewing, smoking behavior, and a number of other factors related to smoking, including peer and family smoking, school performance, child personality characteristics, parent education, parental monitoring, and parental disapproval of smoking. Through this survey, we identified 3547 adolescents who had never tried smoking. We re-contacted 73% (2603) of these adolescents by telephone one to two years after the initial survey to determine if they had initiated smoking. Overall, ten percent (259) of the students had initiated smoking.

Adolescents who saw the most amount of smoking in movies were much more likely to initiate smoking themselves. Seventeen percent (107) of those who had the highest exposure to smoking in movies had initiated smoking, compared to only 3% (22) of those who had the lowest exposure. We recognize that other factors, such as peer and family smoking, child personality characteristics, and parenting characteristics, also influence an adolescent’s decision to smoke. We included these in our analysis as possible alternative explanations for smoking initiation. Even after taking all of these factors into account, we found that adolescents who viewed the most smoking in movies were still 2.7 (95% CI: 1.7, 4.3) times more likely to try smoking compared to those who viewed the least amount of smoking in movies. The influence of movies on adolescent smoking initiation was greatest among children whose parents did not smoke, showing a four-fold increase in risk of smoking initiation when children with high exposure to movie smoking were compared to those with low exposure. Overall, even after controlling for all of the other factors, we found that half (52.2%; 95% CI: 30.0, 67.3) the adolescents who initiated smoking in this study did so because of viewing smoking in movies.

The results of this study confirm prior research by providing strong evidence that viewing smoking in movies promotes smoking initiation among adolescents. Children of non-smoking parents appear to be particularly susceptible to the influence of movie smoking, indicating that modeling non-smoking behavior in the home is not enough to prevent children from initiating smoking. Our findings indicate that eliminating or reducing adolescents’ exposure to smoking in movies could significantly reduce the number of adolescents who initiate smoking.

References:

1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. March 10, 2004 2004;291(10):1238-1245.

2. Dalton MA, Tickle JJ, Sargent JD, et al. The incidence and context of tobacco use in popular movies from 1988-1997. Prev Med. 2002;34(5):516-523.

3. Distefan JM, Gilpin EA, Sargent JD, Pierce JP. Do movie stars encourage adolescents to start smoking? Evidence from California. Prev Med. 1999;28(1):1-11.

4. Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton T. Favourite movie stars, their tobacco use in contemporary movies and its association with adolescent smoking. Tob Control. 2001;10(1):16-22.

5. Pechmann C, Shih CF. Smoking scenes in movies and antismoking advertisements before movies: Effects on youth. J Mark. 1999;63(3):1-13.

6. Sargent JD, Beach ML, Dalton MA, et al. Effect of seeing tobacco use in films on trying smoking among adolescents: Cross-sectional study. BMJ. 2001;323(7326):1394-1397.

7. Dalton MA, Sargent JD, Beach ML, Ahrens MB, Tickle JJ, Heatherton TF. Effect of viewing smoking in movies on adolescent smoking initiation: A cohort study. Lancet. 2003;362:281-285.

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