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Cinema smoking encourages the habit in adolescents
  1. A Rajasekaran
  1. Birmingham Heartlands Hospital, Birmingham, UK, Arvind.Rajasekaran{at}

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Many studies have linked tobacco marketing with an increased uptake of smoking in adolescents. In this longitudinal study 3547 students aged 10–14 years who attended schools in Vermont and New Hampshire, USA and who had never smoked previously were assessed for exposure to smoking in cinemas. Fifty movies were randomly selected from popular contemporary cinema. Trained coders counted the number of smoking occurrences in each movie and exposure to movie smoking was classified in quartiles. At baseline, confounding variables such as grade in school, sex, friend smoking, sibling smoking, and parental smoking were measured. 2603 (73%) students were re-contacted 13–26 months later to ascertain smoking initiation in the interval period.

On average, the students had seen 16 of the 50 movies and were exposed to a mean (SD) of 98.5 (75.1) smoking occurrences; 259 (10%) had started smoking in the follow up period, 107 (17%) in the group with the highest quartile of smoking exposure and 22 (3%) in the group with the lowest quartile. This represents a relative risk of 2.71 (95% CI 1.73 to 4.25) between the two groups after correcting for other confounding variables. Although students with smoking parents had an overall higher risk of smoking initiation, the effect of smoking in cinemas was stronger in adolescents with non-smoking parents; 52.2% of smoking initiation was directly attributed to seeing smoking in movies.

This prospective study serves to establish a strong temporal and causal relationship between viewing smoking in movies and initiation of smoking among adolescents.

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