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Smoking in movies and adolescent smoking: cross-cultural study in six European countries
  1. Matthis Morgenstern1,2,
  2. Evelien A P Poelen3,
  3. Ron Scholte3,
  4. Solveig Karlsdottir4,
  5. Stefán Hrafn Jonsson4,5,
  6. Federica Mathis6,
  7. Fabrizio Faggiano6,7,
  8. Ewa Florek8,
  9. Helen Sweeting9,
  10. Kate Hunt9,
  11. James D Sargent10,
  12. Reiner Hanewinkel1,2
  1. 1Institute for Therapy and Health Research, Kiel, Germany
  2. 2Institute for Medical Psychology and Medical Sociology, University Hospital Schleswig-Holstein, Kiel, Germany
  3. 3Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
  4. 4Directorate of Health, Reykjavik, Iceland
  5. 5University of Iceland, Reykjavik, Iceland
  6. 6Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco (TO), Italy
  7. 7Avogadro University, Novara, Italy
  8. 8Laboratory of Environmental Research, Department of Toxicology, University of Medical Sciences, Poznan, Poland
  9. 9Medical Research Council (MRC) Social & Public Health Sciences Unit, Glasgow, UK
  10. 10Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire, USA
  1. Correspondence to Professor Reiner Hanewinkel, Institute for Therapy and Health Research (IFT-Nord), Harmsstrasse 2, 24114 Kiel, Germany; hanewinkel{at}


Aim To investigate whether the association between exposure to smoking in movies and smoking among youth is independent of cultural context.

Method Cross-sectional survey of 16 551 pupils recruited in Germany, Iceland, Italy, the Netherlands, Poland and Scotland with a mean age of 13.4 years (SD=1.18) and an equal gender distribution. School-based surveys were conducted between November 2009 and June 2010. Using previously validated methods, exposure to movie smoking was estimated from the 250 top-grossing movies of each country (years 2004–2009) and related to ever smoking.

Results Overall, 29% of the sample had tried smoking. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of ever smoking: 14% of adolescents in Q1 had tried smoking, 21% in Q2, 29% in Q3 and 36% in Q4. After controlling for age, gender, family affluence, school performance, television screen time, number of movies seen, sensation seeking and rebelliousness and smoking within the social environment (peers, parents and siblings), the adjusted ORs for having tried smoking in the entire sample were 1.3 (95% CI 1.1 to 1.5) for adolescents in Q2, 1.6 (95% CI 1.4 to 1.9) for Q3 and 1.7 (95% CI 1.4 to 2.0) for Q4 compared with Q1. The adjusted relationship between ever smoking and higher movie smoking exposure levels was significant in all countries with a non-linear association in Italy and Poland.

Conclusions The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Limiting young people's exposure to movie smoking could have important public health implications.

  • Movies
  • smoking
  • youth
  • exposure
  • Europe
  • clinical epidemiology
  • complementary medicine
  • tobacco and the lung

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  • See Editorial, p 844

  • Linked articles 200095, 200053, 200789

  • Funding European Commission, Ministry of Health of the Federal Republic of Germany. The coding of the US movies was supported by the National Institutes of Health (grant NIH CA 077028). The Scottish fieldwork was supported by additional funds from the UK Medical Research Council (MC_US_A540_0041).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Study implementation was approved in all six study centres by the respective ethical boards and data protection agencies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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