Background: Studies have linked exposure to movie smoking and smoking initiation among adolescents in the United States, but there has been only one published study of adolescents outside the U.S.
Method: A cross-sectional survey of 5586 schoolchildren aged 10-17 with a mean of 12.8 (SD=1.2) years from randomly selected secondary schools in Schleswig-Holstein, Germany, was taken in October/November 2005. In August 2006, using previously validated methods, exposure to movie smoking was estimated from 398 internationally distributed films (98% produced and distributed by U.S. studios) released in Germany and examined its relationship with ever and current (30-day) smoking.
Results: Overall, 40.7% of the sample had tried smoking, and 12.3% were current smokers. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of smoking initiation: 0.17 of adolescents in Q1 had tried smoking; 0.35 in Q2; 0.47 in Q3; and 0.64 in Q4. Movie smoking exposure was significantly associated with the prevalence of current smoking: 0.03 for adolescents in Q1; 0.08 in Q2; 0.14 in Q3; and 0.25 in Q4. After controlling for sociodemographics, parent/friend/sibling smoking, school performance, personality characteristics, TV consumption, receptivity to tobacco marketing, and parenting style, the adjusted odds ratios for having tried smoking were 1.7 (95% confidence interval [CI]=1.4-2.1) for Q2, 1.8 (95% CI=1.5-2.3) for Q3, and 2.2 (95% CI=1.8-2.8) for Q4 compared with adolescents in Q1. The adjusted odds ratios for current smoking were 1.4 (95% CI=0.9-2.2) for Q2, 1.7 (95% CI=1.1-2.6) for Q3, and 2.0 (95% CI=1.3-3.1) for Q4 compared with adolescents in Q1.
Conclusions: Smoking in internationally distributed movies is associated with ever and current smoking among German adolescents. This suggests the need for prospective studies of this association in countries other than the U.S. and research into the potential impact of countrywide policies that would limit exposure of young adolescents to movie smoking.