Exposure to smoking in internationally distributed American movies and youth smoking in Germany: a cross-cultural cohort study

Pediatrics. 2008 Jan;121(1):e108-17. doi: 10.1542/peds.2007-1201.


Objective: Studies of US adolescents have linked exposure to movie smoking with smoking behavior. It is unclear whether European adolescents are also responsive to movie tobacco imagery.

Methods: A longitudinal study was conducted to assess exposure to movie smoking in 2711 German never-smokers (aged 10 to 16 years). Movie smoking exposure was estimated by asking adolescents if they had seen movies from a list of 50 movie titles, randomly selected for each adolescent from 398 internationally distributed movies released between 1994 and 2004 that became box-office hits in Germany. These films were reviewed for smoking content. Adolescents were resurveyed 12 to 13 months later to determine smoking status, and results were compared with a similarly designed survey of 2603 white US adolescents. We hypothesized replication of the main effect of the exposure on trying smoking, and an interaction, with a significantly larger response among adolescents whose parents did not smoke.

Results: The 398 internationally distributed movies represented 80% of the German box-office hits within this time frame, with the majority (388) produced and/or distributed internationally by US companies. Smoking was present in 74% of the movies. Overall, 503 (19%) of the students tried smoking during the follow-up period. The incidence of trying smoking was associated with increased exposure to movie smoking. The form of the dose-response was similar to the US sample, with the strongest response to movies seen in the lower 2 quartiles of exposure. After controlling for baseline covariates, exposure to movie smoking remained a significant predictor of trying smoking in German adolescents, and the effect was significantly stronger in adolescents whose parents did not smoke.

Conclusions: Smoking in internationally distributed US movies predicts trying smoking among German adolescents, closely replicating findings from a longitudinal study of white US adolescents. Smoking in these movies could have important worldwide public health implications.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Cohort Studies
  • Cross-Cultural Comparison
  • Female
  • Germany / epidemiology
  • Global Health
  • Humans
  • Imitative Behavior*
  • International Cooperation
  • Linear Models
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Motion Pictures*
  • Population Groups / psychology
  • Prevalence
  • Probability
  • Sex Distribution
  • Smoking / epidemiology*
  • Smoking / psychology*
  • United States