Exposure to smoking in films and own smoking among Scottish adolescents: a cross-sectional study

Abstract

Background: Evidence of high exposure of UK youth to images of smoking in films has led to calls for an 18 rating for films with smoking to reduce smoking in youth. However, the only study to date in the UK to test for an association showed no relation between film-smoking exposure and smoking among young adults.

Objective: To assess whether there is an association between exposure to film images of smoking and own smoking among UK adolescents and whether repeated viewings of films has an impact.

Design: Cross-sectional study.

Participants: 1999 pupils aged 15-16 years from 13 Scottish schools. Outcome Smoked tobacco in the past year. EXPOSURE MEASURE: Film-smoking exposure was assessed using the Beach method; account for repeated viewings of films was then used to modify estimated exposure. Covariates included: media usage, parental restriction on and context of TV/film viewing, family connectedness, parental monitoring and friends' smoking.

Results: Most (71%) students had not smoked in the past year. About half reported no parental restrictions on TV/film viewing. Many reported repeated viewings of films; accounting for this more than doubled exposure estimates and strengthened the association with smoking. Adolescents with high exposure to film smoking were more likely to have smoked than those with low exposure (adjusted odds ratio (AOR) 2.08, 95% CI 1.22 to 3.55). Additionally, adolescents who reported parental rules about TV/film watching were less likely to smoke (AOR 0.37 (0.27 to 0.52)) than those who did not. Adolescents who mainly watched films with friends had higher exposure to film smoking and were more likely to smoke (AOR 2.19 (1.10 to 4.38)).

Conclusions: Exposure to film smoking is associated with smoking among Scottish adolescents. These data lend support to calls for an 18 rating for films with images of smoking.

Figure 1

Lowess plot comparing the crude dose–response to higher exposure to film smoking with greater parental TV/film restrictions. Approximately 15% of adolescents with lowest exposure to film-smoking have tried smoking compared with 33% for those with highest exposure levels. Approximately 38% of adolescents reporting no parental TV/film restrictions have tried smoking (these adolescents represent about half of adolescents in the sample), whereas almost none with multiple restrictions have tried smoking.