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Item does not contain fulltext, OBJECTIVES: To investigate the hypothesis that exposure to alcohol consumption in movies affects the likelihood that low-risk adolescents will start to drink alcohol. METHODS: Longitudinal study of 2346 adolescent never drinkers who also reported at baseline intent to not to do so in the next 12 months (mean age 12.9 years, SD = 1.08). Recruitment was carried out in 2009 and 2010 in 112 state-funded schools in Germany, Iceland, Italy, Netherlands, Poland, and Scotland. Exposure to movie alcohol consumption was estimated from 250 top-grossing movies in each country in the years 2004 to 2009. Multilevel mixed-effects Poisson regressions assessed the relationship between baseline exposure to movie alcohol consumption and initiation of trying alcohol, and binge drinking (>= 5 consecutive drinks) at follow-up. RESULTS: Overall, 40% of the sample initiated alcohol use and 6% initiated binge drinking by follow-up. Estimated mean exposure to movie alcohol consumption was 3653 (SD = 2448) occurrences. After age, gender, family affluence, school performance, TV screen time, personality characteristics, and drinking behavior of peers, parents, and siblings were controlled for, exposure to each additional 1000 movie alcohol occurrences was significantly associated with increased relative risk for trying alcohol, incidence rate ratio = 1.05 (95% confidence interval, 1.02-1.08; P =.003), and for binge drinking, incidence rate ratio = 1.13 (95% confidence interval, 1.06-1.20; P<.001). CONCLUSIONS: Seeing alcohol depictions in movies is an independent predictor of drinking initiation, particularly for more risky patterns of drinking. This result was shown in a heterogeneous sample of European youths who had a low affinity for drinking alcohol at the time of exposure.

Item does not contain fulltext, Background Based on evidence that exposure to smoking in movies is associated with adolescent smoking, the WHO has called on countries to assign a rating that restricts youth access to such movies. Objective To evaluate youth access to movies that portray smoking in European countries and compare with that in the USA. Methods The authors identified the most commercially successful movies screened in six European countries (Germany, Iceland, Italy, the Netherlands, Poland and UK) and the USA between 2004 and 2009. The authors coded the 464 movies that were screened in both Europe and the USA according to whether or not they portrayed smoking. Results 87% of the movies were ‘youth’ rated in Europe (ratings board classification as suitable for those younger than 16 years) compared to only 67% in the USA (suitable for those younger than 17 years). Smoking was portrayed in 319 (69%) movies. 85% of the movies that portrayed smoking were ‘youth’ rated in Europe compared with only 59% in the USA (p<0.001). Conclusions Tobacco imagery is still common in popular films shown in European countries and the USA. None of the seven countries examined followed the WHO recommendations on restricting youth access to movies that portray smoking. Compared to the USA, European youths have access to substantially more movies in general, and this gives them access to more movies that portray smoking in particular.

Item does not contain fulltext, Seeing smoking depictions in movies has been identified as a determinant of smoking in adolescents. Little is known about how such media influences interact with other social risk factors. Differences in smoking rates in different socio-economic status groups might be explainable by differences in media exposure. There might also be differences in the average response to movie smoking exposure. We tested this hypothesis within a cross-national study conducted in six European countries. A total of 16,551 pupils from Germany, Iceland, Italy, Netherlands, Poland, and Scotland with a mean age of 13.4 years (SD = 1.18) were recruited from 114 state funded schools. Using previously validated methods, exposure to smoking depictions in movies was estimated for each student and related to ever smoking. The analysis was stratified by level of family affluence (low, medium, high) and migration history of parents (yes vs. no), controlling for a number of covariates like age, gender, school performance, television screen time, sensation seeking and rebelliousness and smoking within the social environment (peers, parents, siblings). We found a significant association for each category of family affluence and ethnicity between ever smoking and movie smoking exposure, also significant adjusted odds ratios for age, school performance, sensation seeking, peer smoking, mother smoking, and sibling smoking. This relationship between movie smoking and adolescent smoking was not moderated by family affluence or ethnicity. Although we used a very broad measure of economic status and migration history, the results suggest that the effects of exposure to movie smoking can be generalized to the population of youths across European countries.

Item does not contain fulltext, Background: Longitudinal studies from the U.S. suggest a causal relationship between exposure to images of smoking in movies and adolescent smoking onset. Purpose: This study investigates whether adolescent smoking onset is predicted by the amount of exposure to smoking in movies across six European countries with various cultural and regulatory approaches to tobacco. Methods: Longitudinal survey of 9987 adolescent never-smokers recruited in the years 2009 2010 (mean age=13.2 years) in 112 state-funded schools from Germany, Iceland, Italy, The Netherlands, Poland, and the United Kingdom (UK), and followed up in 2011. Exposure to movie smoking was estimated from 250 top-grossing movies in each country. Multilevel mixed-effects Poisson regressions were performed in 2012 to assess the relationship between exposure at baseline and smoking status at follow-up. Results: During the observation period (M=12 months), 17% of the sample initiated smoking. The estimated mean exposure to on-screen tobacco was 1560 occurrences. Overall, and after controlling for age; gender; family affluence; school performance; TV screen time; personality characteristics; and smoking status of peers, parents, and siblings, exposure to each additional 1000 tobacco occurrences increased the adjusted relative risk for smoking onset by 13% (95% CI=8%, 17%, p<0.001). The crude relationship between movie smoking exposure and smoking initiation was significant in all countries; after covariate adjustment, the relationship remained significant in Germany, Iceland, The Netherlands, Poland, and UK. Conclusions: Seeing smoking in movies is a predictor of smoking onset in various cultural contexts. The results confirm that limiting young people's exposure to movie smoking might be an effective way to decrease adolescent smoking onset.

Item does not contain fulltext, OBJECTIVE: The goal of this study was to investigate whether the association between exposure to images of alcohol use in movies and binge drinking among adolescents is independent of cultural context. METHODS: A cross-sectional survey study in 6 European countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland) was conducted. A total of 16 551 pupils from 114 public schools with a mean (+/- SD) age of 13.4 (+/- 1.18) years participated. By using previously validated methods, exposure to alcohol use in movies was estimated from the 250 top-grossing movies of each country (years 2004-2009). Lifetime binge drinking was the main outcome measure. RESULTS: Overall, 27% of the sample had consumed >5 drinks on at least 1 occasion in their life. After controlling for age, gender, family affluence, school performance, television screen time, sensation seeking and rebelliousness, and frequency of drinking of peers, parents, and siblings, the adjusted beta-coefficient for lifetime binge drinking in the entire sample was 0.12 (95% confidence interval: 0.10-0.14; P < .001). The crude relationship between movie alcohol use exposure and lifetime binge drinking was significant in all countries; after covariate adjustment, the relationship was still significant in 5 of 6 countries. A sensitivity analysis revealed that the association is content specific, as there was no significant association between lifetime binge drinking and exposure to smoking in movies. CONCLUSIONS: The link between alcohol use in movies and adolescent binge drinking was robust and seems relatively unaffected by cultural contexts.

Item does not contain fulltext, 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