Comparing media and family predictors of alcohol use: a cohort study of US adolescents.

OBJECTIVE: To compare media/marketing exposures and family factors in predicting adolescent alcohol use. DESIGN: Cohort study. SETTING: Confidential telephone survey of adolescents in their homes. PARTICIPANTS: Representative sample of 6522 US adolescents, aged 10-14 years at baseline and surveyed four times over 2 years. PRIMARY OUTCOME MEASURE: Time to alcohol onset and progression to binge drinking were assessed with two survival models. Predictors were movie alcohol exposure (MAE), ownership of alcohol-branded merchandise and characteristics of the family (parental alcohol use, home availability of alcohol and parenting). Covariates included sociodemographics, peer drinking and personality factors. RESULTS: Over the study period, the prevalence of adolescent ever use and binge drinking increased from 11% to 25% and from 4% to 13%, respectively. At baseline, the median estimated MAE from a population of 532 movies was 4.5 h and 11% owned alcohol-branded merchandise at time 2. Parental alcohol use (greater than or equal to weekly) was reported by 23% and 29% of adolescents could obtain alcohol from home. Peer drinking, MAE, alcohol-branded merchandise, age and rebelliousness were associated with both alcohol onset and progression to binge drinking. The adjusted hazard ratios for alcohol onset and binge drinking transition for high versus low MAE exposure were 2.13 (95% CI 1.76 to 2.57) and 1.63 (1.20 to 2.21), respectively, and MAE accounted for 28% and 20% of these transitions, respectively. Characteristics of the family were associated with alcohol onset but not with progression. CONCLUSION: The results suggest that family focused interventions would have a larger impact on alcohol onset while limiting media and marketing exposure could help prevent both onset and progression.

Media as social influence: racial differences in the effects of peers and media on adolescent alcohol cognitions and consumption.

Racial differences in the effects of peer and media influence on adolescents' alcohol cognitions and consumption were examined in a large-scale panel study. With regard to peer influence, results from cross-lagged panel analyses indicated that the relation between perceived peer drinking and own drinking was significant for both Black and White adolescents, but it was stronger for the White adolescents. With regard to media influence, structural modeling analyses indicated that exposure to drinking in movies was associated with more alcohol consumption 8 months and 16 months later. These effects were mediated by increases in the favorability of the adolescents' drinker prototypes, their willingness to drink, and their tendency to affiliate with friends who were drinking. Multiple group analyses indicated that, once again, the effects (both direct and indirect) were much stronger for White adolescents than for Black adolescents. The results suggest media influence works in a similar manner to social influence and that Whites may be more susceptible to both types of influence.

R-rated movie viewing, growth in sensation seeking and alcohol initiation: reciprocal and moderation effects.

The current study employed parallel process and discrete time hazard regressions to examine the interplay among exposure to R-rated movies, sensation seeking, and initiation of alcohol use in a national U.S. sample (N = 6255) of adolescents, ages 10-14, who were followed over four waves spanning 2 years. There was a short-term reciprocal relation between watching R-rated movies and sensation seeking, but over the 2-year observation period, exposure to R-rated movies was associated with increases in sensation seeking and not vice versa. Sensation seeking also moderated the effect of watching R-rated movies on initiation of alcohol consumption such that exposure was associated with greater increases in initiation of alcohol use among low sensation than among high sensation seeking adolescents. The study provides empirical evidence of an environmental media effect on sensation seeking, and important new information about the relations among sensation seeking, media exposure, and adolescent alcohol use.

Watching and drinking: expectancies, prototypes, and friends' alcohol use mediate the effect of exposure to alcohol use in movies on adolescent drinking.

OBJECTIVE: To investigate the psychological processes that underlie the relation between exposure to alcohol use in media and adolescent alcohol use. DESIGN: The design consisted of a structural equation modeling analysis of data from four waves of a longitudinal, nationally representative, random-digit dial telephone survey of adolescents in the United States. MAIN OUTCOME MEASURES: The main outcome measures were adolescent alcohol consumption and willingness to use alcohol. Tested mediators were alcohol-related norms, prototypes, expectancies, and friends' use. RESULTS: Alcohol prototypes, expectancies, willingness, and friends' use of alcohol (but not perceived prevalence of alcohol use among peers) were significant mediators of the relation between movie alcohol exposure and alcohol consumption, even after controlling for demographic, child, and family factors associated with both movie exposure and alcohol consumption. CONCLUSION: Established psychological and interpersonal predictors of alcohol use mediate the effects of exposure to alcohol use in movies on adolescent alcohol consumption. The findings suggest that exposure to movie portrayals may operate through similar processes as other social influences, highlighting the importance of considering these exposures in research on adolescent risk behavior.

Alcohol-branded merchandise and its association with drinking attitudes and outcomes in US adolescents.

OBJECTIVE: To describe ownership of alcohol-branded merchandise (ABM) and its association with attitudinal susceptibility, initiation of alcohol use, and binge drinking. DESIGN: Three-wave longitudinal study. SETTING: Confidential telephone survey. PARTICIPANTS: Representative US sample of 6522 adolescents aged 10 to 14 years at baseline survey (4309 of whom were never-drinkers at 8 months); subjects were resurveyed at 16 and/or 24 months. Main Exposures Ownership of ABM (first assessed at the 8-month survey) and attitudinal susceptibility to alcohol use. OUTCOME MEASURES: Initiation of alcohol use that parents did not know about and binge drinking (> or =5 drinks in a row). RESULTS: Prevalence of ABM ownership ranged from 11% of adolescents (at 8 months) to 20% (at 24 months), which extrapolates to 2.1 to 3.1 million US adolescents, respectively. Clothing and headwear comprised 88% of ABM. Beer brands accounted for 75% of items; 45% of items bore the Budweiser label. Merchandise was obtained primarily from friends and/or family (71%) but was also purchased by the adolescents themselves (24%) at stores. Among never-drinkers, ABM ownership and susceptibility were reciprocally related, each significantly predicting the other during an 8-month period. In turn, we found that ABM ownership and susceptibility predicted both initiation of alcohol use and binge drinking, while controlling for a broad range of covariates. CONCLUSIONS: Alcohol-branded merchandise is widely distributed among US adolescents, who obtain the items one-quarter of the time through direct purchase at retail outlets. Among never-drinkers, ABM ownership is independently associated with susceptibility to as well as with initiation of drinking and binge drinking.

Youth exposure to alcohol use and brand appearances in popular contemporary movies.

AIMS: To describe alcohol use and alcohol brand appearances in popular movies and estimate adolescents' exposure to this alcohol-related content. DESIGN AND SETTING: Nationally representative, random-digit dialed survey in the United States and content analysis of alcohol depictions in the top 100 US box office hits each year from 1998 to 2002 and 34 top movies from early 2003. PARTICIPANTS: A total of 6522 US adolescents aged 10-14 years. MEASUREMENTS: Frequency of alcohol use and brand appearances in movies by Motion Picture Association of America (MPAA) rating. Estimated exposure to minutes of movie alcohol use and brand appearances among US adolescents in this age group. FINDINGS: Most movies (83%, including 56.6% of G/PG-rated movies) depicted alcohol use and 52% (including 19.2% of G/PG movies) contained at least one alcohol brand appearance, which consisted of branded use by an actor 30.3% of the time. These movies exposed the average US adolescent 10-14 years of age to 5.6 [95% confidence interval (CI) 5.4, 5.7] hours of movie alcohol use and 243.8 (95% CI 238, 250) alcohol brand appearances (5 billion in total), mainly from youth-rated movies. Exposure to movie alcohol content was significantly higher among African American youth than youth of other races. CONCLUSIONS: Alcohol use and brand appearances are portrayed frequently in popular US movies (which are distributed world-wide). Children and adolescents in the United States are exposed to hours of alcohol use depictions and numerous brand appearances in movies and most of this exposure is from movies rated for this segment of the population.

Exposure of US adolescents to extremely violent movies.

OBJECTIVE: Despite concerns about exposure to violent media, there are few data on youth exposure to violent movies. In this study we examined such exposure among young US adolescents. METHODS: We used a random-digit-dial survey of 6522 US adolescents aged 10 to 14 years fielded in 2003. Using previously validated methods, we determined the percentage and number of US adolescents who had seen each of 534 recently released movies. We report results for the 40 that were rated R for violence by the Motion Picture Association of America, UK 18 by the British Board of Film Classification and coded for extreme violence by trained content coders. RESULTS: The 40 violent movies were seen by a median of 12.5% of an estimated 22 million US adolescents aged 10 to 14 years. The most popular violent movie, Scary Movie, was seen by >10 million (48.1%) children, 1 million of whom were 10 years of age. Watching extremely violent movies was associated with being male, older, nonwhite, having less-educated parents, and doing poorly in school. Black male adolescents were at particularly high risk for seeing these movies; for example Blade, Training Day, and Scary Movie were seen, respectively, by 37.4%, 27.3%, and 48.1% of the sample overall versus 82.0%, 81.0%, and 80.8% of black male adolescents. Violent movie exposure was also associated with measures of media parenting, with high-exposure adolescents being significantly more likely to have a television in their bedroom and to report that their parents allowed them to watch R-rated movies. CONCLUSIONS: This study documents widespread exposure of young US adolescents to movies with extreme graphic violence from movies rated R for violence and raises important questions about the effectiveness of the current movie-rating system.

Population-Based Assessment of Exposure to Risk Behaviors in Motion Pictures.

The aim of most population-based studies of media is to relate a specific exposure to an outcome of interest. A research program has been developed that evaluates exposure to different components of movies in an attempt of assess the association of such exposure with the adoption of substance use during adolescence. To assess exposure to movie substance use, one must measure both viewing time and content. In developing the exposure measure, the study team was interested in circumventing a common problem in exposure measurement, where measures often conflate exposure to media with attention to media. Our aim in this paper is to present a validated measure of exposure to entertainment media, the Beach method, which combines recognition of a movie title with content analysis of the movie for substance use, to generate population based measures of exposure to substance use in this form of entertainment.

Movie exposure to smoking cues and adolescent smoking onset: a test for mediation through peer affiliations.

OBJECTIVE: To determine whether the effect of movie exposure to smoking on adolescent smoking onset is mediated through increased affiliation with peers who smoke. DESIGN: A longitudinal study was conducted with a sample of 5th- 8th graders; persons who were nonsmokers at the baseline assessment (N = 2,614) were followed up 18 months later. Movie exposure to smoking cues was assessed at baseline with a rigorous coding procedure. MAIN OUTCOME MEASURE: A school-based survey and follow-up telephone interview determined whether the participant smoked cigarettes. RESULTS: Longitudinal structural modeling analysis indicated movie-smoking exposure was related to smoking onset both through an indirect effect involving increased affiliation with peer smokers and through a direct effect. The analysis controlled for demographics, parenting style, rebelliousness and sensation seeking, school performance, parental smoking, and sibling smoking; several of these variables also had mediated or direct effects to smoking onset. CONCLUSION: The effect of movie exposure on adolescent smoking onset is attributable in part to a social mechanism. Implications of media effects for prevention are discussed.

Exposure to smoking depictions in movies: its association with established adolescent smoking.

OBJECTIVE: To assess the association between exposure to movie smoking and established adolescent smoking. DESIGN: Longitudinal survey of a representative US adolescent sample. SETTING: Adolescents were surveyed by telephone in their homes. PARTICIPANTS: Sixty-five hundred twenty-two US adolescents aged 10 to 14 years at baseline, resurveyed at 8 months (8M) (n = 5503), 16 months (16M) (n = 5019), and 24 months (24M) (n = 4575). Main Exposure Exposure to smoking in 532 box-office hits released in the 5 years prior to the baseline survey. Outcome Measure Established smoking (having smoked more than 100 cigarettes during lifetime). RESULTS: Of 108 incident established smokers with data at the 24M survey, 85% were current (30-day smokers) and 83% endorsed at least 1 addiction symptom. Established smoking incidence was 7.4, 15.8, and 19.7 per 1000 person-years of observation for the baseline-to-8M, 8M-to-16M, and 16M-to-24M observation periods, respectively. In a multivariate survival model, risk of established smoking was predicted by baseline exposure to smoking in movies with an adjusted overall hazard ratio of 2.04 (95% confidence interval, 1.01-4.12) for teens in the 95th percentile of movie-smoking exposure compared with the 5th percentile. This effect was independent of age; parent, sibling, or friend smoking; and sensation seeking. Teens low on sensation seeking were more responsive to the movie-smoking effect (hazard ratio, 12.7; 95% confidence interval, 2.0-80.6) compared with teens who were high on sensation seeking (hazard ratio, 1.01; 95% confidence interval, 0.4-2.6). CONCLUSION: In this national US adolescent sample, exposure to smoking in movies predicted risk of becoming an established smoker, an outcome linked with adult dependent smoking and its associated morbidity and mortality.

Prevalence of smoking among major movie characters: 1996-2004.

BACKGROUND: Reports of a relationship between watching smoking in movies and smoking among adolescents have prompted greater scrutiny of smoking in movies by the public health community. OBJECTIVE: To assess the smoking prevalence among adult and adolescent movie characters, examine trends in smoking in movies over time, and compare the data with actual smoking prevalence among US adults and adolescents. DESIGN AND METHODS: Smoking status of all major human adolescent and adult movie characters in the top 100 box office hits from 1996 to 2004 (900 movies) was assessed, and smoking prevalence was examined by Motion Picture Association of America (MPAA) rating and year of release. RESULTS: The movies contained 5944 major characters, of whom 4911 were adults and 466 were adolescents. Among adult movie characters, the overall smoking prevalence was 20.6%; smoking was more common in men than in women (22.6% v 16.1%, respectively, p<0.001), and was related to MPAA rating category (26.9% for movies rated R (restricted, people aged <17 years require accompanying adult), 17.9% for PG-13 (parents strongly cautioned that some material might be inappropriate for children) and 10.4% for G/PG (general audiences, all ages; parental guidance suggested for children), p<0.001). In 1996, the smoking prevalence for major adult movie characters (25.7%) was similar to that in the actual US population (24.7%). Smoking prevalence among adult movie characters declined to 18.4% in 2004 (p for trend <0.001), slightly below that for the US population for that year (20.9%). Examination of trends by MPAA rating showed that the downward trend in smoking among adult movie characters was statistically significant in movies rated G/PG and R, but not in those rated PG-13. A downward trend over time was also found for smoking among adolescent movie characters. There was no smoking among adult characters in 43.3% of the movies; however, in 39% of the movies, smoking prevalence among adult characters was higher than that in the US adult population in the year of release. CONCLUSIONS: Smoking prevalence among major adolescent and adult movie characters is declining, with the downward trend among adult characters weakest for PG-13-rated movies. Although many movies depict no adult smoking, more than one third depict smoking as more prevalent than that among US adults at the time of release.