EFFECTS OF SMOKING SCENES IN MOVIES?’

EFFECTS OF SMOKING SCENES IN MOVIES?’

Psychological Reports, 2007, 100, 3-18. © Psychological Reports 2007

CAN CIGARETTE WARNINGS COUNTERBALANCE
EFFECTS OF SMOKING SCENES IN MOVIES?’
ISABELLE GOLMIER                                   JEAN-CHARLES CHEBAT
National Bank of Canada                                 HEC-Montreal School of Management
Ecole des Hautes Etudes Commerciales de Montreal
CLAIRE GELINAS-CHEBAT
Department of Linguistics

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Universitc> du Que’hec a Montrc’al
Summary. Scenes in movies where smoking occurs have been empirically shown to influence teenagers to smoke cigarettes. The capacity of a Canadian warning label on cigarette packages to decrease the effects of smoking scenes in popular movies has been investigated. A 2 x 3 factorial design was used to test the effects of the same movie scene with or without electronic manipulation of all elements related to smok­ing, and cigarette pack warnings, i.e., no warning, text-only warning, and text +pic­ture warning. Smoking-related stereotypes and intent to smoke of teenagers were mea­sured. It was found that, in the absence of warning, and in the presence of smoking scenes, teenagers showed positive smoking-related stereotypes. However, these effects were not observed if the teenagers were first exposed to a picture and text warning. Also, smoking-related stereotypes mediated the relationship of the combined presenta­tion of a text and picture warning and a smoking scene on teenagers’ intent to smoke. Effectiveness of Canadian warning labels to prevent or to decrease cigarette smoking among teenagers is discussed, and areas of research are proposed.
The problem of teenager consumption of tobacco is serious. Approxi­mately 22% of Canadian teenagers between 15 and 19 years currently smoke cigarettes (Health Canada, 2003). Sociodemographic analyses indicated that they are more likely to be found in the lower income and lower education segment of the Canadian population (Health Canada, 1995, 1999), as is also the case in other countries (Goldberg, Kindra, Lefebvre, Liefeld, Madill-Marshall, Martoharadjono, & Vredenburg, 1995; Blum, Beuhring, Shew, Bearinger, Sieving, & Resnick, 2000). In Canada, warning labels on cigarette packages have been conceived as one of the key strategies to prevent teenag­ers from smoking.
In 2000, the Canadian government adopted one of the world’s toughest laws for cigarette warnings (Health Canada, 2004). Each warning label coy-
‘Address correspondence to Jean-Charles Chebat, Chair of Commercial Space and Customer Service Management Holder, HEC-Montreal School of Management, 3000 Cote-Sainte-Cathe­rine Local 4.348, Montreal, Quebec, Canada 11.3T 2A7 or e-mail ( Jean-Ch.arles.Chebat@hec. ca), The first and third authors gratefully acknowledge a research grant they received from the Quebec Council of Social Research (CQRSC).
DOT 10.2466/P80.100.1.3-18

Influence of Motion Picture Rating on AdolescentResponse to Movie Smoking
WHAT’S KNOWN ON THIS SUBJECT: The US Surgeon General hasdetermined that the relationship between movie smoking
exposure (MSE) and youth smoking is causal; however, it is not
known whether movie rating influences how adolescents respond.
WHAT THIS STUDY ADDS: The response to PG-13–rated MSE wasindistinguishable from R-rated MSE. An R rating for smoking could
reduce smoking onset in the United States by 18% (by eliminating
PG-13 MSE), an effect similar to making all parents maximally
authoritative in their parenting.
AUTHORS: James D. Sargent, MD,a Susanne Tanski, MD,MPH,a and Mike Stoolmiller, PhDb
        Cotton Cancer Center, Geisel School of Medicine atDartmouth, Lebanon, New Hampshire; and bCollege of Education,
University of Oregon, Eugene, Oregon
KEY WORDSadolescent smoking, motion picture rating, movie smoking
ABBREVIATIONSCI—confidence interval
MPAA—Motion Picture Association of America
MSE—movie smoking exposure
www.pediatrics.org/cgi/doi/10.1542/peds.2011-1787
doi:10.1542/peds.2011-1787
aNorris
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abstract
OBJECTIVE: To examine the association between movie smoking expo-sure (MSE) and adolescent smoking according to rating category.
METHODS: A total of 6522 US adolescents were enrolled in a longitudinalsurvey conducted at 8-month intervals; 5503 subjects were followed up at
8 months, 5019 subjects at 16 months, and 4575 subjects at 24 months.
MSE was estimated from 532 recent box-office hits, blocked into 3 Motion
Picture Association of America rating categories: G/PG, PG-13, and R. A
survival model evaluated time to smoking onset.
RESULTS: Median MSE in PG-13–rated movies was ∼3 times higher thanmedian MSE from R-rated movies, but their relation with smoking was
essentially the same, with adjusted hazard ratios of 1.49 (95% confidence
interval [CI]: 1.23–1.81) and 1.33 (95% CI: 1.23–1.81) for each additional
500 occurrences of MSE respectively. MSE from G/PG-rated movies was
small and had no significant relationship with adolescent smoking. At-
tributable risk estimates showed that adolescent smoking would be re-
duced by 18% (95% CI: 14–21) if smoking in PG-13–rated movies was
reduced to the fifth percentile. In comparison, making all parents max-
imally authoritative in their parenting would reduce adolescent smoking
by 16% (95% CI: 12–19).
CONCLUSIONS: The equivalent effect of PG-13-rated and R-rated MSEsuggests it is the movie smoking that prompts adolescents to
smoke, not other characteristics of R-rated movies or adolescents
drawn to them. An R rating for movie smoking could substantially
reduce adolescent smoking by eliminating smoking from PG-13 movies.
Pediatrics 2012;130:228–236
Accepted for publication Apr 16, 2012
Address correspondence to James D. Sargent, MD, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH

  1. E-mail: james.d.sargent@dartmouth.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2012 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they haveno financial relationships relevant to this article to disclose.
FUNDING: Supported by the National Cancer Institute (grantCA077026) and the American Legacy Foundation. Funded by the
National Institutes of Health (NIH).
COMPANION PAPER: A companion to this article can be found onpage 221, and online at www.pediatrics.org/cgi/doi/10.1542/
peds.2011-1792.
228
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ARTICLE
Almost 50 years since the 1964 SurgeonGeneral’s Report on Smoking and Health,
smoking remains the number 1 cause of
preventable death in the United States,
responsible for .400 000 deaths per
year, prompting a need to know more
about what fuels this epidemic. In March
2012, a new Surgeon General’s Report
was released, entitled “Preventing To-
bacco Use Among Youth and Young
Adults,” and in which the Surgeon Gen-
eral stated: “The evidence is sufficient to
conclude that there is a causal rela-
tionship between depictions of smoking
in movies and the initiation of smoking
among young people.”1 Thus, much is
known about the relation between ex-
posure to movie smoking and youth
smoking, but studies are only beginning
to examine whether the context in which
movie smoking is presented modifies its
association with adolescent smoking.
In a recently published experiment,2 ex-
posure to movie clips portraying smok-
ing as relaxing was associated with
a significantly stronger desire to smoke
compared with exposure to clips
without a motive for the smoking. Al-
though experimental studies allow the
researcher to control exposure and
serve to tease out underlying cognitive
mechanisms, it is difficult to study actual
smoking behavior in an experimental
setting, and therefore it is hard to judge
what the behavioral implications of the
findings would be.
Another way to assess context is toconsider movie rating. Movie ratings
are a marker for the presence of con-
textual elements considered to be
“adult” by the ratings board. To the
extent that sex, violence, profanity, and
illicit drug use are considered in the
Motion Picture Association of America
(MPAA) ratings system,3 smoking in
movies with an adult rating (eg, R [re-
stricted to individuals aged $17 years
unless accompanied by a parent or
guardian]) would depict characters
who model these behaviors, along with
PEDIATRICS Volume 130, Number 2, August 2012
FIGURE 1
Examples of different contextual treatments of movie smoking, clockwise from top left: Cruella de Vil, anuncomplicated villain in 101 Dalmatians (rated G; Walt Disney Productions, 1961); Gwyneth Paltrow
smoking in the context of a sexually provocative scene in Great Expectations (rated R; 20th Century Fox
Film Corporation, 1998); Ethan Hawke blowing smoke into a backlit wine glass to show what the planet
Titan looks like in Gattica (rated PG-13; Columbia Pictures Corporation, 1997); and Brad Pitt smoking
after a brutal fight scene from Fight Club (rated R; Fox 2000 Pictures, 1999).
smoking. Indeed, a content analysisfound that MPAA ratings can reliably
distinguish levels of sex, violence, and
profanity but not tobacco use.4 Figure 1
depicts several examples of movie
smoking by rating and a range of con-
texts that might be seen with movie
smoking according to rating category:
simple villainy (G [appropriate for gen-
eral audiences]), visually stimulating (PG-
13 [parents are strongly cautioned, con-
tent may not be suitable for children aged
,13 years]), and violence and sex (R).
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Examining how movie ratings affect themovie smoking–behavior association
could have important implications on
ratings for movie smoking,5 especially
given that 60% of the movie smoking
exposure (MSE) comes from youth-
rated (almost entirely PG-13) movies.6
In the United States, an R rating for
smoking would serve to effectively eli-
minate smoking from movies marketed
to youths, based on the current business
model for movie production, in which
the rating is negotiated between pro-
duction company and the director be-
fore movie production.7 The implication
is that a production company intending
to include the youth market would have
to eliminate smoking in the production
process, as is currently done with sexand violence to obtain the PG-13 rating.
However, the hypothetical benefits of
limiting MSE in youth-rated movies
depends partly on how strongly the
smoking in them is linked with ado-
lescent smoking. Importantly, limiting
smoking to R-rated movies would have
little impact if the dose-response be-
tween smoking in youth-rated movies
and adolescent smoking was small.
In addition, if only R-rated movie smokingwas linked with behavior, it would se-
riously undermine the idea that it is
movie smoking specifically, as opposed
to the sex, violence, profanity, and illicit
drug use that prompts smoking onset.
Indeed, a recent essay speculated that
the movie smoking–youth smoking re-
lationship might not be causal because
MSE is “inextricably entangled with a
host of other variables in movies…
such as alcohol or recreational drug
portrayal, violence, coarse language,
and sexual content,”8 raising concerns
about specificity. The essay went fur-
ther, suggesting that it may not be the
movies at all that prompt adolescents
to smoke. Instead, adult movies may
attract risk-taking adolescents who
come to see the proscribed behaviors
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(ie, adolescents who end up smokingfor other reasons). In this scenario,
R-rated MSE would be hypothesized to
be overwhelmingly strong in its ability
to predict youth smoking, because R-rated
MSE picks up the effect of seeing “adult”
behaviors relegated to these movies
and identifies unmeasured risk factors
among the adolescents that see them.
The current study examined smokingonset in a cohort of US adolescents
followed up for 4 waves over a 2-year
period. Exposure to smoking in movies
at study onset was divided into 3 cat-
egories (G/PG, PG-13, and R) to assess
the prospective relationship between
each type of exposure and onset of
smoking. Based on the idea that it is
primarily the movie smoking that
prompts adolescents to smoke (with the
adult context being secondary), we hy-
pothesized that R-rated movie smoking
would have only a slightly stronger as-
sociation with adolescent smoking than
PG-13–rated movie smoking and that
PG-13–rated movie smoking would still
be an important predictor of smoking,
given that it accounts for a large share
of the exposure.
in the unweighted sample were compa-rable to those of the 2000 US Census.9
Missing data/attrition increased from 7adolescents at baseline to 2451 at 24
months. Attrition analyses indicated
that adolescents lost to follow-up were
more likely to be nonwhite; were from
families with lower parental education/
income and lived in rented versus
parent-owned residences; had poorer
school performance; and scored higher
on sensation-seeking scales. To mini-
mize attrition bias, estimation was
carried out after multiple imputation
using the missing at random assump-
tion (missing data are missing at ran-
dom conditional on covariates included
in the model).10 The MICE procedure in
R was used to stochastically impute
missing data.11 To improve the quality
of the imputations, baseline auxiliary
variables that were predictive of
missing data (but not necessarily the
outcomes) were also included in the
imputation. All variables were treated
as numeric, and the predictive mean
matching procedure was used to cre-
ate 15 imputed values for each missing
score. Convergence was assessed by
checking plots of the mean and vari-
ance of the imputations for each vari-
able across the 15 streams for signs of
problems, such as trends or lack of
proper mixing. No problems were ap-
parent. For descriptive statistics, we
averaged across the 15 imputations to
obtain a single best estimate for each
missing data point.
Assessment of MSE Dose
Adolescents’ exposure to movie smok-ing was estimated by using previously
validated methods.12 The top 100 movies
with highest US gross revenues each
year were selected for each of the 5
years preceding the baseline survey
(1998–2002, N = 500) and 32 high
earners during the first 4 months of

  1. Older movies were included be-

cause adolescents often watch these

movies on video/DVD. The survey ran-domly selected 50 movie titles from the
larger pool of 532 movies for each ad-
olescent interview. Movie selection was
stratified according to the MPAA rating
so that the distribution of movies in
each list reflected the distribution of
the full sample of movies (19% G/PG,
41% PG-13, and 40% R). Respondents
were asked (no/yes) whether they had
ever seen each movie title on their unique
list.
Trained coders counted the number ofsmoking occurrences in each of the 532
movies by using previously validated
methods.13 A smoking occurrence was
counted whenever a major or minor
character handled or used tobacco in a
scene or when tobacco use was de-
picted in the background (eg, brands
present or “extras” smoking in a bar
scene), irrespective of the scene’s du-
ration or how many times the tobacco
product appeared. We summed the
number of smoking occurrences each
adolescent had seen from his or her
unique list of 50 movies, stratifying
counts by rating blocks (G/GP, PG-13
and R categories), and scaling these
counts to reflect exposure to that of the
full sample of 532 movies, given the
adolescent’s reported viewing habits
by rating.12 To limit extreme values and
reduce the effect of outliers, MSE
measures were Winsorized14 at the
second and 98th percentiles (values
more extreme were recoded back to
the second or 98th percentile value). To
assess equivalent doses of exposure,
the response to each increment of 500
movie smoking occurrences was
modeled, which would approximate the
median overall dose of MSE.
Outcome Assessment
Smoking initiation was assessed byasking: “Have you ever tried smoking a
cigarette, even just a puff?” Those who
answered “yes” were classified as
having tried smoking. This measure
METHODS
Participants and Procedure
Participants were 6522 adolescents,ages 10 to 14 years, recruited in 2003 by
using random digit dial methods de-
scribed previously.9 After verbal paren-
tal consent and adolescent assent were
obtained, participants were surveyed
via telephone about media exposures,
tobacco and alcohol use, sociodemo-
graphic characteristics, and other risk
factors. Subjects were resurveyed every
8 months 3 more times, with the last
follow-up at 24 months. The study pro-
cedures were approved by the Dart-
mouth College Committee for Protection
of Human Subjects. The completion
rate for the survey was 66%; distri-
butions of age, gender, ethnicity,
household income, and census region
230
SARGENT et al
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ARTICLE
was used rather than current (30-day)smoking because current smoking is
infrequent in the early stages of ciga-
rette use.15 Smoking initiation is an
important outcome because approxi-
mately one-third of initiators go on to
become addicted smokers.16,17 For the
US sample, confidentiality in responses
was assured in the adolescent assent
statement, and subjects indicated
their answers to sensitive questions by
pressing numbers on the telephone.
seeking.34 To prevent problems due tooutliers, covariates were Winsorized at
the second and 98th percentiles.14
Statistical Analysis
Onset of smoking was ascertained atthe 8-, 16-, and 24-month surveys. An
incident case was defined as an ado-
lescent who became a smoker from the
pool of those who were not smokers at
the previous survey. As a first step,
generalized additive logistic models
werefittoshow the crude dose-response
relation between the MSE according to
MPAA rating and probability of smoking
initiation. In addition to strong linear
trends, both PG-13– and R-rated MSE
had significant negative quadratic trends
(significantly stronger response at
lower dose ranges); however, only the
negative quadratic effect for R-rated
MSE remained significant after adjust-
ing for all covariates in the full model.
For ease of interpretation and because
conclusions did not change, only the
linear effects for all MSE measures
were used (quadratic estimates avail-
able on request from the first author).
For the models, MSE was entered as a
continuous variable and scaled so that
each 1-point increment represented an
increase in dose of 500 movie smoking
occurrences. To determine the associa-
tion between exposure to movie smok-
ing according to MPAA rating and time to
smoking initiation, discrete time hazard
survival models35–37 were fit to each of
the 15 imputed complete data sets fol-
lowing standard procedures for pooling
the estimates and obtaining SEs.11 The
hazard model assessed time to onset
based on data from all 3 intervals over
the 24-month period. For all models,
results for main effects were judged
significant for P values ,.05.
Attributable fraction calculations wereconducted after model fitting by ob-
taining the model-predicted number of
events with the observed data and the
model-predicted number of events when
Covariates
In addition to the movies viewed, otherinformation was collected from the
adolescents, including age, gender, race,
parent education, household income,
school performance, involvement in ex-
tracurricular activities, weekly spending
money, television watching (hours per
day), personality characteristics (rebel-
liousness, sensation-seeking propensity),
parent/sibling/peer smoking, cigarette
availability at home, and adolescent-
reported parenting practices.18 Author-
itative parenting style describes parents
that are both responsive and effective
in monitoring their children19; this con-
struct has a strong and consistent
track record in predicting lower levels
of substance use.18,20–32 The current
study used a 10-item version of the
Authoritative Parenting Index,18 in which
we combined results for questions
about responsiveness (“he/she makes
me feel better when I’m upset/listens
to what I have to say”) and monitoring
(“he/she asks me what I do with my
friends/knows where I am on the
weekend” [a = .79 survey 1, .81 survey 2])
and referenced questions to the per-
son the adolescent viewed as the
main caregiver. The assessment of
other covariates and their reliabilities
has been described previously.9,33 The
sensation-seeking scale used here has
been validated in longitudinal research
and has a reliabilities comparable to
other accepted scales for sensation
levels of MSE in our sample were alteredto a low level (ie, the fifth percentile) to
indicate what might happen if smoking
was largely removed from movies the
adolescents had watched. The attrib-
utable fractions were compared with
similar assessments for sensation
seeking (setting all adolescents at the
lowest level), or authoritative parenting
(setting all parents at the most author-
itative level). For each of the 15 impu-
tations, estimates and SEswere obtained
for the attributable fractions using 100
bootstrap replications. The bootstrap
estimates and SEs were then pooled
across the 15 multiple imputation mo-
dels using standard procedures.
RESULTS
Description of the Sample
Table 1 describes the predictor varia-bles for the study sample at baseline.
Age was equally represented and ranged
from 10 to 14 years at baseline; male
and female genders were also equally
represented. Race/ethnicity was broadly
reflective of the US population, with
11% black and 19% Hispanic ethnicity.
Some 18% of families were classified
as low-income, with 7% having incomes
of #$20 000 and 11% having income
between $20 000 and $29 000 per year.
At baseline, 83%, 88%, and 69% of ado-
lescents reported having no friends,
siblings, or parents, respectively, who
smoked, and 14% thought there was at
least some chance that they could ob-
tain cigarettes from home without their
parent’s knowledge. With respect to
media use, 28% watched $3 hours of
television per day. Only 15% reported no
weekly spending money, and 10%
reported having .$20 per week to
spend.
Dose of MSE by MPAA Rating and ItsRelation With Smoking Onset
Table 1 also displays the median andinterquartile range for MSE according
to MPAA rating category. High-dose
231
PEDIATRICS Volume 130, Number 2, August 2012
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(95th percentile) MSE was similar forPG-13– and R-rated movies (894 and
1002 occurrences, respectively) and
∼5 times that of the 95th percentile for
G/PG-rated MSE. However, the typical
(median) dose to adolescents for PG-
13–rated MSE was much higher than
for R-rated MSE (275 and 93 occurrences,
respectively), reflecting higher viewer-
ship of PG-13–rated movies overall. The
correlation between the 3 MSE variables
was .53 for PG-13–rated versus R-rated
movies, .18 for PG-13–rated versus G/
PG-rated movies, and .15 for R-rated
versus G/PG-rated movies.
Figure 2 shows the dose-response re-lation of MSE according to rating cat-
egory with the 8-month probability of
trying smoking using all three 8-month
observation periods; the unadjusted
probability of trying smoking was not
significantly different across the 3
periods. The null hypothesis is repre-
sented by the horizontal line set at the
average probability of trying smoking
(6.4%). Figure 2 illustrates the mark-
edly larger exposure to PG-13–rated
and R-rated movie smoking compared
with G/PG-rated movies, for which dose
did not extend past 200 occurrences,
even for the most highly exposed ado-
lescents. The relation for G/PG-rated
MSE and adolescent smoking (dotted
green line) was not significantly differ-
ent from zero. The unadjusted hazard
ratio associated with a 500-smoking
occurrence dose of G/PG-rated MSE
was 1.47 (95% CI: 0.65–3.36). Restrict-
ing G/PG-rated MSE to the observed
range (0–165 occurrences) made the
unadjusted hazard ratio even lower:
1.14 for the 95th percentile compared
with fifth percentile of actual G/PG-
rated MSE. In contrast, PG-13–rated
(dashed red line) and R-rated (solid
blue line) MSE had much larger ex-
posure ranges and crude relations
with youth smoking that were similar
to each other and strongly diver-
gent from the null hypothesis. The
232
SARGENT et al
TABLE 1 Description of the Never Smoker Sample at Baseline (N = 5830)
N
Age, y10
11
12
13
14
Race/ethnicity
White
Black
Hispanic
Other
Gender
Male
Female
Family income (31000), $
,20
20–29
30–49
50–74
75–99
$100
Parent education
#9th grade
9th–11th grade
12th grade
High school diploma
Vocational/technical school
Some college
Associate degree
Bachelor degree
Postgraduate
Either parent smokes
No
Yes
Cigarettes available at home
Definitely no
Probably no
Probably yes
Definitely yes
Sibling(s) smoke
No
Yes
Peers smoke
None
Some
Most
Television viewing
None
,1 h/d
1–2 h/d
3–4 h/d
.4 h/d
School performance
Below average
Average
Above average
Excellent
Weekly spending money, $
None
1–5
6–0
11–15
11601244
1238
1213
975
3619619
1095
497
29702860
 401625
693
1183
1180
1748
 353414
229
1274
199
1004
501
1116
740
39991831
5005487
251
87
5115715
4854879
97
 3181151
2760
1139
462
 1261340
2479
1885
 8541907
1362
359
Proportion
.2.21
.21
.21
.17
.62.11
.19
.09
.51
.49
.07.11
.12
.2
.2
.3
.06.07
.04
.22
.03
.17
.09
.19
.13
.69.31
.86.08
.04
.01
.88.12
.83.15
.02
.05.2
.47
.2
.08
.02.23
.43
.32
.15.33
.23
.06
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ARTICLE
TABLE 1 Continued
N
16–2021–50
.50
796458
94
Median
Continuous variablesResponsive parenting
Demanding parenting
Sensation seeking
Rebelliousness
Extracurricular activities
Movie Smoking Exposure
G/PG-rated
PG-13–rated
R-rated
Proportion
.14.08
.02
Interquartile Range (25th–75th)
2.42.3
0.8
0.2
1.8
 61275
93
  22
0.5
1.5
1597
0
2.82.8
1.3
0.4
2.2
123514
393
indistinguishable from that of R-ratedMSE, a finding that directly refutes spec-
ulation8 that it is other adult-oriented
content or some yet-to-be-identified
individual risk factor that attracts
youths to R movies which causes the
response. Combined with recently
published experimental data that show
a movie smoking effect on susceptibil-
ity to smoke using a randomized de-
sign,38 the results strongly support the
idea that it is the movie smoking in
PG-13- and R-rated movies that stim-
ulates youths to smoke.
Because exposure to PG-13–rated mov-ies is large,39 the smoking in these
movies accounts for about two-thirds
of the population effect. Thus, an un-
ambiguous R rating for smoking could
reduce adolescent smoking onset by
almost one-fifth, as newly produced
smoke-free PG-13–rated movies come
into the market and old ones lose the
adolescent audience. The attributable
fraction estimate for PG-13– and R-
rated MSE is smaller than previous
estimates in predominantly white
adolescents40–42 (the pooled estimate
for those studies from an earlier meta-
analysis5 was 0.44 [95% CI: 0.34–0.58]
compared with 0.26 [95% CI: 0.23–0.29]
for this study), in part because the
response to movie smoking among
minority adolescents was less strong
than among whites.43,44 Regardless of
what the final attributable risk is,
however, the public health impact of
PG-13 smoking is important: it ranks on
the order of the impact of parenting
effectiveness.
Not only was exposure to G/PG MSE-rated small, the relation for G/PG-
rated MSE was not significantly different
from zero. Low responsiveness to
smoking in G/PG movies is consistent
with the results of an experimental
study that failed to find an effect of
cartoon and G/PG movie smoking on
attitudes in elementary school-aged
children.45 Another similarly designed
233
unadjusted hazard ratios for each500 occurrences of PG-13–rated and
R-rated MSE were 3.44 (95% CI: 2.74–
4.32) and 3.14 (95% CI: 2.58–3.83),
respectively.
Table 2 shows the adjusted hazard ra-tios for MSE according to MPAA rating.
There was no significant relation be-
tween exposure to G/PG-rated MSE and
adolescent smoking. The adjusted haz-
ard ratios for a 500-occurrence dose of
PG-13– and R-rated MSE were 1.49 (95%
CI: 1.23–1.81) and 1.33 (95% CI: 1.13–
1.57), respectively. Wald tests showed
that the MSE–youth smoking relation
for PG-13– and R-rated movies was not
significantly different from each other
but both were significantly higher
than the G/PG-rated MSE–youth smok-
ing relation.
This study was designed to detect a maineffect of MSE on adolescent smoking and
powered to detect an overall odds ratio
of 1.4 for the relation between smoking
in movies and smoking onset with
a powerof 0.97.Power for these analyses
was considerably reduced when MSE
was subdivided by MPAA rating into 3
correlated variables, especially consid-
ering the small range of G/PG-rated MSE.
However, additional power calculations
indicated that, even with this small
range, the power of the study to detect
an effect similar to PG-13 MSE (an
PEDIATRICS Volume 130, Number 2, August 2012
adjusted hazard ratio of 1.5 for a 500-occurrence dose) was 0.71.
Attributable Fraction Estimation
The attributable fraction estimate forsetting all PG-13– and R-rated MSE to
the fifth percentile was 0.26 (95% CI:
0.23–0.29), indicating that largely re-
moving the risk factor would reduce
smoking onset over the period by 26%.
Setting PG-13-rated MSE alone to the
fifth percentile (which approximates
the probable impact of an R rating for
smoking) was associated with an at-
tributable fraction of 0.18 (95% CI:
0.14–0.21). For comparison, the attrib-
utable fractions for setting authorita-
tive parenting to the highest level or
sensation seeking to the lowest level
were 0.16 (95% CI: 0.19–0.12) and 0.30
(95% CI: 0.35–0.25), respectively. Thus,
eliminating smoking from youth-rated
movies would reduce smoking by as
much as making all parents maximally
authoritative in their parenting.
DISCUSSION
This study provided a test of whether itis primarily the smoking in movies, not
the other adult behaviors that go along
with it, that affects adolescents’ be-
havior. The dose-response between PG-
13–rated MSE and youth smoking is
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FIGURE 2
The unadjusted relation between exposure to G/PG-, PG-13–, and R-rated MSE and the 8-month hazardprobability of smoking onset for US adolescents. The unadjusted probability (hazard) of trying smoking
was not significantly different across each of the three 8-month follow up periods and was equal to
0.064, shown in the plot as a thin horizontal line. All 3 exposures (G/PG [dotted green line], PG-13
[dashed red line], and R [solid blue line]) were entered as linear effects. The small lines on either side
of each curve represent the 95% CIs for the estimate. The model was estimated on the log odds scale by
using logistic regression as is standard for discrete time survival analysis. Because the log odds scale
is difficult to interpret, however, the fitted relations were converted to the probability scale. The change
of scaling of the y-axis from log odds to probability creates the apparent curvilinearity.
TABLE 2 Association Between MSE According to MPAA Rating and Time to Trying (Hazard of)
Smoking
Adjusted Hazard Odds Ratio
Low
MSEa according to movie ratingG/PG-rated
PG-13–rated
R-rated
0.491.49
1.33
Test
Wald testsG/PG versus R and PG-13
G/PG versus PG-13
G/PG versus R
PG-13 versus R
a
95% CI
High
1.091.81
1.57
P
the findings of this study and a relatedpublication50 are consistent with this
causal interpretation. Our conclusion
that it is the smoking in PG-13– and R-
rated movies that prompts adolescents
to smoke is strengthened theoretically
on the parsimonious notion of a social
modeling effect and supported by social
cognitive theory.51 Our study was not
powered to detect a small effect, such
as that seen in the unadjusted relation
between G/PG-rated MSE and adoles-
cent smoking in this study (but it is
adequate to rule out an effect similar to
that of PG-13–rated movies). It also does
not empirically test what might be found
if smoking in G/PG movies was in-
creased to the point that it was pro-
vided similar to exposure in other
types of movies. Thus, the study cannot
be used as a justification for adding
more smoking to G/PG-rated movies.
Finally, this study cannot tell us exactly
what contextual situations are most
problematic, as the study by Shadel
et al2 was able to do.
With the elimination of image-based to-bacco marking, the epidemic of smoking
is maintained, in part, by movie images
of smoking. This study suggests that it is
the depiction of smoking in movies, not
other contextual variables, that matters
for the onset of youth smoking. It sug-
gests greater emphasis on reducing
exposure to smoking in PG-13–rated
movies through an unambiguous R rat-
ing for smoking52 and less emphasis on
images of smoking commonly found in
G- and PG-rated movies, which contrib-
ute little to exposure. Finally, even if the
MPAA agrees to modernize its volun-
tary film rating system to eliminate
smoking from youth-rated films, youth
will still receive some exposure to
smoking from R-rated movies, so it is
also important to motivate and assist
parents in restricting access to these
movies, which would further reduce
adolescent exposure to onscreen
smoking.53–59
0.221.23
1.13
df
  1. click here for more information on this paper
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 6.5322.55
22.37
0.74
21
1
1
.038.011
.018
.458
 MSE entered as a continuous variable and scaled so that each 1-point increment represents 500 movie smokingoccurrences.
experimental study found an effect forsmoking in a PG-13–rated movie.46 These
2 experimental studies, combined with
our population-level results, suggest
that the explanation is that smoking
images delivered by G/PG cartoons
and other family-oriented films fail to
effectively communicate favorable ex-
pectancies or utilities for smoking. Thus,
the emphasis afforded to cartoon smok-
ing in previous studies47,48 may be mis-
placed from a public health standpoint.
234
SARGENT et al
This finding also suggests that onlyeliminating smoking from G/PG-rated
films would not reduce the effects of
smoking in movies on youth smoking;
there is little MSE in G/PG-rated films6,49
and what imagery is there is not partic-
ularly salient. Thus, the only effective
ratings option for the MPAA in limiting the
impact of MSE is an R rating for smoking.
The causal inference for movie smokingand youth smoking mentioned earlier1
cannot be made from 1 study alone, but
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ARTICLE
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Influence of Motion Picture Rating on Adolescent Response to Movie SmokingJames D. Sargent, Susanne Tanski and Mike Stoolmiller
Pediatrics 2012;130;228; originally published online July 9, 2012;
DOI: 10.1542/peds.2011-1787
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Influence of Motion Picture Rating on Adolescent Response to Movie SmokingJames D. Sargent, Susanne Tanski and Mike Stoolmiller
Pediatrics 2012;130;228; originally published online July 9, 2012;
DOI: 10.1542/peds.2011-1787
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthlypublication, it has been published continuously since 1948. PEDIATRICS is owned,
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Qualitative Health Researchhttp://qhr.sagepub.com/
Female Youths’ Perceptions of Smoking in Popular Films
Shannon Jetté, Brian Wilson and Robert SparksQual Health Res 2007 17: 323
DOI: 10.1177/1049732306298513
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Female Youths’ Perceptions of Smoking inPopular Films
Shannon JettéBrian Wilson
Robert Sparks
University of British Columbia, Vancouver, Canada
Qualitative Health ResearchVolume 17 Number 3
March 2007 323-339
© 2007 Sage Publications
10.1177/1049732306298513
http://qhr.sagepub.com
hosted at
http://online.sagepub.com
In this study, the authors used focus group interviews to explore how female adolescents in a Canadian high schoolinterpreted and used tobacco imagery in films in their daily lives. Findings from interviews with 20 smokers led them
to argue that smoking scenes in films might stimulate youth smoking and that cigarettes are an important symbol in
youth peer groups with explicit social meanings and functions. Their analysis of interviews with 17 nonsmokers
revealed that although the majority noticed smoking in movies, it did not detract from their viewing experience.
Although both smokers and nonsmokers were aware that tobacco placements in films served as a form of product
promotion, they typically focused on smoking’s function as a dramatic device for character development rather than
its promotional value. Overall, both groups appeared capable of critical readings of smoking in films but tended not
to use these capabilities when viewing movies.
Keywords: tobacco; youth; media; peer culture; Canada
      ver the past decade, there has been growing con-cern that tobacco use in films reinforces positive
smoking-related attitudes and behaviors in youth. The
rate of smoking in movies has been high during this
period, with the percentage of smokers in films being at
least twice the actual rate in North America (Escamilla,
Cradock, & Kawachi, 2000; Glantz, Kacirk, &
McCulloch, 2004; Hazan, Lipton, & Glantz, 1994;
Stockwell & Glantz, 1997). According to some analysts,
this degree of overrepresentation serves to normalize
smoking in the eyes of youth audiences, an especially
noteworthy point in light of evidence that youth who
overestimate the prevalence of risk behaviors among
peers are more likely to engage in such behaviors
(Perkins & Wechsler, 1996). Moreover, smoking in
Hollywood movies is rarely associated with negative
health consequences and instead tends to be linked with
glamour, wealth, and many other images and meanings
that might appeal to young people (Dalton et al., 2002;
McIntosh, Bazzini, Smith, & Wayne, 1998).
There is also evidence to suggest that exposure to
tobacco use in movies might encourage youth smoking.
More specifically, cross-sectional studies show an
association between youth with a favorite actor who
smokes and smoking by the same youth (Distefan,
Gilpin, Sargent, & Pierce, 1999; Tickle, Sargent, Dalton,
O
Beach, & Heatherton, 2001), as well as evidence of anincreased prevalence of smoking experimentation
among youth with higher levels of exposure to movie
smoking (Sargent et al., 2001). Contributing to this body
of correlational research are longitudinal studies that
link exposure to smoking in films with youth smoking
initiation (Dalton et al., 2003) and having favorite actors
who smoke on-screen with subsequent smoking behav-
ior among female adolescents (Distefan, Pierce, &
Gilpin, 2004).
Although the studies noted above offer important
insights into the types of smoking-related representa-
tions that exist in film (and the potential impacts of
these portrayals), there remain several areas where
existing literature on youth, tobacco, and film require
expansion and enrichment. For example, research
focused on the impacts of tobacco-related media
images is seldom guided by theories offered by those
working within the field of communication/media
studies; that is to say, those studying the impacts of
tobacco-related messages could benefit greatly from
attention to frameworks developed by communication
scholars that help describe (a) the ways in which the
social and cultural backgrounds of viewers are related
to viewer interpretations of media images, (b) the
ways in which viewer understandings of images are
323
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324 Qualitative Health Research
related to the everyday cultural activities of these sameviewers, and (c) the ways in which these images inter-
act with other messages that exist in the cultural envi-
ronment that viewers inhabit. In the same way, only a
limited number of researchers whose work is focused
on youth, media, and smoking have developed studies
around the idea that interpretations of these smoking-
related images are negotiated within peer cultural
groups. More specifically, there is limited research that
aims to discern qualitatively how young people under-
stand and use the images they are exposed to in their
everyday cultural lives.
Although these gaps are a notable concern for those
working in the field of research focused on media,
tobacco, and youth health, they are equally disconcert-
ing for those tasked with devising antismoking initia-
tives (e.g., antismoking media messages) aimed at
youth. Stated plainly, health promoters need more infor-
mation about the ways in which young people make
sense of smoking portrayals, a point with particular sig-
nificance when we consider the amount of time and
money that has been spent on antismoking campaigns
over the past decade and that youth smoking has
decreased only marginally over that period (Physicians
for a Smoke-Free Canada, 2005).
The study reported in this article was designed with
the goal of contributing theoretical, empirical, and
practical insights to this broad area of research and
social concern. These contributions are offered in the
following sections. In the first section, we describe
approaches to studying youth and media that guided
our understanding of (a) how audiences make sense of
the media messages they are exposed to and (b) how
the tobacco-related symbols and messages that youth
encounter are given meaning through and, ultimately,
“used” within their cultural and/or peer groups. In this
section, we also offer a brief history of research
focused on relationships between youth, smoking, and
films, and consider how the study reported here will
contribute to this body of work. A series of study ques-
tions inspired by this review of the literature is then
outlined. In the second section, we describe the
method used for the study, a qualitative research tech-
nique commonly used in communication studies
known as audience ethnography, which includes media
viewing and focus group discussion. In the third section,
we describe findings from this study, a study focused
on the ways in which tobacco use in Hollywood films
are understood by female smokers and female non-
smokers in a lower middle-class high school in
Western Canada. In the fourth section, the findings are
discussed in relation to previous theoretical and sub-stantive research. We conclude the article with some
practical suggestions for ways in which this research
can inform the design of antismoking programs aimed
at youth and for future research in the area of youth,
media, and smoking.
Related Literature
Ethnographic Research: Youth Culture andSmoking
   Our approach to understanding youth audiences andmedia messages was influenced by a previous study
conducted by two of the authors (Wilson & Sparks,
1996, 1997, 2001), in which they explored how two
groups of middle-class male youth—youth who shared
an interest in playing and viewing basketball but had
distinct cultural backgrounds (i.e., one group lived in
Vancouver and was non-Black; the other was in Toronto
and was made up of Black youth)—interpreted sneaker
(sports shoe) commercials featuring celebrity Black ath-
letes (Wilson & Sparks, 1996). The research focused
not only on the ways in which the groups understood
these commercials but also on the meanings of such
advertisements (and, in turn, Black athletes and ath-
letic apparel) in their daily lives. To aid in the analysis,
previous work in the areas of audience research and
youth cultures was drawn on, with Radway’s (1991)
interpretive community framework being central to the
exploration of youth as media audiences. Radway
adopted the notion of interpretive communities (fol-
lowing Fish, 1979) in an attempt to describe the inter-
pretive strategies that readers (in her cases, romance
novel readers) bring to a certain genre of text. She
argued that although texts can be understood in a vari-
ety of ways, similar interpretations are produced by
“similarly located” readers: readers who share social
background characteristics and lifestyles. Radway’s
work is especially influential, because she was sensi-
tive not only to the ways in which people interpret
media but also to the ways in which these interpreta-
tions, and, most notably, the act of reading itself, are
related to the social contexts that people inhabit. For
example, Radway found that romance novel reading
was used by her interviewees as a temporary “declara-
tion of independence” (p. 7) from their duties as wives
and mothers.
Radway’s (1991) research was influential for the pre-
viously noted work on young male audiences (Wilson &
Sparks, 1996, 1997, 2001), because it sensitized us to
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Jetté et al. / Perceptions of Smoking 325
the ways in which (a) youthful audience tastes in andinterpretations of media texts might relate to their social
and cultural context; and, more broadly, (b) the mes-
sages young people are exposed to (might) influence
decision making, social perceptions, and identity nego-
tiations in day-to-day life. Specifically, Radway’s under-
standing of the interpretive community was integrated
with youth subcultural theory to examine the role of
television commercial messages in the lives of youth
cultural groups. In doing so, we drew on the classic
work of subcultural theorist Hebdige (1979), who stud-
ied spectacular working class British youth subcultures
(e.g., punk rockers and skinheads) in the 1970s. He used
the term bricolage to describe the process by which
groups of youth, as a cultural response to feelings of
alienation, actively construct meaning out of unremark-
able consumer items (e.g., using safety pins as earrings)
with the goal of producing styles that both offended and
symbolically defied authority. Willis (1990) extended
Hebdige’s analysis, demonstrating how all youth (not
just those who are members of spectacular subcultures)
exercise symbolic creativity in the realm of leisure,
negotiating their identities through the use of available
consumer items (like clothes or certain brands of ciga-
rettes) and leisure activities (like shopping or smoking).
Three ethnographic studies conducted in Canada
also affected the design of the present study by offer-
ing a foundation from which to think about the sym-
bolic meanings of cigarettes in youth cultures. In the
first study, McCracken (1992) found evidence to sug-
gest that smoking behavior and beliefs among youth
are highly formalized and ritualized, that youth use
smoking as a means of identity construction at a time
when they are moving away from the “gravitational
pull” (p. 7) of their parents, and that cigarettes and
smoking give teens access to concrete cultural mean-
ings (masculine or feminine image) and pragmatic
functions (mood management), as well as interper-
sonal rituals and displays (sharing a match, blowing
smoke rings). A limitation of McCracken’s work was
that external sources of these meanings, such as the
mass media, were not explicitly considered. In the
second ethnographic study, Connop, King, and Boyce
(1999) studied cigarette use by marginalized teens
and found that cigarettes served as a powerful sym-
bolic tool in the identity formation and group dynam-
ics of the participants. The youth used smoking as a
“symbolic gesture of resistance to authority as well as
a requisite for group membership” (p. 5). The final
study was specific to late adolescent female smokers
(Seguire & Chalmers, 2000). Researchers found that
many of the participants began smoking to fit in witha social group and used cigarettes as a vehicle to cre-
ate (or attempt to create) an image of maturity and to
increase their self-esteem. Smoking was also used by
the young women to rebel against their parents and to
cope with uncomfortable feelings such as stress,
boredom, anger, and sadness.
Influenced by these works (and guided by
Radway’s [1991] interpretive community frame-
work), we offer an analysis of the understandings that
youth with a shared habit of viewing popular films
derive from smoking imagery in movies and the pos-
sible ways in which the social location of the viewers
(as smokers and nonsmokers and adolescent females)
might relate to these interpretations. Embedded
within the research is an investigation of how por-
trayals of smoking in films inform the youths’ under-
standings of the potential roles of cigarettes and
smoking in youth culture.
As part of our investigation, we also address a more
general question at the root of audience research, which
is, Are youth critical, active viewers, or do they pas-
sively accept messages propagated in the mass media?
Previous research on youth audiences has been divided
on this issue. For example, Miles (2000) has argued that
youth have the ability to think critically about the media
they encounter but only insofar as their immediate,
personal experiences give them the tools for critical
assessment. In other words, many young people live
consumer lifestyles that might constrain their ability to
deconstruct media messages, leaving them “potentially
vulnerable” to the “more subtle ideological messages”
(p. 84) in the mass media.
Although these issues are centrally relevant when
we attempt to understand the ways in which young
people interpret tobacco imagery in films, there is only
limited research on the topic. In fact, we could find
only three studies in the area. Two of these were focus
group–driven studies conducted in New Zealand by
McCool, Cameron, and Petrie (2001, 2003) with 12-
and 13-year-olds and 16- and 17-year-olds, respec-
tively. Their findings suggest that stereotypical smok-
ing imagery in films might play a central role in
reinforcing cultural interpretations of smoking in
younger children (McCool et al., 2001), whereas “per-
vasive and credible” (McCool et al., 2003, p. 1023)
depictions of smoking might reassure older teens who
smoke or are tolerant of smoking that tobacco use is
socially acceptable and even normal. Older youth
tended to base their interpretations of smoking in films
on their own experiences with cigarettes (McCool
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326 Qualitative Health Research
et al., 2003), whereas younger participants (who hadlower smoking rates than the older youth) tended to
draw on observations of family members or friends
who smoke (McCool et al., 2001). Older and younger
youth jointly recognized that tobacco placements in
films can function simultaneously as a form of promo-
tion and as an artistic device, whereas both resisted the
suggestion that smoking imagery in films affected their
desire to smoke. Significantly, both groups also pre-
sented a “predominantly nonchalant response to smok-
ing imagery in film” (McCool et al., 2003, p. 1023),
and the researchers concluded that it is the “virtually
unconscious acceptance of tobacco imagery that may
render it as powerful” (p. 1031).
The other key study was performed by a team of
researchers working with the World Health Organiza-
tion (WHO, 2003) who conducted eight focus group
interviews with male and female adolescents aged 16 to
18 in an attempt to determine the impact of smoking in
Bollywood films1 on the behavior of Indian youth. A
key finding of the study was the importance of films in
the lives of the teens: Some of the youth admitted to
being influenced by smoking in films because it was
made to appear fashionable, and some attempted to
emulate smoking styles depicted in Bollywood films.
with desirable teenage meanings, such as personal free-dom, social success, and thinness (Greaves, 1996;
O’Keefe & Pollay, 1996), little is known about the
meaning of cigarettes in the Canadian female youth
culture (with the exception of work by Dunn &
Johnson, 2001; Moffat & Johnson, 2001; Seguire &
Chalmers, 2000) and even less about their interpreta-
tions of smoking in films.
With these gaps in the literature in mind, we con-
structed a set of research questions that guided the
study reported in this article. These are How do smok-
ing depictions in movies inform female adolescents’
understandings of tobacco use in their everyday lives?
To what extent are female adolescents critical viewers
of smoking imagery in films? and Do the interpreta-
tions of young females vary between smokers and non-
smokers (i.e., do they represent distinct interpretive
communities)?
Method
   We conducted focus group interviews to explorethe above research questions. As a research technique
that involves the collection of data through group
interaction on questions presented by the moderator,
the focus group interview can draw out specific ideas
and themes not addressed in casual conversation and
generate more in-depth information than would be
obtained by a survey (Morgan, 1996). By encourag-
ing the interaction of the participants, this research
technique creates a group effect, which allows the
researcher to observe participants as they both ques-
tion and explain themselves to each other (Morgan,
1996). Such interaction offers insight into the extent
of agreement and disagreement among the partici-
pants, and allows the researcher to clarify differences
in opinions (Morgan, 2004). With its open and inter-
active approach, the focus group is also an excellent
technique for exploring people’s thoughts and behav-
iors in a respectful and noncondescending manner
(Morgan & Krueger, 1993). The focus group inter-
view is an especially useful methodological tool for
gaining insight into viewers’ interpretations of media
and, as such, is a commonly used research technique
within the field of audience studies (Jhally & Lewis,
1992; Lewis, 1991; Wilson & Sparks, 1996). When
focus groups are used in combination with a media-
viewing component, as is the case in this study, the
technique is sometimes called audience ethnography
(Alasuutari, 1999).
Reflections and Research Questions
   Because national culture and identity are likely toaffect the kinds of films young people watch, as well
as their interpretations, it is important that research like
that conducted in New Zealand (McCool et al., 2001;
2003) and India (WHO, 2003) be conducted in other
national contexts. Even if one assumes there is a sig-
nificant overlap in the movie-viewing habits of youth
globally, it is likely that youth in different national con-
texts view popular culture through different cultural
lenses (McCracken, 1988). In addition, we could not
find any research that focused on potential differences
in the interpretations of smoking in popular films by
smokers and nonsmokers. Although McCool et al. and
the WHO researchers included both smokers and non-
smokers, the interpretive similarities and differences
between these groups were not examined in any depth.
Questions remain about how youth resist or accept
smoking messages in films. Indeed, understanding
how smokers and nonsmokers accommodate media
depictions of smoking might facilitate the creation of
more effective antismoking campaigns.
A final note concerns smoking among female ado-
lescents: Despite evidence that the tobacco industry tar-
gets female youth in Canada by associating cigarettes
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Jetté et al. / Perceptions of Smoking 327
    For this project, the interviews were used to exam-ine the understandings that female youth with a shared
habit of viewing popular films derive from smoking
imagery in movies, and the possible ways in which the
social location of the viewers (as smokers and non-
smokers and as adolescent females) might relate to
these interpretations. The sample was made up of 10
groups of female adolescents (with 3 to 5 participants
in each group) who watch at least two North American
popular films per month on video, on DVD, on televi-
sion, or in the theatre (i.e., have a shared viewing
habit). Five of the groups consisted of 14- to 16-year-
old nonsmokers (average age of 15 years), and the
other five groups comprised 14- to 19-year-old smok-
ers (with an average age of 16 years).2 The smoker and
nonsmoker groups shared a similar class background,
were racially diverse, and reflected the ethnic compo-
sition of their school and location in an urban center in
Western Canada.
The number of focus groups (10; 5 with smokers, 5
with nonsmokers) was based on the recommendation
that most projects consist of four to six focus groups
when studying a relatively homogenous population, as
the data typically become saturated at this point (i.e.,
very little new information emerges) (Morgan, 2004).
Following Morgan’s and Jhally and Lewis’s (1992)
observation that smaller focus groups allow for an
increased level of participant involvement and are eas-
ier to manage—both important considerations when
conducting research with female adolescents—the
number of participants in discussion sessions was 3 to

  1. This size was also a result of using friendship groups

to recruit participants, as the youth typically “hung
out” in groups of 3 to 5.
The research was conducted between October 2003
and February 2004 in a high school located in British
Columbia, Canada. The average income of families
living in this area is $49,615.00, and the median
income is $39,928.00 (Statistics Canada, 2001).
Approximately 1,700 students (Grades 8 to 12) are
enrolled in this school, which offers a variety of acad-
emic, enriched, and career preparation programs, as
well as a number of alternative programs (in which the
classroom environment is less structured or tradi-
tional). Nonsmokers were recruited from the hallway
of the school or through teacher contacts; many of the
smokers were recruited from a designated smoking
area adjacent to the school. In both cases, groups of
friends were recruited to ease the inhibitions of the par-
ticipants and encourage a natural flow of conversation
(Lewis, 1991). Although some of the groups were

  1. click here for more information on this paper
more cohesive than others, all of the participants werefamiliar with the other group members and appeared
comfortable in each other’s presence. A potential limi-
tation of using friendship groups is a tendency toward
peer group conformity (or groupthink), but the fact that
there was a certain level of within-group variation dur-
ing the discussions suggests that at least some of the
youth were willing to express opinions contrary to
those of their peers. In these instances, using friendship
groups might have reduced the tendency toward group-
think, because the youth were comfortable enough
with one another to disagree on certain points (some-
thing that might not have occurred had they been
strangers).
On initial contact, potential participants were
given the appropriate information sheets and consent
form. If the youth expressed an interest in participat-
ing, a meeting time was arranged. The focus group
sessions began with a discussion about the confiden-
tial and voluntary nature of the project. Informed con-
sent was received from all participants, and informed
passive consent was received from the participants’
parents. The project had received prior approval by
the University of British Columbia research ethics
board. The introduction was followed by the film-
viewing segment, in which the group members
watched three movie clips with smoking scenes: one
from My Best Friend’s Wedding (Zuckerman &
Hogan, 1997) (which associates smoking with stress
relief), one from Center Stage (Hytner, 2000) (which
links smoking and teenage rebellion), and one of
either Fight Club (London & Fincher, 1999) or 10
Things I Hate About You (Lazar & Junger, 1999)
(both of which associate smoking with male tough-
ness). The clips featured Hollywood stars Julia
Roberts, Zoe Saldana, Brad Pitt, and Heath Ledger,
respectively, and were shown as a way of initiating
discussion about tobacco imagery in films.3 The
group interview followed the viewing segment and
was moderated by one of the authors (a 29-year-old
White female graduate student with previous inter-
view experience). All sessions were audiorecorded.
The group questions were based on a semistructured
interview guide that began with general questions
about the films to ease respondents into a relaxed but
directed conversation. For instance, the participants
were asked, Which clip did you like the best and why?
What did you think of the actor in the clip? The dis-
cussion then narrowed to focus on more specific ques-
tions concerning the authenticity of smoking in film,
stereotypical images of smoking, saliency of brand
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328 Qualitative Health Research
placement, participants’ opinions on the inclusion ofsmoking in popular film, and earliest memories of
movies with smoking. The youth were also asked gen-
eral questions about smoking at their school and about
some of their personal experiences with cigarettes.
Notes were made about the group’s interactions
after each session, and these data were used to supple-
ment the interview data, which were transcribed from
the audiotapes after the interviews. The notes tended to
focus on group dynamics (i.e., Was a hierarchy appar-
ent within a group? Did a few members control the
conversation?) and allowed the researchers to consider,
for instance, whether respondents appeared simply to
be agreeing with more outspoken group members, or
whether a participant might be embellishing a fact
(e.g., her experiences with smoking) to impress other
group members. Thus, the context in which comments
were made was taken into consideration during analy-
sis, and some data were not included, as they were
deemed to be unreliable. Nonverbal cues were also
used by the moderator during the interview to get a
sense of the level of agreement among the group
members. If there appeared to be disagreement among
the participants (or if certain members were not
expressing an opinion), then the moderator used these
cues to probe further.
The transcripts and notes were read multiple times,
and a classification system for the major themes was
developed following standard ethnographic and focus
group methods (Hammersley & Atkinson, 1995;
Knodel, 1993). Several of the central codes identified
were based on topics that were outlined in the focus
group discussion guide and directly pursued in the
interviews (e.g., saliency of tobacco imagery, percep-
tions of authenticity). Patterns or themes that emerged
spontaneously (for example, the theme of cigarette
cravings) were also coded. After the coding process
was complete, the textual data were entered into
ATLAS.ti, a qualitative data analysis program that
facilitates the organization and management of large
amounts of textual data by allowing the researcher to
select and code relevant data into analytic categories.
The key categories were then further examined for
possible between-category relationships, and the
extent of within-group agreement on various concepts
was also determined at this stage. Data concerning the
extent of within-group agreement on key themes were
then put into a larger context and used to consider sim-
ilarities and differences between the groups.
One potential problem with this analytic process is
that of coder bias in selecting representative quotes
from the transcripts, or, in other words, taking quota-tions out of context to prove a point. In this case, we
avoided coder bias by requiring the existence of
numerous quotations to support a coding decision (i.e.,
evidence of within-group agreement was required)
(Knodel, 1993). The reliability of the findings was
increased by our use of extensive intracoding (i.e., the
transcripts were reviewed on numerous occasions to
ensure that the same areas of text were consistently
being coded in a similar manner). Moreover, having
the researcher who was involved with the data collec-
tion also engage in the data analysis might enhance the
accuracy of the interpretative analysis, as she is able to
consider the context in which the comments were
made (see, e.g., Knodel, 1993).
Findings and Analysis
   The research findings are presented in two parts. InPart 1, we share the smokers’ interpretations and per-
ceptions of tobacco imagery in film, whereas Part 2
focuses on those of the nonsmokers. Participant per-
ceptions of the influence of smoking in film on young
viewers, thoughts about the inclusion of smoking in
film, and media literacy skills are some of the key top-
ics covered in these sections. This presentation of
results is reflective of dominant themes that emerged
during the audience ethnography. Although the find-
ings have been divided into distinct categories, these
are somewhat artificial divisions, as the youth
responses were frequently relevant to various topics. It
should also be noted that the participants’ responses
are not limited to their perceptions of smoking inci-
dents in the clips shown. In many cases, for example,
comments about clips flowed into narratives about the
role of smoking and cigarettes in their everyday lives.
When presenting the results, participant responses
have at times been classified as “typical” or “repre-
sentative” (following the work of Wilson & Sparks,
1996, 1999, 2001). “Typical” responses are defined
as those supported by most members of the specified
groups (i.e., the nonsmokers, the smokers, or both
groups). Comments were categorized as “representa-
tive” when a few participants in a group responded in
a similar manner and there did not appear to be any
disagreement among the remaining group members.
Instances in which one or two participants in a group
expressed an opinion that did not seem to be indica-
tive of the sentiments of the rest of the group are also
highlighted throughout the results section. Similarly,
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Jetté et al. / Perceptions of Smoking 329
discussions within a group are presented when therewas either a disagreement on an issue or when several
respondents participated in the development of an
idea (following the work of McCool et al., 2001).
Part 1: Smoker Interpretations
   The findings of the smoker interviews are reportedin two sections. In the first, we identify key findings
concerning the impact of movies on youth smoking
and include smoker perceptions of how tobacco
imagery in films (might have) influenced their deci-
sions to start smoking and continues to affect the
amount that they smoke. In the second section, we
focus on media literacy and include discussions of the
purpose and believability of smoking scenes in movies.
Perceptions of the Impact of Movies on YouthSmoking
   “And every time I saw her take a puff off that smoke,I’m like . . . ‘I’m getting a smoke!’”: Movies and
celebrities as a social influence on smoking initiation.
When asked whether seeing smoking in films influ-
enced their smoking initiation, none of the smokers in
the five groups acknowledged this to be the case. The
majority rejected the idea outright, instead citing the
influence of family members and friends on their
smoking initiation. Typical responses included
Not really because I have a lot of friends that I chillwith and like, they smoke . . . both my parents
smoke.
No, it was more my mom.
Speaker 1: More friends than movies. Movie’s just amovie.
Speaker 2: Friends they have real stuff.
Speaker 1: Movies . . . can’t just give it to you, right?
Friends . . . they give it to you . . . Take a puff, take a
puff. Before you know it you have a whole cigarette
taking puffs out of that.
the idea]. I’m like, thinking about it . . . Like, I wasobsessed with that movie . . .
Speaker 2: It’s so weird, because like, I was, too.
And a couple of my friends were, too. It was the
favorite movie . . .
Interviewer: So, what did you think about them
smoking in it? If anything? . . .
Speaker 1: I just thought, like, they were.
Speaker 2: They looked too young.
Speaker 1: . . . But they looked, they were like my
age, like, at that time, so I was just like “hmmm.”
Like, I don’t know. I didn’t know what to think . . . I
still think of like, bad girls or something.
   It is important to note that the first speaker, quotedabove, had stated earlier in the interview that she was
not influenced to start smoking by seeing actors
smoke. It was not until she was asked to recollect her
earliest smoking memories that she was able to recall
the scene from the movie and then acknowledge the
possibility that it made her think about trying. Thus, a
more nuanced analysis of the results suggests that for
this youth, seeing Christina Ricci (one of her favorite
actors at the time) smoking in Now and Then might
have influenced her attitudes or beliefs about smoking,
and possibly contributed to her smoking initiation.
In another group, a participant’s recollection of her
earliest smoking/movie memory suggests that even
though the smoking depiction might not have influ-
enced her to start smoking, it almost certainly encour-
aged her to continue at a time when she was just
experimenting with cigarettes:
Oh, there was this one movie . . . and there was thisone girl from England . . . she . . . was really good and
then she met this guy and she really, really, really liked
him. And then before you know it, out of the blue,
she’s smoking! . . . She’s wearing make-up and she’s
in her house and she’s smoking. Her mom’s an alco-
holic. She’s just like . . . “Do the F-in dishes yourself,
mom!” And like she’s just harsh, like, changed . . .
And every time I saw her take a puff off that smoke,
I’m like—and this is just when I started smoking,
too—I’m like, “I’m getting a smoke!” Like it just
seemed—even though I wasn’t totally addicted, I just
thought: “Ahh, that makes me want to go for a smoke.”
   Despite these denials, however, responses in two ofthe groups included indirect but still powerful evidence
that smoking in films might contribute to youth smok-
ing initiation, as seen in the following discussion about
the Hollywood film Now and Then (Todd & Glatter,
1995):
Speaker 1: And I like Christina Ricci and I was like“Oh, she smokes. Oh” [says it like she is intrigued by
   Later in the interview, the same participantacknowledged that when she began to smoke, she
wanted to act out and rebel. The parallels between her
early smoking behavior and the movie character
described above are striking:
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330 Qualitative Health Research
When I started smoking, I was going through a lot.A lot. A lot of shit with my family . . . And I just like,
I wanted to get out. And I wanted to hang with
the baddest person in the world. And do the baddest
stuff . . . Now I regret it all. I totally regret it all.
I wish I was stronger. But I wasn’t. I was very weak.
When you see a person smoking, you’re like, “Ahh,but I want a smoke.”
When I see it, I think that . . . I just want to have adrag. “Oh my, God. I want a smoke.”
In spite of the fact that she had already started smok-ing when she viewed the clip, the way the character
used cigarettes in the film (to act out) might have rein-
forced her belief that smoking was a vehicle for doing
the “baddest stuff,” encouraging her own cigarette use.
Members in one of the groups discussed the possi-
bility that smoking in films by a favorite actor might
influence young people to start to smoke. As one par-
ticipant explained,
And if they like . . . the character, or whatever, andthey kind of relate to the character, then it makes it
more like, “Oh, well, I can just be like her in that
movie. Oh, I look just like her, like, or him.” Right?
So, it does kind of influence, but you don’t like to
say it. Like, you don’t like to actually think you’re
doing it because that person is doing it? But it does
kind of, like in a little subtle way.
   Conversely, members in one of the groups respondedwith “kind of” and “not really” when asked if seeing an
actor smoke in a movie causes them to crave a cigarette.
They were the exception, however, as several of the
smokers in the other four groups appeared eager to con-
firm that they have cravings when they see smoking in
films, with little or no within-group disagreement. This
admission was made spontaneously by participants in
three of the groups and came as a surprise, as in other
circumstances they were unwilling to admit to being
influenced by the media. It might be that in the hierarchy
of youth smoking culture, this admission is acceptable
(and even desirable), as it elevates one to the status of an
established smoker who gets “full-blown” cravings.
Media Literacy
   “So people can relate to it and also because theyget funding”: Smokers’ perceptions of the film indus-
try and tobacco placements in movies. When posed
with the question “Why does a director put smoking
in a film,” the smokers in four of the groups acknowl-
edged that it serves as both a promotional tool (to
advertise brands) and an artistic tool (to develop a
character). The discussion typically proceeded with
one or two individuals commenting on the role of
smoking and the other members agreeing (or not
commenting), which raises the possibility that not all
of the participants were aware of the promotional
intent of smoking scenes. Representative comments
were as follows:
Speaker 1: Because . . . it’s a stereotype.Speaker 2: And probably it’s advertising, too.
Speaker 1: To advertise the brands and stuff like thatSpeaker 2: Or to tell more about the character.
Speaker 3: Give more description of someone, right?
Speaker 2: Exactly, more of a style for them.
   Embedded in the last comment are two insightsinto why young people might deny that movies influ-
ence their smoking uptake. The first is that the influ-
ence is so subtle that they are not aware of it. The
second is that young people (and people in general)
do not like to admit that they are influenced by the
mass media, as is suggested by the comment, “You
don’t like to actually think you’re doing it because
that person is doing it.”
   “I just remember in the movie, Casino, I always,always wanted a smoke”: Smoking in films and ciga-
rette cravings. When asked if they notice tobacco
imagery in films, some of the smokers revealed that
not only do they find it to be a salient feature of
movies, they crave a cigarette when they see an actor
smoke. The following comments are representative of
the smokers in four of the groups:
When I’m watching movies, I don’t pay attention tothe negativity of it. It makes me crave one. Like,
every time I see someone smoking in the movie, or
smoking on the street, it makes me want to go out
and get one . . . I pretty much have to stop the movie
if I don’t have a pack of smokes around me . . . Like,
I’m a chain smoker in a movie. Like, I gotta smoke.
Because you always see people smoking, right?”
    In the fifth group, no one acknowledged that smok-ing in movies was a form of advertising, and one
respondent simply explained that it was included “to
make it [the movie] look realistic, obviously.”
Nevertheless, when the group was subsequently asked
if they noticed brands in movies, the same participant
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Jetté et al. / Perceptions of Smoking 331
exclaimed, “There’re these cool brown smokes!They’re like in brown papers and they’re really long. I
want to try them. They look so cool. And they’re in
Final Destination II.” The group then discussed brands
they had seen in movies without ever acknowledging
that brand placements might be a form of advertising.
Thus, it appears although some youth are knowledge-
able about movie production and the fact that money
might change hands between tobacco companies and
producers to have brand placements in films, others are
not. Most significant, the majority of smokers
acknowledged that smoking in films might be a form
of tobacco promotion only when specifically asked by
the interviewer why smoking might be included in a
film. Only one participant talked about brand place-
ments in films on her own accord.
By comparison, the idea that tobacco imagery in a
film aids character development and helps make a
scene more believable was a more prominent theme
throughout the interviews. The groups recognized
that certain types of characters were stereotypically
associated with smoking in films. Representative
comments included
Um, for guys, it would be like, the rugged.
Speaker 1: Rich, spoiled kid.Speaker 2: Stuck up people. Yeah, they have the
money. Why not?
Well, in Center Stage I thought it was like, the out-cast, like the one girl.
Um, I think that a type of smoker would be like thatguy . . . that’s kind of known like, to be more of like,
the rebel . . . as opposed to like the people in school
that like, just do their work and are . . . bookworms.
films. Often, discussions with smokers about the believ-ability of a clip segued into conversations about “real
life” smoking, as the participants drew on personal
experiences with cigarettes and compared the smoking
depiction in the movie clip to their life. The following
represent typical responses:
Speaker 1: She [Julia Roberts] knew that she wasn’tallowed to smoke in there, but she didn’t care
because she was like upset or whatever . . . Because
when you are stressed, the first thing you go for, if
you’re a smoker, is your smokes . . .
Speaker 2: This morning.
Speaker 1: Yeah, like after a bad test.
Speaker 3: If you’re in a bad mood, then you need a
smoke.
You know what I noticed? . . . how after he [BradPitt] offered the smokes and Edward Norton said
“No,” then . . . he never blew the smoke in his face
. . . I do that with Terry . . . she has asthma.
Well, in Fight Club, they were like drinking andsmoking and I do that. They go hand in hand . . .
like, even if you don’t light it yourself, if you’re
around people, it almost always gets passed.
Yeah, because you smoke in a bar when you drinkand then you smoke when you’re in a room . . . So,
yeah, it’s realistic.
Um, I think she’s [Zoe Saldana’s] kind of stupid.Like, anybody knows you’re not supposed to be
smoking . . . doing . . . an activity like ballet and
especially inside the building where you’re taking
the class . . . It’s a contradiction.
Oh, yeah, for sure [it was realistic]. Like anytimelike a negative incident or situation happens, you
want to go outside and like have a smoke, like
“ahhhh.” Like . . . I was having a bad day, and I was
like, “[Teacher], I really need to go for a smoke right
now.” Like, I just can’t stand this, like I gotta go and
get my mind off things, kind of thing.
Speaker 1: Obviously you can’t smoke in there.Others: Yeah
Speaker 1: The first thing you do would not be, in a
new school, is light up a cigarette. You would go out-
side, right?
   The smokers’ recognition that smoking in films isa way to support character development and make a
scene more believable might make them less likely to
question (or think critically about) its inclusion in
films. Furthermore, their understanding that certain
types of characters smoke in films means they are
familiar with the social meanings and identity types
associated with cigarettes and have the capacity to
enact these same meanings and roles in their own
lives, should they choose to do so.
   “Because when you’re stressed, the first thing you gofor . . . is your smokes”: Personal experiences with cig-
arettes and assessing the authenticity of smoking in
  Firsthand experience with cigarettes enabled thesmokers to criticize portrayals of smoking that did
not accurately reflect their perceptions of the reality
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332 Qualitative Health Research
of smoking, and the comments illustrate how some ofthe respondents rejected scenes of actors smoking
indoors. The extent to which the youth would criti-
cize smoking scenes when watching movies under
normal viewing circumstance, however, is not clear.
For instance, although a few participants questioned
the idea of a dancer smoking (based on their under-
standing that smoking impairs fitness), others felt that
smoking simply made the character more rebellious.
Along the same line, some of the participants did not
question Julia Roberts’s smoking indoors, because
they recognized that Roberts’s character was too
stressed out to care about where she was allowed to
smoke. The fact that many of the youth related to the
ways in which tobacco was used in the clips (to
relieve stress, when drinking, etc.) suggests that
viewing smoking scenes that resonate with their per-
sonal experiences might simply serve to reinforce
their smoking behavior.
You don’t really think anything of it.
No, it’s not a turn off.
I don’t really think much of it. I’m just, like focusingon him [Brad Pitt].
It’s different in movies than in real life . . . When youcan smell it in real life . . . I don’t like the smell of it
at all.
   It might be that the nonsmokers did not mind see-ing smoking in films because they viewed it as an
artistic device used to develop a character. Typical
responses included
Well, obviously that’s why they put it in movies.’Cause some characters, it just gives them more—
Like, it helps them with their character.
It’s an easy way for you to make a character in amovie. It’s really easy.
I don’t like smoking or—and I don’t do it, but . . .I think it rolls in with her character.
To make the character more realistic. To be moredown to earth, because like, everybody now smokes.
To make it more realistic.
It does build a character . . . Like, you wouldn’texpect some people to smoke . . . And then it just
makes them more bad.
Part 2: Nonsmoker Interpretations
   The findings of the interviews with the nonsmokersare reported in two sections. In the first, we focus on
the youths’ perceptions of smoking in movies, includ-
ing their awareness of smoking in films and thoughts
on why it is included. The second outlines the non-
smokers’ ideas about the impacts of tobacco imagery
in movies on young viewers. The theme of media liter-
acy underlies the results in both of these sections.
Perceptions of Tobacco Use in Films
   “You don’t really think anything of it”: The major-ity of the nonsmokers have an “aware but don’t care”
attitude toward smoking in films. For the majority of
the nonsmokers, smoking in films appears to be an
accepted part of the movie-going experience that nei-
ther draws attention away from the plot of a film nor
detracts from the appeal of a movie. Many (but not
all) of the youth reported that they did not mind see-
ing smoking in films, even though they were very
much aware of the negative health implications of
smoking and found it to be distasteful in “real life.”
For these youth, cigarettes appear somewhat innocu-
ous when those smoking them are glamorous movie
stars and the smell of cigarette smoke is confined to
the movie set. The following are typical responses
regarding the saliency of tobacco imagery in films:
Like I won’t make a mental note . . . I’ll just see itand it will just pass.
   When asked to elaborate on the types of charactersthat usually smoke in films, the participants had little
trouble identifying what they saw as stereotypical
smokers. Examples included
The private school girl.
Usually, like the bad guy. Sometimes, if you watchthe older movies and like, you know, the evil cowboy
dude’s all like, on his horse and he’s smoking and he
says “Let’s go get ’em, boys.”
Older country people.
The stereotypical popular group?
Like really, really blond girls.
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Jetté et al. / Perceptions of Smoking 333
   Only one participant felt that smoking was unnec-essary for character development, although she, too,
recognized the image that a movie director might be
trying to construct by having a character smoke:
Well, they could have done without it [smoking] . . .I didn’t think he [Brad Pitt] really needed, like if he
didn’t it would still, like, mean the same thing. I
guess he was doing it to be kind of all like hardcore
and big and stuff, but . . . I don’t think it really
helped him be like that.
film. In contrast, the notion that tobacco use in moviesis a dramatic device often emerged spontaneously dur-
ing the interviews.
Some of the nonsmokers drew on their health knowl-
edge to comment on the realism of the smoking scenes.
For example, participants in three of the five groups cri-
tiqued the clip from Center Stage (Hytner, 2000)
because they found cigarette smoking to be incompati-
ble with the discipline and physical training of ballet:
Speaker 1: She’s [Zoe Saldana] a dancer. She shouldknow that she’s kind of like an athlete, so she should
not do, smoke or drugs or anything like that. She
probably knows . . .
Speaker 2: Yeah, I don’t—usually when you think
about athletes and stuff you would expect them not
to be smoking or drinking or like anything else, but
when you like kind of see in a movie, it kind of takes
the dancer or whatever out of them.
I don’t think—ballet dancers wouldn’t smoke.
   It should be clarified that the ambivalence towardsmoking in films was not unanimous among the non-
smokers. A few of the participants (who also made
several media-savvy comments during the inter-
views) appeared to find smoking in films to be more
salient and disagreeable than the rest:
It makes me feel kind of sick to my stomach some-times? Like if you see like more than three people
and they’re all standing around “Yeah, hah” [imitates
smoking]. You know, then I would start to feel kind
of sick because I can just smell it my mind and I’m
like [makes a face]. Right? . . . So I notice it a lot.
   For the most part, however, the nonsmokersappeared to view smoking as a legitimate technique
for helping to develop a character and make a movie
more realistic. They recognized that smoking carries
with it a variety of meanings (such as toughness and
rebelliousness) and that having a character smoke
helps mobilize these meanings. This is not to say that
these youth lacked media literacy skills, however.
Like the smokers, the nonsmokers were aware that
smoking in movies functioned as a form of advertis-
ing. Representative comments included
Yeah, do they get more money if they show thebrand?
Or maybe the company just pays the movie to like,put it in so that they can see the brand. And they’re
like, “Oh, I want that.”
I think it’s advertising . . . Yeah, they smoke. Andpeople say, “Oh, yeah, smoking is cool” and stuff
like that.
   These interpretations were not universallyaccepted, however, as other group members observed
that having the dancer smoke added to her rebellious
image. The following conversation reveals how in
some cases both ideas emerged and were accepted
within the same group:
Speaker 1: Yeah, she’s the rebel of the dance classand everyone’s perfect and then she’s not and she’s
the smoking one.
Speaker 2: Yeah, and she’s also like the one, like,
drinking beer at a bar, at a pub or whatever
Speaker 1: Yeah . . . and she’s got her like harsh like,
accent and
Interviewer: So you were saying
Speaker 2: Normally you wouldn’t think of a ballet
dancer . . . she’s being unhealthy, right?
As was the case with the smokers, however, the major-ity of the participants did not identify smoking in
movies as a form of advertising until they were specif-
ically asked why a director might include smoking in a
    This example illustrates how health messages caninteract and even conflict with popular cultural repre-
sentations of smoking, underscoring the complexity of
messages about smoking in the everyday lives of young
people. The fact that the typical nonsmoker’s response
to smoking in films was an aware-but-don’t-care attitude
suggests that smoking in films slips “under the radar” of
most of the nonsmokers and calls into question whether
these youth critically deconstruct tobacco use in films
under normal circumstances and whether their status
as nonsmokers bears any relationship to their media
literacy skills.
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334 Qualitative Health Research
Perceptions of the Impact of Movies on YouthSmoking Initiation
   “I would never start smoking because JuliaRoberts or Brad Pitt started”: Nonsmoking youths’
perceptions of smoking in movies and youth smoking
initiation. Comments made by nonsmokers regarding
the relationship between on-screen smoking and
youth smoking uptake demonstrate a tendency to
blame the viewer. Instead of condemning the actor for
smoking on-screen, the youth were more inclined to
pass judgment on the kind of individual who might be
influenced by the actor’s actions. The following are
representative comments:
I would never start smoking because Julia Roberts orBrad Pitt started and I like, I’m in love with them or
like idolize them? . . . I’m always surprised at how
many people would . . . Because like, they see some-
body do it and so they want to do it . . . but it wouldn’t
make me start smoking.
Speaker 1: If they like, like the character and theylike, want to be like them.
Speaker 2: If they’re really, like, naïve people who
think that that’s what’s going to make them happy.
And then you think about all those crazy, likewannabe fans. They’re like “(gasps) she smokes.
Maybe I should smoke, too. You know, just to be just
like Julia” . . . And I just feel so sorry for them
because they’re so stupid. So I mean, like, when you
get like an actor or actress or whatever, like, smok-
ing in movies and it kind of like, affects some of the
fans. Not me. But, you know, some of the crazy ones
out there, so [laughing].
that smoking in films influenced their smoking initia-tion. Both the smokers and nonsmokers did not want to
appear duped by the media, although this semblance of
independence was undermined by and exposed in their
other responses.
Discussion
   Findings from interviews with smokers demon-strated that smoking scenes in films might stimulate
youth smoking and that cigarettes are an important
symbol in youth peer groups, with explicit social
meanings and functions. The results of interviews with
nonsmokers revealed that although the majority
noticed smoking in movies, it did not detract from their
viewing experience. Although both the smokers and
the nonsmokers were aware that tobacco placements in
films served as a form of product promotion, they typ-
ically focused on smoking’s function as a dramatic
device for character development rather than its pro-
motional value. Overall, both groups appeared to be
capable of critical readings of smoking in films but
tended not to use these capabilities when viewing
movies. In this discussion section, we elaborate on
these findings with a focus on the ways in which our
research compares to and informs previous studies
related to youth, smoking, and media.
Movies and Youth Smoking Behavior
   These findings corroborate previous research andextend our understanding of how representations of
smoking in films affect youth smoking. The smokers
in the present study broadly rejected the idea that
smoking imagery in films influenced their smoking
uptake and instead attributed their smoking to friends
and family. Similarly, both the younger and the older
participants in qualitative studies conducted in New
Zealand (McCool et al., 2001, 2003) made compara-
ble claims. Nevertheless, previous survey research
suggests that the effects of smoking in films on smok-
ing initiation were as strong as other sources of social
influence (i.e., family members, peer groups) (Dalton
et al., 2003; Distefan et al., 2004). This discrepancy
between the quantitative and qualitative findings
might be attributable to the fact that many of the
Canadian participants, like the New Zealand youth,
were aware that smoking in movies was a device for
advertising a brand. As McCool et al. (2001) pointed
out, being aware of the promotional intent of tobacco
placements likely precludes any admission to being
   These statements suggest two things. First, the use ofthe words “crazy,” “naïve,” and “stupid” indicates the
nonsmokers had a negative view of anyone who would
start smoking because their favorite actor smoked in a
film. This demonstrates that these participants felt it
was the responsibility of the viewer to resist being
influenced by smoking in movies and reinforces the
idea that young people focus more on individual
responsibility and less on the responsibility of corpora-
tions or social institutions. Second, it appears that in
youth peer cultures, it is undesirable to admit that one is
subject to the influences of the mass media, as several
of the participants were quick to point out that they
would never be influenced to start smoking by images
in the media. This latter point, especially, allows for a
more nuanced understanding of the smokers’ denial
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Jetté et al. / Perceptions of Smoking 335
affected by such tactics. When this issue wasapproached in a more indirect manner in the present
study (i.e., asking about early memories of movies
with smoking), a different picture emerged, as the rec-
ollections of a few of the female smokers suggest that
seeing smoking in films positively influenced their
attitudes toward cigarette use, perhaps making them
more receptive to the idea of smoking. The perspec-
tives of the nonsmoker participants are also informa-
tive on this point. Many of them believed that young
people might be influenced to smoke by seeing a
celebrity smoke but viewed such individuals in a neg-
ative light. This suggests that within youth culture, it
is important to appear above the influence of the
media. With this in mind, it seems likely that smokers
would not admit to being influenced to try smoking as
a result of seeing actors smoke, even if they had been.
At the same time, however, smokers were willing to
concede that smoking in films triggered their cravings
and influenced their smoking behavior by giving them
the physical urge to smoke a cigarette. This is a unique
contribution to the literature on youth smoking and
popular films, as the previous studies conducted in
New Zealand (McCool et al., 2001, 2003) and India
(WHO, 2003) did not report a similar finding. The
absence of such evidence in the New Zealand research
(McCool et al., 2001, 2003) might be related to the fact
that the participants did not actually view smoking
scenes in movies and, as a result, did not have the
visual cue of someone smoking to trigger their urge to
smoke. Although the teens in the Indian study (WHO,
2003) viewed smoking scenes in Bollywood films, dif-
ferences in their perceptions of the need to smoke
when viewing such depictions might be a reflection of
the genre (Bollywood versus Hollywood films), cul-
tural differences between the groups of youth in the
respective countries, or even the youths’ level of addic-
tion to cigarettes.
The fact that many of the female smokers in the
study described here reported this urge to smoke
when viewing tobacco use in films helps to explain
existing research that confirms a continued high inci-
dence of smoking scenes in movies (Glantz et al.,
2004). By appealing to smokers’ physical addiction
through film portrayals of smoking, the tobacco
industry would ostensibly be able to sell more ciga-
rettes to individuals who are already addicted, as well
as to entice potential new smokers, and this means
that film placements have tangible short-term as well
as long-term benefits for the industry. This triggering
of cravings might occur regardless of whether the
  1. click here for more information on this paper
movie glamorizes smoking and is an important pointbecause of its potential connection to the continuance
as well as the uptake of smoking by youth peer
groups. Previous research (Glantz et al., 2004; Hazan
et al., 1994; Stockwell & Glantz, 1997) has found
that high rates of cigarette use in films tends to nor-
malize smoking and might lead youth audiences to
overestimate the prevalence of smoking in “real life.”
The research reported in this article demonstrates an
actual response to the stimulus of seeing smoking in
movies, and this finding would most likely serve to
reinforce peer smoking (as well as individual smok-
ing), as adolescents tend to smoke in the context of
their peers.
Smoking in films might also influence the smoking
behavior of established smokers in a way that is more
subtle. Similar to the older youth in the New Zealand
project (who also had experience with smoking)
(McCool et al., 2003), the smokers in the present study
viewed tobacco imagery in films with an appreciation
for images that resonated with their personal smoking
experiences. Moreover, they appeared to draw on their
experiences with smoking when assessing the believ-
ability of a smoking portrayal and were able to dis-
cuss the believability of the clips with confidence.
Although this is potentially a positive development
with regard to the media literacy of young smokers (as
it appears that they have the ability to assess critically
the realism of smoking in films), it is also possible that
viewing such depictions simply serves to reinforce and
normalize the ways in which they use cigarettes. As a
result, smoking imagery in films might justify and
encourage their smoking behavior.
In addition to providing insight into the role of
tobacco imagery in movies in the lives of the female
smokers, participant responses reveal something
about the role of smoking in the lives of these youth,
as conversations about tobacco use in films often
segued into conversations about the ways they used
tobacco: to rebel against authority (i.e., do the “bad-
dest” stuff), in conjunction with alcohol, and to
relieve stress. These findings corroborate previous
ethnographic research in Canada, which suggests that
for young people, cigarettes might be used as a tool
to exercise symbolic creativity in their everyday lives,
as well as a way of resisting authority (or the main-
stream school culture) and cope with uncomfortable
feelings (Connop et al., 1999; McCracken, 1992;
Seguire & Chalmers, 2000). In this way, the present
study supports the view that cigarettes, and, by exten-
sion, the act of smoking, can be empowering for
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336 Qualitative Health Research
young females. One of the ironies of youth smoking,however, is that although young people might feel
(and be) empowered by smoking at school or within
their peer group, at the level of the marketplace, they
are objectified and recruited by tobacco companies to
a social practice (smoking) that is addictive and, ulti-
mately, fatal for half of its followers. When one con-
siders this bigger picture, the celebration of the
symbolic creativity of youth put forth in the youth
subculture literature (e.g., Willis, 1990) seems less
applicable to the issue of smoking.
smoking) might inform young women’s attitudes andbeliefs about tobacco use.
Audiences, Youth, and the InterpretiveCommunity
   Following Radway’s (1991) understanding of theinterpretive community concept, we theorized that
smokers and nonsmokers would likely interpret and,
especially, use media texts about smoking in some-
what different ways because of their distinct social
locations (i.e., related to their experience with smok-
ing). At the same time, it was also assumed that there
would be some shared interpretations because of their
common locations as female youth in the same
school. Evidence suggests that this is the case. For
instance, the two groups differed in the extent to
which they notice smoking in film and their percep-
tions of the influence of smoking in film on youth
smoking initiation. Media texts also appeared to play
a role in the everyday lives of some of the female
smokers, as several reported that tobacco imagery in
film might influence their smoking style and fre-
quency. There was, obviously, no such evidence of
impact on smoking rituals among the nonsmokers. A
notable similarity between the two groups was that
the majority did not appear to think critically about
tobacco imagery in film but instead accepted it as a
normal part of a movie used to develop a character or
make a scene more realistic. Other similarities
included (ironically) an awareness that smoking in
film might be a form of advertising and a desire to
give the impression that one is impervious to the
influence of such advertising.
It should also be noted that within each group (i.e.,
smokers or nonsmokers), interpretations and assess-
ments were not always uniform. Instead, some
within-group variation did exist, such as the level of
media literacy skills of the youth and the extent to
which they were judgmental of smoking depictions in
film. These differences might have arisen because
this study’s definition of social location is somewhat
broad. Other factors, such as age and race, might
interact with smoking status to create differences in
interpretation. In fact, even smoking status is a nebu-
lous concept, as one can be in various stages of her
smoking career (from a social smoker to an estab-
lished smoker to one hoping to quit). In this sense, the
conceptual struggles encountered in this study were
akin to those described by Radway (1991), who had
Nonsmokers’ Critical Awareness ofTobacco Imagery in Films
   The majority of the nonsmokers in this study tookan aware-but-don’t-care stance toward smoking in
movies. For most of the youth, smoking appeared to
blend into the background of a movie, as they focused
more on the characters or the plot of the film. The
findings also suggest that the absence of cigarette
smoke makes smoking in films less offensive for
many youth and, therefore, less noticeable. Although
many of the nonsmokers found smoking to be a dis-
tasteful habit, the majority were not critical of actors
for smoking in movies. Overall, the nonsmokers
seemed to view smoking in films as an accepted part
of the movie-going experience and an artistic tool for
developing a character. In this way, the nonsmokers in
the present study and the New Zealand respondents
(McCool et al., 2001, 2003) appear to share a “pre-
dominantly nonchalant response to smoking imagery
in film” (McCool et al., 2003, p. 1023). Moreover,
many of the female nonsmokers tended to accept
depictions of smoking in films as an accurate reflec-
tion of reality. This suggests that adolescent females
with little direct experience with smoking might, to
some extent, be informed about smoking by tobacco
imagery in movies. On the other hand, it is important
to caution against making claims about “the ‘linearity’
and directness of this informational process” (Wilson
& Sparks, 1999, p. 618), and one should not assume
that all youth with a lack of experience with smoking
will automatically accept movie depictions of smok-
ing to be true. For instance, a few of the participants
drew on their health knowledge to question the
imagery of a dancer who smokes. The possibility that
tobacco imagery informs youths’ understandings of
smoking is a cause for concern, however, as such mes-
sages (particularly those that glamorize and normalize
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Jetté et al. / Perceptions of Smoking 337
a similar difficulty defining social location (i.e.,determining exactly how membership in the romance
reading-community was constituted).
Audiences, Youth, and Media Literacy
    The findings in this study support Miles’s (2000)argument that young people have the potential to be
critical viewers but do not always use their literacy
skills in their media-saturated, consumer-oriented
lifestyles. Although most of the groups were able to
differentiate a promotional and artistic rationale for
including smoking in movies, and some drew on health
knowledge to critique smoking scenes, it was not clear
to what extent they would critically deconstruct smok-
ing scenes when watching a film under normal view-
ing circumstances. Discussions with the participants
about movie watching showed that they tended to
become engrossed in the plot of a film. For example,
the majority of the nonsmokers explained that although
they were aware of smoking in movies, they did not
usually take much notice of it. Although smoking in
films appeared to be more salient to the smokers, the
fact that they notice it mainly because it makes them
crave a cigarette suggests that they are not thinking
about smoking in an overly critical manner either.
Even the youths’ awareness that smoking in films
might be a form of tobacco promotion comes into
question under closer scrutiny. The idea that smoking
in films is an artistic tool for developing a character
emerged in all of the interviews (especially among the
nonsmokers), whereas the fact that film placements are
a form of promotion was (for the most part) mentioned
only when the youth were specifically asked why a
director puts smoking in movies. Most important,
when the smokers talked about specific brands, con-
spicuously absent was any mention of the fact that the
placements were a type of promotion, suggesting that
the female adolescents in the study did not use their
media literacy skills to think critically about this mat-
ter. In short, the relaxed attitude of many of the youth
toward smoking in films suggests that they tend not to
assess smoking in movies critically and tend to accept
portrayals of smoking in films (which are often glam-
orized and unrealistic) at face value.
Conclusion
  In addition to contributing to broader theoreticaldebates around the media literacy of youth audiences
(see Miles, 2000), findings from this study have impli-cations on a more practical level for tobacco control
policies. Evidence that smoking in films influenced the
smoking behavior of some of the smokers, whereas it
was largely ignored by the nonsmokers, contributes to
a growing body of literature that is critical of tobacco
placements and imagery in Hollywood films, and that
might be used by members of the health care commu-
nity and activist groups to influence policy related to
the inclusion of tobacco imagery in Hollywood films.
Despite efforts by the health community and activist
groups to lessen the impact on young viewers of
tobacco placements in movies, laws related to artistic
freedom mean that smoking in movies will remain an
issue for the foreseeable future. As a result, findings
from this study are important on a pedagogical level, as
they provide guidance for those who wish to create
media literacy strategies that might counteract the con-
tinued use of tobacco in films. Evidence that young
people (smokers and nonsmokers alike) do not wish to
appear as if they have been duped by the media points
to the value of educating youth about the tactics of the
tobacco industry and the industry’s history of targeting
audiences through Hollywood films.4 With this in
mind, a class project in which youth take control of the
media (e.g., string together clips of smoking scenes
and critically assess these clips) might help to activate
young people’s critical thinking skills—which the
young women in this study appeared to possess but not
always use—so that tobacco use in movies is less
likely to slip “under the radar.”5
Another approach is to get young people involved
in spreading the message that youth are targeted by
the tobacco industry through cigarette placement in
film. Reality Check is one example of a youth-driven
movement based in New York that teaches youth how
to educate other young people about the tobacco
industry. The group has grown to include youth from
other American states, and more than 10,000 young
people have attended Reality Check events.6
A final note should be made regarding the impact
of tobacco imagery in films on smoking initiation
among young women. The fact that many of the non-
smokers in this study were not critical of smoking in
films (i.e., did not seem to use special deconstructive
strategies when watching movies) yet have not started
to smoke suggests that smoking initiation is a com-
plex issue that cannot be attributed solely to a
person’s unthinking acceptance of smoking in films.
Although exposure to smoking imagery in movies
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338 Qualitative Health Research
might play a role in youth smoking initiation, asdemonstrated by previous survey-based research
(Dalton et al., 2003; Distefan et al., 2004), the obvi-
ous complexity of the issue of youth smoking rein-
forces the importance of qualitative research like that
conducted here, which facilitates a more in-depth
exploration of the issue and considers the personal
experiences and life histories of youth, as well as
respondent interpretations of other messages about
tobacco in the environment (e.g., messages from
family and/or community). The fact that several of
the youth in this study drew on health-related mes-
sages to critique smoking scenes in the clips leads us
to suggest that future researchers should explore this
apparent mixing of messages in more depth. Finally,
qualitative projects such as the one described here, as
well as those in New Zealand (McCool et al., 2001,
2003) and India (WHO, 2003), should continue to be
conducted in different cultural contexts. By expand-
ing the scope of such research to include youth from
different backgrounds, we will continue to build our
understanding of how social location shapes young
people’s interpretations of smoking in films and
tobacco more generally.
  1. More specifically, educators can have students put together

clips of smoking scenes from movies (using a program such as
iMovie) or download images of actors smoking from the internet
and paste these into a simple PowerPoint presentation. A possible
project that does not require the use of a computer is to have
students look through magazines for pictures of actors smoking (in
movies or “real life”) and create a collage of these images.
Smoking advertisements featured in magazines may also be used.
Classroom discussions can then be held to critically assess these
images of tobacco use; the Web site http://www.cdc.gov/tobacco/
celebrities/SceneSmoking/HSGuide.htm provides teachers with
information on possible classroom discussions.

  1. More information is provided on the Reality Check Web

site: http://www.realitycheckny.org/RCNY/siteMapSet/reality-
check/rcnyFlash.cfm.

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  1. Bollywood films are India’s equivalent to Hollywood films.
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  1. click here for more information on this paper
Shannon Jetté is a doctoral student at the University of BritishColumbia in Vancouver, British Columbia, Canada.
Brian Wilson, PhD, is an associate professor at the University ofBritish Columbia in Vancouver, British Columbia, Canada.
Robert Sparks, PhD, is an associate professor at the Universityof British Columbia in Vancouver, British Columbia, Canada.
 

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