title: Smoking in movies and adolescent smoking: cross-cultural study in six European countries.
abstract: OBJECTIVE
  To investigate whether the association between exposure to smoking in movies and smoking among youth is independent of cultural context.
  
  
  METHODS
  Cross-sectional survey of 16,551 pupils recruited in Germany, Iceland, Italy, the Netherlands, Poland and Scotland with a mean age of 13.4 years (SD=1.18) and an equal gender distribution. School-based surveys were conducted between November 2009 and June 2010. Using previously validated methods, exposure to movie smoking was estimated from the 250 top-grossing movies of each country (years 2004-2009) and related to ever smoking.
  
  
  RESULTS
  Overall, 29% of the sample had tried smoking. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of ever smoking: 14% of adolescents in Q1 had tried smoking, 21% in Q2, 29% in Q3 and 36% in Q4. After controlling for age, gender, family affluence, school performance, television screen time, number of movies seen, sensation seeking and rebelliousness and smoking within the social environment (peers, parents and siblings), the adjusted ORs for having tried smoking in the entire sample were 1.3 (95% CI 1.1 to 1.5) for adolescents in Q2, 1.6 (95% CI 1.4 to 1.9) for Q3 and 1.7 (95% CI 1.4 to 2.0) for Q4 compared with Q1. The adjusted relationship between ever smoking and higher movie smoking exposure levels was significant in all countries with a non-linear association in Italy and Poland.
  
  
  CONCLUSIONS
  The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Limiting young people's exposure to movie smoking could have important public health implications.
authors.affiliation: Institute for Therapy and Health Research (IFT-Nord), Harmsstrasse 2, 24114 Kiel, Germany.
authors.forename: Matthis
authors.initials: M
authors.lastname: Morgenstern
authors.forename: Evelien A P
authors.initials: EA
authors.lastname: Poelen
authors.forename: Ron
authors.initials: R
authors.lastname: Scholte
authors.forename: Solveig
authors.initials: S
authors.lastname: Karlsdottir
authors.forename: Stefán Hrafn
authors.initials: SH
authors.lastname: Jonsson
authors.forename: Federica
authors.initials: F
authors.lastname: Mathis
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Faggiano
authors.forename: Ewa
authors.initials: E
authors.lastname: Florek
authors.forename: Helen
authors.initials: H
authors.lastname: Sweeting
authors.forename: Kate
authors.initials: K
authors.lastname: Hunt
authors.forename: James D
authors.initials: JD
authors.lastname: Sargent
authors.forename: Reiner
authors.initials: R
authors.lastname: Hanewinkel
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007100:Imitative Behavior; D008297:Male; D009040:Motion Pictures / Q000706:statistics & numerical data*; D010379:Peer Group; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult