© 2004 American Public Health Association
At the time the research for this article was completed, Janet M. Distefan was with the Cancer Prevention and Control Program, Cancer Center, University of California, San Diego. John P. Pierce and Elizabeth A. Gilpin are with the Cancer Prevention and Control Program, Cancer Center, University of California, San Diego. Correspondence: Requests for reprints should be sent to John P. Pierce, PhD, Cancer Prevention and Control Program, Cancer Center, University of California, San Diego, La Jolla, CA 92093-0645 (e-mail: jppierce{at}ucsd.edu).
Objectives. We sought to determine whether adolescents whose favorite movie stars smoke on-screen are at increased risk of tobacco use. Methods. During interviews, adolescent never smokers taking part in the California Tobacco Survey nominated their favorite stars. We reviewed popular films released during 1994 through 1996 to determine whether stars smoked on-screen in at least 2 films. Results. One third of never smokers nominated a star who smoked on-screen, which independently predicted later smoking risk (odds ratio [OR] = 1.36; 95% confidence interval [CI] = 1.02, 1.82). The effect was strong among girls (OR = 1.86; 95% CI = 1.26, 2.73). Among boys, there was no independent effect after control for receptivity to tobacco industry promotions. Conclusions. Public health efforts to reduce adolescent smoking must confront smoking in films as a tobacco marketing strategy.
Adolescents watch an average of 3 movies per week,1 and cigarette smoking among actors in movies has increased in frequency over the past decade.2 Several recent observational studies suggest that the apparent product placement of smoking in movies might encourage young people to start smoking.36 Public health advocates are calling for the removal of smoking from movies targeted at children and young adolescents.7 Evidence exists that adolescent smoking is partially attributable to aggressive tobacco marketing strategies aimed at youths via popular culture.811 One such strategy is to ensure that stars smoke in popular movies.1214 Placing products or brand identifiers in movies is recognized as a standard marketing option to advertise and promote product use.15 Previously unreleased tobacco industry documents emphasize the value of marketing strong positive images for cigarettes in movies,12 and, in the 1980s, the chairman-elect of Phillip Morris focused on the need to find more opportunities to portray cigarettes on-screen.12 The advertising literature notes that movie product placements are effective if the viewer interprets the brand image according to who the character is and how the brand is used by the character.16 The perceived optimal (i.e., most expensive) placements are in scenes in which the brand is used by the movies stars.17 Examples cited in the literature include the 65% increase in sales of Hersheys Reeses Pieces candy after its use by the main character in the movie E.T.18 and dramatic increases in demand for the BMW Z3 automobile, evident by long waiting lists and the withdrawal of discounts for purchase, following the James Bond characters use of the car in the movie Goldeneye.16,19,20 If on-screen smoking by a main character is associated with initiation of smoking among adolescents, this would indicate credible evidence that placement of cigarettes in movies is a successful marketing strategy to encourage minors to smoke. We report results from a longitudinal study, conducted between 1996 and 1999, involving a representative sample of California adolescents who were initially aged 12 to 15 years. At baseline, adolescents who reported that they had never smoked were asked to nominate their 2 favorite male and female movie stars. The most popular stars movies in the 3 years before baseline were reviewed, and whether or not the star smoked on-screen was recorded. Adolescent smoking status was reassessed 3 years later in a follow-up interview.
The baseline sample for this study included 3104 never smokers aged 12 to 15 years who were interviewed as part of the 1996 California Tobacco Survey (CTS), a random-digit-dialing telephone survey of households in California. Versions of the CTS have been conducted approximately every 3 years since 1990. After separate funding was obtained in 1999, a letter was sent to each adolescents original address introducing the follow-up survey. Verbal parental consent was obtained, and a telephone interview was scheduled for the adolescent. Completed follow-up interviews were available for 2084 adolescents (77% of the homes located), or 67% of the original sample. All surveys were offered in either English or Spanish. Nonrespondents were more likely to be members of non-White ethnic groups (rates of nonresponse were 52.2% among African Americans and 21.6% among non-Hispanic Whites), to report average or below-average performance at school (rates of nonresponse were 49.8% among those who reported average or below-average school performance and 27.2% among those who reported performing better or much better than average), and to have family members who were smokers (rates of nonresponse were 37.2% among those exposed to familial smoking and 29.0% among those not exposed to familial smoking). The adolescent surveys conducted at baseline and follow-up included questions (described previously11) focusing on demographic characteristics, exposure to smoking among family and friends, self-reported school performance, and receptivity to tobacco advertising and promotions. Other measures are described in the sections to follow.
Smoking
Smoking Status of Favorite Star
Parental Disapproval of Smoking
Statistical Analysis
We computed variance estimates and 95% confidence intervals (CIs) using the jackknife procedure.21 To evaluate demographic differences, we performed modified 2-tailed
On-Screen Smoking Status of Favorite Stars Table 1
Respondents whose favorite stars smoked on-screen (34.6%) were more likely to be girls (39.2% vs 29.9%) and to be in their middle adolescent years (40.7% among those aged 1415 years at baseline vs 29.5% among those aged 1213 years at baseline). African American adolescents were less likely (10.5%) to name a star who smoked on-screen than were members of other groups (rates of 35.0% to 40.1%). Favorite nominated stars who were classified as not smoking on-screen were Julia Roberts (named by 6% of girls and 2% of boys), Michelle Pfieffer (6% of girls and 5% of boys), Tom Cruise (12% of girls and 6% of boys), Tom Hanks (4% of girls and 3% of boys), Arnold Schwarzenegger (0% of girls and 12% of boys), Jim Carrey (3% of girls and 12% of boys), and Mel Gibson (4% of girls and 3% of boys).
Receptivity to Tobacco Advertising and Promotions
Predicting Smoking at Follow-Up Table 3
When the multivariate analysis was restricted to girls, having a favorite star who smoked on-screen increased the risk of smoking almost twofold (OR = 1.86; 95% CI = 1.26, 2.73). Figure 1
The results of this longitudinal study indicate that smoking by stars in movies significantly increases the risk of future smoking among adolescent girls who have never smoked, independent of effects arising from other tobacco advertising and promotional practices. Adolescent girls who had a favorite star who smoked in movies released between 1994 and 1996, before the baseline survey, had more than 80% increased odds of smoking by the time of the follow-up interview relative to those whose favorite star did not smoke on-screen. The lack of effect among boys (as described subsequently) may, in part, be due to a stronger influence of their receptivity to other tobacco advertising and promotional practices. There is a considerable literature suggesting that product placement in film is an effective way to promote behavior.1517 Substantial increases in sales have accompanied a number of product placements in movies.15,24,25 The practice of product placement grew rapidly throughout the 1990s and is now common in virtually every big-budget Hollywood film.26,27 The rapid diffusion of this practice has been attributed to the money that product placements offer movie studios, producers, and directors.28 While it is compulsory that the tobacco industry comply with demands of the Federal Trade Commission (as per the Federal Cigarette Labeling and Advertising Act) for information on expenditures for product placement in movies, records suggest that no money was spent on these activities throughout the 1990s.29 However, previously unreleased documents exposed in litigation against the tobacco industry clearly indicate that the practice occurred.12 We classified 41% of girls and 30% of boys in California who had never smoked in 1996 as having a favorite movie star who smoked on-screen. This is a very conservative estimate in that we considered the films of only the most nominated stars; we also required at least one of an adolescents favorite stars to smoke in at least 2 film releases in the 3 years before the baseline survey before we classified the adolescent as having a favorite star who smoked on-screen. These criteria would be expected to significantly underestimate exposure levels and to bias the analysis toward finding no effect of on-screen smoking among movie stars. There are several possible explanations for the lack of effect among boys. Although genre was not coded in this study, the lack of effect for boys may reflect gender differences in film genre preferences. Previous research has shown that female adolescents prefer movies characterized as romances/dramas,30,31 which tend to contain high levels of star smoking,32 and male adolescents prefer action/adventure films,30,31 which tend to involve lower levels of star smoking.32 This effect was also seen in our study. Brad Pitt smoked repeatedly in dramatic films and was nominated by female adolescents, and Pamela Anderson smoked less frequently in an action film and was nominated by male adolescents. Boys nominated female actors who smoked in R-rated films. Leading female actors are more likely to smoke in films aimed at young audiences (i.e., films rated PG and PG-13) than in R-rated movies.33 Indeed, some public health advocates have voiced their concern about the high prevalence of smoking in PG-13 movies as a reason for adding smoking to the criteria for rating movies.34 The lack of effect seen among boys may also be related to the time period covered by this study. In 1996, the tobacco industrys use of promotional items to promote smoking peaked, before being limited by the Master Settlement Agreement reached between the tobacco industry and the states attorneys general in 1998. Without the high receptivity to promotional items seen among adolescent boys in 1996, smoking by actors might have been more strongly associated with increased smoking initiation on the part of boys. Conversely, if girls were more receptive to industry promotional activities, the effect of product placement in movies may have been diminished. At baseline, African American adolescents were less likely than other adolescents to nominate a star who smoked on-screen during the study period, and notably our review did not identify any favorite African American actor who smoked on-screen. This suggests that the tobacco industry was not trying to associate cigarettes with favorite African American actors (Whitney Houston, Wesley Snipes, and Will Smith) during the study period, although soon after this period Will Smith smoked cigars repeatedly in the film Independence Day. The study period occurred at the end of more than a decade of declining trends in smoking among African American adolescents.35
Limitations
Conclusions
Data for the 1996 California Tobacco Survey were collected under contract 95-23211 from the California Department of Health Services, Tobacco Control Section. The follow-up surveys were funded by the Robert Wood Johnson Foundation under grant 035086. Preparation of this article was supported by grant 9RT-0036 from the University of California Tobacco Related Disease Research Program.
Human Participant Protection
Contributors J. M. Distefan performed the analysis for this study, J. P. Pierce created the analysis plan, and E. A. Gilpin reviewed the analysis plan. All of the authors were involved in writing the article. Accepted for publication April 15, 2003.
1. Glantz S. What to do about Hollywood: tobaccos smoldering affair. Los Angeles Times. June 2, 2001:F12. 2. Stockwell TF, Glantz SA. Tobacco use is increasing in popular films. Tob Control. 1997;6:282284.[Abstract] 3. Dalton MA, Sargent JD, Mott LA, et al. Relation between parental restrictions on movies and adolescent use of tobacco and alcohol. Effective Clin Pract. 2002;5:110.
4. Sargent JD, Beach ML, Dalton MA, et al. Effect of seeing tobacco use in films on trying smoking among adolescents: cross sectional study. BMJ. 2001;323:16.
5. Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton TF. Favourite stars, their tobacco use in contemporary movies, and its association with adolescent smoking. Tob Control. 2001;10:1622. 6. Distefan JM, Gilpin EA, Sargent JD, Pierce JP. Do stars encourage adolescents to start smoking? Evidence from California. Prev Med. 1999;28:111.[Web of Science][Medline] 7. Smoke free movies. Available at: http://www.smokefreemovies.ucsf.edu/index.html. Accessed May 8, 2002.
8. Feighery E, Borzekowski D, Schooler C, Flora J. Seeing, wanting, owning: the relationship between receptivity to tobacco marketing and smoking susceptibility. Tob Control. 1998;7:123128. 9. Coeytaux RR, Altman DG, Slade J. Tobacco promotions in the hands of youth. Tob Control. 1995;4:253257.
10. Pierce JP, Gilpin EA, Choi WS. Sharing the blame: smoking experimentation and future smoking-related mortality due to Joe Camel and Marlboro advertising and promotions. Tob Control. 1999;8:3744.
11. Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking. JAMA. 1998;279:511515. 12. Mekemson C, Glantz S. How the tobacco industry built its relationship with Hollywood. Tob Control. 2002;11(suppl 1):8191. 13. Sargent JD, Tickle JJ, Beach ML, Dalton MA, Ahrens MB, Heatherton TF. Brand appearances in contemporary cinema films and contribution to global marketing of cigarettes. Lancet. 2001;357:2932.[Web of Science][Medline]
14. Shields DL, Carol J, Balbach ED, McGee S. Hollywood on tobacco: how the entertainment industry understands tobacco portrayal. Tob Control. 1999;8:378386. 15. Wells W, Burnett J, Moriarty S. Advertising Principles and Practice. 5th ed. Englewood Cliffs, NJ: Prentice Hall; 2000:353. 16. Karrh JA. Why some brand placements are effective: insights from impression management research. In: Muehling DD, ed. Proceedings of the 1998 Conference of the American Academy of Advertising. Pullman, Wash: Washington State University; 1998:306307. 17. DeLorme DC, Reid LN. Moviegoers experiences and interpretations of brands in films revisited. J Advertising. 1999;28:7173. 18. Higgins KT. Theres gold in silver screen product plugs. Advertising Age. 1985;19:6. 19. Entertainment Resources and Marketing Association. Let us put you in the movies. Available at: http://www.erma.org/brndwk/brandweek.html. Accessed May 8, 2002. 20. McKee KB, Pardun CJ. Product as hero: product placements as effective advertising. In: Muehling DD, ed. Proceedings of the 1998 Conference of the American Academy of Advertising. Pullman, Wash: Washington State University; 1998:307. 21. Efron B. The Jackknife, the Bootstrap and Other Resampling Plans. Philadelphia, Pa: Society for Industrial and Applied Mathematics; 1982. 22. Rao JKN, Scott AJ. The analysis of categorical data from complex sample surveys: chi-squared tests for goodness of fit and independence in two-way tables. J Am Stat Assoc. 1981;76:221230.[Web of Science] 23. Brisk JM, Broene P, James P, Severynse J. A Users Guide to WesVarPC. Rockville, Md: Westat Inc; 1996. 24. Fuller LK. We cant duck the issue: imbedded advertising in the motion pictures. In: Frith KT, ed. Undressing the Ad: Reading Culture in Advertising. New York, NY: Peter Lang; 1997:109129. 25. Pardun CJ, McKee KB. Product placements as public relations: an exploratory study of the role of the public relations firm. Public Relations Rev. 1999;25:481. 26. Snyder S. Movies and product placement: is Hollywood turning films into commercial speech? University Ill Law Rev. Winter 1992:301337. 27. Gupta PB, Gould SJ. Consumers perceptions of the ethics and acceptability of product placements in movies: product category and individual differences. J Curr Issues Res Advertising. 1997;19:3750. 28. Balasubramanian SK. Beyond advertising and publicity: hybrid messages and public policy issues. J Advertising. 1994;23:2946. 29. Federal Trade Commission. Cigarette report for 1999. Available at: http://www.ftc.gov/bcp/menu-tobac.htm. Accessed May 8, 2002. 30. Kids and Media at the New Millennium. Menlo Park, Calif: Kaiser Family Foundation; 1999. Report 1536. 31. Fischoff S, Antonio J, Lewis D. Favorite films and film genres as a function of race, age, and gender. J Media Psychol. 1998;3:19. 32. Dalton MA, Tickle JJ, Sargent JD, Beach ML, Ahrens MB, Heatherton TF. The incidence and context of tobacco use in popular movies from 19881997. Prev Med. 2002;34:516523.[Web of Science][Medline]
33. Escamilla G, Cradock AL, Kawachi I. Women and smoking in Hollywood movies: a content analysis. Am J Public Health. 2000;90:412414. 34. Glantz SA. Rate movies with smoking "R." Effective Clin Pract. 2002;5:3134. 35. Tobacco Use Among U.S. Racial/Ethnic Minority Groups: A Report of the Surgeon General. Atlanta, Ga: Centers for Disease Control and Prevention; 1998. This article has been cited by other articles:
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