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perimentation occurs as a result of tobacco advertising and promotions (Pierce et al. 1999). Emery and colleagues (1999) estimated that each year, tobacco-marketing efforts generate approximately 193,000 additional adult smokers who began smoking as adolescents because of such marketing (Emery et al. 1999). The influence of these pro-tobacco campaigns has been shown to be stronger than the presence of antismoking messages (Straub et al. 2003).

The body of research linking pro-tobacco campaigns to the initiation of youth smoking is alarming, especially given studies indicating that approximately one-third of adolescents who initiate smoking progress into addicted smoking (Anthony et al. 1994; Choi et al. 1997). It is thus important to explore whether and to what extent exposure to smoking in movies has a similar influence on adolescent tobacco use and whether such influence varies by age, gender, and parental influences. In this appendix, we provide a comprehensive review of empirical research investigating the relationship between exposure to smoking depictions in movies, adolescent smoking-related attitudes, and adolescent smoking behavior. We begin with some theoretical bases underlying the links between exposure to tobacco use in the movies and youth behavior.


The theoretical basis for the important role of social constructs in shaping smoking behaviors stems largely from Social Cognitive Theory (e.g., Akers and Lee 1996; Bandura 1986), Social Norms Theory, and Social Marketing Theory, which are also the basis for much of the health research investigating the relationship between exposure to smoking in movies and adolescent smoking behavior. These theories posit that social modeling (observing others perform a behavior and reaping the rewards of that behavior [Bandura 1986]) and social norms (believing that a given behavior is normative and frequent [Wakefield et al. 2003]) are powerful influences on teaching adolescents about behavior in social contexts and are strongly related to adolescents’ behavior. Applied to smoking, depictions of smoking in the movies often serve to influence or change youth’s attitudes about smoking, in part by glamorizing smoking and the smoker him or herself. Often the smoker is portrayed positively—attractive, slim, wealthy, and sexy. Smokers are often shown reaping smoking-related benefits (e.g., coping, relaxation), yet rarely are they seen experiencing any harm or negative stigma from smoking. Depictions of smoking in the movies are also expected to increase the perception that smoking is normative.

Current opinion about adolescent smoking largely considers social factors to be the main set of variables influencing experimental smoking (Lynch and Bonnie 1994; Sargent 2005), including peers and family, which are also key influences on the development of social norms. Adolescents are particularly cued into the social context around them, including media influences on depictions of various behaviors and related positive and negative outcomes. Parallel with physical and cognitive maturation, important social changes take place in adolescence that shift the focus of affiliation gradually from parents to peers and from group relations to intimate relations with individuals outside the family. These expanding social relationships from adolescence through young adulthood broaden adolescents’ sense of extrafamilial reality and reinforce their increasing sense of individuality and need for autonomy. Adolescents’ newly acquired ability to think abstractly and to take a third person’s perspective is an important prerequisite for successful socialization and is tied to new responsibilities and freedom, including trying new and risky behavior such as drinking alcohol, having sex, and smoking cigarettes (e.g., Steinberg and Cauffman 1996). This sets the stage for a variety of social factors to influence adolescents’ attitudes and beliefs for numerous behaviors, including movies and television depictions of behav-

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