The influence of smoking imagery on the smoking intentions of young people: testing a media interpretation model

Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis

BACKGROUND

Despite a steady decline in adolescent smoking globally, it remains a prevalent risk factor for non-communicable disease. Previous research points to differences in socio-environmental and psychosocial risk factors for smoking and how they vary across different settings with disparate social and cultural characteristics. As a result, smoking rates have remained disproportionately higher in some settings while decreasing in others. This study explored the socio-environmental and psychosocial risk factors for smoking susceptibility in a high-income and upper-middle income setting.

METHODS

Cross-sectional data were obtained from 1,573 male and female adolescents aged 11-15 years who completed self-administered questionnaires in schools in Northern Ireland and Bogotá, Colombia. Using logistic regression analysis, we examined how socio-environmental and psychosocial predictors of smoking susceptibility compared across the two countries.

RESULTS

In Northern Ireland, reduced odds of smoking susceptibility were significantly associated with less family smoking (OR: 0.64, 95% CI: 0.41-1.00); having access to information about smoking in school (OR: 0.75, 95% CI: 0.59-0.96); negative attitudes towards smoking (OR: 0.35, 95% CI: 0.23-0.51); higher levels of openness (OR: 0.59, 95% CI: 0.50-0.69); and higher levels of self-reported wellbeing (OR: 0.57, 95% CI: 0.44-0.74). Increased odds of smoking susceptibility were associated with reporting less smoking of a mother (OR: 1.37, 95% CI: 1.06-1.76); higher levels of extraversion (OR: 1.40, 95% CI: 1.04-1.90); and receiving pocket money (OR: 1.20, 95% CI: 1.06-1.37). In Bogotá, reduced odds of smoking susceptibility were significantly associated with reporting less smoking among friends (OR: 0.86, 95% CI: 0.76-0.98); higher levels of self-efficacy (OR: 0.58, 95% CI: 0.40-0.83); greater perceived behavioural control to quit smoking (OR: 0.71, 95% CI: 0.56-0.90); and lower levels of truancy (OR: 0.69, 95% CI: 0.52-0.92). In Bogotá, no factors were associated with increased odds of smoking susceptibility in the final model.

CONCLUSIONS

The findings illustrate that there were differences in predictors of adolescent smoking susceptibility across the two settings. By using a comparative approach we demonstrate that smoking interventions and policies must be sensitive to the cultural and normative context within which they are implemented.

Effect of Exposure to Smoking in Movies on Young Adult Smoking in New Zealand

Onscreen Smoking Is a Form of Tobacco Marketing

Tobacco advertising has been prohibited in New Zealand since 1990, and the government has set a goal of becoming a smokefree nation by 2025. However, tobacco marketing persists indirectly through smoking in motion pictures, and there is strong evidence that exposure to onscreen smoking causes young people to start smoking. We investigated the relationship between exposure to smoking in movies and youth smoking initiation among New Zealand young adults. Data from an online survey of 419 smokers and non-smokers aged 18 to 25 were used to estimate respondents’ exposure to smoking occurrences in 50 randomly-selected movies from the 423 US top box office movies released between 2008 and 2012. Analyses involved calculating movie smoking exposure (MSE) for each respondent, using logistic regression to analyse the relationship between MSE and current smoking behaviour, and estimating the attributable fraction due to smoking in movies.

Effect of Smoking in Movies on New Zealand Youth

Exposure to smoking occurrences in movies was associated with current smoking status. After allowing for the influence of family, friends and co-workers, age and rebelliousness, respondents’ likelihood of smoking increased by 11% for every 100-incident increase in exposure to smoking incidents, (aOR1.11; p< .05). The estimated attributable fraction due to smoking in movies was 54%; this risk could be substantially reduced by eliminating smoking from movies currently rated as appropriate for youth. We conclude that exposure to smoking in movies remains a potent risk factor associated with smoking among young adults, even in a progressive tobacco control setting such as New Zealand. Harmonising the age of legal tobacco purchase (18) with the age at which it is legal to view smoking in movies would support New Zealand’s smokefree 2025 goal.

Perceived social and media influences on tobacco use among Samoan youth

Background

Tobacco use among young Pacific populations continues to undermine efforts to reduce the escalating rates of non-communicable disease in the region. Reducing tobacco use to less than 5 percent by 2025 is now a World Health Organisation (WHO) mandated target for the Pacific region. Yet, little is known about the drivers to uptake of tobacco use among young people in the Pacific. Family and peers are expected to be important in this process, but similarly, tobacco marketing may also play an important role. The tobacco industry has been highly adaptive to the changing media environment across the Pacific Islands. The aim of this study was to develop an understanding of the social cultural and media drivers to tobacco uptake and use among young Samoans to contribute to the design of effective tobacco control intervention.

Methods

We examined high school students (aged 16 and 17 years) perceptions of tobacco use in their community, access and use of media channels and the extent to which they are cognizant of both pro and anti-tobacco imagery across a range of media. Data was collected through in-depth semi-structured interviews. A thematic analysis of the interview data identified common and divergent beliefs, attitudes and behaviours surrounding tobacco use and the influence of the media.

Results

Family is critically important for representing normative tobacco use in Samoa. The use of media, in particular digital media, was found to be conditioned by parental views on the use of media in the home. Media access remains highly regulated within more traditional households. Loyalty to traditional cultural practices (Fa’a Samoa) underpinned views on the limited influence of media on social norms around tobacco use. Parents were thought to have the greatest influence on youth smoking. Tobacco use was viewed as a personal, or family issue, and not a problem that was amendable to change at a societal level.

Conclusion

In order to develop effective and culturally relevant tobacco control policies, the public health community must consider social norms around tobacco use as well as patterns of media use among young Samoans.

Adolescent males' awareness of and willingness to try electronic cigarettes

PURPOSE

Electronic cigarettes (e-cigarettes) are a new type of device that delivers vaporized nicotine without the tobacco combustion of regular cigarettes. We sought to understand awareness of and willingness to try e-cigarettes among adolescent males, a group that is at risk for smoking initiation and may use e-cigarettes as a "gateway" to smoking.

METHODS

A national sample of 11-19-year-old males (n = 228) completed an online survey in November 2011. We recruited participants through their parents, who were members of a panel of U.S. households constructed using random-digit dialing and addressed-based sampling.

RESULTS

Only two participants (< 1%) had previously tried e-cigarettes. Among those who had not tried e-cigarettes, most (67%) had heard of them. Awareness was higher among older and non-Hispanic adolescents. Nearly 1 in 5 (18%) participants were willing to try either a plain or flavored e-cigarette, but willingness to try plain versus flavored varieties did not differ. Smokers were more willing to try any e-cigarette than nonsmokers (74% vs. 13%; OR 10.25, 95% CI 2.88, 36.46). Nonsmokers who had more negative beliefs about the typical smoker were less willing to try e-cigarettes (OR .58, 95% CI .43, .79).

CONCLUSIONS

Most adolescent males were aware of e-cigarettes, and a substantial minority were willing to try them. Given that even experimentation with e-cigarettes could lead to nicotine dependence and subsequent use of other tobacco products, regulatory and behavioral interventions are needed to prevent "gateway" use by adolescent nonsmokers. Campaigns promoting negative images of smokers or FDA bans on sales to youth may help deter use.

Do parents have any influence over how young people appraise tobacco images in the media?

BACKGROUND

Socio-cultural factors, including media and family, play an important role in introducing and reinforcing pro-smoking intentions. Tendencies to appraise smokers in media in positive, negative, and empathic ways may play a role in the social and familial dynamics influencing smoking intentions.

OBJECTIVE

This study assessed: (1) social group differences in appraisals of pro- and antismoking imagery in media; (2) whether parental antismoking expectations are associated with less positive appraisals; and (3) whether these appraisal tendencies mediate the relationship between parental antismoking expectations and smoking intentions.

METHODS AND MATERIALS

Adolescents (N = 515, ages 11-13, M = 11.5 years) from Auckland, New Zealand completed a multimedia, computer-based questionnaire assessing media exposure of smoking imagery in four media clips as well as media exposure, parental attitudes toward smoking, and smoking intentions.

RESULTS

Appraisals of smoking imagery in the media clips and media consumption were patterned on the basis of gender, ethnic group, school economic status, and peer and parent smoking behaviors. Positive appraisals of the smoking images were found to mediate the relationship between weaker parental antismoking expectations and greater smoking intentions.

CONCLUSION

Parents may have significant influence over how adolescents perceive smoking imagery in media by presenting clear and unambiguous expectations about tobacco use at home. These expectations may shape how adolescents respond to smoking images by effectively "tainting" the image.

Perceptions of smoking prevalence by youth in countries with and without a tobacco advertising ban

This study examined a proposed mechanism by which exposure to cigarette advertising may mediate the subsequent smoking of youth. We hypothesized that children's exposure to cigarette advertising leads them to overestimate the prevalence of smoking, and that these distorted perceptions, in turn, lead to increased intentions to smoke. Children in Finland, where there has been a total tobacco advertising ban since 1978, were compared with children in the United States at a time when tobacco advertising was ubiquitous. Samples of 477 8- to 14-year-old Helsinki students and 453 8- to 14-year-old Los Angeles students whose lifetime cigarette use consisted of no more than a puff of a cigarette were administered questionnaires in their classrooms. The primary hypothesis was confirmed. Los Angeles youth were significantly more likely than Helsinki youth to overestimate the prevalence of adult smoking, in spite of the fact that actual adult smoking prevalence in Helsinki was almost twice that of Los Angeles adults. A similar, significant pattern for perceived peer smoking was obtained, with Los Angeles youth being more likely than Helsinki youth to overestimate prevalence, in spite of the actual greater prevalence of youth smoking in Helsinki.

R-rated film viewing and adolescent smoking

OBJECTIVES

As smoking is very common in R-rated films, we sought to determine if viewing R-rated films is associated with adolescent smoking.

METHODS

Three annual cross-sectional surveys conducted of 88,505 Year 10 students of largely European, Maori, Asian or Pacific Islander ethnicity in secondary schools in New Zealand between 2002 and 2004. Outcomes of interest were: intention to smoke among never smokers; past experimentation with smoking among current non-smokers; current smoking status; and current frequency of smoking.

RESULTS

Dose-response relationships were observed between the frequency of viewing R-rated films and all outcome measures controlling for age, gender, ethnicity, peer smoking, parental smoking, socioeconomic status, pocket money and household smoking rules. Compared to never viewing R-rated films, viewing at least weekly nearly tripled the relative risk (2.81; 95% confidence interval 2.57, 3.09) of never smokers being susceptible to smoking, and more than doubled the risk of both past experimentation (2.28; 95% CI 2.12, 2.45) and smoking>/=monthly (2.31; 95% CI 2.10, 2.54). Each of these risks was seen across all ethnic groups.

CONCLUSIONS

Our results extend the association that has been demonstrated between viewing R-rated films and current smoking in American youth by demonstrating the same association in youth of different ethnic and cultural backgrounds in New Zealand.