Look, James doesn't deserve to have all of you Joe-baiters filling up his thread with comments on how wrong I am about smoking in kids and exposure to T-shirts showing cool characters smoking.
My thinking on this line was really a synthesis of a whole lot of information I've read over the years about smoking, dating from about 1991 when my mentor, Aubrey Taylor, Ph.D., and President of the American Physiological Society wrote the position paper for the American Heart Association that detailed the major health issue with passive smoke exposure. In 1995 I initiated a program at the private pharmaceutical company I worked for as a Senior Scientist to develop an agent that might become a clinical treatment for COPD- the drug went through a phase 2 trial with several hundred patients taking it, and is currently still a candidate for a phase 3 trial and submission to the FDA as a clinical treatment.
At any rate, I did a quick search this evening, and these were just the easiest to find journal articles which showed or reviewed a positive correlation between exposure to tobacco in films or in ads with initiation of smoking in kids. I didn't access the surgeon general's report on youth smoking, but apparently it has more compelling data.
From reading these and a few of the articles again, I can say that my hypothesis is that:
Exposure to tobacco use in any way where the person using the tobacco is considered a positive influence by the child will increase the likelihood that child will initiate tobacco use.
This hypothesis is based on the evidence below wherein tobacco use by film actors resulted in such activity ; i.e., initiation of tobacco use. I have generalized this from film actors to any sort of media, as tobacco advertising is repeatedly reported to be quite effective amongst those it is targeted toward- as demonstrated by the increase in tobacco use by females after advertising campaigns targeted toward women, with no concomitant increase among men.
A short list of references:
Minerva Pediatr. 2004 Dec;56(6):553-65.
Youth and tobacco.
Tanski SE, Prokhorov AV, Klein JD.
Center for Child Health Research, University of Rochester, Rochester, NY 14620, USA. email@example.com
Youth around the world take up smoking and use tobacco products at high rates. Young people may not grasp the long-term consequences of tobacco use, although tobacco consumption and exposure has been shown to have significant negative health effects. Youth use a variety of tobacco products that are smoked, chewed, or sniffed, including machine-manufactured cigarettes, cigars, bidis, kreteks, sticks, and snuff. Prevention efforts have focused on countering those aspects that are believed to contribute to smoking uptake, such as tobacco industry advertising and promotion, and access to tobacco. There are many aspects of tobacco promotion through the media that have been more difficult to control, however, such as product placement within popular cinema movies. Once a youth has taken up tobacco, he or she is more likely than an adult to become addicted and should be offered treatment for tobacco cessation. Although there is not yet sufficient evidence to prove efficacy, the same treatments are suggested for youth as are recommended for adults, including nicotine replacement products. Given the severity of the tobacco epidemic worldwide and the devastating health effects on an individual and population basis, there are currently many efforts to curtail the tobacco problem, including the World Health Organization (WHO) sponsored Framework Convention on Tobacco Control. It is through comprehensive and collaborative efforts such as this that the global hazard of tobacco is most likely to be overcome.
CA Cancer J Clin. 2003 Mar-Apr;53(2):102-23.
CA Cancer J Clin. 2003 Sep-Oct;53(5):316.
Tobacco control for clinicians who treat adolescents.
Sargent JD, DiFranza JR.
Dartmouth Medical School, Hanover, NH, USA.
Smoking remains the most common preventable cause of death in the developed world, and is rapidly becoming an important cause of death in the developing world. Nicotine is a powerfully addictive substance, and the tobacco industry spends billions annually promoting it in the United States. It is therefore important for clinicians to understand why people smoke, to address smoking in patients of all ages, and to lobby for health-preserving tobacco control policies at the community level. Children take up smoking in response to social influences: smoking by friends, parents, and family, and through exposure to smoking in media. Parents who smoke not only model the behavior, but also often make the product available by leaving cigarettes around the house. Media influences include the dollar 10 billion spent per year on tobacco marketing, but more importantly, the modeling of the behavior on screen by movie and television stars. Once children start smoking, many rapidly lose autonomy over the behavior. Youth can get hooked after smoking just a few cigarettes. The most effective community efforts for reducing tobacco use are: raising the price of tobacco; halting the sale of tobacco to minors; enforcing strict school tobacco policies; and making public places smoke free through local ordinances. Working with individuals, clinicians should support cessation in all smokers, including parents of children and adolescents. They should screen children for smoking risk factors beginning at age 10. They should teach parents to maintain smoke-free households, to set nonsmoking expectations early on, and to monitor adolescents for signs of smoking. Parents should limit exposure to adult media (e.g., R-rated movies) and use family television time to discuss the effect of seeing screen depictions of smoking on adolescent behavior. Adolescents who smoke should be assessed for signs of nicotine dependence and counseled about quitting. Clinicians are effective community voices; they should participate in efforts to raise tobacco taxes, limit the display of tobacco advertising, and make public places smoke free because of the adverse health effects of passive exposure to cigarette smoke.
Epidemiol Rev. 1995;17(1):48-65.
Epidemiology of tobacco use and dependence.
Giovino GA, Henningfield JE, Tomar SL, Escobedo LG, Slade J.
Epidemiology Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 30341-3724, USA.
Knowledge of the epidemiology of tobacco use and dependence can be used to guide research initiatives, intervention programs, and policy decisions. Both the reduction in the prevalence of smoking among US adults and black adolescents and the decline in per capita consumption are encouraging. These changes have probably been influenced by factors operating at the individual (e.g., school-based prevention programs and cessation programs) and environmental (e.g., mass media educational strategies, the presence of smoke-free laws and policies, and the price of tobacco products) levels (for a discussion of these factors, see, e.g., refs. 2, 48, 52, 183, and 184). The lack of progress among adolescents, especially whites and males, and the high risk for experimenters of developing tobacco dependence present cause for great concern (48, 183-186). In addition to those discussed above, several areas of research can be recommended. 1. Better understanding of the clustering of tobacco use with the use of other drugs, other risk behaviors, and other psychiatric disorders could better illuminate the causal processes involved, as well as the special features of the interventions needed to prevent and treat tobacco dependence. 2. To better understand population needs, trend analyses of prevalence, initiation, and cessation should, whenever possible, incorporate standardized measures of these other risk factors. Future research should compare the effect of socioeconomic status variables on measures of smoking behavior among racial/ethnic groups in the United States. 3. For reasons that may be genetic, environmental, or both, some persons do not progress beyond initial experimentation with tobacco use (2, 48, 183, 187-192), but about one-third to one-half of those who experiment with cigarettes become regular users (48, 193, 194). Factors, both individual and environmental, that can influence the susceptibility of individuals to tobacco dependence need further attention. 4. To estimate their sensitivity and specificity, comparisons of the National Household Survey on Drug Abuse indicators of dependence with DSM-based criteria are needed. Public health action continues to be warranted to reduce the substantial morbidity and mortality caused by tobacco use (195). A paradigm for such action has been recommended and involves preventing the onset of use, treating tobacco dependence, protecting non-smokers from exposure to secondhand smoke, promoting nonsmoking messages while limiting the effect of tobacco advertising and promotion on young people, increasing the real (inflation-adjusted) price of tobacco products, and regulating tobacco products (186).
Tob Control 2000;9:47-63 ( Spring )
Investing in youth tobacco control: a review of smoking prevention and control strategies
Paula M Lantza, Peter D Jacobsona, Kenneth E Warnera, Jeffrey Wassermanb, Harold A Pollacka, Julie Bersona, Alexis Ahlstroma
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA, b RAND, Santa Monica, California, USA
Part of Summary
TOBACCO ADVERTISING RESTRICTIONS
Of all consumer products, cigarettes are the most heavily advertised and marketed. There is great concern that tobacco advertising and marketing---including the distribution of promotional products such as clothing, sporting equipment, and gear for outdoor activities---is positively associated with youth smoking.61-67 A historical review of tobacco marketing foci and smoking rates among youth showed that smoking initiation among females (but not males) greatly increased at the same time large scale marketing campaigns aimed at women were implemented.62 This work showed that "major marketing impact occurred in youth smoking initiation only in the sex group targeted", and adds indirect evidence to the proposition that youth smoking initiation is influenced by industry advertising and marketing.62
While and colleagues reported that cigarette advertising "appears to increase children's awareness of smoking at a generic level and encourages them to take up the behaviour, beginning with any cigarettes which are available and affordable".68 Altman and colleagues found evidence that youth awareness of tobacco marketing campaigns, receipt of free tobacco samples, and receipt of direct mail promotional paraphernalia were found to be associated with susceptibility to tobacco use.69 Consistent with these findings, Pierce and colleagues reported that adolescents who had a tobacco promotional item and/or had an interest in tobacco advertising (that is, had a favourite advertisement) were significantly more likely to initiate smoking in the following three years.63 Pierce and colleagues concluded that a significant portion of youth experimentation with smoking can be attributed to tobacco promotional activities. However, because these promotional items are not randomly distributed, selection bias could explain this finding.
The econometric evidence on the effects of advertising on cigarette consumption has focused on the aggregate impact on adult smoking. With many studies finding no significant relationship, and many others finding a significant but generally small relationship, this literature is indeterminate on the issue.70 In any event, technical limitations of the dominant econometric approach71 combined with a lack of studies on adolescent smoking make this literature of little utility in trying to assess whether advertising affects smoking by children.
Similarly, the potential effect of restrictions or bans on cigarette advertising on adolescent smoking behaviour also is unclear. Some states and municipalities have implemented restrictions regarding tobacco advertising. For example, the state of Utah and several major cities such as San Francisco and Baltimore have banned tobacco advertising from all billboards and other objects of display. These types of bans are too new to have been evaluated yet, and the implementation of similar bans has been delayed because of legal challenges. Nevertheless, the evidence regarding the effects of cigarette advertising bans is mixed, as different statistical analyses have come to opposite conclusions about whether bans reduce cigarette consumption.70 Saffer and Chaloupka explain the inconsistent findings by the fact that partial and complete bans have different effects, but are not clearly distinguished from each other in research studies.72 Using both theory and the existing empirical evidence, these researchers conclude that partial bans have little effect because they afford cigarette companies the opportunity to switch advertising expenditures to other promotional media and methods. In contrast, they find that complete bans could reduce tobacco consumption by approximately 6%, an amount that may seem small but could still have an important public health impact.
Pediatrics. 2007 May;119(5):e1167-76.
Exposure to movie smoking among US adolescents aged 10 to 14 years: a population estimate.
Sargent JD, Tanski SE, Gibson J.
Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire, USA. firstname.lastname@example.org
BACKGROUND: Several studies have linked seeing smoking in movies with adolescent smoking, but none have determined how much movie smoking adolescents see. OBJECTIVE: Our aim was to determine exposure to movie smoking in a representative sample of young US adolescents. METHODS. We surveyed 6522 nationally representative US adolescents aged 10-14 years. We content analyzed 534 contemporary box-office hits for movie smoking. Each movie was assigned to a random subsample of adolescents (mean: 613) who were asked whether they had seen the movie. Using survey weights, we estimated the total number of US adolescents who had seen each movie and then multiplied by the number of smoking depictions in each movie to obtain gross smoking impressions seen by adolescents. RESULTS: The 534 movies were mainly rated PG-13 (41%) and R (40%), and 74% contained smoking (3830 total smoking occurrences). On average, each movie was seen by 25% of the adolescents surveyed. Viewership was higher with increased age and lower for R-rated movies. Overall, these movies delivered 13.9 billion gross smoking impressions, an average of 665 to each US adolescent aged 10-14 years. Although this sample's R-rated movies contained 60% of smoking occurrences, they delivered only 39% of smoking impressions because of lower adolescent viewership. Thirty popular movies each delivered > or =100 million gross smoking impressions. Thirty actors each delivered >50 million smoking impressions, such that just 1.5% of actors delivered one quarter of all character smoking to the adolescent sample. CONCLUSIONS: Popular movies deliver billions of smoking images and character smoking depictions to young US adolescents. Removing smoking from youth-rated films would substantially reduce exposure from new box-office hits. Furthermore, the popular actors who frequently smoke in movies could have a major impact on adolescent movie smoking exposure by choosing not to portray characters who smoke.
Pediatrics. 2004 Jul;114(1):149-56.
Effect of parental R-rated movie restriction on adolescent smoking initiation: a prospective study.
Sargent JD, Beach ML, Dalton MA, Ernstoff LT, Gibson JJ, Tickle JJ, Heatherton TF.
Department of Pediatrics, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA. email@example.com
OBJECTIVE: To determine if young adolescents who report that their parents restrict viewing R-rated movies have a lower risk of trying smoking in the future. DESIGN: Prospective observational study. Students from 15 schools in New Hampshire and Vermont, randomly selected from all middle schools with >150 students, were surveyed in 1999. Baseline never-smokers were surveyed again by telephone 13 to 26 months later to determine smoking status. OUTCOME MEASURE: Trying smoking during the follow-up period. RESULTS: The majority of the 2596 students were white, with ages ranging from 10 to 14 years. Nineteen percent reported that their parents never allowed them to view R-rated movies, 29% were allowed once in a while, and 52% were allowed sometimes or all the time. Ten percent of students tried smoking during the follow-up period. Smoking-initiation rates increased as parental restriction of R-rated movies decreased (2.9% for adolescents reporting that their parents never allowed them to view R-rated movies, 7.0% for those allowed to view them once in a while, and 14.3% for those allowed to view them sometimes or all the time). There was a strong and statistically significant effect of parental R-rated movie restriction on adolescent smoking even after controlling for sociodemographics, social influences (friend smoking, receptivity to tobacco promotions), parenting style (maternal support and control, parental disapproval of smoking), and characteristics of the adolescent (school performance, sensation seeking, rebelliousness, self-esteem). Compared with adolescents whose parents never allowed them to view R-rated movies, the adjusted relative risk for trying smoking was 1.8 (95% confidence interval [CI]: 1.1, 3.1) for those allowed to watch them once in a while and 2.8 (95% CI: 1.6, 4.7) for those allowed to watch them sometimes or all the time. The effect was especially strong among adolescents not exposed to family (parent or sibling) smoking, among whom the adjusted relative risk for smoking was 4.3 (95% CI: 1.4, 13) for those allowed to view R-rated movies once in a while and 10.0 (95% CI: 3.6, 31) for those allowed to view them sometimes or all the time. CONCLUSIONS: Parental restriction from watching R-rated movies strongly predicts a lower risk of trying smoking in the future. The effect is largest among adolescents not exposed to family smoking. By exerting control over media choices and by not smoking themselves, parents may be able to prevent or delay smoking in their children.