To our knowledge, there has been no assessment of the relationship between the viewing of smoking behavior in visual media (television and films) and the adoption of smoking among youth. We hypothesize that exposure to smoking in visual media is associated with the uptake of smoking in adolescents. We will investigate this association through a feasibility study. The goals of the study are to determine how to best measure this environmental exposure and to explore its relationship with adolescent smoking behavior. The study will include the following components: 1) A content analysis of on-screen smoking behavior for 500 major motion pictures available on video tape between 1990 and 1996. The content analysis will provide us with a way to rate movies according to the amount and type of smoking behavior they portray; 2) A conference bringing together experts in the fields of tobacco epidemiology, communications, marketing, and behavioral psychology. The objective of the conference is to establish a consensus on how to measure smoking in visual media. These measures will be refined throughout the first two years of the study; 3) Focus groups with adolescents to evaluate their responses to a range of smoking behaviors and associated themes exhibited in movies. Based on the results of the focus groups, we will choose movies that portray smoking in contexts that adolescents view as favorable; 4) A randomized experiment in which adolescents are randomly assigned to view a movie that does or does not portray smoking behavior. After viewing the movie, students will be surveyed to determine their susceptibility to smoking and their perception of the utility of smoking; 5) A one-year cohort study of 50 adolescents. To determine the types of visual media viewed over time and the stability of their movie and star preferences over time, we will interview these adolescents monthly by telephone; 6) Two large cross sectional studies of adolescents to evaluate the relationship between star preference and exposure to tobacco use in visual media and reported smoking behavior. The primary outcome variables for this study include smoking experience and, for non-smokers, a recently developed index that combines a measure of smoking experimentation with susceptibility. This index predicts an adolescent's risk of becoming a smoker in the future. Secondary outcome measures will include variables measuring perceived utility of smoking and whether adolescents view smoking as normative behavior.
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