Exposure to Smoking Imagery in the Movies and Experimenting with Cigarettes among Mexican Heritage Youth

There is growing evidence that an adolescent's decision to try cigarettes is influenced by level of exposure to movies in which smoking is portrayed. Less is known about how ethnicity affects this process. We examined whether acculturation and/or country of birth influence the relationship between exposure to smoking imagery in the movies and experimenting with cigarettes among Mexican origin youth. We prospectively followed 1,328 Mexican origin adolescents ages 11 to 13 years at baseline. We assessed which of 50 movies (randomly selected from a pool of 250 popular contemporary movies released from 1999 to 2004 and content analyzed for smoking) adolescents had seen. Smoking behavior was assessed at baseline and at 6-month intervals over 24 months. Ten percent of the adolescents had experimented at baseline; 17% tried subsequently. Multivariate analyses revealed, as exposure to smoking imagery in the movies increased, the chances of having ever experimented [adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI), 1.10-1.48] and of being a new experimenter (AOR = 1.19; 95% CI, 1.01-1.40) increased, equivalent to a 4.2% increased risk of ever and a 3.0% increased risk of new experimenting for each additional quartile of movie exposure. This effect was moderated by country of birth. For Mexican-born youth, exposure to smoking imagery in the movies was the strongest independent predictor of new experimentation (AOR = 1.52; 95% CI, 1.14-2.05). For U.S.-born youth, we observed a ceiling effect: the percent of experimenters increased with increasing exposure, and then flattened. Among Mexican-born youth, exposure to smoking imagery in the movies may be an important part of the acculturation process associated with smoking initiation. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3435–43)