Product Placement and the Influence of Movies on Adolescent Substance Use Anna Adachi-Mejia, PhD Research Assistant Professor of Pediatrics Dartmouth Medical School Dartmouth-Hitchcock Medical Center

Dartmouth Visual Media Team

James D. Sargent, MD Madeline A. Dalton, PhD Todd F. Heatherton, PhD Michael L. Beach, MD, PhD Linda T. Titus-Ernstoff, PhD Jennifer J. Tickle, PhD Jennifer J. Gibson, MS M. Bridget Ahrens, MPH Anna M. Adachi-Mejia, PhD The Team at Westat Diana Nelsen Dan Nassau Bindi Rakhra Tom Wills, PhD Mike Stoolmiller, PhD

Meg Gerrard, PhD Rick Gibbons, PhD Susanne Tanski, MD MPH Sonya Dal Cin, PhD Keilah Worth, PhD Elaina Bergamini Auden McClure, MD, MPH Weiping Liu Diana Smith Don Carmichael Scott Gerlach Eugene Demidenko, PhD George Li Jenna Anstey Amy Bernhardt, MA

Disclosures Dr. Adachi-Mejia has documented that she has no financial disclosures.

Goals for today… 1. Understand the association between movie smoking/drinking exposure and smoking and drinking among adolescents 2. Become familiar with the social psychology theories that may underpin this association

Product placement in movies Examples?

Product Placement • ET clip

Sunglass Popularity…

Product Placement in Movies

“Product Placement is the most cost-effective way to get worldwide advertising for your brand.” www.movieplacement.com

What Are People Worried About? Profanity Sex Drugs Violence Smoking Drinking

So why would we care if kids emulate smoking at a young age?

Tobacco Is a Risk Factor for 6 of the World’s 8 Leading Causes of Death

Hatched areas indicate proportions of deaths related to tobacco use.

2 out of 3 of smokers say they wish they could quit. Of those who try to quit, only 1 out of 10 succeeds. Most smokers, 80%, say they wish they had not started.

Smoking • 90% of adult smokers started before age 18 • 3,000 youth become regular smokers each day; 1 million start smoking each year • Smokers starting before age 15 have cancer rates 19 times higher than non-smokers • Tobacco is the leading cause of death in US • 440,000 deaths annually

Tobacco industry documents

“If younger adults turn away from smoking, the industry must decline.” RJ Reynolds report, 1984

Tobacco Industry Documents

“Pre-smokers.” RJ Reynolds draft paper, 1973

What has the tobacco industry said about you?

“…the base of our business is the high school student.” Lorillard memo, 1978

Tobacco industry documents “They represent tomorrow’s cigarette business.” The “14-24 age group…will account for a key share of the total cigarette volume – for at least the next 25 years.” RJ Reynolds tobacco marketing plan, 1974

They want youth to think they won’t become addicted

“…how very young smokers at first believe they cannot become addicted, only to later discover, to their regret, that they are.” Report, Bates No. 689753864, 1980

“Recently, anti-smoking groups have also had some early successes at eroding the social acceptability of smoking. Smoking is being positioned as an unfashionable, as well as unhealthy, custom. We must use every creative means at our disposal to reverse this destructive trend. I do feel heartened at the increasing number of occasions when I go to a movie and see a pack of cigarettes in the hands of the leading lady. This is in sharp contrast to the state of affairs just a few years ago when cigarettes rarely showed up in cinema. We must continue to exploit

new opportunities to get cigarettes on screen and into the hands of smokers.”

– Hamish Maxwell, Philip Morris, 1983

How Might a Media Effect Work? • Modeling Behavior • Social Normalization – “everybody” smokes and drinks…

• Image Identification and Branding

Social Learning Theory • From Bandura’s social cognitive theory we know that people can LEARN by OBSERVING others. – This can be real-life observation, or symbolic through movies and TV – Can learn how to do things (smoke/drink) – Can form expectations • why people do things (stressed, upset, need to relax) • how you are supposed to respond to things (craving) • Consequences of behavior (reinforcing/punishing)

“Superpeer” or Cultivation Theory: Social Normalization • Smoking and drinking is socially acceptable • LOTS of people smoke and drink – If it looks like lots of people do something, people may start, to be like everyone else

• Movies are a window to a world beyond which we know… – It looks real

• The world in movies is very UNLIKE reality

Actor endorsement

Background appearances

Men in Black II

Mrs. Doubtfire - 1993

“It’s like sending each one of them a packet of cigarettes and saying ‘light up.’”

The Evidence

Linking Tobacco Use in Movies with Adolescent Smoking Is what they view related to what they do? • Measure the Exposure – How much smoking do adolescents see in the movies they watch? – Does it vary from adolescent to adolescent?

• Link seeing smoking with trying smoking

Media Influences on Adolescent Smoking Behavior Supported since 1997 by National Institutes of Health (CA-77026) Continued support since 2005 from NIAAA and the American Legacy Foundation

AIMS • Describe smoking in popular contemporary movies • Assess exposure to movie smoking among adolescents • Determine if movie smoking exposure is linked with adolescent smoking

Study Characteristic Recruitment date Recruitmnt states Selection criteria Survey method Baseline Follow up Sample size (baseline) Average F/U period Sample size (follow-up) Retention Mean baseline age (SD) Race/ethnicity Movie sample

Study Sample Northern N.E. U.S. Sep-99 Sep-03 NH/VT All 50 states Never smoker Never smoker School-based Telephone 3547 18 months 2603 73% 12.0 (1.1) 95% White 601 movies

RDD-telephone Telephone 5829 16 months 5018 86% 11.9 (1.4) Representative 532 movies

Select Popular Movies • Box office/video hits NNE Baseline: Top 25 ’88-’95, Top 100 ’96-’98, Top 50 ’99, stars National Baseline: Top 100,’98-’02, and $15M+ Q1 ’03 Intervals: Top 100 box office/DVD rentals

N 601 532 ~150

Generate movie lists • Randomly select 50 movies for each survey • Use stratified movie sampling to ensure representative distribution by rating (e.g. baseline 45% R, 30% PG 13, 25% G/PG) Content Analysis

Survey Youth • Questionnaire assesses which of the 50 movies the adolescent has ever seen

Count the tobacco use occurrences

Merge Movie Tobacco Use Exposure Variable Number movie tobacco use occurrences seen

National Baseline Movie Smoking Exposure • Movie smoking was present in 74% of movies in the total sample of 532 movies • Adolescents had seen a mean of 13 of the 50 movies on their individualized list – mean exposure of 61 movie smoking occurrences – Exposure to smoking in movies was significantly higher among Hispanic (mean 65 smoking occurrences) and African American (74) adolescents compared with Caucasian adolescents (57), (p < 0.001)

Predictor Variable Have you ever tried smoking a cigarette, even just a puff? (yes, no)

Smoking Initiation at 16 months by Movie Smoking Exposure (crude) Quartile of Movie Smoking Exposure

Incident Smoking

Q1

6.6%

Q2

13.2%

Q3

20.7%

Q4

33.5% P