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Does the exposure to smoking cues in movies affect adolescents' immediate smoking behavior?
Addictive Behaviors 38 (2013) 2203–2206
Contents lists available at SciVerse ScienceDirect
Addictive Behaviors
Short Communication
Does the exposure to smoking cues in movies affect adolescents' immediate smoking behavior? Kirsten Lochbuehler ⁎, Marloes Kleinjan, Rutger C.M.E. Engels Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
H I G H L I G H T S ► Smoking in movies had no effect on adolescent smokers’ immediate smoking behavior. ► This association was not affected by several smoking- and movie-related variables. ► Adolescent smokers do not seem to be affected by smoking movie exposure.
a r t i c l e Keywords: Smoking behavior Cue-reactivity Movies Adolescents Media
i n f o
a b s t r a c t Introduction: Various studies have demonstrated that environmental smoking cues elicit smoking-related responses in smokers. However, cue reactivity studies among adolescent smokers are scarce. Therefore, the aim of this study was to examine the effect of smoking portrayal in movies on immediate smoking behavior in adolescent smokers. Method: A total of 65 adolescent daily smokers (between the ages of 16 and 18 years) were exposed to a one-hour movie clip, with or without smoking characters, and were allowed to smoke while watching the movie. Results: The exposure to smoking cues in movies had no effect on immediate smoking behavior. This association was not affected by several smoking- and movie-related variables. Conclusions: No influence of smoking cues in movies on immediate smoking behavior in adolescent daily smokers was found. More experimental research on the effects of environmental cues on adolescent smokers in different stages of addiction is needed. © 2013 Elsevier Ltd. All rights reserved.
1. Introduction Previous research has demonstrated an association between the exposure to smoking cues in movies and smoking initiation (Dalton et al., 2003; Hanewinkel & Sargent, 2007, 2008; Jackson, Brown, & L'Engle, 2007; Sargent et al., 2005, 2001; Thrasher, Jackson, Edna, & Sargent, 2008; Titus-Ernstoff, Dalton, Adachi-Mejia, Longacre, & Beach, 2008; Wills, Sargent, Stoolmiller, & Gibbons, 2007) and established smoking (Dal Cin, Stoolmiller, & Sargent, 2012; Dalton et al., 2009; Sargent et al., 2007) in adolescents. These studies indicate an impact of smoking portrayal in movies on different developmental stages of smoking. However, the few experimental studies on the effects of movie smoking exposure on smokers showed mixed findings and focused on adult smokers (Harakeh, Engels, Vohs, van Baaren, & Sargent, 2010; Lochbuehler, Peters, Scholte, & Engels, 2010; Shmueli,
⁎ Corresponding author at: Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. Tel.: +31 24 361 2567; fax: +31 24 361 2776. E-mail address: [email protected] (K. Lochbuehler). 0306-4603/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.addbeh.2013.01.022
Prochaska, & Glantz, 2010). It is unclear how adolescent smokers who differ from adult smokers with regard to their smoking history and developmental stage of addiction respond to smoking cues in movies. As smoking portrayal in movies is prevalent and watching movies is among the most popular leisure time activities (Roberts, 2000; Roberts, Foehr, & Rideout, 2005; Sargent et al., 2001), the exposure to smoking portrayal in movies might be highly relevant to the development of addiction in adolescent novice smokers. Moreover, adolescents might be particularly susceptible to environmental smoking cues, as their regulatory executive system (e.g. psychosocial abilities that improve decision making and moderate risk taking) has not yet been fully developed (Steinberg, 2007; Wiers et al., 2007). The current study aims to examine the effect of smoking portrayal in movies on immediate smoking behavior in adolescent smokers. In an experimental study, adolescent smokers were exposed to the same movie either with or without smoking characters and were allowed to smoke while watching the movie. We hypothesized that the exposure to a movie with smoking would lead to smoking more cigarettes than the exposure to the same movie without any smoking. Furthermore, we tested moderation effects of various smoking-related and movie-related variables.
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K. Lochbuehler et al. / Addictive Behaviors 38 (2013) 2203–2206
2. Material and methods 2.1. Sample and procedure We obtained permission by schools to approach smoking students in schoolyards in Nijmegen and ask if they would engage in an experiment. A total of 65 adolescent smokers (53.8% female) between the ages of 16 and 18 years (M = 16.86 years; SD = .68) were invited to participate in two independent studies. They were told two cover stories: first that they were participating in a study on tobacco marketing, and second in research on lifestyle and celebrities. When the participants arrived at the lab, they were welcomed by the first research assistant and asked to go outside to smoke a cigarette, to control for baseline craving levels (Drobes & Tiffany, 1997). Afterwards, they gave their opinion on cigarette packages and filled in a questionnaire on their smoking habits and their current craving. In the second experiment, conducted by a different research assistant, participants were randomly assigned to one of two movie conditions. In the experimental condition, 34 adolescent smokers were exposed to the edited version of the movie in which several characters smoked. In the control condition, 31 adolescent smokers were exposed to the edited version of the same movie in which the smoking was completely removed. Participants were told that we were interested in how people watch movies at home and that they would be allowed to smoke and consume drinks and nuts, all of which were provided. Then, the edited version of the Dutch movie Het Schnitzelparadijs (2005) (65 min) was shown. The version shown in the experimental condition contained 14 smoking scenes (=5.42 min). Details on how movie clips are edited for this purpose can be found elsewhere (Lochbuehler, Engels, & Scholte, 2009; Lochbuehler et al., 2010). During the movie, the behavior of the participants was observed and recorded with a hidden camera. After watching the movie, the participants completed a questionnaire (see Measures) and were asked about the real aim of the study (none of whom guessed correctly). They were debriefed, thanked and given €20 for their participation. The protocols for the study were approved by the Ethical Committee of the Faculty of Social Sciences, Radboud University Nijmegen. 2.2. Measures As part of the first experiment, participants answered questions on their smoking habits (e.g., age of initiation, number of cigarettes smoked per day and week), their nicotine dependence (mFTQ; modified Fagerström Tolerance Questionnaire; Fagerstrom, 1991; Prokhorov, Pallonen, Fava, Ding, & Niaura, 1996; α=.70), their loss of autonomy over tobacco use (DiFranza et al., 2000; O'Loughlin et al., 2002; α=.84), their craving (QSU-4; Carter & Tiffany, 2001; α=.92 before and .93 after the movie) and their positive and negative affect (Diener & Emmons, 1984; α=.84 for positive and .89 for negative affect). After watching the movie, the participants completed a questionnaire assessing their transportation (adapted version of the Transportability Scale; Dal Cin, Zanna, & Fong, 2004; α = .82), their identification with the main characters (Cohen, 2001; α = .83 for the male and .88 for the female main character), characters' attractiveness (Hines, Saris, & Throckmorton-Belzer, 2000; α = .88 for main male and .81 for main female character), their film appreciation (Engels, Hermans, van Baaren, Hollenstein, & Bot, 2009; α=.72), and their positive and negative affect (Diener & Emmons, 1984; α=.86 for positive and .68 for negative affect). 3. Results 3.1. Descriptive statistics All participants were daily smokers (26.2% smoked 1–5 cigarettes/ day, 40.0% smoked 6–10 cigarettes/day, 32.3% smoked 11–20 cigarettes/ day, 1.5% smoked 21–30 cigarettes/day) and smoked on average 58.45 cigarettes/week (SD=33.87). They reported, on average, to have initiated
smoking at the age of 12.62 years (SD=2.04). Participants' craving level prior to the experiment was on average 19.41 (SD=19.45) and they reported a mean score of .55 (SD=.26) on the mFTQ and a mean score of 2.40 (SD=.57) on the HONC. Randomization over the two conditions and experimental manipulation were successful. On average, participants smoked 2.42 cigarettes (SD =1.30, range 0–7). Four participants did not smoke at all during the experiment: two in the experimental and two in the control condition. The two groups did not differ with regard to the time the first (p= .41; experimental condition: M= 13.00 min; SD =13.76; control condition: M=10.36; SD =9.78) and the second (p= .07; experimental condition: M =30.13; SD= 12.32; control condition: M =36.86; SD= 13.39) cigarette was lit. The average scores for the film-related variables can be found in Table 1. 3.2. Effect of smoking cues in movies on immediate smoking behavior An independent samples t-test was conducted in order to test the effect of smoking cues in movies (movie with smoking scenes vs. movie without any smoking scenes) on immediate smoking behavior (number of cigarettes smoked while watching the movie). No significant effect of smoking cues in movies on immediate smoking behavior was found, t(1,63) =.55, p = .59. In the experimental condition, the participants smoked on average 2.50 cigarettes (SD= 1.54) and in the control condition, the participants smoked on average 2.32 cigarettes (SD= .98). We conducted several ANOVAs to test possible interaction effects with gender, various smoking habits (e.g., daily and weekly smoking behavior, time since age of initiation), nicotine dependence measures, craving, transportation, identification with the characters, attractiveness of the characters, film appreciation, positive and negative affect and whether they had seen the movie before. No interaction effects were found. 4. Discussion The goal of this study was to examine adolescent smokers' response to smoking cues in movies. Adolescent smokers were exposed to a movie with or without depictions of smoking and were allowed to smoke while watching the movie. Contrary to what we expected, adolescent smokers confronted with smoking characters did not light up more cigarettes than adolescent smokers confronted with non-smoking characters. Explanations for the lack of effect can, perhaps, be found within the assumptions of the dual process model (Wiers et al., 2007). This model, which is used to explain the development of addiction, is divided into an appetitive, approach-oriented system and a regulatory executive system. The model proposes that the automatic link between cues and behavior is influenced by the ability and motivation to control. With regard to the appetitive system, little is known about the timeline of the development of incentive salience and the
Table 1 Independent samples t-test for several film-related variables per condition. Smoking movie
Transportation Identification female character Identification male character Attractiveness female character Attractiveness male character Film appreciation Positive affect before movie Negative affect before movie Positive affect after movie Negative affect after movie
Non-smoking movie
Mean
SD
Mean
SD
t
p
4.99 3.25 3.48 3.67 3.09 3.23 4.26 .74 4.41 .29
.96 .78 .69 .61 .77 .36 .91 1.16 .81 .51
4.91 3.29 3.46 3.53 3.10 3.31 3.86 .49 4.22 .14
1.09 .76 .60 .60 .77 .29 1.17 .89 1.01 .42
.34 −.22 −1.0 .95 −.05 −.96 1.54 .95 .86 1.32
.74 .83 .31 .34 .96 .34 .13 .35 .40 .19
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amount of pairings needed to evoke sensitization and cue-induced appetitive response tendencies. It might be the case that smokers with a short smoking history, such as the adolescent smokers in our sample, have formed first associations, but are not yet completely susceptible to environmental smoking cues. This assumption is supported by the low levels of nicotine dependence measures (mFTQ and HONC), which indicate that the adolescents in our sample might still be in the earlier stages of the development of nicotine dependence. With regard to the regulatory executive system, there are indications that adolescents might have more difficulties regulating appetitive response tendencies, as their regulatory executive system has not yet been fully developed (Wiers et al., 2007). Among adolescent smokers, who might not be permitted to smoke at home, the opportunity to smoke might play an important role. In a previous similar study, adults smoked on average the same number of cigarettes during the movie as the adolescents (Lochbuehler et al., 2010), but adults' baseline craving levels were higher due to deprivation from smoking. Although the adolescent smokers were not deprived, they smoked the same amount as the adults. Another explanation for the lack of findings can be found in the dose of cue-exposure. Longitudinal studies, which assessed cumulative exposure to smoking cues in movies, demonstrated an effect on nicotine dependence and established smoking in adolescents (Dal Cin et al., 2012; Dalton et al., 2009; Sargent et al., 2007). The current experiment exposed smokers to a single movie. It may be that experiments allowing multiple exposures and the possibility to assess a dose–response relationship show different results. None of the smoking- and movie-related variables had an influence on the association between smoking cues in movies and smoking behavior. It remains unclear, why an interaction effect with transportation which was found in a previous study among adults (Lochbuehler et al., 2010), was not replicated. It is important to note that scores on transportation in the current study did not deviate from scores in the adult study (Lochbuehler et al., 2010), suggesting that adolescents are not less engaged in the movie. Some limitations need to be mentioned. First, based on previous research among adults we expected to find medium to large effects (Lochbuehler et al., 2010). A-priori power calculations indicated that a sample of 65 participants would be appropriately powered to detect medium effects. However, our sample size was not powered to detect a small population effect, which can therefore not be ruled out. Second, although all participants reported being daily smokers, their daily smoking habits and therefore their nicotine dependence levels, varied. Future studies should focus on more homogeneous samples with regard to smoking history and habits. Third, although asking participants to smoke a cigarette before cue-exposure has been used in other cue-reactivity studies (Carpenter et al., 2009; Drobes & Tiffany, 1997), this might have influenced participants' background craving and diminished their cue-reactivity. However, smoking a cigarette before the movie did not prevent participants from smoking and adolescent smokers smoked on average the same number of cigarettes during the movie than deprived adult smokers in a similar study (Lochbuehler et al., 2010). Still, it cannot be ruled out that a different experimental setup in terms of satiation/deprivation could lead to different results. In conclusion, this study found no influence of smoking cues in movies on immediate smoking behavior in adolescent smokers. Experimental cue-reactivity research among adolescent smokers is scarce. As adolescent smokers differ from adult smokers in smoking habits, history and developmental stage of addiction, more experimental research on the effects of environmental cues on adolescent smokers is needed to better understand the progression of addition. Role of funding sources Funding for this study was provided by the Behavioural Science Institute, Radboud University Nijmegen. The Behavioural Science Institute had no role in the study design,
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collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors KL and RCME were responsible for the study concept and design. KL and RCME contributed to the acquisition of the data. KL, MK and RCME performed the analyses and interpreted the findings. KL drafted the manuscript. MK and RCME provided critical revision of the manuscript for important intellectual content. All authors critically reviewed content and approved the final manuscript for publication.
Conflict of interest All authors declare that they have no conflicts of interest.
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Sargent, J. D., Beach, M. L., Dalton, M. A., Mott, L. A., Tickle, J. J., Ahrens, M. B., et al. (2001). Effect of seeing tobacco use in films on trying smoking among adolescents: Cross sectional study. British Medical Journal, 323, 1–6. Sargent, J. D., Stoolmiller, M., Worth, K. A., Dal Cin, S., Wills, T. A., Gibbons, F. X., et al. (2007). Exposure to smoking depictions in movies: Its association with established adolescent smoking. Archives of Pediatrics & Adolescent Medicine, 161(9), 849–856. Shmueli, D., Prochaska, J. J., & Glantz, S. A. (2010). Effect of smoking scenes in films on immediate smoking: A randomized controlled study. American Journal of Preventive Medicine, 38(4), 351–358. Steinberg, L. (2007). Risk taking in adolescence. Current Directions in Psychological Science, 16(2), 55–59. http://dx.doi.org/10.1111/j.1467-8721.2007.00475.x. Thrasher, J. F., Jackson, C., Edna, A., & Sargent, J. (2008). Exposure to smoking imagery in popular films and adolescent smoking in Mexico. American Journal of Preventive Medicine, 35(2), 95–102.
Titus-Ernstoff, L., Dalton, M. A., Adachi-Mejia, A. M., Longacre, M. R., & Beach, M. L. (2008). Longitudinal study of viewing smoking in movies and initiation of smoking by children. Pediatrics, 121, 15–21. Wiers, R. W., Bartholow, B. D., van den Wildenberg, E., Thush, C., Engels, R. C. M. E., Sher, K. J., et al. (2007). Automatic and controlled processes and the development of addictive behaviors in adolescents: A review and a model. Pharmacology, Biochemistry and Behavior, 86, 263–283. Wills, T. A., Sargent, J. D., Stoolmiller, M., & Gibbons, F. X. (2007). Movie exposure to smoking cues and adolescent smoking onset: A test for mediation through peer affiliations. Health Psychology, 26(6), 769–776.
Contents lists available at SciVerse ScienceDirect
Addictive Behaviors
Short Communication
Does the exposure to smoking cues in movies affect adolescents' immediate smoking behavior? Kirsten Lochbuehler ⁎, Marloes Kleinjan, Rutger C.M.E. Engels Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
H I G H L I G H T S ► Smoking in movies had no effect on adolescent smokers’ immediate smoking behavior. ► This association was not affected by several smoking- and movie-related variables. ► Adolescent smokers do not seem to be affected by smoking movie exposure.
a r t i c l e Keywords: Smoking behavior Cue-reactivity Movies Adolescents Media
i n f o
a b s t r a c t Introduction: Various studies have demonstrated that environmental smoking cues elicit smoking-related responses in smokers. However, cue reactivity studies among adolescent smokers are scarce. Therefore, the aim of this study was to examine the effect of smoking portrayal in movies on immediate smoking behavior in adolescent smokers. Method: A total of 65 adolescent daily smokers (between the ages of 16 and 18 years) were exposed to a one-hour movie clip, with or without smoking characters, and were allowed to smoke while watching the movie. Results: The exposure to smoking cues in movies had no effect on immediate smoking behavior. This association was not affected by several smoking- and movie-related variables. Conclusions: No influence of smoking cues in movies on immediate smoking behavior in adolescent daily smokers was found. More experimental research on the effects of environmental cues on adolescent smokers in different stages of addiction is needed. © 2013 Elsevier Ltd. All rights reserved.
1. Introduction Previous research has demonstrated an association between the exposure to smoking cues in movies and smoking initiation (Dalton et al., 2003; Hanewinkel & Sargent, 2007, 2008; Jackson, Brown, & L'Engle, 2007; Sargent et al., 2005, 2001; Thrasher, Jackson, Edna, & Sargent, 2008; Titus-Ernstoff, Dalton, Adachi-Mejia, Longacre, & Beach, 2008; Wills, Sargent, Stoolmiller, & Gibbons, 2007) and established smoking (Dal Cin, Stoolmiller, & Sargent, 2012; Dalton et al., 2009; Sargent et al., 2007) in adolescents. These studies indicate an impact of smoking portrayal in movies on different developmental stages of smoking. However, the few experimental studies on the effects of movie smoking exposure on smokers showed mixed findings and focused on adult smokers (Harakeh, Engels, Vohs, van Baaren, & Sargent, 2010; Lochbuehler, Peters, Scholte, & Engels, 2010; Shmueli,
⁎ Corresponding author at: Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. Tel.: +31 24 361 2567; fax: +31 24 361 2776. E-mail address: [email protected] (K. Lochbuehler). 0306-4603/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.addbeh.2013.01.022
Prochaska, & Glantz, 2010). It is unclear how adolescent smokers who differ from adult smokers with regard to their smoking history and developmental stage of addiction respond to smoking cues in movies. As smoking portrayal in movies is prevalent and watching movies is among the most popular leisure time activities (Roberts, 2000; Roberts, Foehr, & Rideout, 2005; Sargent et al., 2001), the exposure to smoking portrayal in movies might be highly relevant to the development of addiction in adolescent novice smokers. Moreover, adolescents might be particularly susceptible to environmental smoking cues, as their regulatory executive system (e.g. psychosocial abilities that improve decision making and moderate risk taking) has not yet been fully developed (Steinberg, 2007; Wiers et al., 2007). The current study aims to examine the effect of smoking portrayal in movies on immediate smoking behavior in adolescent smokers. In an experimental study, adolescent smokers were exposed to the same movie either with or without smoking characters and were allowed to smoke while watching the movie. We hypothesized that the exposure to a movie with smoking would lead to smoking more cigarettes than the exposure to the same movie without any smoking. Furthermore, we tested moderation effects of various smoking-related and movie-related variables.
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2. Material and methods 2.1. Sample and procedure We obtained permission by schools to approach smoking students in schoolyards in Nijmegen and ask if they would engage in an experiment. A total of 65 adolescent smokers (53.8% female) between the ages of 16 and 18 years (M = 16.86 years; SD = .68) were invited to participate in two independent studies. They were told two cover stories: first that they were participating in a study on tobacco marketing, and second in research on lifestyle and celebrities. When the participants arrived at the lab, they were welcomed by the first research assistant and asked to go outside to smoke a cigarette, to control for baseline craving levels (Drobes & Tiffany, 1997). Afterwards, they gave their opinion on cigarette packages and filled in a questionnaire on their smoking habits and their current craving. In the second experiment, conducted by a different research assistant, participants were randomly assigned to one of two movie conditions. In the experimental condition, 34 adolescent smokers were exposed to the edited version of the movie in which several characters smoked. In the control condition, 31 adolescent smokers were exposed to the edited version of the same movie in which the smoking was completely removed. Participants were told that we were interested in how people watch movies at home and that they would be allowed to smoke and consume drinks and nuts, all of which were provided. Then, the edited version of the Dutch movie Het Schnitzelparadijs (2005) (65 min) was shown. The version shown in the experimental condition contained 14 smoking scenes (=5.42 min). Details on how movie clips are edited for this purpose can be found elsewhere (Lochbuehler, Engels, & Scholte, 2009; Lochbuehler et al., 2010). During the movie, the behavior of the participants was observed and recorded with a hidden camera. After watching the movie, the participants completed a questionnaire (see Measures) and were asked about the real aim of the study (none of whom guessed correctly). They were debriefed, thanked and given €20 for their participation. The protocols for the study were approved by the Ethical Committee of the Faculty of Social Sciences, Radboud University Nijmegen. 2.2. Measures As part of the first experiment, participants answered questions on their smoking habits (e.g., age of initiation, number of cigarettes smoked per day and week), their nicotine dependence (mFTQ; modified Fagerström Tolerance Questionnaire; Fagerstrom, 1991; Prokhorov, Pallonen, Fava, Ding, & Niaura, 1996; α=.70), their loss of autonomy over tobacco use (DiFranza et al., 2000; O'Loughlin et al., 2002; α=.84), their craving (QSU-4; Carter & Tiffany, 2001; α=.92 before and .93 after the movie) and their positive and negative affect (Diener & Emmons, 1984; α=.84 for positive and .89 for negative affect). After watching the movie, the participants completed a questionnaire assessing their transportation (adapted version of the Transportability Scale; Dal Cin, Zanna, & Fong, 2004; α = .82), their identification with the main characters (Cohen, 2001; α = .83 for the male and .88 for the female main character), characters' attractiveness (Hines, Saris, & Throckmorton-Belzer, 2000; α = .88 for main male and .81 for main female character), their film appreciation (Engels, Hermans, van Baaren, Hollenstein, & Bot, 2009; α=.72), and their positive and negative affect (Diener & Emmons, 1984; α=.86 for positive and .68 for negative affect). 3. Results 3.1. Descriptive statistics All participants were daily smokers (26.2% smoked 1–5 cigarettes/ day, 40.0% smoked 6–10 cigarettes/day, 32.3% smoked 11–20 cigarettes/ day, 1.5% smoked 21–30 cigarettes/day) and smoked on average 58.45 cigarettes/week (SD=33.87). They reported, on average, to have initiated
smoking at the age of 12.62 years (SD=2.04). Participants' craving level prior to the experiment was on average 19.41 (SD=19.45) and they reported a mean score of .55 (SD=.26) on the mFTQ and a mean score of 2.40 (SD=.57) on the HONC. Randomization over the two conditions and experimental manipulation were successful. On average, participants smoked 2.42 cigarettes (SD =1.30, range 0–7). Four participants did not smoke at all during the experiment: two in the experimental and two in the control condition. The two groups did not differ with regard to the time the first (p= .41; experimental condition: M= 13.00 min; SD =13.76; control condition: M=10.36; SD =9.78) and the second (p= .07; experimental condition: M =30.13; SD= 12.32; control condition: M =36.86; SD= 13.39) cigarette was lit. The average scores for the film-related variables can be found in Table 1. 3.2. Effect of smoking cues in movies on immediate smoking behavior An independent samples t-test was conducted in order to test the effect of smoking cues in movies (movie with smoking scenes vs. movie without any smoking scenes) on immediate smoking behavior (number of cigarettes smoked while watching the movie). No significant effect of smoking cues in movies on immediate smoking behavior was found, t(1,63) =.55, p = .59. In the experimental condition, the participants smoked on average 2.50 cigarettes (SD= 1.54) and in the control condition, the participants smoked on average 2.32 cigarettes (SD= .98). We conducted several ANOVAs to test possible interaction effects with gender, various smoking habits (e.g., daily and weekly smoking behavior, time since age of initiation), nicotine dependence measures, craving, transportation, identification with the characters, attractiveness of the characters, film appreciation, positive and negative affect and whether they had seen the movie before. No interaction effects were found. 4. Discussion The goal of this study was to examine adolescent smokers' response to smoking cues in movies. Adolescent smokers were exposed to a movie with or without depictions of smoking and were allowed to smoke while watching the movie. Contrary to what we expected, adolescent smokers confronted with smoking characters did not light up more cigarettes than adolescent smokers confronted with non-smoking characters. Explanations for the lack of effect can, perhaps, be found within the assumptions of the dual process model (Wiers et al., 2007). This model, which is used to explain the development of addiction, is divided into an appetitive, approach-oriented system and a regulatory executive system. The model proposes that the automatic link between cues and behavior is influenced by the ability and motivation to control. With regard to the appetitive system, little is known about the timeline of the development of incentive salience and the
Table 1 Independent samples t-test for several film-related variables per condition. Smoking movie
Transportation Identification female character Identification male character Attractiveness female character Attractiveness male character Film appreciation Positive affect before movie Negative affect before movie Positive affect after movie Negative affect after movie
Non-smoking movie
Mean
SD
Mean
SD
t
p
4.99 3.25 3.48 3.67 3.09 3.23 4.26 .74 4.41 .29
.96 .78 .69 .61 .77 .36 .91 1.16 .81 .51
4.91 3.29 3.46 3.53 3.10 3.31 3.86 .49 4.22 .14
1.09 .76 .60 .60 .77 .29 1.17 .89 1.01 .42
.34 −.22 −1.0 .95 −.05 −.96 1.54 .95 .86 1.32
.74 .83 .31 .34 .96 .34 .13 .35 .40 .19
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amount of pairings needed to evoke sensitization and cue-induced appetitive response tendencies. It might be the case that smokers with a short smoking history, such as the adolescent smokers in our sample, have formed first associations, but are not yet completely susceptible to environmental smoking cues. This assumption is supported by the low levels of nicotine dependence measures (mFTQ and HONC), which indicate that the adolescents in our sample might still be in the earlier stages of the development of nicotine dependence. With regard to the regulatory executive system, there are indications that adolescents might have more difficulties regulating appetitive response tendencies, as their regulatory executive system has not yet been fully developed (Wiers et al., 2007). Among adolescent smokers, who might not be permitted to smoke at home, the opportunity to smoke might play an important role. In a previous similar study, adults smoked on average the same number of cigarettes during the movie as the adolescents (Lochbuehler et al., 2010), but adults' baseline craving levels were higher due to deprivation from smoking. Although the adolescent smokers were not deprived, they smoked the same amount as the adults. Another explanation for the lack of findings can be found in the dose of cue-exposure. Longitudinal studies, which assessed cumulative exposure to smoking cues in movies, demonstrated an effect on nicotine dependence and established smoking in adolescents (Dal Cin et al., 2012; Dalton et al., 2009; Sargent et al., 2007). The current experiment exposed smokers to a single movie. It may be that experiments allowing multiple exposures and the possibility to assess a dose–response relationship show different results. None of the smoking- and movie-related variables had an influence on the association between smoking cues in movies and smoking behavior. It remains unclear, why an interaction effect with transportation which was found in a previous study among adults (Lochbuehler et al., 2010), was not replicated. It is important to note that scores on transportation in the current study did not deviate from scores in the adult study (Lochbuehler et al., 2010), suggesting that adolescents are not less engaged in the movie. Some limitations need to be mentioned. First, based on previous research among adults we expected to find medium to large effects (Lochbuehler et al., 2010). A-priori power calculations indicated that a sample of 65 participants would be appropriately powered to detect medium effects. However, our sample size was not powered to detect a small population effect, which can therefore not be ruled out. Second, although all participants reported being daily smokers, their daily smoking habits and therefore their nicotine dependence levels, varied. Future studies should focus on more homogeneous samples with regard to smoking history and habits. Third, although asking participants to smoke a cigarette before cue-exposure has been used in other cue-reactivity studies (Carpenter et al., 2009; Drobes & Tiffany, 1997), this might have influenced participants' background craving and diminished their cue-reactivity. However, smoking a cigarette before the movie did not prevent participants from smoking and adolescent smokers smoked on average the same number of cigarettes during the movie than deprived adult smokers in a similar study (Lochbuehler et al., 2010). Still, it cannot be ruled out that a different experimental setup in terms of satiation/deprivation could lead to different results. In conclusion, this study found no influence of smoking cues in movies on immediate smoking behavior in adolescent smokers. Experimental cue-reactivity research among adolescent smokers is scarce. As adolescent smokers differ from adult smokers in smoking habits, history and developmental stage of addiction, more experimental research on the effects of environmental cues on adolescent smokers is needed to better understand the progression of addition. Role of funding sources Funding for this study was provided by the Behavioural Science Institute, Radboud University Nijmegen. The Behavioural Science Institute had no role in the study design,
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collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors KL and RCME were responsible for the study concept and design. KL and RCME contributed to the acquisition of the data. KL, MK and RCME performed the analyses and interpreted the findings. KL drafted the manuscript. MK and RCME provided critical revision of the manuscript for important intellectual content. All authors critically reviewed content and approved the final manuscript for publication.
Conflict of interest All authors declare that they have no conflicts of interest.
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