Tobacco, alcohol, and other risk behaviors in film: how well do MPAA ratings distinguish content?

Nearly Five Times Higher than We Think: How Much People Underestimate the Amount of Alcohol in Popular Movies and What Predicts Underestimation?

Reducing alcohol use is challenging due to the volume of alcohol shown in media and the relationship between exposure and use. It is unclear to what degree people are aware of and able to estimate alcohol exposure in the media, such as in movies. In this study, 609 Australian adults estimated the amount of alcohol exposure in up to 10 of 102 popular movies they remembered best. They reported when they last saw each movie, their alcohol use, age, and gender. Participants underestimated the amount of alcohol in movies by an average of 35.39 times. Movies classified as featuring adult content (PG-13 or R) and movies with the greatest amount of alcohol were particularly underestimated. Individual’s age, gender, alcohol use, or when the movie was last viewed had no effect on underestimation. In conclusion, due to the severe underestimation, alcohol exposure should be more seriously reviewed by governmental and medial organizations.

Understanding the Nature of Media Effects From Onscreen Exposure to Alcohol, Sex, and Their Combination

PURPOSE

Combinations of risk behaviors are common in popular media, which make it difficult to understand how exposure to risk content affects adolescent risk behaviors. The purpose of this study was to determine whether media effects associated with exposure to multiple risk behaviors (i.e., combined alcohol and sex, sex only, alcohol only, and no risk) in television content have specific or more general effects on attitudes and norms associated with performing these behaviors.

METHODS

Adolescents aged 14-17 years from an opt-in Qualtrics panel (n = 338) were randomized into one of four conditions, which varied the presence of risk behaviors (i.e., combined alcohol and sex, sex only, alcohol only, and no risk) that were featured in a brief video clip from a popular television show. We tested the content effects on behavioral attitudes and norms for performing each of the behaviors.

RESULTS

Analysis of variance analyses showed that exposure to combined alcohol and sex resulted in more positive attitudes toward engaging in combining alcohol and sex, drinking, and smoking. Exposure to the sex only, alcohol only, and no risk videos did not influence any attitudes or norms.

CONCLUSIONS

A brief exposure to combined risk behaviors in media may increase positive attitudes related to the combination behavior (alcohol and sex), a component behavior (alcohol), and also more general risk-taking behaviors (smoking).

Parental Restriction of Movie Viewing Prospectively Predicts Adolescent Alcohol and Marijuana Initiation: Implications for Media Literacy Programs

Youth are heavy consumers of media, and exposure to mature media content is associated with initiation and progression of substance use. Parental restriction of such content has been shown to be an effective mechanism to reduce negative consequences attributed to exposure to mature media content. This study assessed the influence of parental restriction of movie watching across Motion Picture Association of America rating categories on subsequent alcohol and marijuana initiation at 1- and 2-year follow-up. Using data from a longitudinal study of adolescent substance use (N = 1023), we used logistic regression analyses to determine the odds of alcohol and marijuana initiation across movie rating categories, within R-rated restriction categories in particular, and based on changes in parental restriction of movies over time. All analyses controlled for important parental, personality, and behavioral correlates of adolescent substance use. Results suggest that restriction of R-rated movies is protective of both alcohol and marijuana initiation. Important differences among parental restriction of R-rated movie categories emerged such that being allowed to watch them with adult supervision was protective of substance use, while those who reported watching R-rated films despite parental restrictions were at heightened risk for alcohol initiation. Changes in parental movie restrictions were not predictive of substance use initiation over the subsequent year. Implications of these findings for media literacy program prevention strategies are discussed.

Are movies with tobacco, alcohol, drugs, sex, and violence rated for youth? A comparison of rating systems in Argentina, Brazil, Mexico, and the United States

BACKGROUND

This study aimed to determine between-country differences and changes over time in the portrayal of youth risk behaviors in films rated for youth in Argentina, Brazil, Mexico and the United States.

METHODS

Content and ratings were analyzed for 362 films that were popular across all four countries from 2002 to 2009. Country-specific ratings were classified as either youth or adult, and Generalized Estimating Equations were used to determine between-country differences in the presence of tobacco, alcohol, drugs, sexual content, and violence in youth-rated films. Within-country differences in this content over time were also assessed, comparing films released from 2002 to 2005 with those released from 2006 to 2009.

RESULTS

In the US, films rated for youth were less likely to contain all five risk behaviors than in youth-rated films in Argentina, Brazil, and, when the "15 and older" rating was considered a youth rating, in Mexico. All three Latin American countries "downrated" films that received an adult rating in the US. Nevertheless, tobacco and drug use in youth-rated films declined over time in all countries, whereas moderate to extreme alcohol use and violence involving children or youth increased in all countries.

CONCLUSIONS

Tobacco and drug use have declined in popular US films, but these behaviors are still prevalent in films rated for youth across the Americas. The apparent success of advocacy efforts to reduce tobacco and other drugs in films suggests that similar efforts be directed to reduce alcohol portrayals.

Violent film characters' portrayal of alcohol, sex, and tobacco-related behaviors

OBJECTIVE

To determine the extent to which movies popular with adolescents feature characters who jointly engage in violence and other risk behaviors. We hypothesized that violent characters engage in other risk behaviors equally often in films rated appropriate for children over 12 (PG-13) and Restricted (R)-rated films.

METHODS

Content analysis of a sample of top-grossing movies from 1985 to 2010 (n = 390). We coded movies for the presence of at least 1 main character who was involved in violence and either sex, tobacco, or alcohol use within a 5-minute movie segment and throughout a film.

RESULTS

Approximately 90% of the movies contained a segment with a main character involved in violence, and ~77% of the films had the same character engaging in at least 1 other risk behavior. A violent character was portrayed most often partaking in alcohol-related and sexual behaviors. G and PG movies had less co-occurrence than PG-13 or R-rated movies, but there was no statistical difference between PG-13 and R-rated movies with regards to violence co-occurring with other risk behaviors. These trends did not vary over time.

CONCLUSIONS

Popular films that contain violent characters also show those characters engaging in other risk behaviors. Similar rates of co-occurrence between PG-13 and R-rated films suggest that the Motion Picture Association of America ratings system is not sensitive to the joint portrayal of violence and alcohol, sex, and tobacco-related risk behaviors. The on-screen clustering of violence with other risk behaviors is cause for concern and worthy of additional research.

Specificity of early movie effects on adolescent sexual behavior and alcohol use

Adolescents' movie sex exposure (MSE) and movie alcohol exposure (MAE) have been shown to influence later sexual behavior and drinking, respectively. No study to date, however, has tested whether these effects generalize across behaviors. This study examined the concurrent influences of early (i.e., before age 16) MSE and MAE on subsequent risky sex and alcohol use among a national sample of 1228 U.S. adolescents. Participants reported their health behaviors and movie viewing up to six times between 2003 and 2009 in telephone interviews. The Beach method was used to create a population-based estimate of each participant's MSE and MAE, which were then entered into a structural equation model (SEM) to predict lifetime risky sex and past month alcohol use at ages 18-21. For both men and women, MAE predicted alcohol use, mediated by age of initiation of heavy episodic drinking (HED) and age of sexual debut; MAE also predicted risky sex via age of sexual debut. Among men only, MSE indirectly predicted risky sex and alcohol use. Findings indicated that early exposure to risk content from movies had both specific and general effects on later risk-taking, but gender differences were evident: for men, MSE was a stronger predictor than MAE, but for women, only MAE predicted later risk behavior. These results have implications for future media research, prevention programs for adolescent sex and alcohol use, and movie ratings that can guide parents' decisions as to which movies are appropriate for their children.

Movie smoking and youth initiation: parsing smoking imagery and other adult content

Objectives

To isolate the independent influence of exposure to smoking and other adult content in the movies on youth smoking uptake.

Methods

We used discrete time survival analysis to quantify the influence of exposure to smoking and other adult content in the movies on transitioning from (1) closed to open to smoking; (2) never to ever trying smoking; and (3) never to ever hitting, slapping, or shoving someone on two or more occasions in the past 30 days. The latter is a comparative outcome, hypothesized to have no correlation with exposure to smoking in the movies.

Results

Assessed separately, both exposure to smoking imagery and exposure to adult content were associated with increased likelihood of youth becoming open to smoking (OR = 1.09, 95% CI: 1.04–1.15 and OR = 1.10, 95% CI: 1.04–1.17) and having tried smoking (OR = 1.06, 95% CI: 1.00–1.12 and OR = 1.06, 95% CI: 1.00–1.13). Both measures were also separately associated with aggressive behavior (OR = 1.09, 95% CI: 1.04–1.14 and OR = 1.09, 95% CI: 1.04–1.15). A very high correlation between the two measures (0.995, p<0.000) prevented an assessment of their independent effects on smoking initiation.

Conclusion

Although exposure to smoking in the movies is correlated with smoking susceptibility and initiation, the high correlation between exposure to smoking in the movies and other adult content suggests that more research is needed to disentangle their independent influence on smoking.

Influence of motion picture rating on adolescent response to movie smoking

OBJECTIVE

To examine the association between movie smoking exposure (MSE) and adolescent smoking according to rating category.

METHODS

A total of 6522 US adolescents were enrolled in a longitudinal survey conducted at 8-month intervals; 5503 subjects were followed up at 8 months, 5019 subjects at 16 months, and 4575 subjects at 24 months. MSE was estimated from 532 recent box-office hits, blocked into 3 Motion Picture Association of America rating categories: G/PG, PG-13, and R. A survival model evaluated time to smoking onset.

RESULTS

Median MSE in PG-13-rated movies was ∼3 times higher than median MSE from R-rated movies, but their relation with smoking was essentially the same, with adjusted hazard ratios of 1.49 (95% confidence interval [CI]: 1.23-1.81) and 1.33 (95% CI: 1.23-1.81) for each additional 500 occurrences of MSE respectively. MSE from G/PG-rated movies was small and had no significant relationship with adolescent smoking. Attributable risk estimates showed that adolescent smoking would be reduced by 18% (95% CI: 14-21) if smoking in PG-13-rated movies was reduced to the fifth percentile. In comparison, making all parents maximally authoritative in their parenting would reduce adolescent smoking by 16% (95% CI: 12-19).

CONCLUSIONS

The equivalent effect of PG-13-rated and R-rated MSE suggests it is the movie smoking that prompts adolescents to smoke, not other characteristics of R-rated movies or adolescents drawn to them. An R rating for movie smoking could substantially reduce adolescent smoking by eliminating smoking from PG-13 movies.

Endocrine disruptors, travel-associated illness, and media violence: important health considerations for children and adolescents

PURPOSE OF REVIEW

This article addresses three important topics that are part of contemporary life for children: endocrine disruptors, hazards of international travel, and the impact of media violence on children and adolescents.

RECENT FINDINGS

Practitioners will learn about phthalates and Bisphenol-A as endocrine disruptors. In published studies, elevated phthalates were associated with an increase in pubertal gynecomastia and premature thelarche. Bisphenol-A was judged by the Food and Drug Administration as having some concern for potential effects on brain, behavior, and prostate gland in fetuses, infants, and young children: hence, the decision to take reasonable steps to reduce exposure of infants. In travel-related diseases, diarrheal disease (primarily Campylobacter and Salmonella), dermatologic conditions (animal bites), systemic febrile illness (malaria and dengue fever), and respiratory illnesses predominate. Children and adolescents spend more than 7 h using media per day. The degree to which media violence can be linked to behavior is not conclusive, but the prevention message for practitioners is important because parents can have an important mitigating effect.

SUMMARY

Endocrine disruptors, travel-related diseases, and media violence are part of modern day life for our children. Pediatricians need to stay abreast of recent findings and have access to up-to-date resources to assist them in providing contemporary advice and guidance to patients and families.