Television viewing and smoking volume in adolescent smokers: a cross-sectional study Klaas Gutschoven and Jan Van den Bulck * Katholieke Universiteit Leuven, Department of Communication, 3000 Leuven, Belgium Available online 7 June 2004 Abstract Background. Previous research has shown a relationship between television viewing and smoking initiation. The relationship between television viewing and the amount of cigarettes consumed by adolescent smokers per time unit (day, week, month...) has not yet been studied. Methods. A cross-sectional sample of children by means of self-reports administered by research assistants in schools was obtained. Participants were 421 smokers in a random sample of 4th year students in 15 secondary schools in Flanders, Belgium. Main outcome measures were quantifiable, closed survey questions about smoking volume, whether or not parents and friends smoked, frequency of going out and average weekly TV viewing volume. Results. Television viewing was a significant predictor of smoking volume. Smokers who watch more TV smoke more. The relationship was curvilinear (quadratic). The relationship becomes stronger (curves upward) for higher levels of viewing. Those who watch 5 or more hours a day smoke between 60 and 147 cigarettes more per week than those who watch 1 h or less. Conclusions. Television viewing is significantly related to smoking volume. The content of television may glamorize smoking. Children may learn to associate smoking with viewing regardless of content. It is also possible that heavier smoking leads to more viewing or that a third variable influences both smoking volume and viewing. Regardless of the causal direction of the relationship television viewing appears to be an indicator or predictor of smoking volume. The curvilinear nature of the relationship deserves further attention. D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. Keywords: Television; Smoking; Smoking volume; Gender; Educational level; Peer smoking; Parental smoking Introduction Studies have shown that it is still very common to see characters smoke in movies or television drama [1–8]. While the prevalence of smoking in movies decreased from the 1960s through the 1980s, it increased again in the 1990s. A recent study by Glantz et al. [6] even found that smoking in movies was more prevalent in the year 2002 than it was in the 1950s. Smoking in movies or on television is often depicted in a positive way. One study showed that smokers are portrayed as attractive and successful individuals. Men are depicted as smokers more often than women are [7]. The authors analyzed a random sample of 62 of the top grossing US films between 1960 and 1990 and concluded that films consistently portray smokers as successful, attractive white males. In a similar analysis, McIntosh et al. [9] concluded that smokers in movies are sexier and more romantic than non- smokers are. Others have found that even modest levels of viewing music videos may result in substantial exposure to glamorized depictions of tobacco [1]. The authors compared the percentage of music videos showing smoking behaviors on four different US music video networks. Their analysis indicated that between 11.9% and 25.7% of all music videos depicted on these networks showed smoking behavior. While much of the research about the content of audiovi- sual media has been conducted in the United States of America, it is important to note that in many countries, a large portion of what is broadcast on television is American fiction. In Flanders, Belgium, during prime time, 38.3% of fiction on public channels and 82.3% of fiction on commer- cial channels is American. 87.5% of the movies shown on public channels and 96.3% of the movies shown on com- mercial channels are from the United States [10]. It seems 0091-7435/$ - see front matter D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2004.04.019 * Corresponding author. Katholieke Universiteit Leuven, Department of Communication, Van Evenstraat 2A, 3000 Leuven, Belgium. E-mail address: jan.vandenbulck@soc.kuleuven.ac.be (J. Van den Bulck). www.elsevier.com/locate/ypmed Preventive Medicine 39 (2004) 1093 – 1098