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Epidemiology Article Critique

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Molly Zielenbach

on 15 December 2014

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Transcript of Epidemiology Article Critique

Increased movie smoking exposure is associated with cigarette smoking among adolescents over 2 years. This association is independent of movie MPAA rating.
Exposure to smoking behavior in movies
Measure: 100 popular and recent movies used in a questionnaire that was sent to participants
Accurately measured?
Outcome is smoking behavior initiated
Measure: Question - "have you ever tried smoking, even a puff?"
Answer yes was classified as having tried smoking
Accurately measured?
Prospective Cohort Study
Participants surveyed about media exposures, tobacco and alcohol use, demographic information, and other risk factors
Surveys completed at baseline then every 8 months for 24 total months
Completion rate only 66%, so missing data was estimated to minimize attrition bias
Measure of association is the Adjusted Hazard Odds Ratio
Study Sample
Exposure and Outcomes
Image by Tom Mooring
Study Design
Epidemiology Article Critique : Cohort Study
"Influence of Motion Picture Rating on Adolescent Response to Movie Smoking"

Isabelle Wiles, Chelsea Williams, Yineng Zhu,
Molly Zielenbach

Sample Size:
6522 US adolescents;
aged from 10 to 14 years
Random-digit-dial (RDD) telephone survey
Study Objectives
Examine the association between movie smoking exposure and adolescent smoking by movie rating category
Evidence currently exists stating that the relationship between movie smoking exposure and adolescent smoking is causal
No current information on the influence of movie rating on adolescent smoking
Study Limitations
Sample limitations:
Need parental consent
Missing data/ Attrition (only a 66% completion rate)
Exposure measurement
Survey contained a random sample of current and past movies, possible that it didn't fully capture movie watching behavior for many participants
Possibility that an underlying individual or environmental characteristic leads to both increased movie exposure and smoking behavior and was not accounted for - for example, social groups often determine movies watched and smoking initiation

Follow-up Time:
# Adolescents
Intervals Followed*
* 1 interval = 8 months
Follow-up Time:
Study Strengths
As a prospective cohort study:
Clear temporal sequence between movie smoking exposure and adolescent smoking
Can directly calculate incidence
Better quality of exposure and confounder data
Less vulnerable to bias

Using General Cohort:
Can study effects of different levels of movie smoking exposures on adolescent smoking
Using internal comparison group:
The comparison group is most comparable to exposed group
Using questionnaire:
Good for getting study-required information like lifestyle, exposure to movie smoking, adolescent smoking, etc.
Confounding & Bias
Attrition Bias
Recall Bias
Exposure to smoking through other medias
Peer influence and social structure
MSE and youth smoking relation in PG-13 and R rated movies was higher than in G/PG Rated movies
Removing MSE from PG-13 and R rated movies would reduce smoking onset over the 8 month study period by 26%
Eliminating smoking from youth-rated movies would reduce smoking by as much as making all parents maximally authoritative in their parenting.
Smoking in PG-13 and R rated movies prompts youth to smoke.
The depiction of smoking in movies affects the onset of youth smoking more than other contextual factors.
Proposals For Future Research & Public Health Programming
A possible RCT testing changing movie ratings to R for films with high smoking exposure
A cohort study assessing TV smoking exposure on youth
Table 1 - Baseline Characteristics
Figure 2. Exposure to Movie smoking and Probability of trying smoking
Full transcript