Alcohol in movies4th European Alcohol Policy Conference

Brussels, June 21-22, 2010

Reiner Hanewinkel, Ph.D.

Hellboy II: The Golden Army (2008) Cast: Ron Perlman,

Selma Blair, Doug Jones

US-Rating: PG-13 for sequences of sci-fi action and violence, and some language Germany: ≥ 12

What happens in Vegas (2008)

Cast: Ashton Kutcher, Cameron Diaz

Rating: PG-13 for some sexual and crude content, and language,including a drug reference Germany: ≥ 6

Match Point (2005)

Cast: Jonathan Rhys Meyers, Scarlett Johansson

Rating: R for some sexuality Germany: ≥ 6

Cast:Tom CruisePenélope CruzCameron DiazKurt RussellTilda Swinton

Vanilla Sky (2001)

Rated R for sexuality and strong language Germany: ≥ 16

Any alcohol use

Beer

Wine

Liquor

One or more

Branded use by actor

Background

Verbal mention of use

83%

64%

67%

71%

52%

30%

41%

9%

Types of alcohol used in movieAlcohol brand appearances

Alcohol use and alcohol brand appearances in 534 contemporary Hollywood movies

Addiction 2008;103:1925-32

Purpose

To investigate the association of movie alcohol use and German adolescent alcohol use

Germany

Schleswig-Holstein

Surveys conducted

42 schools randomly selected

27 schools (64%)agreed to participate

5,581 studentswere surveyed at baseline

Sample description:─ Equally distributed by sex

─ Mean age: 12.8 yearsRange: 11-17 years

─ Alcohol use without parental knowledge: 36.6%

─ Binge drinking : 18.1%

Sample recruitment

Int J Epidemiol 2007;36:1068-77

Generate Survey Movie List

398 Top Movies, 1994-2004

Questionnaire assesses which of the 50 movies the adolescent has ever seen

Survey Adolescents

Randomly selected 50 movies for each survey

Timed alcohol use in movies

Movie Content Analysis

Hours of alcohol use in movies seen

Merge

Exposure Assessment

Beach MethodInt J Epidemiol 2007;36:1068-77

What is shown in German cinemas?

Most popular movies in Germany were produced and distributed by Hollywood Studios

─ 86% of top 25 box office hits in Germany, 1994-2001

─ 75% of top 100 box offce hits in Germany, 2002-2004

80% of all box office hits in Germany are produced and/or distibuted by Hollywood Companies

Int J Epidemiol 2007;36:1068-77

020

040

060

0

Fre

qu

en

cy

0 5 10 15 20

Movie alcohol use seen (hours)

Estimated exposure to alcohol use from 398 popular contemporary movies among German teens

All kids have seen drinking movie stars Median exposure: 3.44 hours

Some kids have seen more than10 hours of alcohol use on screen

Int J Epidemiol 2007;36:1068-77

0.2

.4.6

.8 P

reva

len

ce

0 5 10 15 20Hours of Movie Alcohol Exposure

Alcohol Use Without Parental Knowledge

Binge Drinking

Association between exposure to movie alcohol useand adolescent drinking outcome

Int J Epidemiol 2007;36:1068-77

Limitations of a cross-sectional survey

─ Shows only an association─ Not cause─ Perhaps high risk adolescents are attracted to

movies containing alcohol use

A longitudinal follow-up can address these issues

(1) We were able to complete follow-up surveys in 2,708 of 3,432 (79%) baseline never drinkers one year after the baseline examination.

(2) Some 885 (33%) of baseline never drinkers tried drinking without parental knowledge, some 387 (14%) tried binge drinking during the follow-up period.

Follow-up

Pediatrics 2009;123:989-95

Dose-response between exposure to movie alcohol use at baseline and adolescent drinking initiation at follow-up

0.2

.4.6

.8

Initi

atio

n o

f D

rinki

ng

0 5 10 15 20

Hours of Movie Alcohol Exposure

Drinking Without Parental KnowledgeBinge Drinking

Pediatrics 2009;123:989-95

Adjusted relative risks (ARR) for trying alcohol during observation period

Drinking without parental knowledge

Binge Drinking

ARR (95% CI) ARR (95% CI)

Alcohol use in movies seen:

Quartile 1 1.00 1.00

Quartile 2 1.42 (1.16-1.74) 1.44 (0.96-2.17)

Quartile 3 1.94 (1.65-2.28) 1.95 (1.27-3.00)

Quartile 4 2.00 (1.69-2.37) 2.23 (1.48-3.37)

Adjusted for:SES; age; gender; school performance; rebelliousness/sensation-seeking;parenting style, peer and parent alcohol use

Pediatrics 2009;123:989-95

(1) Almost all German kids are exposed to drinking contained in Hollywood movies, from which many see hours of drinking and a broad number of brands.

(2) Movie alcohol use is associated with drinking without parental knowledge and binge drinking.

(3) The association is shown not only in cross sectional but also longitudinal, i.e., the exposure precedes the drinking.

(4) The association is independent of a number of potential confounding influences.

Conclusions

(1) Hollywood film studios distribute hundreds of American-made movies to a global market.

(2) The alcohol industry probably pays to have brands in these movies

(3) These movies probably influence adolescents in other countries to drink.

(4) Youth alcohol use is a key public health concern.

Implications (I)

(5) European Countries should consider placing youth restrictions on movies with drinking and banning product placement.

(6) Studies on the frequency of alcohol use in European movies and brand appearances are warranted.

Implications (II)

Funding

Content coding of the US movies:National Institutes of Health

Rated PG for mild language and some crude humorGermany: General Audience

Shrek (2001)

Thanks for your attention!