The teen screen scene: How does media and advertising influence youth addiction?

When we are looking for factors that change behaviour we can look inside the individual for personal characteristics that make people vulnerable to addiction and we can look outside the individual for features of the environment that encourage addictive behaviours. Addiction is a multi-faceted behaviour that is strongly influenced by contextual factors that cannot be encompassed by any single theoretical perspective.

The media (television, radio, newspapers, etc.) are an important channel for portraying information and channelling communication. Knowledge about how the mass media work may influence both the promotion of potentially addictive behaviour (as in advertising), and for the promotion of health education (such as promoting abstinence or moderation). Much of the research done on advertising is done by the companies themselves and thus remains confidential. The media, especially television and film, often portray addictions (e.g., heroin addiction in the film Trainspotting, marijuana use in the TV show Weeds, gambling addiction in the TV show Sunshine, etc.). Because of this constant portrayal of various addictions, television and film dramas often create controversy because of claims that they glorify addictive behaviour. The popularity of media drama depicting various addictions requires an examination of their themes and the potential impact on the public.

A 2005 study in the Journal of the Royal Society of Medicine by Dr. H. Gunasekera and colleagues analysed the portrayal of sex and drug use in the most popular movies of the last 20 years using the Internet Movie Database list of the top 200 movies of all time. The researchers excluded a number of films including those released or set prior to the HIV era (pre-1983), animated films, films not about humans, and family films aimed at children. The top 200 films following the exclusions were reviewed by one of two teams of two observers using a data extraction sheet tested for inter-rater reliability. Sexual activity, sexually transmitted disease (STD) prevention, birth control measures, drug use and any consequences discussed or depicted were recorded.

The study reported that there were 53 sex episodes in 28 (32%) of the 87 movies reviewed. There was only one suggestion of condom use, which was the only reference to any form of birth control. There were no depictions of important consequences of unprotected sex such as unwanted pregnancies, HIV or other STDs. Movies with cannabis (8%) and other non-injected illicit drugs (7%) were less common than those with alcohol intoxication (32%) and tobacco use (68%) but tended to portray their use positively and without negative consequences. There were no episodes of injected drug use. The researchers concluded that sex depictions in popular movies of the last two decades lacked safe sex messages. Drug use, though infrequent, tended to be depicted positively. They also concluded that the social norm being presented in films was of great concern given the HIV and illicit drug pandemics.

Drug use in this context could be argued to illustrate a form of observational learning akin to advertisement through product placement. A similar 2002 study by Dr. D. Roberts and colleagues examined drug use within popular music videos. Whilst depictions of illicit drugs or drug use were relatively rare in pop videos, when they did appear they were depicted on a purely neutral level, as common elements of everyday activity.

The makers of such drama argue that presenting such material reflects the fact that addictions are everywhere and cut across political, ethnic, and religious lines. Addiction is certainly an issue that impacts all communities. However, it is important to consider possible impacts that it might have on society. Empirical research suggests that the mass media can potentially influence behaviours. For example, research indicates that the more adolescents are exposed to movies with smoking the more likely they are to start smoking. Furthermore, research has shown that the likeability of film actors and actresses who smoke (both on-screen and off-screen) relates to their adolescent fans’ decisions to smoke. Perhaps unsurprisingly, films tend to stigmatise drinking and smoking less than other forms of drug taking. However, the media transmit numerous positive messages about drug use and other potential addictions, and it is plausible that such favourable portrayals lead to more use by those that watch them. Anecdotally, some things may be changing. For instance, there appears to be more emphasis on the media’s portrayal of alcohol as socially desirable and positive as opposed to smoking that is increasingly being regarded as anti-social and dangerous.

Back in 1993, the British Psychological Society (1993) called for a ban on the advertising of all tobacco products. This call was backed up by the UK government’s own research which suggested a relationship between advertising and sales. Also, in four countries that had banned advertising (New Zealand, Canada, Finland and Norway) there was been a significant drop in tobacco consumption.

However, public policy is not always driven by research findings, and the powerful commercial lobby for tobacco has considerable influence. In her reply to the British Psychological Society, the Secretary of State for Health (at the time) rejected a ban saying that the evidence was unclear on this issue and efforts should be concentrated elsewhere. This debate highlights how issues of addictive behaviours cannot be discussed just within the context of health. There are also political, economic, social and moral contexts to consider as well. The British government and European Community made commitments to ban tobacco advertising though they found it difficult to bring it in as quickly as they hoped. It is now rare to see smoking advertised anywhere in the UK but there is a new trend in television drama and films to set the action in a time or location where smoking is part of the way of life (for example the US television programme Mad Men).

Just as the British Government have banned cigarette advertising and banned smoking in public places, they have also deregulated gambling through the introduction of the 2005 Gambling Act. This Act came into effect on September 1st 2007 and allowed all forms of gambling to be advertised in the mass media for the first time. This has led to a large number of nightly television adverts for betting shops, online poker, and online bingo. Whether this large increase in gambling advertising will impact on gambling participation and gambling addiction remains to be seen. There have been very few studies that have examined gambling advertising and those that have been done are usually small scale and lack representativeness.

In an article I wrote in 2010 looking at these issues, I reached a number of conclusions that I don’t think have changed in the past few years since I wrote that article. My conclusions were:

• Glamorisation versus reality is complicated: The issue of glamorisation versus reality is of course complicated. Although the drama producers hope to accurately depict various addictions, they still need to keep ratings up. Clearly, positive portrayals are more likely to increase ratings and programmes might favour acceptance of drug use over depictions of potential harms.
• Research on the role of media effects is inconclusive: More research on how the media influence drug use is needed in order to evaluate the impact of such drama. With media and addiction, it is important to walk with caution, as the line between reality and glamorisation is easy to cross. More research is needed that investigates direct, indirect, and interactive effects of media portrayals on addictive behaviour.
• Relationship between advertising and addictive behaviour is mostly correlational: The literature examining the relationship between advertising on the uptake of addictive behaviour is not clear cut and mostly correlational in nature hence it is not possible to make causal connections.
• There could be different media effects for different addictions: Although there appears to be some relationship between tobacco advertising and tobacco uptake, this does not necessarily hold for all addictive behaviours. For instance, some academics claim that econometric studies of alcohol advertising expenditures come to the conclusion that advertising has little or no effect on market wide alcohol demand.
• Research done to date may not be suitable: Survey research studies have failed to measure the magnitude of the effect of advertising on youth intentions or behaviour in a manner that is suitable for policy analysis. As a consequence, policy makers may introduce and/or change policy that is ineffective or not needed on the basis of research that was unsuitable in answering a particular question.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Cape, G. S. (2003). Addiction, stigma, and movies. Acta Psychiatrica Scandinavica, 107, 163-169.

Dalton, M.A., Sargent, J.D., Beach, M.L., Titus-Ernstoff, L., Gibson, J.J., Aherns, M.B., & Heatherton, T.F. (2003). Effect of viewing smoking in movies on adolescent smoking initiation: A cohort study. Lancet, 362, 281-285.

Distefan, J. M., E. A. Gilpin, et al. (1999). Do movie stars encourage adolescents to start smoking? Evidence from California. Preventive Medicine, 28, 1-11.

Griffiths, M.D. (2005). Does advertising of gambling increase gambling addiction? International Journal of Mental Health and Addiction, 3 (2), 15-25.

Griffiths, M.D. (2010). Media and advertising influences on adolescent risk behaviour. Education and Health, 28(1), 2-5.

Gunasekera, H. Chapman, S. Campbell, S. (2005). Sex and drugs in popular movies: An analysis of the top 200 Films. Journal of the Royal Society of Medicine, 98, 464-470.

Nelson, J.P. (2001). Alcohol advertising and advertising bans: A survey of research methods, results, and policy implications. In M.R. Baye & J.P. Nelson (Eds.), Advances in Applied Microeconomics, Volume 10: Advertising and Differentiated Products (Chapter 11). Amsterdam: Elsevier Science.

Roberts, D.F., Christenson, P.G. Henriksen, L. & Bandy, E. (2002). Substance Use in Popular Music Videos. Office Of National Drug Control Policy. Located at: http://www.mediacampaign.org/pdf/mediascope.pdf

Wilde, G.J.S. (1993). Effects of mass media communications on health and safety habits: An overview of issues and evidence. Addiction, 88, 983-996.

Will, K. E., B. E. Porter, et al. (2005). Is television a healthy and safety hazard? A cross-sectional analysis of at-risk behavior on primetime television. Journal of Applied Social Psychology, 35, 198-22

What a drag: A brief look at cigarette smoking and nicotine dependence

Cigarette smoking among adults (i.e., those aged 18 years and over) has been a highly prevalent behaviour in Great Britain for decades but overall rates have significantly declined in recent times. Figures show that the highest recorded level of nicotine smoking among British males was in 1948 when four-fifths smoked (82%) although at that time only two-thirds smoked manufactured cigarettes (as the rest smoked pipes and/or cigars). The highest recorded level of nicotine smoking among British females was in the mid-1960s (45%) slightly higher than the prevalence rate of 41% in 1948.

A 2003 study by Dr. M. Jarvis in the journal Addiction reported that since 2000 the overall adult smoking rates in Great Britain had been declining by around 0.4% per year. More recently, the British prevalence rates of smoking remained constant at 21% between 2007 and 2009 (according to a 2013 report by Action on Smoking and Health [ASH]). According to the 2013 Office for National Statistics report, the most recent prevalence rate is 20% (21% of men and 19% of women). This equates to around 10 million British adult cigarette smokers. Smoking prevalence rates are highest in young adults. More specifically, in the 20-24 year age group, the prevalence rate of nicotine smoking is 30% in males and 28% in females. Only 1% of children are nicotine smokers at the age of 11 years. By the age of 15 years, 11% of children are regular smokers. As the 2013 ASH report noted:

“Since the mid 1970s cigarette consumption has fallen among both men and women. The overall reported number of cigarettes smoked per male and female smoker has changed little since the mid 1980s, averaging 13 cigarettes per smoker per day. As in previous years, men smoked slightly more per day on average than women and there was an association between consumption and socio-economic group. In 2011, smokers in manual occupations smoked an average of 14 cigarettes a day compared with 11 a day for those in managerial or professional groups… In 2011, 63% of smokers said they would like to stop smoking altogether. Other ways of measuring dependence include how difficult people would find it to go for a whole day without smoking and how soon they smoke after waking… In 2011, 60% of smokers said they would find it hard to go for a whole day without smoking. Eighty-one per cent of heavier smokers (20 or more a day) said they would find it difficult, compared to 32% of those smoking fewer than 10 cigarettes per day”.

Like drug addictions more generally, nicotine addiction is a complex combination of influences including genetic, pharmacological, psychological, social and environmental factors. In 2010, the US Surgeon General asserted that “there is no established consensus on criteria for diagnosing nicotine addiction” but that there are a number of symptoms can be viewed as addiction indicators such as:

• Drug use that is highly controlled or compulsive with psychoactive effects
• Stereotypical patterns of use
• Continued use despite harmful effects
• Relapse following abstinence accompanied by recurrent cravings.

A 2000 report by the Royal College of Physicians also noted that nicotine fulfils criteria for defining an addiction and states that:

“It is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration…Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”

One of the key characteristics of drug addiction or dependence on a substance is the degree of compulsion experienced by the user. Since 1992, the British General Lifestyle Survey (which typically surveys around 15,000 adults from over 9000 households annually) has asked three questions relevant to nicotine dependence and addiction. The first is whether the person would like to stop smoking, the second is whether person would find it easy or difficult not to smoke for a whole day, and the third is how soon after waking up they smoke their first cigarette. Since 1992, there has been almost no change in any of the three measures.

The latest 2013 survey reported that 63% of smokers said they would like to stop smoking altogether and 60% felt it would be difficult for them to go a day without smoking. Four-fifths (81%) of heavy smokers (i.e., those smoking 20 or more cigarettes a day) said they would find it difficult to give up smoking compared to one-third (32%) of lighter smokers (i.e., those smoking less than 10 cigarettes a day). The average number of cigarettes smoked per day is 13, and 14% smoke a cigarette within five minutes of getting up in the morning, a figure that rises to 35% among heavy smokers who smoke more than 20 cigarettes a day. Research consistently shows that approximately two-thirds of smokers want to quit the behaviour yet the majority are unable to do so, which is also suggestive of a genuine addiction. Those that do try to quit smoking typically experience a wide range of withdrawal symptoms including craving for nicotine, irritability, anxiety, difficulty concentrating, restlessness, sleep disturbances, decreased heart rate, and increased appetite or weight gain.

Outside of Great Britain, tobacco and other drug use prevalence have been examined extensively among youth and adults. For example, by the Monitoring the Future research group in the U.S. (http://monitoringthefuture.org). They reported that daily (20 or more days in last 30 days) cigarette smoking varied from 11.4% among 18 year olds to 17% among 50 year olds. One may infer that daily cigarette smoking is addictive use, though several studies measure tobacco (nicotine) addiction specifically. Tobacco addiction (dependence) among older teenagers has been found to vary between 6% and 8%. Studies have found a prevalence rates of between 1.7% to 9.6% for tobacco addiction among college students.

In a 2004 issue of the Archives of General Psychiatry, Dr. Jon Grant and colleagues found a prevalence of 12.8% for tobacco addiction among a U.S. national sample of adults. A few years later in a 2009 issue of the American Journal of Public Health, Dr. R.D. Goodwin and colleagues found a prevalence of 21.6% and 17.8% for tobacco addiction among a U.S. national sample of male and female adults, respectively. It appears that daily smoking demonstrates about the same level of prevalence as direct measures of dependence, particularly among adults.

In a 2011 study that I carried out with Dr. Steve Sussman and Nadra Lisha, we estimated that past year nicotine dependence prevalence in the general adult population of the U.S. as being approximately 15%. A different summary of research on the epidemiology of drug dependence has shown that of all people who initiate cigarette use, almost one-third become addicted smokers (32%), a figure that is much higher addiction rate than for users of heroin (23%), cocaine (17%), alcohol (15%) or cannabis (9%).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Action on Smoking and Health (2012). Nicotine and addiction. London: Action on Smoking and Health.

Action on Smoking and Health (2013). Smoking statistics: Who smokes and how much. London: Action on Smoking and Health.

Benowitz, N. (2010). Nicotine addiction. New England Journal of Medicine, 362, 2295–2303,

Carpenter C.M., Wayne, G.F., & Connolly, G.N. (2007). The role of sensory perception in the development and targeting of tobacco products. Addiction, 102, 136-147.

Goodwin, R.D., Keyes, K.M., & Hasin, D.S. (2009). Changes in cigarette use and nicotine dependence in the United States: Evidence from the 2001-2002 wave of the National Epidemiologic Survey of Alcoholism and Related Conditions. American Journal of Public Health, 99, 1471-1477.

Grant, B.F., Hasin, D.S., Chou, P., Stinson, F.S., & Dawson, D.A. (2004a). Nicotine dependence and psychiatric disorders in the United States. Archives of General Psychiatry, 61, 1107-1115.

Information Centre for Health and Social Care (2011). Smoking drinking and drug use among young people in England in 2011. London: Information Centre for Health and Social Care.

Jarvis, M. (2003). Monitoring cigarette smoking prevalence in Britain in a timely fashion. Addiction, 98, 1569-1574.

Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.

Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Wald, N. & Nicolaides-Bouman, A. (1991). UK Smoking Statistics (2nd edition). Oxford: Oxford University Press.