Today alone, more than 4,400 U.S. teenagers will start smoking, according to statistics from the Substance Abuse and Mental Health Administration. Many of these adolescents will be lured to cigarettes by advertisements and movies that feature sophisticat

Today alone, more than 4,400 U.S. teenagers will start smoking, according to statistics from the Substance Abuse and Mental Health Administration. Many of these adolescents will be lured to cigarettes by advertisements and movies that feature sophisticated models and actors, suggesting that smoking is a glamorous, grown-up activity. However, teens who are savvier about the motives and methods of advertisers may be less inclined to take to cigarettes, a University of Pittsburgh School of Medicine study indicates. Teens with above-average smoking media literacy (SML) are nearly half as likely to smoke as their less media-literate peers, according to the lead study in the current issue of the Journal of Adolescent Health. The results not only suggest that SML training could be an effective intervention to decrease teen smoking, but they also provide some of the first quantitative evidence linking SML to smoking. "Many factors that influence a teen's decision to smoke - like peer influence, parental smoking and risk-seeking tendency - are difficult to change," said the study's lead author, Brian Primack, M.D., Ed.M., assistant professor in the School of Medicine's division of general internal medicine. "However, media literacy, which can be taught, may be a valuable tool in efforts to discourage teens from smoking." Earlier research by Dr. Primack and his colleagues established the reliability and validity of the scale used to measure SML. In that work, more than 1,200 suburban Pittsburgh high school students were assigned SML scores of 1 to 10 based on their responses to an 18-item survey in which they agreed or disagreed with statements such as, "Advertisements usually leave out a lot of important information" and "Movie scenes with smoking in them are made very carefully." The higher their scores, the higher their SML. In the current study, Dr. Primack and his colleagues conducted further analysis, more completely quantifying the relationship between SML and smoking behavior. They found that the median SML score of all of the survey participants was 6.8, and students with scores above the median were half as likely to smoke or to be susceptible to future smoking than those below the median, even after controlling for over a dozen demographic, environmental and intrinsic risk factors for smoking. The analysis suggests that even minor intervention may be able to influence behavior. According to survey data, decrease in an SML score of just one point corresponded with a 30 percent increase in a student's likelihood to smoke or be susceptible to smoking. These findings hold promise for schools and other community organizations searching to implement effective tobacco control programs that are geared especially to teenage audiences. Many of the programs currently in use tend to rely heavily on negative messages and reprimands, which often fail to achieve the intended goal. Media literacy training could be more useful in decreasing smoking rates, the University of Pittsburgh study suggests. Even schools without the resources necessary to sustain a full media literacy program in their curricula could find the information obtained through the study helpful, the researchers say. These results may encourage research into the relationship between media literacy and other harmful health behaviors, Dr. Primack added. "Research has linked media exposure to eating behaviors, alcohol abuse, social violence and sexual behavior. Perhaps media literacy will turn out to be valuable in addressing these health-related areas as well," he said. While this study provides compelling evidence of the potential of media literacy training as a tobacco control intervention, further research on the topic is necessary, Dr. Primack notes. For example, the student population surveyed in this study was largely homogeneous in terms of race and socioeconomic status, so the results will need to be confirmed among more diverse groups. Also, a longitudinal study tracking the relationship between SML scores and smoking initiation would help to shed light on the decision-making process of teen smokers. ### Other study authors include Michael Fine, M.D., M.Sc., and Melanie A. Gold, D.O., also of the University of Pittsburgh School of Medicine, and Stephanie R. Land, Ph.D., University of Pittsburgh Graduate School of Public Health. The study was funded by the Maurice Falk Fund and Tobacco Free Allegheny. Additional contact: Lisa Rossi Contact: Kelli McElhinny

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