1. Alcohol in movies 4th European Alcohol Policy Conference Brussels, June 21-22, 2010 Reiner Hanewinkel, Ph.D.

2. 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

3. 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

4. Match Point (2005) Cast: Jonathan Rhys Meyers, Scarlett Johansson Rating: R for some sexuality Germany: ≥ 6

5. Cast: Tom Cruise Penélope Cruz Cameron Diaz Kurt Russell Tilda Swinton Vanilla Sky (2001) Rated R for sexuality and strong language Germany: ≥ 16

6. Alcohol use and alcohol brand appearances in 534 contemporary Hollywood movies Addiction 2008;103:1925-32

7. Purpose To investigate the association of movie alcohol use and German adolescent alcohol use

8. Germany Schleswig-Holstein Surveys conducted

9. 42 schools randomly selected 27 schools (64%) agreed to participate 5,581 students were surveyed at baseline Sample description: ─Equally distributed by sex ─Mean age: 12.8 years Range: 11-17 years ─Alcohol use without parental knowledge: 36.6% ─Binge drinking : 18.1% Sample recruitment Int J Epidemiol 2007;36:1068-77

10. 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 Method Int J Epidemiol 2007;36:1068-77

11. 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

12. 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 than 10 hours of alcohol use on screen Int J Epidemiol 2007;36:1068-77

13. Association between exposure to movie alcohol use and adolescent drinking outcome Int J Epidemiol 2007;36:1068-77

14. 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

15. (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

16. Dose-response between exposure to movie alcohol use at baseline and adolescent drinking initiation at follow-up Pediatrics 2009;123:989-95

17. 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 11.00 Quartile 21.42(1.16-1.74)1.44(0.96-2.17) Quartile 31.94(1.65-2.28)1.95(1.27-3.00) Quartile 42.00(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

18. (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

19. (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)

20. (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)

21. Funding Content coding of the US movies: National Institutes of Health

22. Rated PG for mild language and some crude humor Germany: General Audience Shrek (2001) Thanks for your attention!