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Background: Exposure to smoking imagery in films in consistently associated with smoking behavior and its psychological antecedents among adolescents in high-income countries, but its association with adolescent smoking in middle-income countries is unknown.

Methods: In 2006, a cross-sectional sample of 3876 Mexican adolescents in secondary school was surveyed on smoking behavior, smoking risk factors, and exposure to 42 popular films that contained smoking. Participants were classified into quartiles of exposure to smoking imagery across all films they reported having seen. Models were estimated to determine associations among quartiles of film-smoking exposure, smoking behavior, and the psychological antecedents of smoking, adjusting for age, gender, sensation seeking, self-esteem, parental smoking, sibling smoking, best-friend smoking, having a bedroom TV, and private versus public school attendance. Analyses were conducted in 2007.

Results: Adolescents were exposed to an average of 51.7 (SE=1.3) minutes of smoking in the films they viewed. Crude and adjusting ORs indicated positive associations between quartiles of film-smoking exposure and both current smoking (AOR4v1=3.13; p<0.0001) and having ever smoked (AOR4v1=2.42;p<0.0001). Data from never-smokers (n=2098) were analyzed to determine associations between film-smoking exposure and psychological antecedents of smoking uptake. Crude and adjusted coefficients indicated significant, positive associations between exposure and susceptibility to smoking (AOR4v1=1.66; p<0.05); favorable attitudes toward smoking (Adjusted B4v1=0.44;p<0.0001); and perceived peer prevalence of smoking (Adjusted B4v1=0.26; p<0.0001).

Conclusions: Exposure to smoking in films appears associated with smoking among Mexican adolescents. Policies could aim to decrease youth exposure to smoking in nationally and internationally distributed.

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