IJE Advance Access published online on March 24, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn053
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Letter to the Editor |
Exposure to alcohol use in motion pictures and teen drinking in Germany
School of Medicine, Cardiff University, UK.
Corresponding author. School of Medicine, Cardiff University, UK. E-mail: dinanin{at}cardiff.ac.uk
We read with interest the recent article on alcohol use in motion pictures and teen drinking in Germany by Reiner Hanewinkel and colleagues.1 We were pleased to see this important current public health issue being dealt with and this is the first study of its kind outside the United States.
It is alarming to read that 87.6% of movies in the sample depicted some alcohol use, but there are issues that we wish to raise with the authors. We note the good range of socioeconomic statuses included, a dose–response relationship and similarity of results to a US sample. However, only 64% of schools agreed to participate, and of those schools who did participate 12.7% of their students were excluded, as the parents did not give permission. We question why these pupils were not granted permission and whether the characteristics of non-participants were different from the study population.
A further issue concerns the time-span of the films selected, the mean age of participants was 12.8, and so they are unlikely to have seen the older films from the sample which are up to 10 years old. There is a possibility that the teenagers had seen a larger number of films, but they were all recent and so the exposure measurement will be an underestimate.
Other issues regarding the movies should have been taken into account, for example the context that the alcohol was consumed, and also whether depictions of alcohol were in a positive or negative manner.
We appreciate it is very hard to measure behaviours, but we wonder about the reliability of self-reported alcohol, teenagers have a tendency to show off and therefore exaggerate. It also seems pertinent to question the type of alcohol consumed and how regularly these activities of binge drinking and alcohol consumption without parental knowledge occur.
The authors have made attempts to adjust for confounders but other confounders do not appear to have been considered, for example spare-time activities, the type of television programme viewed, whether the subject had a television set in their bedroom and other cultural influences. We are therefore cautious about the strength of the conclusions and believe a causal relationship cannot be established without further investigations.
Conflict of interest: None declared.
Reference
1 Hanewinkel R, Tanski SE, Sargent JD. Exposure to alcohol use in motion pictures and teen drinking in Germany. Int J Epidemiol (2007) 36:1068–77.
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