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Depictions of substance use is prolific in media and usually appear in one of two forms: advertising, in which alcohol and tobacco products are marketed towards youth, and media messages, in which alcohol, tobacco, and drugs are often glorified without showing the consequences. Research shows that certain types of media can influence the way youth think about substances which in turn can affect their relationships with them. Subsequently, it is important to understand how substance use portrayals in media affect children.

What the Evidence Says
Alcohol advertising can affect children’s alcohol use.
Commercials for alcohol can be found in almost all forms of media, and can have a lasting effect on youth. Longitudinal studies show that exposure to alcohol advertising leads to future alcohol use (Anderson, de Bruijn, Angus, Gordon, & Hastings, 2009).

Substance use in TV and movies can affect children’s beliefs and behaviors. Studies show that approximately 80% of a child’s smoking exposure was in movies rated G, PG, or PG-13 (Titus-Ernstoff, Dalton, Adachi-Mejia, Longacre, & Beach, 2008). Overall, studies have shown a causal relationship between media exposure and substance use, with the strongest link between media and tobacco use (Nunez-Smith et al., 2010).

Music lyrics about substance use can affect adolescent attitudes about substances. Many forms of lyrical music contain references to substance use, especially alcohol and marijuana. Over exposure to music containing references to substance use being normative and without consequences, may lead to adolescents accepting these messages as their beliefs, fueling the potential for them to experiment with substance use.

During the Visit
If your patient screens “positive” on the media use survey and is experimenting with substance use, it is important to discuss these issues with the patient and his/her family.
  • Educate parents about how portrayals of characters and celebrities drinking, using drugs, or smoking in media can directly affect how their child views these activities. Subsequently, recommend that parents monitor and limit (when possible) their child’s exposure to media containing glorified substance use.
  • Describe how parents can teach media literacy skills to children and teens in order to recognize and respond to advertisements and other depictions of substance use.
  • Encourage parents to set a good example by avoiding media use in front of their children that glorifies alcohol, tobacco, or drug use.
  • During the well child visit, talk about media in relation to substance abuse. This opens the door for conversation and offers a way for the patient and/or parents to bring up any questions they might have.
Future Directions
As the body of research grows, there is more evidence that suggests that the media can play a role as to whether a child or teen will experiment with drugs, alcohol, and tobacco. We need to consider more innovative ways to reach youth with anti-substance campaigns, and to use media to promote practical skills for dealing with peer pressure.


  • Anderson, P., de Bruijn, A., Angus, K., Gordon, R., & Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcohol, 44(3), 229-243. doi:10.1093/alcalc/agn115
  • Austin, E. W., & Nach-Ferguson, B. (1995). Sources and influences of young school-aged children’s general and brand-specific knowledge about alcohol. Health Communication, 7(1), 1-20.
  • Dalton, M. A., Sargent, J. D., Beach, M. L., Titus-Ernstoff, L., Gibson, J. J., Ahrens, M. B., . . . Heatherton, T. F. (2003). Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet, 362(9380), 281-285. doi:10.1016/S0140-6736(03)13970-0
  • Epstein, J. A., & Botvin, G. J. (2008). Media resistance skills and drug skill refusal techniques: What is their relationship with alcohol use among inner-city adolescents? Addict Behav, 33(4), 528-537. doi:10.1016/j.addbeh.2007.11.001
  • Fielder, L., Donovan, R. J., & Ouschan, R. (2009). Exposure of children and adolescents to alcohol advertising on Australian metropolitan free-to-air television. Addiction, 104(7), 1157-1165. doi:10.1111/j.1360-0443.2009.02592.x
  • Goldstein, A. O., Sobel, R. A., & Newman, G. R. (1999). Tobacco and alcohol use in G-rated children’s animated films. Journal of the American Medical Association, 281(12), 1131-1136. Retrieved from http://jama.jamanetwork.com/data/Journals/JAMA/4612/JTV80003.pdf
  • Hunt, K., Henderson, M., Wight, D., & Sargent, J. D. (2011). Exposure to smoking in films and own smoking among Scottish adolescents: a cross-sectional study. Thorax, 66(10), 866-874. doi:10.1136/thoraxjnl-2011-200095
  • Lochbuehler, K., Sargent, J. D., Scholte, R. H., Pieters, S., & Engels, R. C. (2012). Influence of smoking cues in movies on children’s beliefs about smoking. Pediatrics, 130(2), 221-227. doi:10.1542/peds.2011-1792
  • Morgenstern, M., Sargent, J. D., Engels, R. C., Scholte, R. H., Florek, E., Hunt, K., . . . Hanewinkel, R. (2013). Smoking in movies and adolescent smoking initiation: longitudinal study in six European countries. Am J Prev Med, 44(4), 339-344. doi:10.1016/j.amepre.2012.11.037
  • Nunez-Smith, M., Wolf, E., Huang, H. M., Chen, P. G., Lee, L., Emanuel, E. J., & Gross, C. P. (2010). Media exposure and tobacco, illicit drugs, and alcohol use among children and adolescents: a systematic review. Subst Abus, 31(3), 174-192. doi:10.1080/08897077.2010.495648
  • Primack, B. A., Kraemer, K. L., Fine, M. J., & Dalton, M. A. (2009). Media exposure and marijuana and alcohol use among adolescents. Substance Use and Misuse, 44(5), 722-739. doi:10.1080/10826080802490097
  • Primack, B. A., Longacre, M. R., Beach, M. L., Adachi-Mejia, A. M., Titus, L. J., & Dalton, M. A. (2012). Association of established smoking among adolescents with timing of exposure to smoking depicted in movies. J Natl Cancer Inst, 104(7), 549-555. doi:10.1093/jnci/djs138
  • Sargent, J. D., Wills, T. A., Stoolmiller, M., Gibson, J., & Gibbons, F. X. (2006). Alcohol use in motion pictures and its relation with early-onset teen drinking. J Stud Alcohol, 67(1), 54-65. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16536129
  • Scull, T. M., Kupersmidt, J. B., Parker, A. E., Elmore, K. C., & Benson, J. W. (2010). Adolescents’ media-related cognitions and substance use in the context of parental and peer influences. J Youth Adolesc, 39(9), 981-998. doi:10.1007/s10964-009-9455-3
  • Shmueli, D., Prochaska, J. J., & Glantz, S. A. (2010). Effect of smoking scenes in films on immediate smoking: a randomized controlled study. Am J Prev Med, 38(4), 351-358. doi:10.1016/j.amepre.2009.12.025
  • Snyder, L. B., Milici, F. F., Slater, M., Sun, H., & Strizhakova, Y. (2006). Effects of alcohol advertising exposure on drinking among youth. Archives of Pediatrics and Adolescent Medicine, 160(1), 18-24. doi:10.1001/archpedi.160.1.18
  • Strasburger, V. C., American Academy of Pediatrics. Council on, C., & Media. (2010). Policy statement–children, adolescents, substance abuse, and the media. Pediatrics, 126(4), 791-799. doi:10.1542/peds.2010-1635
  • Tanski, S. E., McClure, A. C., Li, Z., Jackson, K., Morgenstern, M., Li, Z., & Sargent, J. D. (2015). Cued Recall of Alcohol Advertising on Television and Underage Drinking Behavior. JAMA Pediatr. doi:10.1001/jamapediatrics.2014.3345
  • Titus-Ernstoff, L., Dalton, M. A., Adachi-Mejia, A. M., Longacre, M. R., & Beach, M. L. (2008). Longitudinal study of viewing smoking in movies and initiation of smoking by children. Pediatrics, 121(1), 15-21. doi:10.1542/peds.2007-0051
  • Wills, T. A., Gibbons, F. X., Sargent, J. D., Gerrard, M., Lee, H. R., & Dal Cin, S. (2010). Good self-control moderates the effect of mass media on adolescent tobacco and alcohol use: tests with studies of children and adolescents. Health Psychol, 29(5), 539-549. doi:10.1037/a0020818
  • Winpenny, E. M., Marteau, T. M., & Nolte, E. (2014). Exposure of children and adolescents to alcohol marketing on social media websites. Alcohol Alcohol, 49(2), 154-159. doi:10.1093/alcalc/agt174

This toolkit was created with funding from Harvard Pilgrim Health Care