In 8 longitudinal studies (all deemed high quality), higher exposure to smoking in movies was significantly associated with a 46% increased risk of initiating smoking (RR 1.46; 95% CI 1.23 to 1.73). These pooled estimates were significantly different from each other (p=0.02). Moderate levels of heterogeneity were seen in the meta analyses.Conclusions: The cross sectional association between young people reporting having seen smoking imagery in films and smoking status is greater than the prospective association.
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