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New Truth Initiative report shows troubling use of tobacco imagery in tv shows, movies and music videos most popular among youth as e-cigarette epidemic persists

Research shows exposure to on-screen tobacco imagery makes young people 3 times more likely to start vaping nicotine

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A new report released today by Truth Initiative—the national public health organization dedicated to achieving a culture where young people reject smoking, vaping and nicotine—finds pervasive smoking and vaping imagery lit up screens in 2020 amid the persistent youth e-cigarette epidemic. While You Were Streaming: Nicotine on Demand is the fourth annual report from Truth Initiative that monitors tobacco imagery across the most popular streaming and broadcast shows among 15- to 24-year-olds each year, and the impact these depictions have on youth vaping and smoking initiation. For the first time, the report includes data on shows that youth frequently binge-watched, as well as top newly released movies and Billboard chart-topping music videos finding that tobacco pervades some of the most watched entertainment content of the year.

This is cause for serious concern given the on-going youth e-cigarette epidemic and the fact that research shows on-screen exposure to tobacco imagery makes young people more likely to start vaping. A landmark 2020 study published in Preventive Medicine, found that exposure to smoking images through episodic programming can triple a young person’s odds of starting to vape nicotine. According to the December 2021 Monitoring the Future (MTF) survey, nearly 20% of high school seniors used e-cigarettes in the past 30 days, a measure of current use. The latest National Youth Tobacco Survey (NYTS) data showed that of the high school students who vaped, 43% did so almost daily, signaling that many young people are at risk for a lifetime of nicotine addiction.

Truth Initiative’s latest report shows that 60% of young people’s top 15 favorite 2020 streaming and broadcast season releases featured smoking, exposing an estimated 27 million youth to tobacco imagery. Fox shows including “The Simpsons,” “Big Mouth,” and “Bob’s Burgers,” were among the top offenders. Truth Initiative also analyzed top binge-watched shows among 15-24 year old’s, finding that about two-thirds (64%) included tobacco depictions, including “The Queen’s Gambit,” “The Umbrella Academy,” “Shameless,” and “On My Block.” Additionally, over 30% of 15- to 24-year-olds report binge-watching “Stranger Things”—the top offending show in 2018 and 2019— in the past year despite not having a new season in 2020. Binge-watching is an important behavior to examine because research shows the more tobacco imagery young people see on-screen, the more likely they are to initiate use.

Spotlight on Netflix

For the past two years, the National Association of Attorneys General has sent letters to major U.S. streaming services and creative guilds urging these organizations to take action. Despite a pledge to limit tobacco depictions in its offerings appealing to youth, Netflix remains the worst offender four years in a row based on its new 2020 season releases and popular binge-worthy shows. Some of Netflix’s top shows increased the amount of tobacco compared to previous seasons, such as its superhero show “The Umbrella Academy,” which tripled tobacco instances in its latest season and managed to include tobacco in every episode. “The Queen’s Gambit,” also included tobacco in every episode and appears to depict tobacco as something characters turn to when under stress. This characterization of tobacco taps into a common misconception driven by the tobacco industry that nicotine is a stress-reliever, when in fact nicotine can worsen anxiety symptoms and amplify feelings of depression, which is doubly alarming given the Surgeon General’s December 2021 advisory on the nation’s worsening youth mental health crisis.    

“Onscreen smoking and vaping imagery – in shows, movies, and music videos – points to a troubling trend of the renormalization and glamorization of tobacco in entertainment media and pop culture,” said Robin Koval, CEO and president of Truth Initiative. “This is directly contributing to the youth e-cigarette epidemic and putting a new generation at risk, especially in light of our nation’s youth mental health crisis and the role nicotine plays in amplifying feelings of anxiety and depression. The very thing that young people are turning to for stress relief, as depicted in this popular content, may make it worse. The entertainment industry should not be complicit with the tobacco industry in promoting nicotine use.”

Movies and Music

While You Were Streaming: Nicotine on Demand also includes findings from an analysis by the NORC at the University of Chicago on depictions of smoking imagery in top newly released movies of 2020. As new movie releases were increasingly streamed at home, NORC found that more than a third (38%) of top newly released movies in 2020 depicted tobacco with nearly 1,000 incidents of combustible tobacco depictions combined. These include 10 that are youth-rated, such as Amazon’s PG-rated “The Personal History of David Copperfield” and “Wonder Woman 1984.” Beyond tobacco depictions in PG movies, many of the top offenders included movies that appeal to youth, such as Oscar-winner “Promising Young Woman.” Well-established research shows exposure to smoking in movies causes young people to start using tobacco, a conclusion reached almost a decade ago in a 2012 Surgeon General report. Truth Initiative also analyzed music videos for the first time in this year’s report, finding that about a quarter (23%) of the year’s top 2020 Billboard songs featured smoking and vaping in their music videos, including “Party Girl” by StaySolidRocky, “Bandit” by JuiceWRLD, “My Oh My” by Camila Cabello, and “Heartless” by The Weeknd. Together, these top music videos amassed over 6 billion views on YouTube alone.

Holding the Industry Accountable

This year's report underscores the critical need to put reasonable guidelines into practice to help safeguard today's youth. Truth Initiative calls on the public health community, states, streaming and broadcast companies and creators to adopt the following common-sense measures to help protect impressionable viewers from the harms of repeated tobacco imagery including:

  • States can change their film production subsidy policies to provide tax and other incentives for productions that do not promote tobacco use.
  • Call on directors, writers, and producers to keep tobacco imagery out of their shows.
  • Educate parents about the impact on their children seeing tobacco use onscreen.
  • Conduct additional research on the harmful effects of tobacco imagery in video entertainment across all channels including broadcast, cable, streaming and web-based platforms.
  • Ensure advertising dollars don’t target youth with addictive products and making tobacco companies prove they have not paid for product placement in media popular among youth.

For a comprehensive list of policies to curb tobacco depictions on screens, please refer to the full report.

Free Resources to Help

Truth Initiative provides support and resources designed specifically for young people to help them quit e-cigarette use through its award-winning and lifesaving nationally recognized truth campaign. Nearly 400,000 young people have enrolled in This is Quitting—a free and anonymous text message quit vaping program for teens and young adults from truth. A randomized clinical trial found that young adults aged 18-24 who used This is Quitting had nearly 40% higher odds of quitting compared to a control group. Teens and young adults can text “DITCHVAPE” to 88709 to get immediate help to quit. truth also offers a free, comprehensive digital curriculum, Vaping: Know the truth, that gives students the facts about the health dangers of e-cigarettes and the help they need to quit. Parents and educators can learn more about the curriculum at: Young people can access free resources at

To download the full report and for more information on or research and resources, please visit

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