New study: young people with high exposure to on-screen tobacco imagery have higher intentions to smoke and vape

Young people with the highest exposure to tobacco imagery in popular streaming TV shows had about triple the odds of intending to vape or smoke in the next year compared to those who were exposed to less tobacco imagery, according to new Truth Initiative research published in Addictive Behaviors Reports. 

Truth Initiative researchers have explored connections between tobacco imagery on screen and youth nicotine use for years. Established research has shown that higher exposure to tobacco imagery in movies makes youth twice as likely to start smoking, and Truth Initiative research from 2020 demonstrated that exposure to tobacco imagery through episodic programming can triple a young person’s odds of starting to vape. 

The new study builds on this research and shows the pervasiveness of the issue: more than half of young people surveyed were exposed to 2,000 or more tobacco depictions through popular TV that aired a new season on streaming platforms between 2019-2022.

Findings point to an urgent need to eliminate tobacco imagery in shows popular with young people, and to the critical role that the entertainment industry plays in helping protect young people from a lifetime of nicotine addiction.

Young people with the highest on-screen tobacco exposure had about triple the odds of intending to vape or smoke in the next year

Researchers surveyed 1,032 15- to 24-year-olds to identify 60 popular streaming TV shows and determined the number of tobacco or nicotine depictions in each episode. Researchers then asked young people if they currently used tobacco or nicotine products, and if they intended to use an e-cigarette or smoke a cigarette in the next year. 

Researchers categorized young people into three groups based on their exposure level to tobacco imagery: low (fewer than ~1,168 depictions), moderate (between ~1,168 and 3,075 depictions), and high (more than 3,075 depictions). They found that the level of tobacco exposure mattered: young people with moderate exposure had about double the odds of intending to vape or smoke in the next year, while those with the highest exposure had about triple the odds of intending to vape or smoke in the next year, compared to those with low exposure to tobacco imagery.

Nicotine-naive young people are at greater risk

Researchers found that young people who had not used tobacco products in the past and had high tobacco imagery exposure were at greater risk of intending to smoke or vape in the future, compared to those who were already using tobacco products. Those who already had experience with using tobacco products were less affected by tobacco depictions on TV, suggesting that young people who have not experienced tobacco products in real life may be more susceptible to the effects of on-screen tobacco imagery.

On-screen tobacco imagery remains a pervasive problem

Despite established research that on-screen tobacco depictions have real consequences, tobacco imagery maintains a strong presence in streaming content popular with young people. A separate Truth Initiative report on tobacco imagery in streaming entertainment found that seven of the top 15 shows most popular among 15- to 24-year-olds featured tobacco in 2023. All but one of these shows were repeat tobacco offenders, underscoring the persistence of the problem. 

While entertainment companies continue to put profits over public health, one thing is clear: streaming shows play an important role in nicotine use among young people. Truth Initiative calls for action to protect young people from tobacco exposure on screen, through tobacco prevention policies, increasing awareness, collaborating with creators, empowering actors to not portray tobacco, and enforcing regulations that ban paid tobacco product placements.