Smoke screens: why streamed content might be a health risk

Posted in: Public health, Research

There are increasingly strict limitations on how and where tobacco companies can advertise and promote their products. It’s concerning, then, that audiences, and particularly young people, are still exposed to positive portrayals of tobacco use on TV, film and online media. In this piece, Iona Fitzpatrick of the Tobacco Control Research Group discusses her new research paper, which focuses on tobacco depictions in streamed video on demand.


The advertising and promotion of tobacco products is increasingly restricted under the terms of Article 13 of the Framework Convention for Tobacco Control (FCTC). The FCTC is the world’s first global health treaty, and sets universal standards aimed at reducing the harms of tobacco. Over 160 countries have made a legally binding commitment to enact the treaty.

But even if advertising is banned, packaging is plain apart from health warnings, displays are minimal and sponsorship restricted, there are other ways people’s mindsets on tobacco can be influenced. In our new paper, we explain how we used a new method to record how often and in what manner tobacco use is shown in streamed media content such as on-demand TV.


The power of media

Worldwide, there are around 57 million people using Netflix, streaming nearly 47 billion hours of TV shows and movies each month. Around 50 million people worldwide use Amazon Prime, while Hulu has around 39 million subscribers. Increased exposure to tobacco has been repeatedly linked to higher levels of tobacco use by young people. Research demonstrates that smoking imagery in media sources such as TV provides misleadingly positive impressions of smoking. It also suggests that celebrities and film stars can strongly influence young audiences and their attitudes towards smoking.


Smoking and LMICs

Smoking kills over 8 million people each year, with most of these fatalities occurring in low- and middle-income countries (LMICs). Globally, the total economic cost of smoking has been estimated at around $1436 billion (USD), or 1.8% of the world’s annual GDP. Almost 40% of this cost is shouldered by LMICs. Our research focused on tobacco depictions in streamed content on-demand across 10 LMICs.


Research findings

Each character identified as using tobacco was coded against 13 characterisation variables that recorded key demographic and contextual information.

What we found:

  • Nearly 75% of the series analysed contained at least one depiction of tobacco content.
  • Two series - Stranger Things and Narcos: Mexico - featured tobacco in every coded episode.
  • One episode of Stranger Things featured 143 tobacco depictions.
  • Across all series analysed, 83 characters were shown using tobacco across 38 episodes.
  • The portrayal of habitual tobacco use was associated with stress relief, and the representation of “bad guys”. Nearly all the episodes (89%) featuring tobacco use coded for at least one of these attributes.
  • 45% of the content depicting tobacco use was youth-rated (suitable for under-18s).
  • Almost all characters shown using tobacco were “stars”, and nearly half of tobacco use characterisations were positive, with tobacco use depicted as either fun, cool or sexy. These positive portrayals occurred in youth-rated content nearly 50% of the time.

Our analysis shows that tobacco use was depicted in a range of genres and in content across all three hosting platforms, illustrating its prevalence across content, regardless of production location, series language or age rating. Our research also highlights the on-going normalisation of smoking behaviours in media content readily available to, and in high-demand amongst audiences in LMICs, including young people.


A risk to public health

This is of particular concern because LMIC audiences have some of the lowest exposure to educational anti-tobacco mass media campaigns. Considering existing research that links exposure to smoking uptake, and geographical disparities in the implementation and enforcement of FCTC Article 13, the ongoing normalisation of tobacco use in popular media highlights the potential of streamed content in driving smoking uptake and exacerbating global health inequalities.


Addressing concerns

Monitoring how tobacco use is depicted in popular media could be a key component in the ongoing assessment and management of tobacco promotion and advertising legislation. Production companies and hosting platforms also have a role to play. The inclusion of tobacco content in the libraries of streaming services such as Netflix, Amazon Prime and Hulu presents a risk to the health of millions of people, not just in LMICs but globally. We urge these services to include tobacco health and content warnings, anti-tobacco messaging and the use of adult (18+) ratings for any content featuring actual or implied tobacco use or tobacco branding.

Introducing international regulatory guidelines dealing specifically with emerging media forms such as on-demand services, could help combat the proliferation of positive tobacco messaging, and ultimately reduce potential dangers to health, particularly for young people.

Header image: Glenn Carstens-Peters on Unsplash

Posted in: Public health, Research

Read the full paper in Tobacco Control