Health Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research and Canadian Cancer Society Research Institute.

No abstract

The tobacco epidemic is one of the biggest public health challenges the world has ever faced, killing more than 8 million people around the world every year. In 2017, tobacco killed 3.3 million users and people exposed to secondhand smoke from lung-related conditions including chronic respiratory diseases, tracheal, bronchus and lung cancers, respiratory infections and tuberculosis. Despite the strong body of evidence around the harms of tobacco use to lung health from direct and passive exposure to tobacco smoke, there are still several knowledge gaps that need to be bridged through targeted research, for example, tobacco and nicotine addiction, surveillance and monitoring, waterpipe tobacco, heated tobacco products, electronic nicotine delivery systems, inhalation of aerosols, cessation aids, and dual use. Operational and implementation research can help make current efforts and interventions, that we know work, more effective and more efficient. Tobacco use is on the decline, but the rate of reduction is not fast enough and it is apparent that the agreed global target of 30% reduction in tobacco use among adults by 2025 will not be met. Therefore, accelerated research is needed to crystalize the impact of tobacco control towards reducing tobacco use prevalence across populations. GLOBAL BURDEN OF TOBACCO USE

BackgroundIndia implemented tobacco-free film and TV rules (Rules) to protect adolescents and young adults from tobacco exposure.ObjectiveTo assess tobacco imagery in online series popular among adolescents and young adults.MethodsTen popular online series on streaming platforms were identified after discussions with participants (aged 15–24 years) in New Delhi, and content-coded for tobacco imagery following the Breathe California protocol. Incidents of tobacco use and brand appearances in each series episode were counted, and compliance with Indian Rules was recorded.Results188 episodes across 10 series on Netflix and Amazon Prime Video were coded. Seven series were rated age 16+, two were 18+ and one was 13+. The median number of tobacco incidents per episode in foreign productions was as follows: Amazon’s ‘The Marvellous Mrs Maisel’ (87.5, IQR 62.0–116.0) and Netflix’s ‘The Crown’ (29.0, 18.0–36.0) were higher than Indian productions: Netflix’s ‘Sacred Games’ (9.0, 0.5–14.5) and Amazon’s ‘Mirzapur’ (7.0, 4.0–11.0) (p=0.84). Tobacco incidents per hour ranged from 0 (Bodyguard, Riverdale, 13 Reasons Why) to 106.1 (The Marvellous Mrs Maisel). Seven of 10 series had tobacco imagery and none were compliant with the Rules.ConclusionContrary to Section 5 of India’s Cigarettes and Other Tobacco Products Act, its Rules are not being complied with by the streaming platforms. US-produced streaming media contains more tobacco incidents than Indian-produced media. There is an urgent need for better enforcement of existing Rules on streaming platforms in India, and modernisation of the WHO Framework Convention on Tobacco Control, Article 13 guidelines to account for new streaming platforms to protect youth from tobacco imagery globally.

There are 1.3 billion tobacco users worldwide. That number might be even larger if tobacco did not kill half of its users [1]. Every 4 seconds, tobacco is responsible for another premature death [2]. For decades, the tobacco industry has deliberately used aggressive, duplicitous, and well-resourced tactics to hook generations of users to nicotine and tobacco, driving the global tobacco epidemic. This is primarily achieved through engineering and manipulating of products to sustain addiction, with young people being the main target. The strategy is to replace smokers and ensure market sustainability by making the products appealing and attractive to new and existing users, especially youth. In 1984, R.J. Reynolds stated, "younger adult smokers are the only source of replacement smokers. If younger adults turn away from smoking, the industry must decline" [3]. Such strategies to engage children and adolescents before they are fully aware of the ramifications of their actions have been successfully used by the industry since the 1970s and are still in use today.Over the last decade, as the awareness of the harms of tobacco use has grown and global tobacco control efforts have intensified, the social acceptability of tobacco use has declined, directly impacting the sale of the most popular productdthe cigarette. To maintain its profitability, the multi-billion-dollar industry has aggressively started to look for newer markets in low-and middle-income countries and also come up with