Tobacco imagery in on-demand streaming content popular among adolescents and young adults in India: implications for global tobacco control

Abstract

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.

Quantifying and characterising tobacco content in the most in-demand streamed series in 10 low/middle-income countries in 2019

“…1 2 In spite of national and international restrictions or bans on the advertising, promotion and sponsorship of tobacco products, exposure to tobacco products and smoking behaviours through popular media remains high. [3][4][5][6][7][8][9][10] Youth populations (aged 13-18 years) in low/middle-income countries (LMICs) are especially at risk due to targeting by the tobacco industry to youth and female markets in these regions, [11][12][13] as well as the increased exposure to content afforded by developments in internetconnected personal technologies. 14 15 Smoking kills over 8 million people each year, globally.…”

“…Mass media is a ‘powerful vector’ in the spread of the perceived attractiveness of smoking but can also play a critical role in the education of audiences regarding tobacco-related harms 1 2. In spite of national and international restrictions or bans on the advertising, promotion and sponsorship of tobacco products, exposure to tobacco products and smoking behaviours through popular media remains high 3–10. Youth populations (aged 13–18 years) in low/middle-income countries (LMICs) are especially at risk due to targeting by the tobacco industry to youth and female markets in these regions,11–13 as well as the increased exposure to content afforded by developments in internet-connected personal technologies 14 15…”

“…Youth exposure to smoking-related content can occur in several contexts, including through popular music videos,4 TV,3 film7 and through streamed view-on-demand services including Netflix and Amazon Prime Video 6 10. Recent research into streamed video on demand (SVOD) services indicates that these platforms, in both high-income countries (HICs) like the UK6 and the USA9 and LMICs like India,10 are not only a major avenue for accessing video and audio content27 but also regularly feature tobacco depictions, including tobacco use and tobacco branding. To date, however, no other work has examined such content across other LMICs.…”

Impact of Smoking and Vaping in Films on Smoking and Vaping Uptake in Adolescents: Systematic Review and Meta-Analysis

“…(Bauld, MacKintosh, Ford, & McNeill, 2016) Exposure to tobacco imagery in the films, whether as content or commercial advertising, increases tobacco use by adolescents. (Davis, Gilpin, Loken, Viswanath, & Wakefield, 2008; U.S. Department of Health and Human Services., 2014; U.S. Department of Health and Human Services, 2012;World Health Organisation, 2016) Whilst paid tobacco advertising and product placement have been prohibited in many countries, (Arora et al, 2020;Barker, Whittamore, Britton, & Cranwell, 2019;Kulkarni et al, 2020;Tynan, Polansky, Driscoll, Garcia, & Glantz, 2019) tobacco content, branding and brand alibis, whether paid for or otherwise, still occur in films and other audio-visual media. (Barker, Breton, Cranwell, Britton, & Murray, 2018;Barker, Breton, Murray, Grant-Braham, & Britton, 2019;Barker, Smith, Hunter, Britton, & Murray, 2019;Payne, Orellana-Barrios, Medrano-Juarez, Buscemi, & Nugent, 2016) In our previously published meta-analysis of eight longitudinal studies published by May 2015, children exposed to high levels of such imagery were found to be nearly 50% more likely to become smokers than those unexposed, or exposed to the lowest levels of content.…”

“…Exposure to tobacco imagery in the films, whether as content or commercial advertising, increases tobacco use by adolescents ( Davis et al, 2008 ; U.S. Department of Health and Human Services, 2012 , 2014 ; World Health Organization, 2016 ). While paid tobacco advertising and product placement have been prohibited in many countries ( Arora et al, 2020 ; Barker, Whittamore, et al, 2019 ; Kulkarni et al, 2020 ; Tynan et al, 2019 ), tobacco content, branding, and brand alibis, whether paid for or otherwise, still occur in films and other audio-visual media ( Barker et al, 2018 ; Barker, Breton, et al, 2019 ; Barker, Smith, et al, 2019 ; Leonardi-Bee et al, 2016 ; Payne et al, 2016 ).…”