New report shows tobacco imagery continues to influence youth vaping initiation through on-screen entertainment most popular among 15- to 24-year-olds

Truth Initiative’s annual “While You Were Streaming” study illustrates impact of troubling trend on youth e-cigarette public health crisis

With streaming entertainment options  growing in popularity and nearly every Best Picture nominee at the 2023 Academy Awards featuring smoking, a new report, released today, shows continued high levels of tobacco imagery across TV shows, movies, and music videos, even as peer-reviewed research shows on-screen exposure to these images makes young people three times more likely to start vaping nicotine. “Tobacco’s Starring Role,” Truth Initiative’s fifth annual “While You Were Streaming” study of the most popular on-screen entertainment among 15- to 24-year-olds, found that 25 million young people were exposed to tobacco imagery on top television shows, along with 25 million through top box office movies. Smoking’s insidious presence in entertainment media is cause for serious concern given more than 2.5 million high school and middle school students in the U.S. used e-cigarettes in 2022, according to the National Youth Tobacco Survey (NYTS) with 46% of a high schoolers who vape doing so almost daily.

Read the “While You Were Streaming” report: “Tobacco’s Starring Role: How on-screen tobacco imagery drives youth e-cigarette use and what the entertainment industry can do to change the picture”

“Images have influence, and by giving highly addictive nicotine products a starring role, entertainment platforms and celebrities alike are serving as unpaid spokespeople for the tobacco industry whether they realize it or not, with tremendous consequences for young audiences nationwide,” stated Robin Koval, CEO and President of Truth Initiative. “When young people see smoking imagery, they are three times more likely to start vaping nicotine themselves. With youth tobacco use on the rise, and the youth e-cigarette crisis continuing to be a serious public health threat, the entertainment industry can play a major role in changing this picture to protect our nation’s youth and not be complicit with the tobacco industry in addicting a new generation to nicotine.”

Truth Initiative’s new “While You Were Streaming” video demonstrating the abundance of tobacco imagery in popular entertainment can be viewed on YouTube.

Truth Initiative’s fifth annual “While You Were Streaming” report, “Tobacco’s Starring Role,” demonstrates the breadth and depth of how smoking and vaping nicotine is both normalized and glamorized in today’s top streaming entertainment. Key findings include: 

• Of the 15 most popular streaming shows among 15- to 24-year-olds, 60% contained depictions of tobacco in 2021, a persistently high and unchanged number versus last year’s report and regularly exposed 25 million young people to tobacco imagery. Total tobacco instances in top streaming shows increased from the previous year (425 vs 390), with leading transgressors including Showtime’s “Shameless” – this year’s top offending network and program – Fox’s “The Simpsons,” FX’s “American Horror Story” and its spinoff “American Horror Stories,” and Netflix’s “Big Mouth” and “On My Block.” 
• Animated cartoon shows continue to feature tobacco imagery, even those rated for youth and popular to binge-watch among young people. In addition to the aforementioned “Simpsons” and “Big Mouth,” Fox’s “Family Guy” and Adult Swim’s “Rick and Morty” were repeat tobacco offenders in this year’s list. Of note, Fox’s “Bob’s Burgers” eliminated all tobacco imagery in its latest season, showing it is possible for these shows to take positive action. 
• An analysis by NORC at the University of Chicago found that 47 percent of top films in 2021 featured tobacco imagery, including at least one PG-rated movie and 16 PG-13-rated movies, exposing an estimated 25 million youth and young adults ages 15-24 to tobacco imagery in top movies available on streaming. While it is difficult to compare 2021 films to 2020 due to the impact of the COVID-19 pandemic, it is notable that top films in 2021 featured a total of 2,381 tobacco instances – more than double the year before. Of the 17 youth-rated films containing tobacco, several were nominated for major industry awards such as Best Picture, including “King Richard,” “Minari,” and “West Side Story.” 
• 12.8% of music videos for top 2021 Billboard songs featured tobacco depictions and were viewed over 2 billion times on YouTube, led by major recording artists such as Silk Sonic, Farruko, Elle King and Miranda Lambert, and The Weeknd. While the absolute number of tobacco depictions and percentage of music videos with tobacco imagery are down from 2020 the sheer scale and scope of influence of this imagery is extremely problematic. The impact of this media form cannot be underestimated given the lack of parental controls or age-gating on platforms like YouTube, as well as the lack of data on the age of individual viewers and how often videos are re-watched. 

“The proliferation of tobacco imagery in entertainment content is particularly alarming when you consider how frequently smoking and vaping are portrayed as a stress reliever when we know the exact opposite is true,” added Koval. “Years of scientific research show that nicotine can amplify feelings of anxiety and depression while increasing stress, but so many young people are seeing tobacco depictions and turn to e-cigarettes to cope with stress. As the entertainment industry claims to be concerned with the very real youth mental health crisis facing our nation, we encourage content creators and distributors to partner with us to tackle the portrayal of tobacco use on their platforms, especially given the established connection between nicotine use and mental health.” 

While the report focuses on 2021 media, this year’s Academy Award nominees make clear that the issue continues to persist. Nine out of 10 Best Picture nominees contain tobacco imagery, as well as 28 out of the 39 total films (71.7%) nominated at this year’s ceremony. Seven of the nominated films containing tobacco imagery are rated PG-13 and one is rated PG, including Best Picture nominees “Elvis,” “The Fablemans,” “Top Gun: Maverick,” and “Women Talking.”

With so many streaming options available to young people on demand, on multiple devices, at any time, the stakes are high. And while some shows and platforms have made strides in reducing or eliminating tobacco, many others continue to depict tobacco despite promises to the contrary. For example, Netflix announced in 2019 that it would eliminate tobacco in youth-rated programming and cut back on depictions across the board but has yet to make its specific policy public and continues to include pervasive tobacco imagery in popular shows such as ”Big Mouth” and “On My Block.”

Moving forward, Truth Initiative calls on the entertainment industry, states, and the public health community to adopt a comprehensive set of policies to curb tobacco depictions on screens, including: 

• Developing transparent anti-tobacco policies that do not support the normalization of tobacco and are available to the public, and ensuring that content creators are aware of these policies, so they better understand why creating popular characters using tobacco have enormous detrimental impacts and why distributors need them in place; 
• Expanding education and outreach to ensure that stakeholders including directors, writers, producers, and even parents understand the importance of keeping tobacco out of shows; 
• Informing actors of the power they wield when they use tobacco on screen, as actors rejecting smoking and vaping nicotine on screens would be a powerful statement about the harms of tobacco use;
• Continuing the use of enormously successful anti-tobacco and anti-vaping messaging before and after shows featuring tobacco imagery and featuring specific messages demonstrating the harmful effects of increasingly popular e-cigarette products; 
• Implementing a robust ratings system that ensures that titles with smoking are listed as TV-MA or R, which has the potential to reduce young people’s exposure to tobacco and provide more clarity and information for parents;
• Certifying no tobacco industry payoffs for any production in exchange for including smoking or vaping depictions in a show, as well as refusing website advertisements from tobacco brands or tobacco companies; and
• States ensuring that content with tobacco depictions is not eligible for local productions subsidies like tax breaks and other incentives, with production subsidy policies being changed to provide tax and other incentives only for those productions that do not promote tobacco use. 

To read the full report and list of entertainment industry recommendations, as well as for research methodology, visit truthinitiative.org. 

Many stakeholders may not be aware of the harmful and potentially deadly effects that tobacco content can have on youth and young adults. Truth Initiative’s long-standing Tobacco-Free Screens Coalition works with local community agencies and state and national partners to eliminate tobacco product use on screens and to help educate creatives in the entertainment industry. To learn more and to get involved, visit truthinitiative.org/tobacco-starring-role.  

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. More than 540,000 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. Resources for parents of young people who vape are available for free at BecomeAnEX.org.  

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 truthinitiative.org/curriculum. Young people can access free resources at thetruth.com.