New truth initiative study finds that pervasive tobacco imagery in popular shows poses new threat, making youth more prone to e-cigarette use

Exposure to smoking imagery through episodic programming triples a young person’s chances of vaping initiation

A groundbreaking new report released today by Truth Initiative — the national public health organization behind the proven-effective and nationally-recognized truth^® youth smoking, vaping and nicotine prevention campaign — finds that youth and young adults with high exposure to tobacco imagery in streaming and TV shows are three times more likely to start vaping compared to their peers with no exposure. Titled, Straight to Vape: Pervasive Tobacco Imagery in Popular Shows Poses New Threat, Making Youth More Prone to E-Cigarette Use, this is the first study to establish a direct link between smoking imagery on the small screen and youth e-cigarette use. This new vaping data come as the most popular shows among young people aged 15-24 years old continue to prominently feature tobacco images, and as streaming grows even more rapidly amid the COVID-19 pandemic with many young people spending more time at home. With youth e-cigarette use already at epidemic levels, and a recent study showing young people who have vaped more likely to be diagnosed with coronavirus, it is clear that tobacco content on the small screen is a growing and urgent health risk for young Americans.

Truth Initiative first called attention to the prevalence of tobacco imagery in streaming content in 2018 with its groundbreaking report, While You Were Streaming. The second installment of the report came out in 2019, showing that the re-normalization of tobacco in TV and streaming content most popular among youth and young adults had skyrocketed, exposing millions of young viewers to tobacco use. This year’s report underscores how smoking imagery in popular shows poses a new threat making youth more prone to e-cigarette use. Similar to the first two reports, Netflix’s hit show “Stranger Things,” once again tops the list as the biggest offender with 721 total instances, quadrupling in its latest season compared to its first season. Overall, 73% of the top 15 most popular programs among youth and young adults featured tobacco or smoking imagery in 2018 and 2019, exposing more than 27 million young people to tobacco, including more than 8 million teens. The show “Shameless” had 226 depictions of tobacco and “The Simpsons,” “Family Guy,” and “Big Mouth” each had over 50 tobacco incidences in their 2018 seasons. In its latest season in 2019, tobacco incidences in “Big Mouth” jumped to 130. “Walking Dead” had 39 and “Orange is the New Black”— another repeat offender from previous reports — had 38. 

“Truth Initiative was the first to sound the alarm on the resurgence and glamorization of tobacco imagery on the small screen and its negative impact on young people. The alarm is blaring even louder this year as new data clearly demonstrate that tobacco content is directly fueling the youth e-cigarette epidemic,” said Robin Koval, CEO and President of Truth Initiative. “Put simply, the more tobacco use a young person sees in shows, the more likely they are to start vaping e-cigarettes. As Big Tobacco reinvents itself with electronic products to lure young people to a lifetime of addiction, the entertainment industry should not be complicit and must do more by implementing policies that can limit ongoing tobacco exposure.”

The vaping data contained in this peer-reviewed report published in Preventative Medicine earlier this month used a nationally-representative sample of 4,604 youth aged 15 to 24 years old who had never previously used a tobacco product. In addition to the key finding that tobacco exposure triples a young person’s likelihood of starting to vape, researchers also found that the higher the exposure to tobacco imagery, the greater the odds of subsequent vaping initiation; younger age was also linked with increased likelihood of e-cigarette use.

Vaping is the dominant type of tobacco use today among young people and vapes are often the first tobacco product tried. Youth e-cigarette use has doubled among high school students, from 11.7% in 2017 to 27.5% in 2019; and tripled among middle school students from 3.3% to 10.5%. On top of growing evidence that e-cigarettes impact lung and heart health, young people who have ever used e-cigarettes are up to seven times more likely to start smoking cigarettes than their peers who do not vape.

Though cigarettes are still the primary form of tobacco depicted in episodic content, vaping imagery in shows is on the rise. In 2018, there were 16 e-cigarette instances in the three most popular shows among youth, which grew to 22 instances in 2019’s top five shows. In addition, an estimated 2.5 million youth and young adults watched season one of HBO’s “Euphoria,” which had 67 incidences of e-cigarette use across eight episodes.

The new data around the ongoing exposure of young people to tobacco imagery on the small screen come at a time of unprecedented content consumption driven by COVID-19 stay-at-home orders. In March 2020, the number of children and teen viewers grew by nearly two-thirds, according to Nielsen tracking. The percentage of youth reporting that their most-watched shows aired on streaming platforms nearly tripled, from 29% in 2018 to 84% in 2019.

To help halt the youth e-cigarette epidemic in its tracks, Truth Initiative calls for a comprehensive set of policies to curb tobacco imagery in movies, TV and streaming content that increases the likelihood that young people will start vaping:

• Ratings system – Designate new titles with smoking as TV-MA and include tobacco imagery as an explicit rating factor in TV Parental Guidelines.
• Anti-tobacco and anti-vaping ads – Deploy anti-smoking and anti-vaping messages that illustrate the harmful effects of tobacco.
• Tobacco payoffs – Ensure that no parties or persons involved with a production received anything of value in exchange for including smoking or vaping in a show.
• State public subsidy policies – Change state-level production subsidy policies to remove tax and other incentives for productions that feature tobacco use.
• Education and outreach – Educate directors, writers and producers about the importance of keeping tobacco out of their shows.
• Ongoing research – Continuously monitor tobacco imagery in popular media, including how it is portrayed and who is watching.

Truth Initiative’s latest analysis also spotlights the renormalization of tobacco imagery in movies, video games, and music videos. The organization continues to monitor the dangers of the entertainment industry’s normalization of smoking and highlight the need for actionable solutions. For research, resources and more information, please visit truthinitiative.org.