The risk of encountering tobacco products being advertised, marketed, or promoted on streaming services based on race, ethnicity, socioeconomic status, and smoking habits was identified in a recent study published by Onyeaka et al in JAMA Network Open.
Background
The World Health Organization currently recommends a complete ban on all forms of tobacco advertising and promotion. Although cigarette advertisements on traditional television channels and radio stations have been banned in the United States since the 1970s, these regulations do not extend to portrayals of tobacco in modern streaming content. These gaps may allow tobacco companies to subtly target and influence vulnerable populations while circumventing existing restrictions. As a result, tens of millions of U.S. individuals may be exposed to tobacco content on streaming services.
“When viewers see a character smoking, vaping, or using tobacco in any form, it can reduce the stigma associated with these behaviors,” explained senior study author Sanjay Shete, PhD, Professor of Biostatistics and Epidemiology at The University of Texas MD Anderson Cancer Center. “If a hero or main character smokes, it can subconsciously signal that it’s acceptable, leading some—including … youth—to take the first step on the path to smoking,” he added.
Study Methods and Results
In a nationally representative study, investigators asked respondents who participated in the National Cancer Institute’s Health Information National Trends Survey between March 7 and November 8, 2022, to answer questions regarding whether they had noticed or heard any tobacco products being advertised, marketed, or promoted on television or streaming platforms such as Netflix or Hulu over a 3-month period. They noted that more than 90% of the respondents completed this question.
The investigators revealed an estimated 12.4% of U.S. adults were exposed to tobacco promotion on streaming services. Exposure was highest among Black respondents (19.4%), those with an annual household income of less than $20,000 (17.6%), current smokers (17%), those with a high school education or less (16.4%), and Hispanic respondents (16.4%). Given that the streaming platforms used limited advertisements and prohibited tobacco advisements, most reported exposures were likely caused by tobacco use depictions in shows and movies. This type of promotion may be difficult to regulate, because it is unclear whether tobacco companies fund such depictions or they constitute artistic choices made by content creators.
Conclusions
“As these popular platforms continue to dominate the entertainment space, it becomes increasingly important to consider regulations for this content, especially given the potential for exploitation,” Dr. Shete indicated. “These types of public health interventions can contribute to a healthier and more equitable society by preventing individuals from engaging in behaviors that can increase their risk of cancer and other diseases,” he underscored.
The investigators detailed that limitations of the study included low-response bias associated with population-based surveys, a lack of data on the duration of exposure to the tobacco content, the subjective nature of the questionnaire, and the lack of inclusion of U.S. individuals younger than age 18.
Disclosure: The research in this study was funded by the National Cancer Institute, the Betty B. Marcus Chair in Cancer Prevention, and the Duncan Family Institute for Cancer Prevention and Risk Assessment. For full disclosures of the study authors, visit jamanetwork.com.
