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

Background: In line with the Framework Convention for Tobacco Control (FCTC) Article 13, the advertising and promotion of tobacco products is increasingly restricted. However, popular media continues to pose an exposure risk to youth populations (aged 13-18 years), including in low/middle-income countries (LMICs). This study presents a novel method to record the prevalence of tobacco depictions in streamed media content and the characterisation of that content. Objectives: Evaluate the frequency and characterisation of tobacco depictions in streamed content in LMICs. Methods: Presence of tobacco depictions was evaluated in the four most in-demand series across 10 LMICs for the year 2019; this list included series that were released from 2017 onwards (2017-2019). Each character identified using tobacco was coded against 13 characterisation variables that recorded key demographic information as well as contextual information. Results: The majority of series (72%, 13 of 18) analysed contained at least one depiction of tobacco use. 38% of tobacco depictions (359 of 941) occurred in content deemed suitable for audiences aged 15 years and up. 113 characters were depicted using tobacco across 38 episodes. 'Star' actors, featuring in opening credits with active profiles on the Internet Movie Database, accounted for 73% of tobacco-using characters (83 of 113). 5% of characters depicted using tobacco (6 of 113) were coded as minors (under 18 years). Conclusion: The continued prevalence of positively characterised tobacco content in youth-focused streamed content that is in high demand in LMICs poses a risk as a driver of smoking uptake in youth populations. There is an urgent need to better enforce tobacco advertising, promotion and sponsorship legislation in LMICs, and to update WHO FCTC guidance in line with rapidly evolving media platforms and content that is available internationally.