Keywords: tobacco control, film, movie, youth, young adult, exposure, e-cigarette, tobacco

Purpose & Background: The portrayal of tobacco use in popular media, particularly in films, plays a significant role in shaping the tobacco-related behaviors of youth and young adults (YYA). tobacco imagery in films remains pervasive. This study aims to refine and update previous methodologies for estimating the extent of tobacco exposure in films, focusing on youth exposure via both traditional theater viewings and streaming services.

Methods: Data collection was conducted in two parts: tobacco presence in top ten 2022 box office films was monitored by Breathe California, which tracked tobacco incidents in films based on product type, character role, and other factors. A web-based survey was administered by Truth Initiative and NORC at the University of Chicago to a representative sample of YYA aged 15-24, collecting information on demographic characteristics, tobacco use behaviors, and film viewership. The survey asked respondents about their viewership of the films and whether they saw them in theaters or on streaming platforms. Data from these two components were combined to estimate youth exposure to tobacco imagery in films. Logistic regression was used to examine the association between exposure to tobacco imagery in films and youth tobacco use behaviors.

Results: 35% of the top 114 box office films in 2022 contained tobacco imagery, with a total of 1,167 tobacco incidents across various product categories. 31% of respondents reported using a tobacco product in the past 30 days, while 46% indicated an intention to use tobacco products in the next year. Exposure estimates suggest that 104 million U.S. YYA were exposed to tobacco imagery through in-theater films, while 20 million YYA were exposed via streaming platforms.
exposure to tobacco in films, either on streaming or in theaters, was significantly associated with both current tobacco use and intention to use tobacco products. Additionally, several demographic factors were associated with higher odds of tobacco use. YYA aged 18-24, Hispanic and LGBTQ youth, and those with lower socioeconomic status showed higher odds of tobacco use and intention to use tobacco products.

Conclusion/Implications: These findings highlight the continued influence of tobacco imagery in media and the importance of considering streaming platforms in exposure estimates. Understanding the extent of exposure and its association with tobacco use behaviors is crucial for informing public health interventions and policies aimed at reducing tobacco use initiation and uptake among YYA.