Exposure to tobacco imagery in streaming television is associated with increased intentions to smoke and vape

Introduction: Streaming platforms have changed the way we watch television. Although previous research has established a causal relationship between tobacco exposure on-screen and tobacco use, it's unclear whether changes in the media environment brought about by streaming have altered this process. We hypothesize that youth and young adult's intentions to use cigarettes and e-cigarettes in the future will be positively associated with greater exposure to tobacco imagery in streaming television. Methods: A content analysis identifying the amount of tobacco imagery in 60 popular streaming shows with a new season airing between 2019-2022 and an online survey of 1032 15-24-year-olds were conducted to examine the relationship between exposure to tobacco imagery in streaming television and intentions to use. Results: Compared to those with low exposure to tobacco imagery, moderate and high exposure was associated with 61% and 176% respectively higher odds of increased intentions to use e-cigarettes, and 104% and 168% respectively higher odds of increased intentions to smoke cigarettes. Significant interactions indicate that the relationship between high exposure and intentions to use e-cigarettes and cigarettes was weaker among those who had used a tobacco or nicotine product in the past 30 days. Conclusion: The relationship between exposure to tobacco imagery and intentions to use tobacco or nicotine products in the future endures on streaming media. Future research is needed to parse differential influences on initiation versus cessation and better understand what kinds of depictions drive these relationships.