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Tobacco imagery in on-demand streaming content popular among adolescents and young adults in India: implications for global tobacco control
  1. Monika Arora1,2,
  2. Gaurang P Nazar1,2,
  3. Aastha Chugh1,
  4. Tina Rawal1,2,
  5. Surbhi Shrivastava1,
  6. Praveen Sinha3,
  7. Vineet Gill Munish3,
  8. Fikru Tesfaye Tullu3,
  9. Kerstin Schotte4,
  10. Jonathan R Polansky5,
  11. Stanton Glantz6
  1. 1 HRIDAY, New Delhi, India
  2. 2 Health Promotion Division, Public Health Foundation of India, New Delhi, India
  3. 3 World Health Organization, Country Office for India, New Delhi, India
  4. 4 Tobacco Free Initiative, World Health Organization, Geneva, Switzerland
  5. 5 Onbeyond LLC, Fairfax, California, USA
  6. 6 Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Monika Arora, HRIDAY, New Delhi 110049, India; monika{at}


Background India implemented tobacco-free film and TV rules (Rules) to protect adolescents and young adults from tobacco exposure.

Objective To assess tobacco imagery in online series popular among adolescents and young adults.

Methods Ten popular online series on streaming platforms were identified after discussions with participants (aged 15–24 years) in New Delhi, and content-coded for tobacco imagery following the Breathe California protocol. Incidents of tobacco use and brand appearances in each series episode were counted, and compliance with Indian Rules was recorded.

Results 188 episodes across 10 series on Netflix and Amazon Prime Video were coded. Seven series were rated age 16+, two were 18+ and one was 13+. The median number of tobacco incidents per episode in foreign productions was as follows: Amazon’s ‘The Marvellous Mrs Maisel’ (87.5, IQR 62.0–116.0) and Netflix’s ‘The Crown’ (29.0, 18.0–36.0) were higher than Indian productions: Netflix’s ‘Sacred Games’ (9.0, 0.5–14.5) and Amazon’s ‘Mirzapur’ (7.0, 4.0–11.0) (p=0.84). Tobacco incidents per hour ranged from 0 (Bodyguard, Riverdale, 13 Reasons Why) to 106.1 (The Marvellous Mrs Maisel). Seven of 10 series had tobacco imagery and none were compliant with the Rules.

Conclusion Contrary to Section 5 of India’s Cigarettes and Other Tobacco Products Act, its Rules are not being complied with by the streaming platforms. US-produced streaming media contains more tobacco incidents than Indian-produced media. There is an urgent need for better enforcement of existing Rules on streaming platforms in India, and modernisation of the WHO Framework Convention on Tobacco Control, Article 13 guidelines to account for new streaming platforms to protect youth from tobacco imagery globally.

  • advertising and Promotion
  • low/middle income country
  • media
  • prevention

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  • Twitter @DrMonikaArora, @gaurang_nazar, @chugh_aastha, @still_surbhi, @ProfGlantz

  • Contributors MA, GPN, TR, JRP and SG conceptualised the study. GPN, AC, TR and SS contributed to data collection and analyses. MA, GPN, SG, KS, PS, FTT, VGM, and JRP contributed to interpretation of results. AC and GPN drafted the manuscript and all other authors revised the manuscript critically for intellectual contents. All the authors approved the final manuscript.

  • Funding WHO Country Office for India provided technical oversight and support for this study which was conducted by HRIDAY in collaboration with University of California San Francisco and Onbeyond LLC (USA).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.