The WHO Country Office for India conducted a study on “Tobacco imagery in on-demand streaming content popular among adolescents and young adults in India: implications for global tobacco control”, to assess the impact of tobacco imagery in digital streaming series popular among adolescents and young adults in urban India. The HEALTH PIONEER shares the results.

This study was undertaken in collaboration with HRIDAY, the Center for Tobacco Control Research and Education, University of California, and Onebeyond LLC, California. The study also assessed the compliance of the content shown in these online series with the Tobacco-free Film and Television Rules in India. This is the first such study conducted in the country to generate evidence on implementation of the tobacco free films policy on streaming or over-the-top (OTT) on-demand video streaming platforms such as Amazon Prime, Netflix and Hotstar.

In recent years, on-demand video streaming platforms such as Amazon Prime, Netflix and Hotstar are rapidly becoming popular in India. A recent market research amongst Indians in the age group of 20–25 years has revealed that the time spent on these platforms range from 5 to 20 hours per week.

The study recommends the enforcement of Tobacco-free Film and TV Rules under the Tobacco Control Act of India for all content streamed on all web-based OTT platforms in India, whether produced within the country or internationally. In addition, the study also recommends that the current guidelines under Article 13 of WHO Framework Convention on Tobacco Control (FCTC) pertaining to the depiction of tobacco in entertainment media should be updated to bring newer internet and mobile based platforms under its purview.

Study design

As part of the study, 10 popular Web-series on streaming platforms like Netflix and Amazon Prime, were identified after discussions with participants aged 15–24 years in Delhi. These were content-coded for tobacco imagery using the peer reviewed Breathe California protocol. Incidents of tobacco use and brand appearances in each series episode were counted, and compliance with extant Rules was recorded. In total, 188 episodes across 10 selected series from Netflix and Amazon Prime Video were coded for the content analysis of tobacco imagery and included: The Marvellous Mrs Maisel (rated 16+); Stranger Things (rated 16+); Bodyguard (rated 16+); Riverdale (rated 13+); Narcos (rated 16+); Sacred Games (rated 18+); Mirzapur (rated 18+); Chilling Adventures of Sabrina (rated 16+); 13 Reasons Why (rated 16+); and The Crown (rated 16+).

"The Tobacco-free Film and TV policy pioneered by the Government of India is an innovative approach to health education. This study highlights the urgent need to initiate a dialogue with digital content providers to ensure sterner compliance to the policy and help protect vulnerable age groups like adolescents and young adults from unnecessary exposure to tobacco imagery in entertainment content showcased on these platforms.”

— Dr Roderico H. Ofrin

WHO Country Representative to India