Skip to main content
News Article News Article

Action needed: Tobacco in pop culture

Entertainment media and pop culture continue to portray tobacco use positively, as a normal social behavior and as glamorous, rebellious and edgy. Images of any type of tobacco use — cigarettes, e-cigarettes, cigars, smokeless tobacco, and others — have influence, especially among youth and young adults, who are particularly susceptible to social and environmental influences to use tobacco.

Despite a 19982-4 federal law prohibiting paid tobacco product placements in movies and TV programming, tobacco imagery can still be seen on screens everywhere today — including movies, TV, streaming media and video games. Tobacco imagery across these platforms contributes to the renormalization of smoking, risking the national progress that’s been made to reduce the smoking rate. Additionally, the expansion of the media landscape and increasing screen time among young people means that there are more opportunities for exposure than ever before. 

Taking action on tobacco use in pop culture is especially crucial given the surging rate of e-cigarette use among young people. Vaping is threatening to addict a new generation to nicotine, and youth who use e-cigarettes are four times more likely to go on to smoke cigarettes than their non-vaping peers. Keeping tobacco imagery out of movies, video games, TV shows and other forms of pop culture and entertainment media is critical to protecting the health of youth and young adults.

Woman Watching TV

Tobacco in movies

Is smoking in movies bad?

Research shows that youth exposure to tobacco imagery in movies directly influences youth smoking behaviors. For example:

  • Thirty-seven percent of adolescents who start smoking do so because of smoking images they saw in movies.
  • Youth who are heavily exposed to on-screen smoking imagery are approximately two to three times as likely to begin smoking, compared with youth who are lightly exposed.
  • Implementing an R rating for movies with smoking would lead to an 18% decline in teen smoking and prevent up to a million deaths among children and teens alive today.

Today, all six major studios — Comcast, Disney, Fox, Sony, Time Warner and Viacom — have adopted policies to decrease tobacco depictions in their youth-rated films. Still, tobacco use remains prevalent in movies that appeal to youth because many of these policies include exceptions and loopholes.

According to the latest data on smoking in movies, progress in reducing smoking exposure in youth-rated movies has stalled. The number of G, PG and PG-13 films with tobacco and smoking imagery decreased slightly, from 38% in 2017 to 31% in 2018. Additionally, the number of tobacco incidents in youth-rated films increased from 915 incidents in 2017 to 1,258 incidents in 2018.

Action needed: Movies

Truth Initiative® joins several other public health groups in endorsing measures to reduce youth exposure to tobacco in movies, including:

  • Prohibiting the identification of tobacco brands in movies
    Evidence shows that teens are more susceptible to brand promotion than adults.13 Cigarette and other tobacco product brands, such as JUUL, are some of the most recognizable brands among youth and young adults.25-27
  • Ensuring that tobacco companies and their representatives have not paid media companies in exchange for using or showing tobacco products in movies
    Movie studios must certify that no payment for brand placement took place at any point during production, and they can confirm that by adding a note in movie credits.29
  • Requiring strong anti-tobacco ads to run before any film with tobacco, regardless of its rating
    Showing evidence-based and proven-effective anti-tobacco ads from public education campaigns like truth® helps to counteract the impact of smoking imagery in a film.
  • Giving an R rating to all movies that contain smoking unless the movie clearly depicts the dangers and consequences of tobacco use or accurately depicts a historical figure who used tobacco
    Given the strong connection between tobacco imagery and youth tobacco use, tobacco does not belong in youth-rated films. Giving an R rating to movies that contain tobacco will keep parents aware and help them and their children make appropriate decisions.
  • Disallowing production subsidy policies to support movies that contain tobacco use
    Films with tobacco depictions should not be eligible for local production subsidies, including tax breaks and other incentives. It makes bad financial and health sense for states to support movies that promote tobacco use with these subsidies, considering state governments pay $39.9 billion each year on tobacco-related health care costs through Medicaid.

Tobacco in TV and streaming

Smoking on streaming services like Netflix

The popularity of streaming, combined with the pervasive rise of smoking in episodic content, is putting a new generation of young Americans at risk.

Truth Initiative has released two reports on this topic, showing that tobacco imagery is increasing on the small screen in two ways: the number of shows featuring tobacco imagery and the amount of depictions in each show. Researchers analyzed the 13 most popular broadcast and streaming shows among young people aged 15-24 and found that:

  • Ninety-two percent of the shows analyzed contained images of tobacco.
  • There was a 176% increase in tobacco depictions overall and a 379% increase in tobacco depictions in youth-rated programs between the 2015-16 and 2016-17 seasons. 
  • The most popular streaming network among young people, Netflix, increased depictions 190% between the two seasons and displayed more tobacco depictions than programs aired on broadcast or cable TV.
  • Approximately 28 million young people have been exposed to tobacco use based on the estimated viewership of the shows.

Action needed: TV broadcast and streaming

Preliminary data suggest an emerging threat to a new generation of young people. Truth Initiative recommends several measures to protect young viewers from tobacco imagery in TV and streaming content, including:

  • Prohibiting states from allowing TV and streaming production subsidies to support shows that contain tobacco use
    States can change their film production subsidy policies to provide tax and other incentives for only those productions that do not promote tobacco use.
  • Including tobacco use in TV Parental Guidelines ratings
    Currently, neither the TV Parental Guidelines ratings,30 developed by the television industry, or streaming service ratings,31-33 based on the TV Parental Guidelines, use tobacco use as a ratings indicator or have descriptors with the rating that indicate tobacco use. Including tobacco use in these guidelines would help parents make healthy decisions about the TV and streaming shows their children watch. Shows with tobacco depictions should have a TV-MA rating unless the show clearly depicts the dangers and consequences of tobacco use or accurately depicts a historical figure who used tobacco.
  • Encouraging directors, writers and producers to keep tobacco out of their shows
    It is important to work in partnership with the creators and distributors of broadcast, cable and streaming shows to ensure future content does not include tobacco imagery.
  • Conducting additional research on tobacco in TV and streaming shows
    It is reasonable to conclude that tobacco imagery in movies and tobacco imagery in TV and streaming shows affect youth tobacco use in similar ways. However, further research is needed to understand those effects.

Tobacco in video games

Smoking in video games

Smoking is prevalent and often glamorized in video games played by youth, with some young gamers describing tobacco use as making a character “cooler,” “tougher” or “grittier.” Between 1994 and 2011, 60 out of 78 large video game publishers included tobacco imagery in at least one, and often more, of their games rated appropriate for youth.

Tobacco use in video games is likely to promote youth smoking in similar ways to tobacco use in movies, and video games are much more popular with teens. Teens spend an average of 25 times more time playing video games than going to the movies, which are more active and intense experiences. They rank playing video games as their second favorite media activity, and 56% of them play video, computer or mobile games on any given day.

In 2016, Truth Initiative surveyed 200 video game players aged 18 and over, and the results underscore concern about smoking in video games:

  • Participants felt that tobacco, or nicotine, was portrayed negatively in only 6.5% of games where tobacco use appeared.
  • A little more than 93% of video games showing tobacco use portrayed it in a positive or neutral light.
  • Participants perceived that most video game characters that use tobacco — 77% — did not experience any health effects from their tobacco use.
  • Some video game characters can be shown benefiting from tobacco use.

Action needed: Video games

While research linking tobacco in video games to youth smoking behavior is still taking shape, there are steps that the industry and individuals can take to reduce the risks posed by video games. These include:

  • Conducting additional research on tobacco imagery in video games and subsequent tobacco use
    Smoking in video games may be more influential than smoking in movies because youth spend considerably more time playing video games than they do at the movies.34 Video games are more active and intense experiences than movies, and in some video games, players can actually simulate smoking for their characters.35-38
  • Giving a “mature” rating to all games that depict tobacco use and disclose such use in the ratings descriptor
    Descriptive ratings would help parents and the public understand what is in video games and make healthy decisions. Video game content descriptors often fail to mention tobacco use. Tobacco content appeared in 42% of video games participants reports playing in a 2015 survey, but only 8% of those games had tobacco warnings in their Entertainment Software Rating Board ratings.
  • Encouraging game developers and publishers stop including tobacco imagery in games, especially ones marketed to or played by youth
    The public health community needs to do more to partner with developers and educate them about the consequences of tobacco depictions in their games.
  • Educating parents, policymakers and other adults to increase awareness on the connection between tobacco depictions in media and tobacco use among youth
    Education can increase public pressure on developers and encourage responsible industry practices to keep tobacco use out of video games.

Exposure to tobacco imagery in pop culture puts the health of young people at risk. Preventing tobacco from appearing in movies, video games, TV shows and other forms of pop culture is necessary to protect youth and young adults.

Because each area is governed in different ways, Truth Initiative recommends separate measures for movies, TV and streaming and video games, all based on the same core ideas: 

  • Educating parents and the public on the prevalence of tobacco imagery in entertainment media and pop culture and the health consequences of exposure  
  • Holding media industries accountable for indicating when tobacco imagery is present and giving an appropriate rating when it is
  • Educating the creative professionals in these industries and encouraging responsible practices around tobacco depictions in entertainment media
  • Ensuring that states are not subsidizing film, television and streaming productions that contain tobacco use
  • Encouraging policymakers to recognize the prevalence of tobacco in these media sources and its effects on tobacco use.
  • Conducting additional research to learn more about the consequences of exposure to tobacco in all media to develop best practices for protecting youth

All producers of video content, regardless of platform, should adopt the following policy principals:

  • In future productions, commit to no tobacco depictions (including e-cigarettes) in youth-rated content (e.g., TV-14, PG-13 or below) unless:
    • the depiction unambiguously reflects the dangers and consequences of tobacco use, or
    • the depiction represents the tobacco use of an actual person, as in a biographical drama or documentary.
  • Clearly mark previously produced material with tobacco descriptors so parents can appropriately evaluate content.
  • Include anti-smoking advertising before previously produced material with youth ratings and tobacco depictions.
  • Certify that no tobacco product placement appears in any future production (including consideration paid to producers, actors, etc.).


1.            Smoke Free Movies at University of California San Francisco. History: 1920s to 1950s.

2.            National Association of Attorneys General. Master Settlement Agreement. 1998;

3.            Federal Cigarette Labeling and Advertising Act of 1965. Pub L. 1965(89-92):15.

4.            Family Smoking Prevention and Tobacco Control Act. Public Law No: 111-31. Vol HR 12562009.

5.            U.S. Department of Health and Human Services. The health consequences of smoking – 50 years of progress: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2014.

6.            Tynan MA, Polansky JR, Titus K, Atayeva R, Glantz SA. Tobacco Use in Top-Grossing Movies - United States, 2010-2016. MMWR Morbidity and mortality weekly report. 2017;66(26):681-686.

7.            Millett C, Glantz SA. Assigning an '18' rating to movies with tobacco imagery is essential to reduce youth smoking. Thorax. 2010;65(5):377-378.

8.            SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007. State Estimates of Substance Use and Mental Health from the 2006-7 National Surveys on Drug Use and Health. Estimated numbers in the population for Tables B.1 to B.24: (Online) Table 14. Cigarette Use in Past Month, by Age Group and State: Estimated Numbers (in Thousands), Annual Averages Based on 2006 and 2007 NSDUHs. Consulted at

9.            Dalton MA, Sargent JD, Beach ML, et al. Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet. 2003;362(9380):281-285.

10.          Dalton MA, Beach ML, Adachi-Mejia AM, et al. Early exposure to movie smoking predicts established smoking by older teens and young adults. Pediatrics. 2009;123(4):e551-558.

11.          Titus-Ernstoff L, Dalton MA, Adachi-Mejia AM, Longacre MR, Beach ML. Longitudinal study of viewing smoking in movies and initiation of smoking by children. Pediatrics. 2008;121(1):15-21.

12.          Sargent JD, Beach ML, Adachi-Mejia AM, et al. Exposure to movie smoking: its relation to smoking initiation among US adolescents. Pediatrics. 2005;116(5):1183-1191.

13.          National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute;2008.

14.          Truth Initiative. Played: Smoking and Video Games. 2017;

15.          Truth Initiative. Played: This Year's Video Games Glamorize Tobacco Use to Youth. December 19, 2017;

16.          Forsyth SR, Malone RE. Smoking in Video Games: A Systematic Review. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2015.

17.          Barrientos-Gutierrez T, Barrientos-Gutierrez I, Lazcano-Ponce E, Thrasher JF. Tobacco content in video games: 1994-2011. The Lancet Oncology. 2012;13(3):237-238.

18.          Raiff BR, Jarvis BP, Rapoza D. Prevalence of video game use, cigarette smoking, and acceptability of a video game-based smoking cessation intervention among online adults. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 2012;14(12):1453-1457.

19.          AJ VANR, Kuss DJ, Griffiths MD, Shorter GW, Schoenmakers MT, D VDM. The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents. Journal of behavioral addictions. 2014;3(3):157-165.

20.          Shi L, Mao Y. Weekend television viewing and video gaming are associated with less adolescent smoking. Journal of Substance Use. 2011;16(2):109-115.

21.          Truth Initiative. While you were streaming: Tobacco use sees a normalization in on-demand digital content, diluting progress in broadcast and theaters. 2018;

22.          PR Web. U.S. Product Placement Market Grew 13.7% in 2017, Pacing for Faster Growth in 2018, Powered by Double-Digit Growth in Television, Digital Video and Music Integrations. June 13, 2018;

23.          Mekemson C, Glantz SA. How the tobacco industry built its relationship with Hollywood. Tobacco control. 2002;11 Suppl 1:I81-91.

24.          PM, PHILIP MORRIS,MAXWELL,H. DRAFT SPEECH FOR HAMISH MAXWELL, MARKETING MEETING, 000624. 1983 June 24. Philip Morris Records. Unknown.

25.          U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2012.

26.          Glasser AM, Johnson AL, Rath JM, Williams VF, Vallone DM, Villanti AC. Tobacco Product Brand Preference among US Young Adults, 2011-2014. Tobacco regulatory science. 2016;2(1):44-55.

27.          Willett JG, Bennett M, Hair EC, et al. Recognition, use and perceptions of JUUL among youth and young adults. Tobacco control. 2018.

28.          National Association of Attorneys General. Master Settlement Agreement. Section III: Permanent Relief, (e) Prohibition on Payments Related to Tobacco Products and Media. 1998;

29.          Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual healthcare spending attributable to cigarette smoking: an update. American journal of preventive medicine. 2015;48(3):326-333.

30.          TV Parental Guidelines. About the TV Ratings and V-Chip.

31.          Netflix. How does Netflix decide the maturity rating on TV shows and movies?

32.          Hulu. What parental controls are available to restrict mature videos? March 20, 2017.

33.          Amazon. How to Set Prime Video Parental Controls.

34.          Kaiser Family Foundation. Generation M2: Media in the Lives of 8- to 18-Year-Olds. January 2010;

35.          Red Dead Wiki. Chewing Tobacco. 2018;

36.          Metal Gear Wiki. Cigarette. 2018;

37.          GTA Wiki. Smoking. 2018;

38.          GTA Wiki. Redwood Cigarettes. 2018;