Discussion

This is the first study to estimate the extent to which music videos deliver tobacco or alcohol imagery and lyrics to adults and adolescents. It demonstrates that this small sample of videos, which was among the most popular in the UK over a 12-week period from late 2013, delivered over 1.2 billion 10 s intervals containing tobacco or alcohol content to the British population. Approximately one-third of these impressions were delivered to people aged 11–18, and per capita rates in this age group were nearly four times higher than in adults. Impressions per capita were also much higher in girls than in boys. If these levels of exposure were typical then in 1 year, music videos would be expected to deliver over four billion impressions of alcohol, and nearly one billion of tobacco, in Britain alone. Further, the number of impressions has been calculated on the basis of on one viewing only; however, many of the videos had been watched multiple times (see online supplementary appendix 1), so this number is likely to be much bigger.

Our findings are consistent with previous research that found a larger sample of movies delivered 13.9 billion gross smoking impressions, an average of 665 to each US adolescent aged 10–14 years, and adds to the wider substance exposure research by including, for the first time, alcohol content reach.19 Since many of the popular songs in our sample were globally as well as nationally successful, it is evident that music videos are a major global as well as national medium of exposure to imagery that promotes smoking and alcohol consumption.

Legislation prohibiting paid-for placement of branded tobacco products has been in place since 2002 in the UK, and many other countries apply similar restrictions. It is therefore unlikely that tobacco brand appearances in UK-made music videos are funded by the tobacco industry, though the possibility remains that funding of generic imagery still occurs. The association between exposure to smoking imagery and smoking in films and uptake of smoking occurs even when branding is absent, which suggests that the effect of such exposure on the likelihood of smoking initiation is unrelated to branding.21 Tobacco companies still therefore have an incentive to encourage inclusion of smoking in films and music videos, but it seems likely that legal restraints on funding at least in part explain the much lower levels of tobacco than alcohol content.

Alcohol promotion in the UK is regulated only by ASA, the Portman Group and alcohol industry voluntary codes of practice, and as we have reported previously many alcohol companies have overt associations with artists who in turn feature their products in music videos.9 Such paid-for content directly contravenes several of these codes of practice such as associating alcohol with rites of passage into adulthood and drinking to excess.15 ,22 ,23 The lower levels of tobacco exposure we found indicate that similar controls on alcohol promotion could significantly reduce exposure of children through this medium, but would not completely remove it.

One relevant limitation of this research is that we have selected our sample of videos from the top UK music chart, which are not necessarily the most watched music videos on YouTube. However, we argue that a British audience is most likely to watch the videos associated with the most popular chart songs. Our survey of adults was carried out later than that of adolescents, which may have reduced the disparity between adult and adolescent exposure, because adults had more time in which to watch the videos. Conversely, we also acknowledge that the time differences could have influenced the adult results because of recall bias resulting in adult respondents forgetting if they had seen a video or not. Our 10 s interval monitoring is semiquantitative, and affords similar weight to any appearance within the 10 s interval, however long in duration. While there is currently no accepted means of coding the plethora of imagery that can occur in this medium, a more quantitative approach is an urgent developmental priority. Coverage bias is a problem for most survey methods including online. We used YouGov because its members’ panel has a sufficient coverage drawn from lower prevalence groups and because it uses purposive sampling.24 Further, the survey data were weighted on key demographics. Online surveys have overtaken telephone surveys with similar response rates to face-to-face interviewing and provide social distance which reduces respondent reluctance to reveal sensitive information (in this case adolescent smoking and drinking behaviour) and YouGov scans all responses for inattentiveness (eg, straight line ticking).24

Music videos are almost unregulated for their content. While films are age classified in most countries, and television content is subject to controls on what is broadcast during periods when children are likely to be watching, music videos are subject to none of these restraints. The British Board of Film Classification has consulted on introducing an age-rating system for music videos made in the UK, but this is a global problem and at present only includes drug misuse, dangerous behaviour presented as safe, bad language, sexual behaviour and nudity, and threatening behaviour and violence. Owing to the obvious health implications for adolescents, we suggest that overly positive portrayals of both alcohol and tobacco in music videos should be included in both the drug misuse and dangerous behaviour presented as safe rating categories. One means of reducing impact at the national level would be to require antismoking/alcohol messages to be broadcast immediately before any video containing smoking or alcohol, or to apply the practice on tobacco in Indian cinema of publishing health warnings in subtitles over the video. However, a more effective alternative may be to cut out this content at source, through negotiation with the video makers and publishers. Disney films has now announced that it will no longer make films including smoking.25 We need a similar degree of social responsibility across the tobacco, alcohol and music industries. It is well established that young people exposed to depictions of tobacco and alcohol content in films are more likely to start smoking or to consume alcohol;1–8 therefore, future research should focus on exploring the behavioural effects of exposure to similar content in music videos through large-scale longitudinal studies.