Blasting Off Again: An Observational Study on Substance Use Content Exposure in Pokémon Twitch Streams.

Introduction: The Pokémon franchise has an array of media (i.e., TV series, movies, merchandise, and Trading Card Game) that has attracted global youth and adults since its creation in 1996. Specifically, users have been known to discuss, promote, and purchase Pokémon Trading Card Game on the livestreaming platform Twitch. However, Pokémon Trading Card Game livestreaming content may also include potentially harmful content for youth and adolescents, such as depictions of substance use. Hence, the objective of this study was to assess whether popular Twitch Pokémon Trading Card Game content and influencers promote substance use topics and behavior. Methods: This study was conducted in 3 phases: (1) data mining on 2 Twitch data aggregation websites (Sullygnome.com and TwitchTracker.com) within the Pokémon Trading Card Game category; (2) data filtering using keywords through a snowball sampling strategy on the title of a Twitch stream; and (3) content coding using the WHO protocol on Internet Monitoring of Marketing of Unhealthy Products to Children and Adolescents for influencer and microinfluencer substance use marketing, including depictions of substance use or promotion of products on the streamer's profile. The authors also conducted an assessment of any underage moderation for Twitch livestreams. Results: A total of 1,025 highly active Pokémon Trading Card Game streamers were recruited and analyzed. The use and promotion of substance use in the form of alcohol, cannabis, or tobacco was detected in 25.07% (n=257) of these Pokémon Trading Card Game Twitch streamers. Frequent substance use detected was alcohol (90.27%, n=232), followed by polysubstance use (6.61%, n=17), cannabis (n=6, 2.33%), and tobacco (n=2, 0.78%). Content coding detected 3 general themes, with behavioral being the most observed. This included behavioral content of substance use for the specific reason of casual use (46.06%, n=228) and for intoxication (26.26%, n=130). In addition, close to three quarters (72.76%, n=187) of streamers' accounts did not prohibit underage access to account content or livestreams. Conclusions: In this study, the authors detected Twitch streamers violating Twitch community guidelines that may have exposed millions of youths and young adults in the Pokémon Trading Card Game category to different depictions of substance use. Although Twitch prohibits monetary gain in exchange for posting substance use content, the apparent lack of enforcement of Twitch community guidelines and the absence of age verification means that youth who enjoy Pokémon Trading Card Game content may also be exposed to content actively promoting substance use behaviors.