Background: Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. We report an analysis of tobacco and alcohol content, and estimates of population exposure to this content, in a sample of reality 6television programmes broadcast in the UK. Methods: We used one-minute interval coding to quantify tobacco and alcohol content in all episodes of five reality TV programmes aired between January and August 2018 (Celebrity Big Brother; Made in Chelsea ; The Only Way is Essex ; Geordie Shore and Love Island), and estimated population exposure using viewing data and UK population estimates. Results: We coded 5219 intervals from 112 episodes. Tobacco content appeared in 110 (2%) intervals in 20 (18%) episodes, and alcohol in 2212 (42%) intervals and in all episodes. The programmes delivered approximately 204 million tobacco gross impressions to the UK population, including 48.26 million to children; and for alcohol, 5.4 billion and 593 million respectively. Conclusion: Tobacco, and especially alcohol, content is common in reality TV. The popularity of these programmes with young people, and consequent exposure to tobacco and alcohol imagery, represents a potentially major driver of smoking and alcohol consumption
