AbstractBackgroundExposure to alcohol, tobacco and foods high in fat, sugar or salt (HFSS) content in media is a risk factor for smoking, alcohol use and HFSS consumption in young people. We report an analysis of tobacco, alcohol and HFSS content in a sample of reality TV programmes broadcast on TV and video-on-demand services throughout a 1-year period.MethodsWe used 1-min interval coding to quantify content in all episodes of 20 different reality TV programmes between August 2019 and August 2020 and estimated population exposure to a sample of these programmes using viewing data and UK population estimates.ResultsWe coded 13 244 intervals from 264 episodes. Tobacco content appeared in 227 intervals (2%) across 43 episodes (2%), alcohol in 5167 intervals (39%) across 258 episodes (98%) and HFSS in 1752 intervals (13%) across 234 episodes (88%). A sample of 15 series delivered ~157.4 million tobacco, 3.5 billion alcohol and 1.9 billion HFSS gross impressions to the UK population, including 24 000, 12.6 million and 21.4 million, to children, respectively.ConclusionTobacco, alcohol and HFSS content are common in reality TV programmes. These programmes deliver exposure to tobacco, alcohol and HFSS imagery, which are a potential driver of tobacco use, alcohol use and HFSS consumption in young people.