Changes in tobacco imagery and smokers' depiction in Spanish top-grossing films before and after the implementation of a comprehensive tobacco control policy in Spain

INTRODUCTION As more restrictions on tobacco marketing communication are implemented, tobacco marketing has persisted through smoking in films. Our aims were to assess changes in tobacco imagery exposure in Spanish top-grossing films before and after the banning of tobacco advertising in Spain, and to determine whether the depiction of smoking characters has changed over the years.METHODS A repeated cross-sectional study measured the tobacco content in the 10 Spanish top-grossing films in 2005, 2010 and 2015 (n=30) before and after a complete tobacco advertising ban. We conducted a descriptive and regression analysis of changes in tobacco impressions by year.RESULTS The 30 films contained 1378 tobacco occurrences (90.2% positive for tobacco) with a median length of eight seconds onscreen. Total tobacco occurrences deemed positive for tobacco interests significantly increased in 2010 and 2015 compared to 2005. However, we observed decreased odds of tobacco brands appearances (OR=0.25; p<0.001) in 2010 and of implied tobacco use (OR=0.44; p=0.002), and tobacco brands appearances (OR=0.36; p<0.001) in 2015 compared to 2005. There was a change of pattern in the type of role smokers played from a leading role to a supporting one (p<0.001). The population reach of positive for tobacco occurrence in Spanish top-grossing films decreased from 15.9 (95% CI: 15.86-15.86) per 1000 spectators in 2005 to 0.8 (95% CI: 0.82-0.82) in 2015.CONCLUSIONS The implementation of a ban on complete tobacco product advertising was followed by a decrease in tobacco incidents across top-grossing Spanish films. Yet, exposure to smoking in films is still unacceptably high.