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 banning tobacco advertising in Spain and to determine whether the depiction of smoking characters has changed over the years. Material and Methods A repeated cross-sectional study measured the tobacco content in the 10 Spanish top-grossing films of each of the three years 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 1,378 tobacco occurrences [90.2% positive for tobacco] with a median length of eight seconds onscreen. Total positive for tobacco occurrences did not significantly increase in 2010 or 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 play from a leading role to a supporting one (p<0.001). 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 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.