Tobacco imagery in popular films in China from 2001 to 2020: a declining trend.

BACKGROUND: Exposure to tobacco imagery in films can result in tobacco use among adolescents and young adults. Efforts have been made to limit tobacco imagery in films in China. Our study investigates the level and trend of tobacco imagery in popular films in China from 2001 to 2020. METHODS: The running time of the 20 top-grossing films in China annually from 2001 to 2020 was divided into 5 min intervals, and those containing tobacco imagery were coded for the following aspects: country of origin, presence of warning, presence of minors and the presence of tobacco brands. RESULTS: We coded 9423 five-minute intervals across 400 films. Tobacco imagery occurred in 1344 intervals across 239 films. There was a declining trend in the proportion of films (r=-0.515, p=0.022) and the proportion of intervals (r=-0.004, p<0.001) with tobacco imagery over time. None of the films with tobacco imagery contained a warning for their audience against smoking. Chinese films contained more tobacco imagery than international films, and tobacco imagery related to minors and tobacco brands were present despite regulations. CONCLUSION: Tobacco imagery remains in films in China. The relevant authorities and film producers should ban films with tobacco imagery in China; for example, they should ban films with tobacco imagery from participating in awards, add warnings to films with tobacco imagery and give films containing tobacco imagery a default 'R' classification.