BackgroundExposure to tobacco and alcohol imagery in films is strongly associated with uptake and consumption of both tobacco and alcohol in young people. In an analysis of popular UK films over the 20 years from 1989 to 2008, we have previously documented substantial tobacco and alcohol content in films marketed to children and young people. In view of increasing awareness of the potential harm of this exposure, this study was undertaken to assess whether these exposures continue to be prevalent in more recent films, by analysing the most popular films in the years 2009–11. MethodsOccurrence of tobacco (tobacco use, implied use, tobacco paraphernalia, and tobacco brand appearances) and alcohol (alcohol use, inferred alcohol use, other alcohol reference, and alcohol brand appearances) imagery was measured by 5-min interval coding in the 15 most commercially successful films in the UK in each year from 2009 to 2011. Each 5-min period of film was coded as positive for each category of tobacco or alcohol imagery, or both, if at least one such incident occurred during the 5-min period. FindingsAll of the 45 most popular films for 2009–11 were rated by UK film classifiers as suitable for youth audiences (those aged younger than 18 years). Any tobacco was present in a third of all films (15 of 45), whereas any alcohol was present in more than four-fifths (37 of 45 [82%]). Tobacco use occurred in 11 films, and alcohol use occurred in 26. Tobacco branding was infrequent, but two brands, Marlboro and K & J, were clearly identifiable. Alcohol branding was far more frequent, occurring in 22% (ten of 45) of films, with the most frequently occurring brands being Jagermeister, Singha, and Budweiser. When combined with earlier findings using the same methods in films from 1989 to 2008, tobacco was present in 65% (225 of 345) of films, and alcohol in 86% (295 of 345) of films. Tobacco content in each of the coded categories decreased between 1989 and 2010, but increased again in 2011, largely as a result of two films: The King's Speech and Sherlock Homes: a Game of Shadows. Alcohol content fluctuated over the 23 years, without any significant decline overall (p>0·05). Overall, the most commonly represented tobacco brands were Marlboro, Silk Cut, and Embassy, and the most common alcohol brands were Budweiser, Miller, and Coors. InterpretationAlthough conventional tobacco promotion is heavily restricted in the UK, tobacco imagery continues to be evident in films classified for and popular with youth audiences. The amount of tobacco content in films has decreased over the years but increased again in 2011. Alcohol advertising and promotion remains largely self-regulated in the UK, and there has been no appreciable reduction in any alcohol depictions in youth classified films. UK film regulators are aware of the effects of film content on youth audiences, but in practice do not seem to consider either tobacco or alcohol imagery in the age classification process of films suitable for young people. FundingThis research was done as part of the research undertaken by AL as part of a research fellowship funded by the UK Centre for Tobacco Control Studies, which is a UKCRC Centre of Public Health Research Excellence. Funding was from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, and the Department of Health.