Background/Objectives: To describe the perception of anti-smoking campaigns and pro-tobacco advertising among people who smoke in Spain in 2016, 2018 and 2021.

Methods: Repeated cross-sectional study of a nationally representative sample of adults who smoke. Information on noticing anti-smoking campaigns (information about the dangers of smoking or encouraging quitting) and pro-tobacco advertising (things that promote smoking) in the last 6 months was described by type of medium or site, sociodemographic and smoking-related variables, using prevalence ratios (PR) and 95% confidence intervals (CI) estimated with Poisson regression models adjusted for sex, age and educational level.

Results: The prevalence of noticing pro-tobacco advertising was higher than that of noticing anti-smoking campaigns in 2016 (37.7%, 95%CI 31.9-44.0%; vs. 31.5%, 95%CI 36.6-48.3%) and 2018 (47.5%, 95%CI 41.7-53.4%; vs. 42.3%, 95%CI 36.6-48.3%), but the opposite was true in 2021 (23.9%, 95%CI 19.4-29.0%; vs. 38.0%, 95%CI 32.9-43.5%). Noticing anti-smoking campaigns was more common than noticing pro-tobacco advertising on TV, radio, newspapers, social media, the internet and billboards throughout the years, except for billboards in 2016. A significant decrease in noticing anti-smoking campaigns between 2016 and 2021 was observed for TV (PR 0.43; 95%CI 0.30-0.60), radio (PR 0.38; 95%CI 0.21-0.71) and newspapers (PR 0.39; 95%CI 0.25-0.60). Conversely, a significant increase in noticing pro-tobacco advertising was observed between 2016 and 2021 on TV (PR 1.22; 95%CI 1.07-1.39), radio (PR 1.12; 95%CI 1.05-1.18), newspapers (PR 1.09; 95%CI 1.03-1.15), billboards (PR 1.08; 95%CI 1.01-1.15), and in bars/pubs (PR 1.41: 95%CI 1.25-1.60), outside and inside tobacco shops (PR 1.15; 95%CI 1.03-1.28 and PR 1.26; 95%CI 1.05-1.51, respectively) and social events (PR 1.30; 95%CI 1.19-1.41). While noticing anti-smoking campaigns in 2021 was higher among young people, those with high income, and those who smoke occasionally, no significant differences in noticing pro-tobacco campaigns were observed by any other socio-demographic or smoking-related variables.

Conclusions/Recommendations: People who smoke in Spain noticed anti-smoking campaigns more than pro-tobacco advertising in recent years. Nevertheless, a significant increase in pro-tobacco advertising was noticed in many media during these years. Stricter control of pro-tobacco advertising is needed.

Funding: Instituto de Salud Carlos III (grant PI17/01338, co-funded by European Regional Development Fund ERDF, a way to build Europe); Canadian Institutes of Health Research (grant FDN-148477); Government of Catalonia (2021SGR00906).