Background:
Tobacco consumption is a critical concern in populous low-income countries, like India. The social acceptability of tobacco perpetuates its use: the positive portrayal of tobacco in the media has been associated with increased consumption of tobacco. Hence, to counter the pro-tobacco imagery in the visual media, the Government of India modified its tobacco control law in 2011/2012, called as "Film Rule", requiring film theaters and television channels to screen pre-approved anti-tobacco public service announcements and a disclaimer at the beginning and during the middle of programs when tobacco consumption is depicted; and, health warning scrolls on screen while tobacco is in use onscreen.

Methods:
Four studies were undertaken to monitor the genesis, implementation and effectiveness of the Rule. First, a news media analysis in the lead up the implementation of the Film Rule identified industry arguments against the Rule. Two observational studies, including exit interviews of cinema-goers, monitored the implementation and effectiveness of the Rule. Finally, legal research identified legal loopholes and opportunities.

Results:
Findings from this comprehensive set of studies identified standard arguments against the Rule - such as impingement of creative freedom, arguments that health warnings are ineffective - and provide guidance for addressing these attacks preemptively. The observational studies identified over 80% compliance with the Film Rule in film theaters but less than 10% compliance by television channels. Exit interviews among film-goers also found positive impact among those exposed to anti-tobacco messaging. Legal research identified strengths in the current law, enabling implementation, and opportunities for its advancement within existing media laws and procedures.

Conclusions:
The Film Rule is a novel health financing mechanism for sustained mass media campaigns at low (or no) cost to governments. Our studies show positive impact of the Rule and offer valuable lessons for strengthening the law within India and for other countries considering similar approaches.