Title: Reducing population exposure to unhealthy commodity advertising: evaluation of the Bristol Advertising and Sponsorship Policy (pre-intervention Data Collection)
Funder: Department of Health and Social Care

Abstract: Aims of the Research: This research project aims to collect information on how much people in the city of Bristol and in South Gloucestershire see advertisements for unhealthy products such as junk foods and soft drinks, alcohol, and gambling. It also aims to find out how often they use these products. This is important because Bristol City Council will ban this sort of advertising in the city at the end of 2021. To be able to see if the ban had an effect we need to collect information before and after the ban. This research project will collect information before the ban and a larger study, which we hope to conduct in future, will collect further information after the ban. We will then compare the results between the before and after groups._x000D_ Background of the Research: Research has shown that the more people see adverts for unhealthy products the more they use them, and that this is especially the case for children and young people. People who are on lower incomes are exposed to more unhealthy adverts, including from bus stops and billboards in their neighbourhoods. Some research also suggests that if these adverts are removed, this has a positive effect on people’s behaviours. In 2019 the Mayor of London brought in a new policy to ban adverts for foods and drinks high in fat, sugar and/or salt at any places in London owned by Transport for London (Tfl). A first assessment of this policy shows positive effects on people buying less of the unhealthy products. Bristol City Council will start a similar advertisement ban at the end of 2021, but it will also include alcohol and gambling. This will be the first policy like this outside London. _x000D_ Design and methods used: A survey will be sent to people living in Bristol. It will collect information on exposure to the advertising of unhealthy products and the use of those products. The same survey will be sent to people living in South Gloucestershire so we can compare with a similar area nearby that does not have the same ban. We can then repeat the survey after the ban has started so that we can compare before-and-after results. We will also collect photos and Google Street View images from all advertisement sites that will be affected by the ban, as well as those in the area without the ban, so that we can compare real changes in a future evaluation study. Lastly, we will interview people who designed and planned the policy about how it was made and put into practice. _x000D_ Patient and public involvement: This research proposal has been designed with input from the PPI Lead of NIHR Applied Research Collaboration West (ARC West) and with a member of the ARC West PPI group with an interest in this topic. She has agreed to be a co-applicant for this work. She will help with study design, design of the survey, attend study management meetings, and will be active in any publishing of results. If a full evaluation is to be carried out, she will continue to lead the PPI group._x000D_ Publication of results: We expect the main results in the second study after the ban. However, we will use the information from this first study to find out more about exposure to unhealthy advertising and different incomes or ethnicities in Bristol and South Gloucestershire.

Lay abstract: Background: The exposure of people, especially children and young people, to advertisements of unhealthy commodities is recognised as a risk factor for the development of non-communicable diseases, and gradients of such advertisement exposures across deprivation and ethnicity contribute to health inequalities. Outdoor public spaces are important locations for advertisements, and there is some evidence that bans on advertisements of unhealthy commodities here can have positive impacts on public health, including from evaluation of the impact of the 2019 ban on High Fat, Sugar and Salt (HFSS) foods and drinks advertisement by Transport for London (TfL). Bristol City Council will bring in a comparable ban to the one by TfL, but with a wider remit also including alcohol and gambling; this will be the first such policy outside of London. To conduct a scientifically robust evaluation of this policy, it is essential to prospectively collect baseline data on exposure to advertisements and related consumption before the ban is implemented, so that it can be directly compared with similarly collected post-policy data. _x000D_ Aims and objectives: The research aims to collect baseline data on exposure to advertisements of unhealthy commodities and consumption of such products in outdoor spaces in Bristol (pre-implementation of the new policy) and in the control area of South Gloucestershire, to inform a future pre/post full evaluation of the policy. In addition, the research aims to collect insights into rationale and development of the policy, its intended and perceived impacts, and barriers and facilitators to its implementation._x000D_ Methods: A future full evaluation will have a controlled repeated cross-sectional (pre-post) design, with some repeated measures. In the current research pre-implementation self-reported data on exposure to advertisement of HFSS foods and beverages, alcohol and gambling and use of such products will be collected through a population survey in Bristol and South Gloucestershire populations. In addition, exposure data will be collected through photographs and Google Street View images of the advertisement sites in Bristol and the control area. Interviews with stakeholders involved in the development or implementation of the policy will be conducted and analysed using structured framework analysis. PPI has been embedded throughout the project and informed the current proposal. A dedicated PPI Lead co-applicant will be part of the research team. A Study Steering Group has been established with an independent Chair and contributors from PHE and SUSTAIN._x000D_ Timelines for delivery: The baseline data collection project will be conducted in a 6-month period (Nov’21-April’22) with the survey being done in November and focus group and structured interviews across November-February. _x000D_ Anticipated impact and dissemination: The data in this research will constitute the pre-implementation data for a future full evaluation (which will be submitted to the NIHR Public Health Research Board in 2022), which is when impact is anticipated. The baseline data and stakeholder interviews will inform a mixed-methods manuscript exploring health inequalities in relation to advertisement exposures in the context of the rationale and development of the policy and its intended impacts.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE