Evaluating the effectiveness of policies and natural experiments

Work Package Leader: Tessa Langley, University of Nottingham

Aim: To assess the effect of existing and emerging policies designed to reduce consumption of unhealthy commodities.

Objectives are to:

• Investigate the effects of tobacco and alcohol policies on product diversity, price and consumption using a standardised framework, and to extend the framework to food policy;
• Identify strategies used to circumvent advertising restrictions, and potential inadequacies of existing regulatory approaches related to unhealthy commodity imagery in the media;
• Evaluate implementation of tobacco and alcohol treatment in the healthcare system.

Methods and Data Sources: We will extend an established analytic framework developed to evaluate population-level policy effects (such as those from standardised packaging on tobacco product pricing, diversification and consumption) to investigate other tobacco and alcohol policy interventions, such as Minimum Unit Pricing for alcohol in Scotland and increased UK excise tax on tobacco. Changes in behaviour will be evaluated using nationally representative surveys (including WP3 data) and analysis of primary care medical records. Market developments, purchasing behavior and pricing will be assessed using the Nottingham Online Price Database (a real-time online tobacco and alcohol supermarket price tracker), and commercial sales data from Nielsen and Kantar Worldpanel. We will also begin developing this approach to investigate the effect of policies directed at ultra-processed food and drinks on price, sales and consumption.

We have established semi-quantitative methods to measure imagery related to tobacco and alcohol products and consumption in the entertainment media. We will apply these methods to: document alcohol, tobacco and food imagery in popular terrestrial and video-on-demand television, music videos, film and other conventional and new media; explore the extent to which unhealthy commodity brands and consumption are promoted and/or normalised through inclusion in media consumed by children and young adults; quantify this exposure based on viewing figures; and identify failings in current regulations intended to prohibit or restrict such exposure.

We will use routinely-collected data to evaluate implementation of smoking cessation and alcohol interventions in NHS care in England, in relation to targets specified in the 2017 Tobacco Control Plan and the 2014 NHS Five-Year Forward View. Data sources will include Stop Smoking Services returns, Quality Outcomes Framework data, primary care records (using the Health Improvement Network (THIN) and/or Clinical Practice Research Datalink (CPRD) databases), Hospital Episode Statistics, Smoking at the Time of Delivery and other datasets. We will evaluate ascertainment of tobacco and alcohol use in NHS patients, delivery of interventions, and where possible outcomes; and compare data by region to identify exemplar areas of success. Where relevant, this WP will be supported by qualitative research to understand whether and how policies are being implemented and why they are or are not having the intended effect.