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Background The United Kingdom (UK) fully-implemented standardised packaging for cigarettes and rolling tobacco on 20th May 2017. We explore adolescent’s awareness of, and responses to, standardised cigarette packaging in the UK after it became mandatory. Methods Eight focus groups were conducted in schools in Scotland with 16–17 year-olds ( n =  41), between November 2017 and November 2018, to explore awareness of, and responses to, standardised cigarette packaging. Unlike in Australia, where only straight-edged flip-top cigarette packs are permitted, in the UK standardised cigarette packs can have slim designs, and different edge types (straight, rounded or bevelled) and opening styles (flip-top or shoulder box). We explored how each of these pack formats was perceived. We also explored to what extent brand variant name differentiated cigarettes sold in standardised packaging. Results Most participants were aware of standardised packaging without being shown pack stimuli. Standardised packs were considered embarrassing and off-putting, and the health warnings salient. Among the standardised packs shown, there was a preference for the slimmer pack, viewed as more discrete and the cigarettes potentially less harmful, and the shoulder box, considered cool and different. Participants were interested in some brand variant names on standardised packs (e.g. Legendary Black), particularly those they considered to imply coolness and sophistication. Conclusion Adolescents consider standardised cigarette packs in the UK unappealing, and the warnings salient, two core aims of this measure. However, positive reactions to some of the standardised packs (slimmer pack, shoulder box), and variant names used, has implications for countries developing standardised packaging regulations.

ObjectivesAs tobacco companies can circumvent tax increases, a minimum retail price per-cigarette/per-gram of roll-your-own tobacco presents an additional mechanism for governments to reduce smoking. We examined (1) anticipated responses to a hypothetical minimum price-per-cigarette/per-gram among smokers in the UK; (2) what demographic and smoker characteristics are associated with anticipated responses; and (3) whether minimum pricing may help ex-smokers stay quit.DesignCross-sectional survey (May–July 2019).SettingUK.ParticipantsAdult cigarette smokers (n=2412) and ex-smokers (n=700).Main outcome measurementsAnticipated responses to a hypothetical minimum price of £10.00 for 20 cigarettes (£0.50 per-cigarette) and £13.50 for 30 grams of roll-your-own tobacco (£0.45 per-gram); approximately £0.10 per-cigarette/per-gram increases on the cheapest prices in leading UK supermarkets (January 2019). Smokers were presented with ten options (eg, ‘Try to quit’) and asked which they would do (Yes/No) and then which they would most likely do. Ex-smokers were asked to what extent the minimum prices would help them stay quit (A lot vs Lesser agreement).ResultsAmong smokers, 55.6% said they would most likely smoke the same amount, 10.7% they would smoke less, 9.5% they would try to quit and 5.8% they would use e-cigarettes more often. Anticipated reactions were associated with demography and smoker characteristics, for example, C2DE (lower social grade) smokers were less likely than ABC1 (higher social grade) smokers to say they would smoke the same as they do now (ORAdj=0.74, 95% CI 0.62 to 0.88). Among ex-smokers, 38.5% said the minimum prices would help them stay quit ‘A lot’, more so among C2DE than ABC1 participants (ORAdj=1.80, 95% CI 1.30 to 2.49).ConclusionsIn response to a hypothetical minimum price for cigarettes and roll-your-own tobacco, approximately a fifth of smokers in the UK indicated they would smoke less or quit and almost two-fifths of ex-smokers indicated the prices would help them stay quit.

Background To explore continuities and changes in gambling behaviour during the COVID-19 pandemic and the factors that influenced these among a sample of regular sports bettors. Methods A longitudinal qualitative study using in-depth interviews. Sixteen sports bettors living in Britain took part in the first interviews in July-November 2020, and 13 in the follow-up interviews in March-September 2021. Results Individual patterns of gambling were episodic: it was common for gambling to increase during some periods of the pandemic and to decrease during others, reflecting the dynamic and (often) challenging circumstances which people were living through at the time. Changes and continuities in gambling during the pandemic were influenced by a range of factors which we have grouped into two main themes relating to ‘gambling and the sports landscape’ and ‘disruption to day-to-day life’. It was common for a constellation of factors to influence gambling behaviour rather than a single factor. These constellations of factors varied from person to person and at different times during the pandemic. Conclusions Findings of the present study are consistent with earlier literature examining gambling careers before the advent of COVID-19 showing that gambling trajectories are non-linear. Our research suggests that ‘typical’ patterns of gambling behaviour (e.g. being episodic), and the broader known risk and protective factors within individuals, families, communities and societies have been amplified during the pandemic. Findings highlight the adaptability of the gambling industry to continue to reach consumers through product offerings and marketing even in a period of unprecedented restrictions on supply, and show the potential resulting harms of these actions among gamblers at risk of experiencing gambling problems. Taken together, findings from this study provide important new insights relevant to discussions about gambling regulation, and support calls for multifaceted and comprehensive policy, regulatory, and treatment approaches, to minimise gambling-related harms.

Research on alcohol warnings has increased in the last decade, providing key evidence to governments on warning format and contents. The bulk of this research, however, has been conducted in Anglosphere countries, whereas fewer studies have focused on other countries which have high per capita alcohol consumption, and where the high social acceptability of drinking is liable to affect how people accept and react to prevention measures. Since France has one of the highest per capita alcohol consumption rates in the world according to the World Health Organization (WHO), we therefore explore how young adults in France react to warnings on alcoholic beverage advertisements. We conducted 25 in-depth interviews, in 2017, with 18–25-year-old drinkers in France. Respondents were asked open-ended questions on the perceived impact of various warning contents (i.e., on health risk, social-cost risk, and on short- vs. long-term risk) and formats (text only vs. larger text combined with colored pictograms). Warnings that targeted youth-relevant risks (i.e., road accidents or sexual assault) were considered to be the most meaningful and credible, although warnings communicating longer term risks (i.e., brain, cancer) were also thought to be influential. Less familiar risks, such as marketing manipulation and calorie intake, elicited the most negative reactions. Larger text-and-pictogram warnings were considered to be the most effective format in capturing attention and increasing awareness. Regardless of format and content, however, these warnings were not perceived as effective for decreasing alcohol consumption.

Background Recent regulatory changes in the system by which premises are licensed to sell alcohol, have given health representatives a formal role in the process in England and Scotland. The degree to which local public health teams engage with this process varies by locality in both nations, which have different licensing regimes. This study aims to critically assess the impact on alcohol-related harms - and mechanisms - of public health stakeholders’ engagement in alcohol premises licensing from 2012 to 2018, comparing local areas with differing types and intensities of engagement, and examining practice in Scotland and England. Methods The study will recruit 20 local authority areas where public health stakeholders have actively engaged with the alcohol premises licensing system (the ‘intervention’) and match them to a group of 20 lower activity areas using genetic matching. Four work packages are included: (1) Structured interviews and documentary analysis will examine the type and level of intervention activity from 2012 to 2018, creating a novel composite measure of the intensity of such activity and will assess the local licensing system and potential confounding activities over the same period. In-depth interviews with public health, licensing, police and others will explore perceived mechanisms of change, acceptability, and impact. (2) Using longitudinal growth models and time series analyses, the study will evaluate the impact of high and low levels of activity on alcohol-related harms using routine data from baseline 2009 to 2018. (3) Intervention costs, estimated National Health Service cost savings and health gains will be evaluated using the Sheffield Alcohol Policy Model to estimate impact on alcohol consumption and health inequalities. (4) The study will engage public health teams to create a new theory of change for public health involvement in the licensing process using our data. We will share findings with local, national and international stakeholders. Discussion This interdisciplinary study examines, for the first time, whether and how public health stakeholders’ involvement in alcohol licensing impacts on alcohol harms. Using mixed methods and drawing on complex systems thinking, it will make an important contribution to an expanding literature evaluating interventions not suited to traditional epidemiological research.

While passage of the bill into law was undoubtedly a crucial step, the intended public health benefits of the Act, to both individuals and wider society, will only be fully realised once all measures have commenced. [...]research with young adults in France, where a similar policy already exists under the Évin law, has found that removing characters and wider context, as is broadly proposed in Ireland, reduces the attractiveness of alcohol advertising and limits the potential behavioural impact (Gallopel-Morvan et al., 2022). [...]a study of health information in digital alcohol marketing in Ireland found that marketing rarely contained consumer protection messages, and none contained explicit health warnings or references to independent sources of public health information about alcohol (Critchlow and Moodie 2022). [...]brand sharing’ or ‘alibi marketing’ has already been documented on public transport and within the sporting area during events, both places where advertising for regular strength products is now prohibited (Critchlow et al., 2022; Harrison, 2023).

According to the legislation, however, the display of such brand iconography is only interpreted as alcohol advertising in circumstances where it may ‘reasonably be regarded’ as a recommendation of the (alcohol) product to the public. Clarification concerning zero-alcohol products also has implications for enforcing other parts of the Act. Since November 2021, Sect. 15 has made it an offence to advertise alcohol in or on a sports area during a sports event (e.g., logos on the pitch or sports track) [1]. [...]during matches played in Ireland as part of the 2022 Six Nations Championship, for which Guinness is the lead sponsor, the goalpost covers have displayed branding for Guinness 0.0% [8, 9]. Since November 2020, Sect. 22 of the Act has also required mixed retailers (e.g., supermarkets, convenience stores, etc.) to physically segregate alcohol products and associated advertising from non-alcohol products [1]. N.C has received funding to examine the nature, impact, and regulation of alcohol marketing from Alcohol Focus Scotland, Alcohol Action Ireland, Cancer Research UK, the Institute of Alcohol Studies, the National Institute for Health and Care Research, and Scottish Health Action on Alcohol Problems.

Exposure to marketing for foods high in fat, salt or sugar (HFSS) reportedly influences consumption, nutritional knowledge and diet-related health among adolescents. In 2018/2019, the UK government held two consultations about introducing new restrictions on marketing for HFSS foods. To reinforce why these restrictions are needed, we examined adolescents' awareness of marketing for HFSS foods, and the association between past month awareness and weekly HFSS food consumption. Cross-sectional survey that measured past month awareness of ten marketing activities for HFSS foods (1 = everyday; 6 = not in last month). Frequencies were converted into aggregate past month awareness across marketing activities and grouped into three categories (low/medium/high). Consumption was self-reported for fifteen foods (twelve HFSS) (1 = few times/d; 9 = never). For each food, frequency was divided into higher/lower weekly consumption. United Kingdom. 11-19-year-olds (n 3348). Most adolescents (90·8 %) reported awareness of a least one marketing activity for HFSS foods, and at least half reported seeing ≥70 instances in the past month. Television, social media and price offers were the marketing activities most frequently reported. Awareness was associated with higher weekly consumption for ten of the twelve HFSS foods. For example, those reporting medium marketing awareness were 1·5 times more likely to report higher weekly consumption of cakes/biscuits compared with those reporting low awareness (AOR = 1·51, P = 0·012). The likelihood of higher weekly HFSS food consumption increased relative to the level of marketing awareness. Assuming there is a causal relationship between marketing awareness and consumption, the restrictions proposed by the UK government are likely to help reduce HFSS consumption.

IntroductionAs a result of the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive, all packs of cigarettes (factory-made and hand-rolled) in the UK must be drab brown, display pictorial warnings on the principal display areas and contain no less than 20 cigarettes or 30 g of tobacco. The legislation was phased in between May 2016 and May 2017. Our objective was to monitor pack, brand and product changes preimplementation and postimplementation.MethodsOur surveillance of the cigarette market involved a review of the trade press, a monthly monitor of online supermarkets and regular visits to stores, from May 2015 to June 2017.ResultsBefore standardised packaging there were changes to the pack graphics (eg, redesigned packs and limited editions) and pack structure (eg, resealable inner foil) and the issue of a number of reusable tins. After standardised packaging, changes included newer cigarette pack sizes for some brand variants (eg, 23 and 24 packs). Changes to the branding prestandardised packaging included brand extensions, and poststandardised packaging included brand and/or variant name change, often with the inclusion of colour descriptors and brand migrations. Product changes prestandardised packaging included the introduction of novel filters (eg, filters with two flavour-changing capsules, tube filters, firmer filters and filters with granular additives). There was non-compliance with the legislation, with slim packs, which are not permitted, on sale after standardised packaging was implemented.ConclusionsOur findings highlight the need to monitor developments in markets introducing standardised packaging and have policy implications for countries considering this measure.