{
  "abstract": "Background In 2021, Bristol became the first city outside London to introduce a policy to restrict advertisements of high fat, salt and sugar (HFSS) products and other unhealthy commodities (alcohol, gambling and payday loans) on council-owned sites. This research explored how the policy was implemented and evaluated its impact on exposure, consumption/use of these products, and household purchasing of HFSS products.Methods Twenty-two semi-structured interviews with council employees (n=12), stakeholders from third sector organisations (n=5), industry (n=3) and government organisations (n=2) were carried out.We collected advertisement exposure information through in-person auditing pre- and post-implementation (n= 348 sites).We further conducted a repeated cross-sectional survey of exposure and consumption of residents of Bristol (intervention) and South Gloucestershire (comparator) before (n=2543) and after (n=2076) implementation. We also analysed 2020–23 timeseries of purchased foods and drinks by Bristol households (n=217) and three control areas (Cardiff, Gloucestershire, and Sheffield; n=795) using Kantar’s Worldpanel Take Home data.Results Widespread cross-council support for the policy facilitated its implementation. Interviewees stated that this policy acted as a springboard for further restrictions influencing other local authorities to adopt a similar policy and that the policy is part of a systemwide approach to improve public health. Interviewees stated that the policy would benefit from stronger internal auditing processes to prevent policy violations and that it could be extended to restrict high carbon products and potentially include additional advertising spaces.Unhealthy commodities advertisement exposure reduced in Bristol (11% to 0.8%) but increased in the comparator (0.9% to 18%). There was no measurable impact of the policy on consumption/use of unhealthy commodities, although the overall direction of results suggested a potential reduction. There were also no significant differences in household weekly energy purchased from HFSS products compared to the counterfactual (+897.6 kcal, 95% CI-57.7, 1,853.0), nor for fat, sugar or salt specifically.Conclusion There was no evidence of a measurable impact of the policy on purchasing or consumption of unhealthy products, which can be explained by the small change in exposure; only ~30% of outdoor advertising space is owned by the Council (with only 11% advertising unhealthy commodities pre-policy).Although the policy was always intended as part of a system change rather than a stand-alone policy, lessons for other local authorities intending to pursue similar policies include cross-department communication during conceptualisation and implementation, and incorporating continued learnings from other local authorities, as well as an improved internal auditing system.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK",
        "NIHR Applied Research Collaboration West, ARC West, Bristol, UK"
      ],
      "name": "Frank de Vocht"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Genevieve Buckland"
    },
    {
      "affiliations": [
        "NIHR Applied Research Collaboration West, ARC West, Bristol, UK"
      ],
      "name": "Sarah Harding"
    },
    {
      "affiliations": [
        "Obesity Institute, Leeds Beckett University, Leeds, UK"
      ],
      "name": "James Nobles"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK",
        "NIHR Applied Research Collaboration West, ARC West, Bristol, UK"
      ],
      "name": "Russell Jago"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK",
        "NIHR Applied Research Collaboration West, ARC West, Bristol, UK"
      ],
      "name": "Jeremy Horwood"
    },
    {
      "affiliations": [
        "NIHR Applied Research Collaboration West, ARC West, Bristol, UK"
      ],
      "name": "Carlos Sillero Rejon"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK",
        "NIHR Applied Research Collaboration West, ARC West, Bristol, UK"
      ],
      "name": "William Hollingworth"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments Society, London School of Hygiene Tropical Medicine, London, UK"
      ],
      "name": "Steve Cummins"
    },
    {
      "affiliations": [
        "Department of Public Health, Environments Society, London School of Hygiene Tropical Medicine, London, UK"
      ],
      "name": "Amy Yau"
    },
    {
      "affiliations": [
        "School for Policy Studies, University of Bristol, Bristol, UK"
      ],
      "name": "Sarah Blake"
    },
    {
      "affiliations": [
        "Bristol Hub for Gambling Harms Research, University of Bristol, Bristol, UK"
      ],
      "name": "Agnes Nairn"
    },
    {
      "affiliations": [
        "School for Policy Studies, University of Bristol, Bristol, UK"
      ],
      "name": "Zoi Toumpakari"
    }
  ],
  "title": "OP27 Implementation and evaluation of the impact of the new unhealthy commodities outdoor advertising restrictions policy in Bristol: a natural experiment evaluation",
  "uid": "fb17d8e8-6c0d-5bda-90d7-4f113d4f484b"
}