How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviews

Is minimum unit pricing for alcohol having the intended effects on alcohol consumption in Scotland?

BACKGROUND AND AIMS

The Scottish Government introduced minimum unit pricing (MUP) for alcohol on 1 May 2018. This means retailers in Scotland cannot sell alcohol to consumers for less than £0.50 per unit (1 UK unit = 8 g ethanol). The Government intended the policy to increase the price of cheap alcohol, cut alcohol consumption overall and particularly among those drinking at hazardous or harmful levels, and ultimately reduce alcohol-related harm. This paper aims to summarise and assess the evidence to date evaluating the impact of MUP on alcohol consumption and related behaviours in Scotland.

ARGUMENT

Evidence from analyses of population-level sales data suggest, all else being equal, MUP reduced the volume of alcohol sold in Scotland by ~ 3.0% to 3.5%, with the largest reductions affecting cider and spirits sales. Analyses of two time series datasets on household-level alcohol purchasing and individual-level alcohol consumption suggest reductions in purchasing and consumption among those drinking at hazardous and harmful levels, but offer conflicting results for those drinking at the most harmful levels. These subgroup analyses are methodologically robust, but the underlying datasets have important limitations as they rely on non-random sampling strategies. Further studies identified no clear evidence of reduced alcohol consumption among those with alcohol dependence or those presenting to emergency departments and sexual health clinics, some evidence of increased financial strain among people with dependence and no evidence of wider negative outcomes arising from changes in alcohol consumption behaviours.

CONCLUSIONS

Minimum unit pricing for alcohol in Scotland has led to reduced consumption, including among heavier drinkers. However, there is uncertainty regarding its impact on those at greatest risk and some limited evidence of negative outcomes, specifically financial strain, among people with alcohol dependence.

Local Government Stakeholder Perceptions of Legitimacy and Conflict of Interest: The Alcohol Industry and the "Drink Free Days" Campaign in England

BACKGROUND

Industry involvement in alcohol policy is highly contentious. The Drink Free Days (DFD) campaign (2018- 2019) run by Public Health England (PHE), an executive agency of government, and Drinkaware, an industry-funded 'alcohol education charity' to encourage middle-aged drinkers to abstain from drinking on some days was criticised for perceived industry involvement. We examine the extent to which the DFD campaign was supported by local-authority Directors of Public Health (DPHs) in England - which have a statutory remit for promoting population health within their locality - and their reasons for this.

METHODS

Our mixed-methods approach included a stakeholder mapping, online survey, and semi-structured interviews. The stakeholder mapping provided the basis for sampling survey and interview respondents. In total, 25 respondents completed the survey, and we conducted 21 interviews with DPHs and their local authority (LA) representatives. We examined survey responses, and coded free-text survey and interview responses to identify key themes.

RESULTS

While some respondents supported the DFD campaign, others did not promote it, or actively opposed it, due mainly to concerns about conflicts of interest and the legitimacy of industry involvement in the campaign. These were considered to undermine PHE's independence and deflect attention from more important, evidence-based policy interventions such as alcohol pricing while conferring vicarious credibility on Drinkaware. We also found low levels of knowledge about alcohol-related harm, the effectiveness of different policies to address these and the policy-influencing strategies used by the alcohol industry.

CONCLUSION

The findings highlight the dangers of industry partnership and potential conflicts of interest for government agencies and the ineffectiveness of the campaigns they run at local and national levels. They demonstrate the need for caution in engaging with industry-associated bodies at all levels of government and are thus of potential relevance to studies of other health-harming industries and policy contexts.

Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods

Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.

Intended and unintended consequences of the implementation of minimum unit pricing of alcohol in Scotland: a natural experiment

Background

Scotland was the first country to implement minimum unit pricing for alcohol nationally. Minimum unit pricing aims to reduce alcohol-related harms and to narrow health inequalities. Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. This study comprised three components.

Objectives

This study comprised three components assessing alcohol consumption and alcohol-related attendances in emergency departments, investigating potential unintended effects of minimum unit pricing on alcohol source and drug use, and exploring changes in public attitudes, experiences and norms towards minimum unit pricing and alcohol use.

Design

We conducted a natural experiment study using repeated cross-sectional surveys comparing Scotland (intervention) and North England (control) areas. This involved comparing changes in Scotland following the introduction of minimum unit pricing with changes seen in the north of England over the same period. Difference-in-difference analyses compared intervention and control areas. Focus groups with young people and heavy drinkers, and interviews with professional stakeholders before and after minimum unit pricing implementation in Scotland allowed exploration of attitudes, experiences and behaviours, stakeholder perceptions and potential mechanisms of effect.

Setting

Four emergency departments in Scotland and North England (component 1), six sexual health clinics in Scotland and North England (component 2), and focus groups and interviews in Scotland (component 3).

Participants

Research nurses interviewed 23,455 adults in emergency departments, and 15,218 participants self-completed questionnaires in sexual health clinics. We interviewed 30 stakeholders and 105 individuals participated in focus groups.

Intervention

Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers.

Results

The odds ratio for an alcohol-related emergency department attendance following minimum unit pricing was 1.14 (95% confidence interval 0.90 to 1.44; p = 0.272). In absolute terms, we estimated that minimum unit pricing was associated with 258 more alcohol-related emergency department visits (95% confidence interval –191 to 707) across Scotland than would have been the case had minimum unit pricing not been implemented. The odds ratio for illicit drug consumption following minimum unit pricing was 1.04 (95% confidence interval 0.88 to 1.24; p = 0.612). Concerns about harms, including crime and the use of other sources of alcohol, were generally not realised. Stakeholders and the public generally did not perceive price increases or changed consumption. A lack of understanding of the policy may have caused concerns about harms to dependent drinkers among participants from more deprived areas.

Limitations

The short interval between policy announcement and implementation left limited time for pre-intervention data collection.

Conclusions

Within the emergency departments, there was no evidence of a beneficial impact of minimum unit pricing. Implementation appeared to have been successful and there was no evidence of substitution from alcohol consumption to other drugs. Drinkers and stakeholders largely reported not noticing any change in price or consumption. The lack of effect observed in these settings in the short term, and the problem-free implementation, suggests that the price per unit set (£0.50) was acceptable, but may be too low. Our evaluation, which itself contains multiple components, is part of a wider programme co-ordinated by Public Health Scotland and the results should be understood in this wider context.

Future work

Repeated evaluation of similar policies in different contexts with varying prices would enable a fuller picture of the relationship between price and impacts.

Trial registration

Current Controlled Trials ISRCTN16039407.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.

Sydney's 'last drinks' laws: A content analysis of news media coverage of views and arguments about a preventive health policy

INTRODUCTION

News media representation of preventive health policies can influence public discussion and political decision making, impacting policy implementation and sustainability. This study analysed news media coverage of the contested 'last drinks' alcohol laws in Sydney, Australia, to understand the arguments made by different 'actors' (stakeholders) regarding the laws and provide insights on how preventive health policies are positioned within media discourse.

METHODS

We identified print and online news media articles discussing the laws from 2014 to 2020. Content analysis was used to quantify the arguments made to justify support or opposition to the laws.

RESULTS

A total of 445 articles were included for analysis. Four hundred and thirty-five actors were identified, with industry actors mentioned most (213 times) followed by health actors (136 times). There were more quotes from opponents of the laws compared to supporters of the laws (57% vs. 25%). The proportion of media mentions reduced for supporters (34% in 2014 to 14% in 2020) while mentions increased for opponents (47% in 2014 to 73% in 2020). Supporters used arguments about crime, safety and health. Opponents of the laws focused on issues such as Sydney's 'night time economy' and negative impacts of the laws.

DISCUSSION AND CONCLUSIONS

Opponents of the laws strategically used the media to influence public debate. Opponents, including industry actors, also ignored the health impacts of alcohol and utilised campaign groups to advocate against the laws. These findings have implications for how governments and advocates communicate and build support for contested preventive health policies.

Media representations of opposition to the 'junk food advertising ban' on the Transport for London (TfL) network: A thematic content analysis of UK news and trade press

BACKGROUND

Advertising of less healthy foods and drinks is hypothesised to be associated with obesity in adults and children. In February 2019, Transport for London implemented restrictions on advertisements for foods and beverages high in fat, salt or sugar across its network as part of a city-wide strategy to tackle childhood obesity. The policy was extensively debated in the press. This paper identifies arguments for and against the restrictions. Focusing on arguments against the restrictions, it then goes on to deconstruct the discursive strategies underpinning them.

METHODS

A qualitative thematic content analysis of media coverage of the restrictions (the 'ban') in UK newspapers and trade press was followed by a document analysis of arguments against the ban. A search period of March 1, 2018 to May 31, 2019 covered: (i) the launch of the public consultation on the ban in May 2018; (ii) the announcement of the ban in November 2018; and (iii) its implementation in February 2019. A systematic search of printed and online publications in English distributed in the UK or published on UK-specific websites identified 152 articles.

RESULTS

Arguments in favour of the ban focused on inequalities and childhood obesity. Arguments against the ban centred on two claims: that childhood obesity was not the 'right' priority; and that an advertising ban was not an effective way to address childhood obesity. These claims were justified via three discursive approaches: (i) claiming more 'important' priorities for action; (ii) disputing the science behind the ban; (iii) emphasising potential financial costs of the ban.

CONCLUSION

The discursive tactics used in media sources to argue against the ban draw on frames widely used by unhealthy commodities industries in response to structural public health interventions. Our analyses highlight the need for interventions to be framed in ways that can pre-emptively counter common criticisms.

Co-regulation and alcohol industry political strategy: A case study of the Public Health England-Drinkaware Drink Free Days Campaign

This article examines the Drink Free Days (DFD) campaign run by Public Health England and the industry funded alcohol education charity, Drinkaware, in eight English regions in 2018-2019. More specifically, it examines uses, and usefulness, of the campaign to the alcohol producers which fund Drinkaware. It draws on 36 semi-structured interviews with policy actors and a framing analysis of industry social media accounts and news coverage of the campaign. Industry-associated bodies such as Drinkaware have been identified as key components of alcohol industry strategies to influence policy and shape the regulatory contexts in which they operate in three ways. First, funding such bodies forms part of corporate social responsibility programmes which allow companies to position themselves as legitimate policy actors and 'part of the solution' to alcohol related harms. Second, reliance on industry funding incentivises governments to co-operate with industry actors and provides leverage in policy debates. Third, their programmes absorb policy bandwidth and deflect from more effective, evidence based interventions (e.g. on pricing and advertising) which affect industry sales and profits. This is particularly effective if the perception of independence from the industry is created. The analysis presented below suggests that the DFD was not used explicitly by the industry actors for public relations purposes. However, it was useful to their broader strategic aims. It reinforced the position of Drinkaware as a key policy actor and promoted the particular, industry-favoured understanding of alcohol harms and their solutions which it promotes. This is in keeping with the previous insights from international research literature on corporate political activity in health harming industries which finds that policy influence is often subtle, indirect and designed to embed organisations within the policy architecture. It suggests that government agencies should proceed with great caution in entering into such partnerships with industry associated bodies.

The Commercial Determinants of Three Contemporary National Crises: How Corporate Practices Intersect With the COVID-19 Pandemic, Economic Downturn, and Racial Inequity

Policy Points  The United States finds itself in the middle of an unprecedented combination of crises: a global pandemic, economic crisis, and unprecedented civic responses to structural racism.  While public sector responses to these crises have faced much justified criticism, the commercial determinants of these crises have not been sufficiently examined.  In this commentary we examine the nature of the contributions of such actors to the conditions that underpin these crises in the United States through their market and nonmarket activities.  On the basis of this analysis, we make recommendations on the role of governance and civil society in relation to such commercial actors in a post-COVID-19 world.

Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019

OBJECTIVES

To advance understanding of how message framing can be used to maximise public support across different pricing policies for alcohol, tobacco and sugary drinks/foods that prevent consumption of cancer-causing products.

DESIGN

We designed a 3×4×3 randomised factorial experiment to test responses to messages with three pricing policies, four message frames and three products.

SETTING

Online survey panel (Qualtrics) in 2019.

PARTICIPANTS

Adults (N=1850) from the UK and USA.

INTERVENTIONS

Participants randomly viewed one of 36 separate messages that varied by pricing policy (increasing taxes, getting rid of price discounts, getting rid of low-cost products), four frames and product (alcohol, tobacco, sugary drinks/foods).

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed the relationship between the message characteristics and four dependent variables. Three were related to policy support: (1) increasing taxes on the product mentioned in the message, (2) getting rid of price discounts and special offers on the product mentioned in the message and (3) getting rid of low-cost versions of the product mentioned in the message. One was related to reactance, a psychological response to having one's freedom limited.

RESULTS

We found no effect for pricing policy in the message. Frames regarding children and reducing cancer risk moderated some outcomes, showing promise for real-world use. We found differences in support by product and reactance with greatest support and least reactance for tobacco policies, less support and more reactance for alcohol policies, and the least support and most reactance for sugary drinks/foods policies.

CONCLUSIONS

Cancer prevention efforts using policy interventions can be informed by the message framing literature. Our results offer insights for cancer prevention advocacy efforts across the UK and USA and highlight that tax versus non-tax approaches to increasing the cost of cancer-causing products result in similar responses from consumers.

Policy congruence and advocacy strategies in the discourse networks of minimum unit pricing for alcohol and the soft drinks industry levy

BACKGROUND AND AIM

Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL).

DESIGN

Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers.

SETTING

United Kingdom.

OBSERVATIONS

For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles.

MEASUREMENTS

Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks.

FINDINGS

The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think-tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both.

CONCLUSION

A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross-sector collaboration among policy opponents than proponents.

News Media and the Influence of the Alcohol Industry: An Analysis of Media Coverage of Alcohol Warning Labels With a Cancer Message in Canada and Ireland

OBJECTIVE

Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated.

METHOD

We identified and systematically reviewed news articles published between 2017-2019 covering an AWL academic study in Yukon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis.

RESULTS

Overall, 68.4% of media articles covering the Yukon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AWLs with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AWLs were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43).

CONCLUSIONS

News coverage of AWLs with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies.

The impact of promoting revised UK low-risk drinking guidelines on alcohol consumption: interrupted time series analysis

Background

The UK’s Chief Medical Officers revised the UK alcohol drinking guidelines in 2016 to ≤ 14 units per week (1 unit = 10 ml/8 g ethanol) for men and women. Previously, the guideline stated that men should not regularly consume more than 3–4 units per day and women should not regularly consume more than 2–3 units per day.

Objective

To evaluate the impact of promoting revised UK drinking guidelines on alcohol consumption.

Design

Interrupted time series analysis of observational data.

Setting

England, March 2014 to October 2017.

Participants

A total of 74,388 adults aged ≥ 16 years living in private households in England.

Interventions

Promotion of revised UK low-risk drinking guidelines.

Main outcome measures

Primary outcome – alcohol consumption measured by the Alcohol Use Disorders Identification Test – Consumption score. Secondary outcomes – average weekly consumption measured using graduated frequency, monthly alcohol consumption per capita adult (aged ≥ 16 years) derived from taxation data, monthly number of hospitalisations for alcohol poisoning (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: T51.0, T51.1 and T51.9) and assault (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: X85–Y09), and further measures of influences on behaviour change.

Data sources

The Alcohol Toolkit Study, a monthly cross-sectional survey and NHS Digital’s Hospital Episode Statistics.

Results

The revised drinking guidelines were not subject to large-scale promotion after the initial January 2016 announcement. An analysis of news reports found that mentions of the guidelines were mostly factual, and spiked during January 2016. In December 2015, the modelled average Alcohol Use Disorders Identification Test – Consumption score was 2.719 out of 12.000 and was decreasing by 0.003 each month. After the January 2016 announcement, Alcohol Use Disorders Identification Test – Consumption scores did not decrease significantly (β = 0.001, 95% confidence interval –0.079 to 0.099). However, the trend did change significantly such that scores subsequently increased by 0.005 each month (β = 0.008, 95% confidence interval 0.001 to 0.015). This change is equivalent to 0.5% of the population moving each month from drinking two or three times per week to drinking four or more times per week. Secondary analyses indicated that the change in trend began 6 months before the guideline announcement. The secondary outcome measures showed conflicting results, with no significant changes in consumption measures and no substantial changes in influences on behaviour change, but immediate reductions in hospitalisations of 7.3% for assaults and 15.4% for alcohol poisonings.

Limitations

The pre-intervention data collection period was only 2 months for influences on behaviour change and the graduated frequency measure. Our conclusions may be generalisable only to scenarios in which guidelines are announced but not promoted.

Conclusions

The announcement of revised UK low-risk drinking guidelines was not associated with clearly detectable changes in drinking behaviour. Observed reductions in alcohol-related hospitalisations are unlikely to be attributable to the revised guidelines. Promotion of the guidelines may have been prevented by opposition to the revised guidelines from the government's alcohol industry partners or because reduction in alcohol consumption was not a government priority or because practical obstacles prevented independent public health organisations from promoting the guidelines. Additional barriers to the effectiveness of guidelines may include low public understanding and a need for guidelines to engage more with how drinkers respond to and use them in practice.

Trial registration

Current Controlled Trials ISRCTN15189062.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

News Media and the Influence of the Alcohol Industry: An Analysis of Media Coverage of Alcohol Warning Labels With a Cancer Message in Canada and Ireland

OBJECTIVE

Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated.

METHOD

We identified and systematically reviewed news articles published between 2017-2019 covering an AWL academic study in Yukon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis.

RESULTS

Overall, 68.4% of media articles covering the Yukon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AWLs with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AWLs were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43).

CONCLUSIONS

News coverage of AWLs with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies.

'Tied up in a legal mess': The alcohol industry's use of litigation to oppose minimum alcohol pricing in Scotland

This article examines the alcohol industry's legal challenges to minimum unit pricing (MUP) in Scotland through the stages heuristic of the policy process. It builds on previous studies of alcohol pricing policy in Scotland and across the UK, and of the use of legal challenges by health harming industries to oppose health policy globally. Having failed to prevent MUP passing into law, industry actors sought to frustrate the implementation of the legislation via challenges in the Scottish, European and UK courts. However, the relevance of legal challenges is not limited to the post-legislative stage of the policy process but was foreshadowed in all earlier stages of the policy process. The potential for a legal challenge to MUP, and the alcohol industry's clearly articulated intention to pursue such action, was used by industry actors to seek to prevent the adoption of MUP in the agenda setting, policy formulation and legislative stages and created significant 'regulatory chill' in other areas of Scottish and UK alcohol policy. Litigation, and the prospect of it, was thus part of a coherent and integrated long-term strategy which adapted to changes in the political climate and to different stages in the policy process. While both the rhetoric and reality of litigation failed to prevent policy implementation, it succeeded in causing a delay of six years, imposing significant costs on the Scottish government and creating policy inertia in Scottish alcohol policy subsequently. Moreover, the inclusion of a 'sunset clause' in the legislation, requiring ongoing evaluation of the policy's effects, presents additional opportunities for the industry to reverse MUP. Thus, industry strategies to undermine MUP and delay further alcohol policy developments require ongoing attention by policy actors and scholars.

Evaluating possible intended and unintended consequences of the implementation of alcohol minimum unit pricing (MUP) in Scotland: a natural experiment protocol

INTRODUCTION

Scotland is the first country to carry out a national implementation of minimum unit pricing (MUP) for alcohol. MUP aims to reduce alcohol-related harms, which are high in Scotland compared with Western Europe, and to improve health equalities. MUP is a minimum retail price per unit of alcohol. That approach targets high-risk alcohol users. This work is key to a wider evaluation that will determine whether MUP continues. There are three study components.

METHODS AND ANALYSIS

Component 1 sampled an estimated 2800 interviewees at a baseline and each of two follow-ups from four Emergency Departments in Scotland and Northern England. Research nurses administered a standardised survey to assess alcohol consumption and the proportion of attendances that were alcohol-related.Component 2 covered six Sexual Health Clinics with similar timings and country allocation. A self-completion survey gathered information on potential unintended effects of MUP on alcohol source and drug use.Using a natural experiment design and repeated cross-sectional audit, difference between Scotland (intervention) and North England (control) will be tested for outcomes using regression adjusting for differences at baseline. Differential impacts by age, gender and socioeconomic position will be investigated.Component 3 used focus groups with young people and heavy drinkers and interviews with stakeholders before and after MUP implementation. The focus groups will allow exploration of attitudes, experiences and behaviours and the potential mechanisms by which impacts arise. The interviews will help characterise the implementation process.

ETHICS AND DISSEMINATION

Study components 1 and 2 have been ethically approved by the NHS, and component 3 by the University of Stirling. Dissemination plans include peer-reviewed journal articles, presentations, policy maker briefings and, in view of high public interest and the high political profile of this flagship policy, communication with the public via media engagement and plain language summaries.

TRIAL REGISTRATION NUMBER

ISRCTN16039407; Pre-results.

Following in the footsteps of tobacco and alcohol? Stakeholder discourse in UK newspaper coverage of the Soft Drinks Industry Levy

OBJECTIVE

In politically contested health debates, stakeholders on both sides present arguments and evidence to influence public opinion and the political agenda. The present study aimed to examine whether stakeholders in the Soft Drinks Industry Levy (SDIL) debate sought to establish or undermine the acceptability of this policy through the news media and how this compared with similar policy debates in relation to tobacco and alcohol industries.

DESIGN

Quantitative and qualitative content analysis of newspaper articles discussing sugar-sweetened beverage (SSB) taxation published in eleven UK newspapers between 1 April 2015 and 30 November 2016, identified through the Nexis database. Direct stakeholder citations were entered in NVivo to allow inductive thematic analysis and comparison with an established typology of industry stakeholder arguments used by the alcohol and tobacco industries.

SETTING

UK newspapers.

PARTICIPANTS

Proponents and opponents of SSB tax/SDIL cited in UK newspapers.

RESULTS

Four hundred and ninety-one newspaper articles cited stakeholders' (n 287) arguments in relation to SSB taxation (n 1761: 65 % supportive and 35 % opposing). Stakeholders' positions broadly reflected their vested interests. Inconsistencies arose from: changes in ideological position; insufficient clarity on the nature of the problem to be solved; policy priorities; and consistency with academic rigour. Both opposing and supportive themes were comparable with the alcohol and tobacco industry typology.

CONCLUSIONS

Public health advocates were particularly prominent in the UK newspaper debate surrounding the SDIL. Advocates in future policy debates might benefit from seeking a similar level of prominence and avoiding inconsistencies by being clearer about the policy objective and mechanisms.

The handling of evidence in national and local policy making: a case study of alcohol industry actor strategies regarding data on on-premise trading hours and violence in Norway

BACKGROUND

Effective alcohol policy measures conflict with the interests of the alcohol industry. In this study we addressed how various alcohol industry actors in Norway have responded to research findings and police data relating to the possible impacts of changes in on-premise trading hours on violent offending.

METHODS

A content analysis of documents was undertaken. The documents comprised i) hearing statements from policy processes on on-premise trading hours at the national level, and in 15 Norwegian cities, and ii) newspaper articles and other media coverage of this topic in Norway.

RESULTS

Alcohol industry actors employed a range of strategies to shape the use of evidence regarding on-premise trading hours and violence. Nationally, the relevance of the international research literature was questioned before the publication of an unfavourable national study which was criticized directly. This led to commissioned attacks on the findings, constructing what were claimed to be disagreements between experts, emphasis on the complexity of violence and the role of confounding variables, and deflecting attention to alternative interventions. The handling of evidence at the local level was importantly different, where different industry actors and forms of evidence, notably police data, were involved in debates.

CONCLUSION

Alcohol industry actors employed various strategies to shape perceptions and use of evidence to advance their interests. The particular strategies and arguments changed over time as new data and research became available, and also varied between the national and the local levels, and by categories of industry actors.

The palatability of sugar-sweetened beverage taxation: A content analysis of newspaper coverage of the UK sugar debate

BACKGROUND

Excess sugar consumption, including sugar-sweetened beverages (SSBs), contributes to a variety of negative health outcomes, particularly for young people. The mass media play a powerful role in influencing public and policy-makers' perceptions of public health issues and their solutions. We analysed how sugar and SSB policy debates were presented in UK newspapers at a time of heightened awareness and following the announcement of the UK Government's soft drinks industry levy (SDIL), to inform future public health advocacy.

METHODS & FINDINGS

We carried out quantitative content analysis of articles discussing the issues of sugar and SSB consumption published in 11 national newspapers from April 2015 to November 2016. 684 newspaper articles were analysed using a structured coding frame. Coverage peaked in line with evidence publication, campaigner activities and policy events. Articles predominantly supportive of SSB taxation (23.5%) outnumbered those that were predominantly oppositional (14.2%). However, oppositional articles outnumbered supportive ones in the month of the announcement of the SDIL. Sugar and SSB consumption were presented as health risks, particularly affecting young people, with the actions of industry often identified as the cause of the public health problem. Responsibility for addressing sugar overconsumption was primarily assigned to government intervention.

CONCLUSION

Our results suggest that the policy landscape favouring fiscal solutions to curb sugar and SSB consumption has benefited from media coverage characterising the issue as an industry-driven problem. Media coverage may drive greater public acceptance of the SDIL and any future taxation of products containing sugar. However, future advocacy efforts should note the surge in opposition coinciding with the announcement of the SDIL, which echoes similar patterns of opposition observed in tobacco control debates.

Next generation media monitoring: Global coverage of electronic nicotine delivery systems (electronic cigarettes) on Bing, Google and Twitter, 2013-2018

News media monitoring is an important scientific tool. By treating news reporters as data collectors and their reports as qualitative accounts of a fast changing public health landscape, researchers can glean many valuable insights. Yet, there have been surprisingly few innovations in public health media monitoring, with nearly all studies relying on labor-intensive content analyses limited to a small number of media reports. We propose to advance this subfield by using scalable machine learning. In potentially the largest contemporary public health media monitoring study to date, we systematically characterize global news reports surrounding electronic cigarettes or electronic nicotine delivery systems (ENDS) using natural language processing techniques. News reports including ENDS terms (e.g., "electronic cigarettes") from over 100,000 sources (all sources archived on Google News or Bing News, as well as all news articles shared on Twitter) were monitored for 1 January 2013 through 31 July 2018. The geographic and subject (e.g., prevalence, bans, quitting, warnings, marketing, prices, age, flavor and industry) foci of news articles, their popularity among readers who share news on social media, and the sentiment behind news articles were assessed algorithmically. Globally there were 86,872 ENDS news reports with coverage increasing from 8 (standard deviation [SD] = 8) stories per day in 2013 to 75 (SD = 56) stories per day during 2018. The focus of ENDS news spanned 148 nations, with the plurality focusing on the United States (34% of all news). Potentially overlooked hotspots of ENDS media activity included China, Egypt, Russia, Ukraine, and Paraguay. The most common subject was warnings about ENDS (18%), followed by bans on using ENDS (13%) and ENDS prices (9%). Flavor and age restrictions were the least covered news subjects (~1% each). Among different subject foci, reports on quitting cigarettes using ENDS had the highest probability of scoring in the top three deciles of popularity rankings. Moreover, ENDS news on quitting and prices had a more positive sentiment on average than news with other subject foci. Public health leaders can use these trends to stay abreast of how ENDS are portrayed in the media, and potentially how the public perceives ENDS. Because our analytical strategies are updated in near real time, we aim to make media monitoring part of standard practice to support evidence-based tobacco control in the future.

Framing the policy debate over spirits excise tax in Poland

Industry lobbying remains an obstacle to effective health-oriented alcohol policy. In 2013, an increase in excise tax on spirits was announced by the Polish government. This article presents a qualitative analysis of the public debate that ensued on the potential economic, health and social effects of the policy. It focuses on how competing groups, including industry actors, framed their position and sought to dominate the debate. Online archives of five Polish national newspapers, two spirits trade associations, and parliamentary and ministerial archives were searched. A thematic content analysis of the identified sources was conducted. The overall findings were compared with existing research on the framing of the Minimum Unit Pricing (MUP) debate in the UK. A total of 155 sources were analysed. Two main frames were identified: health, and economic. The spirits industry successfully promoted the economic frame in their own publications and in the media. The debate was dominated by arguments about potential growth of the grey market and losses in tax revenue that might result from the excise tax increase. The framing of the debate in Poland differed from the framing of the MUP debate in the United Kingdom. The Polish public health community was unsuccessful in making health considerations a significant element of the alcohol policy debate. The strategies pursued by UK health advocates offer lessons for how to make a more substantial impact on media coverage and promote health-oriented legislation.

'Nothing can be done until everything is done': the use of complexity arguments by food, beverage, alcohol and gambling industries

BACKGROUND

Corporations use a range of strategies to dispute their role in causing public health harms and to limit the scope of effective public health interventions. This is well documented in relation to the activities of the tobacco industry, but research on other industries is less well developed. We therefore analysed public statements and documents from four unhealthy commodity industries to investigate whether and how they used arguments about complexity in this way.

METHODS

We analysed alcohol, food, soda and gambling industry documents and websites and minutes of reports of relevant health select committees, using standard document analysis methods.

RESULTS

Two main framings were identified: (i) these industries argue that aetiology is complex, so individual products cannot be blamed; and (ii) they argue that population health measures are 'too simple' to address complex public health problems. However, in this second framing, there are inherent contradictions in how industry used 'complexity', as their alternative solutions are generally not, in themselves, complex.

CONCLUSION

The concept of complexity, as commonly used in public health, is also widely employed by unhealthy commodity industries to influence how the public and policymakers understand health issues. It is frequently used in response to policy announcements and in response to new scientific evidence (particularly evidence on obesity and alcohol harms). The arguments and language may reflect the existence of a cross-industry 'playbook', whose use results in the undermining of effective public health policies - in particular the undermining of effective regulation of profitable industry activities that are harmful to the public's health.

Media Coverage of Alcohol Issues: A Critical Political Economy Framework-A Case Study from Ireland

There is a growing literature on news media representations of alcohol-related issues. However, current scholarship has neglected critical political economic frameworks to interpret media coverage of alcohol. This paper presents such a framework that conceives of news organisations as corporations that share the values and interests of political and economic elites. The media are thus expected to present viewpoints that are more aligned with the alcohol industry than the scientific consensus on public health policy would warrant. The media are also expected, but to a lesser extent, to present a certain amount of support for public health perspectives because these are supported by a few socioeconomic elite groups (the medical professions, progressive politicians). The case of Ireland from 2012 to 2017 illustrates the framework empirically. Four main newspapers’ coverage of the Public Health (Alcohol) Bill and related policies is examined. Results show that, overall, 44.0% of articles support public health measures and 56.0% are opposed or remain neutral. It is argued that the media are not strong proponents of public health for multiple reasons: there are more articles opposed to or neutral toward public health measures than supporting them; the number of supportive articles remains relatively small and there are still many pieces presenting drinks industry views; there are virtually no calls in the media for stronger measures; supportive coverage is partially explained by the pub owners lobby’s support for minimum unit pricing; the media often downplay or ignore the negative consequences of alcohol, such as its role in accidents; many news articles normalise drinking and promote events sponsored by the industry; there is not a single Irish journalist covering alcohol issues systematically; and other policy issues that are prioritised by elites receive multiple times more media coverage than public health measures. In short, the media reflect the views of the political and economic establishment on public health measures: there is some support from the medical professions and progressive politicians, but overall, there is a clear reluctance to support strong public health strategies. One main recommendation for public health advocates to promote their perspectives is to diversify the mass media and make them less commercial in nature, as well as to engage with non-corporate, so-called progressive “alternative media” outlets.

Between a rock and a hard place: Economic expansion and social responsibility in UK media discourses on the global alcohol industry

CONTEXT

Transnational alcohol corporations (TACs) employ a range of strategies to achieve their business objectives, including attempts to frame perceptions of their activities in media debates. TACs aim to achieve a favourable regulatory environment by presenting themselves as socially responsible actors. However, the need to secure financial investment means they must also emphasise their potential for growth. This article investigates tensions between these objectives in coverage of the global alcohol industry in the UK print media.

METHODS

This article examines coverage of the world's four largest TACs in five British daily newspapers and one industry publication between March 2012 and February 2013. 477 articles were identified for analysis through keyword searches of the LexisNexis database. Thematic coding of articles was conducted using Nvivo software.

FINDINGS

Two conflicting framings of the alcohol industry emerge from our analysis. The first presents TACs as socially responsible actors; key partners to government in reducing alcohol-related harms. This is targeted at policy-makers and the public in an attempt to shape policy debates. The second framing highlights TACs' potential for economic growth by establishing new markets and identifying new customer bases. This is targeted at an audience of potential investors.

CONCLUSIONS

A fundamental contradiction lies at the heart of these framings, reflecting the tensions that exist between TACs' political and financial strategies. Alcohol industry involvement in policy-making thus involves a fundamental conflict of interests. Consequently, the UK government should reassess the prominence it currently affords to the industry in the development and delivery of alcohol policy.

Hard to Avoid but Difficult to Sustain: Scotland's Innovative Health Tax on Large Retailers Selling Tobacco and Alcohol

Context

In the context of increasing health spending and a constrained budget, the Scottish government levied a new “health” tax on large retailers selling alcohol and tobacco in April 2012. This innovative tax, the Public Health Supplement, had the potential to finance additional health spending while discouraging retailers from selling tobacco. We present a case study of the levy; examine how it evolved over time and what impacts it had; explore why, in 2015, the government decided to discontinue the policy; and consider how this experience might inform future strategies for addressing tobacco and alcohol harms via taxes on retailers.

Methods

We employed 3 data sources: (1) policy documents (both documents in the public domain and documents obtained via Freedom of Information requests), (2) media coverage of the debates surrounding the Public Health Supplement, and (3) key informant interviews. We analyzed these data collectively, in chronological order, triangulating between sources.

Findings

When the Supplement was announced in 2011, a clear health rationale was advanced. However, the policy, as subsequently implemented, was not designed to elicit a behavioral response from retailers in terms of alcohol or tobacco sales. It was successful in generating a predictable revenue stream, but there was no evidence that this was earmarked for health. Hence, the substantive health content of the policy was questionable, a fact that was highlighted by industry opponents of the tax, while there was also a lack of competing support from health interests. The industry's campaign was influential in the government's subsequent decision to reduce the rate of the tax and restrict its duration to 3 years.

Conclusions

A tax may be considered a “health” tax on the basis that it raises revenue for health spending and/or that it helps achieve health aims (eg, behavioral change), but there may be tension between these goals in policy design. Framing a tax as a health measure may increase public support in the short term, but this may not be sustained if such framing is insufficiently justified.

The role of the Sheffield model on the minimum unit pricing of alcohol debate: the importance of a rhetorical perspective

The minimum unit pricing (MUP) alcohol policy debate has been informed by the Sheffield model, a study which predicts impacts of different alcohol pricing policies. This paper explores the Sheffield model's influences on the policy debate by drawing on 36 semi-structured interviews with policy actors who were involved in the policy debate. Although commissioned by policy makers, the model's influence has been far broader than suggested by views of 'rational' policy making. While findings from the Sheffield model have been used in instrumental ways, they have arguably been more important in helping debate competing values underpinning policy goals.

Why media representations of corporations matter for public health policy: a scoping review

Background

Media representations play a crucial role in informing public and policy opinions about the causes of, and solutions to, ill-health. This paper reviews studies analysing media coverage of non-communicable disease (NCD) debates, focusing on how the industries marketing commodities that increase NCD risk are represented.

Methods

A scoping review identified 61 studies providing information on media representations of NCD risks, NCD policies and tobacco, alcohol, processed food and soft drinks industries. The data were narratively synthesized to describe the sample, media depictions of industries, and corporate and public health attempts to frame the media debates.

Results

The findings indicate that: (i) the limited research that has been undertaken is dominated by a focus on tobacco; (ii) comparative research across industries/risk-factors is particularly lacking; and (iii) coverage tends to be dominated by two contrasting frames and focuses either on individual responsibilities (‘market justice’ frames, often promoted by commercial stakeholders) or on the need for population-level interventions (‘social justice’ frames, frequently advanced by public health advocates).

Conclusions

Establishing the underlying frameworks is crucial for the analysis of media representation of corporations, as they reflect the strategies that respective actors use to influence public health debates and decision making. The potential utility of media research lies in the insights that it can provide for public health policy advocates about successful framing of public health messages and strategies to counter frames that undermine public health goals. A better understanding of current media debates is of paramount importance to improving global health.