Stakeholder perspectives on the implementation and impact of Bristol’s unhealthy commodity advertising restrictions policy

Abstract Introduction: In 2021, Bristol became the first English local authority (LA) outside London to introduce restrictions on advertisements for high fat, salt and sugar products and other unhealthy commodities (alcohol, gambling and payday loans) on LA outdoor advertising sites (bus shelters and some billboards). This study aimed to explore the policy’s acceptability, implementation barriers and facilitators, perceived impacts, and considerations for sustaining and wider roll out of the policy. Methods: Twenty-two online semi-structured interviews were conducted with key stakeholders from Bristol-City-Council (n=12), advertising industries (n=3), third-sector advertising and sustainability organisations (n=5) and the Office for Health Improvement and Disparities (n=2). Interview transcripts were analysed using inductive and deductive thematic analysis. Results: Stakeholders acknowledged the importance of this policy as part of a system-wide approach to decrease consumption and use of unhealthy commodities. However, several barriers to behaviour change were recognised: 1) limited LA ownership of outdoor advertising spaces relative to privately owned advertising spaces, 2) complimentary advertising restrictions already in place in the city, and 3) industry adaptations to enable advertising of unhealthy commodities to continue such as displacement of advertisements onto non-LA-owned advertising sites. To sustain the policy, stakeholders highlighted the need for a formal auditing process and continued reviewing and improving of the policy in response to industry adaptations as well as expanding the policy to include private advertising spaces. Conclusion: While the policy was seen as a valuable step toward reducing use and consumption of unhealthy commodities, its impact on behaviour may be limited due to the LA owning relatively little outdoor advertising space and by industry adaptations to enable advertising of unhealthy commodities to continue.