The Bristol Evaluation of Advertising Restrictions (BEAR) study: Findings from the baseline data

Project aims

This current work is part of the larger BEAR study, evaluating the effectiveness and impact of the Bristol advertising policy. The larger project aims to compare the impact of Bristol’s new outdoor advertisement policy with other areas that haven’t got a similar policy.

We want to find out:

• Whether the policy reduced the number of unhealthy products being advertised in Bristol
• Whether people used or bought less of these products
• The impact on people’s health and associated health costs
• What people thought about the policy
• What policymakers and others, such as those selling fast-food, thought of the policy

In this initial work, we were interested in:

• Understanding the rationale, barriers and facilitators to implementing the policy
• Describing the outdoor advertising of unhealthy products that residents of Bristol and South Gloucestershire noticed, as well as their consumption of these products

We will estimate what impact the policy could have on health and health costs in Bristol.

What we did

Before the policy started in Bristol, we gathered data between January and March 2022. We did this by distributing a specially designed survey among people from Bristol and neighbouring South Gloucestershire, which doesn’t have a policy like this.

The survey asked residents whether they had seen advertisements for unhealthy products, alcohol or gambling in their local area and also whether they consumed those products. We did this to find out where people were seeing adverts and what effect this had on them.

In addition to this, three of our researchers travelled to advertising sites listed on the council’s database. They used their phones to photograph the advertisements displayed at these sites. We did this to compare the difference between what we recorded and what people reported seeing.

Further, we talked to council staff and people from voluntary sector organisations involved in developing it. We asked participants to talk about:

• How they had been involved in the policy
• The history of the policy
• The process of planning the policy
• The anticipated impacts of the policy
• Initial challenges and facilitators facing policy development
• Future plans for the policy

What we found and what this means

Fifty-eight per cent of the people in Bristol and South Gloucestershire who responded to our questionnaire reported seeing advertisements for unhealthy products in the week before they were asked to complete it. This was highest for high fat, salt and sugar foods (40 per cent).

Sixteen per cent of residents reported seeing advertisements for high fat, salt and sugar foods appealing specifically to children. For these products in particular, younger people were more likely to report seeing adverts than older people. Those living in more deprived areas were also more likely to come across this type of advertising.

We found that people’s self-reported exposure to outdoor advertisements correlated with our audit of advertising sites. This means that asking people to report on their exposure to outdoor advertisements might be a useful methodology for population studies. However, we know that self-reported exposure can be biased and measurement errors can be significant so inferences from studies using this exposure metric should be made with caution.

During interviews we were told that the climate for introducing the policy in Bristol was broadly supportive, especially as the council had recently signed up to a national healthy weight initiative. Our interviewees confirmed that it was easier to build their case for this policy because of the “groundwork” previously done by Transport for London and hoped that introducing it would bring down the volume of unhealthy products people were buying in the long term.

Barriers to the policy included:

• The council owning a relatively small proportion of the outdoor advertising space in Bristol
• The potentially limited reach of restrictions
• The conflict between some of the restrictions and the objectives of other council departments, such as promoting Bristol’s economy through festivals

Overall, our results suggest that younger people and those living in more deprived areas are more likely to see unhealthy product advertisements, particularly for unhealthy food and drinks. This means that policies specifically restricting such advertisements may have the potential to reduce health inequalities, as was hoped when this policy was developed.

Future evaluation of these types of policies should provide evidence of any public health impact.

What next?

We are currently collecting follow-up data. Following the implementation of the policy, we have again sent our survey out to residents in Bristol and South Gloucestershire.

We will analyse whether the food and drink residents of Bristol consume has changed. We will compare this with residents of South Gloucestershire where there is not a similar policy.

We plan to estimate what impact the policy could have on health and health costs in Bristol.