Understanding the Lived Experience of Alcohol and Tobacco Environments, 2022-2023

Emslie, Carol and Dimova, Elena and Smith, Mathew (2023). Understanding the Lived Experience of Alcohol and Tobacco Environments, 2022-2023. [Data Collection]. Colchester, Essex: UK Data Service. 10.5255/UKDA-SN-856665

This research project will measure change in the availability of alcohol and tobacco in Scottish neighbourhoods over time. We will explore how this change relates to health outcomes and how residents experience the availability of alcohol and tobacco in their neighbourhoods. The findings will be important because smoking and alcohol consumption are leading causes of illness and death. In Scotland smoking causes one in every 5 deaths and one in 20 deaths is related to alcohol. This harm is not equally shared; those on the lowest incomes suffer the greatest harm. These illnesses and deaths are preventable. The World Health Organisation recommends that nations prioritise interventions that reduce the supply of alcohol and tobacco.

Why might neighbourhood supply of alcohol and tobacco matter? Research suggests that when there are a lot of outlets in a neighbourhood this impacts upon consumption in three ways. 1. The outlets may be more competitive and drive prices down to attract customers. 2. Oversupply may normalise the products when they are sold alongside everyday commodities, such as bread and milk. 3. Tobacco and alcohol may simply be easier to buy in areas where there are more outlets.

In order to explore the relationship between supply, behaviour and harm we need data on the location of every outlet in Scotland selling tobacco and/or alcohol. Ideally, to be able to say something about whether the relationship may be causal, we need this data over time. We have already collected data on the specific location of every outlet selling tobacco and licensed to sell alcohol over multiple time periods (2012 and 2016 (nationwide alcohol and tobacco) and 2008 (alcohol in four cities)). As part of this project we will collect updated data for 2019/20. This will allow us to measure this change over time. Using an approach called trajectory modelling we will group neighbourhoods that have had a similar degree of change; some neighbourhoods may have lost, or gained, local shops or pubs, whereas some may not have changed at all. We will then identify features of these neighbourhoods that may be driving this change, for example the age profile of the population or poverty levels. This will help policy makers understand the drivers of change in our neighbourhoods.

To measure the relationship between changing supply and harm we will link these trajectories, and our measures of availability at each time point, to alcohol and tobacco health outcomes (behaviour, illness and death). We will use statistical models to see whether areas experiencing an increase or decrease in outlets have seen a corresponding increase or decrease in these outcomes. This will allow us to get a better understanding of whether an over supply of alcohol and tobacco is related to smoking and alcohol consumption and harm. These findings will provide important evidence related to the provision of such commodities in our neighbourhoods.

Although these statistics are important to report we also need to understand why an oversupply of alcohol and tobacco may influence behaviour and harm. Whilst the literature suggests the pathways listed above, we know little about the experiences of individuals living in neighbourhoods with contrasting availability. We don't understand the individual experience of these pathways. We will meet with groups of individuals, in neighbourhoods of contrasting trajectories, to talk to them about the supply of alcohol and tobacco. We will explore their experiences of neighbourhood and assess how their perceived notions of their neighbourhood availability contrast with our statistical measures. Finally, we will meet with residents, retailers and policy stake-holders to explore potential interventions related to supply. Policies at this level require public, retailer and political support. We will discuss the priorities held by various groups, present our empirical results and gauge attitudes towards potential interventions.

Data description (abstract)

Alcohol and cigarette consumption are key vectors in driving the rise in health inequalities in recent decades. High availability is associated with increased alcohol and tobacco related harms. Our ESRC mixed methods study explored changes in alcohol and tobacco availability across Scotland, population health and the lived experience. The qualitative work package (archived here) aimed to understand the experiences of people living in different alcohol and tobacco environments (as measured by outlet density), explore relationships between outlet density and health behaviours and examine views on a range of potential alcohol and tobacco policy interventions. Data were collected via 11 online focus groups, and two supplementary interviews, (n=45 participants in total) from different neighbourhoods across Scotland. Our sampling frame was designed to include neighbourhoods which had experienced relatively large rises or falls in alcohol or tobacco density over time (identified via our quantitative data), affluent and deprived communities and more rural and urban areas. Alcohol and cigarette consumption are key vectors in driving the rise in health inequalities in recent decades. High availability is associated with increased alcohol and tobacco related harms. Our ESRC mixed methods study explored changes in alcohol and tobacco availability across Scotland, population health and the lived experience. The qualitative work package (archived here) aimed to understand the experiences of people living in different alcohol and tobacco environments (as measured by outlet density), explore relationships between outlet density and health behaviours and examine views on a range of potential alcohol and tobacco policy interventions. Data were collected via 11 online focus groups (n=45 participants in total) from different neighbourhoods across Scotland. Our sampling frame was designed to include neighbourhoods which had experienced relatively large rises or falls in alcohol or tobacco density over time (identified via our quantitative data), affluent and deprived communities and more rural and urban areas. Participants were asked about; the nature of alcohol and/or tobacco availability in their neighbourhood; how they understood availability; what consumption patterns they were aware of in terms of individuals, but also in terms of where availability may shape drinking and/or smoking behaviours; what harms they understood to stem from drinking and/or smoking availability; and about viability and acceptability of range of potential alcohol and tobacco interventions.

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