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Introduction:\ud \ud The COVID-19 pandemic necessitated unprecedented changes in alcohol availability, including closures, curfews and restrictions. We draw on new data from three UK studies exploring these issues to identify implications for premises licensing and wider policy.\ud \ud Methods:\ud \ud (i) Semi-structured interviews (n = 17) with licensing stakeholders in Scotland and England reporting how COVID-19 has reshaped local licensing and alcohol-related harms; (ii) semi-structured interviews (n = 15) with ambulance clinicians reporting experiences with alcohol during the pandemic; and (iii) descriptive and time series analyses of alcohol-related ambulance callouts in Scotland before and during the first UK lockdown (1 January 2019 to 30 June 2020).\ud \ud Results:\ud \ud COVID-19 restrictions (closures, curfews) affected on-trade premises only and licensing stakeholders highlighted the relaxation of some laws (e.g. on takeaway alcohol) and a rise in home drinking as having long-term risks for public health. Ambulance clinicians described a welcome break from pre-pandemic mass public intoxication and huge reductions in alcohol-related callouts at night-time. They also highlighted potential long-term risks of increased home drinking. The national lockdown was associated with an absolute fall of 2.14 percentage points [95% confidence interval (CI) −3.54, −0.74; P = 0.003] in alcohol-related callouts as a percentage of total callouts, followed by a daily increase of +0.03% (95% CI 0.010, 0.05; P = 0.004).\ud \ud Discussion and Conclusions:\ud \ud COVID-19 gave rise to both restrictions on premises and relaxations of licensing, with initial reductions in alcohol-related ambulance callouts, a rise in home drinking and diverse impacts on businesses. Policies which may protect on-trade businesses, while reshaping the night-time economy away from alcohol-related harms, could offer a ‘win–win’ for policymakers and health advocates.

Objectives: Policy responses to the COVID-19 pandemic in 2020 led to behaviour changes in the UK’s population, including a sudden shift towards working from home. These changes may have affected overall exposure to fine particulate matter (PM2.5), an air pollutant and source of health harm. We report the results of a simulation model of a representative sample of the UK’s population, including workers and non-workers, to estimate PM2.5 exposure before and during the pandemic. Methods: PM2.5 exposure was simulated in April and August 2017–2020 for 10,000 individuals across the UK drawn from the 2011 nationwide census. These data were combined with data from the UK’s ambient PM2.5 monitoring network, time use data and data on relevant personal behaviour before and during the first stage of the pandemic (such as changes in smoking and cooking). Results: The simulated exposures were significantly different between each year. Changes in ambient PM2.5 resulted in regional and temporal variation. People living in homes where someone smoked experienced higher exposure than those in smoke-free homes, with an increase of 4 µg/m3 in PM2.5 exposure in 2020. Conclusions: Changes in PM2.5 exposure were minimal for most individuals despite the simulated increases in cooking activity. Those living in smoking homes (estimated to be around 11% of the UK population) experienced increased exposure to PM2.5 during COVID lockdown measures and this is likely to have increased mortality and morbidity among this group. Government policy should address the risk of increased exposure to second-hand smoke in the event of future COVID-19-related restrictions.

Crawford Moodie,* Kathryn Angus,* Martine Stead* Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland*These authors contributed equally to this workCorrespondence: Crawford MoodieInstitute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, ScotlandTel +44 1786 467390Email c.s.moodie@stir.ac.ukAbstract: Standardized packaging of tobacco products has now been fully implemented in 15 countries. However, there is limited evidence, apart from in Australia, on how consumers have responded to the policy. Two systematic reviews explored consumer, tobacco industry and retailer response to standardized packaging in the United Kingdom (UK), which became mandatory for cigarettes (factory-made and hand-rolled) from May 2017, following a twelve-month transition period. In the first review, electronic databases were searched for published primary research from January 2016 to February 2019. The second review used the same methods, with searches conducted between February 2019 and September 2020. The current study conducted a narrative synthesis of the findings exploring consumer response from these two systematic reviews. Eleven studies met the inclusion criteria. Studies examined consumer response to on-pack warnings (n=7 studies), appeal of packs and smoking (n=4), perceptions of harm (n=5), and behavioral responses (n=8). There was consistent evidence that standardized packaging was associated with increased warning salience and effectiveness, and reduced appeal. Findings were mixed with respect to whether standardized packs were associated with increased perceptions of harm. Standardized packaging was generally thought to deter never or occasional smokers. Standardized packaging was associated with increased thoughts of quitting during the transition period, but no study directly explored cessation or relapse prevention. Some smokers switched to cheaper cigarettes. Standardized packaging in the UK seems to be reducing the appeal of packaging and smoking and making warnings more salient, but the behavioral impact is unclear. More consumer research is needed to assess longer-term behavioral response.Keywords: cigarettes, smoking, marketing, policy, public health, review

Electronic cigarettes (e-cigarettes) are battery-powered devices that heat a liquid, usually containing nicotine, to allow users to inhale the vapour. The evidence so far suggests they are far less harmful than smoking and can help people to quit smoking. However, as e-cigarettes are a relatively new product and their long-term effects are unknown, they should not be used by people who have never smoked, particularly young people. In 2016 and 2017, regulations were introduced to help ensure that e-cigarette advertising is socially responsible. This means protecting young people, minimising conflation between e-cigarettes and tobacco, and preventing uptake of e-cigarettes amongst people who don’t smoke or use nicotine. The Tobacco and Related Products Regulations 2016 (TRPR) set rules on how e-cigarettes can be advertised and prohibited marketing in specific media channels. Subsequently, the UK Advertising Standards Authority (ASA), Committee of Advertising Practice (CAP) Code and Broadcast Committee of Advertising Practice (BCAP) Code, updated in 2017, set out further advertising regulations in CAP Code Rule 22 and BCAP Code Rule 33. The overall aim of this report was to assess compliance with and the impact of the current UK e-cigarette marketing regulations. The UK Government is obliged to review and deliver a report on the TRPR within five years of the legislation being enacted, by May 2021. This report will help to inform the Government’s review. This report brings together two complementary studies to provide a description of e-cigarette advertising spend, advertising content, compliance with advertising regulations, and reported noticing and appeal of e-cigarette marketing. Study A (by the Institute for Social Marketing & Health) consisted of an analysis of e-cigarette advertising expenditure in the UK in 2019 and a detailed content analysis of a sample of advertising taken from the same year. Study B consisted of an analysis of survey data from the International Tobacco Control Policy Evaluation Project (ITC Project), which measured reported noticing of e-cigarette marketing by young people (16 to 19-year-olds) between 2017 and 2019, and adults (aged 18 and older) between 2016 and 2018 in a broad range of marketing channels.

Additional file 1.

Additional file 4. Observation Protocol Trolley Services Wave 1.