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.

Cigarette smoking and harmful use of alcohol are major preventable causes of early death, disease, accidents and injury in the UK. Although the health effects of smoking have been widely recognised for decades, active and passive smoking still kill over 100,000 people and cause over 160,000 new cases of illness in children each year. Half of the 10 million smokers in the UK today will be killed by their smoking unless they stop. In contrast to smoking, alcohol consumption in the UK has increased markedly in the last thirty years. Ten million people in the UK now drink alcohol to harmful levels, and alcohol causes over 15,000 deaths, 1 million hospital admissions, and accidents and violence that together cost our society more than £20 billion each year. Like the effects of smoking, these harms affect the poorest in society most. Also like tobacco, alcohol consumption is driven by very powerful multinational industries with substantial political influence. It is therefore essential to find better ways to prevent smoking and harmful use of alcohol, now and in the future, and to prevent commercial interests from undermining these actions. Much has been learnt from the successes of reducing smoking prevalence, and many successful tobacco strategies can be applied to prevent alcohol harm. However, alcohol strategies must also take account of the fact that while smoking is dangerous at all levels, low levels of alcohol consumption do not have equivalent health harms to tobacco. So while tobacco policy can be pursued with the aim of eradicating smoking from society, alcohol policy has to aim to prevent consumption to levels that cause significant harm to the user, or to others. This proposal aims to address these problems by bringing together leading tobacco and alcohol researchers to build on success in tobacco research over the past five years by creating a new research centre, the UK Centre for Tobacco and Alcohol Studies (UKCTAS), to study new ways to prevent tobacco and alcohol-related harm, and promote their implementation. Since 2008 we have applied this approach in smoking prevention through the existing UK Centre for Tobacco Control Studies (UKCTCS), and achieved significant impacts on tobacco policy and practice (see www.ukctcs.org). We now propose to continue our tobacco work and to establish a major new focus on alcohol, by incorporating leading international alcohol researchers into the new Centre. Our work will aim to: 1. Understand and identify preventable reasons why people smoke or use alcohol to a harmful degree, and improve understanding of the health impacts of these behaviours 2. Understand and develop better population measures to to reduce smoking and harmful use of alcohol 3. Develop and implement better individual health interventions to prevent smoking and harmful use of alcohol 4. Develop and apply harm reduction strategies for those otherwise likely to continue to smoke or sustain harm from alcohol 5. Understand the tactics of the industry to encourage tobacco and alcohol consumption and thus undermine health policy and practice 6. Use the outcomes of our research to work, with other professional and public groups and individuals, to improve UK and international action to prevent smoking and harm from alcohol We will also aim to further develop our training and development of academic, policymaker and practitioner capacity for tobacco and alcohol work in the future, and to establish UKCTAS as a self sustaining Centre by the end of the five-year funding period. The main benefits of the Centre will be the achievement of sustained reductions in harms to individuals and society from tobacco and alcohol use.