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.

The main causes of health conditions such as cancer, heart disease, respiratory diseases and diabetes (Non-Communicable Diseases, NCDs) are things we consume such as tobacco, alcohol and foods high in salt, sugar and fat. These products are often manufactured by large companies, 'Unhealthy Commodity Producers' (UCPs), who make a lot of money from their sale and whose interests can conflict with health goals. UCPs try to increase their profits by using advertising to make their products more attractive, selling them in places where they are more likely to be bought, and pricing them in ways that increase consumption. We also know that UCPs target their products at people who may be more susceptible to these tactics. As a result, the health of poorer people and communities can be more affected. Because UCPs are powerful, their actions can have an impact on governments which can mean that policies to protect health (such as taxes on unhealthy products, or advertising bans) are less likely to be put in place, or can be delayed or changed. SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harm) is an ambitious new programme that aims to reduce NCDs by doing research that will help inform policies and practices to promote health. SPECTRUM's work will support governments, local authorities, public health bodies and other organisations in dealing with the influence of UCPs. SPECTRUM will mainly focus on tobacco and alcohol, but will also consider unhealthy food and drinks. Our research will be conducted in eight areas of research that will focus on: 1) how thinking about and studying NCD prevention at different levels (as part of a system) can lead to better evidence, policy and practice 2) understanding and finding ways to address the actions and influence of UCPs 3) using better information from surveys and other types of data about people's behaviour which could help inform policies and practices to prevent NCDs 4) analysing the impact of unhealthy products and policies on the economy 5) identifying how changing local communities, and the availability of unhealthy products in these communities, can reduce product use and harms 6) developing and evaluating new policies and practices to prevent NCDs 7) studying how to reduce stigma and mental ill-health related to unhealthy products 8) examining what new or improved regulations or ways of working could reduce (unfair) levels of harm in relation to unhealthy products. SPECTRUM brings together world-leading researchers from 10 UK Universities with support from academics overseas. Our work will be developed with a range of partner organisations that includes health bodies, charities, and companies who provide data and whose staff have skills that can help our research. We will involve the public through regularly meeting with groups made up of members of the public, specific meetings called 'citizen's juries', and by interviewing people from communities across the country. We will work with our partners, politicians and civil servants, health and social care professionals and others to jointly design and deliver research so that it meets their needs. We expect SPECTRUM to speed up how evidence is used to inform new and existing policy and practices to improve the health of people in the UK, and to develop research that could also support progress in other countries.