Table 1 Policy options to reduce tobacco and alcohol consumption. The six policy themes were defined based on the information from our review and survey. The examples of policy options within each theme are based on the information from our review, survey and workshop

Price

To reduce access to harmful products by raising the retail price and hence reducing affordability, whilst increasing the affordability of healthy options.

- Adjust the structure and rates of taxation.

- Move to ‘fully specific’ taxation, i.e. all excise duty applied in proportion to the amount of harmful product content such as the concentration of ethanol in alcoholic beverages.

- Introduce rules for the minimum amount of tax that must be applied to a product (c.f. minimum excise tax for tobacco).

- Introduce minimum sales prices (cf. minimum unit pricing for alcohol).

- Regulate multi-buy offers and discounts.

- Introduce economic incentives for healthier products e.g. low tax for low alcohol beer.

Place

To reduce access to harmful products, and encourage healthy options, by managing retailers and where consumption takes place.

- Increase penalties for retailers breaking the terms of licenses.

- Restrict the number, density and location of retail outlets.

- Restrict hours of sale.

- Introduce licenses to sell tobacco and combine or coordinate licenses to sell tobacco and alcohol.

- Raise the minimum age of sale and/or enforce current rules with proof of age initiatives and action to reduce proxy sales.

- Regenerate neighbourhoods and town centres to create health-promoting environments.

- Introduce smoke-free zones

- Encourage alcohol-free social venues.

Promotion

To inform people about the harms of consumption and promote healthy behaviours, whilst counteracting the strategies employed by the tobacco and alcohol industries to promote consumption.

- Target initiatives (e.g. social marketing or mass media campaigns) to specific groups of people to provide information on the health effects of consumption, and to promote and maintain healthy behaviours as the norm.

- Support school-based programmes to improve mental well-being, resilience, self-control and social/personal competence skills that might help people resist influences to smoke or drink.

- Design initiatives that combine health promotion messages across tobacco and alcohol e.g. by referring to common health harms such as cancer.

- Design initiatives that raise awareness among the public and policymakers of the unhealthy effects of the companies that produce and market tobacco and alcohol products (cf. the US tobacco ‘Truth’ campaign [23]).

Person

To strengthen the system of organisations and technology that encourages and supports people to quit or reduce consumption in the long term.

- Increase the funding and training of practitioners to deliver existing services.

- Change procedures so that healthcare practitioners can identify people who both smoke and drink to harmful levels, and advise them why and how to reduce their smoking and drinking.

- Change the structure of specialist services to better support people who both smoke and drink.

- Support community groups that widen access to peer support and take the time to understand the context of a person’s life.

- Provide flexible access to support for people with mental health problems at all levels of the continuum (in distress, acute or chronic).

Prescriptive

To regulate the nature of and limit people’s exposure to tobacco and alcohol marketing, and in doing so to reduce the influence of that marketing on the culture of consumption.

- Prohibit marketing targeted to vulnerable people, e.g. people with mental health problems.

- Regulate direct advertising e.g. the use of lifestyle messages and sponsorship of sports events.

- Regulate indirect advertising e.g. third-parties talking about products on social media and product placement in films.

- Regulate branding, packaging and sales quantity.

- Regulate short-term sales promotion e.g. through branding and packaging, extra displays and other measures to stimulate publicity.

- Regulate product content of harmful substances.

- Regulate labelling so individuals understand contents, including warnings about health harms.

- Bring marketing regulations for alcohol into alignment with regulations for tobacco under the Framework Convention on Tobacco Control (FCTC) [24].

Industry regulation (cross-cutting)

To limit the ability for the tobacco and alcohol industries to influence the formation and effectiveness of public policy, and to recoup the public costs generated by tobacco and alcohol consumption.

- Limit the influence that tobacco and alcohol companies have on government policy, including direct lobbying and indirect influence through third party organisations and political donations.

- Exclude psychoactive substances from trade agreements.

- Bring regulations on access to and collaboration with government by the alcohol companies into alignment with tobacco companies under article 5.3 of the FCTC.

- Engage with international organisations to regulate the activity of transnational tobacco and alcohol companies.

- Monitor the responses of tobacco and alcohol companies to regulation.

- Promote open and transparent reporting of tobacco and alcohol company activities e.g. marketing expenditure, lobbying activity and funding of third-party organisations.

- Limit the influence that tobacco and alcohol companies have on the design and delivery of Person and Promotion initiatives.

- Increase enforcement to minimise the trade in ‘illicit’ (i.e. tax free) products.

- Introduce an annual levy on tobacco and alcohol companies, and hypothecate the money raised to pay for initiatives to reduce the societal costs of tobacco and alcohol consumption e.g. by funding healthcare, policing.