{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:19:54Z","timestamp":1788787194501,"version":"build-2803163510"},"reference-count":35,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":89,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR152114"],"award-info":[{"award-number":["NIHR152114"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In 2021, Bristol became the first English local authority (LA) outside London to introduce restrictions on advertisements for high fat, salt and sugar products and other unhealthy commodities (alcohol, gambling and payday loans) on LA outdoor advertising sites (bus shelters and some billboards). This study aimed to explore the policy\u2019s acceptability, implementation barriers and facilitators, perceived impacts and considerations for sustaining and wider roll out of the policy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>22 online semi-structured interviews were conducted with key stakeholders from Bristol-City-Council (n=12), advertising industries (n=3), third-sector advertising and sustainability organisations (n=5) and the Office for Health Improvement and Disparities (n=2). Interview transcripts were analysed using inductive and deductive thematic analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Stakeholders acknowledged the importance of this policy as part of a system-wide approach to decrease consumption and use of unhealthy commodities. However, several barriers to behaviour change were recognised: (1) limited scope for change of outdoor advertising exposure, (2) displacment of adverts for unhealthy comodities and (3) adaptations to advertising copy. To sustain the policy, stakeholders highlighted the need for a formal auditing process and continued reviewing and improving of the policy in response to industry adaptations as well as expanding the policy to include private advertising spaces.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While the policy was seen as a valuable step towards reducing use and consumption of unhealthy commodities, its impact on behaviour may be limited due to the LA owning relatively little outdoor advertising space and by industry adaptations to enable advertising of unhealthy commodities to continue.<\/jats:p>\n                  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Taking down junk food ads. 2019."},{"key":"2026090706050878000_4.2.e004102.18","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003915","article-title":"Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis","volume":"19","author":"Yau","year":"2022","journal-title":"PLoS Med"},{"key":"2026090706050878000_4.2.e004102.19","unstructured":"Office for National Statistics . Census 2021 data. 2021."},{"key":"2026090706050878000_4.2.e004102.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15995-z","article-title":"Advertisement of unhealthy commodities in Bristol and South Gloucestershire and rationale for a new advertisement policy","volume":"23","author":"Scott","year":"2023","journal-title":"BMC Public Health"},{"key":"2026090706050878000_4.2.e004102.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2025-004137","article-title":"Evaluating the changes in household purchases of foods and drinks high in fat, salt and sugar following Bristol\u2019s outdoor advertisement restrictions policy: a quasi-experimental study","volume":"4","author":"Buckland","year":"2026","journal-title":"BMJ Public Health"},{"key":"2026090706050878000_4.2.e004102.22","unstructured":"Buckland G , Toumpakari Z , Sillero-Rejon C , et al . Evaluation of the impact of the bristol\u2019s outdoor advertisement restrictions policy on self-reported exposure to advertisements, consumption and use of unhealthy commodities. Research Square [Preprint]."},{"key":"2026090706050878000_4.2.e004102.23","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026090706050878000_4.2.e004102.24","doi-asserted-by":"crossref","unstructured":"Braun V , Clarke V . What can \u201cthematic analysis\u201d offer health and wellbeing researchers?. Taylor & Francis, 2014:26152.","DOI":"10.3402\/qhw.v9.26152"},{"key":"2026090706050878000_4.2.e004102.25","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1628806"},{"key":"2026090706050878000_4.2.e004102.26","unstructured":"Du Plooy A . A framework for the planning and integration of OOH advertising media in south Africa . University of Pretoria, Available: https:\/\/repository.up.ac.za\/bitstream\/handle\/2263\/24225\/Complete.pdf"},{"key":"2026090706050878000_4.2.e004102.27","first-page":"181","article-title":"Practitioners\u2019 view of the role of OOH advertising media in IMC campaigns. 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Nutrient profiling model 2018. Department of Health and Social Care; 2026."},{"key":"2026090706050878000_4.2.e004102.32","unstructured":"National Health and Medical Research Council . Eat for health., Australian dietary guidelines providing the scientific evidence for healthier australian diets. Department of Health and Ageing; 2013."},{"key":"2026090706050878000_4.2.e004102.33","unstructured":"World Health Organization . WHO regional office for Europe nutrient profile model. 2023."},{"key":"2026090706050878000_4.2.e004102.34","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/heapro\/dax044","article-title":"Children\u2019s exposure to food advertising: the impact of statutory restrictions","volume":"34","author":"Whalen","year":"2019","journal-title":"Health Promot Int"},{"key":"2026090706050878000_4.2.e004102.35","unstructured":"Transport for London . Advertising annual report: 2017\/18. 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