Projects & Research Partnerships

SYNTAX: Integrated evidence synthesis for joint appraisal of tobacco and alcohol tax interventions for harm reduction in the UK

The SYNTAX project aimed to provide evidence and tools to inform the potential scale of effects of taxation across tobacco and alcohol as an intervention to improve public health and reduce health inequalities in the UK.

Introduction

Alcohol consumption and tobacco smoking are major modifiable risk factors for non-communicable diseases and people who both drink and smoke are at a further increased health risk.

Taxation is recognised worldwide as an effective way to reduce alcohol consumption and encourage smokers to quit, however there is a need to improve the evidence base upon which the joint effects of changes to tobacco and alcohol tax will be calculated. This means for example so that the relationships among alcohol and tobacco use and socioeconomic status can be considered.

Research tasks

This research developed new evidence on current and potential tobacco and alcohol pricing and tax policy in England. There were three key tasks:

  1. Understand the joint patterns of purchasing and use of the products across population subgroups.
  2. Use a consistent methodology to estimate the effects of industry influence on tax pass-through for off-trade alcohol, on-trade alcohol and tobacco.
  3. Produce more detailed evidence on how tobacco and alcohol consumption responds to price rises (the price elasticities of demand) and an understanding of the uncertainty in these estimates. For example, we need to better understand the extent to which consumers might quit smoking vs. switch to cheaper products.

Finally, the research plan recognised the need for impact assessment models capable of assessing the joint effects of tobacco and alcohol tax changes. This involves modelling the potential impact of combined alcohol and tobacco tax policy options on outcomes including changes in participation in drinking or smoking (any use vs abstinence), consumption levels, consumer expenditures, tax revenues to Government and net revenues to retailers, risk of harm related to 85 different clinical conditions, healthcare (NHS) costs, quality adjusted life years and mortality.

For information about the previous research that this project builds on see Partos et al. (2020) for tobacco and Meier et al. (2016) for alcohol.

Objectives

The objectives were designed to produce the evidence required for joint policy analysis of alcohol and tobacco tax policy changes.

Qualitative investigation to understand through published evidence and stakeholder interviews the options for tobacco and alcohol tax policy changes, which options UK experts view as achievable and why.

Analysis of social patterns in alcohol and tobacco spending to quantify the patterns of purchasing and consumption of across product types and price points for socio-demographic groups defined by age, sex, and socioeconomic status and for different smoker and drinker groups.

Analysis of industry and consumer responses to tax changes to estimate the likely responses to tax changes in terms of:

  1. Alcohol and tobacco industry pricing strategy via modifying the extent to which tax changes are 'passed through' to product retail prices.
  2. Consumer demand for alcohol and tobacco products by estimating new price elasticities of demand for 10 alcohol product categories and two tobacco products in an integrated way.

Population modelling to appraise the health and economic outcomes of tax interventions – To develop a health and economic model of the combined effects of changes to tax on alcohol and tobacco products, and use this model to appraise scenarios for changes to tax that are designed to support decision-making on tax policy

Key project information

This project is funded by the National Institute for Health and Care Research (NIHR) under its Public Health Research programme (Project Ref 16/105/26). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Dates

March 2018 – February 2021

Funding

£716,422.09

Chief investigator

Professor Alan Brennan

Institutions involved

University of Sheffield
University of Bath

Key contact

syntax@sheffield.ac.uk

Details of the outputs from the SYNTAX project are available on the STAPM website.

Visit the STAPM website

Public involvement

The project team wanted to gain perspectives from people with lived experience on the options for alcohol and tobacco tax policy changes, and how any changes might affect people differently according to their alcohol and tobacco consumption and socio-demographic characteristics. They then used their understanding of the public perspectives to guide the process of generating and interpreting the research findings.

Three public panels were involved:

The Sheffield Addiction Recovery Research Panel

This group comprised former and current service users for drug and alcohol treatment and family and carers of people who have had experience of drug and alcohol misuse. Supported by the Clinical Research Office of Sheffield Teaching Hospitals NHS Foundation Trust.

The Tobacco and Nicotine Discussion Group in Nottingham

The Tobacco and Nicotine Discussion Group comprised current smokers or those trying to quit smoking who were experienced in discussing tobacco and new nicotine product use, tobacco control policy, approaches to smoking cessation and new developments in tobacco harm reduction. Funded as part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), and subsequently the SPECTRUM UK Prevention Research Partnership consortium.

The Alcohol and Food Discussion Group

This group comprised members of the public who were occasional or regular drinkers and experienced in discussing alcohol consumption, public health policy relating to alcohol and related research ideas and current projects. Also funded through UKCTAS and subsequently SPECTRUM.

Each panel was visited by SYNTAX researchers and members were guided through a structured discussion of alcohol and tobacco consumption behaviours, how consumption depends on product prices and available income, and their views on tax policy changes and its potential effects. These discussions were influenced by briefing information given to panel members including on the current rates of and revenues from alcohol and tobacco tax in the UK.

Outputs

Alcohol and tobacco are not separate worlds: Conceptualising changes to tobacco and alcohol policy as affecting a single interlinked system (2021) BMC Public Health

11.6% of households buy both alcohol and tobacco and households with lower income spend a higher proportion of their income on tobacco and alcohol: Do dual purchasers behave differently? An analysis of purchasing data for households that buy both alcohol and tobacco in the United Kingdom (2021) Addiction

The combined use of alcohol and tobacco increases the health and mortality burden on people who both smoke and drink: Alcohol and Tobacco Attributable Fractions for Scotland, The University of Sheffield

Because they are not separate worlds, pricing policies that reduce tobacco consumption could affect alcohol consumption, and vice versa: Estimation of integrated price elasticities for alcohol and tobacco in the United Kingdom using the Living Costs and Food Survey 2006-2017 (2023) Drug and Alcohol Review

Impact analyses should consider the combined effects of alcohol and tobacco pricing policies on health and economic inequalities, and how the effects of changes to the price of each commodity might trade-off: Mapping alcohol and tobacco tax policy interventions to inform health and economic impact analyses: A United Kingdom based qualitative framework analysis (2023) International Journal of Drug Policy

Research team

Project Co-ordinators

  • Prof Alan Brennan
  • Dr Duncan Gillespie

Stakeholder interview team

  • Dr Jenny Hatchard
  • Dr Penny Buykx

Others involved in the project

  • Ryan Kai Le Chen, Research Assistant, Sheffield Centre for Health and Related Research, University of Sheffield
  • Anna Gilmore, Professor of Public Health, Department for Health, University of Bath
  • Petra Meier, Professor of Public Health, Sheffield Centre for Health and Related Research, University of Sheffield
  • John Holmes, Reader in Alcohol Policy, Sheffield Centre for Health and Related Research, University of Sheffield
  • Colin Angus, Senior Research Fellow, Sheffield Centre for Health and Related Research, University of Sheffield
  • Rosemary Hiscock, Research Associate, Department for Health, University of Bath
  • Robert Pryce, Research Associate, Sheffield Centre for Health and Related Research, University of Sheffield
  • Luke Wilson, Research Associate, Sheffield Centre for Health and Related Research, University of Sheffield
  • Damon Morris, Research Associate, Sheffield Centre for Health and Related Research, University of Sheffield
  • Grace Leeming, Research Assistant, Sheffield Centre for Health and Related Research, University of Sheffield

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