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Background: On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a mechanism designed to address increasing prevalence of obesity and associated ill health by reducing sugar consumption. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative. Methods: Media content analysis was used to build a dataset of relevant newspaper articles, which were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the network of stakeholders and coalitions evident in the debate as it was presented in UK newspapers, in the lead up to and following the announcement of the Soft Drinks Industry Levy in the UK, from May 2015 to November 2016. Results: Coding identified 3883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Network visualisations revealed a complex network of stakeholders with clear sceptical and supportive coalitions. Industry stakeholders appeared less united in the network than anticipated, particularly before the SDIL announcement. Some key industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver appeared as a dominant stakeholder, firmly embedded with public health advocates. Conclusion: This study highlights the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Polarisation of stakeholders arose from differences in ideology, focus on a specific policy and statements about the weight of evidence. Vocal celebrity policy entrepreneurs may be instrumental in gaining public and policy makers' support for future upstream regulation to promote population health, to facilitate alignment around a clear ideology.

Background On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a mechanism designed to address increasing prevalence of obesity and associated ill health by reducing sugar consumption. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative. Methods Media content analysis was used to build a dataset of relevant newspaper articles, which were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the network of stakeholders and coalitions evident in the debate as it was presented in UK newspapers, in the lead up to and following the announcement of the Soft Drinks Industry Levy in the UK, from May 2015 to November 2016. Results Coding identified 3883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Network visualisations revealed a complex network of stakeholders with clear sceptical and supportive coalitions. Industry stakeholders appeared less united in the network than anticipated, particularly before the SDIL announcement. Some key industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver appeared as a dominant stakeholder, firmly embedded with public health advocates. Conclusion This study highlights the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Polarisation of stakeholders arose from differences in ideology, focus on a specific policy and statements about the weight of evidence. Vocal celebrity policy entrepreneurs may be instrumental in gaining public and policy makers' support for future upstream regulation to promote population health, to facilitate alignment around a clear ideology.

Political actors participate in policy debates as an advocacy strategy to influence political opponents and public opinion. They often engage in cross-sectoral advocacy by participating in multiple adjacent debates. To investigate what factors influence cross-sectoral advocacy in policy debates, we examined advocacy coalitions in two health policy debates in the UK – the regulation of sugar-sweetened beverages and alcoholic drinks. We predicted cross-sectoral advocacy efforts across 237 actors, such as health charities, manufacturers, or retailers, as a function of their belief system alignment relative to their advocacy coalition. In a methodological innovation, Bayesian item response models were applied to policy beliefs stated publicly by actors in eleven newspapers to measure the ideological positions of actors and beliefs relative to their advocacy coalition. Extreme belief alignment relative to one's coalition, a small spread of stated beliefs, and a strong engagement were found to explain cross-sectoral advocacy.

Political actors participate in policy debates as an advocacy strategy to influence political opponents and public opinion. They often engage in cross-sectoral advocacy by participating in multiple adjacent debates. To investigate what factors influence cross-sectoral advocacy in policy debates, we examined advocacy coalitions in two health policy debates in the UK – the regulation of sugar-sweetened beverages and alcoholic drinks. We predicted cross-sectoral advocacy efforts across 237 actors, such as health charities, manufacturers, or retailers, as a function of their belief system alignment relative to their advocacy coalition. In a methodological innovation, Bayesian item response models were applied to policy beliefs stated publicly by actors in eleven newspapers to measure the ideological positions of actors and beliefs relative to their advocacy coalition. Extreme belief alignment relative to one's coalition, a small spread of stated beliefs, and a strong engagement were found to explain cross-sectoral advocacy.

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.

Supportive interventions are needed for the family and carers of people with multiple sclerosis. A rapid realist review and realist evaluation explored what helps, who it helps, when and how. Literature analysis was synthesised with a thematic analysis of qualitative interviews and focus groups with 49 family and carers of people with multiple sclerosis. The resulting model summarised a family of interventions that could help people develop their capabilities and expand their resources, resulting in more positive outcomes. This may prevent or delay a 'tipping point' where capacity to care is overwhelmed by caring roles.

Background: Excess sugar consumption, including sugar-sweetened beverages (SSBs), contributes to a variety of negative health outcomes, particularly for young people. The mass media play a powerful role in influencing public and policy-makers' perceptions of public health issues and their solutions. We analysed how sugar and SSB policy debates were presented in UK newspapers at a time of heightened awareness and following the announcement of the UK Government's soft drinks industry levy (SDIL), to inform future public health advocacy. Methods and Findings: We carried out quantitative content analysis of articles discussing the issues of sugar and SSB consumption published in 11 national newspapers from April 2015 to November 2016. 684 newspaper articles were analysed using a structured coding frame. Coverage peaked in line with evidence publication, campaigner activities and policy events. Articles predominantly supportive of SSB taxation (23.5%) outnumbered those that were predominantly oppositional (14.2%). However, oppositional articles outnumbered supportive ones in the month of the announcement of the SDIL. Sugar and SSB consumption were presented as health risks, particularly affecting young people, with the actions of industry often identified as the cause of the public health problem. Responsibility for addressing sugar overconsumption was primarily assigned to government intervention. Conclusion: Our results suggest that the policy landscape favouring fiscal solutions to curb sugar and SSB consumption has benefited from media coverage characterising the issue as an industry-driven problem. Media coverage may drive greater public acceptance of the SDIL and any future taxation of products containing sugar. However, future advocacy efforts should note the surge in opposition coinciding with the announcement of the SDIL, which echoes similar patterns of opposition observed in tobacco control debates.

OBJECTIVE: In politically-contested health debates stakeholders on both sides present arguments and evidence in order to influence public opinion and the political agenda. The aim of this study was to examine whether stakeholders in the soft drinks industry levy (SDIL) debate sought to establish or undermine the acceptability of this policy through the news media and how this compared to similar policy debates in relation to tobacco and alcohol industries. DESIGN: Quantitative and qualitative content analysis of newspaper articles discussing sugar-sweetened beverage (SSB) taxation published in 11 UK newspapers between 1 April 2015 and 30 November 2016, identified through the Nexis database. Direct stakeholder citations were entered into NVivo to allow inductive thematic analysis and comparison with an established typology of industry stakeholder arguments used by the alcohol and tobacco industries. SETTING: UK newspapers. SUBJECTS: Proponents and opponents of SSB tax/SDIL cited in UK newspapers. RESULTS: 491 newspaper articles cited stakeholders' (n=287) arguments in relation to SSB taxation (n=1,761: 65% supportive and 35% opposing). Stakeholders' positions broadly reflected their vested interests. Inconsistencies arose from: changes in ideological position; insufficient clarity on the nature of the problem to be solved; policy priorities; consistency with academic rigour. Both opposing and supportive themes were comparable with the alcohol and tobacco industry typology. CONCLUSIONS: Public health advocates were particularly prominent in the UK newspaper debate surrounding the SDIL. Advocates in future policy debates might benefit from seeking a similar level of prominence and avoiding inconsistencies by being clearer about the policy objective and mechanisms.