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Tlais AZA, Polo A, Granehäll L, Filannino P, Vincentini O, De Battistis F, Di Cagno R, Gobbetti M. Sugar lowering in fermented apple-pear juice orchestrates a promising metabolic answer in the gut microbiome and intestinal integrity. Curr Res Food Sci 2024; 9:100833. [PMID: 39290653 PMCID: PMC11406026 DOI: 10.1016/j.crfs.2024.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/29/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024] Open
Abstract
Excessive sugar consumption in young people, who are the major consumers of sugary drinks, combined with limited physical activity, is an important determinant of obesity. Despite their natural appeal, fruit juices have a similar sugar content to that of sugary drinks and once metabolized, they may induce the same biological response. This study aimed to verify whether fermentation processes can make juice consumption healthier and whether reduced-sugar juices have a specific impact on intestinal function. We designed a tailored fermentation of apple-pear juices with lactic acid bacteria and yeasts, which resulted in a reduction of sugar content (27-66%) and caloric intake, and an increase in mannitol content. The impact of newly developed apple-pear juices on gut microbiome composition and functionality was evaluated in vitro using the Simulator of the Human Intestinal Microbial Ecosystem (SHIME). Promising changes were found in the gut microbiota and its metabolic responses and functionality, targeting pathways related to obesity and weight loss (lipopolysaccharide and secondary metabolite biosynthesis, polycyclic aromatic hydrocarbon degradation, and amino sugar and nucleotide sugar metabolism). Additionally, the fermented apple-pear juices positively modulated the intestinal epithelial features. While the simulation of the study simplifies the complex in vivo conditions, it suggests that low-sugar fermented apple-pear juices can elicit targeted responses in the gut ecosystem, contributing to healthier alternatives to traditional fruit juices.
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Affiliation(s)
- Ali Zein Alabiden Tlais
- Faculty of Agricultural, Environmental and Food Sciences, Free University of Bolzano-Bozen, 39100, Bolzano, Italy
- International Center on Food Fermentation, 39100, Bolzano, Italy
| | - Andrea Polo
- Faculty of Agricultural, Environmental and Food Sciences, Free University of Bolzano-Bozen, 39100, Bolzano, Italy
- International Center on Food Fermentation, 39100, Bolzano, Italy
| | - Lena Granehäll
- Faculty of Agricultural, Environmental and Food Sciences, Free University of Bolzano-Bozen, 39100, Bolzano, Italy
| | - Pasquale Filannino
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, 70121, Bari, Italy
- International Center on Food Fermentation, 39100, Bolzano, Italy
| | - Olimpia Vincentini
- U.O Alimentazione, Nutrizione e Salute, Dipartimento Sicurezza Alimentare, Nutrizione e Sanità Pubblica Veterinaria, Istituto Superiore di Sanità, 00161, Roma, Italy
| | - Francesca De Battistis
- U.O Alimentazione, Nutrizione e Salute, Dipartimento Sicurezza Alimentare, Nutrizione e Sanità Pubblica Veterinaria, Istituto Superiore di Sanità, 00161, Roma, Italy
| | - Raffaella Di Cagno
- Faculty of Agricultural, Environmental and Food Sciences, Free University of Bolzano-Bozen, 39100, Bolzano, Italy
- International Center on Food Fermentation, 39100, Bolzano, Italy
| | - Marco Gobbetti
- Faculty of Agricultural, Environmental and Food Sciences, Free University of Bolzano-Bozen, 39100, Bolzano, Italy
- International Center on Food Fermentation, 39100, Bolzano, Italy
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Ahsan A, Amalia N, Rahmayanti KP, Adani N, Wiyono NH, Endawansa A, Utami MG, Miranti Yuniar A, Anastasia EV, Pertiwi YBA. Political economy analysis of health taxes (tobacco, alcohol drink and sugar-sweteened beverage): qualitative study of three provinces in Indonesia. BMJ Open 2024; 14:e085863. [PMID: 39107020 PMCID: PMC11308894 DOI: 10.1136/bmjopen-2024-085863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/22/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This investigates the challenges and opportunities surrounding health tax implementation, with a particular focus on subnational government in Indonesia, where the decentralisation context of health tax remains understudied. DESIGN Employing a qualitative methodology using a problem-driven political economy analysis approach. SETTING We are collecting data from a total of 12 focus group discussions (FGDs) conducted between July and September 2022 in three provinces-Lampung, Special Region of/Daerah Istimewa Yogyakarta and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs) and alcoholic beverages-we explore the multifaceted dynamics of health tax policies. PARTICIPANT These FGDs involved a mean of 10 participants in each FGD, representing governmental institutions, non-governmental organisations and consumers. RESULTS Our findings reveal that health tax policies have the potential to contribute significantly to public health. Consumers understand tobacco's health risks, and cultural factors influence both tobacco and alcohol consumption. For SSBs, the consumers lack awareness of long-term health risks is concerning. Finally, bureaucratic complexiting and decentralised government hinder implementation for all three commodities. CONCLUSION Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardised packaging. Addressing these challenges is critical for realising the full potential of health tax policies.
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Affiliation(s)
- Abdillah Ahsan
- Department of Economics, University of Indonesia Faculty of Economics and Business, Depok, Jawa Barat, Indonesia
| | - Nadira Amalia
- Department of Economics, Faculty of Economics and Administration, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Krisna Puji Rahmayanti
- Department of Public Administration, Faculty of Administrative Science, Universitas Indonesia, Depok, Jawa Barat, Indonesia
| | - Nadhila Adani
- Department of Economics, University of Indonesia Faculty of Economics and Business, Depok, Jawa Barat, Indonesia
| | - Nur Hadi Wiyono
- Faculty of Economics, University of Indonesia, Demographic Institute, Depok, Jawa Barat, Indonesia
| | - Althof Endawansa
- Faculty of Economics, University of Indonesia, Demographic Institute, Depok, Jawa Barat, Indonesia
| | - Maulida Gadis Utami
- Department of Economics, University of Indonesia Faculty of Economics and Business, Depok, Jawa Barat, Indonesia
| | - Adela Miranti Yuniar
- Department of Economics, University of Indonesia Faculty of Economics and Business, Depok, Jawa Barat, Indonesia
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Ku LJE, Moo CC, Li YC, Chang YH, Hsu YH, Huang YC, Lu CL, Li CY. Support for a hypothetical sugar-sweetened beverage tax in Taiwan. Health Promot Int 2024; 39:daae028. [PMID: 38568731 DOI: 10.1093/heapro/daae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Sugar-sweetened beverages (SSBs) are drinks that contain added sugar or sweeteners and provide calories with no additional nutrients, and some countries have imposed additional taxes on the SSBs to reduce consumption, which is considered an SSB tax policy. This study used a cross-sectional online survey to examine the patterns of public support for an SSB tax in Taiwan. The sample included 1617 adults aged ≥ 20 years, who answered the survey questionnaire between May 2020 and April 2021. The respondents were recruited using convenience sampling, but sampling weights were applied to represent the Taiwanese population. Generalized ordered logit models with sampling weights were used to examine the correlates of public support for an SSB tax. Results showed that ~60% of the respondents supported the SSB tax and 47% perceived the tax to be effective. The respondents who were aware of the perceived health risks of SSBs or those who believed that one should be partly responsible for the health impact of SSBs were more likely to show support for the SSB tax. In adjusted regression models, both one's perceived risk and perceived responsibility of SSBs were positively associated with the perceived effectiveness of the SSB tax after sociodemographic characteristics were controlled. These research findings show evidence that there is public support for implementing an SSB tax to reduce SSB consumption in Taiwan.
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Affiliation(s)
- Li-Jung Elizabeth Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
| | - Cherl Cy Moo
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
| | - Yueh-Chen Li
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
| | - Yuu-Hueih Hsu
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
| | - Yi-Chin Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
| | - Chin-Li Lu
- Graduate Institute of Food Safety, National Chung Hsing University, No. 250, Kuo Kuang Rd., Taichung, 402, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Rd., East Rd., Tainan, 701, Taiwan
- Department of Public Health, College of Public Health, China Medical University, No. 100, Section 1, Jingmao Rd., Taichung, 406, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, No.500, Lioufeng Rd., Taichung, 413, Taiwan
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Mohd Hanim MFB, Md Sabri BA, Yusof N. Online commentaries of the sugar-sweetened beverages tax in Malaysia: Content analysis. Public Health Nurs 2024; 41:139-150. [PMID: 37953703 DOI: 10.1111/phn.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Implementing taxes on sugary drinks, or SSBs, has been a controversial topic in many countries, including Malaysia. This study aimed to examine how Malaysian Facebook users responded to the announcement and implementation of the SSBs tax through netnography. METHODS This cross-sectional study employed qualitative and quantitative methods and used an inductive approach and thematic content analysis to analyze online commentaries on news articles published on popular online news portals from November 2018 to August 2019. Data was collected by downloading the commentaries onto Microsoft Word and importing them into NVivo. RESULTS Of the commentaries analyzed, 60.9% rejected the SSBs tax, and 39.1% favored it. No association was found between the online news articles and the slants of the commentaries. CONCLUSION The results of this study demonstrate a clear divide in public opinion regarding the SSBs tax in Malaysia, with many online readers expressing opposition to the tax despite evidence of the harmful effects of sugar presented in the articles they are commenting on. These findings have implications for policymakers and public health advocates seeking to implement similar taxes in the future.
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Affiliation(s)
- Muhammad Faiz Bin Mohd Hanim
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
- Oral Health Program, Ministry of Health, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Budi Aslinie Md Sabri
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
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Lemken D, Wahnschafft S, Eggers C. Public acceptance of default nudges to promote healthy and sustainable food choices. BMC Public Health 2023; 23:2311. [PMID: 37993839 PMCID: PMC10664270 DOI: 10.1186/s12889-023-17127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Default nudges are an increasingly prominent tool for promoting healthy and sustainable food choices; however, questions of acceptance remain. While default nudges are more acceptable to the public than traditionally paternalistic tools that aim to restrict choice, they are also the least acceptable amongst nudging strategies. Little research has investigated the aspects of default nudge design that can be leveraged to better uphold freedom of choice, increase public acceptance, and therefore heighten legitimacy of default nudges. Consequently, this study examines public acceptance of five food choice default nudges with demonstrated precedent of effectiveness, as drawn from research studies and/or real-world policies, along with a design variation of each anticipated to increase acceptance. Three drivers of acceptance - perceived intrusiveness, perceived effectiveness, and own behavior - are examined. METHODS An online survey was administered in Germany (N = 451) to a sample representative of the adult population on quotas of age, gender and income. Acceptance and drivers were measured using seven-point Likert scales. Significant differences in median acceptance of the nudge were determined and displayed graphically. Ten proportional odds ordered logit models were applied and estimated using a maximum likelihood approach to investigate the mechanisms of nudge acceptance. RESULTS Examined changes in nudge design, particularly decreasing costliness of opting out and increasing transparency, increased the acceptance of three of the five nudges (N2.2: p = 0.000; N3.2: p = 0.000; N4.2: p = 0.008). Perceived intrusiveness emerged as the most prominent driver of acceptance (negative relationship), followed by perceived effectiveness (positive relationship). Own engagement in the target behavior of the nudge and socio-demographic variables demonstrated negligible impact on acceptance. CONCLUSIONS Mitigating the costliness of opting out and improving nudge transparency emerge as key opportunities for choice architects to improve public acceptance, and thereby potentially identify 'sweet spots' in designing default nudges that are both effective and acceptable. The protection of individual freedom of choice and effectiveness are key aspects for choice architects to communicate to increase acceptance.
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Affiliation(s)
- Dominic Lemken
- Institute for Food and Resource Economics, University of Bonn, Nußallee 21, 53115, Bonn, Germany
| | - Simone Wahnschafft
- Research Training Group in Sustainable Food Systems, University of Göttingen, Heinrich- Düker-Weg 12, 37073, Göttingen, Germany.
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Zhang X, Bai J, Xian M, Sun J, Xu H. Attitudes of Chinese residents toward sugar-sweetened beverage tax and their willingness to pay: a cross-sectional survey. Front Nutr 2023; 10:1268436. [PMID: 37955019 PMCID: PMC10634395 DOI: 10.3389/fnut.2023.1268436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background Excessive consumption of sugar-sweetened beverages (SSBs) is associated with increased risks of obesity and chronic diseases. To effectively control SSB consumption, several countries including Mexico, France, and the United Kingdom have implemented SSB taxes. However, research on SSB taxes in China is limited. Objective To assess the attitudes of Chinese residents toward the SSB tax and their willingness to pay the tax. Methods: Data were collected through a questionnaire survey among 881 respondents. The generalized ordered logit regression model and marginal effect analysis were used to analyze Chinese participants' attitudes toward SSB tax and their willingness to pay it. Results The average monthly expenditure on SSBs was 44.8 ± 45.3 Yuan (RMB) (6.95 ± 7.02$), and 54.6% of residents supported the SSB tax; they were willing to pay, on average, 1.19 times the original price after additional tax. Age, physical exercise, self-rated health status, weight control plan, awareness of SSBs, children's consumption of SSBs, and proximity to the nearest SSB outlet significantly influenced attitudes toward tax. Notably, SSB awareness had the greatest effect on tax attitudes, with a 17% increase in the probability of supporting SSB tax for every one-level increase in SSB awareness among residents. Conclusion Residents in China have attained a certain level of awareness of, support for, and willingness to pay SSB tax. However, promoting knowledge about the health effects of SSBs and conducting further research to evaluate the effect of SSB tax on obesity prevention in China is still essential.
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Affiliation(s)
- Xuanfei Zhang
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Jinrui Bai
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Mengyao Xian
- Business School, Beijing Normal University, Beijing, China
| | - Junmao Sun
- Chinese Academy of Agricultural Sciences, Beijing, China
| | - Haiquan Xu
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China
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Curley C, Eddie R, Tallis K, Lane TS, Yazzie D, Sanderson PR, Lorts C, Shin S, Behrens TK, George C, Antone-Nez R, Ashley C, de Heer HD. The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:622-632. [PMID: 37253351 PMCID: PMC10363222 DOI: 10.1097/phh.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking. OBJECTIVE To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences. DESIGN Cross-sectional survey. SETTING The Navajo Nation. PARTICIPANTS A total of 234 Navajo Nation community members across 21 communities. OUTCOME MEASURES The percentage of participants who were supportive of the HDNA. RESULTS Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001). CONCLUSIONS The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.
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Affiliation(s)
- Caleigh Curley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Regina Eddie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Kristen Tallis
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Taylor S. Lane
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Del Yazzie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Priscilla R. Sanderson
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Cori Lorts
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Sonya Shin
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Timothy K. Behrens
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Carmen George
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Ramona Antone-Nez
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Christine Ashley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Hendrik D. de Heer
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
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BORG MARIKA, CAUCHI DANIEL, GAUCI CHARMAINE, CALLEJA NEVILLE. Addressing childhood obesity through policy: A cross-sectional study in Malta. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E323-E336. [PMID: 38125997 PMCID: PMC10730052 DOI: 10.15167/2421-4248/jpmh2023.64.3.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Introduction Childhood overweight and obesity are major public health challenges, with Malta having one of the highest prevalences among European countries. The COVID-19 pandemic may further worsen this epidemic. The food and physical activity environments impact children's behaviours. This study looks at barriers to maintain a healthy weight, responsibility to address obesity, and assesses parental support for 22 policies aimed at addressing childhood obesity. Public support for policy is key because it influences which policies are adopted and their success. Methods A cross-sectional, paper-based, quantitative survey was conducted amongst parents of primary school-aged children in Malta in 2018-2019. Ethical approval was obtained. Statistical analysis was performed using SPSS. Results 1,169 parents participated. The food environment was more commonly identified as a barrier to maintain a healthy weight than the physical activity environment. Parents were least supportive of taxation policies, and most in favour of increasing spaces available for safe physical activity (94.0%), followed by providing free weight management services for children (90.8%). The level of support varied significantly by various socio-demographic/economic characteristics; parents with a higher educational level were significantly more supportive of most policies. Most findings were consistent with the international literature. Conclusions Most policies supported are trans-sectoral; a health-in-all policies approach is needed to address the obesogenic environment. The strong public support identified for several policies should embolden policymakers to consider policy options that were not previously considered.
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Affiliation(s)
- MARIKA BORG
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - DANIEL CAUCHI
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - CHARMAINE GAUCI
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - NEVILLE CALLEJA
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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9
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Csákvári T, Elmer D, Németh N, Komáromy M, Mihály-Vajda R, Boncz I. Assessing the impact of Hungary's public health product tax: an interrupted time series analysis. Cent Eur J Public Health 2023; 31:43-49. [PMID: 37086420 DOI: 10.21101/cejph.a7284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/27/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Imposing taxes on unhealthy goods can generate income, raise people's health awareness, and eventually decrease the prevalence of chronic diseases. Our aim was to assess the impact of Hungary's public health product tax (PHPT) since its implementation in September 2011. Differences in purchasing habits between households with different income statuses were also compared. METHODS A retrospective, descriptive analysis of tax bases and income was carried out, and an interrupted time series analysis using the generalised least squares method was performed to examine the changes in trends regarding the purchase of taxable products before and after the implementation of the tax. The amount of tax base (in kilograms or litres), income (in HUF and EUR), and annual purchased quantity of food and beverage groups per household were assessed. Data were derived from the National Tax and Customs Administration of Hungary and the Hungarian Household Budget and Living Conditions Surveys. The study sample was composed of households who participated in the surveys (mean = 8,359, SD = 1,146) between 2006 and 2018. RESULTS The households' tax bases and incomes increased constantly (with a few exceptions). The total revenue was 19.49 billion HUF (67.37 million EUR) in 2012 and 59.19 billion HUF (168.55 million EUR) in 2020. However, the households' purchasing habits did not change as expected. A significant short-term decrease (between 2012 and 2013) in purchasing unhealthy goods was observed for three groups: soft drinks (p = 0.009), jams (p = 0.047), and fruit juices (p = 0.038). Only soft drinks showed a significant decreasing trend in the post-intervention period between 2012 and 2018 (p < 0.001). CONCLUSIONS We concluded that the PHPT did not decrease households' unhealthy food purchasing trend, although it has a positive effect as it can create revenue for health care and health-promoting programmes.
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Affiliation(s)
- Tímea Csákvári
- Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pecs, Hungary
- National Laboratory on Human Reproduction, University of Pecs, Pecs, Hungary
| | - Diána Elmer
- Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pecs, Hungary
- National Laboratory on Human Reproduction, University of Pecs, Pecs, Hungary
| | - Noémi Németh
- Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pecs, Hungary
| | - Márk Komáromy
- Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pecs, Hungary
| | - Réka Mihály-Vajda
- National Laboratory on Human Reproduction, University of Pecs, Pecs, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pecs, Pecs, Hungary
- National Laboratory on Human Reproduction, University of Pecs, Pecs, Hungary
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10
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Scheidmeir M, Kubiak T, Luszczynska A, Wendt J, Scheller DA, Meshkovska B, Müller-Stierlin AS, Forberger S, Łobczowska K, Neumann-Podczaska A, Wieczorowska-Tobis K, Zeeb H, Steinacker JM, Woods CB, Lakerveld J. Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes. Eur J Public Health 2022; 32:iv32-iv49. [PMID: 36444105 PMCID: PMC9897019 DOI: 10.1093/eurpub/ckac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents. METHODS A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science). RESULTS Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability. CONCLUSION Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
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Affiliation(s)
- Marie Scheidmeir
- Department of Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Department of Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Janine Wendt
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences (UiO-PHN), University of Oslo, Oslo, Norway
| | | | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Karolina Łobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland
| | | | | | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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11
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Public perception of the tax on sweetened beverages in France. Public Health Nutr 2022; 25:3240-3251. [PMID: 35942709 PMCID: PMC9991787 DOI: 10.1017/s1368980022001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance. DESIGN A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling. SETTINGS NutriNet-Santé prospective cohort study. PARTICIPANTS Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France. RESULTS Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax. CONCLUSION The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.
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12
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Piekara A. Sugar Tax or What? The Perspective and Preferences of Consumers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12536. [PMID: 36231840 PMCID: PMC9566220 DOI: 10.3390/ijerph191912536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Reducing high-calorie food and beverages consumption is a multi-dimensional challenge spanning agriculture to food marketing. Adverse health effects resulting from sugar-sweetened beverages such as obesity, diabetes, cardiovascular disease or dental carries have been described on numerous occasions. Poland is one of the countries that have introduced the sugar tax. The study aims to understand the degree of consumers' awareness of the upcoming changes and their opinions and assessments of the efficiency of various activities. The study was based on Computer-Assisted Web Interview (CAWI). The sample comprised 500 adult consumers. Most of the respondents (69.6%) are aware that a new charge for sweetened beverages is going to be introduced, and for 78.9% of the respondents, it is important to take action aimed at reducing the consumption of sweetened beverages by consumers. Well-educated respondents as well as women perceive a greater degree of need to take specific action within the area of health policy (p-value 0.010 and 0.000 respectively). The sugar tax is considered an effective tool for limiting the purchase of sweetened products. Other types of activities within the framework of preventative healthcare that aim to reduce the consumption of sugar by society should also be developed.
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Affiliation(s)
- Agnieszka Piekara
- Department of Bioprocess Engineering, Wroclaw University of Economics and Business, Komandorska 118-120, 53-345 Wrocław, Poland
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13
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Case KK, Pineda E, Olney J, Segal AB, Sassi F. The 'sugar tax' in Bermuda: a mixed methods study of general population and key stakeholder perceptions. BMC Public Health 2022; 22:1557. [PMID: 35974346 PMCID: PMC9379233 DOI: 10.1186/s12889-022-13945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Taxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018–2019, the Bermuda government introduced a phased tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar, and eliminated import duties on select healthy food items. The aim of this study was to conduct an mixed methods evaluation of perceptions of the tax among the general population and key stakeholders. Methods We conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Survey data was analysed using thematic analysis, summary statistics, and Chi-squared tests. Key informant interviews were analysed using the framework method. Results General population respondents had high awareness of the sugar tax (94%) but low awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption due to beliefs the tax would not be effective (44%), and because of the high price of healthy food (20%). However, nearly half (48%) reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness but limited understanding of the tax policy. Informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The lack of clear price differentiation between taxed and un-taxed products and the absence of accompanying health education were key factors believed to affect the impact of the tax. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed to other priorities after implementation. Conclusions There was high awareness, but limited acceptability of the Bermuda sugar tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13945-9.
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Affiliation(s)
- Kelsey K Case
- School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Elisa Pineda
- School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.,Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Jack Olney
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Alexa Blair Segal
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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14
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Christian D, Maharjan M, Kotov A, Cotter T, Mullin S, Nurse V, McGaw B, Chen D, Puri P, Wang S, Negi NS, Murukutla N. How the "Are We Drinking Ourselves Sick?" Communication Campaign Built Support for Policy Action on Sugary Drinks in Jamaica. Nutrients 2022; 14:nu14142866. [PMID: 35889823 PMCID: PMC9318558 DOI: 10.3390/nu14142866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This study assesses the effectiveness of a campaign “Are We Drinking Ourselves Sick?” that ran nationally in Jamaica in four phases from 2017 to 2019 to increase knowledge about the harms of sugary drinks, shift attitudes, and build support for policy actions to address sugary drink consumption, including a tax and a ban in schools. Methods: Campaign impact was measured in representative cross-sectional household surveys of adults ages 18 to 55. A baseline survey was conducted before the launch of the campaign (n = 1430). Evaluation surveys were conducted mid-campaign (n = 1571) and post-campaign (n = 1500). Campaign impact was assessed by comparing changes across survey periods on key knowledge, attitudinal and policy support outcome indicators. The independent association between campaign awareness and outcomes was analyzed using logistic regression analyses. Results: The campaign was recalled by more than 80% of respondents and was well-received with 90% or more respondents describing it as believable and relevant. There was a decline in knowledge on the harms of sugary drinks from the baseline to post-campaign period, notably on risks of diabetes (adjusted odds ratio or AOR = 0.62, p < 0.001), overweight and obesity (AOR = 0.58, p < 0.001), and heart disease (AOR = 0.79, p < 0.003). However, post-campaign awareness was independently associated in logistic regression analysis with improved knowledge of the harms of sugary drinks, including risks of diabetes (AOR = 1.45, p = 0.019), overweight or obesity (AOR = 1.65, p = 0.001), and heart disease (AOR = 1.44, p = 0.011). Support for government action remained high across survey waves (≥90%), and campaign awareness was independently associated with increased policy support for sugary drinks taxes (Mid-campaign: AOR = 1.43, p = 0.019; post-campaign: AOR = 1.46, p = 0.01) and restrictions on sugary drinks in schools (AOR = 1.55, p = 0.01). Conclusion: This study demonstrates the role that media campaigns can play in maintaining knowledge and concern about the health harms of sugary drinks and increasing support for policy passage.
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Affiliation(s)
- Donnelle Christian
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Meena Maharjan
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
- Correspondence:
| | - Alexey Kotov
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Trish Cotter
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Sandra Mullin
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Vonetta Nurse
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Barbara McGaw
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Deborah Chen
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Pallavi Puri
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Shuo Wang
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Nalin Singh Negi
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Nandita Murukutla
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
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15
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Oddo VM, Knox MA, Pinero Walkinshaw L, Saelens BE, Chan N, Jones-Smith JC. Evaluation of Seattle's sweetened beverage tax on tax support and perceived economic and health impacts. Prev Med Rep 2022; 27:101809. [PMID: 35656219 PMCID: PMC9152812 DOI: 10.1016/j.pmedr.2022.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/03/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
It is important to understand whether the publics' attitudes towards sugary beverage taxes (SBT) change after tax implementation to ensure the long-term success of tax policies. Seattle's SBT went into effect on January 1, 2018. We administered a mixed-mode survey to adults in Seattle and comparison areas, pre- and 2-years post-tax, to evaluate the impact of the SBT on 1) tax support and 2) perceived tax impacts (N = 2,933). Using a difference-in-differences approach, we employed adjusted income-stratified modified Poisson models to test the impacts of the tax on net changes in attitudes in Seattle versus the comparison areas, pre- to post-tax. Among lower-income individuals in Seattle, support for the tax increased by 14% (PRDD: 1.14; 95% CI: 1.08, 1.21) and there was a 20% net-increase in the perception that the SBT would positively affect the economy (PRDD: 1.20; 95% CI: 1.05, 1.39), compared to changes in the comparison areas. Among higher-income individuals in Seattle, support for the tax was not different (PRDD: 0.93; 95% CI: 0.70, 1.22) pre- to post-tax, but there was a net-increase in the perception that the tax would have negative effects on small businesses (PRDD: 1.44; 95% CI: 1.03, 2.00) and family finances (PRDD: 1.86; 95% CI: 1.09, 3.19). After living with the tax for 2-years, support for the tax increased among lower-income individuals in Seattle. Tax support was high and unchanged among higher-income individuals, but overall attitudes became more negative. Policy makers should consider investing in ongoing campaigns that explain the benefits of SSB taxes and revenues.
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Affiliation(s)
- Vanessa M. Oddo
- University of Illinois Chicago, College of Applied Health Sciences, Department of Kinesiology and Nutrition, Chicago, IL, USA
| | - Melissa A. Knox
- University of Washington, Department of Economics, Seattle, WA, USA
| | - Lina Pinero Walkinshaw
- University of Washington School of Public Health, Department of Health Systems and Population Health, Seattle, WA, USA
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA, USA
| | - Nadine Chan
- Public Health - Seattle and King County, Seattle, WA, USA
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Jessica C. Jones-Smith
- University of Washington School of Public Health, Department of Health Systems and Population Health, Seattle, WA, USA
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
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16
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Bodo YL, Etilé F, Julia C, Friant-Perrot M, Breton E, Lecocq S, Boizot-Szantai C, Bergeran C, Jabot F. Public health lessons from the French 2012 soda tax and insights on the modifications enacted in 2018. Health Policy 2022; 126:585-591. [DOI: 10.1016/j.healthpol.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/25/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
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17
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Fernández Sánchez-Escalonilla S, Fernández-Escobar C, Royo-Bordonada MÁ. Public Support for the Imposition of a Tax on Sugar-Sweetened Beverages and the Determinants of Such Support in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3758. [PMID: 35409442 PMCID: PMC8998005 DOI: 10.3390/ijerph19073758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: Taxes on sugar-sweetened beverages are an effective public health intervention, but can be difficult to implement in the absence of public support. This is the first study to analyze the Spanish population’s support for a tax on sugar-sweetened beverages. (2) Methods: We conducted a cross-sectional study of a representative sample of the Spanish adult population (n = 1002), using a computer-aided telephone interview with a questionnaire on nutritional policies. The support for the tax was calculated by the percentage of those who agreed plus those who strongly agreed with the measure. The sociodemographic determinants of support for the tax were analyzed using chi-squared test (χ2) and Poisson multiple regression models with robust variance. (3) Results: Of the participants, 66.9% supported a tax on sugar-sweetened beverages. Support for the tax was 9.2% higher (70% vs. 64.1%) when responders were first asked about support for tax relief and subsidies for healthy foods (p = 0.049). Support for the tax was 16% and 35% lower among persons reporting center and right-wing political sympathies (p < 0.01), and 16% lower among regular consumers of sugar-sweetened beverages (p = 0.01). (4) Conclusions: A clear majority of the Spanish population is in favor of imposing a tax on sugar-sweetened beverages. Awareness-raising campaigns and a policy of combining the measure with subsidies or tax cuts on healthy foods could increase the level of support among those currently against the intervention.
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Affiliation(s)
| | - Carlos Fernández-Escobar
- Public Health and Epidemiology Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, 28871 Alcalá de Henares, Spain;
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18
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Howse E, Cullerton K, Grunseit A, Bohn-Goldbaum E, Bauman A, Freeman B. Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods. Health Res Policy Syst 2022; 20:26. [PMID: 35246170 PMCID: PMC8895540 DOI: 10.1186/s12961-022-00829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.
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Affiliation(s)
- Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia. .,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katherine Cullerton
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Erika Bohn-Goldbaum
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Tan JY, Ong SG, Teng A, Ng B, Yao J, Luo N, Rebello SA. Perspectives of Adult Singaporeans toward Potential Policies to Reduce the Consumption of Sugar Sweetened Beverages-A Cross-Sectional Study. Nutrients 2021; 13:4231. [PMID: 34959783 PMCID: PMC8706143 DOI: 10.3390/nu13124231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Excessive consumption of sugar sweetened beverages (SSB) is of growing concern, and several countries are implementing measures to reduce SSB consumption. Understanding perceptions towards SSB policies is crucial to prioritize policy actions and to effectively frame public communication. We conducted a cross-sectional study in a sample of 754 adult Singaporeans to examine support towards 10 hypothetical policies to reduce SSB consumption. Policy scenarios were presented to participants and support was assessed using a 5-point Likert scale. Opinions about policies were elicited by asking participants "What other thoughts do you have about this policy?". We used logistic regression to examine determinants of policy support, and thematic analyses to understand opinions about policies. We observed good public support for a variety of SSB policies. In general, less restrictive policies such as traffic light labels (85.0% agreed/strongly agreed) and free access to water at eateries (77.1%) were better supported as compared to restrictive policies such as portion-size restrictions (64.5%) and taxation (55.0%). There was limited variation by age, ethnicity, income, physical activity and body mass index. Concerns about policies largely centered on loss of personal autonomy and economic implications for businesses. Nevertheless, participants also recognized that policies could support healthier beverage consumption by increasing awareness and enabling informed decision making. Findings from this study provide insights into consumer's perceptions of SSB policies, and can inform public health advocacy and government action in this area.
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Affiliation(s)
- Jing Yuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (J.Y.T.); (S.G.O.); (A.T.); (B.N.)
| | - Siong Gim Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (J.Y.T.); (S.G.O.); (A.T.); (B.N.)
| | - Albert Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (J.Y.T.); (S.G.O.); (A.T.); (B.N.)
| | - Benedict Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; (J.Y.T.); (S.G.O.); (A.T.); (B.N.)
| | - Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (J.Y.); (N.L.)
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (J.Y.); (N.L.)
| | - Salome A. Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (J.Y.); (N.L.)
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Adams J, Pell D, Penney TL, Hammond D, Vanderlee L, White M. Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017-2019). BMJ Open 2021; 11:e051677. [PMID: 34561262 PMCID: PMC8475144 DOI: 10.1136/bmjopen-2021-051677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation. DESIGN Repeat cross-sectional online survey. SETTING The UK. PARTICIPANTS UK respondents to the International Food Policy Study aged 18-64 years who provided information on all variables of interest in November-December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284). OUTCOME MEASURES Self-reported support for, and perceived effectiveness of, the SDIL. RESULTS The adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar. CONCLUSIONS We found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.
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Affiliation(s)
- Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Pell
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Midlands Region, NHS RightCare, Newcastle upon Tyne, UK
| | - Tarra L Penney
- School of Global Health, York University Faculty of Health, Toronto, Ontario, Canada
| | - David Hammond
- School of Public Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- School of Nutrition, Laval University, Quebec, Quebec, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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21
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Shen X, Li CJ, Dong T, Cao H, Feng J, Lei Z, Wang Z, Han X, Lv C, Gan Y. Public Opinion and Expectations: Development of Public Health Education in China After COVID-19 Pandemic. Front Public Health 2021; 9:702146. [PMID: 34447736 PMCID: PMC8383066 DOI: 10.3389/fpubh.2021.702146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Policymakers must promote the development of public health education and human resources. As a feature of the political environment, public opinion is essential for policy-making, but virtually the attitudes of Chinese citizens toward human resources development in public health is unknown. Methods: This study conducted a crosssectional survey from February 4, 2021 to February 26, 2021 in China. We adopted a convenient sampling strategy to recruit participators. Participants filled out the questions, which assess the attitudes of the expanding public health professionals. A logistic regression analysis was given to identify the predictors associated with the attitudes of the subjects. Results: There were 2,361 residents who have finished our questionnaire. Chinese residents who lived in urban (OR = 1.293, 95% CI = 1.051-1.591), "themselves or relatives and friends have participated in relevant epidemic prevention work" (OR = 1.553, 95% CI = 1.160-2.079), "themselves or family members engaged in medical-related work" (OR = 1.468, 95% CI = 1.048-2.056), and those who "were aware of public health before the outbreak of COVID-19" (OR = 1.428, 95% CI = 1.125-1.812) were more likely to support the promotion of public health education and training. Conclusions: The present study found that 74.50% of Chinese citizens supported the promotion of public health education and training in China, in which economic status, personal perception, and comprehension are the crucial factors that influence public opinion. COVID-19 has aroused the attention of Chinese residents to public health education, with only 22.11% of residents being aware of public health before the outbreak of COVID-19. The COVID-19 pandemic has profound implications for human society. Literally, this impact will feed back into future public health policies based on public opinion. This innovative perspective will also help us better understand the potential social impact of COVID-19 on human resources and development for health in the modern world.
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Affiliation(s)
- Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Crystal Jingru Li
- Department of Psychology, School of Education and Human Development, Hong Kong Education University, Hong Kong, China
| | - Tianyi Dong
- Department of Labor and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Cao
- Department of Labor Economics and Management, Beijing Vocational College of Labour and Social Security, Beijing, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zihui Lei
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zijian Wang
- School of Arts and Communication, Guangxi University of Science and Technology, Liuzhou, China
| | - Xiaotong Han
- Department of Emergency Medicine, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabolomics, Hunan Provincial People's Hospital/The First Affiliated Hospital, Hunan Normal University, Changsha, Hunan, China
| | - Chuanzhu Lv
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bombak AE, Colotti TE, Raji D, Riediger ND. Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:36. [PMID: 34344480 PMCID: PMC8329609 DOI: 10.1186/s41043-021-00259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting. METHODS This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software. RESULTS Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight. CONCLUSIONS Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.
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Affiliation(s)
- Andrea E. Bombak
- Department of Sociology, University of New Brunswick, Tilley Hall, Room 9, Fredericton, NB E3B 5A3 Canada
- School of Health Sciences, Community Health Division, Central Michigan University, 1280 E Campus Dr, Mt Pleasant, MI 48859 USA
| | - Taylor E. Colotti
- School of Health Sciences, Community Health Division, Central Michigan University, 1280 E Campus Dr, Mt Pleasant, MI 48859 USA
| | - Dolapo Raji
- School of Health Sciences, Community Health Division, Central Michigan University, 1280 E Campus Dr, Mt Pleasant, MI 48859 USA
| | - Natalie D. Riediger
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, 407 Human Ecology Building, Winnipeg, MB R3T 2N2 Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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Essman M, Stoltze FM, Carpentier FD, Swart EC, Taillie LS. Examining the news media reaction to a national sugary beverage tax in South Africa: a quantitative content analysis. BMC Public Health 2021; 21:454. [PMID: 33676468 PMCID: PMC7937301 DOI: 10.1186/s12889-021-10460-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND South Africa was the first sub-Saharan African country to implement a sugar-sweetened beverage (SSB) tax called the Health Promotion Levy (HPL) in April 2018. Given news media can increase public awareness and sway opinions, this study analyzed how the media represented the HPL, including expressions of support or challenge, topics associated with the levy, and stakeholder views of the HPL. METHODS We performed a quantitative content analysis of online South African news articles related to the HPL published between January 1, 2017 and June 30, 2019. We coded the presence or absence of mentions related to health and economic effects of the HPL and HPL support or opposition. Prevalence of these mentions, overall and by source (industry, government, academics, other), were analyzed with Pearson χ2 and post-hoc Fisher exact tests. RESULTS Across all articles, 81% mentioned health, and 65% mentioned economics topics. 54% of articles expressed support, 26% opposition, and 20% a balanced view of the HPL. All sources except industry expressed majority support for the HPL. Health reasons were the most common justifications for support, and economic harms were the most common justifications for opposition. Statements that sugar intake is not related to obesity, the HPL will not reduce SSB intake, and the HPL will cause industry or economic harm were all disproportionately high in industry sources (92, 80, and 81% vs 25% prevalence in total sample) (p < 0.001). Statements that sugar intake is related to obesity and non-communicable diseases were disproportionately high in both government (46 and 54% vs 31% prevalence in total sample) (p < 0.001) and academics (33 and 38% vs 25% prevalence in total sample) (p < 0.05). Statements that the HPL will improve health and the HPL will reduce health care costs were disproportionately high in government (47% vs 31% prevalence in total sample) (p < 0.001) and academics (44% vs 25% prevalence in total sample) (p < 0.05), respectively. CONCLUSIONS Industry expressed no support for the HPL, whereas academics, government, and other sources mainly expressed support. Future studies would be improved by linking news media exposure to SSB intake data to better understand the effects news media may have on individual behavior change.
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Affiliation(s)
- Michael Essman
- Gillings School of Global Public Health, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernanda Mediano Stoltze
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Elizabeth C Swart
- Faculty of Community and Health Sciences, University of the Western Cape, Robert Sobukwe Rd, Bellville, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Gillings School of Global Public Health, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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The Acceptance of Key Public Health Interventions by the Polish Population Is Related to Health Literacy, But Not eHealth Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155459. [PMID: 32751180 PMCID: PMC7432801 DOI: 10.3390/ijerph17155459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
Background: Public health and health promotion rely on many different interventions, which range from health education and communication, through community mobilisation and changes to environmental conditions, to legal and fiscal actions. The introduction of the increased tax on sugar-sweetened beverages (SSB), popularly called sugar tax (ST), and a mandatory programme of vaccinations are the strategies inciting the most vivid discussions in Polish society. The study was intended to assess the determinants of the attitudes of Polish society regarding the ST and to vaccinations. Methods: For the analysis, the data originating from the survey of a representative adult sample of Polish society (n = 1000) was used. The survey was based on computer-assisted telephone interviewing (CATI). The assessment of the relationships between the selected variables and the opinions about the introduction of the ST and the safety and effectiveness of vaccinations were carried out using the chi2 test and univariate logistic regression models. Results: The acceptance of the ST and vaccination showed a significant relationship to the level of health literacy (HL) but not to eHealth literacy (eHL). Respondents having a higher rather than lower HL; older rather than younger; married rather than singles; retired, or on a disability pension, rather than vocationally active and nonusers of the Internet rather than users were more likely to show an acceptance for both interventions. Those more frequently using health care services and those with chronic diseases showed a greater belief in the safety and effectiveness of vaccinations. Conclusions: The relationship between the opinions of the two public health interventions analysed and the sociodemographic variables demonstrated similar patterns. Interestingly, the opinions were associated only with HL and not with eHL and users of the Internet were more sceptical about the interventions.
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Public acceptability of a sugar-sweetened beverage tax and its associated factors in the Netherlands. Public Health Nutr 2020; 24:2354-2364. [PMID: 32495730 PMCID: PMC8145443 DOI: 10.1017/s1368980020001500] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: To investigate the level of public acceptability of a sugar-sweetened beverage (SSB) tax and its associated factors. Design: Participants completed an online self-administered questionnaire. Acceptability of an SSB tax was measured on a seven-point Likert scale (strongly disagree to strongly agree). Associations between acceptability and sociodemographic factors, weight status, SSB consumption and beliefs about effectiveness (e.g., ‘An SSB tax would reduce people’s SSB consumption’), appropriateness, socioeconomic and economic benefit, implementation and trust were assessed using multivariable linear regression analyses. Setting: The Netherlands. Participants: Dutch adults aged ≥18 years representative of the Dutch population for age, sex, education level and location (n 500). Results: Of the participants, 40 % supported and 43 % opposed an SSB tax in general. Moreover, 42 % supported (43 % opposed) an SSB tax as a strategy to reduce overweight, and 55 % supported (32 % opposed) an SSB tax if revenue is used for health initiatives. Participants with a low education level (B = –0·82, 95 % CI –1·31, –0·32), overweight (B = –0·49, 95 % CI –0·89, –0·09), moderate or high SSB consumption (B = –0·86, 95 % CI –1·30, –0·43 and B = –1·01, 95 % CI –1·47, –0·56, respectively) and households with adolescents (B = –0·57, 95 % CI –1·09, –0·05) reported a lower acceptability of an SSB tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P < 0·001). Conclusions: Public acceptability of an SSB tax tends to be higher if revenue is used for health initiatives. The factors associated with acceptability should be taken into consideration.
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Gillison F, Grey E, Griffin T. Parents' Perceptions and Responses to the UK Soft Drinks Industry Levy. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:626-631. [PMID: 31919006 DOI: 10.1016/j.jneb.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To record parents' awareness of the UK soft drinks industry levy (SDIL) and explore associations between negative psychological reactance to the levy and motivation and intentions to change consumption and purchasing. METHODS A cross-sectional online survey with UK-based parents of children aged 5-11 years (n = 237). Regression analyses were used to test associations between psychosocial responses to the levy and behavioral intentions to change family consumption and purchasing. RESULTS A total of 92% of responding parents were aware of the SDIL. Of the responding parents, 57% supported its aims, but 29% felt it threatened their freedom of choice. A total of 41% expressed intention to change shopping habits or restrict their child's intake as a result. Reactance and motivation were poorer in low-income families, and intentions to change were positively predicted by motivation. CONCLUSIONS AND IMPLICATIONS This snapshot suggests that the UK SDIL is largely supported by parents and associated with intentions to change their children's intake.
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Affiliation(s)
- Fiona Gillison
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom.
| | - Elisabeth Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom
| | - Tania Griffin
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdom
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Jürkenbeck K, Zühlsdorf A, Spiller A. Nutrition Policy and Individual Struggle to Eat Healthily: The Question of Public Support. Nutrients 2020; 12:E516. [PMID: 32085503 PMCID: PMC7071418 DOI: 10.3390/nu12020516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
The evidence for the effectiveness of nutrition policy interventions is growing. For the implementation of such interventions, social acceptability is crucial. Therefore, this study provides insight into public support for nutrition policy measures such as labelling and taxation. Further it analyses the level of acceptance in a quantitative segmentation approach. A new element to our approach is the comparison of different policy instruments, focusing on the interaction between policy acceptance and the perceived individual struggle to eat healthily. The survey was conducted in November 2017 and a total of 1035 German consumers are included in the data. The results indicate that the majority of German citizens accept nutrition policy interventions. Based on a cluster analysis, five different target groups according to the general acceptance of policy interventions and their own struggle to eat healthily are derived. The five-cluster solution reveals that both consumers who tend to eat a healthy diet as well as those who have problems with their diet support nutritional interventions. This shows that the perceived own struggle to eat healthily does not predict whether consumers accept nutrition policy interventions.
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Affiliation(s)
- Kristin Jürkenbeck
- Department of Agricultural Economics and Rural Development, Marketing of Food and Agricultural Products, University of Goettingen, 37073 Göttingen, Germany; (A.Z.); (A.S.)
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Pattern and correlates of public support for public health interventions to reduce the consumption of sugar-sweetened beverages. Public Health Nutr 2019; 22:3270-3280. [PMID: 31544722 DOI: 10.1017/s1368980019002076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the pattern and correlates of public support for twelve public health interventions aimed at reducing sugar-sweetened beverage (SSB) consumption. DESIGN Cross-sectional population-based survey. Respondents were recruited using a random digit dialling procedure (landline telephone) and a random selection of telephone numbers (mobile telephone). Sampling quotas were applied for age, and the sample was stratified according to administrative regions. SETTING The province of Québec, Canada. SUBJECTS One thousand adults aged between 18 and 64 years and able to answer the survey questionnaire in French or English. RESULTS Support was observed for a number of public health interventions, but the more intrusive approaches were less supported. Support for taxation as well as for sale and access restriction was positively associated with the perceived relevance of the government intervention, perceived effectiveness, and perceived associations between SSB consumption and chronic diseases. Believing that SSB consumption is a personal choice and daily consumption were generally negatively associated with strong support and positively associated with strong opposition. Sparse associations between sociodemographic and socio-economic characteristics were observed, with the exception of sex and age: women were generally more likely to support the examined public health strategies, while younger respondents were less likely to express support. CONCLUSIONS Increasing perceived effectiveness and government responsibility for addressing the issue of SSB consumption could lead to increased support for SSB interventions. Increasing the belief that SSB consumption could be associated with chronic diseases would increase support, but SSB consumers and younger individuals are expected to be resistant.
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Eykelenboom M, van Stralen MM, Olthof MR, Schoonmade LJ, Steenhuis IHM, Renders CM. Political and public acceptability of a sugar-sweetened beverages tax: a mixed-method systematic review and meta-analysis. Int J Behav Nutr Phys Act 2019; 16:78. [PMID: 31484538 PMCID: PMC6727579 DOI: 10.1186/s12966-019-0843-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax. METHODS Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions. RESULTS Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38-0.47) supports an SSBs tax, 39% (0.29-0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60-0.72) supports an SSBs tax if revenue is used for health initiatives. CONCLUSIONS Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.
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Affiliation(s)
- Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Kwon J, Cameron AJ, Hammond D, White CM, Vanderlee L, Bhawra J, Sacks G. A multi-country survey of public support for food policies to promote healthy diets: Findings from the International Food Policy Study. BMC Public Health 2019; 19:1205. [PMID: 31477071 PMCID: PMC6721115 DOI: 10.1186/s12889-019-7483-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor diet is a significant contributor to the burden of global disease. There are numerous policies available to address poor diets; however, these policies often require public support to encourage policy action. The current study aimed to understand the level of public support for a range of food policies and the factors associated with policy support. METHODS An online survey measuring support for 13 food policies was completed by 19,857 adults in Australia, Canada, Mexico, the United Kingdom (UK) and the United States (US). The proportion of respondents that supported each policy was compared between countries, and the association between demographic characteristics and policy support was analysed using multivariate logistic regression. RESULTS The level of support varied between policies, with the highest support for policies that provided incentives (e.g., price subsidies) or information (e.g., calorie labelling on menus), and the lowest support for those that imposed restrictions (e.g., restrictions on sponsorship of sport events). This pattern of support was similar in all countries, but the level differed, with Mexico generally recording the highest support across policies, and the US the lowest. Several demographic characteristics were associated with policy support; however, these relationships varied between countries. CONCLUSION The results suggest that support for food policies is influenced by several factors related to the policy design, country, and individual demographic characteristics. Policymakers and advocates should consider these factors when developing and promoting policy options.
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Affiliation(s)
- Janelle Kwon
- Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Lana Vanderlee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Gary Sacks
- Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia.
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Oddo VM, Krieger J, Knox M, Saelens BE, Chan N, Walkinshaw LP, Podrabsky M, Jones-Smith JC. Perceptions of the possible health and economic impacts of Seattle's sugary beverage tax. BMC Public Health 2019; 19:910. [PMID: 31288764 PMCID: PMC6617661 DOI: 10.1186/s12889-019-7133-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 06/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Taxes on sugary beverages are an emerging strategy to improve health by reducing consumption and raising revenues to support community wellbeing. However, taxes may have unintended consequences, and perceptions of these consequences may affect attitudes towards this policy. METHODS In June 2017, the Seattle City Council passed an ordinance imposing a tax on sugary beverages, effective January 1, 2018. Between October and December 2017, we recruited 851 adults in Seattle to complete a survey (telephone or online) about support for the tax and their perceptions of tax-related health and economic impacts. We first analyzed data for the full sample. We then tested for differences in participants' responses by household income level (< 260% Federal Poverty Level [FPL], ≥ 260% FPL) and across race/ethnicities using chi-square tests. Analyses used population weights and adjusted for multiple comparisons, using the Holm-Bonferroni Sequential Correction (p < 0.01). RESULTS A majority of participants supported the sugary beverage tax (59%; 95% Confidence Interval [CI]: 55, 63%) and believed that the tax would improve public health (56%; CI: 52, 60%). Most participants believed that the tax would not negatively affect small businesses (52%; CI: 48, 56%) nor result in job loss (66%; CI: 62, 70%). Most participants also perceived that the tax would not negatively impact their own finances (79%; CI: 75, 82%). However, fewer lower-income (48%; CI: 42, 53%), versus higher-income participants (61%; CI: 55, 66%), perceived that the tax would improve public health, would not result in job loss (lower-income: 58%; CI: 53, 64%; higher-income: 71%; CI: 66, 75%) and would not negatively affect their own finances (lower-income: 68%; CI: 62, 73%; higher-income: 85%; CI: 81, 88%). Compared to non-Hispanic Whites, (82%; CI: 79, 86%), a smaller proportion of non-Hispanic Blacks (63%; 95% CI: 48, 75%), and Hispanics (67%; 95% CI: 51, 79%), perceived that the tax would have negative consequences for their own family finances. CONCLUSIONS A majority of respondents supported the sugary beverage tax in Seattle. Lower-income participants were more concerned about potential financial consequences. Further evaluation of the extent to which unintended consequences occur is needed.
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Affiliation(s)
- Vanessa M. Oddo
- Department of Health Services and Center for Public Health Nutrition, University of Washington School of Public Health, 330 Raitt Hall, Seattle, WA 98195 USA
| | - James Krieger
- Healthy Food America and Departments of Medicine and Health Services, University of Washington, Box 22260, Seattle, WA 98122 USA
| | - Melissa Knox
- Department of Economics, University of Washington, 305 Savery Hall, Seattle, WA 98195 USA
| | - Brian E. Saelens
- Seattle Children’s Research Institute and Department of Pediatrics, University of Washington School of Medicine, 2001 8th Ave, Suite 400, Seattle, WA 98121 USA
| | - Nadine Chan
- Public Health - Seattle and King County and Department of Epidemiology, University of Washington School of Public Health, 401 5th Ave, Suite 1300, Seattle, WA 98104 USA
| | - Lina Pinero Walkinshaw
- Department of Health Services and Center for Public Health Nutrition, University of Washington School of Public Health, 330 Raitt Hall, Seattle, WA 98195 USA
| | - Mary Podrabsky
- Department of Health Services and Center for Public Health Nutrition, University of Washington School of Public Health, 330 Raitt Hall, Seattle, WA 98195 USA
| | - Jessica C. Jones-Smith
- Departments of Health Services and Epidemiology and Center for Public Health Nutrition, University of Washington School of Public Health, 305-G Raitt Hall, Seattle, WA 98195 USA
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Miller CL, Dono J, Wakefield MA, Pettigrew S, Coveney J, Roder D, Durkin SJ, Wittert G, Martin J, Ettridge KA. Are Australians ready for warning labels, marketing bans and sugary drink taxes? Two cross-sectional surveys measuring support for policy responses to sugar-sweetened beverages. BMJ Open 2019; 9:e027962. [PMID: 31248926 PMCID: PMC6597645 DOI: 10.1136/bmjopen-2018-027962] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To assess public support for 10 potential policy initiatives to reduce sugar-sweetened beverage (SSB) consumption. DESIGN A 2014 historical data set, which employed a face-to-face survey in one Australian state (study 1), provided the basis for comparison with our 2017 nationally representative, cross-sectional, computer-assisted telephone interviewing population survey (study 2). PARTICIPANTS Study 1: South Australians, 15+ years (n=2732); study 2: Australians, 18+ years (n=3430). PRIMARY OUTCOME MEASURES levels of support for SSB-specific policy initiatives. For the 2017 national study (study 2), demographic characteristics, body mass index, knowledge of potential harms caused by consuming SSBs and SSB consumption were included in multivariable regression analyses. RESULTS In 2017, all 10 potential policy initiatives received majority support (60%-88% either 'somewhat' or 'strongly' in favour). Initiatives with educative elements or focused on children received high support (>70%), with highest support observed for text warning labels on drink containers (88%) and government campaigns warning of adverse health effects (87%). Higher support was observed for SSB tax paired with using funds for obesity prevention (77%) than a stand-alone tax (60%). Support for policy initiatives was generally greater among those who believed SSB daily consumption could cause health problems in adults (4%-18% absolute difference) and/or in children (8%-26% absolute difference) and lower among SSB high consumers (7+ drinks per week; 9%-29% absolute difference). State-specific data comparison indicated increased support from 2014 to 2017 for taxation (42%vs55%; χ2=15.7, p<0.001) and graphic health warnings (52%vs68%; χ2=23.4. p<0.001). CONCLUSIONS There is strong public support for government action, particularly regulatory and educational interventions, to reduce SSB consumption, which appears to have increased since 2014. The findings suggest that framing policies as protecting children, presenting taxation of SSBs in conjunction with other obesity prevention initiatives and education focused on the harms associated with SSB consumption will increase support.
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Affiliation(s)
- Caroline L Miller
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Joanne Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Wittert
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kerry A Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation. Public Health Nutr 2019; 23:374-383. [PMID: 31179956 DOI: 10.1017/s1368980019001356] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption. DESIGN We conducted six focus group discussions using a semi-structured guide. SETTING The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented. PARTICIPANTS Adults aged 18 years or above living in Soweto (n 57). RESULTS Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons. CONCLUSIONS While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.
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Public support for health taxes and media regulation of harmful products in South Korea. BMC Public Health 2019; 19:665. [PMID: 31146724 PMCID: PMC6543563 DOI: 10.1186/s12889-019-7044-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/24/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Public health policy is inevitably associated with either a strong presence or lack of public support. We investigated factors associated with both the public support of and opposition to health taxes and the media regulation regarding advertising harmful products in Korea. METHODS We interviewed 1200 respondents that were recruited using an equal-probability sampling method in accordance with the 2016 Korean census. Our investigation examined the extent of support and opposition towards health taxes and the media regulation of advertising that targets the consumption of tobacco, alcohol, and unhealthy foods according to socioeconomic characteristics, health habits, body mass index (BMI), and exposure to the advertising of harmful products. The study was conducted using a univariate and stepwise multivariate regression analysis. RESULTS The majority (71.8%) of the respondents were supportive of imposing health taxes in general. Despite a high prevalence of tobacco and alcohol consumption among the respondents, they strongly supported media regulation of tobacco (72.3%), alcohol (63.7%), and eating broadcasts (51.9%) food advertising (44.0%). Those that were non-smokers, earned a high-income, were married, or had a child were likely to support at least one kind of regulation regarding alcohol and smoking related advertising. An exposure to excessive advertising of unhealthy products was associated with increase of respondents supporting the media regulation. Those who regarded the media as being influential seemed to be more supportive of health taxes or media regulation. CONCLUSION Our results indicated strong public support among the respondents for health taxes and the media regulation regarding the advertising of unhealthy products. Based on our data, we are optimistic that countries whose population show a high rate of tobacco, alcohol or unhealthy food consumption may launch public policy in addressing these factors.
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Pell D, Penney T, Hammond D, Vanderlee L, White M, Adams J. Support for, and perceived effectiveness of, the UK soft drinks industry levy among UK adults: cross-sectional analysis of the International Food Policy Study. BMJ Open 2019; 9:e026698. [PMID: 30827952 PMCID: PMC6429875 DOI: 10.1136/bmjopen-2018-026698] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To answer four questions: What are attitudes, knowledge and social norms around sugar-sweetened beverages (SSBs)? What are current levels of trust in messages on SSBs? What is current support for, and perceived effectiveness of, the UK soft drinks industry levy (SDIL)? What is the association between attitudes, knowledge, social norms, trust, SSB consumption and sociodemographic factors; and support for, and perceived effectiveness of, the SDIL? DESIGN Cross-sectional online survey. SETTING UK. PARTICIPANTS UK respondents to the 2017 International Food Policy Study aged 18-64 years who provided information on all variables of interest (n=3104). OUTCOME MEASURES Self-reported perceived effectiveness of, and support for, the SDIL. RESULTS Most participants supported the SDIL (70%), believed it would be effective (71%), had a positive attitude to SSBs (62%), had knowledge of the link between SSBs and obesity (90%), and trusted messages from health experts (61%), but not those from the food and beverage industry (73%). Nearly half (46%) had negative social norms about drinking SSBs. In adjusted models, older age, non-consumption of SSBs, social norms to not drinks SSBs, knowledge of the link between SSBs and obesity and trust in health expert messages were associated with greater support for the SDIL, whereas having dependent children and trusting messages from the food and beverage industry were associated with less support. In adjusted models, older age was associated with lower perceived effectiveness of the SDIL, whereas social norms to not drink SSBs, negative attitudes to SSBs and trusting messages from health experts and the food and beverage industry were associated with greater perceived effectiveness. CONCLUSIONS There was strong support for the SDIL and belief that it would be effective. Those with more 'public health' orientated norms and trust were generally more likely to support the SDIL or believe that it would be effective.
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Affiliation(s)
- David Pell
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tarra Penney
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Richardson TE, Yanada BA, Watters D, Stupart D, Lamichhane P, Bell C. What young Australians think about a tax on sugar‐sweetened beverages. Aust N Z J Public Health 2018; 43:63-67. [DOI: 10.1111/1753-6405.12858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/01/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
| | | | | | | | | | - Colin Bell
- School of MedicineDeakin University Victoria
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Trends in sweetened beverages consumption among adults in the Brazilian capitals, 2007–2016. Public Health Nutr 2018; 21:3307-3317. [DOI: 10.1017/s1368980018002161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo analyse trends in sweetened beverages consumption among adults in Brazil between 2007 and 2016.DesignA time-series analysis, with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). The prevalence of regular consumption (≥5 d/week), the average daily consumption (millilitres) and the prevalence of non-consumption of these beverages were analysed. The temporal variations of the indicators were calculated by linear regression. The analyses were performed for the complete set of the evaluated population and stratified by sociodemographic characteristics.SettingBrazilian capitals and Federal District.SubjectsBrazilian adults aged ≥18 years (n 519 641).ResultsThere was a reduction in both regular and average daily consumption of sugar- and artificially sweetened beverages (−1·28 percentage points (pp)/year, P=0·001 and −9·63 ml/year, P=0·001, respectively). The same result regarding regular consumption was found when only sugar-sweetened beverages were analysed (−1·11 pp/year, P=0·011). Similar trends were identified in the stratified analyses, with a greater magnitude of reduction among males, young adults, those with higher schooling and residents of more developed regions. Coincidentally, there was an increase in the prevalence of adults who did not consume sweetened beverages (1·54 pp/year, P=0·005).ConclusionsThe consumption of sweetened beverages decreased during the period. However, a significant portion of the population still referred a daily consumption of these beverages.
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Swift JA, Strathearn L, Morris A, Chi Y, Townsend T, Pearce J. Public health strategies to reduce sugar intake in the UK: An exploration of public perceptions using digital spaces. NUTR BULL 2018. [DOI: 10.1111/nbu.12346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - A. Morris
- University of Nottingham; Loughborough UK
| | - Y. Chi
- University of Nottingham; Loughborough UK
| | | | - J. Pearce
- University of Nottingham; Loughborough UK
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Bhawra J, Reid JL, White CM, Vanderlee L, Raine K, Hammond D. Are young Canadians supportive of proposed nutrition policies and regulations? An overview of policy support and the impact of socio-demographic factors on public opinion. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:498-505. [PMID: 29981092 PMCID: PMC6964476 DOI: 10.17269/s41997-018-0066-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Many countries, including Canada, are considering nutrition policies that seek to improve dietary behaviour and related health outcomes. The current study examined support for policy measures among youth and young adults in Canada. METHODS Participants aged 16-30 years were recruited for online surveys using in-person intercept sampling in five Canadian cities as part of the Canada Food Study conducted in October-December, 2016 (n = 2729). Items included support for 21 specific policies in seven key areas: menu labelling, food package symbols and warnings, school policies, taxation and subsidies, zoning restrictions, marketing bans, and food formulation. Linear regression models examined support by age, sex, city, race/ethnicity, parental status, body mass index (BMI), and health literacy. RESULTS Very high levels of support were observed for menu labelling in restaurants and schools, as well as food package symbols and warnings. Taxation, zoning restrictions (e.g., fast food and convenience stores near schools), and bans on marketing to children received relatively lower levels of support. In general, policy support increased with age for all 21 policies (p < 0.01) and greater health literacy for 4 policies (p < 0.05). Males were less supportive than females for 5 policies (p < 0.01). There were significant differences in support for specific race/ethnicity groups for 4 policies (p < 0.05). Support for menu labelling policies increased with BMI (p < 0.05). CONCLUSION Overall, youth and young adults in Canada reported high levels of support for menu labelling, food package symbols/warnings, and school policies. Levels of support were generally consistent across socio-demographic subgroups, with some exceptions.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jessica L Reid
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kim Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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Tamir O, Cohen-Yogev T, Furman-Assaf S, Endevelt R. Taxation of sugar sweetened beverages and unhealthy foods: a qualitative study of key opinion leaders' views. Isr J Health Policy Res 2018; 7:43. [PMID: 30064503 PMCID: PMC6069556 DOI: 10.1186/s13584-018-0240-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022] Open
Abstract
Background Fiscal policies to fight obesity such as taxation of unhealthy foods or sugar-sweetened beverages (SSBs) have gained considerable attention in recent years. Many studies modelling the impact of various magnitudes of taxes on SSB purchasing and their potential effects on various health outcomes have been published; however, legislation and implementation of such taxes have encountered many obstacles in the countries that have implemented them to date. We investigated the perceptions and views of key opinion leaders, policy makers and various other Israeli stakeholders on taxation of SSBs and unhealthy snacks. We also evaluated the challenges and barriers that may be expected for initiating such a policy. Methods A qualitative study based on 39 in-depth interviews with Israeli stakeholders in the fields of health, nutrition, economics, public advocacy and policymaking. Results All stakeholders viewed obesity as a combined societal and personal issue that should be under government responsibility. Only stakeholders from economic sectors thought that taxation of SSBs and unhealthy snacks would reduce their consumption, while the prevailing notion among non-economists was that such a tax would not be acceptable because the higher price would not decrease consumption. Concerns were raised that the tax would mostly affect individuals from low socioeconomic backgrounds. Some of the stakeholders indicated that they would support such a tax only if its revenue would be directed to specific causes such as health-promoting plans. Potential barriers to taxation include: opposition of various sectors, technical and bureaucratic obstacles impeding tax implementation, difficulties in defining which products to tax, and opposition of the treasury to earmark tax revenue for health education. Conclusions Taxation should be a part of a multipronged strategy rather than a sole measure for fighting obesity. Dedicating tax revenues to specific predefined causes should be considered, particularly towards health promotion activities, obesity treatment and prevention, education, and subsidies of healthy food.
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Affiliation(s)
- Orly Tamir
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
| | | | - Sharon Furman-Assaf
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Endevelt
- School of Public Health, Haifa University, Haifa, Israel
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Sainsbury E, Hendy C, Magnusson R, Colagiuri S. Public support for government regulatory interventions for overweight and obesity in Australia. BMC Public Health 2018; 18:513. [PMID: 29669551 PMCID: PMC5907362 DOI: 10.1186/s12889-018-5455-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background There is growing recognition among public health circles of the need for regulatory action for overweight and obesity, but there has been limited research into whether the Australian public supports government intervention. This study aimed to determine the level of public support for food-related regulations for obesity, and to assess the determinants of support. Methods A nationally representative sample of Australian adults (n = 2011) was recruited by market research company Online Research Unit to complete an online survey. The survey measured respondents’ perception of the obesity problem in Australia, and level of agreement on a 5-point Likert scale (strongly disagree to strongly agree) with proposed regulations in three domains; advertising, sponsorship of children’s sport, and taxation. Binary logistic regression models were run to examine the association between demographic variables and support for regulation. Results The majority of respondents (92.5%) considered overweight and obesity to be a somewhat or very serious problem in Australia, and almost 90% felt there should be at least some government regulation to protect the public. Respondents agreed that the government should regulate food and beverage advertising (69.5%), with strongest support for restricting unhealthy food advertising to children (78.9%). There was lower support for prohibiting unhealthy food and beverage company sponsorship of children’s sport (63.4% agreement), and for taxing sugar-sweetened beverages (54.5%), although the majority were still in favour. Support for fiscal policies slightly increased if revenue was to be used for health purposes. Females and tertiary educated respondents showed stronger agreement with proposed regulations (p < 0.05). Conclusions The survey findings suggest the majority of the Australian population recognises obesity to be a serious health problem, and support government regulation of the food environment as a population-level preventative strategy. Electronic supplementary material The online version of this article (10.1186/s12889-018-5455-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia.
| | - Chelsea Hendy
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia
| | - Roger Magnusson
- Sydney Law School, The University of Sydney, Camperdown, 2006, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, 2006, Australia
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Bellisle F, Hébel P, Fourniret A, Sauvage E. Consumption of 100% Pure Fruit Juice and Dietary Quality in French Adults: Analysis of a Nationally Representative Survey in the Context of the WHO Recommended Limitation of Free Sugars. Nutrients 2018; 10:E459. [PMID: 29642428 PMCID: PMC5946244 DOI: 10.3390/nu10040459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
Sugar-containing beverages are often seen as a negative influence on diet quality and body weight control. The present study examines the consumption of 100% fruit juice (FJ) based on a seven-day dietary survey in a representative sample of French adults (n = 1607). About a half of the participants (44%) consumed FJ, most often at breakfast time (60%). Average intake in FJ consumers was 115.6 ± 4.0 mL/day (46.3 ± 1.7 kcal/day). Prevalence of consumption increased with education and income and decreased with age, but no association was observed with body mass index (BMI), physical activity, or smoking. In consumers, FJ brought 2% daily energy and contributed larger proportions of vitamins (B1 7%, B2 3%, B5 5%, B6 6%, B9 10%, C 32%, E 9%, beta-carotene 5%), minerals (magnesium 4%, potassium 7%), and free sugars (19%). FJ consumers ingested more whole fruits, vegetables, and many other foods than non-consumers did. Free sugars represented 11.2% of the daily energy in FJ consumers versus 8.6% in non-consumers. This cross-sectional survey reveals that FJ contributes to diet quality without association with excess body weight. These observations should be confirmed in longitudinal studies. They support the view that contribution to diet quality should be specifically recognized in the context of the World Health Organization (WHO) recommended decrease of free sugar intake.
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Affiliation(s)
- France Bellisle
- Nutritional Epidemiology Research Team, Université Paris 13, INSERM (U1153), INRA (U1125), Cnam, 93017 Bobigny, France.
| | - Pascale Hébel
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013 Paris, France.
| | - Alice Fourniret
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013 Paris, France.
| | - Eléna Sauvage
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013 Paris, France.
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Thomas-Meyer M, Mytton O, Adams J. Public responses to proposals for a tax on sugar-sweetened beverages: A thematic analysis of online reader comments posted on major UK news websites. PLoS One 2017; 12:e0186750. [PMID: 29166399 PMCID: PMC5699796 DOI: 10.1371/journal.pone.0186750] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background Regular consumption of sugar sweetened beverages (SSBs) is associated with weight gain, type 2 diabetes, and dental caries. The UK will introduce a levy on the manufacturers of SSBs in 2018. Details will be negotiated over the next two years. How the UK public views SSB taxes is likely to be an important determinant of the content and success of the final policy. We aimed to capture the views, ideas and concerns of commenters on major UK news websites on SSB taxes. Methods and findings We conducted a qualitative analysis of reader comments to online news coverage of one proposal for an SSB tax in the UK. 1645 comments on four articles were included. Three underpinning themes influenced support or opposition to the tax: the balance between individual responsibility and autonomy, and population need; mistrust of the intention of the proposed tax and those promoting it; and variations in the perceived complexity of unhealthy diets and obesity associated with variations in what are considered appropriate interventions. Arguments under each theme were used to justify both support and opposition in different cases. Conclusions As the final form of the UK SSB tax is negotiated, effort should be made to address the concerns we identified. Our results suggest these efforts could usefully focus on emphasising the social and environmental determinants of diet and obesity, reinforcing the benefits of the tax to the NHS, and pitching the tax as playing into a variety of different conceptualisations of obesity.
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Affiliation(s)
- Molly Thomas-Meyer
- Public Health Department, Essex County Council, Chelmsford, United Kingdom
| | - Oliver Mytton
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jean Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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Mizdrak A, Waterlander WE, Rayner M, Scarborough P. Using a UK Virtual Supermarket to Examine Purchasing Behavior Across Different Income Groups in the United Kingdom: Development and Feasibility Study. J Med Internet Res 2017; 19:e343. [PMID: 28993301 PMCID: PMC5653905 DOI: 10.2196/jmir.7982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/18/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food purchases are needed, especially with respect to assessing differential impacts on population subgroups. OBJECTIVE The aim of this study was to assess the feasibility of using the United Kingdom Virtual Supermarket (UKVS), a three-dimensional (3D) computer simulation of a supermarket, to measure food purchasing behavior across income groups. METHODS Participants (primary household shoppers in the United Kingdom with computer access) were asked to conduct two shopping tasks using the UKVS and complete questionnaires on demographics, food purchasing habits, and feedback on the UKVS software. Data on recruitment method and rate, completion of study procedure, purchases, and feedback on usability were collected to inform future trial protocols. RESULTS A total of 98 participants were recruited, and 46 (47%) fully completed the study procedure. Low-income participants were less likely to complete the study (P=.02). Most participants found the UKVS easy to use (38/46, 83%) and reported that UKVS purchases resembled their usual purchases (41/46, 89%). CONCLUSIONS The UKVS is likely to be a useful tool to examine the effects of nutrition interventions using randomized controlled designs. Feedback was positive from participants who completed the study and did not differ by income group. However, retention was low and needs to be addressed in future studies. This study provides purchasing data to establish sample size requirements for full trials using the UKVS.
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Affiliation(s)
- Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | | | - Mike Rayner
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Wright A, Smith KE, Hellowell M. Policy lessons from health taxes: a systematic review of empirical studies. BMC Public Health 2017; 17:583. [PMID: 28629470 PMCID: PMC5477308 DOI: 10.1186/s12889-017-4497-z] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Taxes on alcohol and tobacco have long been an important means of raising revenues for public spending in many countries but there is increasing interest in using taxes on these, and other unhealthy products, to achieve public health goals. We present a systematic review of the research on health taxes, and aim to generate insights into how such taxes can: (i) reduce consumption of targeted products and related harms; (ii) generate revenues for health objectives and distribute the tax burden across income groups in an efficient and equitable manner; and (iii) be made politically sustainable. METHODS Six scientific and four grey-literature databases were searched for empirical studies of 'health taxes' - defined as those intended to increase the costs of manufacturing, distributing, retailing and/or consuming health-damaging products. Since reviews already exist of the evidence relating to traditional alcohol and tobacco excise taxes, we focus on other taxes such as taxes on retailers and manufacturers of unhealthy products, and consumer taxes targeting unhealthy foods, such as sugar-sweetened beverages. RESULTS Ninety-one peer-reviewed and 11 grey-literature studies met our inclusion criteria. The review highlights a recent, rapid rise in research in this area, most of which focuses on high-income countries and on taxes on food products or nutrients. Findings demonstrate that high tax rates on sugar-sweetened beverages are likely to have a positive impact on health behaviours and outcomes, and, while taxes on products reduce demand, they add to fiscal revenues. Common concerns about health taxes are also discussed. CONCLUSIONS If the primary policy goal of a health tax is to reduce consumption of unhealthy products, then evidence supports the implementation of taxes that increase the price of products by 20% or more. However, where taxes are effective in changing health behaviours, the predictability of the revenue stream is reduced. Hence, policy actors need to be clear about the primary goal of any health tax and frame the tax accordingly - not doing so leaves taxes vulnerable to hostile lobbying. Conversely, earmarking health taxes for health spending tends to increase public support so long as policymakers follow through on specified spending commitments. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42016048603.
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Affiliation(s)
- Alexandra Wright
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD UK
| | - Katherine E. Smith
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD UK
| | - Mark Hellowell
- Global Public Health Unit, Social Policy, School of Social & Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD UK
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Borges MC, Louzada ML, de Sá TH, Laverty AA, Parra DC, Garzillo JMF, Monteiro CA, Millett C. Artificially Sweetened Beverages and the Response to the Global Obesity Crisis. PLoS Med 2017; 14:e1002195. [PMID: 28045913 PMCID: PMC5207632 DOI: 10.1371/journal.pmed.1002195] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Christopher Millett and colleagues argue that artificially sweetened beverages should not be promoted as part of a healthy diet.
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Affiliation(s)
- Maria Carolina Borges
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Maria Laura Louzada
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Thiago Hérick de Sá
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Diana C. Parra
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, St. Louis, Missouri, United States of America
| | - Josefa Maria Fellegger Garzillo
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- PhD Program on Global Health and Sustainability, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Carlos Augusto Monteiro
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Christopher Millett
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Abstract
PURPOSE OF REVIEW There is considerable political and public awareness of new recommendations to reduce sugars and sugar-sweetened beverages in our diets. It is therefore timely to review the most recent changes in guidelines, with a focus on evidence for metabolic health, recent research in the area and gaps in our knowledge. RECENT FINDINGS Sufficient evidence links a high intake of sugar to dental caries and obesity, and high intakes of sugar-sweetened beverages in particular to increased risk of type 2 diabetes. This has led to the updating of dietary recommendations related to added sugars in the diet. The effects of specific sugars at usual intakes as part of an isoenergetic diet are less clear. The glycaemic response to food is complex and mediated by many factors, but sugar intake is not necessarily the major component. SUMMARY There are many challenges faced by healthcare professionals and government bodies in order to improve the health of individuals and nations through evidence-based diets. Sufficiently powered long-term mechanistic studies are still required to provide evidence for the effects of reducing dietary sugars on metabolic health. However, there are many challenges for research scientists in the implementation of these studies.
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Affiliation(s)
- J Bernadette Moore
- aDepartment of Nutritional Sciences, University of Surrey, Guildford, Surrey bSchool of Food Science and Nutrition, University of Leeds, Leeds, UK
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