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Giannichi B, Nilson E, Ferrari G, Rezende LFM. The projected economic burden of non-communicable diseases attributable to overweight in Brazil by 2030. Public Health 2024; 230:216-222. [PMID: 38579649 DOI: 10.1016/j.puhe.2024.02.029] [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: 10/30/2023] [Revised: 02/01/2024] [Accepted: 02/29/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES The prevalence of overweight increases the risk of several non-communicable diseases (NCDs) and, consequently, the costs of health care systems. In this study, we aimed to project the economic burden of NCDs attributable to overweight in Brazil between 2021 and 2030. METHODS A cohort simulation of adults (17-117 years) using multistate lifetable modeling was used to estimate the costs of NCDs attributable to overweight in Brazil. The projections of direct health care costs (outpatient and inpatient expenses in the Unified Health System) and indirect costs (years of productive life lost) considered different trajectories of the prevalence of overweight between 2021 and 2030. RESULTS In 2019, the prevalence of overweight was 55.4% in the adult Brazilian population. We estimate that around 1.8 billion international dollars (Int$) would be spent on the direct health care cost of NCDs between 2021 and 2030, through the continued increase in overweight prevalence observed between 2006 and 2020. The indirect costs over the same time would be approximately 20.1 billion Int$. We estimate that halving the annual increase in body mass index slope from the beginning of 2021 until 2030 would save 20.2 million Int$ direct and indirect costs by 2030. In the scenario of keeping the prevalence of overweight observed in 2019 constant until 2030, the savings would be 40.8 million Int$. Finally, in the scenario of a 6.7% reduction in the prevalence of overweight observed in 2019 (to be achieved gradually until 2030), 74.1 million Int$ would be saved. CONCLUSIONS These results highlight the high economic burden of overweight in the Brazilian adult population.
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Affiliation(s)
- B Giannichi
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - E Nilson
- Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil; Food, Nutrition and Culture Program, Fundação Oswaldo Cruz, Brasília, Brazil; Facultad de Ciencias de la Salud, Universidad Autonoma de Chile, Santiago, Chile
| | - G Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Chile; Facultad de Ciencias de la Salud, Universidad Autonoma de Chile, Santiago, Chile
| | - L F M Rezende
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Facultad de Ciencias de la Salud, Universidad Autonoma de Chile, Santiago, Chile.
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Smith BT, Warren CM, Anderson LN, Hammond D, Manuel DG, Li Y, Andreacchi AT, Rosella LC, Fu SH, Hobin E. The equitable impact of sugary drink taxation structures on sugary drink consumption among Canadians: a modelling study using the 2015 Canadian Community Health Survey-Nutrition. Public Health Nutr 2024; 27:e121. [PMID: 38618932 PMCID: PMC11075107 DOI: 10.1017/s1368980024000545] [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: 05/25/2023] [Revised: 11/09/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Estimate the impact of 20 % flat-rate and tiered sugary drink tax structures on the consumption of sugary drinks, sugar-sweetened beverages and 100 % juice by age, sex and socio-economic position. DESIGN We modelled the impact of price changes - for each tax structure - on the demand for sugary drinks by applying own- and cross-price elasticities to self-report sugary drink consumption measured using single-day 24-h dietary recalls from the cross-sectional, nationally representative 2015 Canadian Community Health Survey-Nutrition. For both 20 % flat-rate and tiered sugary drink tax scenarios, we used linear regression to estimate differences in mean energy intake and proportion of energy intake from sugary drinks by age, sex, education, food security and income. SETTING Canada. PARTICIPANTS 19 742 respondents aged 2 and over. RESULTS In the 20 % flat-rate scenario, we estimated mean energy intake and proportion of daily energy intake from sugary drinks on a given day would be reduced by 29 kcal/d (95 % UI: 18, 41) and 1·3 % (95 % UI: 0·8, 1·8), respectively. Similarly, in the tiered tax scenario, additional small, but meaningful reductions were estimated in mean energy intake (40 kcal/d, 95 % UI: 24, 55) and proportion of daily energy intake (1·8 %, 95 % UI: 1·1, 2·5). Both tax structures reduced, but did not eliminate, inequities in mean energy intake from sugary drinks despite larger consumption reductions in children/adolescents, males and individuals with lower education, food security and income. CONCLUSIONS Sugary drink taxation, including the additional benefit of taxing 100 % juice, could reduce overall and inequities in mean energy intake from sugary drinks in Canada.
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Affiliation(s)
- Brendan T Smith
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
| | - Christine M Warren
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON,
Canada
- Child Health Evaluative Sciences, Sickkids Research
Institute, Toronto, ON,
Canada
| | - David Hammond
- School of Public Health Sciences, University of
Waterloo, Waterloo, ON,
Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Clinical Epidemiology, 501
Smyth Box 511, Ottawa, ON, Canada
- Department of Family Medicine, and School of Epidemiology and Public
Health, University of Ottawa, Ottawa,
ON, Canada
- Bruyère Research Institute, OttawaON, Canada
| | - Ye Li
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
| | - Alessandra T Andreacchi
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
- Institute for Better Health, Trillium Health Partners,
MississaugaON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of
Medicine, University of Toronto, Toronto,
ON, Canada
| | - Sze Hang Fu
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
| | - Erin Hobin
- Public Health Ontario, 661 University Avenue, Suite 1701,
Toronto, ON, Canada
- Dalla Lana School of Public Health, University of
Toronto, 155 College St Room 500, Toronto, ON,
Canada
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Rivera JA, Colchero MA, Pérez-Ferrer C, Barquera S. Perspective: Mexico's Experience in Building a Toolkit for Obesity and Noncommunicable Diseases Prevention. Adv Nutr 2024; 15:100180. [PMID: 38246349 PMCID: PMC10877686 DOI: 10.1016/j.advnut.2024.100180] [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: 10/17/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Noncommunicable diseases (NCDs) are a leading cause of death and disability worldwide, with a higher risk of death in low- and middle-income countries. Diet and excess weight are risk factors for NCDs. In Mexico, the prevalence of overweight and obesity increased dramatically in the last 30 y and is among the highest in the world. To address this public health problem, governments and public health professionals have several policy instruments available. In this study, we present the policy instruments currently approved in Mexico, which include fiscal, informational, and authoritative tools that aim to improve the food environment and promote healthy behaviors (taxes, school food guidelines, front-of-pack labeling, marketing regulations, and dietary guidelines). These types of interventions are important in regions like Latin America, where social inequities and poor access to information are common, and individual healthy choices are often limited. These interventions target the environments in which individuals live, study, work, and seek entertainment, while limiting access to unhealthy choices and offering information to promote healthy alternatives. The Mexican experience in design, implementation, and evaluation of policies to improve the food environment can be useful for other low- and middle-income countries facing similar challenges.
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Affiliation(s)
- Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Mónica Arantxa Colchero
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Carolina Pérez-Ferrer
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Reyes-García A, Junquera-Badilla I, Batis C, Colchero MA, Miranda JJ, Barrientos-Gutiérrez T, Basto-Abreu A. How Could Taxes on Sugary Drinks and Foods Help Reduce the Burden Of Type 2 Diabetes? Curr Diab Rep 2023; 23:265-275. [PMID: 37695402 DOI: 10.1007/s11892-023-01519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Taxes on sugary drinks and foods have emerged as a key strategy to counteract the alarming levels of diabetes worldwide. Added sugar consumption from industrialized foods and beverages has been strongly linked to type 2 diabetes. This review provides a synthesis of evidence on how taxes on sugary products can influence the onset of type 2 diabetes, describing the importance of the different mechanisms through which the consumption of these products is reduced, leading to changes in weight and potentially a decrease in the incidence of type 2 diabetes. RECENT FINDINGS Observational studies have shown significant reductions in purchases, energy intake, and body weight after the implementation of taxes on sugary drinks or foods. Simulation studies based on the association between energy intake and type 2 diabetes estimated the potential long-term health and economic effects, particularly in low- and middle-income countries, suggesting that the implementation of sugary food and beverage taxes may have a meaningful impact on reducing type 2 diabetes and complications. Public health response to diabetes requires multi-faceted approaches from health and non-health actors to drive healthier societies. Population-wide strategies, such as added sugar taxes, highlight the potential benefits of financial incentives to address behaviors and protective factors to significantly change an individual's health trajectory and reduce the onset of type 2 diabetes worldwide, both in terms of economy and public health.
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Affiliation(s)
- Alan Reyes-García
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Isabel Junquera-Badilla
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Carolina Batis
- CONACYT - Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Batis C, Castellanos-Gutiérrez A, Sánchez-Pimienta TG, Reyes-García A, Colchero MA, Basto-Abreu A, Barrientos-Gutiérrez T, Rivera JA. Comparison of Dietary Intake Before vs After Taxes on Sugar-Sweetened Beverages and Nonessential Energy-Dense Foods in Mexico, 2012 to 2018. JAMA Netw Open 2023; 6:e2325191. [PMID: 37486629 PMCID: PMC10366703 DOI: 10.1001/jamanetworkopen.2023.25191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Importance Tax evaluations have shown effectiveness in reducing purchases of taxed items. However, few studies have looked at changes in overall dietary intake according to national surveys. Objective To estimate the contribution of taxed and untaxed beverages and foods to dietary intake over time, and the nutritional dietary profile in total beverages and foods consumed. Design, Setting, and Participants This cross-sectional study used data from 3 National Health and Nutrition Surveys of a nationally representative sample of participants aged older than 1 year in Mexico from 2012 (pretax), 2016, and 2018 (posttax). Data were analyzed from September 2021 to December 2022. Exposure Taxes on sugar-sweetened beverages and nonessential energy-dense foods implemented since 2014. Main Outcomes and Measures The outcomes were the contribution of taxed and untaxed beverages to total beverage volume, the contribution of taxed and untaxed foods to total food energy, and the energy density and content of added sugars and saturated fats. Outcomes were assessed with 24-hour recalls (24HR) (2012 and 2016) and Food Frequency Questionnaires (FFQ) (2012, 2016, and 2018), and were adjusted by sociodemographic and macroeconomic variables. Results A total of 17 239 participants were analyzed from 2012, 18 974 from 2016, and 30 027 from 2018; approximately 50% were men, and approximately 75% lived in urban areas. According to 24HRs, the contribution of taxed beverages to total beverage volume changed -2.3 (95% CI, -4.4 to -0.2) percentage points from 2012 to 2016, while water increased. The contribution of taxed foods to total food energy changed -3.0 (95% CI, -4.2 to -1.8) percentage points, while untaxed whole grains, processed meats, other animal sources, and sugars and desserts increased. The content in total beverages of added sugars changed -1.1 kcal/100 mL (95% CI, -2.0 to -0.2), and in total foods, the content of added sugar changed -0.6 %kcal (95% CI, -1.0 to -0.2), saturated fat changed -0.8 %kcal (95% CI, -1.1 to -0.4), and energy density changed -9.8 kcal/100 g (95% CI, -13.8 to -5.8). Main results were consistent with the FFQ (up to 2018), with some differences in subgroups and nutritional components. Conclusions and Relevance The findings of this study on 3 cross-sectional national dietary surveys are consistent with previous evaluations; after tax implementation, there was a decrease in the contribution of taxed items. Furthermore, some unhealthy untaxed items increased, but the content of unhealthful nutritional components, particularly added sugar, in overall beverages and foods decreased.
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Affiliation(s)
- Carolina Batis
- Consejo Nacional de Ciencia y Tecnología-Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Analí Castellanos-Gutiérrez
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Tania G Sánchez-Pimienta
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alan Reyes-García
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
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Hua SV, Petimar J, Mitra N, Roberto CA, Kenney EL, Thorndike AN, Rimm EB, Volpp KG, Gibson LA. Philadelphia Beverage Tax and Association With Prices, Purchasing, and Individual-Level Substitution in a National Pharmacy Chain. JAMA Netw Open 2023; 6:e2323200. [PMID: 37440231 PMCID: PMC10346119 DOI: 10.1001/jamanetworkopen.2023.23200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023] Open
Abstract
Importance Taxes on sweetened beverages are being implemented around the globe; an understanding of these taxes on individual-level behavior is necessary. Objective To evaluate the degree to which the sweetened beverage tax in Philadelphia, Pennsylvania, was associated with changes in beverage prices and individual-level purchasing over time at a national pharmacy chain in Philadelphia compared with Baltimore, Maryland. Design, Setting, and Participants Using a difference-in-differences approach and generalized linear mixed models, this cohort study examined beverage purchases made by loyalty cardholders at a national chain pharmacy retailer with stores in Philadelphia and Baltimore (control city) from before tax to after tax. Beverage sales (in US dollars) were linked by unique loyalty card numbers to enable longitudinal analyses. Data were collected from January 1, 2015, through December 31, 2017 (2 years before tax and 1 year after tax); data analyses were conducted from January through October 2022. Exposure Implementation of Philadelphia's 1.5 cents/oz tax on sweetened beverages. Main Outcomes and Measures The outcomes were the change in mean beverage price per-ounce and mean beverage volume purchased per cardholder transaction. Individual-level point-of-sale scanner data from all beverage purchases were analyzed. Results A total of 1188 unique beverages were purchased from the same stores before tax and after tax. There were 231 065 unique cardholders in Philadelphia and 82 517 in Baltimore. Mean prices of taxed beverages (n = 2 094 220) increased by 1.6 (95% CI, 1.3-2.0) cents/oz (106.7% pass-through) in Philadelphia compared with Baltimore from before tax to after tax. Philadelphia cardholders purchased 7.8% (95% CI -8.1% to -7.5%) fewer ounces of taxed beverages and 1.1% (95% CI, 0.6%-1.7%) more ounces of nontaxed beverages per transaction. Taxed beverages made up a smaller percentage of cardholders' overall beverage purchases after tax (-13.4% [95% CI, -14.2% to -12.6%]), while nontaxed beverages made up a larger share (9.3% [95% CI, 7.7%-10.7%]). Conclusions and Relevance In this longitudinal cohort study of the Philadelphia beverage tax, the tax was completely passed through to prices and was associated with a 7.8% decline in ounces of taxed beverages purchased at a national pharmacy chain.
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Affiliation(s)
- Sophia V. Hua
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erica L. Kenney
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N. Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Eric B. Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Laura A. Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Pinho-Gomes AC, Dunford E, Jones A. Trends in sugar content of non-alcoholic beverages in Australia between 2015 and 2019 during the operation of a voluntary industry pledge to reduce sugar content. Public Health Nutr 2023; 26:287-296. [PMID: 36274642 PMCID: PMC11077450 DOI: 10.1017/s1368980022002300] [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: 03/05/2022] [Revised: 09/14/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate changes in mean sugar content of non-alcoholic beverages (overall and sugar-sweetened beverages (SSB)) available for purchase in Australia and to compare signatories v. non-signatories of the Australian Beverages Council voluntary pledge from 2018. DESIGN Retrospective observational study. SETTING Australia. PARTICIPANTS About 1500 non-alcoholic beverages per year included in the FoodSwitch Monitoring Datasets for 2015-2019. RESULTS Overall, mean sugar content fell by 1·3 g/100 ml (17·1 %) from 7·5 g/100 ml in 2015 to 6·2 g/100 ml in 2019. SSB have accounted for about 56 % of all beverages available for purchase since 2015. Between 2015 and 2019, the sugar content of SSB dropped by about 10 % (0·8 g/100 ml). Soft drinks and milk-based drinks were the categories with the largest decrease in sugar content. The greater reduction in sugar observed for beverages overall than SSB suggests at least some of the overall decrease in sugar content is due to the appearance of new products with low or no sugar rather than reformulation. Over the same period, beverages with added non-nutritive sweeteners increased from 41 % to 44 %. The decrease in sugar content for all beverages and SSB was, in general, larger for non-signatories than signatories of the voluntary industry pledge. CONCLUSIONS Between 2015 and 2019, the small reduction in sugar content of non-alcoholic beverages in Australia resulted from the combined effects of introducing low- or no-sugar products and reformulation of some categories of SSB. Further policy and regulatory measures are required to reap the most benefit that sugar reduction among non-alcoholic beverages can bring to population health.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine of Population, King’s College London, London, UK
- The George Institute for Global Health, Imperial College London, 84 Wood Lane, LondonW12 0BZ, UK
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina, Chapel Hill, USA
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Lowery CM, Saavedra-Garcia L, Diez-Canseco F, Cárdenas MK, Miranda JJ, Taillie LS. Sugar-sweetened beverage purchases in urban Peru before the implementation of taxation and warning label policies: a baseline study. BMC Public Health 2022; 22:2389. [PMID: 36539775 PMCID: PMC9764463 DOI: 10.1186/s12889-022-14762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru. METHODS This study used monthly household purchase data from a panel of 5145 households from January 2016-December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume. RESULTS The trends analysis showed a decline in total beverage volume of - 52 mL/capita/month (95% CI: - 72, - 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively). CONCLUSIONS Nearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.
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Affiliation(s)
- Caitlin M Lowery
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorena Saavedra-Garcia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Kathia Cárdenas
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Lindsey Smith Taillie
- 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.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 123 W Franklin St, Ste 2107, Chapel Hill, NC, 27516, USA.
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Are intentions to change, policy awareness, or health knowledge related to changes in dietary intake following a sugar-sweetened beverage tax in South Africa? A before-and-after study. Int J Behav Nutr Phys Act 2022; 19:136. [PMID: 36307849 PMCID: PMC9617427 DOI: 10.1186/s12966-022-01370-5] [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: 01/12/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In April 2018, South Africa implemented the Health Promotion Levy (HPL), one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100mL). The objectives of this study were to examine whether the psychological constructs tax awareness, SSB knowledge, SSB risk perception, and intentions to reduce SSB intake were associated with taxed beverage intake, whether they changed from pre- to post-tax, and whether they modified the effect of the HPL. METHODS We collected single day 24-hour dietary recalls surveyed from repeat cross-sectional surveys of adults aged 18-39 years in Langa, South Africa. Participants were recruited in February-March 2018 (pre-tax, N = 2,481) and February-March 2019 (post-tax, N = 2,507) using door-to-door sampling. Surveys measured tax awareness, SSB knowledge, SSB risk perception, and intention to reduce SSB intake. SSB intake was estimated using a two-part model. To examine changes over time, logistic regression models were used for binary outcomes (tax awareness and intention to reduce SSB consumption) and linear regression models for continuous outcomes (SSB knowledge SSB risk perceptions). Effect modification was tested using interaction terms for each psychological construct with time. RESULTS No constructs were associated with SSB intake at baseline. At post-tax, the predicted probability to consume taxed beverages was 33.5% (95% CI 28.5-38.5%) for those who expressed an intention to reduce SSB intake compared to 45.9% (95% CI 43.7-48.1%) for those who did not. Among consumers, intending to reduce SSB intake was associated with 55 (95% CI 28 to 82) kcal/capita/day less SSBs consumed. Tax awareness, SSB knowledge, and SSB risk perception increased by a small amount from pre- to post-tax. Intentions to reduce SSB intake was lower in the post-tax period. The tax effect on SSB intake was modified by SSB knowledge and intention to reduce SSB intake, with higher levels of each associated with lower SSB intake. CONCLUSION After the South African SSB tax was implemented, SSB knowledge and risk perception increased slightly, tax awareness remained low, and only SSB knowledge and behavioral intention to change were significantly associated with taxed beverage intake among participants recruited from a low-income South African township.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities. RECENT FINDINGS In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.
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Affiliation(s)
- Anthony Crimarco
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA.
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11
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Levy RB, Andrade GC, Cruz GLD, Rauber F, Louzada MLDC, Claro RM, Monteiro CA. Three decades of household food availability according to NOVA - Brazil, 1987-2018. Rev Saude Publica 2022; 56:75. [PMID: 35946675 PMCID: PMC9388064 DOI: 10.11606/s1518-8787.2022056004570] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the trend of household food acquisition according to the NOVA classification in Brazil between 1987–1988 and 2017–2018. METHODS We used household food acquisition data from five editions of the Pesquisas de Orçamentos Familiares (Household Budget Surveys), conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), in the years 1987–1988, 1995–1996, 2002–2003, 2008–2009, and 2017–2018. All reported foods were categorized according to the NOVA classification. The household availability of food groups and subgroups was expressed through their share (%) in total calories, for all Brazilian families, by household situation (urban or rural), for each of the five geographic regions of the country, by fifths of the household income per capita distribution (2002–2003, 2008–2009 and 2017–2018 surveys), and for the 11 main urban regions of the country (1987–1988, 1995–1996, 2002–2003, 2008–2009 and 2017–2018 surveys). Linear regression models were used to assess the trend of increasing or decreasing food purchases. RESULTS The diet of the Brazilian population is still composed predominantly of foods in natura or minimally processed and processed culinary ingredients. However, our findings point to trends of increasing share of ultra-processed foods in the diet. This increase of 0.4 percentage points per year between 2002 and 2009 slowed down to 0.2 percentage points between 2008 and 2018. The consumption of ultra-processed food was higher among households with higher income, in the South and Southeast regions, in urban areas, and in metropolitan regions. CONCLUSION Our results indicate an increase in the share of ultra-processed foods in the diet of Brazilians. This is a worrisome scenario, since the consumption of such foods is associated with the development of diseases and the loss of nutritional quality of the diet.
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Affiliation(s)
- Renata Bertazzi Levy
- Universidade de São Paulo . Faculdade de Medicina . Departamento de Medicina Preventiva . São Paulo , SP , Brasil.,Universidade de São Paulo . Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde . São Paulo , SP , Brasil
| | - Giovanna Calixto Andrade
- Universidade de São Paulo . Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde . São Paulo , SP , Brasil
| | - Gabriela Lopes da Cruz
- Universidade de São Paulo . Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde . São Paulo , SP , Brasil.,Universidade de São Paulo . Faculdade de Saúde Pública . Programa de Pós-Graduação em Nutrição em Saúde Pública . São Paulo , SP , Brasil
| | - Fernanda Rauber
- Universidade de São Paulo . Faculdade de Medicina . Departamento de Medicina Preventiva . São Paulo , SP , Brasil.,Universidade de São Paulo . Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde . São Paulo , SP , Brasil
| | - Maria Laura da Costa Louzada
- Universidade de São Paulo . Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde . São Paulo , SP , Brasil.,Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brasil
| | - Rafael Moreira Claro
- Universidade Federal de Minas Gerais . Escola de Enfermagem . Departamento de Nutrição . Belo Horizonte , MG , Brasil
| | - Carlos Augusto Monteiro
- Universidade de São Paulo . Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde . São Paulo , SP , Brasil.,Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Nutrição . São Paulo , SP , Brasil
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12
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Bercholz M, Ng SW, Stacey N, Swart EC. Decomposing consumer and producer effects on sugar from beverage purchases after a sugar-based tax on beverages in South Africa. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101136. [PMID: 35358759 PMCID: PMC9288974 DOI: 10.1016/j.ehb.2022.101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 02/05/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers' product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households' non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.
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Affiliation(s)
- Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates.
| | - Nicholas Stacey
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
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13
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Villegas E, Hammons AJ, Wiley AR, Fiese BH, Teran-Garcia M. Cultural Influences on Family Mealtime Routines in Mexico: Focus Group Study with Mexican Mothers. CHILDREN 2022; 9:children9071045. [PMID: 35884029 PMCID: PMC9318880 DOI: 10.3390/children9071045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022]
Abstract
Mexico’s obesity rates are alarming, and experts project drastic increases in the next thirty years. There is growing interest in understanding how remote acculturation and globalization processes influence health behaviors. The present study used focus group data from a central state, San Luis Potosí, in Mexico to explore mothers’ perspectives on factors that influence family mealtime routines. Thematic analysis was used to identify barriers and facilitators to healthy mealtime routines and diet within families. Twenty-one mothers participated in the focus groups; 76% were full-time stay at home mothers, the majority were low-income (65%), and fewer than half reached a high school education. Three major themes emerged: (1) mothers do most of the visible work involving mealtime routines; (2) family meals are different today, and globalization is a contributing factor; and (3) family mealtimes are shifting to weekend events. Empowering mothers to negotiate diet with family members to build healthy routines, navigate challenges due to changing environments, and set family boundaries around technology use during mealtimes should be taken into consideration when promoting healthy behaviors with Mexican families.
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Affiliation(s)
- Elizabeth Villegas
- Department of Early Childhood, Child Trends, 7315 Wisconsin Ave, Ste 1200W, Bethesda, MD 20814, USA
- Correspondence:
| | - Amber J. Hammons
- Department of Child and Family Science, California State University Fresno, 5300 N Campus Dr. M/S FF12, Fresno, CA 93740, USA;
| | - Angela R. Wiley
- Department of Human Development and Family Studies, Auburn University, 210 Spidle Hall, Auburn, AL 36849, USA;
| | - Barbara H. Fiese
- Department of Human Development and Family Studies, Family Resiliency Center, University of Illinois at Urbana-Champaign, 904 W Nevada St., Urbana, IL 61801, USA;
| | - Margarita Teran-Garcia
- Integrated Health Disparities Programs, University of Illinois Extension, 111 Mumford Hall, 1301 W. Gregory Dr., Urbana, IL 61801, USA;
- Division of Nutritional Sciences, Carle Illinois College of Medicine, Family Resiliency Center, University of Illinois at Urbana-Champaign, 2103 N. Dunlap Ave., Suite B, Champaign, IL 61820, USA
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14
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Soft drink and non-caloric soft drink intake and their association with blood pressure: the Health Workers Cohort Study. Nutr J 2022; 21:37. [PMID: 35668525 PMCID: PMC9171938 DOI: 10.1186/s12937-022-00792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/31/2022] [Indexed: 01/09/2023] Open
Abstract
Background A few prospective studies have investigated the potential association of soft drink and non-caloric soft drink intake with high blood pressure using methods that adequately consider changes in intake over time and hypertensive status at baseline. Objective To prospectively examine the association of soft drink and non-caloric soft drink intake with systolic and diastolic blood pressure in a sample of Mexican adults, overall and by hypertension status. Methods We used data from the Health Workers Cohort Study spanning from 2004 to 2018 (n = 1,324 adults). Soft drink and non-caloric soft drink intake were assessed with a semiquantitative food frequency questionnaire. We fit multivariable-adjusted fixed-effects models to test the association of soft drink and non-caloric soft drink intake with systolic and diastolic blood pressure. The models were adjusted for potential confounders and considering the potential modifying effect of hypertension status at baseline. Results A one-serving increase in soft drink intake was associated with a 2.08 mm Hg (95% CI: 0.21, 3.94) increase in systolic blood pressure and 2.09 mm Hg (95% CI: 0.81, 3.36) increase in diastolic blood pressure over ten years. A stronger association between soft drink intake and diastolic pressure was observed among participants with versus without hypertension at baseline. We found no association between non-caloric soft drink intake and blood pressure. Conclusions Our findings support the hypothesis that soft drink intake increases blood pressure. While further studies should be conducted to confirm our findings, food policies and recommendations to limit soft drink intake are likely to help reduce blood pressure at the population level. We probably did not find an association between non-caloric soft drink intake and blood pressure because of the low consumption of this type of beverage in the cohort. More studies will be needed to understand the potential effect of non-caloric beverages on blood pressure. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-022-00792-y.
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15
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Molina M, Anderson LN, Guindon GE, Tarride JE. A review of implementation and evaluation of Pan American Health Organization's policies to prevent childhood obesity in Latin America. Obes Sci Pract 2022; 8:352-362. [PMID: 35664241 PMCID: PMC9159564 DOI: 10.1002/osp4.572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022] Open
Abstract
Rationale To inform future policies, the study objectives were to determine to what extent the policies included in the 5‐year Plan of Action for the Prevention of Obesity in Children and Adolescents—proposed by Pan American Health Organization (PAHO) and signed by 19 Latin America countries in 2014—have been implemented and evaluated. Methods A scoping review of the Governmental websites for Latin American countries and a literature review was conducted to identify whether policies have been implemented and evaluated. Key information was abstracted. Results The review identified 115 PAHO policies/interventions implemented (43% implemented after signing the proposed plan in 2014). Nearly all (18/19) countries implemented food guidelines or school feeding programs, but fiscal and marketing policies were less commonly implemented (6/19). Through the review, 44 evaluations of PAHO policies were identified of which 23% were qualitative and 77% quantitative. The results of these evaluations were in general positive (e.g., decrease in sugar‐sweetened beverages consumption following tax implementation) but no studies evaluated the outcome of reduced obesity. Conclusions PAHO recommended policies have been implemented to various degrees in Latin America since 2014 and more research is required to understand their impacts on child and adolescent obesity.
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Affiliation(s)
- Mariana Molina
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada.,The Hospital for Sick Children Research Institute Child Health Evaluative Sciences Toronto Ontario Canada
| | - Godefroy E Guindon
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada.,Department of Economics McMaster University Hamilton Ontario Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada.,The Research Institute of St. Joe's Hamilton St. Joseph's Healthcare Hamilton Hamilton Ontario Canada.,McMaster Chair in Health Technology Management Hamilton Hamilton Ontario Canada
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16
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Andreyeva T, Marple K, Marinello S, Moore TE, Powell LM. Outcomes Following Taxation of Sugar-Sweetened Beverages: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2215276. [PMID: 35648398 PMCID: PMC9161017 DOI: 10.1001/jamanetworkopen.2022.15276] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE More than 45 countries and several local jurisdictions have implemented sugar-sweetened beverage (SSB) taxes to improve nutrition and population health, and evidence on their outcomes to date is essential to inform policy discussions. Responding to this need, the World Health Organization commissioned a systematic literature review on the outcomes of fiscal policies, including SSB taxes. OBJECTIVE To assess the associations of implemented SSB taxes with prices, sales, consumption, diet, body weight, product changes, unintended consequences, health, and pregnancy outcomes. DATA SOURCES Searches of 8 bibliographic databases (Business Source Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EconLit, PsycINFO, PubMed, and Scopus) were performed from database inception through June 1, 2020, with no language or setting restrictions. Grey literature was assessed using 14 sources and government websites. STUDY SELECTION The review included primary studies of implemented SSB taxes. DATA EXTRACTION AND SYNTHESIS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. For prices, sales and consumption, results were meta-analyzed using a 3-level random-effects model. Study quality was assessed at the outcome level. MAIN OUTCOMES AND MEASURES Tax pass-through rate for prices, percentage reduction in SSB demand, and price elasticity of demand for sales and consumption. Heterogeneity was assessed using τ2 and the I2 statistic. RESULTS A total of 86 articles were eligible, with 62 studies contributing to the meta-analysis. The overall tax pass-through rate was 82% (95% CI, 66% to 98%; P < .001, I2 = 99%), suggesting tax undershifting. The demand for SSBs was highly sensitive to tax-induced price increases, with the price elasticity of demand of -1.59 (95% CI, -2.11 to -1.08; P < .001; I2 = 100%) and a mean reduction in SSB sales of 15% (95% CI, -20% to -9%; P < .001; I2 = 100%). There was no evidence of substitution to untaxed beverages, and changes in SSB consumption were not significant. The narrative synthesis found reformulation and reduced sugar content of taxed beverages for tiered taxes, cross-border shopping in most studies of local-level taxes, and no negative changes in employment. Data on the heterogeneity of SSB tax outcomes across subpopulations were limited. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis of implemented SSB taxes worldwide, SSB taxes were associated with higher prices and lower sales of taxed beverages.
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Affiliation(s)
- Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Health, University of Connecticut, Hartford
| | - Keith Marple
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Samantha Marinello
- Health Policy and Administration, School of Public Health, University of Illinois Chicago
| | - Timothy E. Moore
- Statistical Consulting Services, Center for Open Research Resources & Equipment, University of Connecticut, Storrs
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago
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17
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Ross A, Swart EC, Frank T, Lowery CM, Ng SW. South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets. Public Health Nutr 2022; 25:1-26. [PMID: 35249582 PMCID: PMC9991735 DOI: 10.1017/s1368980022000507] [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: 08/27/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. DESIGN Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). SETTING Langa, Western Cape, South Africa. PARTICIPANTS Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). RESULTS Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. CONCLUSIONS We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.
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Affiliation(s)
- Alexandra Ross
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa
- DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tamryn Frank
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
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English L, Carmona YR, Peterson KE, Jansen EC, Téllez Rojo MM, Torres Olascoaga L, Cantoral A. Changes in Sugar Sweetened Beverage Intake Are Associated with Changes in Body Composition in Mexican Adolescents: Findings from the ELEMENT Cohort. Nutrients 2022; 14:719. [PMID: 35277078 PMCID: PMC8839416 DOI: 10.3390/nu14030719] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Changes in consumption of sugar sweetened beverage (SSBs) have been associated with increased body mass index (BMI), but little work has evaluated the effect on waist circumference (WC) and body fat percentage during adolescence, a period characterized by rapid growth and change in dietary behaviors. We examined the relationship of changes in SSB intake and changes in adiposity over two years in 464 Mexican adolescents. Food frequency questionnaires were used to sum intake of regular soda, coffee with sugar, tea with sugar, sweetened water with fruit, chocolate milk, corn atole, and a sweetened probiotic milk beverage. Linear regression models were used to estimate the associations of changes in SSBs with changes in BMI, body fat percentage, and WC, adjusting for sex, socioeconomic status, screen time, physical activity, age, and change in age. Adolescents who increased their daily SSB intake by >2 serving had a −2.72% higher body fat percentage (95% CI: 0.61, 4.82); a 1−2 serving increase was associated with a 2.49 cm increase (95% CI: 0.21, 4.76) in WC compared with those with no change in intake. Within an adolescent sample, changes in SSB intake were related to concomitant changes in body fat percentage and WC, but not BMI.
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Affiliation(s)
- Lindsey English
- Department of Nutrition and Dietetics, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Yanelli R. Carmona
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (Y.R.C.); (K.E.P.); (E.C.J.)
| | - Karen E. Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (Y.R.C.); (K.E.P.); (E.C.J.)
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Erica C. Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; (Y.R.C.); (K.E.P.); (E.C.J.)
| | - Martha María Téllez Rojo
- Center for Health and Nutrition Research, National Institute of Public Health in Mexico, Cuernavaca 62100, Mexico; (M.M.T.R.); (L.T.O.)
| | - Libni Torres Olascoaga
- Center for Health and Nutrition Research, National Institute of Public Health in Mexico, Cuernavaca 62100, Mexico; (M.M.T.R.); (L.T.O.)
| | - Alejandra Cantoral
- Department of Health, Universidad Iberoamericana Ciudad de México, Mexico City 01219, Mexico
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19
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Gračner T, Marquez-Padilla F, Hernandez-Cortes D. Changes in Weight-Related Outcomes Among Adolescents Following Consumer Price Increases of Taxed Sugar-Sweetened Beverages. JAMA Pediatr 2022; 176:150-158. [PMID: 34902003 PMCID: PMC8669601 DOI: 10.1001/jamapediatrics.2021.5044] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Following the implementation of a tax on sugar-sweetened beverages (SSBs) in Mexico in 2014, SSB prices increased by about 10% on average, but differently across cities. It remains unclear how observed SSB price changes are associated with adolescent weight-related outcomes. OBJECTIVE To compare weight-related outcomes among adolescents living in cities with differential SSB price changes before and after the SSB tax was implemented in Mexico. DESIGN, SETTING, AND PARTICIPANTS Associations between differential SSB price changes and changes in weight-related outcomes were examined overall and by sex among 12 654 adolescents aged 10 to 18 years born between 1999 and 2002 living in 39 cities in Mexico. Multivariate regressions with individual fixed effects were applied on longitudinal individual-level yearly clinical data (height and weight) from 2012 to 2017 collected by the Instituto Mexicano del Seguro Social (IMSS) and merged with city-level SSB price data from 2011 to 2016 collected by the National Institute of Statistics and Geography (INEGI). Data were analyzed from July 2018 to July 2021. EXPOSURES Yearly city-level changes in SSB prices between 2011 and 2016. MAIN OUTCOMES AND MEASURES Age- and sex-specific body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile and indicator for overweight or obesity if BMI was at or above the 85th percentile. RESULTS Before 2014, 46% of 12 654 adolescents (6850 girls and 5804 boys) included in this study had obesity or overweight. The mean (SD) age was 11.38 (1.08) years. Among girls, a 10% SSB price increase was associated with a 1.3 percentage point absolute decrease (95% CI, -2.19 to -0.36; P = .008) or a 3% relative decrease in overweight or obesity prevalence within 2 years of a price change. For girls with BMI at or above the 75th percentile pretax, this price increase was associated with a 0.59 lower BMI percentile (95% CI, -1.08 to -0.10; P = .02) or a 0.67% relative decrease. Improved outcomes for girls were observed in cities where price increases were greater than 10% after the tax. No such associations were observed for boys. CONCLUSIONS AND RELEVANCE In this study, increased SSB prices were associated with decreased overweight or obesity prevalence among girls but not among boys. Improvements in outcomes were small, and mostly observed for girls with heavier weight and in cities where price increases after the tax were greater than 10%.
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20
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Valizadeh P, Popkin BM, Ng SW. Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor. Am J Clin Nutr 2022; 115:244-255. [PMID: 34610088 PMCID: PMC8755035 DOI: 10.1093/ajcn/nqab330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. OBJECTIVES We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers. METHODS We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects. RESULTS Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. CONCLUSIONS SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation. Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.
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Affiliation(s)
- Pourya Valizadeh
- Agricultural & Food Policy Center, Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
- Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
| | - Barry M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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22
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Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health 2021; 42:439-461. [PMID: 33256536 DOI: 10.1146/annurev-publhealth-090419-103005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
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Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
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23
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Carvalho TCD, Borges AKDM, Koifman RJ, Silva IFD. Time trends in colorectal cancer incidence in four regions of Latin America: 1983-2012. CAD SAUDE PUBLICA 2021; 37:e00175720. [PMID: 34787282 DOI: 10.1590/0102-311x00175720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/06/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess time trends in colorectal cancer incidence from 1983 to 2012 in Latin America. This was an ecological time-series study whose population consisted of individuals aged 20 years or older diagnosed with colorectal cancer. Data from population-based cancer registries in Cali (Colombia), Costa Rica, Goiânia (Brazil), and Quito (Ecuador), were used for rates estimation, while time trends estimations were proceeded by the Joinpoint Regression Program. The study showed an increase in colorectal cancer incidence in men and women in Cali (2.8% and 3.2%, respectively), Costa Rica (3.1% and 2.1%, respectively), and Quito (2.6% and 1.2%, respectively), whereas in Goiânia, only women showed an increase in colorectal cancer rates (3.3%). For colon cancer, we observed an increasing trend in incidence rates in men and women in Cali (3.1% and 2.9%, respectively), Costa Rica (3.9% and 2.8%, respectively), and Quito (2.9% and 1.8%). For rectal cancer, we observed an increasing trend in incidence in men and women in Cali (2.5% and 2.6%, respectively), Costa Rica (2.2% and 1%, respectively), and Goiânia (5.5% and 4.6%, respectively), while in Quito only men showed an upward trend (2.8%). The study found increases in colorectal cancer, colon cancer, and rectal cancer in four Latin America regions. This findings reflect lifestyle, such as dietary changes, following the economic opening, and the prevalence variations of colorectal cancer risk factors by sex and between the four studied regions. Finally, the different strategies adopted by regions for colorectal cancer diagnosis and screening seem to influence the observed variation between anatomical sites.
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Affiliation(s)
| | | | - Rosalina Jorge Koifman
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ilce Ferreira da Silva
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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24
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Álvarez-Sánchez C, Guillén H, Contento IR, Koch P, Théodore FL. Soda Consumption Among Mexican Construction Workers in the Context of the Sugar-Sweetened Beverage Tax. HEALTH EDUCATION & BEHAVIOR 2021; 49:107-117. [PMID: 34706574 DOI: 10.1177/10901981211050031] [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] [Indexed: 11/15/2022]
Abstract
This study explored the psychosocial determinants of consumption of soda and other taxed sugar-sweetened beverages (SSBs) in Mexican construction workers (CWs) and whether consumption changed as a result of the 2014 SSB tax. We conducted a qualitative case study involving in-depth interviews and focus groups (FGs) with 30 Mexican CWs; supplemented with descriptions of the food and beverages consumed during lunch breaks. We used NVivo 10 to classify information according to the analysis categories, primarily informed by the Reasoned Action Approach (RAA). CWs reported not having changed their consumption of soda and other taxed SSBs as a result of the SSB tax, despite the price increase and "knowing" the potential negative consequences of soda drinking. The most important determinants of soda consumption are a deep-seated social norm of soda drinking and use of soda drinking as part of their professional identity; their likeness for soda; a wide availability of soda in their environments; and a low perceived behavioral control (because they thought themselves as addicted to it). Participants indicated that the best way for them not to consume soda would be if it were not available. These findings lend support for the tight regulation of the availability of SSBs. To have a meaningful impact on these consumers, the SSB tax may need to be much higher. Policy-level interventions should be coupled with interventions at the individual and community levels that aim at denormalizing soda consumption, create new meanings in relation to water consumption, and develop behavioral control to decrease soda consumption.
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Affiliation(s)
- Cristina Álvarez-Sánchez
- Teachers College Columbia University, New York, NY, USA
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Héctor Guillén
- Autonomous University of the State of Morelos, Los Volcanes, Cuernavaca, Morelos, Mexico
| | | | - Pamela Koch
- Teachers College Columbia University, New York, NY, USA
| | - Florence L Théodore
- Center for Nutrition and Health Research, The National Institute of Public Health of Mexico, CDMX, Mexico
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25
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Zhong Y, Auchincloss AH, Lee BK, McKenna RM, Langellier BA. Reply to Vale et al. Comment on "Zhong et al. Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax. Int. J. Environ. Res. Public Health 2020, 17, 1336". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10930. [PMID: 34682675 PMCID: PMC8535483 DOI: 10.3390/ijerph182010930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
Thank you for the opportunity to respond to the recent letter to the editor regarding our paper "Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax" [...].
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Affiliation(s)
- Yichen Zhong
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (Y.Z.); (B.K.L.)
| | - Amy H. Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (Y.Z.); (B.K.L.)
| | - Brian K. Lee
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (Y.Z.); (B.K.L.)
| | - Ryan M. McKenna
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (R.M.M.); (B.A.L.)
| | - Brent A. Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (R.M.M.); (B.A.L.)
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26
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Pedroza-Tobias A, Crosbie E, Mialon M, Carriedo A, Schmidt LA. Food and beverage industry interference in science and policy: efforts to block soda tax implementation in Mexico and prevent international diffusion. BMJ Glob Health 2021; 6:bmjgh-2021-005662. [PMID: 34413076 PMCID: PMC8378381 DOI: 10.1136/bmjgh-2021-005662] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/14/2021] [Indexed: 12/20/2022] Open
Abstract
Mexico is the largest soft drink market in the world, with high rates of obesity and type 2 diabetes. Due to strains on the nation’s productivity and healthcare spending, Mexican lawmakers implemented one of the world’s first public health taxes on sugar-sweetened beverages (SSBs) in 2014. Because Mexico’s tax was designed to reduce SSB consumption, it faced strong opposition from transnational food and beverage corporations. We analysed previously secret internal industry documents from major corporations in the University of California San Francisco’s Food Industry Documents Archive that shed light on the industry response to the Mexican soda tax. We also reviewed all available studies of the Mexican soda tax’s effectiveness, contrasting the results of industry-funded and non-industry-funded studies. We found that food and beverage industry trade organisations and front groups paid scientists to produce research suggesting that the tax failed to achieve health benefits while harming the economy. These results were disseminated before non-industry-funded studies could be finalized in peer review. Mexico still provided a real-world context for the first independent peer-reviewed studies documenting the effectiveness of soda taxation—studies that were ultimately promoted by the global health community. We conclude that the case of the Mexican soda tax shows that industry resistance can persist well after new policies have become law as vested interests seek to roll back legislation, and to stall or prevent policy diffusion. It also underscores the decisive role that conflict-of-interest-free, peer-reviewed research can play in implementing health policy innovations.
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Affiliation(s)
- Andrea Pedroza-Tobias
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Eric Crosbie
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA.,Ozmen Institute for Global Studies, University of Nevada, Reno, Nevada, USA
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | | | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA .,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
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27
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Colchero MA, Guerrero-López C. M. CM, Barrientos-Gutiérrez T. T, Salmerón J. J, Bautista-Arredondo S. Willingness to pay for an intervention that reduces soda consumption among a sample of middle-class adult Mexicans. PLoS One 2021; 16:e0255100. [PMID: 34339421 PMCID: PMC8328282 DOI: 10.1371/journal.pone.0255100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the growing public awareness of the adverse health effects of sugar-sweetened beverages (SSB) consumption in Mexico, little is known about the population's intention to reduce SSB consumption and the social value of interventions to accomplish such behavioral change. Therefore, the objective of this study was to assess the willingness to pay (WTP) for an intervention that reduces soda consumption by half in Mexico. METHODS We applied contingent valuation methods in a sample of 471 Mexican adults from a cohort study. We assessed the relative value of benefits by providing incremental information to participants in three scenarios: soda consumption reduction, + health benefits, + social benefits. To estimate factors associated with the WTP, we ran an interval regression. RESULTS 87% of respondents reported they would like to reduce SSB consumption. High soda consumption, intention to reduce soda consumption and higher household income are associated with higher WTP. We found that the WTP increases as additional benefits are provided. The WTP, as a proportion of income, is higher for the lowest income level. CONCLUSION The average WTP per person may be seen as the minimum amount the country should invest on interventions to reduce soda consumption.
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Affiliation(s)
- M. A. Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | | | - Jorge Salmerón J.
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sergio Bautista-Arredondo
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
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28
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Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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29
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Miracolo A, Sophiea M, Mills M, Kanavos P. Sin taxes and their effect on consumption, revenue generation and health improvement: a systematic literature review in Latin America. Health Policy Plan 2021; 36:790-810. [PMID: 33885782 PMCID: PMC8173601 DOI: 10.1093/heapol/czaa168] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
Sin or public health taxes are excise taxes imposed on the consumption of potentially harmful goods for health [sugar-sweetened beverages (SSBs), tobacco, alcohol, among others], aiming to reduce consumption, raise additional revenue and/or improve population health. This paper assesses the extent to which sin taxes (a) can reduce consumption of potentially harmful goods, (b) raise revenue for national health systems and (c) contribute to population health in Latin America. A systematic literature review was conducted on peer-reviewed and grey literature; endpoints included: impact of raising sin taxes on consumption, ability to raise revenue for health and the possibility of population health improvements. Risk of bias for each study was assessed. The synthesis of the literature on sin tax implementation showed improvements in all three endpoints across the study countries. Following the introduction of sin taxes or by simulating their potential impact, nearly all studies explicitly reported that consumption of potentially harmful goods (mainly SSBs and tobacco) declined; revenue was found to have increased in almost all countries, suggesting that there may be additional scope for further tax increase. Simulated improvements in population health have also been shown, by demonstrating a relationship between sin tax increases and reduction in prevalence of diabetes, stroke, heart attacks and associated deaths. However, sin tax effects on health would be better quantified over the long-term. Data quality and availability challenges did place some limitations on sin tax impact assessment. Sin taxes can be effective in reducing consumption of potentially harmful goods, improve population health and generate additional revenue. Promoting further research on this topic should be a priority.
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Affiliation(s)
- Aurelio Miracolo
- Department of Health Policy and Medical Technology Research Group - LSE Health, The London School of Economics and Political Science, Cowdrey House, Houghton Street, London WC2A 2AE, UK
| | - Marisa Sophiea
- Faculty of Medicine, School of Public Health, Imperial College, London, Medical School Building, St Mary's Hospital, Norfolk Place, London W2 1PG, UK
| | - Mackenzie Mills
- Department of Health Policy and Medical Technology Research Group - LSE Health, The London School of Economics and Political Science, Cowdrey House, Houghton Street, London WC2A 2AE, UK
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group - LSE Health, The London School of Economics and Political Science, Cowdrey House, Houghton Street, London WC2A 2AE, UK
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Ruhara CM, Abdool Karim S, Erzse A, Thow AM, Ntirampeba S, Hofman KJ. Strengthening prevention of nutrition-related non-communicable diseases through sugar-sweetened beverages tax in Rwanda: a policy landscape analysis. Glob Health Action 2021; 14:1883911. [PMID: 33876706 PMCID: PMC8079049 DOI: 10.1080/16549716.2021.1883911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Food and beverages high in sugar are recognized to be among the major risk factors for nutrition-related non-communicable diseases. The growing presence of ultra-processed food producers has resulted in shifts to diets that are associated with non-communicable diseases and which include sugar-sweetened beverages. Sugar-sweetened beverage taxation presents an opportunity to prevent non-communicable diseases but it comes with challenges. Objectives: To describe the policy landscape, identify and analyse the facilitators of and barriers to strengthening taxation on sugar-sweetened beverages in Rwanda. Methods: We conducted a desk-based policy analysis to assess the facilitators of and barriers to strengthening sugary beverage taxation policy. We consulted eight stakeholders to validate the findings of the desk review. Results: Non-communicable diseases are recognized as a public health challenge in Government health and non-health policy documents. However, sugar intake is not explicitly identified as a risk factor for non-communicable diseases and existing policies do not clearly aim to reduce sugar consumption. The Rwandan Government's commitment to growing the local sugar industry and the substantial economic contribution of Rwandan beverage producers are potential barriers to fiscal policies aimed at reducing sugar consumption. However, the current 39% excise tax levied on all soft drinks could support the adoption of future sugar-sweetened beverage policies. Conclusions: The landscape for strengthening a sugar-sweetened beverage tax in Rwanda is complex. The policy environment provides both facilitators of and impediments to strengthening the existing tax. A differential tax could be introduced by leveraging on the existing excise tax and linking it to the sugar content of beverages.
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Affiliation(s)
| | - Safura Abdool Karim
- SAMRC Centre for Health Economics and Decision Science Research-PRICELESS SA, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC Centre for Health Economics and Decision Science Research-PRICELESS SA, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre (D17), The University of Sydney, Sydney, Australia
| | | | - Karen J Hofman
- SAMRC Centre for Health Economics and Decision Science Research-PRICELESS SA, University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg, South Africa
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31
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Stacey N, Edoka I, Hofman K, Swart EC, Popkin B, Ng SW. Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study. Lancet Planet Health 2021; 5:e200-e208. [PMID: 33838735 PMCID: PMC8071067 DOI: 10.1016/s2542-5196(20)30304-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. METHODS We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. FINDINGS Mean sugar from taxable beverage purchases fell from 16·25 g/capita per day (95% CI 15·80-16·70) to 14·26 (13·85-14·67) from the pre-HPL announcement to post-announcement period, and then to 10·63 g/capita per day (10·22-11·04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518·99 mL/capita per day (506·90-531·08) to 492·16 (481·28-503·04) from pre-announcement to post announcement, and then to 443·39 mL/capita per day (430·10-456·56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283·45 mL/capita per day (273·34-293·56) pre-announcement to 312·94 (296·29-329·29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. INTERPRETATION The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases. FUNDING Bloomberg Philanthropies, International Development Research Centre, South African Medical Research Council, and the US National Institutes of Health.
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Affiliation(s)
- Nicholas Stacey
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ijeoma Edoka
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Barry Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.
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Drewnowski A, Monterrosa EC, de Pee S, Frongillo EA, Vandevijvere S. Shaping Physical, Economic, and Policy Components of the Food Environment to Create Sustainable Healthy Diets. Food Nutr Bull 2020; 41:74S-86S. [DOI: 10.1177/0379572120945904] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Sustainable healthy diets are those dietary patterns that promote all dimensions of individuals’ health and well-being; have low environmental pressure and impact; are accessible, affordable, safe, and equitable; and are culturally acceptable. The food environment, defined as the interface between the wider food system and consumer’s food acquisition and consumption, is critical for ensuring equitable access to foods that are healthy, safe, affordable, and appealing. Discussion: Current food environments are creating inequities, and sustainable healthy foods are generally more accessible for those of higher socioeconomic status. The physical, economic, and policy components of the food environment can all be acted on to promote sustainable healthy diets. Physical spaces can be modified to improve relative availability (ie, proximity) of food outlets that carry nutritious foods in low-income communities; to address economic access certain actions may improve affordability, such as fortification, preventing food loss through supply chain improvements; and commodity specific vouchers for fruits, vegetables, and legumes. Other policy actions that address accessibility to sustainable healthy foods are comprehensive marketing restrictions and easy-to-understand front-of-pack nutrition labels. While shaping food environments will require concerted action from all stakeholders, governments and private sector bear significant responsibility for ensuring equitable access to sustainable healthy diets.
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Affiliation(s)
- Adam Drewnowski
- University of Washington, Department of Epidemiology, Seattle, WA, USA
| | | | - Saskia de Pee
- UN World Food Programme, Rome, Italy
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Edward A. Frongillo
- University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Stefanie Vandevijvere
- Scientific Institute of Public Health (Sciensano), Department of Epidemiology and Public Health, Brussels, Belgium
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Lawman HG, Bleich SN, Yan J, Hua SV, Lowery CM, Peterhans A, LeVasseur MT, Mitra N, Gibson LA, Roberto CA. One-year changes in sugar-sweetened beverage consumers' purchases following implementation of a beverage tax: a longitudinal quasi-experiment. Am J Clin Nutr 2020; 112:644-651. [PMID: 32619214 PMCID: PMC8491143 DOI: 10.1093/ajcn/nqaa158] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/28/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Few longitudinal studies examine the response to beverage taxes, especially among regular sugar-sweetened beverage (SSB) consumers. OBJECTIVE This study aimed to examine changes in objectively measured beverage purchases associated with the Philadelphia beverage tax on sugar-sweetened and artificially sweetened beverages. METHODS A longitudinal quasi-experiment was conducted with adult sugar-sweetened beverage (SSB) consumers in Philadelphia (n = 306) and Baltimore (n = 297; a nontaxed comparison city). From 2016 to 2017 participants submitted all food and beverage receipts during a 2-wk period at: baseline (pretax) and 3, 6, and 12 mo posttax (91.0% retention; data analyzed in 2019). Linear mixed effects models were used to assess the difference-in-differences in total purchased ounces (fl oz) of taxed beverages in a 2-wk period in Philadelphia compared with Baltimore. Secondary analyses: 1) excluded weeks that contained major holidays at baseline and 12 mo (42% of measured weeks at baseline and 12 mo) because policy implementation timing necessitated data collection during holidays when SSB demand may be more inelastic, and 2) aggregated posttax time points to address serial correlation and low power. RESULTS There were no statistically significant changes in purchased ounces of taxed beverages in Philadelphia compared with Baltimore in the primary analysis. After excluding holiday purchasing, the tax was associated with statistically significant reductions of taxed beverage purchases at 3 and 6 mo (-157.1 ounces, 95% CI: -310.1, -4.1 and -175.1 ounces, 95% CI: -328.0, -22.3, respectively) but not 12 mo. Analyses aggregating all 6 wk of posttax time points showed statistically significant reductions (-203.7 ounces, 95% CI: -399.6, -7.8). CONCLUSIONS A sweetened beverage tax was not associated with reduced taxed beverage purchases among SSB consumers 12 mo posttax in the full sample. Both secondary analyses excluding holiday purchasing or aggregating posttax time periods found reductions in taxed beverage purchases ranging from -4.9 to -12.5 ounces per day. Larger longitudinal studies are needed to further understand tax effects.
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Affiliation(s)
- Hannah G Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sophia V Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caitlin M Lowery
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Peterhans
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael T LeVasseur
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Distributional Changes in U.S. Sugar-Sweetened Beverage Purchases, 2002-2014. Am J Prev Med 2020; 59:260-269. [PMID: 32362508 PMCID: PMC7375910 DOI: 10.1016/j.amepre.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION U.S. policy actions focus on reducing sugar-sweetened beverage purchases. Yet, there are no studies on trends in overall purchase distribution and how it has changed by key subpopulations. This study examined changes in distributions of total sugar-sweetened beverage purchases and its major subtypes (regular carbonated soft drinks and fruit/sports/energy drinks) in 2002-2014 and distinguished among low, moderate, and high purchasers. METHODS Longitudinal data on sugar-sweetened beverage purchases of U.S. households from the 2002-2014 Nielsen Homescan Panel were used. Sugar-sweetened beverages were defined as all caloric non-alcoholic beverages containing added sugars. Longitudinal quantile regression model examined trends across distributions (from quantile 25 to 95) of purchases (measured in kcal/day/capita), while accounting for households' unobserved differences. All statistical analyses were conducted in 2019. RESULTS All households across the total purchase distribution significantly reduced their purchases. High purchasers made less proportional reductions than low purchasers (e.g., 35% at 95th quantile vs 62% at 25th quantile). However, the smaller relative reductions among higher purchasers translated into larger absolute decreases (e.g., 134 kcal/day/capita at 95th quantile vs 23 kcal/day/capita at 25th quantile). Similar patterns in heterogeneity were observed across sugar-sweetened beverage subtype distributions and among racial/ethnic and income groups. In addition, there were significant racial/ethnic and income disparities in total sugar-sweetened beverage purchases in 2002-2003. Although racial/ethnic disparities among higher purchasers improved, income disparity patterns at all purchase levels persisted into 2013-2014. CONCLUSIONS From 2002‒2003 to 2013-2014, U.S. households at all purchase levels made meaningful reductions in sugar-sweetened beverage purchases in both absolute and relative terms. Furthermore, racial/ethnic disparities in total sugar-sweetened beverage purchases narrowed, but income disparity patterns persisted.
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Torres-Álvarez R, Barrán-Zubaran R, Canto-Osorio F, Sánchez-Romero LM, Camacho-García-Formentí D, Popkin BM, Rivera JA, Meza R, Barrientos-Gutiérrez T. Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study. Pediatr Obes 2020; 15:e12636. [PMID: 32282131 DOI: 10.1111/ijpo.12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/29/2020] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In Mexico, a 10% tax to sugar-sweetened beverages was implemented in 2014. Projections of the potential health effect of this tax in children are not available. OBJECTIVE To estimate the 1-year effect of the tax on the body weight of children 5 to 17 years old, and estimated alternative scenarios with higher tax rates (20%, 30%, and 40%). METHODS We used a dynamical mathematical model, recalibrated to the Mexican population. Input data were obtained from the Mexican National Health and Nutrition Survey 2006 and 2012. We estimated the expected average weight reduction, stratified by category of sugar-sweetened beverages consumption. RESULTS With a 10% tax, we estimated an overall weight reduction of 0.26 kg for children and 0.61 kg for adolescents; in high consumers, the reduction could reach 0.50 and 0.87 kg, respectively. Higher tax rates would produce larger weight decreases; in high consumers a 40% tax would result in a reduction of 1.99 kg for children and 3.50 kg for adolescents. CONCLUSION The tax represents an effective component of any child or adolescent weight control program, and must be considered as part of any integrated population-level program for children and adolescent obesity prevention.
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Affiliation(s)
- Rossana Torres-Álvarez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rodrigo Barrán-Zubaran
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Luz M Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | | | - Barry M Popkin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Adherence to Mediterranean diet is inversely associated with the consumption of ultra-processed foods among Spanish children: the SENDO project. Public Health Nutr 2020; 24:3294-3303. [DOI: 10.1017/s1368980020001524] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractObjective:To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.Design:Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.Setting:Spain.Participants:Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.Results:74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.Conclusions:Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF.
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Lobstein T, Neveux M, Landon J. Costs, equity and acceptability of three policies to prevent obesity: A narrative review to support policy development. Obes Sci Pract 2020; 6:562-583. [PMID: 33082998 PMCID: PMC7556431 DOI: 10.1002/osp4.423] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Obesity prevention policies are a priority for many governments and intergovernmental agencies. Policy makers not only use systematic reviews of effectiveness but also consider contextual issues including cost and cost‐effectiveness, equity, rights, acceptability and feasibility. To support their work, the present narrative review examines three contextual issues (costs, equity and acceptability) in relation to three policies for obesity prevention: sweetened beverage taxes, front‐of‐pack nutrition labelling and restrictions on advertising to children. Literature searches led to over 1100 documents, of which 125 informed the present review. Beverage taxes were found likely to be highly cost‐effective, moderately favourable for health equity, supported by the public (depending on the use of revenues) and by health professionals and civil society groups and opposed by commercial interests. Depending on the design, front‐of‐pack nutritional labelling is likely to be highly cost‐effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests. Restrictions on child‐directed advertising are likely to be highly cost‐effective in the longer term, moderately favourable for health equity, supported by the public, health professionals and civil society groups and opposed by commercial interests (unless voluntary). The evidence base needs strengthening, but the authors find that all three policies merit consideration by governmental authorities, and should be implemented to reduce obesity risk.
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Affiliation(s)
- Tim Lobstein
- Policy Department World Obesity Federation London UK.,The Boden Institute, Charles Perkins Centre The University of Sydney Sydney New South Wales Australia
| | - Margot Neveux
- Policy Department World Obesity Federation London UK
| | - Jane Landon
- Policy Department UKPH Consultancy London UK
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Sánchez-Romero LM, Canto-Osorio F, González-Morales R, Colchero MA, Ng SW, Ramírez-Palacios P, Salmerón J, Barrientos-Gutiérrez T. Association between tax on sugar sweetened beverages and soft drink consumption in adults in Mexico: open cohort longitudinal analysis of Health Workers Cohort Study. BMJ 2020; 369:m1311. [PMID: 32376605 PMCID: PMC7201935 DOI: 10.1136/bmj.m1311] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine changes in categories of soft drink consumption in a cohort of Mexican adults, three years after the implementation of the sugar sweetened beverage tax. DESIGN Open cohort longitudinal analysis. SETTING Three waves of the Health Workers Cohort Study, Mexico, spanning 2004 to 2018. PARTICIPANTS 1770 people aged 19 years or older with information on drinks consumption available in at least one of the three cohort waves. MAIN OUTCOME MEASURE Change in probability of belonging to one of four categories of soft drinks consumption (non, low, medium, high) after the tax was implemented. Heterogeneity of associations by income and education was also assessed. RESULTS Before the implementation of the tax, more than 50% of the participants were medium and high consumers of soft drinks and less than 10% were in the non-consumer category. After the tax was implemented, 43% of the population was categorised as medium or high consumers and the prevalence of non-consumers increased to 14%. Three years after implementation of the tax on 1 January 2014, the probability of being a non-consumer of soft drinks increased by 4.7 (95% confidence interval 0.3 to 9.1) percentage points and that of being a low consumer increased by 8.3 (0.6 to 16.0) percentage points compared with the pre-tax period. Conversely, the probability of being in the medium and high levels of soft drinks consumption decreased by 6.8 (0.5 to 13.2) percentage points and 6.1 (0.4 to 11.9) percentage points, respectively. No significant heterogeneity of the tax across income levels was observed, but stronger effects of the tax were seen in participants with secondary school education or higher, compared with those with elementary school or less. CONCLUSIONS The Mexican sugar sweetened beverage tax was associated with a reduction in the probability of consuming soft drinks in this cohort of employees from a healthcare provider. The results cannot be extrapolated to the Mexican population, but they suggest that three years after implementation, the tax had helped to increase the proportion of people who do not consume soft drinks while decreasing the proportion of high and medium consumers.
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Affiliation(s)
- Luz María Sánchez-Romero
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Mexico
- Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Francisco Canto-Osorio
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | | | - M Arantxa Colchero
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Shu-Wen Ng
- Department of Nutrition and Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Paula Ramírez-Palacios
- Epidemiological Research and Health Services Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Jorge Salmerón
- Research Centre in Policy, Population and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Sugar Content and Nutritional Quality of Child Orientated Ready to Eat Cereals and Yoghurts in the UK and Latin America; Does Food Policy Matter? Nutrients 2020; 12:nu12030856. [PMID: 32210128 PMCID: PMC7146401 DOI: 10.3390/nu12030856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
Ready to eat breakfast cereals (REBCs) and yoghurts provide important nutrients to children's diets, but concerns about their high sugar content exist. Food reformulation could contribute to sugar reduction, but policies across countries are not uniform. We aimed to compare the sugar content and nutritional quality of child-orientated REBCs and yoghurts in Latin American countries with the UK. In a cross-sectional study, nutritional information, marketing strategies, and claims were collected from the food labels and packaging of products available in Guatemala, Mexico, Ecuador and the UK. Nutritional quality was assessed using the UK Ofcom Nutrient Profiling System. In total, 262 products were analysed (59% REBCs/41% yoghurts). REBCs in the UK had a lower sugar content (mean ± SD) (24.6 ± 6.4) than products in Ecuador (34.6 ± 10.8; p < 0.001), Mexico (32.6 ± 7.6; p = 0.001) and Guatemala (31.5 ± 8.3; p = 0.001). Across countries, there were no differences in the sugar content of yoghurts. A large proportion (83%) of REBCs and 33% of yoghurts were classified as "less healthy". In conclusion, the sugar content of REBCs in Latin America is higher than those of the UK, which could be attributed to the UK voluntary sugar reduction programme. Sugar reformulation policies are required in Guatemala, Mexico and Ecuador.
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Kusuma D, Kusumawardani N, Ahsan A, K Sebayang S, Amir V, Ng N. On the verge of a chronic disease epidemic: comprehensive policies and actions are needed in Indonesia. Int Health 2020; 11:422-424. [PMID: 31294789 DOI: 10.1093/inthealth/ihz025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 11/12/2022] Open
Abstract
In the midst of tackling the persistent burden of maternal mortality and infectious diseases, Indonesia is facing an increasing burden of non-communicable diseases (NCDs). Although there are increasing national efforts in NCD prevention and control, the worsening trend of NCD risk factors and morbidity is alarming. We provided assessment and discussion on the policies and actions needed in the country including comprehensive efforts to reduce tobacco use and unhealthy diet, the need to reorient the health systems for better NCD prevention and control, and the promotion of NCD-related research that are still lacking.
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Affiliation(s)
- Dian Kusuma
- Centre for Health Economics and Policy Innovations, Imperial College Business School, Imperial College London, South Kensington Campus, London, UK
| | - Nunik Kusumawardani
- National Institute of Health Research and Development, Ministry of Health, Jalan Percetakan Negara No.29 Jakarta Pusat, Indonesia
| | - Abdillah Ahsan
- Faculty of Economics and Business, University of Indonesia, Kampus Baru UI Depok, Indonesia
| | - Susy K Sebayang
- Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Airlangga, Jl Wijaya Kusuma No 113 Banyuwangi, Indonesia
| | - Vilda Amir
- Faculty of Public Health, University of Indonesia, Kampus Baru UI Depok, Indonesia
| | - Nawi Ng
- Department of Public Health and Clinical Medicine, Umeå University, 5B, Målpunkt P, Försörjningsvägen 7, Norrlands universitetssjukhus Epidemiologi och global hälsa, Umeå Universitet, Umeå, Sweden
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Taillie LS, Reyes M, Colchero MA, Popkin B, Corvalán C. An evaluation of Chile's Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study. PLoS Med 2020; 17:e1003015. [PMID: 32045424 PMCID: PMC7012389 DOI: 10.1371/journal.pmed.1003015] [Citation(s) in RCA: 213] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Chile's Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases. METHOD AND FINDINGS In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar WordPanel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as "high-in" or "not high-in" according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law's warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] -22.9 to -22.7; p < 0.001), or 23.7% (95% CI -23.8% to -23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p < 0.001), but for high-educated households this amounted to a larger relative decline (-28.7%, 95% CI -28.8% to -28.6%) compared to low-educated households (-21.5%, 95% CI -21.6% to -21.4%), likely because of the high-educated households' lower level of high-in beverage purchases in the preregulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI -12.0 to -11.9; p < 0.001) or 27.5% (95% CI -27.6% to -27.5%). Calories purchased from beverages classified as "not high-in" increased 5.7 kcal/capita/day (95% CI 5.7-5.7; p < 0.001), or 10.8% (10.8%-10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI -7.4 to -7.3; p < 0.001), or 7.5% (95% CI -7.6% to -7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies. CONCLUSIONS Purchases of high-in beverages significantly declined following implementation of Chile's Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile's policies on purchases of high-in foods, dietary intake, and long-term purchasing changes.
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Affiliation(s)
- Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Marcela Reyes
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | | | - Barry Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Camila Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Zorbas C, Grigsby-Duffy L, Backholer K. Getting the Price Right: How Nutrition and Obesity Prevention Strategies Address Food and Beverage Pricing Within High-Income Countries. Curr Nutr Rep 2020; 9:42-53. [PMID: 31953676 DOI: 10.1007/s13668-020-00300-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Food and beverage prices are major influences on dietary intakes. International health bodies recommend leveraging food prices to create healthier food environments. A policy review was conducted to understand the extent to which national nutrition and obesity prevention policy strategies within high-income countries (i) consider food price as a determinant of health and (ii) propose and implement policies to rebalance food pricing towards healthier options. RECENT FINDINGS Policy strategies were inconsistent and fragmented in their inclusion of food prices as determinants of diet-related health. The equity benefits of pricing policies were often indicated. Fiscal measures and food subsidies in schools were the most commonly proposed and implemented pricing policies, predominantly used in Europe. Price is a pertinent but underutilized policy lever in nutrition policy. Comprehensive food and beverage pricing strategies need to be identified, adopted and implemented to improve population diets for everyone.
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Affiliation(s)
- Christina Zorbas
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Lily Grigsby-Duffy
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Abstract
Objective: To measure change in price of food groups over time (1995–2030) in Brazil, considering the Brazilian Dietary Guidelines’ recommendations. Design: Data from the Household Budget Survey (2008–2009 HBS) and the National System of Consumer Price Indexes (NSCPI) were used to create a data set containing monthly prices for the foods and beverages most consumed in the country (n 102), from January 1995 to December 2017. Data on price of foods and beverages from 2008–2009 HBS (referring to January 2009) were used to calculate real price over time using the monthly variation in prices from NSCPI. All prices were deflated to December 2017. Foods and beverages were classified following the Brazilian Dietary Guidelines’ recommendations. The monthly price for each food group and subgroup was used to analyse changes in prices from 1995 to 2017 and to forecast prices up to 2030 using fractional polynomial models. Setting: Brazil. Participants: National estimates of foods and beverages purchased for Brazil. Results: In 1995, ultra-processed foods were the most expensive group (R$ 6·51/kg), followed by processed foods (R$ 6·44/kg), then unprocessed or minimally processed foods and culinary ingredients (R$ 3·45/kg). Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Forecasts indicate that unhealthy foods will become cheaper than healthy foods in 2026. Conclusions: Food prices in Brazil have changed unfavourably considering the Brazilian Dietary Guidelines’ recommendations. This may imply a decrease in the quality of the population’s diet.
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Royo-Bordonada MÁ, Fernández-Escobar C, Simón L, Sanz-Barbero B, Padilla J. Impact of an excise tax on the consumption of sugar-sweetened beverages in young people living in poorer neighbourhoods of Catalonia, Spain: a difference in differences study. BMC Public Health 2019; 19:1553. [PMID: 31752787 PMCID: PMC6873539 DOI: 10.1186/s12889-019-7908-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 11/07/2019] [Indexed: 02/02/2023] Open
Abstract
Background Sugar-sweetened beverage consumption is contributing to the obesity epidemic. On 28 March 2017, Catalonia enacted a law levying an excise tax on sugar-sweetened beverages for public health reasons. The purpose of this study is to assess the impact of the tax on the consumption of sugar-sweetened beverages in Catalonia (Spain). Methods Before-and-after study to assess changes in the prevalence of consumption of sugar-sweetened beverages among 1929 persons aged 12 to 40 years residing in low-income neighbourhoods of Barcelona (intervention) and Madrid (control). Beverage consumption frequency was ascertained via a validated questionnaire administered during the month prior to the tax’s introduction (May 2017) and again at 1 year after it had come into force. The effect of the tax was obtained using Poisson regression models with robust variance weighted using propensity scores. Results While the prevalence of regular consumers of taxed beverages fell by 39% in Barcelona as compared to Madrid, the prevalence of consumers of untaxed beverages remained stable. The main reason cited by more than two-thirds of those surveyed for reducing their consumption of sugar-sweetened beverages was the increase in price, followed by a heightened awareness of their health effects. Conclusions The introduction of the Catalonian excise tax on sugar-sweetened beverages was followed by a reduction in the prevalence of regular consumers of taxed beverages.
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Affiliation(s)
| | - Carlos Fernández-Escobar
- National School of Public Health, Institute of Health Carlos III, Sinesio Delgado, 8, 28029, Madrid, Spain
| | - Lorena Simón
- National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Belen Sanz-Barbero
- National School of Public Health, Institute of Health Carlos III, Sinesio Delgado, 8, 28029, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Padilla
- Primary Care Health Center Isabel II, Madrid, Parla, Spain
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Pedraza LS, Popkin BM, Batis C, Adair L, Robinson WR, Guilkey DK, Taillie LS. The caloric and sugar content of beverages purchased at different store-types changed after the sugary drinks taxation in Mexico. Int J Behav Nutr Phys Act 2019; 16:103. [PMID: 31718664 PMCID: PMC6849184 DOI: 10.1186/s12966-019-0872-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following the 2014 sugary drinks tax implementation in Mexico, promising reduction in the volume of purchases of taxed beverages were observed overall and at different store-types. However, the tax's effects on purchasing patterns of calories and sugar remain unclear. METHODS Using longitudinal data from Mexican households (n = 7038), we examined changes in volume, calories and total sugar of packaged beverages purchased from 2012 to 2016 overall and by store-type. We used fixed effects models to estimate means for volume, calories, and sugar of households. To address the potential selectivity from households shopping at different stores, we calculated inverse probability weights to model the purchases changes over time by store-type. RESULTS For taxed beverages, the volume of purchases declined by - 49 ml and -30 ml in the first year and second year post tax (2014 and 2015, respectively), while purchases leveled off in the third year of the tax (2016). Calories and sugar from taxed beverage purchases decreased over time, with the majority of the declines occurring in the first two years post-tax implementation. The volume of untaxed beverage purchases increased, whereas changes in calories and total sugar of untaxed beverages were minimal. Store level purchases of taxed beverages significantly decreased in the first two years post taxation (2014 and to 2015) only in supermarkets and traditional stores. The steepest declines in purchases of taxed beverages in 2014 were observed at supermarkets (- 40 ml or - 45%). The volume of purchases of untaxed beverages increased over time in almost all store-types, while calories and sugar minimally decreased over time. CONCLUSION Although the Mexican tax on SSBs has lowered the purchases of sugary drinks 3 years after the tax implementation, the tax should be strengthened and store-specific interventions should be implemented to further reduce SSBs purchases in the Mexican population.
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Affiliation(s)
- Lilia S. Pedraza
- Department of Nutrition, Carolina Population Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, CB # 2107 Carolina Square, Chapel Hill, NC 27516-3997 USA
| | - Barry M. Popkin
- Department of Nutrition, Carolina Population Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, CB # 2107 Carolina Square, Chapel Hill, NC 27516-3997 USA
| | - Carolina Batis
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos Mexico
| | - Linda Adair
- Department of Nutrition, Carolina Population Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, CB # 2107 Carolina Square, Chapel Hill, NC 27516-3997 USA
| | - Whitney R. Robinson
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina USA
| | - David K. Guilkey
- Economics Department, University of North Carolina, Chapel Hill, North Carolina USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Carolina Population Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, CB # 2107 Carolina Square, Chapel Hill, NC 27516-3997 USA
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Affiliation(s)
- Kristine A Madsen
- University of California, Berkeley, School of Public Health, Berkeley
| | - James Krieger
- Healthy Food America, Seattle, Washington
- University of Washington, School of Public Health, Seattle
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