Big Soda’s long shadow: news coverage of local proposals to tax sugar-sweetened beverages in Richmond, El Monte and Telluride

"Don't think of a soda": Contradictory public health messaging from a content analysis of Twitter posts about sugar-sweetened beverage taxes in California from 2015 to 2018

To show how sugar-sweetened beverage (SSB) taxes were framed in posts on Twitter (now known as X) through text and images, we conducted a content analysis on a sample of Tweets from California users posted between January 1, 2015 and December 31, 2018 about SSB taxes in Berkeley, San Francisco, Oakland, and/or Albany, California. We evaluated posts for information sources, arguments for or against SSB tax policies, and images used. We found that posts presented a mix of messages through text and images. The majority of posts (64%) included arguments supporting SSB taxes, 28% presented a neutral position (e.g., factual information) or a mix of both pro-and anti-tax arguments, and 8% opposed. One-third of posts included an image, almost half of which appeared to be stock photos from SSB advertisements: many of these were shared by medical and public health users. Some tax supporters also reposted messages and images from opposition campaigns and added their own criticisms. By reposting opponents' anti-tax messages and images of SSBs, tax supporters may have inadvertently promoted SSBs, reinforced opposition to SSB taxes, and normalized SSBs. While advocates effectively shared pro-tax arguments, they should also ensure that accompanying images reflect the solutions they seek, not just the problem they are trying to combat.

Online commentaries of the sugar-sweetened beverages tax in Malaysia: Content analysis

INTRODUCTION

Implementing taxes on sugary drinks, or SSBs, has been a controversial topic in many countries, including Malaysia. This study aimed to examine how Malaysian Facebook users responded to the announcement and implementation of the SSBs tax through netnography.

METHODS

This cross-sectional study employed qualitative and quantitative methods and used an inductive approach and thematic content analysis to analyze online commentaries on news articles published on popular online news portals from November 2018 to August 2019. Data was collected by downloading the commentaries onto Microsoft Word and importing them into NVivo.

RESULTS

Of the commentaries analyzed, 60.9% rejected the SSBs tax, and 39.1% favored it. No association was found between the online news articles and the slants of the commentaries.

CONCLUSION

The results of this study demonstrate a clear divide in public opinion regarding the SSBs tax in Malaysia, with many online readers expressing opposition to the tax despite evidence of the harmful effects of sugar presented in the articles they are commenting on. These findings have implications for policymakers and public health advocates seeking to implement similar taxes in the future.

Pro- and Anti-Tax Framing in News Articles About California Sugar-Sweetened Beverage Tax Campaigns from 2014-2018

Sugar-sweetened beverages (SSB) contribute to illness, especially among marginalized communities and children targeted by the beverage industry. SSB taxes can reduce consumption, illness burden, and health inequities, while generating revenue for health programs, and as one way to hold the industry responsible for their harmful products and marketing malpractices. Supporters and opponents have debated SSB tax proposals in news coverage - a key source of information that helps to shape public policy debates. To learn how four successful California-based SSB tax campaigns were covered in the news, we conducted a content analysis, comparing how SSB taxes were portrayed. We found that pro-tax arguments frequently reported data to expose the beverage industry's outsized campaign spending and emphasize the health harms of SSBs, often from health professionals. However, pro-tax arguments rarely described the benefits of SSB taxes, or how they can act as a tool for industry accountability. By contrast, anti-tax arguments overtly appealed to values and promoted misinformation, often from representatives from industry-funded front groups. As experts recommend additional SSB tax proposals, and as the industry mounts legislative counter-tactics to prevent them, advocates should consider harnessing community representatives as messengers and values-based messages to highlight the benefits of SSB taxes.

Health taxes in Indonesia: a review of policy debates on the tobacco, alcoholic beverages and sugar-sweetened beverage taxes in the media

INTRODUCTION

One of the WHO's 'best buys' in controlling non-communicable diseases and their risk factors is to impose health taxes. While the Indonesian political process inhibits the implementation of health tax policy, studies to discuss the issue remain limited.

METHODS

We employed media analysis to document health tax policy dynamics, for example, the changes in policy timeline and key actors' statements. We conducted an article search in the Open-Source Intelligence database using appropriate terminology on three commodities, for example, tobacco, alcoholic beverages and sugar-sweetened beverages (SSB).

RESULTS

Throughout the 15 years of implementation (2007-2022), tobacco has received the most policy attention compared with the other two commodities. This is mainly related to the increasing tariff and reforming the tax structure. As Indonesia is a Muslim-majority country, alcohol consumption is low, and a tax on alcoholic beverages was nearly unchanging and lacked media coverage. Ministry of Finance (MoF) officials are key opinion leaders often cited in the media for health taxes. MoF's support for health taxes is important to pass and implement health taxes. While SSB taxation is emerging, key opinion leaders' media statements imply policy contestation, leading to delayed implementation. The policy debates on tobacco taxation implied election years as a major challenge for health tax passages. During the political years, anti-health tax arguments emerged from politicians. While the political contestation on SSB concluded that accentuating the health tax arguments in favour of public health generates the strongest opposition against taxation from the industry.

CONCLUSIONS

Politics of tobacco tax implementation are complex-compared with the other two commodities. The political context drives the divided views among policy-makers. Policy recommendations include generating public allies with key religious opinion leaders, continuing capacity building for politicians and Ministry of Health, and generating evidence-based arguments in favour of public health for MoF.

Corporate political activity in the context of sugar-sweetened beverage tax policy in the WHO European Region

BACKGROUND

Sugar-sweetened beverage (SSB) taxes have emerged as an effective and increasingly popular tool to reduce added sugar intake, an important contributor to obesity and non-communicable diseases. A common barrier to the implementation of well-designed SSB taxes is the opposition of commercial actors. Focusing on the WHO European Region, this study seeks to map if and how key stakeholders have experienced industry efforts to influence SSB taxes.

METHODS

We identified 11 countries in the WHO European Region which have implemented SSB taxes or attempted to do so. Using an online survey informed by the global literature on industry interference with SSB taxation, we approached 70 in-country policymakers, advocates and academics. The data were analysed using an existing framework of corporate political activity.

RESULTS

Twenty-three experts from nine countries responded to the survey. Transnational SSB producers and their business associations were identified as the most active opponents of SSB taxation. Industry claims that the policy would have negative economic effects were identified as the most common and powerful arguments. Direct lobbying was reported in all study countries. Shifts in political activity were recognisable across stages of the policy process, moving from outright opposition to attempts to delay or weaken the policy after its announcement.

CONCLUSION

Those seeking to introduce effective SSB taxation can use our findings to pre-empt and counter industry opposition. We identify several measures for preventing and mitigating industry interference with SSB tax policy.

Implementation of sugar-sweetened beverages tax and its perception among public health stakeholders. A study from Poland

Background

One of tools to tackle growing problem of overweight and obesity are the taxation mechanisms applied to sugar-sweetened beverages, which are expected to influence the common eating behaviors, but also they have impact on the market and public finances. The solution is therefore highly entangled in the complex of social and intersectoral interests generating a number of opportunities and threats affecting its feasibility.

Aims

The study aims to depict the views of Polish stakeholders on the implementation of the sugar tax in Poland, particularly the perception of success determinants, barriers, as well as views on the features of the implemented solutions and possible alternatives.

Methods

We used semi-structured interviews with 18 individuals representing key public health stakeholders in Poland. The interview consisted of four parts, where first concentrated on the advantages and disadvantages of the SSB tax, the second part explored stakeholder involvement and stances, third concerned the feasibility of the project, and in the fourth part respondents were asked for suggestions for decision-makers regarding the content of the project and its implementation process. To reconstruct position of 4 main political parties we applied desk research. We used MAXQDA v2020 to analyse the collected data.

Results

Stakeholders tend to expressed conflicting views on the effectiveness, relevance and socio-economic impact of the SSB tax. All of them agreed that the tax may appear severe for the poorest groups, children and adolescents, while disagreeing about the economic impact of the levy. The allocation of additional tax revenues was raising doubts, with stakeholders believing that the fiscal aim is the basic reason for implementing the tax, while these resources should be primarily dedicated to health promotion intervention and prevention of diet-related diseases. On the other hand, the political debate on the tax was highly superficial with strong populism arising of the presented positions.

Conclusions

There is a need to conduct a thorough public debate and improvements in terms of public communication to increase social awareness, sealing and refining the implemented solutions. Close cooperation with market players and non-governmental organizations is highly recommended.

Analysis of Public Testimony About Philadelphia's Sweetened Beverage Tax

INTRODUCTION

Although interest in beverage taxes has increased in recent years, industry opposition and other challenges have limited their spread in the U.S. Because beverage tax proposals are often unsuccessful, there is limited empirical evidence to inform advocacy efforts. Philadelphia's 1.5 cent-per-ounce tax on sweetened beverages provides an opportunity to understand how public testimony for and against the tax was framed in a city that ultimately passed the policy.

METHODS

A content analysis of all public testimony about the beverage tax presented to the Philadelphia City Council in 2016 was conducted. Testimonies were coded for policy stance (protax or antitax), speaker type, and specific protax or antitax arguments. Quantitative data were analyzed in 2018-2019 using chi-square tests.

RESULTS

A total of 177 unique testimonies were identified, which included 40 protax arguments (grouped into 11 themes) and 31 antitax arguments (grouped into 10 themes). Most testimonies were delivered orally, and most speakers argued in favor of the tax (58%). Among tax supporters, funding early childhood education was the most common argument (71%), whereas tax opponents most frequently argued that sugar-sweetened beverages were the wrong target for the tax (50%).

CONCLUSIONS

This analysis of public testimony revealed that protax advocacy efforts highlighted the revenue benefits for early childhood education and community infrastructure rather than the tax's potential to reduce sweetened beverage consumption and improve health. By contrast, antitax arguments centered on the unfairness of targeting a single industry, potential negative economic impacts, and the perceived lack of evidence that the tax would influence consumer behavior.

Stakeholder views on taxation of sugar-sweetened beverages and its adoption in the Netherlands

An increasing number of governments worldwide have introduced a tax on sugar-sweetened beverages (SSB) for public health. However, the adoption of such a policy is still debated in many other countries, such as in the Netherlands. We investigated Dutch stakeholder views on taxation of SSB and perceived barriers and facilitators to its adoption in the Netherlands. Semi-structured interviews were conducted in 2019 with 27 stakeholders from health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties. Data were analysed using a thematic content approach. The findings reveal that, between and within sectors, stakeholders expressed contradictory views on the effectiveness, appropriateness and (socio)economic effects of an SSB tax. Perceived barriers to the adoption of an SSB tax in the Netherlands included an unfavourable political context, limited advocacy for an SSB tax, a strong lobby against an SSB tax, perceived public opposition, administrative load and difficulties in defining SSB. Perceived facilitators to its adoption included an increasing prevalence of overweight, disappointing results from voluntary industry actions, a change of government, state budget deficits, a shift in public opinion, international recommendations and a solid legal basis. In conclusion, this study shows that several challenges remain to be overcome for the adoption of an SSB tax in the Netherlands. Similar research on stakeholder views in other countries may further inform SSB tax policy processes.

Perceptions of Arguments in Support of Policies to Reduce Sugary Drink Consumption Among Low-Income White, Black and Latinx Parents of Young Children

Purpose:

To test for racial/ethnic differences in perceived argument strength in favor of structural interventions to curb childhood obesity among lower-income parents of young children.

Design:

Cross-sectional, self-report.

Setting:

Online research panel, national sample of 1485 US adults in Fall 2019.

Participants:

Parents of children (age 0-5 years) with an annual income <$40,000, stratified by White, Black and/or Latinx race/ethnicity.

Measures:

SSB consumption, policy support, and strength of arguments in favor of marketing restrictions and a penny-per-ounce tax.

Analysis:

Descriptive statistics, multivariable OLS models.

Results:

Race/ethnicity was not a significant predictor of the perceived strength of a composite of marketing arguments (p_Black = 0.07; p_Latinx = 0.10), however it was a significant predictor of the perceived strength of tax arguments (p_Black = 0.01; p_Latinx = 0.01). Perceptions of strength of 12 of 35 discrete SSB tax arguments differed by race/ethnicity (p < .05). Arguments regarding industry targeting of Black children (marketing: p_Black < .001; p_Latinx = .001; tax: p_Black < .001; p_Latinx = .001), were particularly demonstrative of this difference. In contrast, arguments that these policies would provide support for parents (marketing: p_Black = 0.20; p_Latinx = 0.84) and communities (tax: p_Black = 0.24; p_Latinx = 0.58) were seen as strong arguments across groups.

Conclusions:

Black and Hispanic/Latinx parents may be more prepared to move toward SSB policy support than white parents. Emphasizing community benefits of policy may be effective in moving constituents toward policy support across groups.

Examining the news media reaction to a national sugary beverage tax in South Africa: a quantitative content analysis

BACKGROUND

South Africa was the first sub-Saharan African country to implement a sugar-sweetened beverage (SSB) tax called the Health Promotion Levy (HPL) in April 2018. Given news media can increase public awareness and sway opinions, this study analyzed how the media represented the HPL, including expressions of support or challenge, topics associated with the levy, and stakeholder views of the HPL.

METHODS

We performed a quantitative content analysis of online South African news articles related to the HPL published between January 1, 2017 and June 30, 2019. We coded the presence or absence of mentions related to health and economic effects of the HPL and HPL support or opposition. Prevalence of these mentions, overall and by source (industry, government, academics, other), were analyzed with Pearson χ2 and post-hoc Fisher exact tests.

RESULTS

Across all articles, 81% mentioned health, and 65% mentioned economics topics. 54% of articles expressed support, 26% opposition, and 20% a balanced view of the HPL. All sources except industry expressed majority support for the HPL. Health reasons were the most common justifications for support, and economic harms were the most common justifications for opposition. Statements that sugar intake is not related to obesity, the HPL will not reduce SSB intake, and the HPL will cause industry or economic harm were all disproportionately high in industry sources (92, 80, and 81% vs 25% prevalence in total sample) (p < 0.001). Statements that sugar intake is related to obesity and non-communicable diseases were disproportionately high in both government (46 and 54% vs 31% prevalence in total sample) (p < 0.001) and academics (33 and 38% vs 25% prevalence in total sample) (p < 0.05). Statements that the HPL will improve health and the HPL will reduce health care costs were disproportionately high in government (47% vs 31% prevalence in total sample) (p < 0.001) and academics (44% vs 25% prevalence in total sample) (p < 0.05), respectively.

CONCLUSIONS

Industry expressed no support for the HPL, whereas academics, government, and other sources mainly expressed support. Future studies would be improved by linking news media exposure to SSB intake data to better understand the effects news media may have on individual behavior change.

Media Coverage and Framing of Oakland's Sugar-Sweetened Beverage Tax, 2016-2019

PURPOSE

To describe media coverage and framing of Oakland, California's, sugar-sweetened beverage tax.

DESIGN

Media content analysis.

SAMPLE

Media documents (n = 90), published January 1, 2016-August 31, 2019, were retrieved from Oakland news outlets and ProQuest, NexusUni, EBSCO, and Google.

ANALYSIS

Documents were coded using constant comparative analysis in Atlas.ti v8; with descriptive analyses conducted using Stata/SE v. 15.1.

RESULTS

Documents were published evenly between pre- and post-ballot periods (n = 45); the majority (n = 47) provided neutral framing. Protax documents (n = 33) highlighted SSB consumption and health associations and countered antitax messaging; antitax documents (n = 10) focused on misinformation and sowing public confusion.

CONCLUSION

Neutral media educates and raises awareness. Published prior to a vote, the media may help influence public opinion regarding SSB taxes. SSB tax media advocacy campaigns, giving particular attention to timing and perspective-based framing, may help to secure adoption and support implementation.

Evaluation of Changes in Beverage Prices and Volume Sold Following the Implementation and Repeal of a Sweetened Beverage Tax in Cook County, Illinois

IMPORTANCE

Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact.

OBJECTIVES

To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax.

DESIGN, SETTING, AND PARTICIPANTS

This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020.

EXPOSURES

Implementation and repeal of the Cook County SBT.

MAIN OUTCOMES AND MEASURES

Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores.

RESULTS

The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (β = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (β = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal.

CONCLUSIONS AND RELEVANCE

This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.

Retailer perspectives on sugar-sweetened beverage taxes in the California Bay Area

The sugar-sweetened beverage (SSB) industry has claimed that food and beverage retailers are opposed to SSB taxes. In 2018 and 2019, we formally evaluated retailers' perceptions of SSB taxes using semi-structured interviews (including open- and closed-ended questions) with 103 randomly selected retailers (50 corner and liquor stores; 28 chain convenience, drug, and mass-merchandise stores; 18 chain supermarkets and discount supermarkets; and 7 independent supermarkets) across 3 cities with SSB taxes (Berkeley, Oakland, and San Francisco); interviews occurred in 2018 and 2019 (approximately 3 years, 1 year and 6 months post tax-implementation, respectively). A majority of both small and large retailers reported the tax had only a minimal effect on their business (70%). About half of retailers believed that other cities should adopt SSB taxes (53%), and were supportive of a statewide SSB tax (53%), noting it would level the playing field and better support health in their communities. Retailers' responses did not differ based on neighborhood income, and only 2 responses differed significantly between large and small retailers. Only 2 of 103 retailers reported raising the price of a non-beverage product in response to the tax, specifically raising the price of snack foods of low nutritional quality and alcoholic beverages. A majority of retailers in 3 California cities with SSB taxes have no concerns regarding the tax, endorse the health goals of SSB taxes and support statewide expansion of SSB tax policies.

Regulating the Fast-Food Landscape: Canadian News Media Representation of the Healthy Menu Choices Act

With the rapid rise of fast food consumption in Canada, Ontario was the first province to legislate menu labelling requirements via the enactment of the Healthy Menu Choice Act (HMCA). As the news media plays a significant role in policy debates and the agenda for policymakers and the public, the purpose of this mixed-methods study was to clarify the manner in which the news media portrayed the strengths and critiques of the Act, and its impact on members of the community, including consumers and stakeholders. Drawing on data from Canadian regional and national news outlets, the major findings highlight that, although the media reported that the HMCA was a positive step forward, this was tempered by critiques concerning the ineffectiveness of using caloric labelling as the sole measure of health, and its predicted low impact on changing consumption patterns on its own. Furthermore, the news media were found to focus accountability for healthier eating choices largely on the individual, with very little consideration of the role of the food industry or the social and structural determinants that affect food choice. A strong conflation of health, weight and calories was apparent, with little acknowledgement of the implications of menu choice for chronic illness. The analysis demonstrates that the complex factors associated with food choice were largely unrecognized by the media, including the limited extent to which social, cultural, political and corporate determinants of unhealthy choices were taken into account as the legislation was developed. Greater recognition of these factors by the media concerning the HMCA may evoke more meaningful and long-term change for health and food choices.

Political and public acceptability of a sugar-sweetened beverages tax: a mixed-method systematic review and meta-analysis

BACKGROUND

Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax.

METHODS

Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions.

RESULTS

Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38-0.47) supports an SSBs tax, 39% (0.29-0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60-0.72) supports an SSBs tax if revenue is used for health initiatives.

CONCLUSIONS

Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.

Support for, and perceived effectiveness of, the UK soft drinks industry levy among UK adults: cross-sectional analysis of the International Food Policy Study

OBJECTIVES

To answer four questions: What are attitudes, knowledge and social norms around sugar-sweetened beverages (SSBs)? What are current levels of trust in messages on SSBs? What is current support for, and perceived effectiveness of, the UK soft drinks industry levy (SDIL)? What is the association between attitudes, knowledge, social norms, trust, SSB consumption and sociodemographic factors; and support for, and perceived effectiveness of, the SDIL?

DESIGN

Cross-sectional online survey.

SETTING

UK.

PARTICIPANTS

UK respondents to the 2017 International Food Policy Study aged 18-64 years who provided information on all variables of interest (n=3104).

OUTCOME MEASURES

Self-reported perceived effectiveness of, and support for, the SDIL.

RESULTS

Most participants supported the SDIL (70%), believed it would be effective (71%), had a positive attitude to SSBs (62%), had knowledge of the link between SSBs and obesity (90%), and trusted messages from health experts (61%), but not those from the food and beverage industry (73%). Nearly half (46%) had negative social norms about drinking SSBs. In adjusted models, older age, non-consumption of SSBs, social norms to not drinks SSBs, knowledge of the link between SSBs and obesity and trust in health expert messages were associated with greater support for the SDIL, whereas having dependent children and trusting messages from the food and beverage industry were associated with less support. In adjusted models, older age was associated with lower perceived effectiveness of the SDIL, whereas social norms to not drink SSBs, negative attitudes to SSBs and trusting messages from health experts and the food and beverage industry were associated with greater perceived effectiveness.

CONCLUSIONS

There was strong support for the SDIL and belief that it would be effective. Those with more 'public health' orientated norms and trust were generally more likely to support the SDIL or believe that it would be effective.

Television News Coverage of Public Health Issues and Implications for Public Health Policy and Practice

Television (TV) news, and especially local TV news, remains an important vehicle through which Americans obtain information about health-related topics. In this review, we synthesize theory and evidence on four main functions of TV news in shaping public health policy and practice: reporting events and information to the public (surveillance); providing the context for and meaning surrounding health issues (interpretation); cultivating community values, beliefs, and norms (socialization); and attracting and maintaining public attention for advertisers (attention merchant). We also identify challenges for TV news as a vehicle for improving public health, including declining audiences, industry changes such as station consolidation, increasingly politicized content, potential spread of misinformation, and lack of attention to inequity. We offer recommendations for public health practitioners and researchers to leverage TV news to improve public health and advance health equity.

A Case Study of the Philadelphia Sugar-Sweetened Beverage Tax Policymaking Process: Implications for Policy Development and Advocacy

CONTEXT

Policymakers are increasingly proposing sugar-sweetened beverage (SSB) taxes as an evidence-based strategy to reduce chronic disease risk; and local health departments (LHDs) are well-positioned to play a role in SSB policy development and advocacy. However, most SSB tax proposals fail to become law and limited empiric guidance exists to inform advocacy efforts. In June 2016, Philadelphia, Pennsylvania, passed an SSB tax.

OBJECTIVE

To identify features of the Philadelphia SSB tax policymaking process that contributed to the proposal's passage.

DESIGN

Qualitative case study. Semistructured interviews were conducted with key informants closely involved with the policymaking process. Interviews were audio-recorded and transcribed. Local news media about the SSB tax proposal were analyzed to triangulate interview findings. Analysis was conducted in NVivo 10 using inductive qualitative content analysis.

SETTING

Philadelphia, Pennsylvania, during the SSB tax policymaking in process.

PARTICIPANTS

Nine key informants (2 city councilpersons, 4 city agency officials, 1 community-based advocate, 1 news reporter, and 1 researcher).

RESULTS

The Philadelphia SSB tax proposal was introduced with the explicit goal of financing universal prekindergarten and deliberately not framed as a health intervention. This framing shifted contentious debates about government involvement in individual behavior toward discussions about how to finance universal prekindergarten, a goal for which broad support existed. The LHD played an important role in communicating research evidence about potential health benefits of the SSB tax proposal at the end of the policymaking process.

CONCLUSIONS

During local SSB tax policy development processes, LHD officials and other advocates should encourage policymakers to design SSB tax policies so that revenue is directed toward community investments for which broad public support exists. When communicating with policymakers and the public, LHDs should consider emphasizing how SSB tax revenue will be used in addition to presenting evidence about the potential health benefits of the SSB tax at the local level.

Impact of tax and subsidy framed messages on high- and lower-sugar beverages sold in vending machines: a randomized crossover trial

OBJECTIVE

Framing of fiscal incentives has been suggested to be important in influencing purchase decisions. We aimed to examine the effect of framing a modest price difference between high- and lower-sugar beverages as a tax or a subsidy respectively, using messages placed on vending machines to influence beverage purchases.

DESIGN/SETTING

This is an 11-week randomized crossover trial conducted between August and November 2015, with a two-week run-in period before intervention, targeted at students, staff and faculty of a university campus in Singapore. Twenty-one beverage vending machines were used to implement the intervention involving 'tax message', 'subsidy message' and 'no message (control)'. The former two messages suggest 'a tax for high sugar beverages' or 'a subsidy for lower sugar beverages' respectively. Prices of the beverages offered were fixed at baseline and remained the same in all three experimental conditions: lower-sugar beverage options were priced ~ 10% lower than the corresponding high-sugar option. The machines were randomized to one of the 6 sequences of intervention. Each message intervention period was 3 weeks. The effect of messages was assessed by comparing average weekly units of beverages sold between interventions using mixed effects model.

RESULTS

The average weekly units of high and lower-sugar beverages sold per vending machine were 115 and 98 respectively in the control condition. The percentage of high-sugar beverages sold was 54% in the control, 53% in the tax, and 54% in the subsidy message condition. There was no difference in the weekly units of high-sugar beverages sold for the tax message (- 2, 95% CI -8 to 5, p = 0.61) or the subsidy message (0, 95% CI -10 to 10, p = 0.96) conditions as compared with the control condition. Similarly, there was no difference in the weekly units of lower-sugar beverages sold for the tax message (4, 95% CI -4 to 13, p = 0.32) or the subsidy message (7, 95% CI -4 to 18, p = 0.18) conditions as compared with the control condition.

CONCLUSIONS

The use of tax and subsidy messages to highlight modest price differences did not substantially reduce high-sugar beverage sales in vending machines on an Asian university campus.

Competing with big business: a randomised experiment testing the effects of messages to promote alcohol and sugary drink control policy

Background

Evidence-based policies encouraging healthy behaviours are often strongly opposed by well-funded industry groups. As public support is crucial for policy change, public health advocates need to be equipped with strategies to offset the impact of anti-policy messages. In this study, we aimed to investigate the effectiveness of theory-based public health advocacy messages in generating public support for sugary drink/alcohol policies (increased taxes; sport sponsorship bans) and improving resistance to subsequent anti-policy messages typical of the sugary drink/alcohol industry.

Methods

We conducted a two-wave randomised online experiment assigning Australian adults to one of four health policies (sugary drink tax; sugary drink industry sports sponsorship ban; alcohol tax; alcohol industry sports sponsorship ban). Within each health policy, we randomised participants to one of five message conditions: (i) non-advocacy based message about the size and seriousness of the relevant health issue (control); (ii) standard pro-policy arguments alone; (iii) standard pro-policy arguments combined with an inoculation message (forewarning and directly refuting anti-policy arguments from the opposition); (iv) standard pro-policy arguments combined with a narrative message (a short, personal story about an individual’s experience of the health issue); or (v) standard pro-policy arguments combined with a composite inoculation and narrative message. At time 1, we exposed participants (n = 6000) to their randomly assigned message. Around two weeks later, we re-contacted participants (n = 3285) and exposed them to an anti-policy message described as being from a representative of the sugary drink/alcohol industry. Generalised linear models tested for differences between conditions in policy support and anti-industry beliefs at both time points.

Results

Only the standard argument plus narrative message increased policy support relative to control at time 1. The standard argument plus narrative and standard argument plus inoculation messages were effective at increasing resistance to the persuasive impact of anti-policy messages relative to control at time 2.

Conclusions

Dissemination of advocacy messages using inoculation or narrative components can help strengthen public resistance to subsequent anti-policy messages from industry groups.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4972-6) contains supplementary material, which is available to authorized users.

Partisan Responses to Public Health Messages: Motivated Reasoning and Sugary Drink Taxes

This study examines the public's motivated reasoning of competitive messages about sugary drink taxes, a public health policy approach attempted with some recent success in the United States. In an experiment embedded in a nationally representative survey fielded in the fall of 2012, we randomized participants (N = 5,147) to receive one of four messages: control, a strong protax message, a two-sided message, or a message refuting arguments made in soda company antitax messages. The protax message showed no effects on tax support, while the two-sided message depressed Republicans' support. The refutation message boosted independents' support but produced backlash among Republicans. This motivated response was pronounced among Republicans who were plausibly previously exposed to the sugary drink tax debate. These findings reinforce the communication challenges in an increasingly politicized US health policy discourse.

Public responses to proposals for a tax on sugar-sweetened beverages: A thematic analysis of online reader comments posted on major UK news websites

Background

Regular consumption of sugar sweetened beverages (SSBs) is associated with weight gain, type 2 diabetes, and dental caries. The UK will introduce a levy on the manufacturers of SSBs in 2018. Details will be negotiated over the next two years. How the UK public views SSB taxes is likely to be an important determinant of the content and success of the final policy. We aimed to capture the views, ideas and concerns of commenters on major UK news websites on SSB taxes.

Methods and findings

We conducted a qualitative analysis of reader comments to online news coverage of one proposal for an SSB tax in the UK. 1645 comments on four articles were included. Three underpinning themes influenced support or opposition to the tax: the balance between individual responsibility and autonomy, and population need; mistrust of the intention of the proposed tax and those promoting it; and variations in the perceived complexity of unhealthy diets and obesity associated with variations in what are considered appropriate interventions. Arguments under each theme were used to justify both support and opposition in different cases.

Conclusions

As the final form of the UK SSB tax is negotiated, effort should be made to address the concerns we identified. Our results suggest these efforts could usefully focus on emphasising the social and environmental determinants of diet and obesity, reinforcing the benefits of the tax to the NHS, and pitching the tax as playing into a variety of different conceptualisations of obesity.

Funding quality pre-kindergarten slots with Philadelphia's new 'sugary drink tax': simulating effects of using an excise tax to address a social determinant of health

OBJECTIVE

Philadelphia passed a 1·5-cent-per-ounce sweetened beverage tax (SBT). Revenue will fund 10 000 quality pre-kindergarten slots for poor children. It is imperative to understand how revenue from SBT can be used to fund programmes to address education and other social determinants of health. The objective of the present study was to simulate quality pre-kindergarten attendance, educational achievement and sugar-sweetened beverage (SSB) consumption among Philadelphia children and adolescents under six intervention scenarios: (i) no intervention; (ii) 10 000 additional quality pre-kindergarten slots; (iii) a 1·5-cent-per-ounce SBT; (iv) expanded pre-kindergarten and 1·5-cent-per-ounce SBT; (v) a 3-cent-per-ounce SBT; and (vi) expanded pre-kindergarten and 3-cent-per-ounce SBT.

DESIGN

We used an agent-based model to estimate pre-kindergarten enrolment, educational achievement and SSB consumption under the six policy scenarios. We identified key parameters in the model from the published literature and secondary analyses of the Panel Study of Income Dynamics - Child Development Supplement.

SETTING

Philadelphia, Pennsylvania, USA.

SUBJECTS

Philadelphia children and adolescents aged 4-18 years.

RESULTS

A 1·5-cents-per-ounce tax would reduce SSB consumption by 1·3 drinks/week among Philadelphia children and adolescents relative to no intervention, with larger effects among children below the poverty level. Quality pre-kindergarten expansion magnifies the effect of the SBT by 8 %, but has the largest effect on moderate-income children just above the poverty level. The SBT and quality pre-kindergarten programme each reduce SSB consumption, but primarily benefit different children and adolescents.

CONCLUSIONS

Pairing an excise tax with a complementary programme to improve a social determinant of health represents a progressive strategy to combat obesity, a disease regressive in its social patterning.

Policy lessons from health taxes: a systematic review of empirical studies

BACKGROUND

Taxes on alcohol and tobacco have long been an important means of raising revenues for public spending in many countries but there is increasing interest in using taxes on these, and other unhealthy products, to achieve public health goals. We present a systematic review of the research on health taxes, and aim to generate insights into how such taxes can: (i) reduce consumption of targeted products and related harms; (ii) generate revenues for health objectives and distribute the tax burden across income groups in an efficient and equitable manner; and (iii) be made politically sustainable.

METHODS

Six scientific and four grey-literature databases were searched for empirical studies of 'health taxes' - defined as those intended to increase the costs of manufacturing, distributing, retailing and/or consuming health-damaging products. Since reviews already exist of the evidence relating to traditional alcohol and tobacco excise taxes, we focus on other taxes such as taxes on retailers and manufacturers of unhealthy products, and consumer taxes targeting unhealthy foods, such as sugar-sweetened beverages.

RESULTS

Ninety-one peer-reviewed and 11 grey-literature studies met our inclusion criteria. The review highlights a recent, rapid rise in research in this area, most of which focuses on high-income countries and on taxes on food products or nutrients. Findings demonstrate that high tax rates on sugar-sweetened beverages are likely to have a positive impact on health behaviours and outcomes, and, while taxes on products reduce demand, they add to fiscal revenues. Common concerns about health taxes are also discussed.

CONCLUSIONS

If the primary policy goal of a health tax is to reduce consumption of unhealthy products, then evidence supports the implementation of taxes that increase the price of products by 20% or more. However, where taxes are effective in changing health behaviours, the predictability of the revenue stream is reduced. Hence, policy actors need to be clear about the primary goal of any health tax and frame the tax accordingly - not doing so leaves taxes vulnerable to hostile lobbying. Conversely, earmarking health taxes for health spending tends to increase public support so long as policymakers follow through on specified spending commitments.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42016048603.

Young adults' responses to alternative messages describing a sugar-sweetened beverage price increase

OBJECTIVE

Many jurisdictions in the USA and globally are considering raising the prices of sugar-sweetened beverages (SSB) through taxes as a strategy to reduce their consumption. The objective of the present study was to identify whether the rationale provided for an SSB price increase affects young adults' behavioural intentions and attitudes towards SSB.

DESIGN

Participants were randomly assigned to receive one of eight SSB price increase rationales. Intentions to purchase SSB and attitudes about the product and policy were measured.

SETTING

A forty-six-item cross-sectional Internet survey.

SUBJECTS

Undergraduate students (n 494) at a large US Midwestern university.

RESULTS

Rationale type was significantly associated with differences in participants' purchasing intentions for the full sample (F 7,485=2·53, P=0·014). Presenting the rationale for an SSB price increase as a user fee, an effort to reduce obesity, a strategy to offset health-care costs or to protect children led to lower SSB purchasing intentions compared with a message with no rationale. Rationale type was also significantly associated with differences in perceptions of soda companies (F 7,485=2·10, P=0·043); among low consumers of SSB, messages describing the price increase as a user fee or tax led to more negative perceptions of soda companies.

CONCLUSIONS

The rationale attached to an SSB price increase could influence consumers. However, these message effects may depend on individuals' level of SSB consumption.

Why media representations of corporations matter for public health policy: a scoping review

Background

Media representations play a crucial role in informing public and policy opinions about the causes of, and solutions to, ill-health. This paper reviews studies analysing media coverage of non-communicable disease (NCD) debates, focusing on how the industries marketing commodities that increase NCD risk are represented.

Methods

A scoping review identified 61 studies providing information on media representations of NCD risks, NCD policies and tobacco, alcohol, processed food and soft drinks industries. The data were narratively synthesized to describe the sample, media depictions of industries, and corporate and public health attempts to frame the media debates.

Results

The findings indicate that: (i) the limited research that has been undertaken is dominated by a focus on tobacco; (ii) comparative research across industries/risk-factors is particularly lacking; and (iii) coverage tends to be dominated by two contrasting frames and focuses either on individual responsibilities (‘market justice’ frames, often promoted by commercial stakeholders) or on the need for population-level interventions (‘social justice’ frames, frequently advanced by public health advocates).

Conclusions

Establishing the underlying frameworks is crucial for the analysis of media representation of corporations, as they reflect the strategies that respective actors use to influence public health debates and decision making. The potential utility of media research lies in the insights that it can provide for public health policy advocates about successful framing of public health messages and strategies to counter frames that undermine public health goals. A better understanding of current media debates is of paramount importance to improving global health.