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Abbas H, Guarnizo-Herreño CC, El Tantawi M, Tsakos G, Peres MA. Challenges and way forward for implementation of sugar taxation in the Middle East and North Africa (MENA). Community Dent Oral Epidemiol 2024; 52:375-380. [PMID: 38587110 DOI: 10.1111/cdoe.12955] [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: 11/27/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Over consumption of added sugar beyond the World Health Organization (WHO) recommended level of 10% of daily energy intake has well-established negative health consequences including oral diseases. However, the average consumption of added sugar in the Middle East and North Africa region (MENA-World Bank's regional classification) is 70% higher than the WHO recommended level. Imposing taxes on added sugar has been proposed by the WHO to decrease its consumption. Yet, only 21.6% of the total MENA population are covered by taxation policies targeting added sugar. CHALLENGES Well-recognized challenges for the implementation of sugar taxation in MENA include the tactics used by the food and beverage industry to block these type of policies. However, there are also other unfamiliar hurdles specific to MENA. Historically, there have been incidents of protest and riots partially sparked by increased price of basic commodities, including sugar, in MENA countries. This may affect the readiness of policy makers in the region to impose added sugar taxes. In addition, there are also cultural, lifestyle and consumption behavioural barriers to implementing added sugar taxation. Ultra-processed foods and sugar-sweetened-beverages (SSBs) rich in added sugar are perceived by many in MENA as essential treats regardless of their health risks. Furthermore, some countries even provide subsidies for added sugar. Also, (oral) healthcare providers generally do not engage in policy advocacy mainly due to limited training on health policy. WAYS FORWARD Here, we discuss these challenges and suggest some ways forward such as (1) support from a health-oriented political leadership, (2) raising public awareness about the health risks of over consumption of sugar, (3) transparency during the policy-cycle development process, (4) providing a free and safe environment for a community dialogue around the proposed policy, (5) training of (oral) healthcare professionals on science communication and policy advocacy in local lay language/dialect, ideally evidence informed from local/regional studies, (6) selecting the appropriate political window of opportunity to introduce a sugar tax policy, and (7) clear and strict conflict of interest regulations to limit the influence of commercial players on health policy.
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Affiliation(s)
- Hazem Abbas
- Department of International and Community Oral Health, Tohoku University, Graduate School of Dentistry, Sendai, Japan
| | | | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Georgios Tsakos
- Research Department of Epidemiology and Public Health, WHO Collaborating Centre of Oral Health Inequalities and Public Health, University College London, London, UK
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
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Mohd Hanim MFB, Md Sabri BA, Yusof N. Online commentaries of the sugar-sweetened beverages tax in Malaysia: Content analysis. Public Health Nurs 2024; 41:139-150. [PMID: 37953703 DOI: 10.1111/phn.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Implementing taxes on sugary drinks, or SSBs, has been a controversial topic in many countries, including Malaysia. This study aimed to examine how Malaysian Facebook users responded to the announcement and implementation of the SSBs tax through netnography. METHODS This cross-sectional study employed qualitative and quantitative methods and used an inductive approach and thematic content analysis to analyze online commentaries on news articles published on popular online news portals from November 2018 to August 2019. Data was collected by downloading the commentaries onto Microsoft Word and importing them into NVivo. RESULTS Of the commentaries analyzed, 60.9% rejected the SSBs tax, and 39.1% favored it. No association was found between the online news articles and the slants of the commentaries. CONCLUSION The results of this study demonstrate a clear divide in public opinion regarding the SSBs tax in Malaysia, with many online readers expressing opposition to the tax despite evidence of the harmful effects of sugar presented in the articles they are commenting on. These findings have implications for policymakers and public health advocates seeking to implement similar taxes in the future.
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Affiliation(s)
- Muhammad Faiz Bin Mohd Hanim
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
- Oral Health Program, Ministry of Health, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Budi Aslinie Md Sabri
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
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Abdool Karim S, Kruger P, Mazonde N, Erzse A, Goldstein S, Hofman K. Stakeholder arguments during the adoption of a sugar sweetened beverage tax in South Africa and their influence: a content analysis. Glob Health Action 2023; 16:2152638. [PMID: 36508172 PMCID: PMC9754008 DOI: 10.1080/16549716.2022.2152638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) taxes are recognised as an effective intervention to prevent obesity. More countries are adopting SSB taxes, but the process of the adoption is politically complex. OBJECTIVE This study aimed to analyse how public participation processes influenced the South African tax. METHODS We conducted a content analysis of documents associated with the process of adopting the tax. Records were identified utilising the Parliamentary Monitoring Group database, including draft bills, meeting minutes and written submissions. The records were categorised and then inductively coded to identify themes and arguments. RESULTS We identified six cross-cutting themes advanced by stakeholders: economic considerations, impact on the vulnerable, responsiveness of an SSB tax to the problem of obesity, appropriateness of an SSB tax in South Africa, procedural concerns, and structure of the tax. Stakeholder views and arguments about the tax diverged based on their vested interests. The primary policymaker was most responsive to arguments concerning the economic impact of a tax, procedural concerns and the structure of the tax, reducing the effective rate to address industry concerns. CONCLUSION Both supportive and opposing stakeholders influenced the tax. Economic arguments had a significant impact. Arguments in South Africa broadly echoed arguments advanced in many other jurisdictions.
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Affiliation(s)
- Safura Abdool Karim
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Petronell Kruger
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Natasha Mazonde
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Wits Centre for Health Economics and Decision Science (PRICELESS SA), Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Ali SH, Lowery CM, Trude ACB. Leveraging Multiyear, Geospatial Social Media Data for Health Policy Evaluations: Lessons From the Philadelphia Beverage Tax. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E253-E262. [PMID: 37467151 DOI: 10.1097/phh.0000000000001804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
CONTEXT Public reactions to health policies are vital to understand policy sustainability and impact but have been elusively difficult to dynamically measure. The 2021 launch of the Twitter Academic Application Programming Interface (API), allowing for historical tweet analyses, represents a potentially powerful tool for complex, comprehensive policy analyses. OBJECTIVE Using the Philadelphia Beverage Tax (implemented January 2017) as a case study, this research extracted longitudinal and geographic changes in sentiments, and key influencers in policy-related conversations. DESIGN The Twitter API was used to retrieve all publicly available tweets related to the Tax between 2016 and 2019. SETTING Twitter. PARTICIPANTS Users who posted publicly available tweets related to the Philadelphia Beverage Tax (PBT). MAIN OUTCOME Tweet content, frequency, sentiment, and user-related information. MEASURES Tweet content, authors, engagement, and location were analyzed in parallel to key PBT events. Published emotional lexicons were used for sentiment analyses. RESULTS A total of 45 891 tweets were retrieved (1311 with geolocation data). Changes in the tweet volume and sentiment were strongly driven by Tax-related litigation. While anger and fear increased in the months prior to the policy's implementation, they progressively decreased after its implementation; trust displayed an inverse trend. The 50 tweeters with the highest positive engagement included media outlets (n = 24), displaying particularly high tweet volume/engagement, and public personalities (n = 10), displaying the greatest polarization in tweet sentiment. Most geo-located tweets, reflecting 321 unique locations, were from the Philadelphia region (55.2%). Sentiment and positive engagement varied, although concentrations of negative sentiments were observed in some Philadelphia suburbs. CONCLUSIONS Findings highlighted how longitudinal Twitter data can be leveraged to deconstruct specific, dynamic insights on public policy reactions and information dissemination to inform better policy implementation and evaluation (eg, anticipating catalysts for both heightened public interest and geographic, sentiment changes in policy conversations). This study provides policymakers a blueprint to conduct similar cost and time efficient yet dynamic and multifaceted health policy evaluations.
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Affiliation(s)
- Shahmir H Ali
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York (Dr Ali); Department of Nutrition, University of North Carolina at Chapel Hill, North Carolina (Ms Lowery); and Department of Nutrition and Food Studies, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York (Dr Trude)
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Koon AD, Marten R. Framing health taxes: a scoping review. BMJ Glob Health 2023; 8:e012055. [PMID: 37813439 PMCID: PMC10565303 DOI: 10.1136/bmjgh-2023-012055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023] Open
Abstract
Health taxes are increasingly positioned as effective policy instruments for curbing non-communicable disease, improving health and raising government revenues. Their allure has caused many health advocates to look beyond tobacco and alcohol to other harmful products such as sugar-sweetened beverages (SSBs), salty foods, fatty foods and fossil fuels. These efforts, however, directly conflict with commercial actors' interests. Both pro-tax health advocates and anti-tax industry representatives seek to frame health tax policy in favourable ways. Yet, little is known about which types of frames resonate in which settings, or how they deploy morals and values in their attempts to persuade. To fill this gap, we conducted a scoping review on framing health taxes using six databases in 2022. A total of 40 peer-reviewed empirical research articles, from 2006 to 2022, were identified from 20 different countries. Most research was conducted in high-income countries, published in the last 4 years and increasingly focused on excise taxes for SSBs. Studies captured multiple actors constructing context-specific frames, often tied to broader economic, health and administrative considerations. Actors also engaged in a range of political activities in addition to framing. We found some evidence that anti-tax framing strategies potentially incorporated a broader array of morals and social values. More in-country comparative research, particularly from low/middle-income countries, is needed to understand the politics of framing health taxes. We argue that these insights can improve efforts to advance health taxes by constraining corporate power, improving population level health and promoting greater social harmony.
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Affiliation(s)
- Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert Marten
- Secretariat, WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
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Dam JL, Nagorka-Smith P, Waddell A, Wright A, Bos JJ, Bragge P. Research evidence use in local government-led public health interventions: a systematic review. Health Res Policy Syst 2023; 21:67. [PMID: 37400905 DOI: 10.1186/s12961-023-01009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Local governments play an important role in improving public health outcomes globally, critical to this work is applying the best-available research evidence. Despite considerable exploration of research use in knowledge translation literature, how research is practically applied by local governments remains poorly understood. This systematic review examined research evidence use in local government-led public health interventions. It focused on how research was used and the type of intervention being actioned. METHODS Quantitative and qualitative literature published between 2000 and 2020 was searched for studies that described research evidence use by local governments in public health interventions. Studies reporting interventions developed outside of local government, including knowledge translation interventions, were excluded. Studies were categorised by intervention type and their level of description of research evidence use (where 'level 1' was the highest and 'level 3' was the lowest level of detail). FINDINGS The search identified 5922 articles for screening. A final 34 studies across ten countries were included. Experiences of research use varied across different types of interventions. However, common themes emerged including the demand for localised research evidence, the legitimising role of research in framing public health issues, and the need for integration of different evidence sources. CONCLUSIONS Differences in how research was used were observed across different local government public health interventions. Knowledge translation interventions aiming to increase research use in local government settings should consider known barriers and facilitators and consider contextual factors associated with different localities and interventions.
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Affiliation(s)
- Jennifer L Dam
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia.
| | - Phoebe Nagorka-Smith
- School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Alex Waddell
- Action Lab, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Annemarie Wright
- Victorian Department of Health and Human Services, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, VIC, 3053, Carlton, Australia
| | - Joannette J Bos
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, Clayton, VIC, 3800, Australia
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Hornung J, Sager F. The non-use of evidence in the adoption of a sugar-sweetened beverage tax in OECD countries. Eur J Public Health 2023:ckad098. [PMID: 37328449 PMCID: PMC10393501 DOI: 10.1093/eurpub/ckad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Studies confirm the positive effect of sugar-sweetened beverage (SSB) taxation on public health. However, only a few countries in Europe adopt SSB taxes. From a public policy perspective, we investigate the conditions under which countries do or do not follow this evidence. METHODS Crisp-set Qualitative Comparative Analysis (QCA) of 26 European Organization of Economic Cooperation and Development countries with and without an SSB tax. We test which configurations of conditions (problem pressure, governmental composition, strategic planning, health care system, public health policies, inclusion of expert advice in policymaking) emerge as relevant in determining adoption and non-adoption between the years 1981 and 2021. Pathways that lead to the presence and absence of SSB taxes are identified separately. RESULTS At least one of the following configurations of conditions is present in countries that introduced taxation: (i) high financial problem pressure, low regulatory impact assessment activity; (ii) high public health problem pressure, a contribution-financed health care system, no holistic strategy for combatting non-communicable diseases (NCDs); (iii) a tax-financed health care system, a holistic NCD strategy, high strategic and executive planning capacity. In countries that did not adopt SSB taxes, we find (i) high regulatory impact assessment activity, high levels of sugar export; (ii) no holistic NCD strategy, high spending on preventive care; (iii and iv) a lack of strategic planning capacity and either a high share of spending on preventive care or inclusion of expert advice. DISCUSSION Evidence inclusion requires clear policy priorities in terms of strategy and resources to promote public health.
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Affiliation(s)
- Johanna Hornung
- KPM Center for Public Management and Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Bern, Switzerland
| | - Fritz Sager
- KPM Center for Public Management and Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Bern, Switzerland
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PURTLE JONATHAN, WYNECOOP MEGAN, CRANE MARGARETE, STADNICK NICOLEA. Earmarked Taxes for Mental Health Services in the United States: A Local and State Legal Mapping Study. Milbank Q 2023; 101:457-485. [PMID: 37070393 PMCID: PMC10262390 DOI: 10.1111/1468-0009.12643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023] Open
Abstract
Policy Points Local governments are increasingly adopting policies that earmark taxes for mental health services, and approximately 30% of the US population lives in a jurisdiction with such a policy. Policies earmarking taxes for mental health services are heterogenous in their design, spending requirements, and oversight. In many jurisdictions, the annual per capita revenue generated by these taxes exceeds that of some major federal funding sources for mental health. CONTEXT State and local governments have been adopting taxes that earmark (i.e., dedicate) revenue for mental health. However, this emergent financing model has not been systematically assessed. We sought to identify all jurisdictions in the United States with policies earmarking taxes for mental health services and characterize attributes of these taxes. METHODS A legal mapping study was conducted. Literature reviews and 11 key informant interviews informed search strings. We then searched legal databases (HeinOnline, Cheetah tax repository) and municipal data sources. We collected information on the year the tax went into effect, passage by ballot initiative (yes/no), tax base, tax rate, and revenue generated annually (gross and per capita). FINDINGS We identified 207 policies earmarking taxes for mental health services (95.7% local, 4.3% state, 95.7% passed via ballot initiative). Property taxes (73.9%) and sales taxes/fees (25.1%) were most common. There was substantial heterogeneity in tax design, spending requirements, and oversight. Approximately 30% of the US population lives in a jurisdiction with a tax earmarked for mental health, and these taxes generate over $3.57 billion annually. The median per capita annual revenue generated by these taxes was $18.59 (range = $0.04-$197.09). Per capita annual revenue exceeded $25.00 in 63 jurisdictions (about five times annual per capita spending for mental health provided by the US Substance Abuse and Mental Health Services Administration). CONCLUSIONS Policies earmarking taxes for mental health services are diverse in design and are an increasingly common local financing strategy. The revenue generated by these taxes is substantial in many jurisdictions.
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Affiliation(s)
- JONATHAN PURTLE
- Global Center for Implementation ScienceNew York University School of Global Public Health
| | | | | | - NICOLE A. STADNICK
- ACTRI Dissemination and Implementation Science CenterUniversity of California San Diego
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Purtle J, Stadnick NA, Wynecoop M, Bruns EJ, Crane ME, Aarons G. A policy implementation study of earmarked taxes for mental health services: study protocol. Implement Sci Commun 2023; 4:37. [PMID: 37004117 PMCID: PMC10067193 DOI: 10.1186/s43058-023-00408-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes-defined as taxes for which revenue can only be spent on specific activities-are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project's specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences. METHODS The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman's typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process. DISCUSSION This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA.
| | - Nicole A Stadnick
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Megan Wynecoop
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA
| | - Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74Th St, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13Th St, Philadelphia, PA, 19122, USA
- Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, 425 E 61St St, New York, NY, 10065, USA
| | - Gregory Aarons
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Lou Z, Yi SS, Pomeranz J, Suss R, Russo R, Rummo PE, Eom H, Liu J, Zhang Y, Moran AE, Bellows BK, Kong N, Li Y. The Health and Economic Impact of Using a Sugar Sweetened Beverage Tax to Fund Fruit and Vegetable Subsidies in New York City: A Modeling Study. J Urban Health 2023; 100:51-62. [PMID: 36550343 PMCID: PMC9918717 DOI: 10.1007/s11524-022-00699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences.
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Affiliation(s)
- Zhouyang Lou
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Rachel Suss
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rienna Russo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Heesun Eom
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Brandon K Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Dry T, Baker P. Generating Political Commitment for Regulatory Interventions Targeting Dietary Harms and Poor Nutrition: A Case Study on Sugar-Sweetened Beverage Taxation in Australia. Int J Health Policy Manag 2022; 11:2489-2501. [PMID: 35065543 PMCID: PMC9818088 DOI: 10.34172/ijhpm.2021.174] [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: 06/30/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) taxes are an effective public health policy intervention for improving nutrition and public health. Although implemented in over 50 jurisdictions worldwide, this intervention remains vastly underutilised, and in Australia political commitment for such a tax is low. The aim of this study is to understand the politics of SSB taxation in Australia, what factors have constrained political commitment for a tax, and what might enable such commitment in future. METHODS We adopted a case study design, guided by a theoretical framework developed from the political economy of nutrition literature. Data were collected from 16 interviews with informants from multiple sectors, supported by media articles, journal articles, and grey literature. Data were coded and organized by thematic analysis, and synthesised into the final results. RESULTS Nutrition actors have made significant progress in generating commitment for a SSB tax by producing relevant evidence, raising awareness, advocating for action, employing resonating frames, collaborating with civil society organisations, and forming coalitions increasing their overall cohesion. Nevertheless, political commitment for a SSB tax is low and was found to be impeded by the powerful influence of the food, beverage, and sugar industries, opposition from both major Australian political parties, ideological resistance to regulation, a low quality monitoring and surveillance system for food and nutrition, and limited public advocacy. The influence of nutrition actors was also impeded by weak connections to key policy-makers and missed collaborative opportunities with pro-SSB tax organisations. CONCLUSION The identification of several impediments provides an explanation for why political commitment for a SSB tax is low in Australia and reveals several opportunities for how it might be generated in the future. Political commitment may come about through, for example, actions to limit the influence of industry in policy decision-making, and by strengthening the existing pro-SSB tax coalition.
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Affiliation(s)
- Tristan Dry
- Public Health, School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, VIC, Geelong, Australia
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Moss ME, Luo H, Rosinger AY, Jacobs MM, Kaur R. High sugar intake from sugar-sweetened beverages is associated with prevalence of untreated decay in US adults: NHANES 2013-2016. Community Dent Oral Epidemiol 2022; 50:579-588. [PMID: 34939664 PMCID: PMC9786558 DOI: 10.1111/cdoe.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the association between sugar from sugar-sweetened beverages (SSBs) and untreated decay in permanent teeth and calculate the cost burden of sugar from SSBs on untreated decay in US adults. METHODS Cross-sectional data from the 2013-2014 and 2015-2016 cycles of the National Health and Nutrition Examination Survey (NHANES) were analysed in 2020 (n = 9001 adults aged ≥20). Multivariable analyses assessed sugar intake from SSB consumption with the presence of untreated decay in permanent teeth and number of untreated decayed teeth. Population attributable risk was used to estimate the cost burden arising from SSBs on untreated decay in US adults. RESULTS One fourth (25.1%) of US adults had untreated dental decay, and higher prevalence was observed among those with low income, low education and race/ethnicity of non-Hispanic Black. Overall, 53% of adults reported no intake of SSBs. For the remaining 47%, the median 24-h intake was 46.8 g of sugar from SSBs. The adjusted prevalence ratio (PR) for untreated decay was 1.3 (95% confidence interval [CI] 1.1-1.5) for consumption of 46.8 g or more of sugar from SSBs compared to those reporting no sugar from SSBs. Number of untreated decayed teeth increased with sugar intake from SSBs from lowest to highest tertile: 0.1, (p = .35); 0.4, (p = .006); and 0.6, (p < .001). The cost burden of untreated decay attributable to SSBs in US adults is estimated conservatively at $1.6 billion USD. CONCLUSIONS Community level interventions directed at sugar from SSBs are justified to address disparities in the burden of untreated dental decay.
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Affiliation(s)
- Mark E. Moss
- ECU School of Dental MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Huabin Luo
- Brody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Asher Y. Rosinger
- Department of Biobehavioral HealthPennsylvania State UniversityState CollegePennsylvaniaUSA,Department of AnthropologyPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Molly M. Jacobs
- College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Roopwant Kaur
- ECU School of Dental MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
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13
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Edmondson EK, Shea JA, Gregory EF, Roberto CA, Garcia SM, Kwon J, Virudachalam S. Low-income parents' perceptions of a sweetened beverage tax in Philadelphia. J Nutr Sci 2022; 11:e67. [PMID: 36106086 PMCID: PMC9428665 DOI: 10.1017/jns.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022] Open
Abstract
Objective: To characterise perceptions of the Philadelphia Beverage Tax among low-income parents. Design: We conducted semi-structured interviews and administered demographic questions via telephone. We based the interview guide and initial codebook on a conceptual model illustrating perceived fairness and effectiveness as essential for successfully adopting food policies. We performed thematic analysis using NVivo 12. Setting: We recruited from a primary care paediatrics clinic in Philadelphia, Pennsylvania from July to August 2020. Participants: Philadelphia parents/caregivers of 2- to 11-year-old children with Medicaid insurance. Results: Participants were predominantly African American (97 %), female (100 %), and had annual household incomes <$50 000 (80 %). Participants were 26- to 72-years old, with an average aged child of 5 years (range 7 months to 20 years). Themes emerged regarding tax perceptions, revenue use and behaviour change due to the tax. Using revenue for highly valued programmes and accountability of city government to use revenue as promised were critical elements in perceptions of tax fairness. Some parents avoided the tax through cross-border shopping and buying drink powders or concentrates, influencing perceptions of tax effectiveness. The tax signalled the health dangers of sweetened beverage consumption to most parents. Conclusion: Our findings bring to light four key takeaways for policymakers designing sweetened beverage taxes. (1) Dedication of tax revenue to programmes highly valued by parents and (2) transparency in revenue spending may improve acceptability. (3) State or national taxes may be more effective at decreasing consumption due to cross-border shopping. (4) Pairing taxes with health promotion campaigns may enhance behaviour change.
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Affiliation(s)
- Emma K. Edmondson
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Judy A. Shea
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Emily F. Gregory
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Stephanie M. Garcia
- Policy Lab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South St, 10th Floor, Philadelphia, PA 19146, USA
| | - Jeemin Kwon
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Senbagam Virudachalam
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
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14
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Case KK, Pineda E, Olney J, Segal AB, Sassi F. The 'sugar tax' in Bermuda: a mixed methods study of general population and key stakeholder perceptions. BMC Public Health 2022; 22:1557. [PMID: 35974346 PMCID: PMC9379233 DOI: 10.1186/s12889-022-13945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Taxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018–2019, the Bermuda government introduced a phased tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar, and eliminated import duties on select healthy food items. The aim of this study was to conduct an mixed methods evaluation of perceptions of the tax among the general population and key stakeholders. Methods We conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Survey data was analysed using thematic analysis, summary statistics, and Chi-squared tests. Key informant interviews were analysed using the framework method. Results General population respondents had high awareness of the sugar tax (94%) but low awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption due to beliefs the tax would not be effective (44%), and because of the high price of healthy food (20%). However, nearly half (48%) reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness but limited understanding of the tax policy. Informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The lack of clear price differentiation between taxed and un-taxed products and the absence of accompanying health education were key factors believed to affect the impact of the tax. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed to other priorities after implementation. Conclusions There was high awareness, but limited acceptability of the Bermuda sugar tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13945-9.
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Affiliation(s)
- Kelsey K Case
- School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Elisa Pineda
- School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.,Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Jack Olney
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Alexa Blair Segal
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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15
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Ng S, Yeatman H, Kelly B, Sankaranarayanan S, Karupaiah T. Identifying barriers and facilitators in the development and implementation of government-led food environment policies: a systematic review. Nutr Rev 2022; 80:1896-1918. [PMID: 35388428 PMCID: PMC9263881 DOI: 10.1093/nutrit/nuac016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Policy-specific actions to improve food environments will support healthy population diets. OBJECTIVE To identify cited barriers and facilitators to food environment policy (FEP) processes reported in the literature, exploring these according to the nature of the policy (voluntary or mandatory) and country development status. DATA SOURCES A systematic search was conducted of 10 academic and 7 grey-literature databases, national websites, and manual searches of publication references. DATA EXTRACTION Data on government-led FEPs, barriers, and facilitators from key informants were collected. DATA SYNTHESIS The constant-comparison approach generated core themes for barriers and facilitators. The appraisal tool developed by Hawker et al. was adopted to determine the quality of qualitative and quantitative studies. RESULTS A total of 142 eligible studies were identified. Industry resistance or disincentive was the most cited barrier in policy development. Technical challenges were most frequently a barrier for policy implementation. Frequently cited facilitators included resource availability or maximization, strategies in policy process, and stakeholder partnership or support. CONCLUSIONS The findings from this study will strategically inform health-reform stakeholders about key elements of public health policy processes. More evidence is required from countries with human development indices ranging from low to high and on voluntary policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42018115034.
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Affiliation(s)
- SeeHoe Ng
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Heather Yeatman
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sreelakshmi Sankaranarayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
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16
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Forberger S, Reisch L, Meshkovska B, Lobczowska K, Scheller DA, Wendt J, Christianson L, Frense J, Steinacker JM, Luszczynska A, Zeeb H. Sugar-sweetened beverage tax implementation processes: results of a scoping review. Health Res Policy Syst 2022; 20:33. [PMID: 35331245 PMCID: PMC8944035 DOI: 10.1186/s12961-022-00832-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Taxing sugar-sweetened beverages (SSB) is seen as a win–win situation for governments. It is argued that SSB taxes are relatively easy to implement from a practical perspective compared to for example other nutrition policies. However, the implementation of SSB taxation laws does not happen by itself. Therefore, this work examines implementation processes for SSB taxation in terms of (1) pre-implementation context, (2) taxation instruments used and (3) interactions in the implementation process. Ten databases and grey literature were systematically searched for studies reporting on SSB taxation implementation processes up to February 2020. All studies (N = 1248) were screened independently by two reviewers according to predefined criteria. The selection of variables to be extracted was based on the policy cycle heuristic and informed by intervention implementation research. Information on the process of implementing SSB taxation is limited. Only six cases based on three publications were identified, indicating a gap in this research area. SSB taxation implementation was accomplished by hiring a subcontractor for the implementation or using pre-existing tax collection structures. Political and public support within the implementation process seems to be supportive for the city of Berkeley and for Portugal but was not reported for the Pacific Islands. However, the existing data are very limited, and further research on SSB taxation implementation processes is needed to determine whether the aim of the policy and the envisaged outcome are linked in practice.
Registration The protocol was registered with the Open Science Framework (OSF) (osf.io/7w84q/)
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Affiliation(s)
- Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Lucia Reisch
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.,El-Erian Professor of Behavioural Economics and Policy, University of Cambridge, Cambridge, CB3 9ET, United Kingdom
| | - Biljana Meshkovska
- Institute of Basic Medical Sciences, University of Oslo, Domus Medica, Gaustad, Sognsvannsveien 9, 2. etg., 0372, Oslo, Norway
| | - Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, 53238, Wroclaw, Poland
| | - Daniel Alexander Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jennifer Frense
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jürgen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, 53238, Wroclaw, Poland.,National Institute for Human Resilience, University of Colorado at Colorado Springs, 1420 Austin Bluffs Pkwy, CO Springs, CO, 80918, United States of America
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bibliothekstr.1, 28359, Bremen, Germany
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17
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Elstein JG, Lowery CM, Sangoi P, Peterhans A, Bleich SN, Lawman HG, Roberto CA. Analysis of Public Testimony About Philadelphia's Sweetened Beverage Tax. Am J Prev Med 2022; 62:e178-e187. [PMID: 34753646 DOI: 10.1016/j.amepre.2021.08.023] [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] [Received: 04/17/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Jeanette G Elstein
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin M Lowery
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, North Carolina.
| | - Puja Sangoi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ana Peterhans
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hannah G Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Weiger C, Hoe C, Cohen JE. Seven-year tobacco tax plan in Ukraine: a case study of the actors, tactics and factors motivating policy passage. BMJ Open 2022; 12:e049833. [PMID: 35149561 PMCID: PMC8845221 DOI: 10.1136/bmjopen-2021-049833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In December 2017, the Ukrainian Rada passed legislation that would increase tobacco taxes for the next 7 years to meet requirements of the European Union-Ukraine Association Agreement (EU-UAA). We analysed factors motivating passage of Ukraine's 7-year tobacco tax plan as well as tactics used by both opponents and proponents to describe how the plan was passed. DESIGN A case study approach was used. Data were gathered from semistructured interviews (n=12) and document review (n=24) and analysed using inductive and deductive coding. RESULTS The European Union-Ukraine Association Agreement, a significant budget deficit and a history of tobacco tax success were all contextual factors contributing to policy passage. Proponents of high tobacco taxes capitalised on this opportunity, using media advocacy, generating scientific evidence and collaborating effectively across multiple sectors to support the passage of the plan. Opponents used media advocacy and lobbied to water down several features of the plan, resulting in smaller increases that might not meet EU-UAA requirements. CONCLUSION Industry interference via lobbying continues to hamper passage of high tobacco taxes and should be addressed via legislation that aligns with Article 5.3 of the Framework Convention on Tobacco Control. Proponents should look for windows of opportunity caused by external events, create a multisectoral coalition, including tax experts and use media advocacy to support tax increases. Further work should continue to document what contextual factors support tobacco control policy change.
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Affiliation(s)
- Caitlin Weiger
- Health, Behavior & Society Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Connie Hoe
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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Asada Y, Chriqui JF, Pipito AA, Taher S, Powell LM. "Holding the City's Feet to the Fire": Lessons Learned From Oakland's Implementation of Measure HH Sugar-Sweetened Beverage Tax. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E137-E145. [PMID: 34797249 DOI: 10.1097/phh.0000000000001296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Sugar-sweetened beverage (SSB) taxes offer a promising public health strategy to decrease consumption of sugary beverages. To date, 7 US cities have successfully implemented SSB taxes; however, only a few studies have examined adoption and implementation processes. OBJECTIVES To describe public health and policy lessons learned during the first 2.5 years of implementation of the Oakland, California, penny-per-ounce SSB tax, Measure HH. DESIGN A mixed-methods, longitudinal, qualitative case study was conducted using a combination of key informant interviews with implementation stakeholders as well as analyses of archival documents and media documents from 2016 to 2019. Interviews were digitally recorded and professionally transcribed. Interview transcripts, archival documents, and media documents were analyzed by 3 coders using Atlas.ti v8. Analyses employed principles of constant comparative analysis to identify themes related to lessons learned. SETTING Oakland, California. PARTICIPANTS Key informants (n = 15), archival documents (n = 43), and media documents (n = 90). INTERVENTION Oakland, California's SSB tax (Measure HH). RESULTS Implementation lessons included both success stories and challenges. Successes included contracting a third-party tax administrator to support tax collection and education; leveraging a pro-tax coalition to counteract industry attacks and to protect tax revenue; and offering "quick win" funding to support local needs. Challenges were associated with implementing a "general" tax versus a "special" tax; the lack of explicit revenue allocation in the ordinance to support city-level implementation and oversight; and, the original ordinance language for tax application to distributors. CONCLUSIONS The study offers a range of recommendations-derived from lessons learned over several years of implementation-to policy makers and advocates engaged in SSB tax adoption and implementation efforts in their jurisdictions. SSB tax implementation requires sufficient agency administrative capacity and a strong pro-tax coalition that engages local community organizations to respond to public health needs.
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Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy (Drs Asada, Chriqui, Taher, and Powell and Ms Pipito), and Division of Health Policy and Administration, School of Public Health (Drs Chriqui and Powell), University of Illinois at Chicago, Chicago, Illinois
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20
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Chrisinger BW. Philadelphia's Excise Tax on Sugar-Sweetened and Artificially Sweetened Beverages and Supplemental Nutrition Assistance Program Benefit Redemption. Am J Public Health 2021; 111:1986-1996. [PMID: 34678053 PMCID: PMC8630475 DOI: 10.2105/ajph.2021.306464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the effect of a 2017 excise tax on sugar and artificially sweetened beverages in Philadelphia, Pennsylvania, on the shopping patterns of low-income populations using Supplemental Nutrition Assistance Program (SNAP) data. Methods. I used a synthetic controls approach to estimate the effect of the tax on Philadelphia and neighboring Pennsylvania counties (Bucks, Delaware, and Montgomery) as measured by total SNAP sales ("SNAP redemption") and SNAP redemption per SNAP participant. I assembled biannual data (2005-2019) from all US counties for SNAP redemption and relevant predictors. I performed placebo tests to estimate statistically significant effects and conducted robustness checks. Results. Detectable increases in SNAP spending occurred in all 3 Philadelphia neighboring counties. Per-participant SNAP spending increased in 2 of the neighboring counties and decreased in Philadelphia. These effects were robust across multiple specifications and placebo tests. Conclusions. The tax contributed to increased SNAP shopping in Philadelphia's neighboring counties across both outcome measures, and decreased spending in Philadelphia (at least by 1 measure). This raises questions about retailer behavior, the effectiveness of the tax's public health aim of reducing sugar-sweetened beverage consumption, and policy aims of investing in low-income communities. (Am J Public Health. 2021;111(11):1986-1996. https://doi.org/10.2105/AJPH.2021.306464).
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Affiliation(s)
- Benjamin W Chrisinger
- Benjamin W. Chrisinger is with the Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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21
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Regulating Alcohol: Strategies Used by Actors to Influence COVID-19 Related Alcohol Bans in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111494. [PMID: 34770009 PMCID: PMC8582952 DOI: 10.3390/ijerph182111494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022]
Abstract
South Africa has used intermittent alcohol prohibitions and restrictions as a strategy to relieve hospitals of alcohol-related trauma cases and spare services for COVID-19 caseloads. Alcohol regulation is highly contested and involves a diverse range of actors who influence policies to align with their interests. This study sought to examine the strategies used by these actors to shape the COVID-19 related alcohol regulation in South Africa as presented by online news media. We found that the voice of pro-regulation actors is smaller and fragmented compared to opponents of the regulation as each actor seeks to advance their own interests. Despite the regulations initially being framed as a COVID-19 public health measure, pro-regulation government ministries, such as police and transport, perceive the regulations as a way of reducing existing (pre-pandemic) alcohol-related harm, such as crime, road-traffic injuries, and gender-based violence. The pre-existing failures in the alcohol regulatory environment and the current policy momentum created by COVID-19 could present an opportunity to retain components of the new laws and improve alcohol regulation in South Africa. However, there is a dominant and cohesive alcohol industry voice that strongly opposes the regulations, citing economic impacts, illicit trade and lack of evidence on the positive effects of the alcohol bans. Strategies employed by industry include lobbying, framing, and litigation. The regulations implemented under the guise of COVID-19 prevention have presented valuable lessons for alcohol regulation more generally. However, whether these regulations translate to sustainable policy changes will depend upon how and if the strong industry voice is countered.
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22
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Donnelly GE, Guge PM, Howell RT, John LK. A Salient Sugar Tax Decreases Sugary-Drink Buying. Psychol Sci 2021; 32:1830-1841. [PMID: 34714702 DOI: 10.1177/09567976211017022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many governments have introduced sugary-drink excise taxes to reduce purchasing and consumption of such drinks; however, they do not typically stipulate how such taxes should be communicated at the point of purchase. Historical, field, and experimental data consisting of more than 225,000 purchase decisions indicated that introducing a $0.01-per-ounce sugar-sweetened beverage (SSB) tax-without making it salient on price tags-had no significant effect on purchasing (-1.26%, p = .28). However, when the phrase "includes sugary drink tax" was added to tax-inclusive price tags, SSB purchasing was lower than (a) in the pretax period (-9.78%, p < .001), (b) in a posttax period when drinks did not bear price tags (-5.04%, p < .001), and (c) in a posttax period when drinks bore tax-inclusive price tags that did not mention the tax (-3.83%, p = .002). Making the tax's beneficiary (student programs) salient on price tags had no added effect. Two follow-up studies suggested that tax salience was effective partly because consumers overestimated the tax amount, leading to reduced purchase intentions.
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Affiliation(s)
- Grant E Donnelly
- Department of Marketing and Logistics, Fisher College of Business, The Ohio State University
| | - Paige M Guge
- Department of Psychology, San Francisco State University
| | - Ryan T Howell
- Department of Psychology, San Francisco State University
| | - Leslie K John
- Negotiation, Organizations and Markets Unit, Harvard Business School
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Alvarado M, Penney TL, Unwin N, Murphy MM, Adams J. Evidence of a health risk 'signalling effect' following the introduction of a sugar-sweetened beverage tax. FOOD POLICY 2021; 102:102104. [PMID: 34404960 PMCID: PMC8346947 DOI: 10.1016/j.foodpol.2021.102104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 06/13/2023]
Abstract
Consuming sugar-sweetened beverages (SSBs) has been associated with increased rates of obesity and type 2 diabetes, making SSBs an increasingly popular target for taxation. In addition to changing prices, the introduction of an SSB tax may convey information about the health risks of SSBs (a signalling effect). If SSB taxation operates in part by producing a health risk signal, there may be important opportunities to amplify this effect. Our aim was to assess whether there is evidence of a risk signalling effect following the introduction of the Barbados SSB tax. We used process tracing to assess the existence of a signalling effect around sodas and sugar-sweetened juices (juice drinks). We used three data sources: 611 archived transcripts of local television news, 30 interviews with members of the public, and electronic point of sales data (46 months) from a major grocery store chain. We used directed content analysis to assess the qualitative data and an interrupted time series analysis to assess the quantitative data. We found evidence consistent with a risk signalling effect following the introduction of the SSB tax for sodas but not for juice drinks. Consistent with risk signalling theory, the findings suggest that consumers were aware of the tax, believed in a health rationale for the tax, understood that sodas were taxed and perceived that sodas and juice drinks were unhealthy. However consumers appear not to have understood that juice drinks were taxed, potentially reducing tax effectiveness from a health perspective. In addition, the tax may have incentivised companies to increase advertising around juice drinks (undermining any signalling effect) and to introduce low-cost SSB product lines. Policymakers can maximize the impact of risk signals by being clear about the definition of taxed SSBs, emphasizing the health rationale for introducing such a policy, and introducing co-interventions (e.g. marketing restrictions) that reduce opportunities for industry countersignals. These actions may amplify the impact of an SSB tax.
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Affiliation(s)
- Miriam Alvarado
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Tarra L. Penney
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
- Global Health Program, Faculty of Health, York University, 4700 Keele Street, Toronto, Canada
| | - Nigel Unwin
- Global Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Madhuvanti M. Murphy
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
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Hoe C, Weiger C, Cohen JE. The battle to increase tobacco taxes: Lessons from Philippines and Ukraine. Soc Sci Med 2021; 279:114001. [PMID: 33984689 PMCID: PMC8722441 DOI: 10.1016/j.socscimed.2021.114001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/05/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION While increasing taxes on tobacco is one of the most effective tobacco control measures, its adoption has been slow compared to other tobacco control policies. Given this, there is an urgent need to better understand the political and economic dynamics that lead to its adoption despite immense tobacco industry opposition. The primary aim of this study is to explore the process, actors, and determinants that helped lead to the successful passage of the 2012 Sin Tax Reform Law in the Philippines and the 2017 seven-year plan for tobacco tax increases in Ukraine. METHOD Under the guidance of the Advocacy Coalition Framework, we used a case study approach gathering data from key informant interviews (n = 37) and documents (n = 56). Subsequently, cross-case analysis was undertaken to identify themes across the two cases. RESULTS We found that external events in the Philippines and Ukraine triggered policy subsystem instability and tipped the scale in the favor of tobacco tax proponents. In the Philippines, elections brought forth a new leader in 2010 who was keen to achieve universal health care and improve tax collection efficiency. In Ukraine, the European Union Association Agreement came into force in 2017 and included the Tobacco Products Directive requiring Ukraine to synchronize its excise taxes to that of the European Union. Exploiting these key entry points, tobacco tax proponents formed a multi-sectoral coalition and used a multi-pronged approach. In both countries, respected economic groups and experts who could generate timely evidence were present and used local as well as international data to counter opponents who also used an array of strategies to water down the tax policies. CONCLUSIONS Findings are largely consistent with the Advocacy Coalition Framework and suggest the need for tobacco tax proponents to 1) form a multi-sectoral coalition, 2) include respected economic groups and experts who can generate timely evidence, 3) use both local data and international experiences, and 4) undertake a multi-pronged approach.
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Affiliation(s)
- Connie Hoe
- Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA.
| | - Caitlin Weiger
- Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
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Hagenaars LL, Jeurissen PPT, Klazinga NS, Listl S, Jevdjevic M. Effectiveness and Policy Determinants of Sugar-Sweetened Beverage Taxes. J Dent Res 2021; 100:1444-1451. [PMID: 34034538 DOI: 10.1177/00220345211014463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Sugar consumption is on the rise globally with detrimental (oral) health effects. There is ample evidence that sugar-sweetened beverage (SSB) taxes can efficiently reduce sugar consumption. However, evidence alone is seldom enough to implement a policy. In this article, we present a narrative synthesis of evidence, based on real-world SSB tax evaluations, and we combine this with lessons from policy development case studies. This article is structured according to the Health Policy Analysis Triangle, which identifies a policy's content and process and important contextual factors. SSB tax policy content needs to be coupled to existing problems and public sentiment, which depend on more aspects than aspects related to (oral) health alone. Whether or not to include artificially sweetened beverages, therefore, is not solely a matter of showing the evidence of their oral health impact but also dependent on the stated aim of a tax and public sentiment toward tax policies in general. SSB taxes also need to be in line with existing tax and decision-making rules. Earmarking revenue for specific (health promotion) purposes may therefore be less straightforward as it might appear. The policy process of creating context-sensitive SSB tax policy content is not easy either. Advocacy coalitions need to be formed early in the process, and stamina, expertise, and flexibility are required to get a SSB tax adopted in a specific community. This requires a meticulously considered SSB tax structure implementation process. Oral health professionals who want to lead the way in advocating for SSB taxes should realize that evidence-based arguments on potential effectiveness alone will not be enough to realize change. The oral health community can learn important lessons from other "doctor-activists" such as pulmonologists, who have successfully advocated for higher tobacco taxes by being visible in the public debate with clear messaging and robust policy proposals.
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Affiliation(s)
- L L Hagenaars
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - P P T Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - N S Klazinga
- Department of Social Medicine, Amsterdam UMC-University of Amsterdam, Amsterdam, the Netherlands
| | - S Listl
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Heidelberg, Germany
| | - M Jevdjevic
- Department of Dentistry-Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Espinosa R, Nassar A. The Acceptability of Food Policies. Nutrients 2021; 13:1483. [PMID: 33924784 PMCID: PMC8145031 DOI: 10.3390/nu13051483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
We propose and test a model of food policy acceptability. The model is structured in four levels: government, topic, policy, and individual. In this study, we focus on two levels that are actionable for policy-makers: the topic and policy levels. We assess nine factors using a first online survey with 600 UK nationals and replicate our results in a second survey with 588 participants. Our results suggest that three factors have a positive effect on acceptability at the topic level: awareness of the issue, the legitimacy of state intervention, and social norms. At the policy level, we report a positive effect of the policy's expected effectiveness, its appropriate targeting of consumers, and the perceived support of the majority. On the other hand, more coercive interventions and those generating inequalities are judged to be less acceptable. Additionally, we report an interaction between awareness and coerciveness on acceptability. Participants who are aware of the issue were more likely to support coercive policies. We also find evidence for a trade-off between coerciveness, effectiveness, and acceptability, as more coercive measures are considered more effective, but less acceptable by participants. Our findings offer policy-makers, nutrition experts, and advocates for healthier and more sustainable diets a new and integrated understanding of the underlying factors that determine food policy acceptability.
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Affiliation(s)
| | - Anis Nassar
- Département d’Économie Politique, Université de Fribourg, 1700 Fribourg, Switzerland;
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Purtle J, Joshi R, LÊ-Scherban FÉ, Henson RM, Diez Roux AV. Linking Data on Constituent Health with Elected Officials' Opinions: Associations Between Urban Health Disparities and Mayoral Officials' Beliefs About Health Disparities in Their Cities. Milbank Q 2021; 99:794-827. [PMID: 33650741 DOI: 10.1111/1468-0009.12501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Policy Points Mayoral officials' opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income-based life expectancy disparity in their city. Associations between mayoral officials' opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents. Highly visible and publicized information about mortality disparities, such as that related to COVID-19 disparities, has potential to elevate elected officials' perceptions of the severity of health disparities and influence their opinions about the issue. CONTEXT A substantive body of research has explored what factors influence elected officials' opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official's constituents. We assessed whether the magnitude of income-based life expectancy disparity within a city was associated with the opinions of that city's mayoral official (i.e., mayor or deputy mayor) about health disparities in their city. METHODS The independent variable was the magnitude of income-based life expectancy disparity in US cities. The magnitude was determined by linking 2010-2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials' opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics. FINDINGS In cities in the highest income-based life expectancy disparity quartile, 50.0% of mayoral officials "strongly agreed" that health disparities existed and 52.7% believed health disparities were "very unfair." In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% "strongly agreed" that health disparities existed and 22.2% believed the disparities were "very unfair." A 1-year-larger income-based life expectancy disparity in a city was associated with 25% higher odds that the city's mayoral official would "strongly agree" that health disparities existed (odds ratio [OR] = 1.25; P = .04) and twice the odds that the city's mayoral official would believe that such disparities were "very unfair" (OR = 2.24; P <.001). CONCLUSIONS Mayoral officials' opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income-based life expectancy disparities among their constituents.
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Affiliation(s)
- Jonathan Purtle
- Dornsife School of Public Health and Urban Health Collaborative, Drexel University
| | - Rennie Joshi
- Dornsife School of Public Health and Urban Health Collaborative, Drexel University
| | - FÉlice LÊ-Scherban
- Dornsife School of Public Health and Urban Health Collaborative, Drexel University
| | - Rosie Mae Henson
- Dornsife School of Public Health and Urban Health Collaborative, Drexel University
| | - Ana V Diez Roux
- Dornsife School of Public Health and Urban Health Collaborative, Drexel University
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Sreedhara M, Goins KV, Frisard C, Rosal MC, Lemon SC. Healthy Eating Policy Strategies in Community Health Improvement Plans: A Cross-Sectional Survey of US Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:125-134. [PMID: 31834204 PMCID: PMC7289666 DOI: 10.1097/phh.0000000000001104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Policies (eg, regulations, taxes, and zoning ordinances) can increase opportunities for healthy eating. Community Health Improvement Plans (CHIP) may foster collaboration and local health department (LHD) engagement in policy decision making to improve local food environments. Limited research describes what policies supportive of healthy food environments are included in CHIPs nationally and relationships between LHD characteristics and participation in plans including such policies. OBJECTIVES To determine the proportion of US LHDs who participated in development of a CHIP containing healthy eating policy strategies and assess the association between LHD characteristics and inclusion of any healthy eating policy strategy in a CHIP. DESIGN A cross-sectional national probability survey. PARTICIPANTS Of the 209 US LHDs (serving populations <500 000) (response rate: 30.2%), 176 LHDs with complete data on CHIP status, outcomes, and covariates were eligible for analysis. MAIN OUTCOME MEASURES Thirteen healthy eating policy strategies were organized into 3 categories: increasing availability/identification of healthy foods, reducing access to unhealthy foods, and improving school food environments. Strategies and categories were identified from literature and public health recommendations. RESULTS In total, 32.2% of LHDs reported inclusion of 1 or more healthy eating policy strategies in a CHIP. The proportion of departments reporting specific strategies ranged from 20.8% for school district policies to 1.1% for sugar-sweetened beverage taxes. Local health departments serving 25 000 to 49 999 residents (odds ratio [OR]: 5.00; 95% confidence interval [CI]: 1.71-14.63), 100 000 to 499 999 residents (OR: 3.66; 95% CI: 1.12-11.95), pursuing national accreditation (OR: 4.46; 95% CI: 1.83-10.83), or accredited (OR: 3.22; 95% CI: 1.08-9.63) were more likely to include 1 or more healthy eating policy strategies in a CHIP than smaller LHDs (<25 000) and LHDs not seeking accreditation, respectively, after adjusting for covariates. CONCLUSIONS Few LHDs serving less than 500 000 residents reported CHIPs that included a policy-based approach to improve food environments, indicating room for improvement. Population size served and accreditation may affect LHD policy engagement to enhance local food environments.
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Affiliation(s)
- Meera Sreedhara
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences (Mss Sreedhara, Valentine Goins, and Frisard and Drs Rosal and Lemon) and Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences (Ms Sreedhara), University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karin Valentine Goins
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences (Mss Sreedhara, Valentine Goins, and Frisard and Drs Rosal and Lemon) and Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences (Ms Sreedhara), University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences (Mss Sreedhara, Valentine Goins, and Frisard and Drs Rosal and Lemon) and Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences (Ms Sreedhara), University of Massachusetts Medical School, Worcester, Massachusetts
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences (Mss Sreedhara, Valentine Goins, and Frisard and Drs Rosal and Lemon) and Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences (Ms Sreedhara), University of Massachusetts Medical School, Worcester, Massachusetts
| | - Stephenie C. Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences (Mss Sreedhara, Valentine Goins, and Frisard and Drs Rosal and Lemon) and Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences (Ms Sreedhara), University of Massachusetts Medical School, Worcester, Massachusetts
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Asada Y, Pipito AA, Chriqui JF, Taher S, Powell LM. Oakland's Sugar-Sweetened Beverage Tax: Honoring the "Spirit" of the Ordinance Toward Equitable Implementation. Health Equity 2021; 5:35-41. [PMID: 33681687 PMCID: PMC7929915 DOI: 10.1089/heq.2020.0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose: On November 8, 2016, Oakland, California, voters passed a sugar-sweetened beverage (SSB) tax, which included language to support programs affecting communities and residents most affected by SSB-related health disparities. The purpose of this study was to qualitatively assess the extent to which those communities most affected by SSB-related health disparities were included in implementation decisions and were recipients of funding to support their needs. Methods: A longitudinal case study from 2016 to 2019 in Oakland, CA, explored equity implementation themes through key informant interview transcripts (n=15) triangulated with media (n=90) and archived documents (n=43). Using principals of constant comparative analysis, all documents (n=148) were coded and thematically analyzed in Atlas.ti. Results: SSB taxes-designed to support communities disproportionately impacted by SSB consumption-can be implemented with inclusivity and community representation. The Oakland ordinance established a Community Advisory Board (CAB) that partnered with community organizations throughout implementation to ensure inclusivity and recommend funding for programs to address health inequities, described as the "spirit" of the ordinance. These activities countered the beverage industry's tactics to target lower income communities of color with misinformation campaigns and hinder implementation. Conclusion: A clearly written ordinance provides guidance, which affords an intentional and legal foundation for implementation processes. Establishing a CAB can mitigate inequities as members are invested in the community and initiatives to support residents. Advisory boards are able to liaise between city and local partners, which is a powerful tool for countering opposition campaigns, reaching lower income and communities of color, and ensuring adherence to funding mandates.
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Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A. Pipito
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jamie F. Chriqui
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sabira Taher
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa M. Powell
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Lee JGL, Cristello JV, Buckton CH, Carey RN, Trucco EM, Schenk PM, Ikegwuonu T, Hilton S, Golden SD, Conway DI. Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019. BMJ Open 2021; 11:e041324. [PMID: 33495253 PMCID: PMC7839858 DOI: 10.1136/bmjopen-2020-041324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To advance understanding of how message framing can be used to maximise public support across different pricing policies for alcohol, tobacco and sugary drinks/foods that prevent consumption of cancer-causing products. DESIGN We designed a 3×4×3 randomised factorial experiment to test responses to messages with three pricing policies, four message frames and three products. SETTING Online survey panel (Qualtrics) in 2019. PARTICIPANTS Adults (N=1850) from the UK and USA. INTERVENTIONS Participants randomly viewed one of 36 separate messages that varied by pricing policy (increasing taxes, getting rid of price discounts, getting rid of low-cost products), four frames and product (alcohol, tobacco, sugary drinks/foods). PRIMARY AND SECONDARY OUTCOME MEASURES We assessed the relationship between the message characteristics and four dependent variables. Three were related to policy support: (1) increasing taxes on the product mentioned in the message, (2) getting rid of price discounts and special offers on the product mentioned in the message and (3) getting rid of low-cost versions of the product mentioned in the message. One was related to reactance, a psychological response to having one's freedom limited. RESULTS We found no effect for pricing policy in the message. Frames regarding children and reducing cancer risk moderated some outcomes, showing promise for real-world use. We found differences in support by product and reactance with greatest support and least reactance for tobacco policies, less support and more reactance for alcohol policies, and the least support and most reactance for sugary drinks/foods policies. CONCLUSIONS Cancer prevention efforts using policy interventions can be informed by the message framing literature. Our results offer insights for cancer prevention advocacy efforts across the UK and USA and highlight that tax versus non-tax approaches to increasing the cost of cancer-causing products result in similar responses from consumers.
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Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Julie V Cristello
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Christina H Buckton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel N Carey
- Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Elisa M Trucco
- Department of Psychology and Center for Children and Families, Florida International University, Miami, Florida, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Paulina M Schenk
- Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Theresa Ikegwuonu
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Shelley D Golden
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Amukugo HJ, Abdool Karim S, Thow AM, Erzse A, Kruger P, Karera A, Hofman K. Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Namibia: a policy landscape analysis. Glob Health Action 2021; 14:1903213. [PMID: 33876708 PMCID: PMC8079035 DOI: 10.1080/16549716.2021.1903213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/11/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Nutrition-related non-communicable diseases contribute to approximately half of the premature deaths in Namibia. Westernisation and urbanisation of communities have resulted in changing dietary patterns that see people eating more refined and high sugar content foods that are a risk for nutrition-related non-communicable diseases. Sugar-sweetened beverage taxation has been found to influence consumer purchasing behaviour and to raise revenue for health-promoting activity in other low- and middle-income countries.Objectives: To analyse Namibia's non-communicable diseases prevention policy landscape and assess the readiness of the Government to adopt sugar-sweetened beverage taxation policies for public health.Methods: Government policy documents relating to nutrition-related non-communicable diseases were analysed, utilising predetermined variables based on policy theory. Thirteen key informant interviews were conducted with stakeholders from Government, non-governmental organisations and academic institutions. Data sets were analysed utilising Kingdon's analytical theory for agenda setting.Results: Nutrition-related non-communicable diseases are an increasing problem that requires immediate action. Diet and lifestyle are recognised as major contributors to non-communicable diseases. The Government has adopted a multisectoral approach to the control and prevention of non-communicable diseases in Namibia. A sugar-sweetened beverage tax is envisaged in policy, but there is no progress towards its enactment. At the highest level of Government, the Ministry of Finance has ruled out immediate action towards sugar-sweetened beverage taxation. There is little publicly available information about the Namibian beverages industry, but it is closely tied to the South African drinking industry and is influenced by policy action in that country.Conclusion: The Government of Namibia has taken positive steps and the policy environment is friendly towards an SSB tax. The proximity of trade and the competitive nature of the Namibian drinks industry with South Africa suggest that a regional perspective to advocacy would be of value.
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Affiliation(s)
- Hans Justus Amukugo
- Community Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Safura Abdool Karim
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Director of Academic Titles, School of Public Health, the University of Sydney, Australia
| | - Agnes Erzse
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Petronell Kruger
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Abel Karera
- Allied Health Department, School of Nursing, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Karen Hofman
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
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Ward ZJ, Gortmaker, SL. Sugar-Sweetened Beverage Taxes Are a Sweet Deal: Improve Health, Save Money, Reduce Disparities, and Raise Revenue. JNCI Cancer Spectr 2020; 4:pkaa075. [PMID: 33409453 PMCID: PMC7771423 DOI: 10.1093/jncics/pkaa075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Steven L Gortmaker,
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Powell LM, Leider J. Evaluation of Changes in Beverage Prices and Volume Sold Following the Implementation and Repeal of a Sweetened Beverage Tax in Cook County, Illinois. JAMA Netw Open 2020; 3:e2031083. [PMID: 33369659 PMCID: PMC7770557 DOI: 10.1001/jamanetworkopen.2020.31083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago
- Institute for Health Research and Policy, University of Illinois Chicago
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago
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Six lessons from introducing sweetened beverage taxes in Berkeley, Cook County, and Philadelphia: A case study comparison in agenda setting and decision making. Health Policy 2020; 124:932-942. [DOI: 10.1016/j.healthpol.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
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Bleich SN, Chriqui J, Ng SW. Implementation Science Is Important for Understanding and Advancing Beverage Taxes. Am J Public Health 2020; 110:1266-1267. [PMID: 32783741 PMCID: PMC7427245 DOI: 10.2105/ajph.2020.305840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 08/14/2023]
Affiliation(s)
- Sara N Bleich
- Sara N. Bleich is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Jamie Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago. Shu Wen Ng is with the Department of Nutrition, Gilling School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jamie Chriqui
- Sara N. Bleich is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Jamie Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago. Shu Wen Ng is with the Department of Nutrition, Gilling School of Global Public Health, University of North Carolina at Chapel Hill
| | - Shu Wen Ng
- Sara N. Bleich is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Jamie Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago. Shu Wen Ng is with the Department of Nutrition, Gilling School of Global Public Health, University of North Carolina at Chapel Hill
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Chriqui JF, Sansone CN, Powell LM. The Sweetened Beverage Tax in Cook County, Illinois: Lessons From a Failed Effort. Am J Public Health 2020; 110:1009-1016. [PMID: 32437287 PMCID: PMC7287549 DOI: 10.2105/ajph.2020.305640] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To describe the public health and policy lessons learned from the failure of the Cook County, Illinois, Sweetened Beverage Tax (SBT).Methods. This retrospective, mixed-methods, qualitative study involved key informant (KI) and discussion group interviews and document analysis including news media, court documents, testimony, letters, and press releases. Two coders used Atlas.ti v.8A to analyze 321 documents (from September 2016 through December 2017) and 6 KI and discussion group transcripts (from December 2017 through August 2018).Results. Key lessons were (1) the SBT process needed to be treated as a political campaign, (2) there was inconsistent messaging regarding the tax purpose (i.e., revenue vs public health), (3) it was important to understand the local context and constraints, (4) there was implementation confusion, and (5) the media influenced an antitax backlash.Conclusions. The experience with the implementation and repeal of the Cook County SBT provides important lessons for future beverage tax efforts.Public Health Implications. Beverage taxation efforts need to be treated as political campaigns requiring strong coalitions, clear messaging, substantial resources, and work within the local context.
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Affiliation(s)
- Jamie F Chriqui
- Jamie F. Chriqui and Lisa M. Powell are with the Division of Health Policy and Administration, School of Public Health, and the Health Policy Center, Institute for Health Research and Policy (IHRP), University of Illinois at Chicago. At the time of this study, Christina N. Sansone was a visiting research specialist at IHRP
| | - Christina N Sansone
- Jamie F. Chriqui and Lisa M. Powell are with the Division of Health Policy and Administration, School of Public Health, and the Health Policy Center, Institute for Health Research and Policy (IHRP), University of Illinois at Chicago. At the time of this study, Christina N. Sansone was a visiting research specialist at IHRP
| | - Lisa M Powell
- Jamie F. Chriqui and Lisa M. Powell are with the Division of Health Policy and Administration, School of Public Health, and the Health Policy Center, Institute for Health Research and Policy (IHRP), University of Illinois at Chicago. At the time of this study, Christina N. Sansone was a visiting research specialist at IHRP
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Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel AV, Andrews KS, Bandera EV, Spees CK, Robien K, Hartman S, Sullivan K, Grant BL, Hamilton KK, Kushi LH, Caan BJ, Kibbe D, Black JD, Wiedt TL, McMahon C, Sloan K, Doyle C. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin 2020; 70:245-271. [PMID: 32515498 DOI: 10.3322/caac.21591] [Citation(s) in RCA: 317] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/14/2022] Open
Abstract
The American Cancer Society (ACS) publishes the Diet and Physical Activity Guideline to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. This guideline is developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflects the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS guideline focuses on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. This 2020 ACS guideline is consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes as well as for general health promotion, as defined by the 2015 to 2020 Dietary Guidelines for Americans and the 2018 Physical Activity Guidelines for Americans.
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Affiliation(s)
- Cheryl L Rock
- Department of Family Medicine and Public Health, School of Medicine, University of California at San Diego, San Diego, California
| | - Cynthia Thomson
- Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health Distinguished Outreach Faculty, University of Arizona, Tucson, Arizona
| | - Ted Gansler
- Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Marjorie L McCullough
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | | | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Colleen K Spees
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Comprehensive Cancer Center and James Solove Research Institute, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kimberly Robien
- Department of Exercise and Nutrition Sciences, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sheri Hartman
- Department of Family Medicine and Public Health, University of San Diego Moores Cancer Center, La Jolla, California
| | | | - Barbara L Grant
- Saint Alohonsus Regional Medical Center Cancer Care Center, Boise, Idaho
| | - Kathryn K Hamilton
- Carol G. Simon Cancer Center, Morristown Memorial Hospital, Morristown, New Jersey
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Debra Kibbe
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - Jessica Donze Black
- Community Health, American Heart Association/American Stroke Association, Washington, DC
| | - Tracy L Wiedt
- Cancer Control, American Cancer Society, Atlanta, Georgia
| | - Catherine McMahon
- Strategy and Operations, American Cancer Society Cancer Action Network, Washington, DC
| | - Kirsten Sloan
- Strategy and Operations, American Cancer Society Cancer Action Network, Washington, DC
| | - Colleen Doyle
- Cancer Control, American Cancer Society, Atlanta, Georgia
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Combatting and Preventing Preemption: A Strategic Action Model. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:101-103. [PMID: 30720592 DOI: 10.1097/phh.0000000000000956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhong Y, Auchincloss AH, Lee BK, McKenna RM, Langellier BA. Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1336. [PMID: 32092982 PMCID: PMC7068482 DOI: 10.3390/ijerph17041336] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 12/31/2022]
Abstract
In January 2017, Philadelphia (Pennsylvania) implemented an excise tax ($ 0.015/ounce) on sugar-sweetened and diet beverages. This study is a general population-based study to report on the longer-term impacts of the tax on within-person changes in consumption 12 months after implementation. A quasi-experimental difference-in-difference design was used to contrast Philadelphia vs. nearby comparison cities (Trenton, New Jersey; Camden, New Jersey; and Wilmington, Delaware) at baseline (December 2016-January 2017) vs. 12-month follow-up (December 2017-February 2018). A random-digit-dialing phone survey was administered to a population-based cohort. Analyses assessed changes in 30-day consumption frequency and ounces of sugar-sweetened and diet beverages (and a substitution beverage, bottled water) in the analytic sample (N = 515). After 12 months, relative to the comparison group, Philadelphians were slightly more likely to decrease their frequency of sugar-sweetened beverage consumption (39.2% vs. 33.5%), and slightly less likely to increase their frequency of sugar-sweetened beverage consumption (38.9% vs. 43.0%). The effects of the tax estimated in the adjusted difference-in-difference analysis were very small (for example, changes in monthly sugar-sweetened beverage consumption in Philadelphia relative to comparison cities was -3.03 times or -51.65 ounces) and confidence intervals were very wide. Results suggested that, one year after implementation, there was no major overall impact of the tax on general population-level consumption of sugar-sweetened or diet beverages, or bottled water. Future studies should test whether the tax's effect differs in vulnerable sub-populations.
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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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Long MW, Polacsek M, Bruno P, Giles CM, Ward ZJ, Cradock AL, Gortmaker SL. Cost-Effectiveness Analysis and Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1177-1187. [PMID: 31402290 DOI: 10.1016/j.jneb.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the potential cost-effectiveness of and stakeholder perspectives on a sugar-sweetened beverage (SSB) excise tax and a Supplemental Nutrition Assistance Program (SNAP) policy that would not allow SSB purchases in Maine, US. DESIGN A cost-effectiveness simulation model combined with stakeholder interviews. SETTING Maine, US. PARTICIPANTS Microsimulation of the Maine population in 2015 and interviews with stakeholders (n = 14). Study conducted from 2013 to 2017. MAIN OUTCOME MEASURES Health care cost savings, net costs, and quality-adjusted life-years (QALYs) from 2017 to 2027. Stakeholder positions on policies. Retail SSB cost and implementation cost data were collected. ANALYSIS Childhood Obesity Intervention Cost-Effectiveness Study project microsimulation model with uncertainty analysis to estimate cost-effectiveness. Thematic stakeholder interview coding. RESULTS Over 10 years, the SSB and SNAP policies were projected to reduce health care costs by $78.3 million (95% uncertainty interval [UI], $31.7 million-$185 million) and $15.3 million (95% UI, $8.32 million-$23.9 million), respectively. The SSB and SNAP policies were projected to save 3,560 QALYs (95% UI, 1,447-8,361) and 749 QALYs (95% UI, 415-1,168), respectively. Stakeholders were more supportive of SSB taxes than the SNAP policy because of equity concerns associated with the SNAP policy. CONCLUSIONS AND IMPLICATIONS Cost-effectiveness analysis provided evidence of potential health improvement and cost savings to state-level stakeholders weighing broader implementation considerations.
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Affiliation(s)
- Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
| | - Michele Polacsek
- Department of Public Health, College of Health Professions, University of New England, Portland, ME
| | - Pamela Bruno
- Department of Public Health, College of Health Professions, University of New England, Portland, ME
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Eykelenboom M, van Stralen MM, Olthof MR, Schoonmade LJ, Steenhuis IHM, Renders CM. Political and public acceptability of a sugar-sweetened beverages tax: a mixed-method systematic review and meta-analysis. Int J Behav Nutr Phys Act 2019; 16:78. [PMID: 31484538 PMCID: PMC6727579 DOI: 10.1186/s12966-019-0843-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax. METHODS Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions. RESULTS Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38-0.47) supports an SSBs tax, 39% (0.29-0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60-0.72) supports an SSBs tax if revenue is used for health initiatives. CONCLUSIONS Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.
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Affiliation(s)
- Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Kane RM, Malik VS. Understanding beverage taxation: Perspective on the Philadelphia Beverage Tax's novel approach. J Public Health Res 2019; 8:1466. [PMID: 31044136 PMCID: PMC6478003 DOI: 10.4081/jphr.2019.1466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022] Open
Abstract
Despite the growing global trend of sugar-sweetened beverage (SSB) taxes for their potential as an untapped source of revenue and as a public health boon, these legislative efforts remain controversial. Multiple articles have reviewed this trend in recent years from modeling of long-term impacts to short-term empirical studies, yet most comprehensive, long-term health impact assessments remain forthcoming. These multi-faceted efficacy studies combined with case-based assessments of the policy process, descriptive pieces highlighting unique features of the policy and reflective perspectives targeting unanswered questions create a comprehensive body of literature to help inform present and future legislative efforts. The passage of the Philadelphia Beverage tax required a mix of political entrepreneurs, timing and context; while uniquely employing a nonpublic health frame, specific earmarking and a broadened scope with the inclusion of diet beverages. This perspective on the Philadelphia Beverage Tax will describe the passage and novel features of the Philadelphia Beverage Tax with a discussion of the ethical questions unique to this case.
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Affiliation(s)
- Ryan M. Kane
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Vasanti S. Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Goldstein ND, Suder JS, Purtle J. Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011-2017. Am J Public Health 2018; 109:102-107. [PMID: 30496007 DOI: 10.2105/ajph.2018.304765] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine trends and characteristics of proposed and enacted state legislation that would directly affect states' immunization exemption laws.Methods. We performed content analysis of proposed bills in state legislatures from 2011 to 2017. We classified bills as provaccination or antivaccination.Results. State legislators proposed 175 bills, with the volume increasing over time: 92 (53%) bills expanded access to exemptions, and 83 (47%) limited the ability to exempt. Of the 13 bills signed into law, 12 (92%) limited the ability to exempt. Bills that expanded access to exemptions were more likely to come from Republican legislators and Northeastern and Southern states.Conclusions. Although most proposed legislation would have expanded access to exemptions, bills that limited exemptions were more likely to be enacted into law. Legal barriers to exempt one's children from vaccination persist despite vaccine hesitancy, which is encouraging for public health.Public Health Implications. Most vaccine exemption laws introduced in state legislatures would pose threats to the public's health. There is a need for constituents to engage their elected legislators and advocate provaccination policies.
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Affiliation(s)
- Neal D Goldstein
- Neal D. Goldstein is with the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. Joanna S. Suder is with the Civil Division, Delaware Department of Justice, Wilmington. Jonathan Purtle is with the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
| | - Joanna S Suder
- Neal D. Goldstein is with the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. Joanna S. Suder is with the Civil Division, Delaware Department of Justice, Wilmington. Jonathan Purtle is with the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
| | - Jonathan Purtle
- Neal D. Goldstein is with the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA. Joanna S. Suder is with the Civil Division, Delaware Department of Justice, Wilmington. Jonathan Purtle is with the Department of Health Management and Policy, Drexel University Dornsife School of Public Health
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Chacon V, Paraje G, Barnoya J, Chaloupka FJ. Own-price, cross-price, and expenditure elasticities on sugar-sweetened beverages in Guatemala. PLoS One 2018; 13:e0205931. [PMID: 30346999 PMCID: PMC6197849 DOI: 10.1371/journal.pone.0205931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/19/2018] [Indexed: 01/01/2023] Open
Abstract
Background The obesity epidemic is spreading rapidly in Guatemala, a low/middle income country still struggling with undernutrition. Sugar sweetened beverages (SSBs) consumption is strongly associated with overweight, obesity, and non-communicable diseases. In Guatemala, SSBs are readily available and consumption is high, particularly among adolescents. SSB taxes have been proposed as a cost-effective way to reduce consumption and generate revenues for public health, as has been demonstrated in several countries around the world. Objective To estimate the price, expenditure, quality, and cross-price elasticity of beverage demand using household survey data. Method We conducted a secondary analysis on the 2014 Guatemala Living Conditions National Survey that includes national representative household data on expenditure. Own price, expenditure, quality, and cross-price elasticities of milk, soft drinks, packaged juices, and bottled water were estimated using Deaton’s Almost Ideal Demand System (AIDS), controlling for goods’ quality. Household characteristics and beverage expenditure are summarized for urban and rural locations using descriptive statistics. Results Positive expenditure on soft drinks was highest (50.9% of households). Positive expenditure on bottled water was next for urban households (43.8%) and lowest for rural households (10.8%). Own-price elasticities for all beverages are negative and statistically significant. Own-price elasticity of soft drinks is -1.39, suggesting that with a 10% increase in price, consumption would decrease by 13.9%. Expenditure elasticity for soft drinks (0.99) suggests that a 10% household expenditure increase would result in a 9.9% increase in demand. Milk (0.07) and soft drinks (0.07) have positive quality elasticity implying that, as household total expenditure increases, the quality of these beverages, measured by their unit values, also increases. Conclusion Soft drink demand is highly sensitive to changes in prices, suggesting that SSB taxes could significantly reduce consumption, which, in turn, could contribute to curbing the overweight/obesity epidemic.
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Affiliation(s)
- Violeta Chacon
- Cardiovascular Surgery Unit of Guatemala, Guatemala City, Guatemala
| | - Guillermo Paraje
- Universidad Adolfo Ibáñez, Santiago, Chile.,American Cancer Society, Atlanta, Georgia, United States of America
| | - Joaquin Barnoya
- Cardiovascular Surgery Unit of Guatemala, Guatemala City, Guatemala.,Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Frank J Chaloupka
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Austin SB, Liu SH, Tefft N. Could a tax on unhealthy products sold for weight loss reduce consumer use? A novel estimation of potential taxation effects. Prev Med 2018; 114:39-46. [PMID: 29842920 DOI: 10.1016/j.ypmed.2018.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023]
Abstract
Abuse of widely available, over-the-counter (OTC) drugs and supplements such as diet pills, laxatives, and diuretics by adolescents for weight control is well-documented, yet manufacturers and retailers can sell them to minors without restriction. The aim of our study was to estimate the effect of added taxation of OTC drugs and dietary supplements sold for weight loss on household purchases of these products. With data from 60,538 U.S. households in the 2012 waves of the Nielsen/IRi National Consumer Panel (NCP) and the Nielsen/IRi Retail Scanner (NRS) datasets, we conducted analyses in 2017 to tally annual quantities and expenditures on OTC drugs or dietary supplements making weight-loss, cleanse/detox, or diuretic claims. We estimated the percent reduction in household purchases due to a simulated 20% added tax on each category. Among the 14,151 households reporting at least one purchase in the three claims categories, a 20% higher average price of weight-loss products was associated with a 5.2% lower purchases of those products. Among households with children ages 12 to 17 years old present, purchases were 17.5% lower, and among households with a daughter present, purchases were 10.3% lower. Taxation may be an effective public health strategy to reduce purchasing of potentially dangerous OTC drugs and supplements sold for weight loss, especially for households that include children ages 12-17 years old or a daughter.
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Affiliation(s)
- S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard T.H. Chan School of Public Health and Boston Children's Hospital, Boston, MA, USA.
| | - Selena Hua Liu
- Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard T.H. Chan School of Public Health and Boston Children's Hospital, Boston, MA, USA; Department of Nutrition, Simmons College, Boston, MA, USA
| | - Nathan Tefft
- Department of Economics, Bates College, Lewiston, ME, USA
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Sugar-sweetened beverage taxation in 2017: a commentary on the reasons behind their quick spread in the EU compared with the USA. Public Health Nutr 2018; 22:186-189. [PMID: 30168400 DOI: 10.1017/s1368980018002008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the final issue of Public Health Nutrition in 2017, Kathryn Backholer and colleagues provide a clear overview of the spread of taxes on sugar-sweetened beverages (SSB) in 2017, and a useful overview of opposing arguments and their counterpoints. Backholer et al. argue that much of the action was concentrated in the USA, but in the present commentary we point out that the recent sweep of SSB tax policy announcements in the EU seems much more promising. Policy makers in EU countries seem to learn from neighbouring countries, while political ideologies do not appear to stand in the way. This could have international spillover effects as the default tax thresholds of 5 and 8 g sugar/100 ml, used in EU cases, provide clear incentives for the multinational soda industry to reduce sugar levels across the board, although it is not yet clear whether the tiered tax designs used in the EU are actually more effective than the flat rate tax designs used in the USA. Scholars may contribute to the policy momentum by comparing the effectiveness and feasibility of both designs in different policy contexts, including lower- and middle-income countries. The spread of SSB taxes in the USA will nevertheless most likely be limited so long as it remains a local policy and 'no-go' for the Republican Party. We explain the differences between the EU and USA by comparing the level of fiscal decentralization, the political context and the use of framing strategies.
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Tamir O, Cohen-Yogev T, Furman-Assaf S, Endevelt R. Taxation of sugar sweetened beverages and unhealthy foods: a qualitative study of key opinion leaders' views. Isr J Health Policy Res 2018; 7:43. [PMID: 30064503 PMCID: PMC6069556 DOI: 10.1186/s13584-018-0240-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022] Open
Abstract
Background Fiscal policies to fight obesity such as taxation of unhealthy foods or sugar-sweetened beverages (SSBs) have gained considerable attention in recent years. Many studies modelling the impact of various magnitudes of taxes on SSB purchasing and their potential effects on various health outcomes have been published; however, legislation and implementation of such taxes have encountered many obstacles in the countries that have implemented them to date. We investigated the perceptions and views of key opinion leaders, policy makers and various other Israeli stakeholders on taxation of SSBs and unhealthy snacks. We also evaluated the challenges and barriers that may be expected for initiating such a policy. Methods A qualitative study based on 39 in-depth interviews with Israeli stakeholders in the fields of health, nutrition, economics, public advocacy and policymaking. Results All stakeholders viewed obesity as a combined societal and personal issue that should be under government responsibility. Only stakeholders from economic sectors thought that taxation of SSBs and unhealthy snacks would reduce their consumption, while the prevailing notion among non-economists was that such a tax would not be acceptable because the higher price would not decrease consumption. Concerns were raised that the tax would mostly affect individuals from low socioeconomic backgrounds. Some of the stakeholders indicated that they would support such a tax only if its revenue would be directed to specific causes such as health-promoting plans. Potential barriers to taxation include: opposition of various sectors, technical and bureaucratic obstacles impeding tax implementation, difficulties in defining which products to tax, and opposition of the treasury to earmark tax revenue for health education. Conclusions Taxation should be a part of a multipronged strategy rather than a sole measure for fighting obesity. Dedicating tax revenues to specific predefined causes should be considered, particularly towards health promotion activities, obesity treatment and prevention, education, and subsidies of healthy food.
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Affiliation(s)
- Orly Tamir
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
| | | | - Sharon Furman-Assaf
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Ronit Endevelt
- School of Public Health, Haifa University, Haifa, Israel
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Abstract
Currently, an unhealthy diet is the largest modifiable factor in ill health and death globally. One of the important contributors to unhealthy diets is the pervasiveness of unhealthy food and drink in our daily food environments. Although efforts to build nutrition skills and education across communities are critical, they will be insufficient without substantial changes to the food environments themselves. Here, I discuss how we can improve our food environments by implementing a comprehensive, multilevel and multisetting approach. This approach needs to encompass the various policy contexts for improving population nutrition, from policy set by national governments to that introduced by local community organizations and food retailers. Clinicians can help implement and set healthy food policies across all our health-care settings, even in the absence of government action. To support a comprehensive suite of effective policies, we need to systematically develop and disseminate the evidence for the feasibility, effectiveness and sustainability of workable policies and to understand their role in the development of a healthier food system.
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Affiliation(s)
- Anna Peeters
- Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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Zhong Y, Auchincloss AH, Lee BK, Kanter GP. The Short-Term Impacts of the Philadelphia Beverage Tax on Beverage Consumption. Am J Prev Med 2018; 55:26-34. [PMID: 29656917 DOI: 10.1016/j.amepre.2018.02.017] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/08/2018] [Accepted: 02/22/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION On January 1, 2017, Philadelphia implemented a beverage tax of $0.015/ounce on sugar ("regular") and sugar-substitute ("diet") beverages. The purpose of this study was to evaluate the immediate impact of the tax on residents' consumption of soda, fruit drinks, energy drinks, and bottled water. METHODS A repeat cross-sectional study design used data from a random-digit-dialing phone survey during a no-tax period (December 6-31, 2016) and a tax period (January 15-February 31, 2017) among 899 respondents in Philadelphia, Pennsylvania, and 878 respondents in three nearby comparison cities. Survey questions included frequency and volume of bottled water and beverages. Outcomes were daily consumption, and 30-day consumption frequency and volume. Propensity score-weighted difference-in-differences regression was used to control for secular time trend and confounding. Covariates were sociodemographics, BMI, health status, smoking, and alcohol use. Analyses were conducted in 2017. RESULTS Within the first 2 months of tax implementation, relative to the comparison cities, in Philadelphia the odds of daily consumption of regular soda was 40% lower (OR=0.6, 95% CI=0.37, 0.97); energy drink was 64% lower (OR=0.36, 95% CI=0.17, 0.76); bottled water was 58% higher (OR=1.58, 95% CI=1.13, 2.20); and the 30-day regular soda consumption frequency was 38% lower (ratio of consumption frequency=0.62, 95% CI=0.40, 0.98). CONCLUSIONS Early results suggest that the tax influenced daily consumption of regular soda, energy drinks, and bottled water. Future studies are needed to evaluate longer-term impact of the tax on sugared beverage consumption and substitutions.
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Affiliation(s)
- Yichen Zhong
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Amy H Auchincloss
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
| | - Brian K Lee
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Genevieve P Kanter
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Le Bodo Y, De Wals P. Soda Taxes: The Importance of Analysing Policy Processes Comment on "The Untapped Power of Soda Taxes: Incentivising Consumers, Generating Revenue, and Altering Corporate Behaviours". Int J Health Policy Manag 2018; 7:470-473. [PMID: 29764113 PMCID: PMC5953532 DOI: 10.15171/ijhpm.2017.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/11/2017] [Indexed: 11/20/2022] Open
Abstract
Sarah A. Roache and Lawrence O. Gostin’s recent editorial comprehensively presents soda taxation rationales from a public health perspective. While we essentially agree that soda taxes are gaining momentum, this commentary expands upon the need for a better understanding of the policy processes underlying their development and implementation. Indeed, the umbrella concept of soda taxation actually covers a diversity of objectives and mechanisms, which may not only condition the feasibility and acceptability of a proposal, but also alter its impact. We briefly highlight some conditions that may have influenced soda tax policy processes and why further theory-driven case studies may be instructive.
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Affiliation(s)
- Yann Le Bodo
- Evaluation Platform on Obesity Prevention (EPOP), Quebec Heart and Lung University Institute Research Center - Laval University (Université Laval), Quebec City, QC, Canada.,Faculty of Nursing, Laval University (Université Laval), Quebec City, QC, Canada
| | - Philippe De Wals
- Evaluation Platform on Obesity Prevention (EPOP), Quebec Heart and Lung University Institute Research Center - Laval University (Université Laval), Quebec City, QC, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University (Université Laval), Quebec City, QC, Canada
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