The palatability of sugar-sweetened beverage taxation: A content analysis of newspaper coverage of the UK sugar debate

Examining the Role and Strategies of Advocacy Coalitions in California's Statewide Sugar-Sweetened Beverage Tax Debate (2001-2018)

PURPOSE

California's failed attempts to enact a statewide sugary beverage tax presents an opportunity to advance understanding of advocacy coalition behavior. We investigate the participation of advocacy coalitions in California's statewide sugar-sweetened beverage (SSB) tax policy debate.

DESIGN

Document analysis of legislative bills and newspaper articles collected in 2019.

SETTING

California.

METHOD

A total of 11 SSB tax-related bills were introduced in California's legislature between 2001-2018 according to the state's legislative website. Data sources include legislative bill documents (n = 94) and newspaper articles (n = 138). Guided by the Advocacy Coalition Framework (ACF), we identify advocacy coalitions involved in California's SSB tax debate and explore strategies and arguments used to advance each coalitions' position.

RESULTS

Two coalitions (public health, food/beverage industry) were involved in California's statewide SSB tax policy debate. The public health coalition had higher member participation and referred to scientific research evidence while the industry coalition used preemption and financial resources as primary advocacy strategies. The public health coalition frequently presented messaging on the health consequences and financial benefits of SSB taxes. The industry coalition responded by focusing on the potential negative economic impact of a tax.

CONCLUSION

Multiple attempts to enact a statewide SSB tax in California have failed. Our findings add insight into the challenges of enacting an SSB tax considering industry interference. Results can inform future efforts to pass evidence-based nutrition policies.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Putting a price on healthy eating: public perceptions of the need for further food pricing policies in the UK

BACKGROUND

Understand factors that influence food choice and explore public perceptions of the need for government policies to improve diets in the UK, particularly food pricing interventions.

METHODS

A qualitative study design was used with semi-structured interviews. The study was carried out in Greater Manchester, England. In all, 15 participants from a diverse range of backgrounds were recruited.

RESULTS

Food price, lack of time, availability, and food knowledge and culture were key factors that led some study participants towards unhealthy food choices. The UK's individual, willpower-focused approach to tackling obesity was deemed ineffective and many participants supported further government intervention. Product reformulation was supported as a less intrusive and less regressive way of improving diets than taxation. There was also support for increasing cooking classes within schools.

CONCLUSIONS

Whilst the government ambition to half childhood obesity by 2030 is welcome, population level interventions that enable healthier food choices are needed to achieve this goal. Rising global food prices may make reformulation a more practical policy option than further pricing interventions. Mandatory reformulation of convenience meal and snack products and strengthening education in schools may represent a publicly acceptable and effective package of interventions within a comprehensive strategy to tackle obesity.

A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective

Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Industry views of the UK Soft Drinks Industry Levy: a thematic analysis of elite interviews with food and drink industry professionals, 2018-2020

OBJECTIVES

The UK Soft Drinks Industry Levy (SDIL), implemented in 2018, has been successful in reducing the sugar content and purchasing of soft drinks, with limited financial impact on industry. Understanding the views of food and drink industry professionals involved in reacting to the SDIL is important for policymaking. However, their perceptions of the challenges of implementation and strategic responses are unknown. The aim of this study, therefore, was to explore how senior food and drink industry professionals viewed the SDIL.

DESIGN

We undertook a qualitative descriptive study using elite interviews. Data were analysed using Braun and Clarke's thematic analysis, taking an inductive exploratory and descriptive approach not informed by prior theory or frameworks.

SETTING AND PARTICIPANTS

Interviews were conducted via telephone with 14 senior professionals working in the food and drink industry.

RESULTS

Five main themes were identified: (1) a level playing field…for some; industry accepted the SDIL as an attempt to create a level playing field but due to the exclusion of milk-based drinks, this was viewed as inadequate, (2) complex to implement, but no lasting negative effects; the SDIL was complex, expensive and time consuming to implement, with industry responses dependent on leadership buy-in, (3) why us?-the SDIL unfairly targets the drinks industry; soft drinks are an unfair target when other categories also contain high sugar, (4) the consumer is king; consumers were a key focus of the industry response to this policy and (5) the future of the SDIL; there appeared to be a wider ripple effect, which primed industry to prepare for future regulation in support of health and environmental sustainability.

CONCLUSIONS

Insights from senior food and drink industry professionals illustrate how sugar-sweetened beverage taxes might be successfully implemented and improve understanding of industry responses to taxes and other food and drink policies.

TRIAL REGISTRATION NUMBER

ISRCTN18042742.

Framing a New Nutrition Policy: Changes on Key Stakeholder's Discourses throughout the Implementation of the Chilean Food Labelling Law

The global implementation of structural policies to tackle obesity has been slow, likely because of the competing interests of governments and the food industry. We used the discussion of the Chilean Food Labeling Law to identify influential stakeholders in the media and their frames during different periods of the law's implementation. This involved a content analysis of the food regulation media coverage in five key periods from 2007, when the food bill was first introduced in Congress, to 2018, when the second phase of the law was implemented (N = 1295). We found that most of the law coverage was through elite press. Half of the sources were from the food industry (26.7%) and government (26.2%), while other stakeholders, were less prevalent. Frames were mostly competing, except for cooperation with the law. The main food industry frame used during the discussion of the law was the "economic threat" (41.9%), whose prevalence decreased at the post-implementation period (13%, p < 0.01). No other relevant stakeholders changed their framing. Our results highlight that there are several aspects of public health communication, such as the type of media used, the involvement of scholars and civil society, and the framing, that could be improved to advance food environment policies.

Contextual Factors That May Impact on the Development and Implementation of the Sugary Drinks Policy Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019"

Forde et al proposed an interesting framework to understand marketing response to a tax in sugary drinks based on stakeholder interviews. Sugary drinks regulation can lead to various strategies in the industry's marketing activity. That is, it can either result in the industry introducing no changes or it can lead to changes, which can conflict or align with public health objectives. The importance of Forde and colleagues' analysis lies in the potential for governments to anticipate the industry's reaction to the legislation and the need of drivers to enable both big and small companies to follow the rules. Governments must not forget the importance of other contextual factors that will have an impact both on the development and implementation of this type of policies and on possible responses that could mitigate their impact such as public acceptance, the influence of mass media and corporate activities aimed at influencing policy.

The Instrumental Role of Strategic Communication to Counter Industry Marketing Responses to Sugary Drink Taxes Comment on "Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019"

Strong sugary drink taxes are effective at reducing sugary drinks consumption. In response, the sugary drinks industry employs various marketing strategies to undermine the taxes to protect and maintain its customer base. In their recent article in this journal, Forde et al present a framework for understanding how sugary drinks companies use marketing for this purpose. In this commentary, we reflect on this framework by drawing from recent experiences of sugary drinks industry marketing responses. Further, we review the global evidence on the instrumental role that strategic communication can play in protecting strong taxes from industry responses. We make a case for strategic communication as a vital tool in promoting and protecting sugary drinks tax proposals, both prior to and after their introduction.

Newspaper media framing of obesity during pregnancy in the UK: A review and framework synthesis

Two thirds of women report experiencing weight stigma during pregnancy. Newspaper media is powerful in framing health issues. This review synthesized UK newspaper media portrayal of maternal obesity. NexisUni was searched to identify newspaper articles, published January 2010 to May 2021, reporting content on obesity during pregnancy. Framework synthesis integrated quantitative and qualitative analysis of the content of articles. There were 442 articles included (59% tabloids and 41% broadsheets). Three overarching themes with interacting sub-themes were as follows: (1) Women were blamed for their weight, risks, and NHS impact. (2) Women were solely responsible for solving obesity, gendered from school age. (3) Women with obesity were a burden on individuals (e.g., themselves, their children, and health professionals), to society, and the NHS. Catastrophizing language framed the "problem," "scale," and "public health concern" of maternal obesity, emphasizing risk, and danger and was alarmist, aggressive, and violent as to elicit fear or devalue women. Articles platformed 'expert' voices rather than women's lived experiences. This review identified that UK newspaper media negatively frames and oversimplifies the topic of maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt, stigma, and internalized weight bias. The newspaper media should be harnessed to de-stigmatize maternal obesity and promote maternal well-being.

Print media coverage of breastfeeding in Great Britain: Positive or negative?

Media can be a powerful communication tool to promote breastfeeding, influence mothers' breastfeeding behaviour, create positive social norms and generate support among stakeholders and policymakers for breastfeeding. However, negative stories could deter women from starting or continuing to breastfeed. This study aimed to describe the breadth and focus of the media coverage of breastfeeding and the message frames that are found in three of the most widely read national newspapers and three popular women's magazines in Great Britain over a 12-month period, as part of the Becoming Breastfeeding Friendly in Great Britain (BBF-GB) study. For this retrospective media analysis, 77 articles were identified and 42 were included in the study for coding and analysis. We conducted two content analyses to examine the articles' (1) message framing and (2) alignment with the eight components of an 'enabling breastfeeding environment' using the BBF Gear framework. Articles featuring breastfeeding appear in British newspapers and women's magazines all year round. Twenty-four per cent had a neutral tone, while 59% predominantly focused on the positive aspects or positive social support for breastfeeding, and 17% were predominantly focused on the negative aspects or negative social attitudes towards breastfeeding. The articles mainly focused on personal stories reflecting societal barriers and positive shifts (68%), with 12% presenting an analysis of breastfeeding evidence or barriers. There were fewer references to the legislation (5%) and availability of funding (2%) and support (9%). There was no coverage of national coordination and strategy, evaluation systems, or the political will to raise breastfeeding rates.

Newspaper framing of food and beverage corporations' sponsorship of sport: a content analysis

BACKGROUND

Unhealthy diets are a leading contributor to obesity, disability and death worldwide. One factor cited as contributing to rises in obesity rates is the pervasive and ubiquitous marketing of unhealthy foods and beverages (F&Bs) across a variety of mediums, such as sport sponsorship at both professional and amateur levels. Despite increased academic attention on the detrimental impacts of sport sponsorship within the obesogenic environment, this has not been matched by legislative action. One explanation may be the way that F&B corporations' sport sponsorship is framed within policy debates. Framing is the deliberate ways in which (often contested) issues are presented in communication. This paper examines how sport sponsorship by F&B corporations is framed through media reports.

METHODS

This study employed a mixed methods content and framing analysis. First, we conducted a quantitative newsprint content analysis (n = 234). This then informed and directed a thematic framing analysis of a sub-set of articles (n = 54) that specifically associated sport sponsorship by F&B corporations with obesity and childhood obesity.

RESULTS

The findings suggest that two competing frames are evident within newspaper coverage: 1) public health and 2) industry. The public health frame rejects the sponsorship of sport by High in Fat Sugar and Salt (HFSS) product corporations in particular, calling for such sponsorship to be restricted or banned. The industry frame characterises sponsorship of sport as a form of corporate social responsibility, positioning industry as good moral actors and part of the solution to childhood and adult obesity. These frames are evident across other Unhealthy Commodity Industries (UCIs) policy debates. However, the prominence of industry actors within the sample is potentially indicative of their discursive power within this space, particularly with their emphasis on the financial maintenance of sport as well as encouraging physical activity, contributing to the lack of regulatory development of sport sponsorship by F&B corporations.

CONCLUSIONS

The findings of this study are particularly useful for public health organisations who seek regulatory change, as it may provide further insight into countering industry framing practices, raising the salience of regulation of sport sponsorship and thus increasing the likelihood of regulatory development that seeks to improve population health.

A Comparative Policy Analysis of the Adoption and Implementation of Sugar-Sweetened Beverage Taxes (2016-2019) in 16 Countries

Taxes on sugar-sweetened beverages (SSBs) are recommended as part of comprehensive policy action to prevent diet-related non-communicable diseases (NCDs), but have been adopted by only one quarter of World Health Organization (WHO) Member States. This paper presents a comparative policy analysis of recent SSB taxes (2016–19) in 16 countries. This study aimed to analyse the characteristics and patterns of factors influencing adoption and implementation of SSB taxes and policy learning between countries, to draw lessons for future SSB taxes. The data collection and analysis were informed by an analytical framework that drew on ‘diffusion of innovation’ and theories of policy learning. Qualitative data were collected from policy documents and media, in addition to national statistics. Qualitative data were thematically analysed and a narrative synthesis approach was used for integrated case study analysis. We found adaptation and heterogeneity in the approaches used for SSB taxation with a majority of countries adopting excise taxes, and consistent health framing in media and policy documents. Common public frames supporting the taxes included reducing obesity/NCDs and raising revenue (government actors) and subsequent health system savings (non-government actors). Opposing frames focused on regressivity and incoherence with other economic policy (government actors) and posited that taxes have limited health benefits and negative economic impacts on the food industry (industry). Evident ‘diffusion networks’ included the WHO, predominantly in middle-income countries, and some regional economic bodies. We found indications of policy learning in the form of reference to other countries’ taxes, particularly countries with membership in the same economic bodies and with shared borders. The study suggests that adoption of SSB taxation could be enhanced through strategic engagement by health actors with the policy-making process, consideration of the economic context, use of consistent health frames by cross-sector coalitions, and robust evaluation and reporting of SSB taxation.

Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods

Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.

Concepts of responsibility in the German media debate on sugar taxation: a qualitative framing analysis

Background

Framing plays an important role in health-policy processes. Responsibility for health is a salient and contested concept in the framing around food policies, such as sugar taxes. To deepen the understanding of the sugar tax process in Germany and contribute to a better understanding of how responsibility frames are used in debates on health policies, this study investigated responsibility concepts underlying the German media debate on sugar taxation.

Methods

We analyzed 114 national German newspaper articles, published between January 2018 and March 2019, following an inductive thematic analysis approach with an additional deductive focus on responsibility. We identified important contested concepts around sugar taxation, analyzed their combination into narrative frames, and scrutinized those narrative frames for underlying responsibility concepts.

Results

First, we identified important contested concepts regarding problems, actors and solutions (i.e. sugar tax and its potential alternatives). Those laid the basis for 13 narrative frames, of which the ‘unscrupulous industry’, ‘government failure’, ‘vulnerable youth’ and the ‘oversimplification’, ‘responsible industry’ and ‘nanny state’ frames were most salient. Within the narrative frames, we found a dominance of societal responsibility framing with a conflict between binding, legislative measures and voluntary solutions in cooperation with the food and beverages industry.

Conclusions

Questions around societal responsibility for health and corporate social responsibility framing become more salient in sugar tax debates. Future research should, therefore, investigate how public health advocates can successfully engage with corporate social responsibility narratives, and how legislative measures can be framed in ways that engender trust in governmental actions.

A Systematic Review of Responsibility Frames and Their Effects in the Health Context

Responsibility frames potentially shape the public perception of health issues such as obesity, diabetes, or mental illness, specifically regarding responsibility attributions for their causes and treatment. Which responsibility frames prevail in the health context, and the responses they may elicit from audiences, has not been studied systematically. This systematic review includes studies with different methodological approaches published between 2004 and 2019 (N = 68). Content analyses (n = 56) show that different media attribute health responsibility most frequently, but not exclusively to individuals. Individual responsibility was especially emphasized for obesity, which was also the most studied health issue. Tendencies toward societal attributions of responsibility emerged over time, particularly regarding health risks for which the frames describe a specific cause (e.g., sugar, trans-fat). Experimental studies (n = 12) indicate that individual responsibility frames reduce policy support. The effects of responsibility frames were, however, not as clear-cut as expected with research gaps regarding behavioral and affective outcomes. Overall, there is a clear emphasis on noncommunicable diseases in this field. Finally, the conceptual focus on individual vs. societal health responsibility distracts from social network influences as another relevant health determinant. The implications for health communication are discussed.

Dementia in Media Coverage: A Comparative Analysis of Two Online Newspapers across Time

The news media, specifically online newspapers, is one of the powerful transmitters of discourse due to its rapid accessibility that contributes to social beliefs and attitudes that often shape our perceptions on dementia and Alzheimer’s disease. The media portrayal of dementia is largely heterogeneous, but there is certainly an association between the influence of online news coverage and the social perceptions of dementia that need to be understood more broadly. In this study, we examined the portrayal of dementia in two online newspapers (The New York Times and The Guardian) that might have an influence on dementia discourse by comparing the content and form of the news coverage on dementia across time. This study was guided by three interconnected theoretical understandings: cultivation theory, agenda-setting theory, and spiral of silence theory. A total of 291 published articles featuring dementia from 2014 to 2019 were included in this study and a content analysis of the articles provided insight into the dementia-related news coverage. Our results showed that both newspapers have a decreasing trend in publishing articles related to dementia over time. In addition, dementia-related (modifiable) risk factors as principal news content was significantly associated with the year of publication. Despite a weak association between story categories and newspapers, the majority of articles reported preventive measures as the main story category. Although both newspapers featured more articles with a less negative tone across time when reporting on dementia, derogative wording, as discourse, was commonly used to address the illness. We have provided some insight into understanding how online newspapers potentially affect subjective representations of dementia as well as perpetuate dementia discourse. Finally, we suggest that future study may benefit from establishing a linkage between the depiction of dementia in online newspapers and the contextualization of dementia within cultures.

Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017-2019)

OBJECTIVES

To determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation.

DESIGN

Repeat cross-sectional online survey.

SETTING

The UK.

PARTICIPANTS

UK respondents to the International Food Policy Study aged 18-64 years who provided information on all variables of interest in November-December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284).

OUTCOME MEASURES

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

RESULTS

The adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar.

CONCLUSIONS

We found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.

Sydney's 'last drinks' laws: A content analysis of news media coverage of views and arguments about a preventive health policy

INTRODUCTION

News media representation of preventive health policies can influence public discussion and political decision making, impacting policy implementation and sustainability. This study analysed news media coverage of the contested 'last drinks' alcohol laws in Sydney, Australia, to understand the arguments made by different 'actors' (stakeholders) regarding the laws and provide insights on how preventive health policies are positioned within media discourse.

METHODS

We identified print and online news media articles discussing the laws from 2014 to 2020. Content analysis was used to quantify the arguments made to justify support or opposition to the laws.

RESULTS

A total of 445 articles were included for analysis. Four hundred and thirty-five actors were identified, with industry actors mentioned most (213 times) followed by health actors (136 times). There were more quotes from opponents of the laws compared to supporters of the laws (57% vs. 25%). The proportion of media mentions reduced for supporters (34% in 2014 to 14% in 2020) while mentions increased for opponents (47% in 2014 to 73% in 2020). Supporters used arguments about crime, safety and health. Opponents of the laws focused on issues such as Sydney's 'night time economy' and negative impacts of the laws.

DISCUSSION AND CONCLUSIONS

Opponents of the laws strategically used the media to influence public debate. Opponents, including industry actors, also ignored the health impacts of alcohol and utilised campaign groups to advocate against the laws. These findings have implications for how governments and advocates communicate and build support for contested preventive health policies.

Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis

BACKGROUND

In Malaysia, the Sugar-Sweetened Beverages (SSBs) tax was announced during the parliament's 2019 Budget Speech. The tax was slated to be enforced by April 2019 but was later postponed to July 2019. The announcement has since generated significant media coverage and public feedback.

OBJECTIVE

This study presents a qualitative and quantitative cross-sectional study using netnography to examine how Malaysian online news articles responded to the SSBs tax after the announcement and postimplementation.

METHODS

Online news articles published on popular online news platforms from November 2018 to August 2019 were downloaded using NCapture and imported into NVivo for analysis using the inductive approach and thematic content analysis following the initial SSBs implementation announcement.

RESULTS

A total of 62 news articles were analyzed. Most of the articles positively portrayed the SSBs tax (46.8%) and highlighted its health impacts (76%). There were 7 key framing arguments identified in the articles. The positive arguments revolved around incentivizing manufacturers to introduce healthier products voluntarily, positive health consequences, the tax's impact on government revenue, and the use of the generated revenue toward beneficial social programs. The opposing arguments included increased operating costs to the manufacturer, the increased retail price of drinks, and how the SSBs tax is not a robust solution to obesity. The top priority sector considered in introducing the tax was the health perspective, followed by economic purposes and creating policies such as regulating the food and drinks industry.

CONCLUSIONS

The majority of online news articles positively reported the implementation of the SSBs tax in Malaysia. This suggests media played a role in garnering support for the health policy. As such, relevant bodies can use negative findings to anticipate and reframe counteracting arguments opposing the SSBs tax.

How does the British Soft Drink Association respond to media research reporting on the health consequences of sugary drinks?

Background

Sugar-sweetened beverages (SSBs) are the leading global source of added sugar intake and their consumption is associated with negative health outcomes, such as diabetes, cancers, cardiovascular diseases, and overall mortality. Despite consensus within the public health community about the need to reduce sugar intake, the non-alcoholic beverage industry engages in efforts to publicly undermine the evidence base surrounding the harmful effects of SSBs. There has been limited investigation of how SSB industry actors engage in public debates to challenge public health research and policy on SSBs. To address this gap, we thematically analyze the public comments and press releases of the British Soft Drinks Association (BSDA) since May 2014.

Results

A total of 175 news articles and 7 press releases were identified where the BSDA commented upon new SSB research in public settings. In these comments, four strategies were observed to undermine new research. First, the BSDA challenged study rigour and research design (n = 150). They challenged the policy implications of research by stating observational studies do not demonstrate causation, refuted data sources, questioned researcher motivations, and claimed research design did not account for confounding factors. Second, the BSDA positioned themselves as an altruistic public health partner (n = 52) intent on improving population-level nutrition citing their voluntary industry commitments. Third, the BSDA promoted concepts of safety that align with industry interests (n = 47). Lastly, the BSDA argued that the lifestyle of individual consumers should be the focus of public health interventions rather than the industry (n = 61).

Conclusion

The findings illustrate the BSDA reliance on arguments of causation to discredit research and avoid policy interventions. Given the attention by the BSDA regarding the purported lack of evidence of causation between SSBs and non-communicable diseases, it is imperative that members of the public health community try to educate policy makers about (a) the complex nature of causation; (b) that evidence in favour of public health interventions cannot, and do not, solely rely on causation studies; and (c) that public health must sometimes abide by the precautionary principle in instituting interventions.

Effectiveness and Policy Determinants of Sugar-Sweetened Beverage Taxes

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

What do the Australian public think of regulatory nutrition policies? A scoping review

Effective government policies are crucial to creating healthy food environments. However, changing public policy is a slow and challenging process involving many competing factors. One cited factor is public opinion towards a proposed policy. This study aimed to systematically explore public opinion on regulatory nutrition policy issues in Australia from 2009 to 2019, to determine whether low levels of public opinion corresponded with the low levels of regulatory policy action in this country. We found that there was varying levels of public support in Australia for public health nutrition action. Regulatory- and legislative-based policies generally had moderate to high levels of support except for food and drink taxes, which had low to moderate support. Despite high levels of public support for certain policy initiatives, national public health nutrition policy in Australia has not evolved consistently with the level of public support nor the evidence base over the past decade indicating other more important factors at play in policymaking.

Anticipatory changes in British household purchases of soft drinks associated with the announcement of the Soft Drinks Industry Levy: A controlled interrupted time series analysis

BACKGROUND

Sugar-sweetened beverage (SSB) consumption is positively associated with obesity, type 2 diabetes, and cardiovascular disease. The World Health Organization recommends that member states implement effective taxes on SSBs to reduce consumption. The United Kingdom Soft Drinks Industry Levy (SDIL) is a two-tiered tax, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g of sugar per 100 ml (higher levy tier) are taxed at £0.24 per litre, drinks with ≥5 to <8 g of sugar per 100 ml (lower levy tier) are taxed at £0.18 per litre, and drinks with <5 g sugar per 100 ml (no levy) are not taxed. Milk-based drinks, pure fruit juices, drinks sold as powder, and drinks with >1.2% alcohol by volume are exempt. We aimed to determine if the announcement of the SDIL was associated with anticipatory changes in purchases of soft drinks prior to implementation of the SDIL in April 2018. We explored differences in the volume of and amount of sugar in household purchases of drinks in each levy tier at 2 years post announcement.

METHODS AND FINDINGS

We used controlled interrupted time series to compare observed changes associated with the announcement of the SDIL to the counterfactual scenario of no announcement. We used data from Kantar Worldpanel, a commercial household purchasing panel with approximately 30,000 British members that includes linked nutritional data on purchases. We conducted separate analyses for drinks liable for the SDIL in the higher, lower, and no-levy tiers controlling with household purchase volumes of toiletries. At 2 years post announcement, there was no difference in volume of or sugar from purchases of higher-levy-tier drinks compared to the counterfactual of no announcement. In contrast, a reversal of the existing upward trend in volume (ml) of and amount of sugar (g) in purchases of lower-levy-tier drinks was seen. These changes led to a -96.1 ml (95% confidence interval [CI] -144.2 to -48.0) reduction in volume and -6.4 g (95% CI -9.8 to -3.1) reduction in sugar purchased in these drinks per household per week. There was a reversal of the existing downward trend in the amount of sugar in household purchases of the no-levy drinks but no change in volume purchased. At 2 years post announcement, these changes led to a 6.1 g (95% CI 3.9-8.2) increase in sugar purchased in these drinks per household per week. There was no evidence that volume of or amount of sugar in purchases of all drinks combined was different from the counterfactual. This is an observational study, and changes other than the SDIL may have been responsible for the results reported. Purchases consumed outside of the home were not accounted for.

CONCLUSIONS

The announcement of the UK SDIL was associated with reductions in volume and sugar purchased in lower-levy-tier drinks before implementation. These were offset by increases in sugar purchased from no-levy drinks. These findings may reflect reformulation of drinks from the lower levy to no-levy tier with removal of some but not all sugar, alongside changes in consumer attitudes and beliefs.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN18042742.

Effects of grape juice, red wine and resveratrol on liver parameters of rat submitted high-fat diet

This work evaluated the effect of grape juice, red wine and resveratrol in liver parameters of rats submitted to high-fat diet. Experimental model was conducted with groups of adult females Rattus norvegicus: control (CG); high-fat (HG); grape juice (JG); red wine (RW) and resveratrol solution (RG). The high-fat diet significantly altered hepatocytes and Kupffer cells in all treated groups. HG group presented severe steatosis followed hepatocyte ballooning and tissue damages. JG group minimized hepatic histological lesion caused by high-fat diet and WG group also induced steatosis and inflammation in hepatocytes, similar to HG. Still, resveratrol protected the tissue against fatty liver disease by reducing fat infiltration and inflammation, indicating possible therapeutic effects on the liver. Cell cycle analysis showed that HG promoted damage to the tissue, reducing the viable cell content and increasing apoptosis, even when associated with wine consumption or isolated resveratrol. However, JG protected the liver against cell damage generated by the diet. Consumption of grape juice, even associated with a high-fat diet, represents a promising protection of the liver against cellular damage, but red wine further affects the tissue, and resveratrol alone was able to reduce damage but did not minimize cellular damage to the liver.

The Sweetened Beverage Tax in Cook County, Illinois: Lessons From a Failed Effort

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.

An exploration of the portrayal of the UK soft drinks industry levy in UK national newspapers

OBJECTIVE

News media play a role in politics through the portrayal of policies, influencing public and policymaker perceptions of appropriate solutions. This study explored the portrayal of sugar and sugar-sweetened beverage (SSB) taxes in UK national newspapers. Findings aid understanding of the role newspapers play in shaping understanding and acceptance of policies such as the UK Soft Drink Industry Levy (SDIL).

DESIGN

Articles discussing sugar or SSB taxes published in six UK national newspapers between 1 April 2016 and 1 May 2019 were retrieved from the LexisNexis database. Articles were thematically analysed to reveal policy portrayal.

SETTING/PARTICIPANTS

Analysis of UK newspaper articles.

RESULTS

Two hundred and eighty-six articles were assessed. Sugar and SSB taxes were discussed across the sample period but publication peaked at SDIL announcement and introduction. Themes were split according to support for or opposition to taxation. Supportive messaging consistently highlighted the negative impacts of sugar on health and the need for complex actions to reduce sugar consumption. Opposing messages emphasised individual responsibility for health and the unfairness of taxation both for organisations and the public.

CONCLUSIONS

Sugar and SSB taxes received considerable media attention between 2016 and 2019. All newspapers covered arguments in support of and opposition to taxation. Health impacts of excess sugar and the role of the soft drink industry in reducing sugar consumption were prevalent themes, suggesting a joined-up health advocacy approach. Industry arguments were more varied, suggesting a less collaborative argument. Further research should investigate how other media channels portray taxes such as the SDIL.

The impact of UK soft drinks industry levy on manufacturers' domestic turnover

In March 2016, the UK government announced the Soft Drinks Industry Levy (SDIL) which came into effect in April 2018. In common with the reaction to sugar-sweetened beverage (SSB) taxes in other countries, the SDIL announcement was met with strong industry opposition, with claims that it would harm their profits. The SDIL was designed to incentivise reformulation of SSBs by providing a 2-year delay between the announcement and the enforcement of the levy, and adopting a two-tiered rate based on the sugar content of the drinks. Using interrupted time series analysis, this paper examines how the domestic turnover of UK soft drinks manufacturers changed after the announcement and the implementation of the SDIL. Our results show some evidence of a short-term negative impact of the SDIL announcement on the domestic turnover of the UK soft drinks manufacturers. This effect, however, did not continue post-implementation. These findings suggest that manufacturers were, to a large extent, able to mitigate the effects of levy before it came into effect.

Content analysis of media coverage of breastfeeding in Mexico

Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospective content analysis of documents published between January 1, 2017 and January 1, 2018 to analyse the media coverage related to breastfeeding in Mexico. Content analysis was based on the breastfeeding gear model and a strategic planning technique to identify strengths, weaknesses, opportunities, and threats for enabling the national breastfeeding environment. Media coverage of breastfeeding was more frequent in August (36% of all documents). The top three topics commonly covered by the media were advocacy events promoting breastfeeding, promotion campaigns, and changes in breastfeeding legislation and policy. In general, the media coverage focused on strengths of specific breastfeeding policies. There was limited news coverage of key factors that negatively influenced or threatened the breastfeeding environment. Findings support the need to design strategies to engage the media covering in more depth and breadth diverse aspects of breastfeeding protection, promotion, and support efforts in Mexico.

Media framing of childhood obesity: a content analysis of UK newspapers from 1996 to 2014

BACKGROUND

Media can influence public and policy-makers' perceptions of causes of, and solutions to, public health issues through selective presentation and framing. Childhood obesity is a health issue with both individual-level and societal-level drivers and solutions, but public opinion and mass media representations of obesity have typically focused on individual-level framings, at the cost of acknowledgement of a need for regulatory action.

OBJECTIVE AND SETTING

To understand the salience and framing of childhood obesity across 19 years of UK national newspaper content.

DESIGN AND OUTCOME MEASURES

Quantitative content analysis of 757 articles about childhood obesity obtained from six daily and five Sunday newspapers. Articles were coded manually for definitions, drivers and potential solutions. Data were analysed statistically, including analysis of time trends and variations by political alignment of source.

RESULTS

The frequency of articles grew from a low of two in 1996 to a peak of 82 in 2008, before declining to 40 in 2010. Individual-level drivers (59.8%) and solutions (36.5%) were mentioned more frequently than societal-level drivers (28.3%) and solutions (28.3%) across the sample, but societal solutions were mentioned more frequently during the final 8 years, coinciding with a marked decline in yearly frequency of articles.

CONCLUSIONS

Increased focus on societal solutions aligns with public health goals, but coincided with a reduction in the issue's salience in the media. Those advocating public policy solutions to childhood obesity may benefit from seeking to raise the issue's media profile while continuing to promote structural conceptualisations of childhood obesity.