The impact of the French soda tax on prices and purchases. An ex post evaluation

Effectiveness of implemented global dietary interventions: a scoping review of fiscal policies

BACKGROUND

Although the World Health Organisation (WHO) has proposed the use of fiscal policies to mitigate consumption externalities such as overweight and obesity-related diseases, very little is known about the impacts of the different types and framing of national and/or regional fiscal policies that have been implemented over the years. There is the need to provide up-to-date evidence on the impact of fiscal policies that have been enacted and implemented across the globe.

METHODS

We conducted a scoping review of all implemented government fiscal policies in the food and drinks sector to identify the different types of fiscal policies that exist and the scope of their impact on consumers as well as the food environment. Electronic databases such as the Web of Science and Google Scholar were used to search for appropriate literature on the topic. A total of 4,191 articles were retrieved and 127 were synthesized and charted for emerging themes.

RESULTS

The results from this review were synthesized in MS Excel following Arksey & O'Malley (2005). Emerging themes were identified across different countries/settings for synthesis. The results confirms that fiscal policies improve consumers' health; increase the prices of foods that are high in fats, sugar, and salt; increase government revenue; and shift consumption and purchases towards healthier and untaxed foods.

CONCLUSION

Governments already have the optimum tool required to effect changes in consumer behaviour and the food environment.

Exploring the sugar-sweetened beverage tax (SSBT) pass-through rate in the Irish hospitality sector

BACKGROUND

The World Health Organization (WHO) supports the use of Sugar-Sweetened Beverage Taxes (SSBTs) as a fiscal lever to help reduce sugar consumption and tackle obesity. Obesity is associated with a range of adverse health outcomes. In response to increasing levels of obesity in Ireland, an SSBT was introduced in 2018. Previous research in Ireland has noted that the pass-through rate of the SSBT in retail (off-site consumption) settings was poor. However, to date, no research has examined the SSBT pass-through rate in hospitality (on-site consumption) venues in Ireland.

METHODS

This research examines the SSBT pass-through rate on Coca-Cola versus diet versions of Coca-Cola in a convenience sample of 100 hospitality venues in two provincial Irish cities.

RESULTS

Wilcoxon signed rank test analysis revealed that regular Coca-Cola was significantly more expensive compared to the price charged for diet versions of Coca-Cola. However, in 85.6% of cases the same price was charged for both full-sugar and sugar-free drinks. The mean pass-through rate of the SSBT was 33.8%.

CONCLUSION

The effective functioning of the SSBT is premised on persistent price differences between soft drink prices based on sugar content. However, this is barely evident in the hospitality sector in Ireland. A number of recommendations are suggested, including both increasing the SSBT, and increasing it annually in line with inflation.

A food-exchange model for achieving the recommended dietary intakes for saturated fat in Irish children: analysis from the cross-sectional National Children's Food Survey II

OBJECTIVE

To identify the main foods determining SFA intakes and model the impact of food exchanges to improve compliance with dietary fat recommendations in Irish children.

DESIGN

Estimated food and nutrient intakes were obtained from a cross-sectional study, the National Children's Food Survey II. Participants were categorised into low, medium and high SFA consumers, and the contribution of food categories to SFA intakes was compared. A food-exchange model was developed, whereby a selected range of high SFA foods was exchanged with lower SFA or unsaturated fat alternatives.

SETTING

Participants were randomly selected from primary schools throughout the Republic of Ireland.

PARTICIPANTS

A representative sample of 600 Irish children (5-12 years).

RESULTS

The main determinants of low and high SFA consumers were milk, cheese and butter. These foods, including snack foods and meat and meat products, were considered exchangeable foods within the model. Compared with baseline data, modelled intakes for total fat, SFA, MUFA and trans-fat presented decreases of 3·2, 2·7, 1·6 and < 0·1 % of total energy (% TE), respectively. PUFA, n-6, n-3 and alpha-linolenic acid showed increases of 1·0, 0·8, 0·2 and 0·1 % TE, respectively. Compliance with total fat, MUFA and trans-fat recommendations remained adequate (100 %). Adherence to SFA and PUFA recommendations improved from 18 to 63 % and 80 to 100 %, respectively.

CONCLUSION

The food-exchange model decreased SFA intakes and increased PUFA intakes, suggesting modest dietary changes to children's diets can effectively improve their overall dietary fat profile.

The impact of taxing sugar-sweetened beverages on diabetes: a critical review

The global burden of type 2 diabetes is increasing at an alarming rate, fuelled by the obesity epidemic, with significant associated health and economic consequences and apparent inequalities. Sugar-sweetened beverages (SSBs) are a major source of added sugars in diets worldwide and have been linked to an increased risk of type 2 diabetes through a variety of mechanisms, including excess weight. Taxing SSBs has become a promising public health strategy to reduce consumption and mitigate the burden of type 2 diabetes. A substantial body of evidence suggests that SSB taxes lead to increased prices and subsequent reduced consumption, with a potentially greater effect among lower socioeconomic groups. This highlights the potential for tax policies to have an impact on type 2 diabetes and address health inequalities. Evidence from several ongoing SSB tax schemes, including sales and excise taxes, indicates positive effects on improving consumption patterns, and modelling studies point to health gains by averting type 2 diabetes and other cardiometabolic diseases. In contrast, evidence from empirical evaluation of the impact of SSB tax is scarce. Continued monitoring and the strengthening of evaluation research to develop context-tailored policies are required. In addition, there is a need to implement complementary efforts to amplify the impact of SSB taxation and effectively address the global burden of type 2 diabetes.

Processing of titanium-containing ores for the production of titanium products: A comprehensive review

This article discusses the main technologies for processing titanium-containing raw materials, the advantages, and disadvantages of various technological solutions. The analysis of the literature revealed that the traditional methods for the production of titanium products are mainly focused on the use of ilmenite concentrates. In connection with the depletion of ilmenite deposits, in the near future, there will inevitably be a need for a switch to the use of complex ores - titanomagnetite. Obtaining titanium dioxide (TiO2) from titanomagnetite raw materials with a high content of impurity components requires an individual approach for each specific deposit. The possibility of further improving the development of a technological process for low-temperature (1000-1200 °C) processing of titanomagnetite concentrates via the production of pure TiO2 is proposed.

The effects of taxation on the individual consumption of sugar-sweetened beverages

To assess the impact of taxation on the consumption of sugar-sweetened beverages (SSBs) most economic studies using household data consider the average consumer. Individual consumption is, however, very heterogeneous. In this paper, we propose a three-step methodology to evaluate the impact of SSB taxation on individual consumption. First, we use a disaggregation method to recover individual consumption from observed household consumption. Second, we estimate the demand for different categories of households. Finally, we simulate the impact of a tax policy on individual consumption. We find a high level of heterogeneity in consumption. Adults, both men and women, consume a greater quantity of SSBs than children. More importantly, for any given age category, the average consumption of SSBs increases with body mass index (BMI). Among heavy consumers of SSBs, obese and overweight people are over-represented. In France, a €0.20/l tax on SSBs might decrease sugar intake by more than 2 kg per year on average and by more than 5 kg, roughly 3 teaspoons/day, for 5% of the adult population. Moreover, overweight and obese men and women, who correspond to 41% of the adult population, represent 56% of the last five percentiles of the distribution of the variation in sugar intake. This is a key result because the objective of taxation is to decrease the consumption of individuals who are more at risk, that is those who are overweight and obese. We also show that classical method of the assessment of tax policies based on per-capita consumption underestimate the effect of the tax for obese adults by 9%. Finally, we estimate that a €0.20/l tax on SSBs might avoid about 640 deaths (about 1.6% of the considered diseases) as a consequence of the decrease in SSB consumption.

The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods

CONTEXT

The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking.

OBJECTIVE

To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences.

DESIGN

Cross-sectional survey.

SETTING

The Navajo Nation.

PARTICIPANTS

A total of 234 Navajo Nation community members across 21 communities.

OUTCOME MEASURES

The percentage of participants who were supportive of the HDNA.

RESULTS

Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001).

CONCLUSIONS

The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.

Developing Effective Strategies for Obesity Prevention

Nutrition policies can work with clinical treatments to address the obesity epidemic. The United States has passed beverage taxes at the local level and calorie labeling mandates at the federal level to encourage healthier consumption. Nutritional changes to federal nutrition programs have been either implemented or suggested; evidence shows that the changes that have been implemented have resulted in improvements in diet quality and are cost-effective in decreasing the increase in obesity prevalence. A comprehensive policy agenda that addresses risk of obesity on multiple levels of the food supply will have meaningful long-term effects on obesity prevalence.

Current perspectives on global sugar consumption: definitions, recommendations, population intakes, challenges and future direction

Currently, there is considerable emphasis on the relationship between dietary sugar consumption and various health outcomes, with some countries and regions implementing national sugar reduction campaigns. This has resulted in significant efforts to quantify dietary sugar intakes, to agree on terms to describe dietary sugars and to establish associated recommendations. However, this information is infrequently collated on a global basis and in a regularised manner. The present review provides context regarding sugar definitions and recommendations. It provides a global review of the available data regarding dietary sugar intake, considering forms such as total, free and added sugars. A comprehensive breakdown of intakes is provided by age group, country and sugar form. This analysis shows that free sugar intakes as a percentage of total energy (%E) are the highest for children and adolescents (12-14%E) and the lowest for older adults (8%E). This trend across lifecycle stages has also been observed for added sugars. The available data also suggest that, while some reductions in sugar intake are observed in a few individual studies, overall intakes of free/added sugars remain above recommendations. However, any wider conclusions are hampered by a lack of detailed high-quality data on sugar intake, especially in developing countries. Furthermore, there is a need for harmonisation of terms describing sugars (ideally driven by public health objectives) and for collaborative efforts to ensure that the most up-to-date food composition data are used to underpin recommendations and any estimates of intake or modelling scenarios.

Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective

BACKGROUND

As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose-response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available.

METHODS

The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence.

RESULTS

From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period.

CONCLUSION

Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.

Applicability of the Socioecological Model for Understanding and Reducing Consumption of Ultra-Processed Foods in Canada

Ultra-processed foods (UPFs) have become a major contributor to the diets of Canadians, with a recent report from Statistics Canada suggesting Canadians are consuming almost one-half of their calories from UPFs. Research has linked UPF consumption with increased risk for chronic diseases such as cardiovascular disease and type 2 diabetes, among others. This paper sought to investigate the popularity of UPFs, particularly among children and teens, utilizing the socioecological model as a framework to illustrate how influences at multiple levels (i.e., public policy, organizational, community, interpersonal, and individual) have played a role in the proliferation of UPFs. Evidence from previous studies is used to identify how factors at different levels may influence UPF consumption and discuss potential strategies for reducing UPF consumption. To meaningfully reduce UPF consumption among Canadians, all levels should be considered, with the goal of creating a healthier Canadian population.

Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis

OBJECTIVE

To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001-2002 and 2017-2018 and in neighbouring comparison countries (without a tax).

DESIGN

Repeated cross-sectional surveys.

SETTING

Health Behaviour in School-aged Children study, spanning five survey years (school years 2001-2002 to 2017-2018).

PARTICIPANTS

Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls).

RESULTS

Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (Pinteraction < 0·001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France or Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction = 0·15).

CONCLUSIONS

Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.

Tax on sugary drinks and trends in daily soda consumption by family affluence: an international repeated cross-sectional survey among European adolescents

BACKGROUND

The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear.

OBJECTIVES

We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence.

METHODS

Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently.

RESULTS

Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (P_interactions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (OR_lower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (P_interactions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (P_interactions ≤ 0.08, increased inequalities).

CONCLUSIONS

Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.

The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study

BACKGROUND AND AIM

Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system.

MATERIALS AND METHODS

This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted.

FINDINGS

In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health.

CONCLUSION

Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.

Systematic review on fiscal policy interventions in nutrition

Introduction

Both the World Health Organization and the Lancet Series on Adolescent nutrition recommend that governments adopt fiscal policies to combat diet-related non-communicable diseases (NCDs). However, rigorous, systematic evidence regarding the effects of these interventions is lacking.

Methods

We synthesize the available evidence regarding the impacts of taxes and subsidies that directly affect consumer prices on availability and accessibility of foods and beverages, purchasing behavior, diet quality, health and well-being outcomes as well as considerations for implementation, sustainability and equity.

Results

Our initial search returned 2,113 de-duplicated studies, and ultimately 24 impact evaluations and two systematic reviews met final eligibility criteria and represented unique evaluations. Our meta-analysis of these studies suggests that taxes may decrease purchases of taxed beverages (SMD = -0.14 [95% CI: -0.29 to -0.07], n = 15). Results should be interpreted cautiously due to considerable heterogeneity (Q(14) = 335.19, p = 0.01,τ ^ 2 = 0.03 , I 2 = 95.82%).

Discussion

The evidence base is too limited to draw conclusions about the effects of taxes on beverages and calorie-dense foods on purchases, or on the effects of subsidies on purchasing or diet quality. Overall, the evidence base is inconclusive on whether fiscal policies can meaningfully influence the availability and accessibility of foods and beverages, diet quality, and health outcomes. Policymakers implementing fiscal policies should consider information campaigns on health benefits and health risks associated with certain food and beverage consumption. For taxes, exposure to health information may amplify signaling effects of taxes and reduce avoidance behaviors, such as cross-border shopping. Future evaluations should diversify data sources to better understand impacts on diet and health outcomes.

How the European Union legislations are tackling the burden of diabetes mellitus: A legal surveillance study

Introduction

Surveillance of the European Union's (EU) legislations on the prevention of diabetes mellitus (DM) is needed, to more effectively tackle the rising prevalence of DM.

Methods

This legal surveillance was carried out through a systematic search and screening, using EUR-Lex database to identify treaties, acts, and other legal documents for prevention of DM, non-communicable diseases (NCDs) and obesity, followed by their content analysis and assessment according to DM specific guidelines, target population and functional categories.

Results and discussion

We found 22 legislations aimed at preventing DM, NCDs and obesity, but only 5 out of them specifically addressed preventing DM. The aims of legislations covered a broad spectrum of themes indicated by DM specific guidelines, mostly initiatives of life-course approach in preventing DM, NCDs and obesity from the area of energy intake. The target group of most legislations was the general population; high-risk subgroups such as pregnant women were hardly ever the primary target group. Our results prove that the EU has made cross-sectoral legislative efforts to reduce the disease burden and prevent DM but does not exhaust all possibilities. However, given its persistently rising DM prevalence, it is imperative to make sure that DM is a top health priority for various EU authorities and is incorporated into new initiatives, policies and laws.

The Impact of the Sweetened Beverages Tax on Their Reformulation in Poland-The Analysis of the Composition of Commercially Available Beverages before and after the Introduction of the Tax (2020 vs. 2021)

The aim of this study was to estimate changes in the composition of carbonated and non-carbonated sugar-sweetened beverages before and after the introduction of the beverage tax in Poland. Based on the labels of 198 drinks, the composition and nutritional values of the drinks were compared. The nonparametric Mann-Whitney test was applied to compare the differences in the sugar and juice content as well as energy value. After the introduction of the tax, the median sugar content in the carbonated beverages decreased from 8.6 g to 6.9 g/100 mL (p = 0.004), while in the non-carbonated beverages, it decreased from 5.5 g to 4.8 g/100 mL (p < 0.001). In the entire beverage group, there was a significant drop in the proportion of beverages that contained >5 g of sugars/100 mL (44.4% in 2021 vs. 70.2% in 2020). The median juice content in the carbonated beverages increased from 1.0% to 3.3% (p = 0.121), but totalled 20.0% for both periods in the non-carbonated beverages. The percentage of beverages with a tax-exempt composition (juice content ≥ 20% and sugar content ≤ 5 g/100 mL) almost tripled. After the introduction of the tax, beneficial changes in the compositions of 62% of the analysed beverages were observed in terms of their sugar and/or juice content.

Outcomes Following Taxation of Sugar-Sweetened Beverages: A Systematic Review and Meta-analysis

Importance

More than 45 countries and several local jurisdictions have implemented sugar-sweetened beverage (SSB) taxes to improve nutrition and population health, and evidence on their outcomes to date is essential to inform policy discussions. Responding to this need, the World Health Organization commissioned a systematic literature review on the outcomes of fiscal policies, including SSB taxes.

Objective

To assess the associations of implemented SSB taxes with prices, sales, consumption, diet, body weight, product changes, unintended consequences, health, and pregnancy outcomes.

Data Sources

Searches of 8 bibliographic databases (Business Source Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EconLit, PsycINFO, PubMed, and Scopus) were performed from database inception through June 1, 2020, with no language or setting restrictions. Grey literature was assessed using 14 sources and government websites.

Study Selection

The review included primary studies of implemented SSB taxes.

Data Extraction and Synthesis

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. For prices, sales and consumption, results were meta-analyzed using a 3-level random-effects model. Study quality was assessed at the outcome level.

Main Outcomes and Measures

Tax pass-through rate for prices, percentage reduction in SSB demand, and price elasticity of demand for sales and consumption. Heterogeneity was assessed using τ2 and the I2 statistic.

Results

A total of 86 articles were eligible, with 62 studies contributing to the meta-analysis. The overall tax pass-through rate was 82% (95% CI, 66% to 98%; P < .001, I2 = 99%), suggesting tax undershifting. The demand for SSBs was highly sensitive to tax-induced price increases, with the price elasticity of demand of -1.59 (95% CI, -2.11 to -1.08; P < .001; I2 = 100%) and a mean reduction in SSB sales of 15% (95% CI, -20% to -9%; P < .001; I2 = 100%). There was no evidence of substitution to untaxed beverages, and changes in SSB consumption were not significant. The narrative synthesis found reformulation and reduced sugar content of taxed beverages for tiered taxes, cross-border shopping in most studies of local-level taxes, and no negative changes in employment. Data on the heterogeneity of SSB tax outcomes across subpopulations were limited.

Conclusions and Relevance

In this systematic review and meta-analysis of implemented SSB taxes worldwide, SSB taxes were associated with higher prices and lower sales of taxed beverages.

The predictive value of evaluative bias, attentional bias, approach bias, and self-regulatory control in soft drink consumption

Global consumption of soft drinks has increased rapidly over the past 50 years, making this a major public health problem. Guided by dual-process models, the present study aimed to provide a comprehensive investigation of the roles of cognitive biases (evaluative, attentional, and approach biases) and self-regulatory control in soft drink consumption and choice. Participants were 128 undergraduate students (17-25 years). They completed computer-based measures of the three biases (Implicit Association Task, Dot Probe Task, and Approach Avoidance Task) and self-regulatory control (Go/no-go Task). Soft drink consumption and choice were measured using a taste test and a take home beverage choice task, respectively. Evaluative bias for soft drink cues was positively associated with the amount of soft drink consumed. Self-regulatory control was negatively correlated with amount of soft drink consumed, but only for men. There was no interaction between cognitive biases and self-regulatory control in predicting soft drink consumption or choice. Nonetheless, the results support the application of dual-process models to soft drink consumption in that automatic (evaluative bias) and controlled processes (self-regulatory control) each predicted amount of soft drink consumed, albeit independently and only for certain individuals. Future research should extend these findings to habitual soft drink consumers and to individuals who actively wish to limit their soft drink intake.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies

OBJECTIVES

To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults.

DATA

Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I²statistic, subgroup and sensitivity analyses assessed study heterogeneity.

SOURCES

PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021.

RESULTS

Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies.

CONCLUSIONS

SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate.

CLINICAL SIGNIFICANC

SES should be included as part of the routine screening and risk assessment for tooth wear.

The causal impact of sugar taxes on soft drink sales: evidence from France and Hungary

Sugar-sweetened beverages (SSBs) are associated with increased body weight and obesity, which induce a wide array of health impairments such as diabetes or cardiovascular disorders. Excise taxes have been introduced to counteract SSB consumption. We investigated the effect of sugar taxes on SSB sales in Hungary and France using a synthetic control approach. For France, we found a slight decrease in SSB sales after tax implementation while overall soft drink sales increased. For Hungary, there was only a short-term decrease in SSB sales which disappeared after 2 years, leading to an overall increase in SSB sales. However, both effects are characterized by great uncertainty.

Taxation of Sugar-Sweetened Beverages and its Impact on Dental Caries: A Narrative Review

Dental caries is one of the largest health concerns worldwide, and a key causative factor is excess sugar intake. Sugar-sweetened beverages (SSBs) are one of the largest sources of added sugars, which significantly contribute to adverse oral and general health. To reduce SSB consumption and its consequent impact on health, including dental caries, several interventional measures have been implemented; sugar taxation is one such measure. This review aimed at understanding the current knowledge available regarding the effect of sugar taxation on dental caries. Accordingly, PubMed, the Cochrane Library, Web of Science, and Scopus were searched with relevant keywords and findings from the identified studies are discussed in this review article.

Brown sugar, how come you taste so good? The impact of a soda tax on prices and consumption

Increasing obesity-related problems and rising healthcare expenditures have led governments in developed countries to consider the introduction of soda taxes. We study a recent such tax, implemented in Portugal in February 2017 -one of the first soda taxes worldwide that increases with sugar content (0.08 euros per liter for drinks with less than 80 g of sugar per liter, and 0.16 euros per liter for drinks with 80 g or more sugar per liter, plus VAT). We use extremely detailed panel data from one of the two largest retailers in the country, covering the period between February 2015 and January 2018. We take advantage of the tax breakdown by sugar levels to examine how soda prices and quantities purchased reacted. For identification, we rely on difference-in-differences models with various vectors of fixed effects, comparing each group of products to water. For drinks with more than 80 g of sugar per liter, results indicate almost full price pass-through to the consumer. For drinks with less than 80 g of sugar per liter, price pass-through surpassed 100%. Regarding consumption, our findings suggest stockpiling behavior in the quarter when the tax was approved and before it was actually implemented. In the implementation period, there are no significant changes in quantities purchased for most beverages vis-à-vis water, with the exception of soda drinks with comparatively low levels of sugar. This suggests that benefits of the soda tax in terms of reducing sugar intake are mainly due to reformulation, as producers reduced the sugar content of some drinks to fall below the 80 g per liter threshold.

The effects of an abrupt increase in taxes on candy and soda in Norway: an observational study of retail sales

BACKGROUND

Fiscal policies are used to promote a healthier diet; however, there is still a call for real-world evaluations of taxes on unhealthy foods and beverages. We aimed to evaluate the effect of an abrupt increase, of respectively 80 and 40%, in the excising Norwegian taxes on candy and beverages on volume sales of candy and soda. We expected sales to fall.

METHODS

We analyzed electronic point of sale data covering approximately 98% of volume sales of grocery stores in Norway. In two pre-registered models with weekly (log-)sales of taxed candy and soda from 3884 individual stores, we modeled the difference between the jump (discontinuity) in the trend around the time of the increase in taxes and the corresponding jump in the trend in a control season from the previous years (Model 1). In addition, we modeled the difference between the intervention and the control season in their changes in average sales (Model 2).

RESULTS

Model 1 showed a 6.1% (one-sided 95% CI: not applicable (NA), 23.4, p-value = 0.26) increase and a - 3.9% (95% CI: NA, 4.9, p-value = 0.23) reduction in the differences in the jump in the trends, for candy and soda, respectively. The second model showed a relative decrease of - 4.9% (95% CI: NA, 1.0, p-value = 0.08) in the average sales of candy and an increase of 1.5% (95% CI: NA, 5.0, p-value = 0.24) in sales of soda. Supplementary analyses suggested that the results were sensitive to clustering on the time dimension.

CONCLUSIONS

When using two different quasi-experimental designs to model changes in volume sales of taxed candy and soda, we were not able to detect reductions in sales that coincided with an increase in the taxes. Variation across time makes it difficult to detect potentially small changes in sales even when using an entire country's worth of sales data on the level of individual stores. We speculate that the tax increases were too modest to affect the prices to alter sales sufficiently.

Do prices and purchases respond similarly to soft drink tax increases and cuts?

While in January 2012, Denmark increased the long-standing tax on sugary soft drinks, the tax was cut by half in July 2013 and then completely repealed in January 2014. In this study, we examine whether increases and cuts of the soft drink tax lead to similar over- or under-shifting to prices and to similar demand responses. We use longitudinal scanner data of 1,282 Danish households to estimate within-product changes in prices and within-household changes in purchase quantity. The tax hike was overshifted by a factor of 1.6-1.8, while the tax repeal was fully passed through with a factor of 0.9-1.2. On average, consumption was 13.4 percent lower the year after the tax increase compared to the year before. The repeal of the tax was associated with an increase in purchase quantity of 31.0 percent. This is equivalent to price elasticities of -1.3 for both tax hikes and cuts. The results suggest that consumers react similarly to tax cuts compared to tax increases. Furthermore, the increase in purchases following a tax cut has no limiting effect on purchases of other beverages suggesting an increase in the intake of calories. This might have implications for health in countries that consider repealing current taxes on soft drinks.

Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study

BACKGROUND

Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal.

METHODS AND FINDINGS

We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources.

CONCLUSIONS

The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.