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Dogbe W, Akaichi F, Rungapamestry V, Revoredo-Giha C. Effectiveness of implemented global dietary interventions: a scoping review of fiscal policies. BMC Public Health 2024; 24:2552. [PMID: 39300446 DOI: 10.1186/s12889-024-19988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
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.
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Affiliation(s)
- Wisdom Dogbe
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Faical Akaichi
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | | | - Cesar Revoredo-Giha
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
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Houghton F, Moran Stritch J, Auerbach J, Daly M, Houghton D. Exploring the sugar-sweetened beverage tax (SSBT) pass-through rate in the Irish hospitality sector. BMC Public Health 2024; 24:2360. [PMID: 39215358 PMCID: PMC11363438 DOI: 10.1186/s12889-024-19891-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
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.
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Affiliation(s)
- Frank Houghton
- Technological University of the Shannon, Limerick, Ireland.
| | | | - J Auerbach
- University College Dublin, Dublin, Ireland
| | - M Daly
- University of Limerick, Limerick, Ireland
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Ding N, Desai J. Measuring the harm of sugar sweetened beverages and internalities associated with it. Front Public Health 2024; 12:1152710. [PMID: 39257955 PMCID: PMC11383772 DOI: 10.3389/fpubh.2024.1152710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
Introduction Obesity, which is partly driven by the consumption of sugar-sweetened beverages (SSBs), significantly increases the risk of type-2 diabetes and cardiovascular diseases, leading to substantial health and economic burdens. Methods This study aims to quantify the monetary value of health harms caused by SSB consumption, along with the associated internalities, through a contingent valuation survey. The results are crucial for determining the socially optimal tax rate. Results We surveyed 293 residents of Wellington, New Zealand, to assess their willingness to pay (WTP) for reductions in the risks of diabetes, stroke, and heart disease associated with SSB intake. Logistic regression analysis revealed the marginal WTP for a 1% risk reduction in diabetes, stroke, and heart disease to be NZ$404.86, NZ$809.04, and NZ$1,236.84, respectively. Based on these values, we estimate the marginal harm from SSB consumption to be approximately NZ$17.37 per liter in New Zealand, with internalities amounting to NZ$6.43 per liter, suggesting an optimal tax rate of NZ$6.49 per liter. Discussion Implementing such a tax is feasible and would likely double or triple the price of SSBs in New Zealand.
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Affiliation(s)
- Ningxin Ding
- School of Government, Victoria University of Wellington, Wellington, New Zealand
| | - Jaikishan Desai
- School of Government, Victoria University of Wellington, Wellington, New Zealand
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Rinaldi AEM, Nucci LB, Enes CC. Modeling the potential impact of a sugar-sweetened beverage tax on ischemic heart disease and stroke in Brazil. J Public Health (Oxf) 2024; 46:357-365. [PMID: 38798018 DOI: 10.1093/pubmed/fdae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND A high intake of sugar-sweetened beverages (SSBs) is associated with the risk of several chronic diseases, including ischemic heart disease (IHD) and stroke. This study aimed to model the impact of a 20% tax on all SSBs for IHD and stroke among Brazilian adults. METHODS This was an ex-ante risk comparative study. The model applied a 20% tax on SSBs and projected the incidence, prevalence and mortality of IHD and stroke over a 20-year period (2019-39). Using data on consumption, previously published cross- and own-price elasticities of SSBs, and relative risk, we estimated changes in IHD and stroke burden. RESULTS Our model predicts that a 20% SSB tax may reduce new cases of IHD by ~13%, especially among women, and avert ~8% of the deaths attributable to IHD over 20 years. These results represent a decrease of 19 543 new cases and 8466 and 7274 fewer deaths in the period for men and women, respectively. Estimates of reduction in incidence, prevalence and deaths from stroke were not significant over 20 years. CONCLUSIONS Even under conservative assumptions, our study found that a small reduction in SSB consumption led to a substantial decrease in IHD incidence and mortality in Brazil.
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Affiliation(s)
- Ana Elisa M Rinaldi
- School of Medicine, Postgraduate Program in Health Sciences, Federal University of Uberlândia (FAMED-UFU), 1720, Pará Avenue, Block 2U, Uberlândia, MG 38400-902, Brazil
| | - Luciana Bertoldi Nucci
- School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop (no number), Campinas, SP 13060-904, Brazil
| | - Carla Cristina Enes
- School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop (no number), Campinas, SP 13060-904, Brazil
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Jones-Smith JC, Knox MA, Chakrabarti S, Wallace J, Walkinshaw L, Mooney SJ, Godwin J, Arterburn DE, Eavey J, Chan N, Saelens BE. Sweetened Beverage Tax Implementation and Change in Body Mass Index Among Children in Seattle. JAMA Netw Open 2024; 7:e2413644. [PMID: 38809555 PMCID: PMC11137635 DOI: 10.1001/jamanetworkopen.2024.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/09/2024] [Indexed: 05/30/2024] Open
Abstract
Importance Sweetened beverage taxes have been associated with reduced purchasing of taxed beverages. However, few studies have assessed the association between sweetened beverage taxes and health outcomes. Objective To evaluate the association between the Seattle sweetened beverage tax and change in body mass index (BMI) among children. Design, Setting, and Participants In this longitudinal cohort study, anthropometric data were obtained from electronic medical records of 2 health care systems (Kaiser Permanente Washington [KP] and Seattle Children's Hospital Odessa Brown Children's Clinic [OBCC]). Children were included in the study if they were aged 2 to 18 years (between January 1, 2014, and December 31, 2019); had at least 1 weight measurement every year between 2015 and 2019; lived in Seattle or in urban areas of 3 surrounding counties (King, Pierce, and Snohomish); had not moved between taxed (Seattle) and nontaxed areas; received primary health care from KP or OBCC; did not have a recent history of cancer, bariatric surgery, or pregnancy; and had biologically plausible height and BMI (calculated as weight in kilograms divided by height in meters squared). Data analysis was conducted between August 5, 2022, and March 4, 2024. Exposure Seattle sweetened beverage tax (1.75 cents per ounce on sweetened beverages), implemented on January 1, 2018. Main Outcomes and Measures The primary outcome was BMIp95 (BMI expressed as a percentage of the 95th percentile; a newly recommended metric for assessing BMI change) of the reference population for age and sex, using the Centers for Disease Control and Prevention growth charts. In the primary (synthetic difference-in-differences [SDID]) model used, a comparison sample was created by reweighting the comparison sample to optimize on matching to pretax trends in outcome among 6313 children in Seattle. Secondary models were within-person change models using 1 pretax measurement and 1 posttax measurement in 22 779 children and fine stratification weights to balance baseline individual and neighborhood-level confounders. Results The primary SDID analysis included 6313 children (3041 female [48%] and 3272 male [52%]). More than a third of children (2383 [38%]) were aged 2 to 5 years); their mean (SE) age was 7.7 (0.6) years. With regard to race and ethnicity, 789 children (13%) were Asian, 631 (10%) were Black, 649 (10%) were Hispanic, and 3158 (50%) were White. The primary model results suggested that the Seattle tax was associated with a larger decrease in BMIp95 for children living in Seattle compared with those living in the comparison area (SDID: -0.90 percentage points [95% CI, -1.20 to -0.60]; P < .001). Results from secondary models were similar. Conclusions and Relevance The findings of this cohort study suggest that the Seattle sweetened beverage tax was associated with a modest decrease in BMIp95 among children living in Seattle compared with children living in nearby nontaxed areas who were receiving care within the same health care systems. Taken together with existing studies in the US, these results suggest that sweetened beverage taxes may be an effective policy for improving children's BMI. Future research should test this association using longitudinal data in other US cities with sweetened beverage taxes.
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Affiliation(s)
- Jessica C. Jones-Smith
- Department of Health Systems and Population Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | | | - Suman Chakrabarti
- Nutrition, Diets and Health Unit, International Food Policy Research Institute, New Delhi, India
| | - Jamie Wallace
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Lina Walkinshaw
- Department of Health Systems and Population Health, University of Washington, Seattle
| | | | - Jessica Godwin
- Center for Studies in Demography and Ecology, University of Washington, Seattle
| | | | - Joanna Eavey
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Nadine Chan
- Department of Epidemiology, University of Washington, Seattle
- Public Health—Seattle and King County, Seattle, Washington
| | - Brian E. Saelens
- Department of Pediatrics, University of Washington, Seattle
- Seattle Children’s Research Institute, Seattle, Washington
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Rogers NT, Pell D, Mytton OT, Penney TL, Briggs A, Cummins S, Jones C, Rayner M, Rutter H, Scarborough P, Sharp S, Smith R, White M, Adams J. Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: a controlled interrupted time series analysis. BMJ Open 2023; 13:e077059. [PMID: 38052470 PMCID: PMC10711915 DOI: 10.1136/bmjopen-2023-077059] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To determine changes in household purchases of drinks 1 year after implementation of the UK soft drinks industry levy (SDIL). DESIGN Controlled interrupted time series. PARTICIPANTS Households reporting their purchasing to a market research company (average weekly n=22 091), March 2014 to March 2019. INTERVENTION A two-tiered tax levied on soft drinks manufacturers, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g sugar/100 mL (high tier) are taxed at £0.24/L, drinks with ≥5 to <8 g sugar/100 mL (low tier) are taxed at £0.18/L. MAIN OUTCOME MEASURES Absolute and relative differences in the volume of, and amount of sugar in, soft drinks categories, all soft drinks combined, alcohol and confectionery purchased per household per week 1 year after implementation. RESULTS In March 2019, compared with the counterfactual, purchased volume of high tier drinks decreased by 140.8 mL (95% CI 104.3 to 177.3 mL) per household per week, equivalent to 37.8% (28.0% to 47.6%), and sugar purchased in these drinks decreased by 16.2 g (13.5 to 18.8 g), or 42.6% (35.6% to 49.6%). Purchases of low tier drinks decreased by 170.5 mL (154.5 to 186.5 mL) or 85.8% (77.8% to 93.9%), with an 11.5 g (9.1 to 13.9 g) reduction in sugar in these drinks, equivalent to 87.8% (69.2% to 106.4%). When all soft drinks were combined irrespective of levy tier or eligibility, the volume of drinks purchased increased by 188.8 mL (30.7 to 346.9 mL) per household per week, or 2.6% (0.4% to 4.7%), but sugar decreased by 8.0 g (2.4 to 13.6 g), or 2.7% (0.8% to 4.5%). Purchases of confectionery and alcoholic drinks did not increase. CONCLUSIONS Compared with trends before the SDIL was announced, 1 year after implementation, volume of all soft drinks purchased combined increased by 189 mL, or 2.6% per household per week. The amount of sugar in those drinks was 8 g, or 2.7%, lower per household per week. Further studies should determine whether and how apparently small effect sizes translate into health outcomes. TRIAL REGISTRATION NUMBER ISRCTN18042742.
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Affiliation(s)
| | | | - Oliver T Mytton
- MRC Epidemiology Unit, Cambridge, UK
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Tarra L Penney
- York University - Keele Campus, Toronto, Ontario, Canada
| | - Adam Briggs
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute for Health Policy and Clinical Practice, University of Warwick Warwick Medical School, Coventry, UK
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Harry Rutter
- University of Bath Department of Social and Policy Sciences, Bath, UK
| | - Peter Scarborough
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention, Oxford, UK
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Curley C, Eddie R, Tallis K, Lane TS, Yazzie D, Sanderson PR, Lorts C, Shin S, Behrens TK, George C, Antone-Nez R, Ashley C, de Heer HD. The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:622-632. [PMID: 37253351 PMCID: PMC10363222 DOI: 10.1097/phh.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- Caleigh Curley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Regina Eddie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Kristen Tallis
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Taylor S. Lane
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Del Yazzie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Priscilla R. Sanderson
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Cori Lorts
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Sonya Shin
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Timothy K. Behrens
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Carmen George
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Ramona Antone-Nez
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Christine Ashley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Hendrik D. de Heer
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
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Forde H, Penney TL, White M, Levy L, Greaves F, Adams J. Understanding Marketing Responses to a Tax on Sugary Drinks: A Qualitative Interview Study in the United Kingdom, 2019. Int J Health Policy Manag 2022; 11:2618-2629. [PMID: 35219285 PMCID: PMC9818127 DOI: 10.34172/ijhpm.2022.5465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends that countries implement fiscal policies to reduce the health impacts of sugary drinks. Few studies have fully examined the responses of industry to these policies, and whether they support or undermine health benefits of sugary drinks taxes. We aimed to explore the changes that sugary drinks companies may make to their marketing, and underlying decision-making processes, in response to such a tax. METHODS Following introduction of the UK Soft Drinks Industry Levy (SDIL) in 2018, we undertook one-to-one semi-structured interviews with UK stakeholders with experience of the strategic decision-making or marketing of soft drinks companies. We purposively recruited interviewees using seed and snowball sampling. We conducted telephone interviews with 6 representatives from each of industry, academia and civil society (total n=18), which were transcribed verbatim and thematically analysed. Four transcripts were double-coded, three were excluded from initial coding to allow comparison; and findings were checked by interviewees. RESULTS Themes were organised into a theoretical framework that reveals a cyclical, iterative and ongoing process of soft drinks company marketing decision-making, which was accelerated by the SDIL. Decisions about marketing affect a product's position, or niche, in the market and were primarily intended to maintain profits. A product's position is enacted through various marketing activities including reformulation and price variation, and non-marketing activities like lobbying. A soft drinks company's selection of marketing activities appeared to be influenced by their internal context, such as brand strength, and external context, such as consumer trends and policy. For example, a company with low brand strength and an awareness of trends for reducing sugar consumption may be more likely to reformulate to lower-sugar alternatives. CONCLUSION The theoretical framework suggests that marketing responses following the SDIL were coordinated and context-dependent, potentially explaining observed heterogeneity in responses across the industry.
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Affiliation(s)
- Hannah Forde
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Tarra L. Penney
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
- Global Food Systems and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Louis Levy
- The Faculty of Health and Social Care, University of Chester, Chester, UK
- Public Health England, London, UK
| | - Felix Greaves
- Public Health England, London, UK
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Excellence, London, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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9
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The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study. Nutrients 2022; 14:nu14235163. [PMID: 36501192 PMCID: PMC9737639 DOI: 10.3390/nu14235163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.
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10
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Lozano‐Rojas F, Carlin P. The effect of soda taxes beyond beverages in Philadelphia. HEALTH ECONOMICS 2022; 31:2381-2410. [PMID: 35978481 PMCID: PMC9804786 DOI: 10.1002/hec.4586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Soda taxes are implemented in several cities across the United States (US) with the aim of reducing sugar intake from sugar sweetened beverages (SSBs). Sugar is linked to obesity and to higher risk of diabetes and cardiovascular conditions. Sodas are targeted with these taxes since they are the main source of sugar for consumers in the US. In presence of potential substitutes, the policy can be undermined by consumers changing their sources of sugar. We examine the heterogeneous effects of the 2017 Philadelphia soda tax on purchases of other items containing sugar. We present an empirical evaluation focusing on the potential substitution toward additional sugary foods in Philadelphia and counties bordering Philadelphia. We find an increase in sugar from purchases of sweetened foods of about 4.3% following the introduction of the tax in Philadelphia and of 3.7% in the neighboring localities. The substitution to sugary foods in Philadelphia offsets 19% of the decrease of sugar from SSBs. Additionally, we find that the substitution offsets 37% of the decrease of sugar from SSBs when including counties bordering Philadelphia. These results suggest that while SSB taxes might be effective at lowering consumption of SSBs, substitution patterns may limit the effectiveness of the tax to reduce overall sugar intake.
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Affiliation(s)
- Felipe Lozano‐Rojas
- School of Public and International AffairsUniversity of GeorgiaAthensGeorgiaUSA
| | - Patrick Carlin
- O'Neill School of Public and Environmental AffairsIndiana University BloomingtonBloomingtonIndianaUSA
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11
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Nucci LB, Rinaldi AEM, Ramos AF, Itria A, Enes CC. Impact of a reduction in sugar-sweetened beverage consumption on the burden of type 2 diabetes in Brazil: A modeling study. Diabetes Res Clin Pract 2022; 192:110087. [PMID: 36130646 DOI: 10.1016/j.diabres.2022.110087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
AIM To model the impact of a 20 % tax on sugar-sweetened beverages (SSBs) on the disease burden of T2DM among Brazilian adults. METHODS This is an ex-ante risk comparative study. The model applied a 20 % tax on SSB and projected the incidence, prevalence, and mortality of T2DM over a 20-year period (2019 to 2039). Using recent national data on consumption, previously published cross- and own-price elasticities of SSBs and diabetes relative risk we estimated changes on T2DM burden. RESULTS With a 20 % tax on SSBs, after 10 years, we estimated a reduction of 37,303 new cases of T2DM for men and 56,757 for women; 184,129 prevalent cases for men and 219,236 for women; and 5,386 and 6,075 deaths for men and women, respectively. After 20 years, 8.6 % and 12.4 % new cases of T2DM will have been prevented, 4.0 % and 5.5 % prevalent cases, and 13.7 % and 12.7 % deaths among men and women, respectively. CONCLUSIONS SSB taxes have the potential to reduce the burden of and deaths attributable to T2DM. Our results show that a fiscal policy may significantly impact strategic plans to tackle noncommunicable diseases.
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Affiliation(s)
- Luciana Bertoldi Nucci
- Pontifical Catholic University of Campinas (PUC-Campinas), Center for Life Sciences, Postgraduate Program in Health Sciences, Campinas, SP, Brazil
| | - Ana Elisa M Rinaldi
- Federal University of Uberlândia (UFU), School of Medicine, Postgraduate Program in Health Sciences, Uberlândia, MG, Brazil
| | - Amanda Ferreira Ramos
- Federal University of Uberlândia (UFU), School of Medicine, Nutrition Course, Uberlândia, MG, Brazil
| | - Alexander Itria
- Federal University of Sao Carlos (UFSCar), Management and Technology Sciences Center, Postgraduate Program in Economy, Sorocaba, SP, Brazil
| | - Carla Cristina Enes
- Pontifical Catholic University of Campinas (PUC-Campinas), Center for Life Sciences, Postgraduate Program in Health Sciences, Campinas, SP, Brazil.
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12
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Andreyeva T, Marple K, Marinello S, Moore TE, Powell LM. Outcomes Following Taxation of Sugar-Sweetened Beverages: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2215276. [PMID: 35648398 PMCID: PMC9161017 DOI: 10.1001/jamanetworkopen.2022.15276] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Importance More than 45 countries and several local jurisdictions have implemented sugar-sweetened beverage (SSB) taxes to improve nutrition and population health, and evidence on their outcomes to date is essential to inform policy discussions. Responding to this need, the World Health Organization commissioned a systematic literature review on the outcomes of fiscal policies, including SSB taxes. Objective To assess the associations of implemented SSB taxes with prices, sales, consumption, diet, body weight, product changes, unintended consequences, health, and pregnancy outcomes. Data Sources Searches of 8 bibliographic databases (Business Source Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EconLit, PsycINFO, PubMed, and Scopus) were performed from database inception through June 1, 2020, with no language or setting restrictions. Grey literature was assessed using 14 sources and government websites. Study Selection The review included primary studies of implemented SSB taxes. Data Extraction and Synthesis The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. For prices, sales and consumption, results were meta-analyzed using a 3-level random-effects model. Study quality was assessed at the outcome level. Main Outcomes and Measures Tax pass-through rate for prices, percentage reduction in SSB demand, and price elasticity of demand for sales and consumption. Heterogeneity was assessed using τ2 and the I2 statistic. Results A total of 86 articles were eligible, with 62 studies contributing to the meta-analysis. The overall tax pass-through rate was 82% (95% CI, 66% to 98%; P < .001, I2 = 99%), suggesting tax undershifting. The demand for SSBs was highly sensitive to tax-induced price increases, with the price elasticity of demand of -1.59 (95% CI, -2.11 to -1.08; P < .001; I2 = 100%) and a mean reduction in SSB sales of 15% (95% CI, -20% to -9%; P < .001; I2 = 100%). There was no evidence of substitution to untaxed beverages, and changes in SSB consumption were not significant. The narrative synthesis found reformulation and reduced sugar content of taxed beverages for tiered taxes, cross-border shopping in most studies of local-level taxes, and no negative changes in employment. Data on the heterogeneity of SSB tax outcomes across subpopulations were limited. Conclusions and Relevance In this systematic review and meta-analysis of implemented SSB taxes worldwide, SSB taxes were associated with higher prices and lower sales of taxed beverages.
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Affiliation(s)
- Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy & Health, University of Connecticut, Hartford
| | - Keith Marple
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Samantha Marinello
- Health Policy and Administration, School of Public Health, University of Illinois Chicago
| | - Timothy E. Moore
- Statistical Consulting Services, Center for Open Research Resources & Equipment, University of Connecticut, Storrs
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago
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13
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Bodo YL, Etilé F, Julia C, Friant-Perrot M, Breton E, Lecocq S, Boizot-Szantai C, Bergeran C, Jabot F. Public health lessons from the French 2012 soda tax and insights on the modifications enacted in 2018. Health Policy 2022; 126:585-591. [DOI: 10.1016/j.healthpol.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/25/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
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14
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Ross A, Swart EC, Frank T, Lowery CM, Ng SW. South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets. Public Health Nutr 2022; 25:1-26. [PMID: 35249582 PMCID: PMC9991735 DOI: 10.1017/s1368980022000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. DESIGN Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). SETTING Langa, Western Cape, South Africa. PARTICIPANTS Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). RESULTS Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. CONCLUSIONS We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.
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Affiliation(s)
- Alexandra Ross
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa
- DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tamryn Frank
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
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15
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Vo V, Nguyen KH, Whitty JA, Comans TA. The Effect of Price Changes and Teaspoon Labelling on Intention to Purchase Sugar-Sweetened Beverages: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:199-212. [PMID: 34738192 DOI: 10.1007/s40258-021-00688-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Childhood obesity is a major public health concern and sugar-sweetened beverages (SSBs) are a known contributor. SSB taxation and food labelling have been proposed as policies to reduce consumption by changing purchasing behaviours. The study aimed to analyse caregivers' preferences on commonly purchased SSBs in Australia and to determine the effect of price increases and teaspoon labelling on their purchasing intentions. METHODS We used a discrete choice experiment (DCE) to obtain data about choices between SSB and non-SSB alternatives. 563 caregivers, who had young children aged 3-7 years, completed the experiment online. 286 were randomly allocated to receive choice sets with plain labelling while 277 were assigned to teaspoon labelling. Each participant completed nine choice scenarios where they chose between six SSB and non-SSB beverage options or a no-beverage option, with beverage prices varying between scenarios. While hypothetical, price and teaspoon labelling for sugar content for each beverage was obtained from an informal market survey. Responses from the DCE were modelled using random parameters logit within a random utility theory framework. Household income and children's consumption volumes of soft drink were used to explore preference heterogeneity. RESULTS Using mixed logit as the final model, we found that higher reduction in intended purchases was observed for soft drink and fruit drink in teaspoon labelling than it was in plain labelling. Participants exposed to teaspoon labelling intended to purchase less of flavoured milk and fruit juice compared to those exposed to plain labelling. Compared to baseline prices, a hypothetical 20% increase in SSB prices and the presentation of 'teaspoons of sugar' labelling were predicted to reduce intentional SSB purchases and increase intentional non-SSB purchases. Within each labelling group, there were no significant differences of intentional purchases between the highest and the lowest income quintile, high and low consumers of soft drinks. However, compared to plain labelling, teaspoon labelling was predicted to strongly influence intentional purchases of SSBs and non-SSBs. CONCLUSION This study suggests that a policy to increase SSB price and include teaspoon labelling would lead to a reduced consumption of SSBs and increased consumption of non-SSBs.
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Affiliation(s)
- Vinh Vo
- The Centre for Health Services Research, University of Queensland, St. Lucia, 288 Herston Road, Herston, QLD, 4006, Australia
- Centre for Health Economics, Monash University, Caufield East, Vic., Australia
| | - K-H Nguyen
- The Centre for Health Services Research, University of Queensland, St. Lucia, 288 Herston Road, Herston, QLD, 4006, Australia
| | - J A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tracy A Comans
- The Centre for Health Services Research, University of Queensland, St. Lucia, 288 Herston Road, Herston, QLD, 4006, Australia.
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16
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Gračner T, Kapinos KA, Gertler PJ. Associations of a National Tax on Non-Essential High Calorie Foods with Changes in Consumer Prices. FOOD POLICY 2022; 106:102193. [PMID: 35221447 PMCID: PMC8871466 DOI: 10.1016/j.foodpol.2021.102193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Several governments are considering taxes on non-essential energy-dense, high calorie foods (NEDF) to increase their prices and thereby encourage better diet and health. Alongside a tax on sugary drinks in January 2014, Mexico implemented such a tax: an 8 percent ad-valorem tax on NEDF, defined as those with energy density equal or larger than 275kcal/100g. We study the changes in the prices of taxed and tax-exempt foods following this tax both on average and by tax-eligible foods across store types and cities, using monthly price data between 2012 and 2016. We compare within-product price changes before and after the tax adjusting for product fixed effects, seasonality, and trends, and find that prices of taxed foods increased by 4.8 % on average, but differentially across foods. Prices of candies, cookies and packaged pastries increased by eight or more percent post-tax (vs pre-tax); prices of cakes, and savory snacks increased by less. Prices of fresh pastry and ready-to-eat cereal increased, but only in 2014. Prices of chocolate and pizza did not increase after the tax. For tax-exempt foods, no significant price changes were observed. Variability in price changes for taxed foods were observed by cities as well as by stores: increases were larger in supermarkets compared to smaller grocery stores on average and for most foods. Differences in how prices changed across foods, cities and stores have implications for who is likely to be affected by the tax and how tax effects on diet may vary due to the differential tax pass-through in addition to a heterogenous demand response to changed prices.
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Affiliation(s)
- Tadeja Gračner
- RAND Corporation, 1200 S Hayes Street, Arlington, VA
22202
- Corresponding Author: Tadeja
Gračner, PhD, RAND Corporation, 1200 S Hayes street, 22202 Arlington,
, Phone: 703-413-1100 x5499
| | - Kandice A. Kapinos
- RAND Corporation, 1200 S Hayes Street, Arlington, VA
22202
- UT Southwestern Medical Center, Department of Population
and Data Sciences, 5323 Harry Hines Blvd., Dallas, TX 75390
| | - Paul J. Gertler
- Haas Business School, University of California, Berkeley,
2220 Piedmont Ave, Berkeley, CA 94720
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17
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George C, Bancroft C, Salt S, Curley C, Curley C, Eddie R, Edison T, de Heer H, Sanderson PR, Yazzie D, Antone-Nez R, Shin S. Successful implementation of the Healthy Diné Nation Act in stores on the Navajo Nation. Prev Med Rep 2021; 24:101573. [PMID: 34976637 PMCID: PMC8683936 DOI: 10.1016/j.pmedr.2021.101573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
In 2014, the Navajo Nation Council passed the Healthy Diné Nation Act (HDNA), a 2% tax on unhealthy foods and beverages and a waiver of the 5% sales tax on healthy foods and water, to support health promotion and disease prevention among the Navajo people. Very little research has assessed implementation accuracy of food or beverage taxes and none were implemented within a sovereign Tribal nation. This study assessed the accuracy of HDNA tax implementation among 47 stores located on the Navajo Nation. A pair of tax-exempt items [e.g. a bottle of water and fresh fruit] and a pair of HDNA-tax eligible items [e.g. sugary beverage and candy bar] were purchased between July-December 2019. Receipts were retained to assess taxation. A total of 87.2% of stores accurately implemented the 2% tax on unhealthy items while 55.3% of the stores accurately implemented the 6% tax waiver on healthy items. In all, 51.1% of the stores accurately applied both taxes. There were no significant differences across store type (convenience or grocery stores and trading posts) or geographic region. In conclusion, almost all stores on the Navajo Nation accurately applied a 2% tax on unhealthy foods and beverages, while the proportion of stores applying a waiver on healthy foods was lower. Successful HDNA tax implementation among stores remains an important priority in achieving the goal to support health promotion and disease prevention among Navajo communities.
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Affiliation(s)
- Carmen George
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Carolyn Bancroft
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Shine Salt
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Caleigh Curley
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Cameron Curley
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Regina Eddie
- Northern Arizona University, College of Health and Human Services, School of Nursing, Flagstaff, AZ, United States
| | - Tierra Edison
- Community Outreach and Patient Empowerment, Gallup, NM, United States
| | - Hendrik de Heer
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Priscilla R Sanderson
- Northern Arizona University, College of Health and Human Services, Department of Health Sciences, Flagstaff, AZ, United States
| | - Del Yazzie
- Navajo Nation, Navajo Department of Health, Navajo Epidemiology Center, Window Rock, AZ, United States
| | - Ramona Antone-Nez
- Navajo Nation, Navajo Department of Health, Navajo Epidemiology Center, Window Rock, AZ, United States
| | - Sonya Shin
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, United States
- Community Outreach and Patient Empowerment, Gallup, NM, United States
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18
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Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health 2021; 42:439-461. [PMID: 33256536 DOI: 10.1146/annurev-publhealth-090419-103005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
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Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
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19
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Leider J, Powell LM. Longer-term impacts of the Oakland, California, sugar-sweetened beverage tax on prices and volume sold at two-years post-tax. Soc Sci Med 2021; 292:114537. [PMID: 34838326 DOI: 10.1016/j.socscimed.2021.114537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/27/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Sugar-sweetened beverage (SSB) consumption is associated with obesity and independently associated with type 2 diabetes and cardiovascular disease. Not only is obesity a growing public health problem, but it is also most recently associated with increased risk of severe illness from COVID-19. Taxes on SSBs are a policy tool used to help curb SSB consumption and are currently implemented in 7 U.S. cities and more than 40 countries. On July 1, 2017, Oakland, California, implemented a 1-cent/ounce tax on SSBs with ≥25 kilocalories/12 ounces. This study estimated the impact of the Oakland tax on prices, volume sold, and cross-border shopping two-years post-tax relative to one-year pre-tax. Universal product code-level Nielsen retail scanner data on non-alcoholic beverage sales were analyzed using a difference-in-differences design with Sacramento, California, as the comparison site. Taxed beverage prices increased by 0.67 cents/ounce, on average, in Oakland relative to Sacramento, corresponding to 67% pass-through. Taxed beverage volume sold decreased by 18% in Oakland relative to Sacramento, with a larger decrease for family-size beverages (23%) relative to individual-size beverages (8%). There was a 9% increase in volume sold of taxed beverages in the two-mile border area surrounding Oakland relative to the Sacramento border area, driven by a 12% increase for family-size taxed beverages. After accounting for this cross-border shopping, there was a net decrease of 6% in taxed beverage volume sold in Oakland. There was no significant change in untaxed beverage volume sold in either Oakland or its border area relative to their respective comparison sites, suggesting there was no substitution to untaxed beverages and cross-border shopping may have been limited to taxed beverages. This two-year post-tax study of the Oakland SSB tax adds to the limited number of longer-term evaluations of local U.S. SSB taxes.
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Affiliation(s)
- Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, MC 275, Chicago, IL, 60608, USA.
| | - Lisa M Powell
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, MC 275, Chicago, IL, 60608, USA; Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor Street, MC 923, Chicago, IL, 60612, USA
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20
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Impact of a sugar-sweetened beverage tax two-year post-tax implementation in Seattle, Washington, United States. J Public Health Policy 2021; 42:574-588. [PMID: 34732842 DOI: 10.1057/s41271-021-00308-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/21/2022]
Abstract
This study examines longer-run impacts of the Seattle, Washington, Sweetened Beverage Tax (SBT) on beverage prices, volume sold, and cross-border shopping. We use a difference-in-differences estimation approach, drawing on universal product code-level store scanner data on taxed and untaxed beverages one-year pre-tax and two-year post-tax with Portland, Oregon, as the comparison site. Two-year post-tax, prices of taxed beverages increased by 1.04 cents per ounce (59% tax pass-through rate). Volume sold of taxed beverages fell by 22%. Declines were larger for family-size (29%) compared to individual-size (10%) beverages; particularly for soda (36% decrease for family-size compared to no change for individual-size). We found no change in volume sold of taxed beverages in Seattle's 2-mile border area, suggesting no cross-border shopping. Overall, we found a sustained impact of the Seattle SBT two-year post-tax implementation suggesting that sugar-sweetened beverage taxes may yield permanent reductions in demand for sugary beverages and associated health harms.
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21
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Léger PT, Powell LM. The impact of the Oakland SSB tax on prices and volume sold: A study of intended and unintended consequences. HEALTH ECONOMICS 2021; 30:1745-1771. [PMID: 33931915 DOI: 10.1002/hec.4267] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/15/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
We examine the effects of a sugar-sweetened beverage (SSB) tax that took effect in Oakland, California in 2017. Using rich customized universal product code -level data, we estimate the effect of the SSB tax on prices and volume in the short to medium term in a difference-in-differences framework. We pay particular attention to tax-avoidance strategies that may minimize the policy's intended effect including: (i) transfers to SSBs to the nontaxed border area (i.e., cross-border shopping), (ii) a move from high-priced per ounce single serve to their cheaper multipacks or larger format counterparts (i.e., format switching), and (iii) a move from high-priced beverages to less expensive ones within a category and format (i.e., brand switching). We find that the year-over-year tax pass-through is 49%. We find that volume sold of taxed beverages fell by 14%, but 46% of this decrease is offset with an increase in the border area. We also find evidence of substitution to lower-priced taxed beverages but no evidence of switching to cheaper formats. Finally, we find important dynamic effects with respect to tax pass-through, volume sold and cross-border shopping.
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Affiliation(s)
- Pierre Thomas Léger
- Health Policy and Administration, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lisa M Powell
- Health Policy and Administration, University of Illinois Chicago, Chicago, Illinois, USA
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22
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Bleich SN, Dunn CG, Soto MJ, Yan J, Gibson LA, Lawman HG, Mitra N, Lowery CM, Peterhans A, Hua SV, Roberto CA. Association of a Sweetened Beverage Tax With Purchases of Beverages and High-Sugar Foods at Independent Stores in Philadelphia. JAMA Netw Open 2021; 4:e2113527. [PMID: 34129022 PMCID: PMC8207239 DOI: 10.1001/jamanetworkopen.2021.13527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 01/06/2023] Open
Abstract
Importance The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items. Objective To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores. Design, Setting, and Participants This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties. Main Outcomes and Measures Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods. Results Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001). Conclusions and Relevance This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.
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Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Caroline G. Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark J. Soto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Laura A. Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hannah G. Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Caitlin M. Lowery
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ana Peterhans
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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23
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Bleich SN, Lawman HG, LeVasseur MT, Yan J, Mitra N, Lowery CM, Peterhans A, Hua S, Gibson LA, Roberto CA. The Association Of A Sweetened Beverage Tax With Changes In Beverage Prices And Purchases At Independent Stores. Health Aff (Millwood) 2021; 39:1130-1139. [PMID: 32634353 DOI: 10.1377/hlthaff.2019.01058] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In January 2017 Philadelphia, Pennsylvania, implemented an excise tax of 1.5 cents per ounce on beverages sweetened with sugar or artificial sweeteners. Small independent stores are an important yet understudied setting. They are visited frequently in urban and low-income areas, and sugary beverages are among the most commonly purchased items in them. We compared changes in beverage prices and purchases before and twelve months after tax implementation at small independent stores in Philadelphia and an untaxed control city, Baltimore, Maryland. Our sample included 134 stores with price data and 4,584 customer purchases. Compared with Baltimore, Philadelphia experienced significantly greater increases in the price of taxed beverages (1.81 cents per ounce, or 120.4 percent of the tax) and significantly larger declines in the volume of taxed beverages sold (5.76 ounces, or 38.9 percent) after tax implementation. Beverage excise taxes may be an effective policy tool for decreasing the purchase of sweetened drinks in small independent stores, particularly among populations at higher risk for sugar-sweetened beverage consumption.
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Affiliation(s)
- Sara N Bleich
- Sara N. Bleich is a professor of public health policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Hannah G Lawman
- Hannah G. Lawman is director of research and evaluation in the Division of Chronic Disease Prevention, Get Healthy Philly, Philadelphia Department of Public Health, in Philadelphia, Pennsylvania
| | - Michael T LeVasseur
- Michael T. LeVasseur is an adjunct professor of biostatistics at Drexel University, in Philadelphia
| | - Jiali Yan
- Jiali Yan is a data analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Nandita Mitra
- Nandita Mitra is a professor in the Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - Caitlin M Lowery
- Caitlin M. Lowery is a project manager in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Ana Peterhans
- Ana Peterhans is a project manager in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Sophia Hua
- Sophia Hua is a project manager in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Laura A Gibson
- Laura A. Gibson is a research assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Christina A Roberto
- Christina A. Roberto is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
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24
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Basu S, Jacobs LM, Epel E, Schillinger D, Schmidt L. Cost-Effectiveness Of A Workplace Ban On Sugar-Sweetened Beverage Sales: A Microsimulation Model. Health Aff (Millwood) 2021; 39:1140-1148. [PMID: 32634357 PMCID: PMC7968436 DOI: 10.1377/hlthaff.2019.01483] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sugar-sweetened beverages (SSBs) increase chronic disease risk. We estimated the impact on employee health and health care spending of banning SSB sales in California-based health care organizations. We used survey data from a large, multisite health care organization in California, sampling 2,276 employees three months before and twelve months after a workplace SSB sales ban was imposed. We incorporated the survey data into a simulation model to estimate chronic disease incidence and costs. We estimated that an SSB ban as effective as the one observed would save about $300,000 per 10,000 people over ten years among similar employers, as a result of averted health care and productivity spending—after both SSB sales losses and non-SSB beverage sales gains were accounted for. Sales bans would typically need to reduce SSB consumption by 2.2 ounces per person per day for lost revenue to be fully offset if there were no increase in non-SSB beverage sales.
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Affiliation(s)
- Sanjay Basu
- Sanjay Basu is director of research and population health at Collective Health, in San Francisco, California, and a faculty member at the Center for Primary Care, Harvard Medical School, in Boston, Massachusetts
| | - Laurie M Jacobs
- Laurie M. Jacobs is a researcher at the Institute for Health Policy, University of California San Francisco (UCSF), in San Francisco, California
| | - Elissa Epel
- Elissa Epel is a professor of psychiatry at UCSF
| | - Dean Schillinger
- Dean Schillinger is a professor of general internal medicine at UCSF
| | - Laura Schmidt
- Laura Schmidt is a professor of health policy in the School of Medicine and holds a joint appointment in the Philip R. Lee Institute for Health Policy Studies and the Department of Anthropology, History, and Social Medicine, all at UCSF
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25
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Valizadeh P, Ng SW. Would A National Sugar-Sweetened Beverage Tax In The United States Be Well Targeted? AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS 2021; 103:961-986. [PMID: 35505903 PMCID: PMC9060537 DOI: 10.1111/ajae.12190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sugar-sweetened beverage (SSB) taxes have been proposed to discourage excessive sugar consumption, but it is unclear how high- vs. low-SSB purchasers respond to such taxes. We first examine heterogeneity in the purchase and financial effects of a national SSB tax across different types of households buying varying amounts of SSBs. We find high-SSB purchasers are less responsive to SSB price changes than low purchasers but make larger absolute reductions in SSB purchases in response to the tax, given their notably greater purchase levels prior to the tax. Nonetheless, the economic burden of the tax falls more heavily on high-SSB purchasers who are more likely comprised of lower-income households. We then investigate whether the income regressivity of the tax will be mitigated if low-income households are targeted by fruit and vegetable (FV) subsidies. We show that depending on the tax pass-through and subsidy rates, FV subsidies can fully offset high-SSB purchasers' tax burdens, and subsidy transfers are distributed relatively uniformly across the SSB purchase distribution of low-income households. Therefore, FV subsidy transfers would be financially more beneficial to low- and moderate-SSB purchasers because they bear smaller shares of the tax burden than high-SSB purchasers.
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Affiliation(s)
- Pourya Valizadeh
- Agricultural and Food Policy Center and Department of Agricultural Economics, Texas A&M University
| | - Shu Wen Ng
- Department of Nutrition at the University of North Carolina at Chapel Hill and a faculty fellow at Carolina Population Center
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26
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Altman EA, Madsen KA, Schmidt LA. Missed Opportunities: The Need to Promote Public Knowledge and Awareness of Sugar-Sweetened Beverage Taxes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4607. [PMID: 33925290 PMCID: PMC8123585 DOI: 10.3390/ijerph18094607] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
Despite a growing body of evidence showing that sugar-sweetened beverage (SSB) taxes nudge consumers away from SSBs, we lack an understanding of people's awareness and perceptions of SSB taxes and whether tax awareness and perceptions differ based on sociodemographic characteristics. We used serial cross-sectional study intercept surveys (n = 2715) in demographically diverse neighborhoods of Berkeley and Oakland in 2015 and 2017, and San Francisco and Richmond in 2017. In the year following successful SSB tax ballot measures, 45% of respondents correctly recalled that an SSB tax had passed in their city. In untaxed cities, 14% of respondents incorrectly thought that a tax had passed. Perceived benefits of SSB taxes to the community and to children's health were moderate and, like correct recall of an SSB tax, were higher among respondents with higher education levels. Awareness of SSB taxes was low overall, and perceptions about taxes' benefits varied by educational attainment, reflecting a missed opportunity to educate citizens about how SSB taxes work and their importance. Public health efforts should invest in campaigns that explain the benefits of SSB taxes and provide information about how tax revenues will be invested, both before and after a tax proposal has passed.
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Affiliation(s)
- Emily A. Altman
- School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Kristine A. Madsen
- School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Laura A. Schmidt
- Philip R. Lee Institute for Health Policy Studies, Department of Humanities and Social Sciences, School of Medicine, University of California at San Francisco, San Francisco, CA 94118, USA;
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27
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Stacey N, Edoka I, Hofman K, Swart EC, Popkin B, Ng SW. Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study. Lancet Planet Health 2021; 5:e200-e208. [PMID: 33838735 PMCID: PMC8071067 DOI: 10.1016/s2542-5196(20)30304-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. METHODS We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. FINDINGS Mean sugar from taxable beverage purchases fell from 16·25 g/capita per day (95% CI 15·80-16·70) to 14·26 (13·85-14·67) from the pre-HPL announcement to post-announcement period, and then to 10·63 g/capita per day (10·22-11·04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518·99 mL/capita per day (506·90-531·08) to 492·16 (481·28-503·04) from pre-announcement to post announcement, and then to 443·39 mL/capita per day (430·10-456·56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283·45 mL/capita per day (273·34-293·56) pre-announcement to 312·94 (296·29-329·29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. INTERPRETATION The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases. FUNDING Bloomberg Philanthropies, International Development Research Centre, South African Medical Research Council, and the US National Institutes of Health.
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Affiliation(s)
- Nicholas Stacey
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ijeoma Edoka
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Barry Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.
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28
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Pell D, Mytton O, Penney TL, Briggs A, Cummins S, Penn-Jones C, Rayner M, Rutter H, Scarborough P, Sharp SJ, Smith RD, White M, Adams J. Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: controlled interrupted time series analysis. BMJ 2021; 372:n254. [PMID: 33692200 PMCID: PMC7944367 DOI: 10.1136/bmj.n254] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine changes in household purchases of drinks and confectionery one year after implementation of the UK soft drinks industry levy (SDIL). DESIGN Controlled interrupted time series analysis. PARTICIPANTS Members of a panel of households reporting their purchasing on a weekly basis to a market research company (average weekly number of participants n=22 183), March 2014 to March 2019. INTERVENTION A two tiered tax levied on manufacturers of soft drinks, announced in March 2016 and implemented in April 2018. Drinks with ≥8 g sugar/100 mL (high tier) are taxed at £0.24/L and drinks with ≥5 to <8 g sugar/100 mL (low tier) are taxed at £0.18/L. Drinks with <5 g sugar/100 mL (no levy) are not taxed. MAIN OUTCOME MEASURES Absolute and relative differences in the volume of, and amount of sugar in, soft drinks categories, all soft drinks combined, alcohol, and confectionery purchased per household per week one year after implementation of the SDIL compared with trends before the announcement of the SDIL. RESULTS In March 2019, compared with the counterfactual estimated from pre-announcement trends, purchased volume of drinks in the high levy tier decreased by 155 mL (95% confidence interval 240.5 to 69.5 mL) per household per week, equivalent to 44.3% (95% confidence interval 59.9% to 28.7%), and sugar purchased in these drinks decreased by 18.0 g (95% confidence interval 32.3 to 3.6 g), or 45.9% (68.8% to 22.9%). Purchases of low tier drinks decreased by 177.3 mL (225.3 to 129.3 mL) per household per week, or 85.9% (95.1% to 76.7%), with a 12.5 g (15.4 to 9.5 g) reduction in sugar in these drinks, equivalent to 86.2% (94.2% to 78.1%). Despite no overall change in volume of no levy drinks purchased, there was an increase in sugar purchased of 15.3 g (12.6 to 17.9 g) per household per week, equivalent to 166.4% (94.2% to 238.5%). When all soft drinks were combined, the volume of drinks purchased did not change, but sugar decreased by 29.5 g (55.8 to 3.1 g), or 9.8% (17.9% to 1.8%). Purchases of confectionery and alcoholic drinks did not change. CONCLUSIONS Compared with trends before the SDIL was announced, one year after implementation, the volume of soft drinks purchased did not change. The amount of sugar in those drinks was 30 g, or 10%, lower per household per week-equivalent to one 250 mL serving of a low tier drink per person per week. The SDIL might benefit public health without harming industry. TRIAL REGISTRATION ISRCTN18042742.
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Affiliation(s)
- David Pell
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - Oliver Mytton
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - Tarra L Penney
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
- Faculty of Health, School of Kinesiology and Health Science, Toronto, Canada
| | - Adam Briggs
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Warwick Medical School, University of Warwick, Division of Health Sciences, Coventry, UK
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Catrin Penn-Jones
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - Mike Rayner
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
| | - Stephen J Sharp
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge CB2 0QQ, UK
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29
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Gibson LA, Lawman HG, Bleich SN, Yan J, Mitra N, LeVasseur MT, Lowery CM, Roberto CA. No Evidence of Food or Alcohol Substitution in Response to a Sweetened Beverage Tax. Am J Prev Med 2021; 60:e49-e57. [PMID: 33349471 DOI: 10.1016/j.amepre.2020.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Evidence suggests real-world beverage taxes reduce sweetened beverage purchases, but it is unknown if consumers consequently increase food or alcohol purchases. This study examines whether Philadelphia's 1.5 cents/ounce beverage tax was associated with substitution to 3 kinds of hypothesized substitutes: snacks, nontaxed beverage concentrates, and alcohol. METHODS Using commercial retail sales data and a difference-in-differences approach, analyses compared logged volume and dollar sales of snacks and beverage concentrates between 2016 (pretax) and 2017 (post-tax) at chain food retail stores in Philadelphia (n=180) and Baltimore (nontaxed control city; n=60), and logged volume and dollar sales of wine and spirits at liquor stores in Philadelphia (n=44) and nearby Pennsylvania counties (alternate control; n=66). Additional food analyses examined change in logged volume sales of hypothesized products compared to control products (other foods). Analyses were conducted in 2020. RESULTS Across store types, analyses showed no statistically significant increases in logged volume or dollar sales of snacks or spirits in Philadelphia stores compared to control sites (decreased, ranging from -10% to 0%). Supermarket analyses showed substitution to nontaxed beverage concentrates (27% increase in volume, 36% increase relative to other food) but remained a relatively small percentage of overall beverage dollar sales (12% at baseline, 15% at post). CONCLUSIONS At the population level, there is no evidence that Philadelphia's decline in taxed beverage purchases is offset by increases in snacks or spirits purchasing, but there is evidence of substitution to beverage concentrates in supermarkets. Future studies should explore individual-level purchasing changes.
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Affiliation(s)
- Laura A Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Hannah G Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael T LeVasseur
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Caitlin M Lowery
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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30
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Leider J, Li Y, Powell LM. Pass-through of the Oakland, California, sugar-sweetened beverage tax in food stores two years post-implementation: A difference-in-differences study. PLoS One 2021; 16:e0244884. [PMID: 33395444 PMCID: PMC7781485 DOI: 10.1371/journal.pone.0244884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Taxes on sugar-sweetened beverages (SSBs) have gained support as a policy response to adverse health effects associated with SSB consumption. On July 1, 2017, Oakland, California, implemented a one-cent/ounce tax on SSBs with ≥25 calories/12 fluid ounces. This study estimated the long-term impact of the tax on taxed and untaxed beverage prices. METHODS Data on 5,830 taxed and 5,146 untaxed beverage prices were obtained from 99 stores in Oakland and 111 stores in Sacramento (comparison site), California, in late May-June 2017 and June 2019. Linear regression difference-in-differences models were computed with store and product fixed effects, with robust standard errors clustered on store, weighted based on volume sold by beverage sweetener status, type, and size. RESULTS Taxed beverage prices increased by 0.73 cents/ounce (95% CI = 0.47,1.00) on average in supermarkets and grocery stores in Oakland relative to Sacramento and 0.74 cents/ounce (95% CI = 0.39,1.09) in pharmacies, but did not change in convenience stores (-0.09 cents/ounce, 95% CI = -0.56,0.39). Untaxed beverage prices overall increased by 0.40 cents/ounce (95% CI = 0.05,0.75) in pharmacies but did not change in other store types. Prices of taxed individual-size soda specifically increased in all store types, by 0.91-2.39 cents/ounce (p<0.05), as did prices of untaxed individual-size soda in convenience stores (0.79 cents/ounce, 95% CI = 0.01,1.56) and pharmacies (1.66 cents/ounce, 95% CI = 0.09,3.23). CONCLUSIONS Two years following SSB tax implementation, there was partial tax pass-through with differences by store type and by beverage type and size within store type.
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Affiliation(s)
- Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Yu Li
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Lisa M. Powell
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, Illinois, United States of America
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
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Jones-Smith JC, Pinero Walkinshaw L, Oddo VM, Knox M, Neuhouser ML, Hurvitz PM, Saelens BE, Chan N. Impact of a sweetened beverage tax on beverage prices in Seattle, WA. ECONOMICS AND HUMAN BIOLOGY 2020; 39:100917. [PMID: 32801099 PMCID: PMC11316513 DOI: 10.1016/j.ehb.2020.100917] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
Seattle's Sweetened Beverage Tax is an excise tax of 1.75 cents per ounce on sugar-sweetened beverages and is one of the highest beverage taxes in the U.S. This study examined the impact of Seattle's tax on the prices of beverages. We conducted audits of 407 retail food stores and eating places (quick service restaurants and coffee shops) before and 6 months after the tax was implemented in Seattle and in a comparison area. Ordinary least squares difference-in-differences models with store fixed effects were used to estimate the effect of the tax on prices, stratified by beverage type and store type. In secondary analyses, we assessed the effect of the tax on the price of non-taxed beverages and foods. Results from the adjusted difference-in-differences models indicated the tax was associated with an average increase of 1.58 cents per ounce among Seattle retailers, representing 90 % of the price of the tax. By store type, price increases were highest in smaller grocery stores and drug stores. By beverage type, price increases were highest for energy beverages and soda and lowest for bottled coffee and juice drinks. Prices of some non-taxed beverages also increased while the prices of select healthy foods generally did not. The sweetened beverage tax in Seattle is higher than beverage taxes in most other cities, and nearly the full cost of the tax is being passed through to consumers for many beverage types and stores types.
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Affiliation(s)
- Jessica C Jones-Smith
- University of Washington, School of Public Health, Department of Health Services, Seattle, WA, USA; University of Washington, School of Public Health, Department of Epidemiology, USA.
| | - Lina Pinero Walkinshaw
- University of Washington, School of Public Health, Department of Health Services, Seattle, WA, USA
| | - Vanessa M Oddo
- University of Washington, School of Public Health, Department of Health Services, Seattle, WA, USA
| | - Melissa Knox
- University of Washington, Department of Economics, USA
| | - Marian L Neuhouser
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Philip M Hurvitz
- University of Washington, Urban Form Lab, Department of Urban Design and Planning, Seattle, WA, USA; University of Washington, Center for Studies in Demography and Ecology, Seattle, WA, USA
| | - Brian E Saelens
- Seattle Children's Research Institute, Seattle, WA, USA; University of Washington, School of Medicine, Department of Pediatrics, Seattle, WA, USA
| | - Nadine Chan
- University of Washington, School of Public Health, Department of Epidemiology, USA; Public Health-Seattle & King County, Assessment, Policy, Development and Evaluation Division, Seattle, WA, USA
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Pereda P, Garcia CP. Price impact of taxes on sugary drinks in Brazil. ECONOMICS AND HUMAN BIOLOGY 2020; 39:100898. [PMID: 32622931 DOI: 10.1016/j.ehb.2020.100898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 04/16/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Sugary drink consumption is an important contributor to the current global epidemic of obesity. In recent years, 50 countries or jurisdictions have implemented taxes on sugary drinks as an instrument to discourage consumption. Against the tide, Brazil reduced taxes on these beverages in 2017 and 2018. However, a recent debate - raised by the federal government - has started over taxation of sugary and alcoholic beverages (sin taxes). The effectiveness of this policy will depend on how the taxes are transferred to prices. In this sense, this paper we aim to quantify the impacts of the tax reduction on prices of sugary drinks in Brazil, and therefore to contribute to the debate by calculating the pass-through of taxes to prices of these products in the Brazilian context. We analyze the Brazilian market using a panel data of products, by brand, collected by Euromonitor from 2013 to 2018. Our results suggest that the transfer of taxes to prices depends on the firm size and the type of product, with pass-through rates ranging from 15% to 124%.
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Rogers NT, Pell D, Penney TL, Mytton O, Briggs A, Cummins S, Rayner M, Rutter H, Scarborough P, Sharp SJ, Smith RD, White M, Adams J. 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. PLoS Med 2020; 17:e1003269. [PMID: 33180869 PMCID: PMC7660521 DOI: 10.1371/journal.pmed.1003269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/18/2020] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Nina T. Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
- * E-mail:
| | - David Pell
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Tarra L. Penney
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Faculty of health, School of Kinesiology & Health Science, Keele Campus, Toronto, Canada
| | - Oliver Mytton
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Adam Briggs
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
- Warwick Medical School, University of Warwick, Division of Health Sciences, Coventry, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mike Rayner
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, United Kingdom
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, United Kingdom
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, United Kingdom
| | - Stephen J. Sharp
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Richard D. Smith
- College of Medicine and Health, University of Exeter, Medical School Building, St Luke’s Campus, Exeter, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, United Kingdom
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Moran AJ, Gu Y, Clynes S, Goheer A, Roberto CA, Palmer A. Associations between Governmental Policies to Improve the Nutritional Quality of Supermarket Purchases and Individual, Retailer, and Community Health Outcomes: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7493. [PMID: 33076280 PMCID: PMC7602424 DOI: 10.3390/ijerph17207493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 01/19/2023]
Abstract
Supermarkets are natural and important settings for implementing environmental interventions to improve healthy eating, and governmental policies could help improve the nutritional quality of purchases in this setting. This review aimed to: (1) identify governmental policies in the United States (U.S.), including regulatory and legislative actions of federal, tribal, state, and local governments, designed to promote healthy choices in supermarkets; and (2) synthesize evidence of these policies' effects on retailers, consumers, and community health. We searched five policy databases and developed a list of seven policy actions that meet our inclusion criteria: calorie labeling of prepared foods in supermarkets; increasing U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) benefits; financial incentives for the purchase of fruit and vegetables; sweetened beverage taxes; revisions to the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package; financial assistance for supermarkets to open in underserved areas; and allowing online purchases with SNAP. We searched PubMed, Econlit, PsycINFO, Web of Science, and Business Source Ultimate to identify peer-reviewed, academic, English-language literature published at any time until January 2020; 147 studies were included in the review. Sweetened beverage taxes, revisions to the WIC food package, and financial incentives for fruits and vegetables were associated with improvements in dietary behaviors (food purchases and/or consumption). Providing financial incentives to supermarkets to open in underserved areas and increases in SNAP benefits were not associated with changes in food purchasing or diet quality but may improve food security. More research is needed to understand the effects of calorie labeling in supermarkets and online SNAP purchasing.
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Affiliation(s)
- Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Yuxuan Gu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (Y.G.); (S.C.)
| | - Sasha Clynes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (Y.G.); (S.C.)
| | - Attia Goheer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Anne Palmer
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21202, USA
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35
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Falbe J. The ethics of excise taxes on sugar-sweetened beverages. Physiol Behav 2020; 225:113105. [PMID: 32712210 PMCID: PMC7377978 DOI: 10.1016/j.physbeh.2020.113105] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Sugar-sweetened beverage (SSB) taxation has emerged as a priority policy for promoting health and funding investments in communities most affected by diet-related disease. There are now 8 U.S. jurisdictions and over 40 countries that have implemented SSB taxes. Evaluations show that these policies reduce SSB consumption and purchasing while raising revenues to fund public health, education, and equity. However, there have been few analyses of the ethical considerations of SSB taxation. Using a framework for evaluating the ethics of public health interventions, this paper considers the ethical aspects of SSB excise taxes with respect to: physical health, psychosocial well-being, equality, informed choice, liberty, social and cultural values, and responsibility. Available evidence suggests there is a strong ethical case for levying SSB excise taxes on manufacturers and distributors. SSB excise taxes reduce consumption and purchasing of SSBs and are expected to meaningfully reduce obesity and diet-related morbidity and mortality. Because SSB taxes are specific to a product and its manufacturers, they are unlikely to harm psychosocial health by stigmatizing people who are overweight. SSB excise taxes should lead to greater equality because the health and social benefits are progressive (i.e., low-income individuals are likely to accrue the largest benefits from the tax, even more so when revenues are spent on health and social equity). Meanwhile, the average consumer cost burden that would result if distributors raise SSB prices in reponse to the tax is minimally regressive. Regarding liberty, SSB taxes do not eliminate the option of buying SSBs, but if SSB distributors raise SSB prices, it becomes somewhat more expensive to continue purchasing the same amount of SSBs. Meanwhile, the taxes expand beverage options by funding drinking water availability and prompting industry to expand offerings of unsweetened drinks and SSBs containing less sugar. Furthermore, by averting poor health, SSB taxes should expand overall freedom to pursue one's goals. Informed choice could be facilitated by seeing a higher SSB shelf price (which indicates a drink contains added sugar) and exposure to nutrition education funded with tax revenues. SSB taxation is unlikely to negatively interfere with social or cultural values because taxation would not eliminate having SSBs for special occasions, and SSBs are not a staple of traditional diets. Lastly, SSB taxation attributes responsibility for health in a manner that reflects industry's contribution to obesity and the multisectoral solutions that are needed to prevent diet-related disease.
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Affiliation(s)
- Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, UC Davis. 1 Shields Ave, Davis, CA, 95616, United States.
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Cawley J, Frisvold D, Jones D. The impact of sugar-sweetened beverage taxes on purchases: Evidence from four city-level taxes in the United States. HEALTH ECONOMICS 2020; 29:1289-1306. [PMID: 33463850 DOI: 10.1002/hec.4141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 06/12/2023]
Abstract
Since 2017, many US cities have implemented taxes on sugar-sweetened beverages to decrease consumption of sugary beverages and raise revenue. We analyze household receipt data to examine the impact of taxes on households' beverage purchases in the four largest US cities with such taxes: Philadelphia, PA; San Francisco, CA; Seattle, WA; and Oakland, CA. We compare changes in monthly household purchases in the treatment cities with changes in two comparison groups: (1) areas adjacent to the treatment cities or (2) a matched set of households nationally. An increase in the tax rate of 1 cent per ounce decreases household purchases of taxed beverages by 53.0 ounces per month (12.2%). This impact is consistent with a reduction in individual consumption of 5 calories per day per household member and eventual reduction in weight of 0.5 pounds. However, the decline was concentrated in Philadelphia, where the tax decreased purchases by 27.7%. There was no change in purchases of taxed beverages in the other three cities combined.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management and Department of Economics, Cornell University and NBER, Ithaca, NY, USA
| | - David Frisvold
- Department of Economics, University of Iowa and NBER, Iowa City, IA, USA
| | - David Jones
- Health Research Division, Mathematica Policy Research, Cambridge, MA, USA
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Gonçalves J, Pereira Dos Santos J. Brown sugar, how come you taste so good? The impact of a soda tax on prices and consumption. Soc Sci Med 2020; 264:113332. [PMID: 32992226 DOI: 10.1016/j.socscimed.2020.113332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Judite Gonçalves
- Nova School of Business and Economics, Universidade Nova de Lisboa, Campus de Carcavelos, Rua da Holanda 1, 2775-405, Carcavelos, Portugal.
| | - João Pereira Dos Santos
- Nova School of Business and Economics, Universidade Nova de Lisboa, Campus de Carcavelos, Rua da Holanda 1, 2775-405, Carcavelos, Portugal.
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Falbe J, Grummon AH, Rojas N, Ryan-Ibarra S, Silver LD, Madsen KA. Implementation of the First US Sugar-Sweetened Beverage Tax in Berkeley, CA, 2015-2019. Am J Public Health 2020; 110:1429-1437. [PMID: 32673112 PMCID: PMC7427219 DOI: 10.2105/ajph.2020.305795] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To identify lessons learned from implementation of the nation's first sugar-sweetened beverage (SSB) excise tax in 2015 in Berkeley, California.Methods. We interviewed city stakeholders and SSB distributors and retailers (n = 48) from June 2015 to April 2017 and analyzed records through January 2019.Results. Lessons included the importance of thorough and timely communications with distributors and retailers, adequate lead time for implementation, advisory commissions for revenue allocations, and funding of staff, communications, and evaluation before tax collection begins. Early and robust outreach about the tax and programs funded can promote and sustain public support, reduce friction, and facilitate beverage price increases on SSBs only. No retailer reported raising food prices, indicating that Berkeley's SSB tax did not function as a "grocery tax," as industry claimed. Revenue allocations totaled more than $9 million for public health, nutrition, and health equity through 2021.Conclusions. The policy package, context, and implementation process facilitated translating policy into public health outcomes. Further research is needed to understand long-term facilitators and barriers to sustaining public health benefits of Berkeley's tax and how those differ from facilitators and barriers in jurisdictions facing significant industry-funded repeal efforts.
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Affiliation(s)
- Jennifer Falbe
- Jennifer Falbe is with the Department of Human Ecology, University of California, Davis. Anna H. Grummon is with the Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. At the time of the study, Nadia Rojas was with the School of Public Health, University of California, Berkeley. Suzanne Ryan-Ibarra and Lynn D. Silver are with the Public Health Institute, Sacramento and Oakland, CA. Kristine A. Madsen is with the Division of Community Health Sciences, School of Public Health, and the Berkeley Food Institute, University of California, Berkeley
| | - Anna H Grummon
- Jennifer Falbe is with the Department of Human Ecology, University of California, Davis. Anna H. Grummon is with the Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. At the time of the study, Nadia Rojas was with the School of Public Health, University of California, Berkeley. Suzanne Ryan-Ibarra and Lynn D. Silver are with the Public Health Institute, Sacramento and Oakland, CA. Kristine A. Madsen is with the Division of Community Health Sciences, School of Public Health, and the Berkeley Food Institute, University of California, Berkeley
| | - Nadia Rojas
- Jennifer Falbe is with the Department of Human Ecology, University of California, Davis. Anna H. Grummon is with the Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. At the time of the study, Nadia Rojas was with the School of Public Health, University of California, Berkeley. Suzanne Ryan-Ibarra and Lynn D. Silver are with the Public Health Institute, Sacramento and Oakland, CA. Kristine A. Madsen is with the Division of Community Health Sciences, School of Public Health, and the Berkeley Food Institute, University of California, Berkeley
| | - Suzanne Ryan-Ibarra
- Jennifer Falbe is with the Department of Human Ecology, University of California, Davis. Anna H. Grummon is with the Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. At the time of the study, Nadia Rojas was with the School of Public Health, University of California, Berkeley. Suzanne Ryan-Ibarra and Lynn D. Silver are with the Public Health Institute, Sacramento and Oakland, CA. Kristine A. Madsen is with the Division of Community Health Sciences, School of Public Health, and the Berkeley Food Institute, University of California, Berkeley
| | - Lynn D Silver
- Jennifer Falbe is with the Department of Human Ecology, University of California, Davis. Anna H. Grummon is with the Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. At the time of the study, Nadia Rojas was with the School of Public Health, University of California, Berkeley. Suzanne Ryan-Ibarra and Lynn D. Silver are with the Public Health Institute, Sacramento and Oakland, CA. Kristine A. Madsen is with the Division of Community Health Sciences, School of Public Health, and the Berkeley Food Institute, University of California, Berkeley
| | - Kristine A Madsen
- Jennifer Falbe is with the Department of Human Ecology, University of California, Davis. Anna H. Grummon is with the Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA. At the time of the study, Nadia Rojas was with the School of Public Health, University of California, Berkeley. Suzanne Ryan-Ibarra and Lynn D. Silver are with the Public Health Institute, Sacramento and Oakland, CA. Kristine A. Madsen is with the Division of Community Health Sciences, School of Public Health, and the Berkeley Food Institute, University of California, Berkeley
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Ponce J, Yuan H, Schillinger D, Mahmood H, Lee M, Falbe J, Daniels R, Madsen KA. Retailer perspectives on sugar-sweetened beverage taxes in the California Bay Area. Prev Med Rep 2020; 19:101129. [PMID: 32612904 PMCID: PMC7322349 DOI: 10.1016/j.pmedr.2020.101129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/12/2020] [Accepted: 05/23/2020] [Indexed: 01/22/2023] Open
Abstract
The sugar-sweetened beverage (SSB) industry has claimed that food and beverage retailers are opposed to SSB taxes. In 2018 and 2019, we formally evaluated retailers' perceptions of SSB taxes using semi-structured interviews (including open- and closed-ended questions) with 103 randomly selected retailers (50 corner and liquor stores; 28 chain convenience, drug, and mass-merchandise stores; 18 chain supermarkets and discount supermarkets; and 7 independent supermarkets) across 3 cities with SSB taxes (Berkeley, Oakland, and San Francisco); interviews occurred in 2018 and 2019 (approximately 3 years, 1 year and 6 months post tax-implementation, respectively). A majority of both small and large retailers reported the tax had only a minimal effect on their business (70%). About half of retailers believed that other cities should adopt SSB taxes (53%), and were supportive of a statewide SSB tax (53%), noting it would level the playing field and better support health in their communities. Retailers' responses did not differ based on neighborhood income, and only 2 responses differed significantly between large and small retailers. Only 2 of 103 retailers reported raising the price of a non-beverage product in response to the tax, specifically raising the price of snack foods of low nutritional quality and alcoholic beverages. A majority of retailers in 3 California cities with SSB taxes have no concerns regarding the tax, endorse the health goals of SSB taxes and support statewide expansion of SSB tax policies.
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Affiliation(s)
- Julian Ponce
- University of California, Berkeley, School of Public Health, United States
| | - Haoxuan Yuan
- University of California, San Francisco, Division of General Internal Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, United States
| | - Dean Schillinger
- University of California, San Francisco, Division of General Internal Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, United States
| | - Hina Mahmood
- University of California, Berkeley, School of Public Health, United States
| | - Matthew Lee
- University of California, Berkeley, School of Public Health, United States
| | - Jen Falbe
- University of California, Davis, Human Development and Family Studies Program, Department of Human Ecology, United States
| | - Ryane Daniels
- University of California, San Francisco, Division of General Internal Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, United States
| | - Kristine A. Madsen
- University of California, Berkeley, School of Public Health, United States
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Kao KE, Jones AC, Ohinmaa A, Paulden M. The health and financial impacts of a sugary drink tax across different income groups in Canada. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100869. [PMID: 32442926 DOI: 10.1016/j.ehb.2020.100869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Overconsumption of sugar-sweetened beverages (SSBs) contributes to childhood and adult obesity and numerous related diseases, including heart disease, strokes, cancers, and type 2 diabetes. It also increases healthcare costs. Sugary drink taxes have been implemented in several countries to curb sugar intake. However, there is a concern that sugary drink taxes are regressive. This study assessed the health and financial impacts of a simulated sugary drink tax across different income groups in Canada. METHODS A proportional multi-state life table-based Markov model simulated the 2016 Canadian population by income quintile. The model applied a 20 % tax on sugary drinks and determined the effects on type 2 diabetes and BMI-related diseases compared to no intervention. The income-specific parameters modelled included: population demographics; cross- and own-price elasticities; mean BMI; sugary drink consumption; mortality; and disease epidemiology. RESULTS A 20 % sugary drink tax was estimated to reduce the consumption of sugary drinks by an average of around 15 %, with a greater reduction in the lowest income quintile. The estimated mean reduction in BMI ranged from 0.21 to 0.33, dependent upon sex and income quintile; these reductions were greater among the lower income quintiles for both females and males. The 20 % sugary drink tax was estimated to avert approximately 690,000 DALYs over a lifetime among the 2016 Canadian adult population; estimated DALYs averted were approximately 156,000, 140,000, 137,000, 134,000, and 125,000 for the lowest through to the highest income quintile, respectively. Lifetime health care savings were estimated to be $2.27bn, $2.16bn, $2.17bn, $2.12bn, and $1.98bn for the lowest through to the highest income quintile, respectively. The estimated annual tax burden for the 2016 Canadian population was $1.4bn. The average absolute tax burden was estimated to be $39.00 to $44.30 per person, with the middle-income quintile bearing the heaviest absolute tax burden. The lowest income quintile would pay the highest proportion of income in tax, implying that the tax is regressive. CONCLUSIONS Low-income Canadians would gain the most health benefit from a sugary drinks tax. However, the lowest income quintile would also pay the largest proportion of income in tax. A tax on sugary drinks is therefore financially regressive but forecast to reduce health disparities across Canada.
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Affiliation(s)
- Kai-Erh Kao
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Amanda C Jones
- Department of Public Health, University of Otago, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Mike Paulden
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
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Falbe J, Lee MM, Kaplan S, Rojas NA, Ortega Hinojosa AM, Madsen KA. Higher Sugar-Sweetened Beverage Retail Prices After Excise Taxes in Oakland and San Francisco. Am J Public Health 2020; 110:1017-1023. [PMID: 32437271 PMCID: PMC7287565 DOI: 10.2105/ajph.2020.305602] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To examine how much sugar-sweetened beverage (SSB) excise taxes increased SSB retail prices in Oakland and San Francisco, California.Methods. We collected pretax (April-May 2017) and posttax (April-May 2018) retail prices of SSBs and non-SSBs from 155 stores in Oakland, San Francisco, and comparison cities. We analyzed data using difference-in-differences high-dimensional fixed-effects regressions, weighted by regional beverage sales.Results. Across all beverage sizes, the weighted average price of SSBs increased by 0.92 cents per ounce (95% confidence interval [CI] = 0.28, 1.56) in Oakland and 1.00 cents per ounce (95% CI = 0.35, 1.65) in San Francisco, compared with prices in untaxed cities. The tax did not significantly alter prices of water, 100% juice, or milk of any size examined. Diet soda only, among non-SSBs, exhibited a higher price increase for some sizes in taxed cities.Conclusions. Within 4 to 10 months of implementation, Oakland's and San Francisco's SSB excise taxes significantly increased SSB retail prices by approximately the amount of the taxes, a key mechanism for reducing consumption.
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Affiliation(s)
- Jennifer Falbe
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Matthew M Lee
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Scott Kaplan
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Nadia A Rojas
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Alberto M Ortega Hinojosa
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
| | - Kristine A Madsen
- Jennifer Falbe is with the Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis. At the time of the study, Matthew M. Lee was with the divisions of Community Health Sciences and Epidemiology, University of California, Berkeley School of Public Health. Nadia A. Rojas and Kristine A. Madsen were with the Division of Community Health Sciences, University of California, Berkeley School of Public Health. Scott Kaplan is with the Department of Agricultural and Resource Economics, University of California, Berkeley. Alberto M. Ortega Hinojosa is with the Health Division, IMPAQ International, Oakland, CA
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Chriqui JF, Powell LM. Sugar-Sweetened Beverage Taxes: Increasing Prices to Reduce Beverage Consumption. Am J Public Health 2020. [DOI: 10.2105/ajph.2020.305682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jamie F. Chriqui
- Jamie F. Chriqui is a professor of Health Policy and Administration in the School of Public Health at the University of Illinois at Chicago (UIC) and codirector of the Health Policy Center in the Institute for Health Research and Policy at UIC. Lisa M. Powell is a distinguished professor and director of the Division of Health Policy and Administration in the School of Public Health at UIC
| | - Lisa M. Powell
- Jamie F. Chriqui is a professor of Health Policy and Administration in the School of Public Health at the University of Illinois at Chicago (UIC) and codirector of the Health Policy Center in the Institute for Health Research and Policy at UIC. Lisa M. Powell is a distinguished professor and director of the Division of Health Policy and Administration in the School of Public Health at UIC
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An Assessment of Food Store Compliance With the Cook County Sweetened Beverage Tax. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:E20-E23. [PMID: 32437118 DOI: 10.1097/phh.0000000000001017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To examine the correct application of the $0.01/ounce Cook County, Illinois, Sweetened Beverage Tax on sugar-sweetened and artificially sweetened beverages, a total of 111 beverage products were purchased from 28 food stores in September and November 2017. Purchases were categorized by taxable (sugar-sweetened and artificially sweetened soda and juice drinks) and nontaxable (100% fruit juice and sparkling water) beverage type, store type (limited service vs supermarket/grocery), and area median household income (lower vs higher). Two-sample tests of proportions were conducted to compare correctly taxed purchases. The tax was correctly applied in 91.0% of cases. Correct tax application was found in 87.8% of taxable beverage purchases versus 97.3% of nontaxable beverage purchases (P = .10), 71.4% of juice drink purchases versus 95.6% of nonjuice drink purchases (P < .001), and 85.5% of limited service store purchases versus 100% of supermarket/grocery purchases (P = .01). No significant differences were found by area income.
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Changes in Beverage Marketing at Stores Following the Oakland Sugar-Sweetened Beverage Tax. Am J Prev Med 2020; 58:648-656. [PMID: 32192801 DOI: 10.1016/j.amepre.2019.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In July 2017, Oakland, California implemented a 1 cent/ounce sugar-sweetened beverage tax. This study examined changes in store marketing practices-advertising and price promotions-for sugar-sweetened beverages, artificially sweetened beverages, and unsweetened beverages following the introduction of the tax. METHODS The study employed a quasi-experimental research design and included Oakland as the intervention site and Sacramento, California as a comparison site. Based on data collected pretax (May-June 2017), 6 months post-tax (January 2018), and 12 months post-tax (June 2018) at 249 stores across the 2 sites, exterior and interior advertising for 4 taxed sugar-sweetened beverage subtypes and 6 untaxed artificially sweetened and unsweetened beverage subtypes, as well as price promotions for 59 specific taxed products and 69 untaxed products were examined. In 2019, difference-in-differences logistic regressions estimated pre-post changes in Oakland relative to Sacramento. RESULTS At 6 months post-tax, the odds of sugar-sweetened beverage price promotions fell 50% in Oakland but only 22% in Sacramento. Price promotions for regular soda in particular declined in Oakland post-tax, by 47% at 6 months and 39% at 12 months (versus no change in Sacramento). Moreover, the odds of artificially sweetened beverage price promotions fell by a similar magnitude as sugar-sweetened beverages in Oakland, 55% at 6 months and 53% at 12 months, which differed significantly from Sacramento. No significant post-tax changes were found in sugar-sweetened or artificially sweetened beverage exterior or interior advertising. CONCLUSIONS Rather than increasing marketing, retailers and manufacturers may have tried to offset revenue losses by reducing price promotions for sugar-sweetened beverages, particularly regular soda, and artificially sweetened beverages.
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Powell LM, Leider J, Léger PT. The impact of the Cook County, IL, Sweetened Beverage Tax on beverage prices. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100855. [PMID: 32028211 DOI: 10.1016/j.ehb.2020.100855] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
This study assessed the extent to which the Cook County, IL, Sweetened Beverage Tax (SBT) of one cent per ounce (oz) on sugar-sweetened and artificially sweetened beverages was passed on to consumers in the form of higher prices. We drew on universal product code-level store scanner data and used a pre-post intervention-comparison site difference-in-differences (DID) study design to estimate the impact of the Cook County SBT on prices of taxed beverages, across product categories and sizes, as well as on prices of untaxed beverages. The DID model results showed an over-shifting of the tax with a 119% pass-through rate, on average, across all taxed beverages in Cook County compared to its comparison site. This price change represented, on average, a 34% increase in prices of taxed beverages. For untaxed beverages, prices were estimated to increase slightly by 0.04 cents per oz driven mainly by an increase in milk prices (0.12 cents per oz). We also found some heterogeneity in tax pass-through for the taxed beverages by sweetened beverage product category and size with pass-through being higher, on average, for individual-size (126%) compared to family-size (117%) beverages and higher for energy drinks (145%) compared to other sweetened beverages. Based on the baseline prices of different categories and sizes of beverages, the effective percentage increase in beverage prices resulting from the Cook County SBT ranged from a 52% increase for family-size soda to a 10% increase for family-size energy drinks.
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Affiliation(s)
- Lisa M Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Pierre Thomas Léger
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
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Powell LM, Leider J. The impact of Seattle's Sweetened Beverage Tax on beverage prices and volume sold. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100856. [PMID: 32070906 DOI: 10.1016/j.ehb.2020.100856] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
On January 1, 2018 the city of Seattle, WA, implemented a 1.75-cent per ounce (oz) Sweetened Beverage Tax (SBT) on sugar-sweetened beverages with at least 40 calories per 12 oz. This study drew on universal product code-level store scanner data and used a pre-post intervention-comparison site difference-in-differences (DID) study design to assess the impact of the SBT on taxed beverage prices in Seattle, the volume sold of taxed beverages in Seattle and in its 2-mile border area (cross-border shopping), and the volume sold of untaxed beverages (substitution) relative to changes in its comparison site of Portland, OR. The DID results showed that, on average, in the first year post-tax implementation, prices of taxed beverages rose by 1.03 cents per oz (p < 0.001) corresponding to a 59% tax pass-through rate. Volume sold of taxed beverages fell, on average, by 22% (p < 0.001) in the first year following the implementation of the tax. Volume sold of taxed beverages fell to a greater extent for family- versus individual-size beverages (31% versus 10%) and fell to a greater extent for soda (29%) compared to all other beverage types. Moderate substitution to untaxed beverages was found - volume sold of untaxed beverages increased by 4% (p < 0.05). The results revealed no significant increases in the overall volume sold of taxed beverages in the 2-mile border area of Seattle relative to its comparison site suggesting that tax avoidance in the form of cross-border shopping did not dampen the impact of the tax.
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Affiliation(s)
- Lisa M Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
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Cawley J, Frisvold D, Hill A, Jones D. Oakland's sugar-sweetened beverage tax: Impacts on prices, purchases and consumption by adults and children. ECONOMICS AND HUMAN BIOLOGY 2020; 37:100865. [PMID: 32126505 DOI: 10.1016/j.ehb.2020.100865] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Several cities in the U.S. have implemented taxes on sugar-sweetened beverages (SSBs) in an attempt to improve public health and raise revenue. On July 1, 2017, Oakland introduced a tax of one cent per ounce on SSBs. In this paper, we estimate the impact of the tax on retail prices, product availability, purchases, and child and adult consumption of taxed beverages in Oakland, as well as of potential substitute beverages. We collected data from Oakland stores and their customers and a matched group of stores in surrounding counties and their customers. We collected information in the months prior to the implementation of the tax and again a year later on: (1) prices, (2) purchase information from customers exiting the stores, and (3) a follow-up household survey of adults and child beverage purchases and consumption. We use a difference-in-differences identification strategy to estimate the impact of the tax on prices, purchases, and consumption of taxed beverages. We find that roughly 60 percent of the tax was passed on to consumers in the form of higher prices. There was a slight decrease in the volume of SSBs purchased per shopping trip in Oakland and a small increase in purchases at stores outside of the city, resulting in a decrease in purchases of 11.33 ounces per shopping trip that is not statistically significant. We find some evidence of increased shopping by Oakland residents at stores outside of the city. We do not find evidence of substantial changes in the overall consumption of SSBs or of added sugars consumed through beverages for either adults or children after the tax.
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Affiliation(s)
- John Cawley
- Cornell University and NBER, Department of Policy Analysis and Management and Department of Economics, 2312 Martha Van Rensselaer Hall, Ithaca, New York, 14850, United States.
| | - David Frisvold
- University of Iowa and NBER, Department of Economics, 21 E. Market St., Iowa City, IA, 52240, United States.
| | - Anna Hill
- Mathematica Policy Research, 955 Massachusetts Avenue, Suite 801, Cambridge, MA, 02139, United States.
| | - David Jones
- Mathematica Policy Research, 955 Massachusetts Avenue, Suite 801, Cambridge, MA, 02139, United States.
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Schmacker R, Smed S. Do prices and purchases respond similarly to soft drink tax increases and cuts? ECONOMICS AND HUMAN BIOLOGY 2020; 37:100864. [PMID: 32145515 DOI: 10.1016/j.ehb.2020.100864] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Renke Schmacker
- DIW Berlin, Mohrenstrasse 58, 10117 Berlin, Germany; Freie Universität Berlin, Garystr. 21, 14195 Berlin, Germany.
| | - Sinne Smed
- University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg, Denmark.
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Pomeranz JL, Harris JL. Children's Fruit "Juice" Drinks and FDA Regulations: Opportunities to Increase Transparency and Support Public Health. Am J Public Health 2020; 110:871-880. [PMID: 32298182 DOI: 10.2105/ajph.2020.305621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To compare children's drink products that contain or purport to contain juice and evaluate labels in light of US Food and Drug Administration (FDA) regulations.Methods. In 2019, we analyzed federal law for drinks that contain or purport to contain juice by using LexisNexis and FDA's Web site, identified top-selling children's "juice" drinks in fruit punch flavors, gathered labels in store and online, and extracted data from the principal display and information panels.Results. FDA regulations permit a wide range of names, claims, and fruit vignettes on drinks that contain or purport to contain juice, reflecting the product's flavor and not necessarily its ingredients. We identified 39 brands of children's drinks, including 100% juice (n = 7), diluted juices (n = 11), juice drinks (n = 8), fruit-flavored drinks (n = 8), and flavored waters (n = 5), with nonuniform statements of identity; vitamin C and low-sugar claims; and fruit vignettes representing 19 fruits. Many products contained added sugar and nonnutritive sweeteners but little to no juice.Conclusions. Principal display panels rendered it difficult to differentiate among product types, identify those with added sweeteners, and distinguish healthier products. Revised labeling regulations are warranted to support public health.
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Affiliation(s)
- Jennifer L Pomeranz
- Jennifer L. Pomeranz is with the School of Global Public Health, New York University, New York. Jennifer L. Harris is with the Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford
| | - Jennifer L Harris
- Jennifer L. Pomeranz is with the School of Global Public Health, New York University, New York. Jennifer L. Harris is with the Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford
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Twarog JP, Peraj E, Vaknin OS, Russo AT, Woo Baidal JA, Sonneville KR. Consumption of sugar-sweetened beverages and obesity in SNAP-eligible children and adolescents. Prim Care Diabetes 2020; 14:181-185. [PMID: 31439469 DOI: 10.1016/j.pcd.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Low-income individuals who are eligible for nutrition assistance have been shown to consume a larger portion of their daily calories from beverages with added sugar. We examined the association between Supplemental Nutrition Assistance Program (SNAP) participation and self-reported sugar sweetened beverage (SSB) consumption as well as the association between self-reported consumption of SSBs and overweight/obesity in low-income children. DESIGN Cross-sectional analysis of 1455 SNAP-eligible U.S. children, ages 2-17, who completed a questionnaire and physical examination during the 2009-2010 National Health and Nutrition Examination Survey (NHANES). RESULTS SNAP-eligible children who received SNAP in the last month were more likely to drink soda in the last month [76.0% (2.2)] than those who did not receive benefits [70.5% (2.8)]. These children were also more likely to drink fruit drinks [74.8% (1.6) vs. 69.3% (3.1)]. Among youth in households receiving SNAP benefits, soda consumption in the past month was associated with a greater risk of obesity, particularly Hispanic youth [OR=1.93 (1.07, 3.50), p=0.0314] aged 2-5 [OR=2.71 (1.29, 5.69), p=0.0114]. Additionally, among youth in households receiving SNAP benefits, male children who consumed sugar-sweetened fruit drinks in the past month were significantly more likely to be overweight [3.13 (1.12, 8.73), p=0.0315] as compared to male peers who did not consume any sugar sweetened fruit drinks. CONCLUSION Among youth, SNAP recipients drink more SSBs than their eligible non-recipient peers. Our results indicate that certain populations of children receiving SNAP benefits and consuming SSBs are more likely to be overweight or obese when compared to their peers who receive SNAP benefits but do not consume SSBs.
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Affiliation(s)
- John P Twarog
- New York College of Podiatric Medicine, New York, NY, USA.
| | - Elizabet Peraj
- New York College of Podiatric Medicine, New York, NY, USA
| | - Oren S Vaknin
- New York College of Podiatric Medicine, New York, NY, USA
| | - Ashley T Russo
- New York College of Podiatric Medicine, New York, NY, USA
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Medical Center, New York, NY, USA
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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