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Paraje GR, Jha P, Savedoff W, Fuchs A. Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths. BMJ Glob Health 2023; 8:e011866. [PMID: 37813440 PMCID: PMC10565262 DOI: 10.1136/bmjgh-2023-011866] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol, and SSB is price-responsive and that tax changes are quickly passed on to consumers. This suggests that taxes can be highly effective in changing consumption and reducing the burden of diseases associated with consuming these products. Tobacco, alcohol, and SSB industries oppose taxation on similar grounds, mostly on the regressivity of taxes since regressive taxes take a larger percentage of income from low income earners than from middle and high income earners; but also on the effects taxes might have on employment and economic activity; and, in the case of tobacco, the effects taxation has on illicit trade.Contrary to industry arguments, evidence shows that taxation may have short-term negative financial consequences for low-income households. However, medium and long-term financial benefits from reduced healthcare costs, better health, and welfare largely compensate for such consequences. Moreover, taxation does not negatively affect aggregate economic activity or employment, as consumers switch demand to other products that generate employment and may compensate for any employment loss in taxed sectors. Evidence also shows the revenues generated are generally spent on labour-intensive services. In the case of illicit trade in tobacco, evidence shows that illicit trade has not increased globally (rather the opposite) despite increases in tobacco taxes. Profit-maximising smugglers increase illicit cigarette prices along with the increases in licit cigarette prices. This implies that even when increased taxes divert some demand to the illicit market, they push prices up in the illicit market, discouraging consumption.
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Affiliation(s)
- Guillermo R Paraje
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago de Chile, Chile
| | - Prabhat Jha
- CGHR, Centre for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Alan Fuchs
- World Bank, Washington, District of Columbia, USA
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Shen J, Wang J, Yang F, An R. Impact of soda tax on beverage price, sale, purchase, and consumption in the US: a systematic review and meta-analysis of natural experiments. Front Public Health 2023; 11:1126569. [PMID: 37808982 PMCID: PMC10556476 DOI: 10.3389/fpubh.2023.1126569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background As a primary source of added sugars in the US diet, sugar-sweetened beverage (SSB) consumption is presumed to contribute to obesity prevalence and poor oral health. We systematically synthesized and quantified evidence from US-based natural experiments concerning the impact of SSB taxes on beverage prices, sales, purchases, and consumption. Methods A keyword and reference search was performed in PubMed, Web of Science, Cochrane Library, Scopus, and EconLit from the inception of an electronic bibliographic database to Oct 31, 2022. Meta-analysis was conducted to estimate the pooled effect of soda taxes on SSB consumption, prices, passthrough rate, and purchases. Results Twenty-six natural experiments, all adopting a difference-in-differences approach, were included. Studies assessed soda taxes in Berkeley, Oakland, and San Francisco in California, Philadelphia in Pennsylvania, Boulder in Colorado, Seattle in Washington, and Cook County in Illinois. Tax rates ranged from 1 to 2 ¢/oz. The imposition of the soda tax was associated with a 1.06 ¢/oz. (95% confidence interval [CI] = 0.90, 1.22) increase in SSB prices and a 27.3% (95% CI = 19.3, 35.4%) decrease in SSB purchases. The soda tax passthrough rate was 79.7% (95% CI = 65.8, 93.6%). A 1 ¢/oz. increase in soda tax rate was associated with increased prices of SSBs by 0.84 ¢/oz (95% CI = 0.33, 1.35). Conclusion Soda taxes could be effective policy leverage to nudge people toward purchasing and consuming fewer SSBs. Future research should examine evidence-based classifications of SSBs, targeted use of revenues generated by taxes to reduce health and income disparities, and the feasibility of redesigning the soda tax to improve efficiency.
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Affiliation(s)
- Jing Shen
- Department of Physical Education, China University of Geosciences (Beijing), Beijing, China
| | - Junjie Wang
- School of Kinesiology and Health Promotion, Dalian University of Technology, Dalian, Liaoning, China
| | - Fan Yang
- School of Public Administration, Dongbei University of Finance and Economics, Dalian, Liaoning, China
| | - Ruopeng An
- Brown School, Washington University, St. Louis, MO, United States
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Silver LD, Padon AA, Li L, Simard BJ, Greenfield TK. Changes in sugar-sweetened beverage consumption in the first two years (2018 - 2020) of San Francisco's tax: A prospective longitudinal study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001219. [PMID: 36963015 PMCID: PMC10021346 DOI: 10.1371/journal.pgph.0001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/22/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sugar sweetened beverage (SSB) taxes are a promising strategy to decrease SSB consumption, and their inequitable health impacts, while raising revenue to meet social objectives. In 2016, San Francisco passed a one cent per ounce tax on SSBs. This study compared SSB consumption in San Francisco to that in San José, before and after tax implementation in 2018. METHODS & FINDINGS A longitudinal panel of adults (n = 1,443) was surveyed from zip codes in San Francisco and San José, CA with higher densities of Black and Latino residents, racial/ethnic groups with higher SSB consumption in California. SSB consumption was measured at baseline (11/17-1/18), one- (11/18-1/19), and two-years (11/19-1/20) after the SSB tax was implemented in January 2018. Average daily SSB consumption (in ounces) was ascertained using the BevQ-15 instrument and modeled as both continuous and binary (high consumption: ≥6 oz (178 ml) versus low consumption: <6 oz) daily beverage intake measures. Weighted generalized linear models (GLMs) estimated difference-in-differences of SSB consumption between cities by including variables for year, city, and their interaction, adjusting for demographics and sampling source. In San Francisco, average SSB consumption in the sample declined by 34.1% (-3.68 oz, p = 0.004) from baseline to 2 years post-tax, versus San José which declined 16.5% by 2 years post-tax (-1.29 oz, p = 0.157), a non-significant difference-in-differences (-17.6%, adjusted AMR = 0.79, p = 0.224). The probability of high SSB intake in San Francisco declined significantly more than in San José from baseline to 2-years post-tax (AOR[interaction] = 0.49, p = 0.031). The difference-in-differences of odds of high consumption, examining the interaction between cities, time and poverty, was far greater (AOR[city*year 2*federal poverty level] = 0.12, p = 0.010) among those living below 200% of the federal poverty level 2-years post-tax. CONCLUSIONS Average SSB intake declined significantly in San Francisco post-tax, but the difference in differences between cities over time did not vary significantly. Likelihood of high SSB intake declined significantly more in San Francisco by year 2 and more so among low-income respondents.
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Affiliation(s)
- Lynn D. Silver
- Prevention Policy Group, Public Health Institute, Oakland, California, United States of America
| | - Alisa A. Padon
- Prevention Policy Group, Public Health Institute, Oakland, California, United States of America
| | - Libo Li
- Alcohol Research Group, Public Health Institute, Emeryville, California, United States of America
| | - Bethany J. Simard
- Prevention Policy Group, Public Health Institute, Oakland, California, United States of America
| | - Thomas K. Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California, United States of America
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Haeck C, Lawson N, Poirier K. Estimating consumer preferences for different beverages using the BLP approach. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101138. [PMID: 35453077 DOI: 10.1016/j.ehb.2022.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
The overconsumption of sugar is a significant problem in many jurisdictions, and one possible method to remedy this problem is the taxation of sugar-sweetened beverages (SSBs). To be able to implement an optimal tax, it is important to know the preferences and price sensitivity of consumers. This article therefore estimates the price elasticity of demand for different beverages in Quebec, using the Berry, Levinsohn and Pakes (BLP) random parameter logistic demand model, combined with Nielsen data from 2010 to 2016 and the 2016 Canadian Census. The results suggest that the average consumer prefers high-calorie beverages containing fruits and vegetables, and the estimated price elasticities are between -4.40 (energy drinks) and -1.59 (regular soft drinks). As a result, consumers of energy drinks appear to reduce their consumption the most in the face of rising prices, whereas consumers of soft drinks will decrease their consumption the least. However, at a general level, the implementation of a tax on SSBs in Quebec should generate a significant reduction in consumption.
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Affiliation(s)
- Catherine Haeck
- Département de sciences économiques, Université du Québec á Montréal, 315 Rue Sainte-Catherine E, Montréal H2X 3X2, Québec, Canada
| | - Nicholas Lawson
- Département de sciences économiques, Université du Québec á Montréal, 315 Rue Sainte-Catherine E, Montréal H2X 3X2, Québec, Canada.
| | - Krystel Poirier
- Département de sciences économiques, Université du Québec á Montréal, 315 Rue Sainte-Catherine E, Montréal H2X 3X2, Québec, Canada
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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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Cawley J, Daly M, Thornton R. The effect of beverage taxes on youth consumption and body mass index: Evidence from Mauritius. HEALTH ECONOMICS 2022; 31:1033-1045. [PMID: 35297120 DOI: 10.1002/hec.4497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Taxes on sugar-sweetened beverages (SSBs) are relatively new and there is limited evidence about their impact on SSB consumption or body mass index (BMI) (as opposed to prices, purchases, or sales), their impact on youth (as opposed to adults), or their impact in non-Western nations. This paper adds to the evidence across all these dimensions by estimating the effect of an SSB tax on SSB consumption and the BMI of youth in Mauritius, an island nation in the Indian Ocean, which we compare to Maldives, another island nation which did not implement an SSB tax during the time of our data. Results of difference-in-differences models indicate that the tax in Mauritius had no detectable impact on the consumption of SSBs or the BMI of the pooled sample of boys and girls. However, models estimated separately by sex indicate that the probability that boys consumed SSBs fell by 9.4 percentage points (11%). These are among the first estimates of the effect of SSB taxes on youth consumption and contribute to the limited evidence on the impact of SSB taxes on weight, and in non-Western countries.
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Affiliation(s)
- John Cawley
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
| | - Michael Daly
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York, USA
| | - Rebecca Thornton
- Department of Economics, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Petimar J, Gibson LA, Yan J, Bleich SN, Mitra N, Trego ML, Lawman HG, Roberto CA. Sustained Impact of the Philadelphia Beverage Tax on Beverage Prices and Sales Over 2 Years. Am J Prev Med 2022; 62:921-929. [PMID: 35221175 PMCID: PMC9124672 DOI: 10.1016/j.amepre.2021.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is unclear whether changes in beverage price and sales after beverage tax implementation can be sustained long term. This study aims to quantify the changes in beverage prices and sales in large retailers 2 years after the implementation of the 1.5 cents per ounce Philadelphia beverage tax. METHODS Data on price and volume sales of beverages and potential food substitutes were collected from 109 supermarkets, 45 mass merchandizers, and 350 pharmacies in Philadelphia, Baltimore (control), and Pennsylvania ZIP codes bordering Philadelphia (to investigate potential cross-border shopping for tax avoidance). Difference-in-differences analyses compared beverage prices and volume sales in the year before tax implementation (2016) to 2 years after (2018). Data were analyzed in 2020-2021. RESULTS Difference-in-differences analyses found that after tax implementation, taxed beverage prices in Philadelphia increased by 1.02 cents per ounce (95% CI=0.94, 1.11; 68% pass through), and taxed beverage volume sales in stores decreased by 50% (95% CI=36%, 61%). After accounting for cross-border shopping, taxed beverage volume sales decreased in Philadelphia by 35% in 2018. Volume sales of nontaxed beverages did not change after tax implementation (difference-in-differences=4%, 95% CI= -3%, 12%). Volume sales of nontaxed beverage concentrates increased on average by 34% (95% CI=19%, 51%), but there was no evidence of substitution to high-calorie foods. CONCLUSIONS There was a large reduction in taxed beverage volume sales 2 years after Philadelphia tax implementation, even after accounting for cross-border shopping. Increases in nontaxed beverage concentrate sales likely partially offset this decline, but there was no evidence of post-tax food substitution.
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Affiliation(s)
- Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Laura A Gibson
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiali Yan
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marsha L Trego
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hannah G Lawman
- Division of Chronic Disease & Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Oddo VM, Knox MA, Pinero Walkinshaw L, Saelens BE, Chan N, Jones-Smith JC. Evaluation of Seattle’s Sweetened Beverage Tax on Tax Support and Perceived Economic and Health Impacts. Prev Med Rep 2022; 27:101809. [PMID: 35656219 PMCID: PMC9152812 DOI: 10.1016/j.pmedr.2022.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/03/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
It is important to understand whether the publics’ attitudes towards sugary beverage taxes (SBT) change after tax implementation to ensure the long-term success of tax policies. Seattle’s SBT went into effect on January 1, 2018. We administered a mixed-mode survey to adults in Seattle and comparison areas, pre- and 2-years post-tax, to evaluate the impact of the SBT on 1) tax support and 2) perceived tax impacts (N = 2,933). Using a difference-in-differences approach, we employed adjusted income-stratified modified Poisson models to test the impacts of the tax on net changes in attitudes in Seattle versus the comparison areas, pre- to post-tax. Among lower-income individuals in Seattle, support for the tax increased by 14% (PRDD: 1.14; 95% CI: 1.08, 1.21) and there was a 20% net-increase in the perception that the SBT would positively affect the economy (PRDD: 1.20; 95% CI: 1.05, 1.39), compared to changes in the comparison areas. Among higher-income individuals in Seattle, support for the tax was not different (PRDD: 0.93; 95% CI: 0.70, 1.22) pre- to post-tax, but there was a net-increase in the perception that the tax would have negative effects on small businesses (PRDD: 1.44; 95% CI: 1.03, 2.00) and family finances (PRDD: 1.86; 95% CI: 1.09, 3.19). After living with the tax for 2-years, support for the tax increased among lower-income individuals in Seattle. Tax support was high and unchanged among higher-income individuals, but overall attitudes became more negative. Policy makers should consider investing in ongoing campaigns that explain the benefits of SSB taxes and revenues.
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Affiliation(s)
- Vanessa M. Oddo
- University of Illinois Chicago, College of Applied Health Sciences, Department of Kinesiology and Nutrition, Chicago, IL, USA
- Corresponding author at: Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, 502A, Chicago, IL 60612, USA.
| | - Melissa A. Knox
- University of Washington, Department of Economics, Seattle, WA, USA
| | - Lina Pinero Walkinshaw
- University of Washington School of Public Health, Department of Health Systems and Population Health, 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
- Public Health - Seattle and King County, Seattle, WA, USA
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
| | - Jessica C. Jones-Smith
- University of Washington School of Public Health, Department of Health Systems and Population Health, Seattle, WA, USA
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
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Grummon AH, Roberto CA, Lawman HG, Bleich SN, Yan J, Mitra N, Hua SV, Lowery CM, Peterhans A, Gibson LA. Purchases of Nontaxed Foods, Beverages, and Alcohol in a Longitudinal Cohort After Implementation of the Philadelphia Beverage Tax. J Nutr 2022; 152:880-888. [PMID: 34910200 DOI: 10.1093/jn/nxab421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence suggests that sweetened beverage taxes reduce taxed beverage purchases, but few studies have used individual-level data to assess whether these taxes affect purchases of nontaxed foods, beverages, and alcohol. Additionally, research has not examined whether sweetened beverage taxes influence restaurant purchases. OBJECTIVES We assessed changes in individuals' purchases of taxed beverage types; low-calorie/low-added-sugar nontaxed beverages; high-calorie/high-added-sugar nontaxed beverages, foods, and alcohol; and beverages from restaurants following implementation of the 1.5 cent-per-ounce Philadelphia sweetened beverage tax. METHODS A longitudinal cohort of adult sugar-sweetened beverage consumers in Philadelphia (n = 306; 67% female; mean age: 43.9 years) and Baltimore (n = 297; comparison city without a beverage tax; 58% female; mean age: 41.7 years) submitted all food and beverage receipts during 2-week periods at baseline and at 3, 6, and 12 months posttax. Difference-in-differences analyses compared changes in purchases from pre- to posttax in Philadelphia to changes in Baltimore. RESULTS Purchases of taxed juice drinks [ratio of incidence rate ratios (RIRR) = 0.62; 95% CI, 0.42-0.91], but not other taxed beverage types, decreased in Philadelphia compared to Baltimore following the tax. Analyses did not find changes in purchases of low-calorie/low-added-sugar nontaxed beverages, such as water or milk. Additionally, analyses did not find increases in purchases of most high-calorie/high-added-sugar nontaxed products, including alcohol, juice, candy, sweet snacks, salty snacks, and desserts. Purchases of beverage concentrates increased in Philadelphia (RIRR = 2.22; 95% CI, 1.39-3.54). CONCLUSIONS In this difference-in-differences analysis, the Philadelphia beverage tax was associated with reduced purchases of taxed juice drinks. Purchases of beverage concentrates increased after the tax, but no increases were observed for other high-calorie/high-added-sugar nontaxed foods, beverages, or alcohol.
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Affiliation(s)
- Anna H Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hannah G Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jiali Yan
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sophia V Hua
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Caitlin M Lowery
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Ana Peterhans
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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10
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Grummon AH, Golden SD. Sugar-Sweetened Beverage Pricing Policies: Simulation of Minimum Price Laws and Taxes in New York City. Am J Prev Med 2022; 62:e159-e168. [PMID: 34782187 DOI: 10.1016/j.amepre.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Minimum price laws, which set a price below which a product cannot be sold, are a promising but understudied strategy for reducing the consumption of sugar-sweetened beverages. New York City has implemented a minimum price law for tobacco products and could consider this policy for sugar-sweetened beverages. This study projects the impacts of a sugar-sweetened beverage minimum price law among New York City adults, with effects of a sugar-sweetened beverage excise tax examined for comparison. METHODS In 2020-2021, a microsimulation model of dietary behaviors and body weight was developed using population-based survey data, research on responsiveness to and avoidance of price increases, and a validated weight change model. Analyses applied the model to simulate the impacts of implementing a minimum price law (8 or 10 cents/ounce price floors) or an excise tax (1 or 2 cents/ounce tax rates) on diet and body weight among New York City adults for more than 5 years. Sensitivity analyses varied assumptions about price responsiveness, caloric compensation, and avoidance. RESULTS A sugar-sweetened beverage minimum price law with an 8 cents/ounce floor would reduce average sugar-sweetened beverage intake by 16.5 calories/day (95% uncertainty interval= -17.2, -15.8) and obesity prevalence by 0.86 percentage points (95% uncertainty interval= -1.03, -0.69). Benefits were similar for a minimum price law with a 10 cents/ounce floor and for 1 and 2 cents/ounce taxes (range of obesity reductions: -0.84 to -1.24 percentage points). Benefits persisted in sensitivity analyses and were larger for Black and Hispanic than for White and Asian adults and for adults with lower than for those with higher income. CONCLUSIONS Excise taxes and minimum price laws for sugar-sweetened beverages could both reduce New York City adults' sugar-sweetened beverage consumption and obesity prevalence and narrow sociodemographic disparities in obesity.
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Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
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11
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Powell LM, Leider J. Impact of the Seattle Sweetened Beverage Tax on substitution to alcoholic beverages. PLoS One 2022; 17:e0262578. [PMID: 35041717 PMCID: PMC8765634 DOI: 10.1371/journal.pone.0262578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Taxes are increasingly used as a policy tool aimed at reducing consumption of sugar-sweetened beverages (SSBs), given their association with adverse health outcomes including type 2 diabetes, obesity and cardiovascular disease. However, a potential unintended consequence of such a policy could be that the tax induces substitution to alcoholic beverages. The purpose of this study is to examine the impact of the $0.0175 per ounce Seattle, Washington, Sweetened Beverage Tax (SBT) on volume sold of alcoholic beverages. METHODS A difference-in-differences estimation approach was used drawing on universal product code-level food store scanner data on beer (N = 1059) and wine (N = 2655) products one-year pre-tax (February-November, 2017) and one and two-years post-tax (February-November, 2018 and 2019) with Portland, Oregon, as the comparison site. RESULTS At two-years post-tax implementation, volume sold of beer in Seattle relative to Portland increased by 7% (ratio of incidence rate ratios [RIRR] = 1.07, 95% CI:1.00,1.15), whereas volume sold of wine decreased by 3% (RIRR = 0.97, 95% CI:0.95,1.00). Overall alcohol (both beer and wine) volume sold increased in Seattle compared to Portland by 4% (RIRR = 1.04, 95% CI:1.01,1.07) at one-year post-tax and by 5% (RIRR = 1.05, 95% CI:1.00,1.10) at two-years post-tax. The implied SSB cross-price elasticities of demand for beer and wine, respectively, were calculated to be 0.35 and -0.15. CONCLUSIONS There was evidence of substitution to beer following the implementation of the Seattle SSB tax. Continued monitoring of potential unintended outcomes related to the implementation of SSB taxes is needed in future tax evaluations.
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Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States of America
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States of America
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States of America
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Low-income parents’ perceptions of a sweetened beverage tax in Philadelphia. J Nutr Sci 2022; 11:e67. [PMID: 36106086 PMCID: PMC9428665 DOI: 10.1017/jns.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022] Open
Abstract
Abstract
Objective: To characterise perceptions of the Philadelphia Beverage Tax among low-income parents. Design: We conducted semi-structured interviews and administered demographic questions via telephone. We based the interview guide and initial codebook on a conceptual model illustrating perceived fairness and effectiveness as essential for successfully adopting food policies. We performed thematic analysis using NVivo 12. Setting: We recruited from a primary care paediatrics clinic in Philadelphia, Pennsylvania from July to August 2020. Participants: Philadelphia parents/caregivers of 2- to 11-year-old children with Medicaid insurance. Results: Participants were predominantly African American (97 %), female (100 %), and had annual household incomes <$50 000 (80 %). Participants were 26- to 72-years old, with an average aged child of 5 years (range 7 months to 20 years). Themes emerged regarding tax perceptions, revenue use and behaviour change due to the tax. Using revenue for highly valued programmes and accountability of city government to use revenue as promised were critical elements in perceptions of tax fairness. Some parents avoided the tax through cross-border shopping and buying drink powders or concentrates, influencing perceptions of tax effectiveness. The tax signalled the health dangers of sweetened beverage consumption to most parents. Conclusion: Our findings bring to light four key takeaways for policymakers designing sweetened beverage taxes. (1) Dedication of tax revenue to programmes highly valued by parents and (2) transparency in revenue spending may improve acceptability. (3) State or national taxes may be more effective at decreasing consumption due to cross-border shopping. (4) Pairing taxes with health promotion campaigns may enhance behaviour change.
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Asada Y, Chriqui JF, Pipito AA, Taher S, Powell LM. "Holding the City's Feet to the Fire": Lessons Learned From Oakland's Implementation of Measure HH Sugar-Sweetened Beverage Tax. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E137-E145. [PMID: 34797249 DOI: 10.1097/phh.0000000000001296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Sugar-sweetened beverage (SSB) taxes offer a promising public health strategy to decrease consumption of sugary beverages. To date, 7 US cities have successfully implemented SSB taxes; however, only a few studies have examined adoption and implementation processes. OBJECTIVES To describe public health and policy lessons learned during the first 2.5 years of implementation of the Oakland, California, penny-per-ounce SSB tax, Measure HH. DESIGN A mixed-methods, longitudinal, qualitative case study was conducted using a combination of key informant interviews with implementation stakeholders as well as analyses of archival documents and media documents from 2016 to 2019. Interviews were digitally recorded and professionally transcribed. Interview transcripts, archival documents, and media documents were analyzed by 3 coders using Atlas.ti v8. Analyses employed principles of constant comparative analysis to identify themes related to lessons learned. SETTING Oakland, California. PARTICIPANTS Key informants (n = 15), archival documents (n = 43), and media documents (n = 90). INTERVENTION Oakland, California's SSB tax (Measure HH). RESULTS Implementation lessons included both success stories and challenges. Successes included contracting a third-party tax administrator to support tax collection and education; leveraging a pro-tax coalition to counteract industry attacks and to protect tax revenue; and offering "quick win" funding to support local needs. Challenges were associated with implementing a "general" tax versus a "special" tax; the lack of explicit revenue allocation in the ordinance to support city-level implementation and oversight; and, the original ordinance language for tax application to distributors. CONCLUSIONS The study offers a range of recommendations-derived from lessons learned over several years of implementation-to policy makers and advocates engaged in SSB tax adoption and implementation efforts in their jurisdictions. SSB tax implementation requires sufficient agency administrative capacity and a strong pro-tax coalition that engages local community organizations to respond to public health needs.
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Affiliation(s)
- Yuka Asada
- Institute for Health Research and Policy (Drs Asada, Chriqui, Taher, and Powell and Ms Pipito), and Division of Health Policy and Administration, School of Public Health (Drs Chriqui and Powell), University of Illinois at Chicago, Chicago, Illinois
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Edmondson EK, Roberto CA, Gregory EF, Mitra N, Virudachalam S. Association of a Sweetened Beverage Tax With Soda Consumption in High School Students. JAMA Pediatr 2021; 175:1261-1268. [PMID: 34661612 PMCID: PMC8524354 DOI: 10.1001/jamapediatrics.2021.3991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/21/2021] [Indexed: 11/14/2022]
Abstract
Importance Sweetened beverage taxes are one policy approach to reduce intake of added sugars. Soda is the leading source of added sugars in the US diet, but few studies have examined how such taxes influence sweetened beverage intake in youth. Objective To estimate the association between the Philadelphia, Pennsylvania, beverage tax and adolescent soda intake. Design, Setting, and Participants This economic evaluation of school district-level Youth Risk Behavior Surveillance System data from September 2013 to December 2019 compared weekly soda intake in high school students in Philadelphia, a city with a sweetened beverage tax, with that in 7 comparison cities without beverage taxes. Difference-in-differences regression modeling was used to estimate change in soda intake in Philadelphia compared with control cities. Secondary analyses compared 100% juice and milk intake to explore potential substitution associations. Subgroup analyses evaluated differences by race and ethnicity and weight status (obesity and overweight or obesity). Analyses were performed between August 20 and October 20, 2020. School districts that had weighted data and a survey question on weekly soda intake from 2013 to 2019 were included. The study included high school students, grades 9 to 12, in school districts participating in the Youth Risk Behavior Surveillance System from 2013 to 2019. Exposures Implementation of a sweetened beverage tax in Philadelphia, Pennsylvania, in January 2017. Main Outcomes and Measures Reported weekly servings of soda, 100% juice, and milk. Results A total of 86 928 participants (weighted mean [SD] age, 15.8 [1.3] years; 49% female) from 8 US cities (including Philadelphia) were included. Before the tax, adolescents in the 7 comparison cities had a mean intake of 4 servings of soda per week compared with 5.4 servings per week in Philadelphia. Philadelphia's tax was associated with a reduction of 0.81 servings of soda per week (95% CI, -1.48 to -0.14 servings; P = .02) 2 years after tax implementation. There was no significant difference in 100% juice or milk intake, although Philadelphia adolescents consumed more juice than those in nontaxed cities. In subgroup analyses, the tax was associated with a reduction of 1.13 servings per week in Hispanic/Latinx adolescents (95% CI, -2.04 to -0.23 servings; P = .01) and 1.2 servings per week in adolescents with obesity (95% CI, -2.33 to -0.13 servings; P = .03). Conclusions and Relevance This economic evaluation found that a sweetened beverage tax was associated with a reduction in soda intake among adolescents, providing evidence that such taxes can improve dietary behaviors.
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Affiliation(s)
- Emma K. Edmondson
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Emily F. Gregory
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Senbagam Virudachalam
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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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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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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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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Powell LM, Leider J, Oddo VM. Evaluation of Changes in Grams of Sugar Sold After the Implementation of the Seattle Sweetened Beverage Tax. JAMA Netw Open 2021; 4:e2132271. [PMID: 34739061 PMCID: PMC8571660 DOI: 10.1001/jamanetworkopen.2021.32271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Adults and children routinely exceed recommended intake amounts of added sugars established by dietary guidelines. Taxes are used as a policy tool to reduce demand for sugar-sweetened beverages (SSBs) given consumption-related adverse health outcomes but may induce substitution to other sources of added sugars. OBJECTIVE To examine the extent to which changes in grams of sugar sold from taxed beverages may be offset by changes in grams of sugar sold from untaxed beverages, sweets, and stand-alone sugar after the implementation of the Seattle, Washington, Sweetened Beverage Tax (SBT) on January 1, 2018. DESIGN, SETTING, AND PARTICIPANTS This study used difference-in-differences analyses to examine changes in grams of sugar sold from taxed and untaxed products in Seattle compared with Portland, Oregon, at year 1 and year 2 post tax. This study used Nielsen scanner data from supermarkets and mass merchandise as well as grocery, drug, convenience, and dollar stores on unit sales and measurements for beverage and food product universal product codes (UPCs) for each site for the pretax period (January 8-December 30, 2017) and the corresponding weeks in year 1 post tax (2018) and in year 2 post tax (2019). Nutritional analyses assessed grams of sugar for each UPC. The analytical balanced sample included 1326 taxed beverage UPCs, 239 untaxed beverage UPCs, 2054 sweets UPCs, and 81 stand-alone sugar UPCs. Statistical analysis was performed from January to August 2021. EXPOSURES Implementation of the Seattle SBT. MAIN OUTCOMES AND MEASURES Changes in grams of sugar sold from taxed beverages, untaxed beverages, sweets, and stand-alone sugar. RESULTS At both year 1 and year 2 post tax in Seattle compared with Portland, grams of sugar sold from taxed beverages decreased 23% (year 2 posttax ratio of incidence rate ratios [RIRR] = 0.77; 95% CI, 0.73-0.80). Sugar sold from untaxed beverages increased at year 1 post tax by 4% (RIRR = 1.04; 95% CI, 1.00-1.07) with no change at year 2 post tax. Sugar sold from sweets increased by 4% at both year 1 and year 2 post tax (year 2 posttax RIRR = 1.04; 95% CI, 1.03-1.06). There were no changes in stand-alone sugar sold. CONCLUSIONS AND RELEVANCE This study using difference-in-differences analysis found a net 19% reduction in grams of sugar sold from taxed SSBs at year 2 post tax after accounting for changes in sugar sold from untaxed beverages, sweets, and stand-alone sugar. These results suggest that SSB taxes may effectively yield permanent reductions in added sugars sold from SSBs in food stores.
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Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, University of Illinois Chicago School of Public Health, Chicago
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago
| | - Vanessa M. Oddo
- Department of Kinesiology and Nutrition, University of Illinois Chicago College of Applied Health Sciences, Chicago
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19
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Oddo VM, Leider J, Powell LM. The Impact of Seattle's Sugar-Sweetened Beverage Tax on Substitution to Sweets and Salty Snacks. J Nutr 2021; 151:3232-3239. [PMID: 34159364 DOI: 10.1093/jn/nxab194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) taxes may have broad effects on purchases of untaxed foods, and substitution of SSBs with untaxed sweets and/or salty snacks could offset the intended dietary and health effects of these policies. OBJECTIVES To test whether there were changes in sales and calories sold for untaxed foods in response to the SSB tax in Seattle, Washington, at 12 and 24 months post-tax implementation. METHODS On 1 January 2018, the City of Seattle levied a 1.75 cents per ounce excise tax on distributors selling targeted SSBs. We utilized universal product code-level store scanner data and employed a difference-in-differences approach to assess the impacts of the tax on the changes in 1) sales of sweets and salty snacks; and 2) total calories sold for sweets in Seattle relative to changes in its comparison site of Portland, Oregon, at 12 and 24 months post-tax. RESULTS In the 12 months post-tax, sales of sweets increased by 4% [ratio of incidence rate ratios (RIRR), 1.04; 95% CI, 1.03-1.05] in Seattle relative to the changes in Portland; at 24 months post-tax, sweet sales increased by 6% (RIRR, 1.06; 95% CI, 1.05-1.07) relative to the pretax period. There was no significant change in sales of salty snacks at 12 months (RIRR, 1.00; 95% CI, 0.99-1.01) or 24 months (RIRR, 1.00; 95% CI, 0.98-1.02) post-tax. Total calories sold for sweets increased by 3% (RIRR, 1.03; 95% CI, 1.02-1.05) in Seattle compared with Portland at 12 months post-tax and by 4% (RIRR, 1.04; 95% CI, 1.02-1.05) at 24 months after implementation. CONCLUSIONS There was modest substitution of SSBs for sweets in Seattle following tax implementation. However, this increase in sales and calories sold is not likely to offset previously identified tax-related reductions in the demand for taxed beverages in Seattle. Thus, SSB taxes are a promising policy tool to reduce caloric intake in the United States.
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Affiliation(s)
- Vanessa M Oddo
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Lisa M Powell
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA.,Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
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Krieger J, Magee K, Hennings T, Schoof J, Madsen KA. How sugar-sweetened beverage tax revenues are being used in the United States. Prev Med Rep 2021; 23:101388. [PMID: 34040929 PMCID: PMC8141925 DOI: 10.1016/j.pmedr.2021.101388] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 12/03/2022] Open
Abstract
We sought to describe how revenues from sugar-sweetened beverage (SSB) excise taxes in 7 U.S. cities are being allocated, who is benefiting from these investments, and whether allocations are consistent with the original intent of tax legislation. We collected information from public documents and key informants about allocations in the most recent fiscal year available (ranging from 2018 to 2021). Across the 7 U.S. cities with taxes, the average annual revenue from SSB taxes totaled $133.9 M. In the fiscal year studied, cities allocated a total of $133.2 M in SSB tax revenues. Human and community capital investments totaled $89.6 M (67% of all allocations) funding early childhood development, community infrastructure improvements, and youth and workforce development. Health-related investments totaled $36.9 M (28% of total allocations), funding access to healthy foods and beverages; support for physical activity opportunities; promotion of overall physical, mental or social health and wellbeing; health and nutrition education; chronic-disease prevention and management; and reducing SSB consumption. In the 3 cities that specified how tax revenues would be spent, allocations were consistent with promised uses of revenues. In addition, 85% of aggregated revenues ($112.9 M) were targeted to support work and programs in impacted communities (communities that experience health inequities, discrimination and exclusion). SSB tax revenues are supporting initiatives to improve community health, develop human and community capital, and advance equity. These investments may yield additional health benefits beyond those resulting from lower SSB consumption. Consistent tracking and public reporting on revenue allocations would increase transparency and accountability.
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Affiliation(s)
- James Krieger
- University of Washington, Department of Health Services, USA
| | - Kiran Magee
- Community Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - Tayler Hennings
- Community Health Sciences, School of Public Health, University of California, Berkeley, USA
| | - John Schoof
- University of Washington, Department of Epidemiology, USA
| | - Kristine A. Madsen
- Berkeley Food Institute and the Division of Community Health Sciences, School of Public Health, University of California, Berkeley, USA
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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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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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Marinello S, Leider J, Pugach O, Powell LM. The impact of the Philadelphia beverage tax on employment: A synthetic control analysis. ECONOMICS AND HUMAN BIOLOGY 2021; 40:100939. [PMID: 33232891 DOI: 10.1016/j.ehb.2020.100939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Prevalence of obesity and other diet-related non-communicable diseases (NCDs) have continued to rise for decades in the United States. In addition to adverse health consequences, these diseases have led to substantial economic costs in the form of medical expenses and productivity losses. To address the rise in NCDs, excise taxes on sugar-sweetened beverages (SSBs) are increasingly proposed and implemented as a policy tool for improving dietary intake and population health. To date, few empirical studies have evaluated the potential unintended economic effects of these taxes. In this paper, we examine the impact of the Philadelphia, PA, sweetened beverage tax (applied to both SSBs and artificially sweetened beverages) on employment in key industries that sell sweetened beverages as well as on net total employment. Drawing on monthly employment count data from the Bureau of Labor Statistics from January 2012 through June 2019, we conducted a synthetic control analysis of total, private sector, limited-service restaurant, and convenience store employment. The synthetic controls reproduced nearly identical pre-tax employment trends to Philadelphia and had similar values of important predictors. In the post-tax period, Philadelphia employment was not lower, on average, than the synthetic control employment for each outcome. Placebo tests suggested a null effect of the tax, and the results were robust to changes in predictors and control site criteria. Overall, we did not find that the sweetened beverage tax resulted in job losses up to two and a half years after the tax was implemented. These findings are consistent with other peer-reviewed modeling and empirical papers on the employment and unemployment effects of sweetened beverage taxes.
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Affiliation(s)
- Samantha Marinello
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL, 60612-4394, USA; Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL, 60608-1264, USA.
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL, 60608-1264, USA
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL, 60608-1264, USA
| | - Lisa M Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, M/C 923, Chicago, IL, 60612-4394, USA; Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W. Roosevelt Road, M/C 275, Chicago, IL, 60608-1264, USA
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Grummon AH, Roberto CA, Krieger JW. Is the Association Between Beverage Taxes and Reductions in Sales Driven by Communication of Health Consequences in Addition to Price Increases? JAMA Netw Open 2020; 3:e2032537. [PMID: 33369657 DOI: 10.1001/jamanetworkopen.2020.32537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - James W Krieger
- Healthy Food America, Seattle, Washington
- Department of Health Services, School of Public Health, University of Washington, Seattle
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Powell LM, Leider J. Evaluation of Changes in Beverage Prices and Volume Sold Following the Implementation and Repeal of a Sweetened Beverage Tax in Cook County, Illinois. JAMA Netw Open 2020; 3:e2031083. [PMID: 33369659 PMCID: PMC7770557 DOI: 10.1001/jamanetworkopen.2020.31083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Health taxes are policy tools used to reduce harmful consumption of products and raise tax revenue, and they may also be associated with signaling (ie, informational and educational) factors that enhance their impact. OBJECTIVES To examine changes in prices and volume sold of sweetened beverages following the implementation and repeal of the Cook County, Illinois, Sweetened Beverage Tax (SBT) compared with the comparison site of St Louis County and city, Missouri, which did not impose a tax. DESIGN, SETTING, AND PARTICIPANTS This study used interrupted time series analyses to assess changes in price and volume sold of taxed (based on beverage type and sweetener status) and untaxed beverages in Cook County compared with St Louis following the implementation of the SBT on August 2, 2017, and its repeal effective December 1, 2017. Statistical analysis was performed from January to June 2020. EXPOSURES Implementation and repeal of the Cook County SBT. MAIN OUTCOMES AND MEASURES Changes in taxed and untaxed beverage prices and volume sold. Nielsen food store scanner data were obtained for weekly volume and dollar amount sold of nonalcoholic beverage universal product codes (UPCs) for each site in supermarkets and mass merchandise, grocery, drug, convenience, and dollar stores. RESULTS The analytic samples included 16 510 UPCs for volume and 2141 UPCs (balanced sample) for prices for 122 pretax weeks, 16 tax weeks, and 35 postrepeal weeks. Compared with St Louis, posttax implementation in Cook County resulted in a level increase in taxed beverage prices of 1.13 cents per fluid ounce (95% CI, 1.01 to 1.25 cents per fluid ounce), representing a slight overshifting, followed by a posttax repeal level decrease of -1.19 cents per fluid ounce (95% CI, -1.33 to -1.04 cents per fluid ounce), with no resulting change pretax to posttax repeal. Volume sold of taxed beverages in Cook County compared with St Louis exhibited a posttax implementation level decrease of 25.7% (β = -0.297; 95% CI, -0.415 to -0.179) and a posttax repeal level increase of 30.5% (β = 0.266, 95% CI, 0.124 to 0.408), with no net change in volume sold from pretax to 8 months after repeal. CONCLUSIONS AND RELEVANCE This study using interrupted time series analysis found no net change in volume sold of taxed beverages following the implementation and repeal of the Cook County SBT, suggesting the tax had no signaling association. Repeals of such taxes may fully reverse their associations with reduced demand and harms associated with sweetened beverage intake.
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Affiliation(s)
- Lisa M. Powell
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago
- Institute for Health Research and Policy, University of Illinois Chicago
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago
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Shah NS, Lloyd‐Jones DM, Kandula NR, Huffman MD, Capewell S, O’Flaherty M, Kershaw KN, Carnethon MR, Khan SS. Adverse Trends in Premature Cardiometabolic Mortality in the United States, 1999 to 2018. J Am Heart Assoc 2020; 9:e018213. [PMID: 33222597 PMCID: PMC7763768 DOI: 10.1161/jaha.120.018213] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023]
Abstract
Background Life expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race-sex groups. Methods and Results Using death certificates from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research, we quantified premature deaths (<65 years of age) from heart disease, cerebrovascular disease, and diabetes mellitus from 1999 to 2018. We calculated age-adjusted mortality rates (AAMRs) and years of potential life lost (YPLL) from each cardiometabolic cause occurring at <65 years of age. We used Joinpoint regression to identify an inflection point in overall cardiometabolic AAMR trends. Average annual percent change in AAMRs and YPLL was quantified before and after the identified inflection point. From 1999 to 2018, annual premature deaths from heart disease (117 880 to 128 832), cerebrovascular disease (18 765 to 20 565), and diabetes mellitus (16 553 to 24 758) as an underlying cause of death increased. By 2018, 19.7% of all heart disease deaths, 13.9% of all cerebrovascular disease deaths, and 29.1% of all diabetes mellitus deaths were premature. AAMRs and YPLL from heart disease and cerebrovascular disease declined until the inflection point identified in 2011, then remained unchanged through 2018. Conversely, AAMRs and YPLL from diabetes mellitus did not change through 2011, then increased through 2018. Black men and women had higher AAMRs and greater YPLL for each cardiometabolic cause compared with White men and women, respectively. Conclusions Over one-fifth of cardiometabolic deaths occurred at <65 years of age. Recent stagnation in cardiometabolic AAMRs and YPLL are compounded by persistent racial disparities.
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Affiliation(s)
- Nilay S. Shah
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Donald M. Lloyd‐Jones
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Namratha R. Kandula
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of General Internal Medicine and GeriatricsDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Mark D. Huffman
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Simon Capewell
- Institute of Population SciencesUniversity of LiverpoolUnited Kingdom
| | - Martin O’Flaherty
- Institute of Population SciencesUniversity of LiverpoolUnited Kingdom
| | - Kiarri N. Kershaw
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Mercedes R. Carnethon
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Sadiya S. Khan
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Division of CardiologyDepartment of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
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Khan SS, Greenland P. Comprehensive Cardiovascular Health Promotion for Successful Prevention of Cardiovascular Disease. JAMA 2020; 324:2036-2037. [PMID: 33231646 DOI: 10.1001/jama.2020.18731] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Senior Editor, JAMA
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Acton RB, Kirkpatrick SI, Hammond D. How Does the Probability of Purchasing Moderately Sugary Beverages and 100% Fruit Juice Vary Across Sugar Tax Structures? Obesity (Silver Spring) 2020; 28:2078-2082. [PMID: 32985126 DOI: 10.1002/oby.22992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sugar-sweetened beverage taxes are increasingly used to discourage sugar intake; however, the impact on consumer preferences for particular products is largely unknown. This study explored the impact of two tax structures (tiered vs. nontiered and inclusive vs. exclusive of 100% fruit juice) on participants' probability of purchasing moderately sugary beverages and 100% fruit juice. METHODS A sample of 3,584 Canadians aged 13 years and older completed a series of beverage purchasing tasks, each corresponding to a different tax condition, within an experimental marketplace. Tax conditions included a no-tax control, plus four taxes varying by structure (tiered vs. nontiered) and whether or not 100% fruit juice was included. RESULTS The odds of purchasing a moderately sugary beverage were higher under tiered versus nontiered taxes. Purchases of higher sugar beverages differed little across tiered versus nontiered structures. Odds of purchasing 100% fruit juice were lower when these products were taxed versus not taxed. CONCLUSIONS Results suggest that two key tax structures are likely to function as expected; taxes including 100% fruit juice products may lead to lower probability of purchasing fruit juice, and taxes incorporating multiple tiers may be more likely to encourage purchases of moderately sugary products than nontiered formats.
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Affiliation(s)
- Rachel B Acton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Zhang X, Goh GBB, Chan WK, Wong GLH, Fan JG, Seto WK, Huang YH, Lin HC, Lee IC, Lee HW, Kim SU, Chow WC, Wong VWS. Unhealthy lifestyle habits and physical inactivity among Asian patients with non-alcoholic fatty liver disease. Liver Int 2020; 40:2719-2731. [PMID: 32799384 DOI: 10.1111/liv.14638] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Lifestyle modification is the cornerstone for the management of non-alcoholic fatty liver disease (NAFLD). We aim to understand lifestyle habits of NAFLD patients, compare across Asian regions and identify area of deficiency. METHODS In the multi-centre controlled attenuation parameter (CAP)-Asia study, we collected clinical data and lifestyle habit data of NAFLD patients from Singapore, mainland China, Hong Kong, Taiwan and Malaysia. Physical activity was assessed using the International Physical Activity Questionnaire. RESULTS A total of 555 patients were included in the final analysis (mean age 54.5 ± 11.2 years, 54.1% men and median liver stiffness 6.7 kPa). More patients from mainland China (27.4%) and Taipei (25.0%) were smokers. Modest drinking was more common in Taiwan (25.0%) and Hong Kong (18.2%); only 1.3% had binge drinking. Majority of patients drank coffee (64.0%) and tea (80.2%), with varying amounts and durations in different regions. Soft drinks consumption was most common in Singapore (62.2%) and Malaysia (57.7%). Only 29.7% of patients met the Physical Activity Guidelines Recommendations, with no major differences across regions. Patients with liver stiffness <10 kPa were more likely to report any vigorous activity, and sitting time was an independent factor associated with high CAP. Tea and coffee consumption were independently associated with high CAP and liver stiffness, respectively. CONCLUSIONS Despite some heterogeneity, unhealthy lifestyle and physical inactivity are common across Asian regions. Patients with liver stiffness <10 kPa were more likely to report any vigorous activity. Healthcare providers may use the comparative data to identify areas of deficiency.
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Affiliation(s)
- Xinrong Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - George B-B Goh
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Grace L-H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yi-Hsiang Huang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - I-Cheng Lee
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Cheng Chow
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Vincent W-S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
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30
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Bleich SN, Long MW. Simple Is Better for Local Beverage Tax Policy Diffusion. Circulation 2020; 142:535-537. [PMID: 32776845 PMCID: PMC7418759 DOI: 10.1161/circulationaha.120.048336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (S.N.B.)
| | - Michael W. Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC (M.W.L.)
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Sugar-Sweetened Beverage Taxes: A Political Battle. Am J Public Health 2020; 110:929-930. [PMCID: PMC7287546 DOI: 10.2105/ajph.2020.305714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 09/11/2023]
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Abstract
OBJECTIVE To assess trends in consumption of soda, sweetened fruit drinks/sports drinks and any sugar-sweetened beverage (SSB) from 2013 to 2016 among all children in California aged 2-5 and 6-11 years and by racial-ethnic group. DESIGN Serial cross-sectional study using the California Health Interview Survey (CHIS). SETTING CHIS is a telephone survey of households in California designed to assess population-level estimates of key health behaviours. Previous research using CHIS documented a decrease in SSB consumption among children in California from 2003 to 2009 coinciding with state-level policy efforts targeting child SSB consumption. PARTICIPANTS Parents of children in California aged 2-11 years (n 4901 in 2013-2014; n 3606 in 2015-2016) were surveyed about the child's consumption of soda and sweetened fruit drinks/sports drinks on the day prior. RESULTS Among 2-5-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB remained stable. Sweetened fruit drink/sports drink consumption was higher than soda consumption in this age group. Latino 2-5- year-olds were more likely to consume any SSB in both 2013-2014 and 2015-2016 compared with Whites. Among 6-11-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB also remained stable over time. Latino and African-American 6-11-year-olds were more likely to consume an SSB in 2013-2014 compared with White children. CONCLUSIONS SSB consumption among children in California was unchanged from 2013 to 2016 and racial-ethnic disparities were evident. Increased policy efforts are needed to further reduce SSB consumption, particularly among children of Latino and African-American backgrounds.
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