Abstract
Sweetened beverage taxes are associated with significant reductions in the purchase of sweetened beverages. However, it is unclear whether these taxes play a role in shifting perceptions about sweetened beverages and their health impacts. We utilized pre- and post-tax survey data collected from residents in Seattle, WA, a city that implemented a sweetened beverage tax in 2018 and from residents in an untaxed comparison area. We used income-stratified difference-in-difference linear probability models to compare net changes in the perceived healthfulness of overall sweetened beverage consumption and of different types of sugary beverages over time and across income groups. We found significant increases in the percentage of Seattle respondents with lower incomes who agreed that sweetened beverage consumption raises the risk of diabetes (DD = 9 percentage points (pp) (95% CI: 5 pp, 13 pp); p = 0.002), heart disease (DD = 7 pp (95% CI: 2 pp, 12 pp); p = 0.017), and serious health problems (DD = 12 pp (95% CI: 5 pp, 19 pp); p = 0.009), above and beyond changes in the comparison area. The most prominent changes in perceived health impacts of sweetened beverages were found among lower-income Seattle respondents, while fewer changes were found among higher-income Seattle respondents. Future work could examine the relationship between exposure to pro-tax messaging and changes in consumer perceptions of sweetened beverages.
Highlights
Over the past decade, cities and countries around the world have implemented sweetened beverage taxes with the goal of raising revenue and decreasing sweetened beverage consumption, which has been linked to diabetes and heart disease [1]
Significant relative increases were found in the percentage of Seattle respondents who agreed that sweetened beverage consumption increases the risk of serious health problems (DD = 12 percentage points; p = 0.009), diabetes (DD = 9 pp; p = 0.002), and heart disease (DD = 7 pp; p = 0.017)
We assessed changes in the perceptions of the healthfulness of sweetened beverage consumption and sweetened beverage types in Seattle and comparison areas across higher and lower income groups, before and after a sweetened beverage tax was implemented in Seattle
Summary
Cities and countries around the world have implemented sweetened beverage taxes with the goal of raising revenue and decreasing sweetened beverage consumption, which has been linked to diabetes and heart disease [1]. The media coverage associated with these taxes, along with any explicit pro- or anti-tax media campaigns, may serve to reduce sweetened beverage consumption by increasing awareness of its harms, and open a second pathway (i.e., an “awareness” pathway) by which the existence of sweetened beverage taxes may operate to change public preferences for sweetened beverages [7] Evidence against this “awareness pathway” developing in cities with sweetened beverage taxes was documented in the evaluation of Chicago’s short-lived beverage tax, whereby the purchasing of taxed beverages sharply declined immediately after implementation of the tax but returned to pre-tax levels shortly after the tax was repealed [8]. Cawley et al [10] noted that studies of beverage taxes that use a nearby comparison area find smaller differential changes in beverage consumption between taxed and nearby untaxed areas compared to studies that use a more distant comparison area; this could be due to multiple causes, including sharing a media market, confusion about which areas are taxed, and being exposed to messaging about the tax
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