Sugar-sweetened Beverage Purchases Research Articles

Stretch your SNAP: Stakeholder perspectives of a novel benefits program to enhance diet quality

ObjectiveFamilies enrolled in the Supplemental Nutrition Assistance Program (SNAP) report persistent barriers to purchasing nutritious foods. This mixed-methods study explored SNAP users’ food and beverage purchasing patterns and perspectives regarding potential modifications to SNAP to inform the design of SNAP+, a healthy incentive program to increase fruit and vegetable (FV) and decrease sugar-sweetened beverage (SSB) purchases. MethodsParticipants were recruited through a non-profit organizational network to participate in an online survey. Survey measures included: SNAP usage patterns, meal/shopping patterns, and perceptions of potential changes to SNAP. A subset (N = 28) was invited to participate in an interview to further explore these domains. Frequencies were calculated to explore trends in quantitative data, with thematic analysis applied to qualitative data. ResultsParticipants (N = 278) identified as female (81.0 %), head of household (90.8 %) and mothers (70.5 %), with most (66.5 %) using SNAP ≥ 1 year. Most spend >$15 of SNAP (87.1 %) and >$15 of non-SNAP (60.8 %) dollars on FVs/month. Respondents spend <$5 of SNAP (34.2 %) and non-SNAP (47.5 %) dollars on SSBs/month. Factors shaping purchasing behaviors included: cost (71.6 %), health (80.2 %) and avoiding waste (73.0 %). Inflation and existing purchasing patterns motivated interest in potentially enrolling in SNAP +. Diminished autonomy and a need to reallocate other funds to purchase SSBs were identified as enrollment deterrents. ConclusionSNAP users were generally receptive to modifications that would pair FV incentives with SSB restrictions, yet strategies to maintain autonomy are needed. Results can inform the design of SNAP + to enhance its potential as strategy to positively shape dietary intake patterns.

Evaluation of Changes in Prices and Purchases Following Implementation of Sugar-Sweetened Beverage Taxes Across the US

Sugar-sweetened beverage (SSB) taxes are promoted as key policies to reduce cardiometabolic diseases and other conditions, but comprehensive analyses of SSB taxes in the US have been difficult because of the absence of sufficiently large data samples and methods limitations. To estimate changes in SSB prices and purchases following SSB taxes in 5 large US cities. In this cross-sectional study with an augmented synthetic control analysis, changes in prices and purchases of SSBs were estimated following SSB tax implementation in Boulder, Colorado; Philadelphia, Pennsylvania; Oakland, California; Seattle, Washington; and San Francisco, California. Changes in SSB prices (in US dollars) and purchases (volume in ounces) in these cities in the 2 years following tax implementation were estimated and compared with control groups constructed from other cities. Changes in adjacent, untaxed areas were assessed to detect any increase in cross-border purchases. Data used for this analysis spanned from January 1, 2012, to February 29, 2020, and were analyzed between June 1, 2022, and September 29, 2023. The main outcomes were the changes in SSB prices and volume purchased. Using nutritional information, 5500 unique universal product codes were classified as SSBs, according to tax designations. The sample included 26 338 stores-496 located in treated localities, 1340 in bordering localities, and 24 502 in the donor pool. Prices of SSBs increased by an average of 33.1% (95% CI, 14.0% to 52.2%; P < .001) during the 2 years following tax implementation, corresponding to an average price increase of 1.3¢ per oz and a 92% tax pass-through rate from distributors to consumers. SSB purchases declined in total volume by an average of 33.0% (95% CI, -2.2% to -63.8%; P = .04) following tax implementation, corresponding to a -1.00 price elasticity of demand. The observed price increase and corresponding volume decrease immediately followed tax implementation, and both outcomes were sustained in the months thereafter. No evidence of increased cross-border purchases following tax implementation was found. In this cross-sectional study, SSB taxes led to substantial, consistent declines in SSB purchases across 5 taxed cities following price increases associated with those taxes. Scaling SSB taxes nationally could yield substantial public health benefits.

Soda Taxes and Marketing Conduct

Soda taxes are an increasingly popular policy tool that discourages purchases of sugar-sweetened beverages. This study analyzes how emphasis on marketing conduct elements and their effectiveness might change after soda tax introductions. Prior studies on the effect of soda taxes focus on price increases but neglect other relevant marketing conduct tools (i.e., promotional frequency, promotional discount depth, and feature promotion frequency). This study documents the changes to marketing conduct elements and their effectiveness due to the introduction of soda tax across more than 200 retail stores in five markets. Findings related to price changes are consistent with prior literature; in addition, the study reveals a substantial, hitherto overlooked decrease in promotional frequency (−2%), promotional depth (−12%), and feature promotion frequency (−14%) compared with matched control markets, exacerbating the tax's negative sales effect. Introducing a soda tax also considerably influences the marketing conduct's effectiveness, such that consumers become less sensitive to changes in regular price, feature promotions, and the depth of the promotional discount but respond more to the presence of promotions. Importantly, marketing conduct and effectiveness changes do not align (e.g., while consumers become more sensitive to promotion frequency, managers often reduce them), a relevant insight for policy making.

A New Wave of Sugar-Sweetened Beverage Taxes: Are They Meeting Policy Goals and Can We Do Better?

Little progress has been made in reducing deaths from chronic noncommunicable diseases associated with being overweight or obese worldwide, prompting the World Health Organization and others to recommend the implementation of taxes on sugar-sweetened beverages (SSBs). In response, SSB taxes have been widely implemented over the last decade, and a burgeoning literature aims at understanding their effects. We assess the state of knowledge regarding the impacts of SSB taxes and provide context for the results reported to date based on the recent consumer behavior literature and incentives of supply-chain intermediaries in modern food markets. Evidence suggests only a portion of a tax on distributors or manufacturers is passed forward to consumers, inducing only mild and highly variable impacts on SSB purchases. We argue that the literature provides no consistent evidence that SSB taxes have incentivized increased purchases of healthier beverages and caused overall SSB consumption to decrease. Finally, we consider the efficacy of SSB taxes, alone or in combination with other policies, as part of jurisdictions’ policy goals, including promoting healthier diets, generating revenue, and improving equity.

Cost-benefit analysis of alternative tax policies on sugar-sweetened beverages in Mexico.

In 2014, Mexico implemented a tax on sugar-sweetened beverages (SSB) equivalent to one Mexican peso (MP) per liter to address the high obesity prevalence. This tax has effectively reduced SSB purchases and yielded healthcare savings; however, it remains unknown whether SSB taxes lead to net benefits at the societal level in Mexico. Moreover, public health experts recommend increasing the tax. The objective of this study is to estimate the net benefits of SSB taxes compared to a scenario of no tax in urban Mexico. Taxes include the one-MP tax and alternative higher taxes (two and three MP per SSB liter). Thus, we conducted a cost-benefit analysis from the perspective of the government, producers, and consumers for a simulated closed cohort of adults in a life-table model. We defined net benefits as the difference between economic benefits (the value of statistical life, healthcare savings, and tax revenue) and costs (consumer surplus and profit losses). We found that, at the societal level, all simulated taxes will eventually generate benefits that surpass costs within ten years. Overall net benefits can reach USD 7.1 billion and 15.3 billion for the one-MP and the three-MP tax, respectively. Hence, these benefits increased at a declining rate compared to taxes. The government and consumers will experience overall positive net benefits among society's members. Policymakers should consider time horizons and tradeoffs between health gains and economic outcomes across different society members.

Impact of soda tax on beverage price, sale, purchase, and consumption in the US: a systematic review and meta-analysis of natural experiments.

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. 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. 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). 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.

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents.

Grocery store environments are recognized as one of the most crucial community settings for developing and maintaining healthy nutritional behaviors in children. This is especially true for disadvantaged ethnic minority families, such as immigrants, who reside in the Detroit Metropolitan area and have historically experienced inequities that result in poor health outcomes. Rates of obesity and type II diabetes have affected Detroit 38% more than the rest of the state and nationwide. In 2019, almost 54% of children aged 0-17 in Metro Detroit lived in poverty, and 21.6% experienced food insecurity, compared with the state level of 14.2%. Moreover, nearly 50% of ethnic minority children in Metro Detroit consume sports drinks, and 70% consume soda or pop in an average week. The primary purpose of this study was to explore immigrant parents' perspectives on (1) how in-store Sugar-Sweetened Beverage (SSB) marketing impacts the purchasing behaviors of parents and the eating behaviors of toddlers, and the secondary objective was to (2) determine strategies to reduce SSB purchases and consumption within grocery environments from the viewpoints of immigrant parents. A qualitative multiple-case study design was used to achieve the aims of this study. Semi-structured individual interviews were completed with 18 immigrant parents of children aged 2 to 5 years old who were consumers in 30 independently owned full-service grocery stores within the immigrant enclaves of Detroit, Dearborn, Hamtramck, and Warren, Michigan. Three key thematic categories emerged from the parents' narratives. These themes were: (1) non-supportive grocery store environments; (2) acculturation to the American food environment; and (3) strategies to support reduced SSB consumption among young immigrant children. The findings of this study revealed widespread SSB marketing targeting toddlers within the participating independently owned grocery stores. Even if families with young children practiced healthy nutritional behaviors, the prices, placements, and promotion of SSBs were challenges to establishing and sustaining these healthy eating habits. The parents believed that planning and implementing retail-based strategies in collaboration with families and considering families' actual demands would assist in managing children's eating patterns and reducing early childhood obesity.

Changes in Food and Beverage Purchases Associated With the Coronavirus Disease Pandemic in Mexico

BackgroundPublic policies to contain the spread of coronavirus disease in Mexico could have had an effect on food purchase patterns. ObjectiveThe objective of the study was to assess changes in the quantity of food and beverages purchased and proportion spent on food consumed away from home during the coronavirus disease pandemic in Mexican households. DesignThis study is a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey 2014-2020. Participants/settingThe study included 234,631 households with information on food and beverages purchases from 2014 to 2020. Main outcome measuresFood and beverage purchases were classified into six categories: basic, nonbasic energy-dense foods, prepared food for consumption at home, water, milk, and sugar-sweetened beverages. In the National Household Income and Expenditure Survey 2014-2020, expenditures on food and beverages consumed away from home are not classified into any specific items but represents more than 10% of food and beverage expenditures; therefore, the analyses included the proportion of food and beverage expenditures spent on food consumed away from home. Statistical analyses performedA two-part model was used to evaluate changes in the quantity of food purchased and the proportion spent away from home during the coronavirus disease pandemic in 2020 compared with 2018, adjusting for socio-demographic variables, gross domestic product and previous survey rounds. Results are presented at the national level, by income quintile and by place of residence. ResultsPurchases of basic food increased by 17 g/capita/day at the national level and 22.4 g/capita/day in urban areas (P < 0.001). Purchases of nonbasic energy-dense foods decreased both at the national level (–4.2 g/capita/day; P < 0.001) and by place of residence (–4.8 g/capita/day; P < 0.001 in urban areas and –2.5 g/capita/day; P = 0.001 in rural settings). Purchases of prepared food increased 16 g/capita/day (P < 0.001). In rural areas, purchases of sugar-sweetened beverages increased 7.2 mL/per capita/day (P < 0.001). For the lowest income quintile purchases of processed meat increased 2.4 g/capita/day (P < 0.001). The proportion spent on food consumed away from home decreased by –44.9% (P < 0.001). ConclusionsResults of this study show that during the coronavirus disease lockdown there was an increase in basic and prepared food purchases, whereas purchases of nonbasic energy-dense foods and the proportion spent on food consumed away from home decreased. However, findings showed an increase in sugar-sweetened beverages purchases among rural dwellers and an increase in purchases of processed meat among the lowest income quintile. Various factors such as income reductions, unemployment, mobility restrictions, or increases in prices may have led the observed changes. Future research should be conducted to analyze these potential pathways.

How pictorial warnings change parents’ purchases of sugar-sweetened beverage for their children: mechanisms of impact

BackgroundPictorial health warnings on sugar-sweetened beverages (SSBs) are a promising policy for preventing diet-related disease in children. A recent study found that pictorial warnings reduced parents’ purchases of SSBs for their children by 17%. However, the psychological mechanisms through which warnings affect parental behavior remain unknown. We aimed to identify the mechanisms that explain how pictorial warnings affect parents’ SSB purchasing behavior for their children using secondary data from a randomized trial.MethodsIn 2020–2021, parents of children ages 2 to 12 years (n = 325) completed a shopping task in a convenience store laboratory in North Carolina, USA. Participants were randomly assigned to a pictorial warnings arm (SSBs displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (SSBs displayed a barcode label). Parents then bought a beverage for their child and took a survey measuring 11 potential psychological mediators, selected based on health behavior theories and a model explaining the impact of tobacco warnings. We conducted simple mediation analyses to identify which of the 11 mechanisms mediated the impact of exposure to pictorial warnings on purchasing any SSBs for their children.ResultsTwo of the 11 constructs were statistically significant mediators. First, the impact of pictorial warnings on the likelihood of purchasing any SSB was mediated by parents’ perceptions that SSBs were healthier for their child (mediated effect= −0.17; 95% CI = − 0.33, − 0.05). Second, parents’ intentions to serve SSBs to their children also mediated the effect of warnings on likelihood of purchasing any SSB (mediated effect= −0.07, 95% CI=-0.21, − 0.003).ConclusionsPictorial warnings reduced parents’ purchases of SSBs for their children by making parents think SSBs are less healthful for their children and reducing their intentions to serve SSBs to their children. Communication approaches that target healthfulness perceptions and intentions to serve SSBs may motivate parents to buy fewer SSBs for their children.

Evaluation of the sugar-sweetened beverage tax in Oakland, United States, 2015-2019: A quasi-experimental and cost-effectiveness study.

While a 2021 federal commission recommended that the United States government levy a sugar-sweetened beverage (SSB) tax to improve diabetes prevention and control efforts, evidence is limited regarding the longer-term impacts of SSB taxes on SSB purchases, health outcomes, costs, and cost-effectiveness. This study estimates the impact and cost-effectiveness of an SSB tax levied in Oakland, California. An SSB tax ($0.01/oz) was implemented on July 1, 2017, in Oakland. The main sample of sales data included 11,627 beverage products, 316 stores, and 172,985,767 product-store-month observations. The main analysis, a longitudinal quasi-experimental difference-in-differences approach, compared changes in beverage purchases at stores in Oakland versus Richmond, California (a nontaxed comparator in the same market area) before and 30 months after tax implementation (through December 31, 2019). Additional estimates used synthetic control methods with comparator stores in Los Angeles, California. Estimates were inputted into a closed-cohort microsimulation model to estimate quality-adjusted life years (QALYs) and societal costs (in Oakland) from 6 SSB-associated disease outcomes. In the main analysis, SSB purchases declined by 26.8% (95% CI -39.0 to -14.7, p < 0.001) in Oakland after tax implementation, compared with Richmond. There were no detectable changes in purchases of untaxed beverages or sweet snacks or purchases in border areas surrounding cities. In the synthetic control analysis, declines in SSB purchases were similar to the main analysis (-22.4%, 95% CI -41.7% to -3.0%, p = 0.04). The estimated changes in SSB purchases, when translated into declines in consumption, would be expected to accrue QALYs (94 per 10,000 residents) and significant societal cost savings (>$100,000 per 10,000 residents) over 10 years, with greater gains over a lifetime horizon. Study limitations include a lack of SSB consumption data and use of sales data primarily from chain stores. An SSB tax levied in Oakland was associated with a substantial decline in volume of SSBs purchased, an association that was sustained more than 2 years after tax implementation. Our study suggests that SSB taxes are effective policy instruments for improving health and generating significant cost savings for society.

Changes in sugar-sweetened beverage purchases across the price distribution after the implementation of a tax in Mexico: a before-and-after analysis

BackgroundA tax of one-Mexican peso per liter of sugar-sweetened beverage (SSB) came into effect in January 2014 in Mexico as a national health policy to tackle the high overweight and obesity prevalence. Previous studies have shown an overall reduction in SSB purchases after the tax implementation. However, it remains unknown whether and to what extent SSB consumers switched to cheaper taxed beverages, attenuating the potential effect of the policy. Our study’s objective was to estimate changes in household purchases of taxed SSBs by tertiles of SSB prices (low, middle, and high) in urban areas after the SSB tax implementation in 2014.MethodsBased on purchase data for 2012–2015 from households living in 54 Mexican cities with a population > 50,000 inhabitants, we calculated unit-value SSB prices for the full period and sorted them on a monthly basis to create monthly price tertiles. We merged these price tertiles to household purchases and created average monthly ml/capita/day SSB purchases by price tertile at the city level. We assessed SSB purchase switching patterns before and after the tax implementation through price-tertile stratified linear models. The main variable in the models was a dummy indicator that allowed us to identify the pre-tax period (2012–13) and post-tax period (2014–15). We controlled our models for time trends and contextual economic variables.ResultsIn the regression adjusted models, we found a statistically significant purchase reduction ranging between 10.80 and 13.79 ml/capita/day (p-value < 0.001) across taxed beverages from the middle-price SSB after the tax implementation. We observed no statistically significant reductions in purchases of low-price SSBs and high-price SSBs.ConclusionsOur findings show purchase reductions in the middle-price SSBs, which represents ≈30% of the overall SSB purchases in urban Mexico. Future studies should be conducted to test if the redesign of the current the tax, by either doubling the tax amount or taxing sugar content, might reduce more effectively purchases across all SSBs.

Sugar-sweetened beverage purchases in urban Peru before the implementation of taxation and warning label policies: a baseline study

BackgroundSugar-sweetened beverage consumption is associated with obesity and chronic disease. In 2018, Peru increased the tax on high-sugar beverages (≥6 g of sugar per 100 mL) from 17 to 25%, yet little is known about pre-existing beverage trends or demographic characteristics associated with purchases in the country. The aim of this study was to explore beverage purchasing trends from 2016 to 2017 and examine variation in purchase volume by sociodemographic characteristics among urban households in Peru.MethodsThis study used monthly household purchase data from a panel of 5145 households from January 2016–December 2017 from Kantar WorldPanel Peru. Beverage purchases were categorized by type and tax status under the 2018 regulation (untaxed, lower-sugar taxed, high-sugar taxed). To assess beverage purchasing trends, per-capita volume purchases were regressed on a linear time trend, with month dummies for seasonality and clustered standard errors. Mean volume purchases by beverage tax status (total liters purchased per month), overall and by key demographic characteristics (education, socioeconomic status, and geographic region), were calculated. Mean volume by beverage type was assessed to identify the largest contributors to total beverage volume.ResultsThe trends analysis showed a decline in total beverage volume of − 52 mL/capita/month (95% CI: − 72, − 32) during the 24-month study period. Over 99% of households purchased untaxed beverages in a month, while > 92% purchased high-sugar taxed beverages. Less than half of all households purchased low-sugar taxed beverages in a month and purchase volume was low (0.3 L/capita/month). Untaxed beverage purchases averaged 9.4 L/capita/month, while households purchased 2.8 L/capita/month of high-sugar taxed beverages in 2017. Across tax categories, volume purchases were largest in the high education and high socioeconomic (SES) groups, with substantial variation by geographic region. The highest volume taxed beverage was soda (2.3 L/capita/month), while the highest volume untaxed beverages were milk and bottled water (1.9 and 1.7 L/capita/month, respectively).ConclusionsNearly all households purchased high-sugar taxed beverages, although volume purchases of taxed and untaxed beverages declined slightly from 2016 to 2017. Households with high SES and high education purchased the highest volume of taxed beverages, highlighting the need to consider possible differential impacts of the tax policy change by sub-population groups.

Making A Dent in the Obesity Equation via Coupling Sugar-Sweetened Beverage Taxes with Fruit and Vegetable Subsidies

Obesity rates continue to rise in children and adults alike in the United States and represent a significant threat to public health and economic well-being. Many factors have contributed to the obesity equation, including the widespread availability and appeal of ultra-processed food and drink. Sugar-sweetened beverages (SSBs) represent one such drink, as a critical examination of the available evidence reveals a clear link between their consumption and increased risks of obesity and related conditions such as type 2 diabetes. Taxing SSB purchases therefore presents a potentially valuable means of making a dent in the contribution of one key risk factor to the obesity equation, though the beverage industry has fought against the enactment of these taxes and has instead promoted a generally unclear public health stance on SSBs. This paper explores existing SSB excise taxes that have been implemented in recent years, focusing especially on Philadelphia’s tax as a case study for examining the behavioral changes associated with SSB taxes and the management of SSB tax revenue. It then suggests that SSB tax revenue be directly funneled into the subsidization of fruits and vegetables to maximize the obesity-fighting potential of these relatively novel excise taxes.

Sugar-sweetened beverage consumption and socioeconomic status: A systematic review and meta-analysis.

Sugar-sweetened beverages (SSB) are an independent risk factor for obesity and other non-communicable diseases. Socioeconomic status (SES) is one of the key drivers for the purchase and consumption of SSBs among children and adults; however, there is a lack of strong evidence. This study aims to determine the association between SES and consumption patterns of SSBs across populations. The review was conducted according to PRISMA guidelines. PubMed, MEDLINE, Scopus, EMBASE, LILACS, Web of Science, Cochrane, and CINHAL databases were searched for relevant articles until 2022. Participants included children, adolescents, and adults who consumed different SSBs and were assessed based on their SES. The random-effects model was used to obtain the pooled odds ratio (OR). Twenty-one studies (152,070 participants) met the inclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa tool, with the majority of the studies indicating medium to high quality. Eight ORs from four studies (34,454 participants) were considered for meta-analysis. Results showed those belonging to high SES had 48% lower odds of consuming the SSBs (OR 0.52; 95% CI: 0.42-0.61; p = 0.017). The overall quality of evidence was ascertained using GRADE criteria, illustrating a moderate certainty of evidence between SSB consumption and SES. Meta-analysis suggests that SES influences the consumption pattern of SSBs, with high SES having lower odds of SSB consumption.

Simulation models of sugary drink policies: A scoping review.

Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.

Effect of excise tax on sugar-sweetened beverages in Catalonia, Spain, three and a half years after its introduction

BackgroundThe World Health Organisation urges countries to levy specific excise taxes on SSBs. Currently, more than 50 countries have introduced some type of tax on SSBs. In March 2017, the Autonomous Region of Catalonia approved the introduction of a tiered excise tax on SSBs for public health reasons. To evaluate the effect of the Catalonian excise tax on the price and purchase of sugar-sweetened beverages (SSBs) and their possible substitutes, i.e., non-sugar-sweetened beverages (NSSBs) and bottled water, three and half years after its introduction, and 1 year after the outbreak of the COVID-19 pandemic.MethodsWe analysed purchase data on soft drinks, fruit drinks and water, sourced from the Ministry of Agriculture food-consumption panel, in a random sample of 12,500 households across Spain. We applied the synthetic control method to infer the causal impact of the intervention, based on a Bayesian structural time-series model which predicts the counterfactual response that would have occurred in Catalonia, had no intervention taken place.ResultsAs compared to the predicted (counterfactual) response, per capita purchases of SSBs fell by 0.17 l three and a half years after implementing the SSB tax in Catalonia, a 16.7% decline (95% CI: − 23.18, − 8.74). The mean SSB price rose by 0.11 €/L, an 11% increase (95% CI: 9.0, 14.1). Although there were no changes in mean NSSB prices, NSSB consumption rose by 0.19 l per capita, a 21.7% increase (95% CI: 18.25, 25.54). There were no variations in the price or consumption of bottled water. The effects were progressively greater over time, with SSB purchases decreasing by 10.4% at 1 year, 12.3% at 2 years, 15.3% at 3 years, and 16.7% at three and a half years of the tax’s introduction.ConclusionsThe Catalonian SSB excise tax had a sustained and progressive impact over time, with a fall in consumption of as much as 16.7% three and half years after its introduction. The observed NSSB substitution effect should be borne in mind when considering the application of this type of tax to the rest of Spain.

The Impact of Sugar-Sweetened Beverage Taxes by Household Income: A Multi-City Comparison of Nielsen Purchasing Data.

Due to the role that sugar-sweetened beverages (SSBs) play in the obesity epidemic, SSB taxes have been enacted in the United States in the California cities of Albany, Berkeley, Oakland, and San Francisco, as well as in Boulder, Philadelphia, and Seattle. We pooled five years of Nielsen Consumer Panel and Retail Scanner Data (2014–18) to examine purchasing behaviors in and around these cities that have instituted SSB taxes. We included households that were either subject to the tax during the study period or were in surrounding areas within the same state. The goal was to test for the differential impact of SSB taxes by income level and type of tax. Multivariate analyses of beverage purchases found that (1) there is a dose–response relationship with the size of the SSB tax; (2) the Philadelphia tax, which is the only one that includes low-calorie beverages, is associated with greater reductions in SSB purchases and an increase in bottled water purchase; and (3) approximately 72% of the tax is passed through to consumers, but this does not vary by income level of the household. Few income-related effects were detected. Overall, our findings suggest that the Philadelphia model may be the most effective at encouraging healthy habits in beverage choice.

Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor

US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers. We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects. Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation.Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.

Sugar-sweetened beverage purchases and intake at event arenas with and without a portion size cap

This is the first real-world study to examine the association between a voluntary 16-ounce (oz) portion-size cap on sugar-sweetened beverages (SSB) at a sporting arena on volume of SSBs and food calories purchased and consumed during basketball games. Cross-sectional survey data from adults exiting a Brooklyn, NY, USA arena (Barclays, n = 464) with a 16-oz portion-size restriction and a Manhattan, NY, USA arena with no portion-size restriction (Madison Square Garden, control, n = 295) after the portion cap policy was put in place from March through June 2014 were analyzed. Linear regression models adjusting for sex, age, BMI, ethnicity, race, marital status, education, and income were used to compare the two arenas during the post-implementation period. The survey response rate was 45.9% and equivalent between venues. Among all arena goers, participants at Barclays purchased significantly fewer SSB oz (−2.24 oz, 95% CI [−3.95, −0.53], p = .010) and consumed significantly fewer SSB oz (−2.34 oz, 95% CI[−4.01, −0.68], p = .006) compared with MSG after adjusting for covariates. Among those buying at least one SSB, Barclays’ participants purchased on average 11.03 fewer SSB oz. (95% CI = [4.86, 17.21], p < .001) and consumed 12.10 fewer SSB oz (95% CI = [5.78, 18.42], p < .001). There were no statistically significant differences between arenas in food calories and event satisfaction. In addition, no one reported not ordering a drink due to small size. An SSB portion-size cap was associated with purchasing and consuming fewer SSB oz. without evidence of decreasing satisfaction with the event experience.

Large State Variation in Sugar-Sweetened Beverage Purchases: What We Learn from the Beverage Industry Data.

ABSTRACTNegative health consequences of excessive sugar-sweetened beverage (SSB) consumption have prompted recommendations for SSB taxation to improve diet and health. Over 40 countries and 8 local US jurisdictions have implemented SSB taxes to date. There is considerable interest in state SSB taxes in the USA, but state-level data on SSB consumption levels is lacking. This article uses proprietary data from the Beverage Marketing Corporation on beverage sales across all US retail channels to estimate state-level per capita SSB purchases in 2021. There is considerable variation in per capita SSB purchases across states, from an estimated annual 23.5 gallons (89.1 L) in Hawaii to 51.8 gallons (196.1 L) in Missouri. Current average levels of SSB purchases at 13 ounces (0.38 L) daily leave little to no room for added sugars from all other sources. Policymakers in states with extra-high SSB purchases, especially in the Midwest, should consider effective evidence-based policies, including fiscal approaches, to increase awareness about SSB risks, encourage healthier beverage choices, and improve population diet.