Beverage Tax Research Articles

Implementing policies and programmes to reduce the impact of globalisation on oral health in Pacific Island Countries and Territories

Very little research focuses explicitly on oral health in Pacific Islands countries and territories (PICT). However, oral health will continue to be a concern if policies, programmes, and strategies are not implemented to reduce poor oral health and inequitable outcomes that will affect many Pacific communities. A review of available studies written between 1969 and 2018 shows that dental caries and periodontal diseases were identified as the most significant oral health issue in PICT. The globalisation of imported food products that are high in sugary content has further exacerbated the increase in DMFT (decayed, missing or filled teeth). With the introduction of tobacco, there have also been many oral health issues with oral cancer, periodontal disease, and periodontitis. There is a need for a sugar tax policy, food policy changes, tobacco policy and the removal tax of oral health products in PICT. In addition, most oral health services are provided in the hospitals and often work within their own departments whereas they might be better working closely with other departments such as the public health team or the education sector so, therefore, there needs to be a coordinated collaboration approach with other services that can promote good oral health policies and health promotion activities.

Using supermarket loyalty card data to measure the differential impact of the UK soft drink sugar tax on buyer behaviour

AbstractThis paper explores the impact of the soft drinks sugar tax introduced in the UK in 2018 on the purchasing behaviours of different geo‐demographic consumer segments. We analyse data for a composite good comprising the most popular sugar‐sweetened drinks (SSDs) using loyalty card data from one of the UK’s largest supermarkets. We use pre‐levy data to predict the effect of the tax and corroborate our predictions by analysing actual consumption of the composite good in the first 5 months post‐levy. The results show that the impact of the sugar tax is likely to have the desired effect of reducing the purchase of SSDs. Moreover, though the impact of the tax is likely to vary across different geo‐demographic segments, the evidence suggests that its impact is likely to be greatest on the most vulnerable market segments – families on low incomes – who are among the highest consumers of SSDs in the UK.

Analysis of Public Testimony About Philadelphia's Sweetened Beverage Tax

Although interest in beverage taxes has increased in recent years, industry opposition and other challenges have limited their spread in the U.S. Because beverage tax proposals are often unsuccessful, there is limited empirical evidence to inform advocacy efforts. Philadelphia's 1.5 cent-per-ounce tax on sweetened beverages provides an opportunity to understand how public testimony for and against the tax was framed in a city that ultimately passed the policy. A content analysis of all public testimony about the beverage tax presented to the Philadelphia City Council in 2016 was conducted. Testimonies were coded for policy stance (protax or antitax), speaker type, and specific protax or antitax arguments. Quantitative data were analyzed in 2018-2019 using chi-square tests. A total of 177 unique testimonies were identified, which included 40 protax arguments (grouped into 11 themes) and 31 antitax arguments (grouped into 10 themes). Most testimonies were delivered orally, and most speakers argued in favor of the tax (58%). Among tax supporters, funding early childhood education was the most common argument (71%), whereas tax opponents most frequently argued that sugar-sweetened beverages were the wrong target for the tax (50%). This analysis of public testimony revealed that protax advocacy efforts highlighted the revenue benefits for early childhood education and community infrastructure rather than the tax's potential to reduce sweetened beverage consumption and improve health. By contrast, antitax arguments centered on the unfairness of targeting a single industry, potential negative economic impacts, and the perceived lack of evidence that the tax would influence consumer behavior.

Evaluation of Changes in Grams of Sugar Sold After the Implementation of the Seattle Sweetened Beverage Tax

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. 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. 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. Implementation of the Seattle SBT. Changes in grams of sugar sold from taxed beverages, untaxed beverages, sweets, and stand-alone sugar. 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. 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.

Longer-term impacts of the Oakland, California, sugar-sweetened beverage tax on prices and volume sold at two-years post-tax

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.

The Effect of Price Changes and Teaspoon Labelling on Intention to Purchase Sugar-Sweetened Beverages: A Discrete Choice Experiment.

Childhood obesity is a major public health concern and sugar-sweetened beverages (SSBs) are a known contributor. SSB taxation and food labelling have been proposed as policies to reduce consumption by changing purchasing behaviours. The study aimed to analyse caregivers' preferences on commonly purchased SSBs in Australia and to determine the effect of price increases and teaspoon labelling on their purchasing intentions. We used a discrete choice experiment (DCE) to obtain data about choices between SSB and non-SSB alternatives. 563 caregivers, who had young children aged 3-7years, completed the experiment online. 286 were randomly allocated to receive choice sets with plain labelling while 277 were assigned to teaspoon labelling. Each participant completed nine choice scenarios where they chose between six SSB and non-SSB beverage options or a no-beverage option, with beverage prices varying between scenarios. While hypothetical, price and teaspoon labelling for sugar content for each beverage was obtained from an informal market survey. Responses from the DCE were modelled using random parameters logit within a random utility theory framework. Household income and children's consumption volumes of soft drink were used to explore preference heterogeneity. Using mixed logit as the final model, we found that higher reduction in intended purchases was observed for soft drink and fruit drink in teaspoon labelling than it was in plain labelling. Participants exposed to teaspoon labelling intended to purchase less of flavoured milk and fruit juice compared to those exposed to plain labelling. Compared to baseline prices, a hypothetical 20% increase in SSB prices and the presentation of 'teaspoons of sugar' labelling were predicted to reduce intentional SSB purchases and increase intentional non-SSB purchases. Within each labelling group, there were no significant differences of intentional purchases between the highest and the lowest income quintile, high and low consumers of soft drinks. However, compared to plain labelling, teaspoon labelling was predicted to strongly influence intentional purchases of SSBs and non-SSBs. This study suggests that a policy to increase SSB price and include teaspoon labelling would lead to a reduced consumption of SSBs and increased consumption of non-SSBs.

The effects of a sugar-sweetened beverage tax and a nutrient profiling tax based on Nutri-Score on consumer food purchases in a virtual supermarket: a randomised controlled trial.

To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket. A randomised controlled trial was conducted with a control condition with regular food prices (n 152), an SSB tax condition (n 130) and a nutrient profiling tax condition based on Nutri-Score (n 112). Participants completed a weekly grocery shop for their household. Primary outcome measures were SSB purchases (ordinal variable) and the overall healthiness of the total shopping basket (proportion of total unit food items classified as healthy). The secondary outcome measure was the energy (kcal) content of the total shopping basket. Data were analysed using regression analyses. Three-dimensional virtual supermarket. Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394). The SSB tax (OR = 1·62, (95 % CI 1·03, 2·54)) and the nutrient profiling tax (OR = 1·88, (95 %CI 1·17, 3·02)) increased the likelihood of being in a lower-level category of SSB purchases. The overall healthiness of the total shopping basket was higher (+2·7 percent point, (95 % CI 0·1, 5·3)), and the energy content was lower (-3301 kcal, (95 % CI -6425, -177)) for participants in the nutrient profiling tax condition than for those in the control condition. The SSB tax did not affect the overall healthiness and energy content of the total shopping basket (P > 0·05). A nutrient profiling tax targeting a wide range of foods and beverages with a low nutritional quality seems to have larger beneficial effects on consumer food purchases than taxation of SSB alone.

Impact of a sugar-sweetened beverage tax two-year post-tax implementation in Seattle, Washington, United States.

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.

A Salient Sugar Tax Decreases Sugary-Drink Buying

Many governments have introduced sugary-drink excise taxes to reduce purchasing and consumption of such drinks; however, they do not typically stipulate how such taxes should be communicated at the point of purchase. Historical, field, and experimental data consisting of more than 225,000 purchase decisions indicated that introducing a $0.01-per-ounce sugar-sweetened beverage (SSB) tax—without making it salient on price tags—had no significant effect on purchasing (−1.26%, p = .28). However, when the phrase “includes sugary drink tax” was added to tax-inclusive price tags, SSB purchasing was lower than (a) in the pretax period (−9.78%, p < .001), (b) in a posttax period when drinks did not bear price tags (−5.04%, p < .001), and (c) in a posttax period when drinks bore tax-inclusive price tags that did not mention the tax (−3.83%, p = .002). Making the tax’s beneficiary (student programs) salient on price tags had no added effect. Two follow-up studies suggested that tax salience was effective partly because consumers overestimated the tax amount, leading to reduced purchase intentions.

Soda Consumption Among Mexican Construction Workers in the Context of the Sugar-Sweetened Beverage Tax.

This study explored the psychosocial determinants of consumption of soda and other taxed sugar-sweetened beverages (SSBs) in Mexican construction workers (CWs) and whether consumption changed as a result of the 2014 SSB tax. We conducted a qualitative case study involving in-depth interviews and focus groups (FGs) with 30 Mexican CWs; supplemented with descriptions of the food and beverages consumed during lunch breaks. We used NVivo 10 to classify information according to the analysis categories, primarily informed by the Reasoned Action Approach (RAA). CWs reported not having changed their consumption of soda and other taxed SSBs as a result of the SSB tax, despite the price increase and "knowing" the potential negative consequences of soda drinking. The most important determinants of soda consumption are a deep-seated social norm of soda drinking and use of soda drinking as part of their professional identity; their likeness for soda; a wide availability of soda in their environments; and a low perceived behavioral control (because they thought themselves as addicted to it). Participants indicated that the best way for them not to consume soda would be if it were not available. These findings lend support for the tight regulation of the availability of SSBs. To have a meaningful impact on these consumers, the SSB tax may need to be much higher. Policy-level interventions should be coupled with interventions at the individual and community levels that aim at denormalizing soda consumption, create new meanings in relation to water consumption, and develop behavioral control to decrease soda consumption.

How should we evaluate sweetened beverage tax policies? A review of worldwide experience

Over 45 jurisdictions globally have implemented sweetened beverage taxes. Researchers and policymakers need to assess whether and how these taxes change beverage demand and supply, their intended and unanticipated health, economic and equity impacts. Lessons from such evaluations can maximise the policies’ success and impact on non-communicable disease prevention globally. We discuss key theoretical, design and methodological considerations to help policymakers, funders and researchers commission and conduct rigorous evaluations of these policies and related disease prevention efforts. We encourage involving the perspectives of various stakeholders on what evaluations are needed given the specific context, what data and methods are appropriate, readily available or can be collected within time and budget constraints. A logic model /conceptual system map of anticipated implications across sectors and scales should help identify optimal study design, analytical techniques and measures. These models should be updated when synthesising findings across diverse methods and integrating findings across subpopulations using similar methods.

Public health lessons from the soda taxes enacted in France in 2012 and modified in 2018

Abstract Background In 2016, the WHO officially recommended sugar-sweetened beverage (SSB) taxation as a strategy to reduce consumption, stimulate product reformulation and generate revenues for health-related programmes. This recommendation was based on a number of studies and experiments amongst them the 2012 French SSB tax that was redesigned in 2018. In this presentation, we summarize the lessons learnt from the soda taxes in France and offer insights on their potential public health benefits. Methods Our rationale is structured according to the interdisciplinary perspective of the Soda-Tax research consortium (2019-2023), addressing: (1) the soda tax policy change process; (2) the impact on price and purchases; (3) the consumer receptiveness to the tax and; (4) its legal framework and potential application to other foods/nutrients. Results Our overview of evidence highlights that the process leading to the enactment of the 2012 tax was initially based on a public health justification that was later set aside in favour of budgetary concerns. The tax, whose rate was flat and low and whose scope was extended to artificially-sweetened drinks containing no added sugar, generated modest effects on SSB consumption. Yet, it was ground breaking and offered an opportunity to appreciate its equity, to document its acceptance through a population-based survey and its legal viability. Six years later, the new tax comes closer to international recommendations: it is framed within the scope of public health action, focuses on SSBs and its rate is indexed to the quantity of added sugar in the drink. Conclusions The Soda-Tax project will study the degree of policy learning that may have contributed to the evolution of the 2018 tax, as well as the conditions of its implementation, administratively more complex than the previous one. It will also explore the social acceptability of this new tax and the extent to which it results in higher SSB prices, lower consumption and changes in the market. Key messages The design of the 2012 French soda tax was not optimal for public health, but it set a precedent. The 2018 soda tax, closer to international recommendations, deserves further investigation.

Association of a Sweetened Beverage Tax With Soda Consumption in High School Students

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. To estimate the association between the Philadelphia, Pennsylvania, beverage tax and adolescent soda intake. 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. Implementation of a sweetened beverage tax in Philadelphia, Pennsylvania, in January 2017. Reported weekly servings of soda, 100% juice, and milk. 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). 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.

Reply to Vale et al. Comment on "Zhong et al. Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax. Int. J. Environ. Res. Public Health 2020, 17, 1336".

Thank you for the opportunity to respond to the recent letter to the editor regarding our paper "Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax" [...].

Comment on Zhong et al. Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax. Int. J. Environ. Res. Public Health 2020, 17, 1336.

In February 2020, the paper "Sugar-Sweetened and Diet Beverage Consumption in Philadelphia One Year after the Beverage Tax" was published in the International Journal of Environmental Research and Public Health [...].

Community Perceptions in New York City: Sugar-Sweetened Beverage Policies and Programs in the First 1000 Days

ObjectivesTo examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity.MethodsA multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged.ResultsAmong the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities.ConclusionsA multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.

Avoidance behaviors circumventing the sugar-sweetened beverages tax

Taxes on sugar-sweetened beverages and other types of “sin taxes” are usually introduced at the local level and on the supply side; the efficacy of such taxes is challenged by tax avoidance behavior. In this study, we evaluate the impact of sugar-sweetened beverage taxes in Seattle, WA; Boulder, CO; Cook County, IL (Chicago); Philadelphia, PA, and two cities in the San Francisco Bay Area in California (Berkeley and Oakland). We use grocery scanner data relying on a series of difference-in-difference designs. Results show that each cent per ounce of taxes causes the price of the taxed beverages to increase in a range from 0.47 to 0.98 cents/ounce, and the sales quantity of taxed beverages to decrease in a range of 5.1–14.4%. But the efficacy of the sugar-sweetened beverage tax is undermined by two avoidance behaviors: (1) cross-border shopping avoidance, where people shop outside of the taxed area; (2) substitution avoidance, in which people switch from taxed to tax-exempt beverages that are just as high in sugar. The results from this study provide evidence that sugar-sweetened beverage taxes can be effective. However, to enhance the effectiveness of the taxes, policy makers should consider tax avoidance when developing future similar policies.

Health communication to reduce sugar consumption in Thailand

Excessive sugar consumption is one of the critical health behaviors contributing to Non-Communicable Diseases or NCDs, which are the leading causes of mortality among the Thai population. It is reported that Thai people have a continuous increase in sugar consumption every year associated with higher incidences of NCDs in the country. Therefore, health communication to raise awareness and modify the sugar consumption behavior in Thailand focuses on integrative communication in terms of public policies in accordance with the National NCDs Strategic Plan, guidelines and knowledge in sugar consumption including healthy and unhealthy sugar sources, sugar substitutes and their use in functional foods, health problems related to sugar consumption, the use of GDA Nutrition label, and the application of Healthier Choices standards with appropriate sugar content. With changing lifestyles, social media and technologies play a higher role in health communication regarding sugar consumption, resulting in the development of health applications in conjunction with IoT technology that can be used via smartphones. All these communications aim to promote the reduction of sugar consumption in the prevention of NCDs, thus reducing the premature death rate of the Thai population accordingly.Keywords: health communication, sugar consumption, sugar, sweetener, sugar tax, social media, non-communicable diseases, NCDs, nutrition label, GDA label, IoT

The Impact of Seattle's Sugar-Sweetened Beverage Tax on Substitution to Sweets and Salty Snacks

BackgroundSugar-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. ObjectivesTo 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. MethodsOn 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. ResultsIn 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. ConclusionsThere 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.

Sugar tax cost effective in reducing healthcare burden and costs

Sugar tax cost effective in reducing healthcare burden and costs