Evidence of a health risk ‘signalling effect’ following the introduction of a sugar-sweetened beverage tax

Alvarado, Miriam; Penney, Tarra L.; Unwin, Nigel; Murphy, Madhuvanti M.; Adams, Jean

doi:10.1016/j.foodpol.2021.102104

Cited by 19 publications

(14 citation statements)

References 37 publications

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“…This could potentially lead to underestimation of differences in tax effects if there was regional pricing of beverages by chain PLOS GLOBAL PUBLIC HEALTH retailers, for example. San Jose ´may also have shared the "risk signaling" effect of the Bay Area SSB tax measures [50]. Cawley and Frisvold found greater difference-in-differences using a broader synthetic national control than controls in areas adjacent to taxing cities [22].…”

Section: Limitationsmentioning

confidence: 99%

Changes in sugar-sweetened beverage consumption in the first two years (2018 – 2020) of San Francisco’s tax: A prospective longitudinal study

Silver

Padon

et al. 2023

PLOS Glob Public Health

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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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Section: Limitationsmentioning

confidence: 99%

Changes in sugar-sweetened beverage consumption in the first two years (2018 – 2020) of San Francisco’s tax: A prospective longitudinal study

Silver

Padon

et al. 2023

PLOS Glob Public Health

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“…The 'signaling effect' mechanism suggests that the publicizing and adoption of taxes with associated price increases of taxed foods and beverages communicates to consumers that these products are inferior to untaxed products. Awareness of health risks associated with their consumption may influence consumers to reduce purchases (14, 15,24,34,35,44,45). Two studies reported that signaling effects from taxes were amplified by information campaigns that may have increased awareness of the health risks associated with calorie-dense foods and beverages that are high in sugar, fat or salt (35,46).…”

Section: Design and Implementation Considerationsmentioning

confidence: 99%

Systematic review on fiscal policy interventions in nutrition

et al. 2022

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IntroductionBoth the World Health Organization and the Lancet Series on Adolescent nutrition recommend that governments adopt fiscal policies to combat diet-related non-communicable diseases (NCDs). However, rigorous, systematic evidence regarding the effects of these interventions is lacking.MethodsWe synthesize the available evidence regarding the impacts of taxes and subsidies that directly affect consumer prices on availability and accessibility of foods and beverages, purchasing behavior, diet quality, health and well-being outcomes as well as considerations for implementation, sustainability and equity.ResultsOur initial search returned 2,113 de-duplicated studies, and ultimately 24 impact evaluations and two systematic reviews met final eligibility criteria and represented unique evaluations. Our meta-analysis of these studies suggests that taxes may decrease purchases of taxed beverages (SMD = −0.14 [95% CI: −0.29 to −0.07], n = 15). Results should be interpreted cautiously due to considerable heterogeneity (Q(14) = 335.19, p = 0.01, τ^2=0.03, I2 = 95.82%).DiscussionThe evidence base is too limited to draw conclusions about the effects of taxes on beverages and calorie-dense foods on purchases, or on the effects of subsidies on purchasing or diet quality. Overall, the evidence base is inconclusive on whether fiscal policies can meaningfully influence the availability and accessibility of foods and beverages, diet quality, and health outcomes. Policymakers implementing fiscal policies should consider information campaigns on health benefits and health risks associated with certain food and beverage consumption. For taxes, exposure to health information may amplify signaling effects of taxes and reduce avoidance behaviors, such as cross-border shopping. Future evaluations should diversify data sources to better understand impacts on diet and health outcomes.

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“…Introducing a tax based on sugar content (larger tax for SSB higher in sugar) might also help decrease sugar intake, especially by encouraging SSB manufacturers to reduce the sugar content of their products (43) . Tax introduction or updates are also an opportunity to effectively communicate the detrimental effects of SSB on health (9,44) or raise revenues to fund public health or social programmes (45) . Large taxes on SSB should also come with subsidies for healthy foods to limit tax financial regressivity on low-income households (46) .…”

Section: Public Health Implicationsmentioning

confidence: 99%

“…Following taxation, soda substitution towards 100 % fruit juices (untaxed in 6/6 countries, Table 1) and artificially sweetened beverages (taxed in 5/6 countries, but at lower rate in 2/5 countries) was likely. While substitution towards water (18,19) would be beneficial in terms of obesity prevention, substituting sodas with other sugary drinks (1,28,44) would produce little health benefits.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis

Chatelan

Rouche

Dzielska³

et al. 2022

Public Health Nutr.

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Objective: To examine changes in the proportions of daily, weekly, and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001/02 and 2017/18, and in neighbouring comparison countries (without a tax) Design: Repeated cross-sectional surveys Setting: Health Behaviour in School-aged Children study, spanning five survey years (school years 2001/02 to 2017/18) Participants: Nationally-representative samples of 13y- and 15y-old adolescents (N=236,623, 51.0% girls) Results: Tax sizes (€0.02/L to €0.22/L) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17.9 to 11.9%, P=0.01), Finland (4.2 to 2.5%, P=0.001), Belgium (35.1 to 27.8%, P<0.001), Portugal (17.4 to 14.9%, P=0.02), but not in Hungary (29.8 to 31.3%, P=0.47), or France (29.4 to 28.2%, P=0.27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction<0.001). Prevalence of weekly soda consumption remained stable (Finland, Hungary, France) or increased (Latvia, Belgium); only Portugal experienced a decline (P<0.001), which was larger than in the comparison country (Pinteraction<0.001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France, nor Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction=0.15). Conclusions: Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.

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Evidence of a health risk ‘signalling effect’ following the introduction of a sugar-sweetened beverage tax

Cited by 19 publications

References 37 publications

Changes in sugar-sweetened beverage consumption in the first two years (2018 – 2020) of San Francisco’s tax: A prospective longitudinal study

Changes in sugar-sweetened beverage consumption in the first two years (2018 – 2020) of San Francisco’s tax: A prospective longitudinal study

Systematic review on fiscal policy interventions in nutrition

Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis

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