1
|
Jensen JD, Mielby LA, Kidmose U. Consumer preferences for attributes in sweet beverages and market impacts of beverage innovation. Appetite 2024; 197:107329. [PMID: 38561064 DOI: 10.1016/j.appet.2024.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/11/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
Consumption of sugar-sweetened beverages (SSB) is considered as an important risk factor for the development of overweight and obesity in populations worldwide, with a particular focus on the risks in the younger parts of the population - children and adolescents. Together with fiscal measures and information tools, innovation-based approaches such as the development of sugar-free or sugar-reduced versions of established beverages and development of new beverage products have been used to reduce this challenge, but the effects of product innovation on sugar intake are not well understood from the literature, as previous studies have largely ignored substitution effects of product innovation in the beverage domain. The objective of the present study was to investigate the potential effectiveness of product innovation as a strategy to affect consumers' intake of energy from sweetened non-alcoholic beverages. Using household panel shopping data from approximately 3000 Danish households over the years 2006-2014, we developed a hedonic pricing approach to estimate the influence of product attributes on consumers' utility, based on observed data for Danish households' purchases of sweet drinks. Overall, the study found that beverages' degree of sweetness positively affected the satiation effect of beverage consumption and in turn made the demand for these beverages less sensitive to e.g. price changes or introduction of competing products, whereas the energy density of the beverages positively affected the demand sensitivity to market changes. Findings like these can be useful for assessing market effects as well as environmental and public health impacts of changes to the market environment.
Collapse
Affiliation(s)
- Jørgen Dejgård Jensen
- Copenhagen University, Department of Food and Resource Economics, Rolighedsvej 23, DK-1958, Frederiksberg C, Denmark.
| | - Line Ahm Mielby
- Danish Technological Institute, Food and Production, Kongsvang Allé 29, DK-8000, Aarhus C, Denmark.
| | - Ulla Kidmose
- Aarhus University, Department of Food Science, Agro Food Park 48, DK-8200, Aarhus N, Denmark.
| |
Collapse
|
2
|
Thiboonboon K, Lourenco RDA, Cronin P, Khoo T, Goodall S. Economic Evaluations of Obesity-Targeted Sugar-Sweetened Beverage (SSB) Taxes-A Review to Identify Methodological Issues. Health Policy 2024; 144:105076. [PMID: 38692186 DOI: 10.1016/j.healthpol.2024.105076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 04/06/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Economic evaluations of public health interventions like sugar-sweetened beverage (SSB) taxes face difficulties similar to those previously identified in other public health areas. This stems from challenges in accurately attributing effects, capturing outcomes and costs beyond health, and integrating equity effects. This review examines how these challenges were addressed in economic evaluations of SSB taxes. METHODS A systematic review was conducted to identify economic evaluations of SSB taxes focused on addressing obesity in adults, published up to February 2021. The methodological challenges examined include measuring effects, valuing outcomes, assessing costs, and incorporating equity. RESULTS Fourteen economic evaluations of SSB taxes were identified. Across these evaluations, estimating SSB tax effects was uncertain due to a reliance on indirect evidence that was less robust than evidence from randomised controlled trials. Health outcomes, like quality-adjusted life years, along with a healthcare system perspective for costs, dominated the evaluations of SSB taxes, with a limited focus on broader non-health consequences. Equity analyses were common but employed significantly different approaches and exhibited varying degrees of quality. CONCLUSION Addressing the methodological challenges remains an issue for economic evaluations of public health interventions like SSB taxes, suggesting the need for increased attention on those issues in future studies. Dedicated methodological guidelines, in particular addressing the measurement of effect and incorporation of equity impacts, are warranted.
Collapse
Affiliation(s)
- Kittiphong Thiboonboon
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Paula Cronin
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Terence Khoo
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia, Level 5, Building 20 100 Broadway, Chippendale, NSW 2008, Australia
| |
Collapse
|
3
|
Burton R, Sharpe C, Bhuptani S, Jecks M, Henn C, Pearce-Smith N, Knight S, Regan M, Sheron N. The relationship between the price and demand of alcohol, tobacco, unhealthy food, sugar-sweetened beverages, and gambling: an umbrella review of systematic reviews. BMC Public Health 2024; 24:1286. [PMID: 38730332 PMCID: PMC11088175 DOI: 10.1186/s12889-024-18599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The WHO highlight alcohol, tobacco, unhealthy food, and sugar-sweetened beverage (SSB) taxes as one of the most effective policies for preventing and reducing the burden of non-communicable diseases. This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition as gambling as a public health problem, we also included gambling. METHODS The protocol for this umbrella review was pre-registered (PROSPERO CRD42023447429). Seven electronic databases were searched between 2000-2023. Eligible systematic reviews were those published in any country, including adults or children, and which quantitatively examined the relationship between alcohol, tobacco, gambling, unhealthy food, or SSB price/tax and demand (sales/consumption) or disease/death. Two researchers undertook screening, eligibility, data extraction, and risk of bias assessment using the ROBIS tool. RESULTS We identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs). We did not identify any reviews on gambling. Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations. Reductions in demand were large enough to be considered meaningful for policy. CONCLUSIONS Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue. There may be potential in joining up approaches to taxation across the harm-causing commodities.
Collapse
Affiliation(s)
- Robyn Burton
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England.
- Institute for Social Marketing and Health UK, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | - Casey Sharpe
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
| | - Saloni Bhuptani
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
| | - Mike Jecks
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
| | - Clive Henn
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
| | - Nicola Pearce-Smith
- UK Health Security Agency (UKHSA), 10 South Colonnade, Canary Wharf, London, England
| | - Sandy Knight
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
| | - Marguerite Regan
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
| | - Nick Sheron
- Department of Health and Social Care, Office for Health Improvement and Disparities, 39 Victoria Street, London, England
- The Roger Williams Institute of Hepatology, Kings College London, London, England
| |
Collapse
|
4
|
Verly E, Jolliet O. Moderate low-cost modifications in diet prevent a substantial number of deaths and mitigate environmental impacts in Brazil. Eur J Nutr 2024:10.1007/s00394-024-03375-1. [PMID: 38622295 DOI: 10.1007/s00394-024-03375-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/16/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aimed to estimate the health, economic, and environmental impacts of moderate simulated interventions on dietary intake in Brazil. METHODS Data on food price and consumption were obtained from three nationwide surveys. Baseline dietary intake was estimated for 33,859 individuals aged 25 years and older. Counterfactual intakes were based on six hypothetical intervention scenarios, by changing the weekly frequency and serving size in low or high consumers of fruit and vegetables (FV), milk, whole grains, red and processed meats, and sugar-sweetened beverages. For each scenario, we estimated the attributable number of deaths and disability-adjusted life years (DALY), monetary cost, environmental impacts (14 midpoint indicators), and environmentally-mediated health impacts. RESULTS Compared with the baseline intake and cost, the most expensive intervention (+ 8.3%) was to increase FV intake (+ 125 g), resulting in a 1.2% reduction in all-cause mortality (16,307 deaths/year). The cheapest (- 9.9%) was to reduce red and processed meat intake (- 40 g), resulting in a 1.1% reduction in all-cause mortality (14,272 deaths/year). The combined intervention was, on average, 3.7% cheaper than the baseline cost, resulting in an increase in diet cost for 30% of the population (45-22% in the lower- and higher-income groups); all-cause mortality would be reduced by 3.8% (49,488 deaths/year). Interventions targeting red and processed meats would reduce emissions and resource use by 35-55%, in addition to reducing 2300 DALYs/year. CONCLUSION A meaningful number of deaths can be avoided and environmental impacts reduced through moderate and potentially affordable diet modifications.
Collapse
Affiliation(s)
- Eliseu Verly
- Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier, 524, Rio de Janeiro, RJ, 20550-013, Brazil.
| | - Olivier Jolliet
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Sustain, Technical University of Denmark, Anker Engelunds Vej 1 Bygning 101A, 2800, Kgs. Lyngby, Hovedstaden, Denmark
| |
Collapse
|
5
|
Martin S, McCormack L. Eating behaviors and the perceived nutrition environment among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:685-689. [PMID: 35549833 DOI: 10.1080/07448481.2022.2068019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Objectives: To assess eating behaviors and identify whether there is an association between eating behaviors and the perceived nutrition environment among college students. Participants: College students (n = 180) actively living on campus during the 2019-2020 academic school year. Methods: Cross- sectional study utilizing the validated NEMS-P survey tool to collect all data. A multivariate logistics regression was used to assess the association between eating behaviors and the perceived nutrition environment. Results: Statistically significant association noted between perceived higher cost of healthy eating and decreased consumption of fruit (p = .027), availability of nutrition information (healthy eating signs) and increased vegetable and fruit consumption (p = .018, p = 0.010) and increased ease of purchasing fruits and vegetables and increased consumption (p = 0.037). Conclusion: The campus nutrition environment can provide students the opportunity to learn about and practice healthy eating through available foods and beverages, nutrition education and signs that encourage healthy eating throughout the campus.
Collapse
Affiliation(s)
- Shadai Martin
- Department of Family & Consumer Sciences, New Mexico State University, Las Cruces, New Mexico, USA
| | - Lacey McCormack
- Division of Health and Consumer Sciences, South Dakota State University, Brookings, South Dakota, USA
| |
Collapse
|
6
|
Valizadeh P, Ng SW. Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income. Am J Prev Med 2024:S0749-3797(24)00076-X. [PMID: 38573260 DOI: 10.1016/j.amepre.2024.02.019] [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: 08/23/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. METHODS The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected. RESULTS A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities. CONCLUSIONS Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.
Collapse
Affiliation(s)
- Pourya Valizadeh
- Department of Agricultural Economics, Texas A&M University, College Station, Texas
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| |
Collapse
|
7
|
Phelps NH, Singleton RK, Zhou B, Heap RA, Mishra A, Bennett JE, Paciorek CJ, Lhoste VPF, Carrillo-Larco RM, Stevens GA, Rodriguez-Martinez A, Bixby H, Bentham J, Di Cesare M, Danaei G, Rayner AW, Barradas-Pires A, Cowan MJ, Savin S, Riley LM, Aguilar-Salinas CA, Baker JL, Barkat A, Bhutta ZA, Branca F, Caixeta RB, Cuschieri S, Farzadfar F, Ganapathy S, Ikeda N, Iotova V, Kengne AP, Khang YH, Laxmaiah A, Lin HH, Ma J, Mbanya JCN, Miranda JJ, Pradeepa R, Rodríguez-Artalejo F, Sorić M, Turley M, Wang L, Webster-Kerr K, Aarestrup J, Abarca-Gómez L, Abbasi-Kangevari M, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Aekplakorn W, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Ågren Å, Aguenaou H, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Al-Raddadi R, Al Asfoor D, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alieva AV, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alomary SA, Alomirah HF, Alshangiti AM, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiano Etxezarreta P, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Assefa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Aurélio de Valois CJM, Auvinen J, Avdičová M, Avi S, Azad K, Azevedo A, Azimi-Nezhad M, Azizi F, Babu BV, Bacopoulou F, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Bajramovic I, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Barbosa Filho V, Barceló A, Baretić M, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JL, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedek T, Benedics J, Benet M, Benitez Rolandi GE, Benzeval M, Bere E, Berger N, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Berrios Carrasola X, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Blychfeld Magnazu M, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Botomba S, Bourne RRA, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Braithwaite T, Brajkovich I, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Bringolf-Isler B, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buoncristiano M, Burazeri G, Burns C, Cabrera de León A, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamnan P, Chamukuttan S, Chan A, Chan Q, Charchar FJ, Charles MA, Chaturvedi HK, Chaturvedi N, Che Abdul Rahim N, Chee ML, Chen CJ, Chen F, Chen H, Chen LS, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clare P, Clarke J, Clays E, Cohen E, Cojocaru CR, Colorado-Yohar S, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Czenczek-Lewandowska E, D'Arrigo G, d'Orsi E, da Silva AG, Dacica L, Dahm CC, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis Guedes de Vasconcelos F, de Assis MAA, De Backer G, De Bacquer D, De Bacquer J, de Bont J, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, De Neve JW, Duarte de Oliveira P, De Ridder D, De Ridder K, de Rooij SR, de Sá ACMGN, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Devrishov RD, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Díaz Fernández P, Díez Ripollés MP, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Dörr M, Doua K, Dragano N, Drygas W, Du S, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dwyer T, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Ebrahimi N, Echeverría G, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Elliott P, Enang O, Endevelt R, Engle-Stone R, Erasmus RT, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Evans RG, Faeh D, Fagherazzi G, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Farrugia Sant'Angelo V, Farzi Y, Fattahi MR, Fawwad A, Fawzi WW, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fisberg M, Fischer K, Foo LH, Forsner M, Fottrell EF, Fouad HM, Francis DK, Franco MDC, Fras Z, Fraser B, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gabriela SA, Gaciong Z, Gafencu M, Galán Cuesta M, Galbarczyk A, Galcheva SV, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, García Mérida MJ, García Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Gerdts E, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez Gómez JH, Gomez LF, Gómez SF, Gomula A, Gonçalves Cordeiro da Silva B, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregg EW, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerchet M, Guerrero R, Guessous I, Guimaraes AL, Gujral UP, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, Gurinović MA, Gutiérrez González E, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hardy L, Hari Kumar R, Harmer Lassen T, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Heinen M, Hejgaard T, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Heude B, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hoogendijk E, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huidumac Petrescu C, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea J, Ibrahim MM, Ibrahim Wong N, Igland J, Ijoma C, Ikram MA, Iñiguez C, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ittermann T, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jan N, Jansson A, Janszky I, Janus E, Jarani J, Jarnig G, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jøran Kjerpeseth L, Jørgensen T, Joshi P, Joshi R, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Jurca Simina I, Juresa V, Kaaks R, Kaducu FO, Kadvan AL, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Karlsson O, Kassi Anicet A, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Kazembe BM, Ke C, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klanarong S, Klanova J, Klimek M, Klimont J, Klumbiene J, Knoflach M, Kobel S, Koirala B, Kolle E, Kolo SM, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Koussoh Simone M, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kulothungan V, Kumar RK, Kumari M, Kunešová M, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Laatikainen T, Labadarios D, Lachat C, Lackner KJ, Lai D, Laid Y, Lall L, Lam TH, Landaeta Jimenez M, Landais E, Lankila T, Lanska V, Lappas G, Larijani B, Larissa SP, Lateva MP, Latt TS, Laurenzi M, Lauria L, Lazo-Porras M, Le Coroller G, Le Nguyen Bao K, Le Port A, Le TD, Lee J, Lee J, Lee PH, Lehtimäki T, Lemogoum D, Leong E, Leskošek B, Leszczak J, Leth-Møller KB, Leung GM, Levitt NS, Li Y, Liivak M, Lilly CL, Lim C, Lim WY, Lima-Costa MF, Lin X, Lind L, Lingam V, Linkohr B, Linneberg A, Lissner L, Litwin M, Liu J, Liu L, Liu L, Liu X, Lo WC, Loit HM, Long KQ, Longo Abril G, Lopes L, Lopes MSS, Lopes O, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukrafka JL, Luksiene D, Lundqvist A, Lunet N, Lunogelo C, Lustigová M, Łuszczki E, M'Buyamba-Kabangu JR, Ma G, Ma X, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Madraisau S, Madsen AL, Maestre GE, Maggi S, Magliano DJ, Magnacca S, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Mäki P, Malekpour MR, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malta DC, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mannix MI, Mansour-Ghanaei F, Manyanga T, Manzato E, Mapatano MA, Marcil A, Margozzini P, Maria-Magdalena R, Mariño J, Markaki A, Markey O, Markidou Ioannidou E, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruf FA, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masinaei M, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Matteo G, Maulik PK, Mavrogianni C, Mazur A, McFarlane SR, McGarvey ST, McKee M, McLean RM, McLean SB, McNairy ML, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Meyer HE, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Mridha MK, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Musić Milanović S, Musil V, Musinguzi G, Muyer MT, Nabipour I, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Narayan KMV, Nardone P, Naseri T, Nathalie M, Neal WA, Neelapaichit N, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Norton KI, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O'Neill TW, O'Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Oldenburg B, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Onodugo O, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Ottendahl CB, Otu A, Overvad K, Owusu-Dabo E, Oyeyemi AY, Oyeyemi AL, Paccaud FM, Padez CP, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Pajula N, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Pang Z, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Perez-Londoño A, Pérez CM, Peterkova V, Peters A, Petkeviciene J, Petrauskiene A, Petrovna Kovtun O, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Phiri FP, Pichardo RN, Pierannunzio D, Pierre-Marie P, Pigeot I, Pikhart H, Pilav A, Piler P, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popkin BM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puhakka S, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qiao Q, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Quoc Bao T, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saieva C, Sakata S, Saki N, Šalaj S, Salanave B, Salazar Martinez E, Salhanova A, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sánchez Rodríguez I, Sandjaja, Sans S, Santa-Marina L, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt B, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schultz G, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Sewpaul R, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
Collapse
|
8
|
Huangfu P, Pearson F, Abu-Hijleh FM, Wahlich C, Willis K, Awad SF, Abu-Raddad LJ, Critchley JA. Impact of price reductions, subsidies, or financial incentives on healthy food purchases and consumption: a systematic review and meta-analysis. Lancet Planet Health 2024; 8:e197-e212. [PMID: 38453385 DOI: 10.1016/s2542-5196(24)00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
Poor diets are a global concern and are linked with various adverse health outcomes. Healthier foods such as fruit and vegetables are often more expensive than unhealthy options. This study aimed to assess the effect of price reductions for healthy food (including fruit and vegetables) on diet. We performed a systematic review and meta-analysis on studies that looked at the effects of financial incentives on healthy food. Main outcomes were change in purchase and consumption of foods following a targeted price reduction. We searched electronic databases (MEDLINE, EconLit, Embase, Cinahl, Cochrane Library, and Web of Science), citations, and used reference screening to identify relevant studies from Jan 1, 2013, to Dec 20, 2021, without language restrictions. We stratified results by population targeted (low-income populations vs general population), the food group that the reduction was applied to (fruit and vegetables, or other healthier foods), and study design. Percentage price reduction was standardised to assess the effect in meta-analyses. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. 34 studies were eligible; 15 took place in supermarkets and eight took place in workplace canteens in high-income countries, and 21 were targeted at socioeconomically disadvantaged communities. Pooled analyses of 14 studies showed a price reduction of 20% resulted in increases in fruit and vegetable purchases by 16·62% (95% CI 12·32 to 20·91). Few studies had maintained the price reduction for over 6 months. In conclusion, price reductions can lead to increases in purchases of fruit and vegetables, potentially sufficient to generate health benefits, if sustained.
Collapse
Affiliation(s)
- Peijue Huangfu
- Population Health Research Institute, St George's, University of London, London, UK
| | - Fiona Pearson
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Farah Marwan Abu-Hijleh
- Department of Public Health, College of Health Sciences, QU Health Quality Office, Qatar University, Doha, Qatar
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kathryn Willis
- Population Health Research Institute, St George's, University of London, London, UK
| | - Susanne F Awad
- Infectious Diseases Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Laith J Abu-Raddad
- Infectious Diseases Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| |
Collapse
|
9
|
Symvoulakis EK, Stachteas P, Smyrnakis E, Volkos P, Mantadaki AE, Karelis A, Petraki C, Nioti K, Mastronikolis S, Antoniou AM, Linardakis M. Multiple Behavioral Risk Factors As Assets for Chronic Disease Prevention: Observations From Urban Primary Care Settings in Crete, Greece. Cureus 2024; 16:e56711. [PMID: 38646332 PMCID: PMC11032647 DOI: 10.7759/cureus.56711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
AIM This study aimed to assess the health profile of patient-attendees visiting primary healthcare (PHC) practice settings in the midst of the COVID-19 pandemic and to explore the relationships between multiple behavioral risk factors (MBRFs) and consultation-driven health information. Multiple behavioral risk factors involve a variety of unhealthy behaviors that are associated with an increased prevalence of non-communicable diseases (NCDs). SUBJECTS AND METHODS The study design was based on a dataset analysis, afterward exploring the feasibility and diagnostic capacity of respiratory morbidity aspects from a study previously conducted. The study dataset contained information regarding socio-demographic characteristics, health habits, clinical information, and reported comorbidities from 183 primary care patient-attendees. A categorical regression analysis was performed, using as a numeric variable the multiple MBRFs (clustering of 0 to four factors) in order to examine relationships with the basic and clinical characteristics of the patient-attendees. RESULTS Based on this secondary analysis, it was found that the prevalence of MBRFs is quite common among patient-attendees visiting urban PHC facilities. The prevalence of current smoking, sleep deprivation, increased body weight, and medium/high perceived stress levels were 33.9%, 52.5%, 83.1%, and 35.0%, respectively. An increased occurrence of MBRFs might be significantly predicted by the lower age of patient-attendees (b = -0.221, p = 0.05), by the absence of gray hair at an early age (b = -0.144, p = 0.042), by the physical discomfort during activities (b = 0.191, p = 0.017), or by the lower oxygen saturation (b = -0.184, p = 0.004). Diabetes mellitus (25.1%) was the most prevalent condition, followed by bronchial asthma (18.6%) and depression (15.8%). CONCLUSIONS Lower age, absence of premature hair whitening, physical discomfort during activities, and lower oxygen saturation are linked with an increased occurrence of MBRFs, leading to a neglected way of living. Those factors could be used to alert researchers, policymakers, and PHC professionals to act accordingly in order to prevent or early diagnose NCDs.
Collapse
Affiliation(s)
- Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, GRC
| | - Panagiotis Stachteas
- Laboratory of Primary Health Care, General Practice and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Panagiotis Volkos
- Fourth Local Health Team, Academic Unit of Heraklion, Heraklion, GRC
| | - Aikaterini E Mantadaki
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, GRC
| | - Andreas Karelis
- Department of Family Medicine, Private Primary Care Facilities, Heraklion, GRC
| | - Chrysi Petraki
- Department of Family Medicine, Private Primary Care Facilities, Heraklion, GRC
| | - Kadiani Nioti
- Department of Family Medicine, Private Primary Care Facilities, Heraklion, GRC
| | | | - Aikaterini M Antoniou
- Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, GRC
| | - Manolis Linardakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, GRC
| |
Collapse
|
10
|
Ahles A, Muhammad A, Yenerall JN, Reedy J, Shi P, Zhang J, Cudhea F, Erndt-Marino J, Miller V, Mozaffarian D. How prices and income influence global patterns in saturated fat intake by age, sex and world region: a cross-sectional analysis of 160 countries. BMJ Open 2024; 14:e074562. [PMID: 38253455 PMCID: PMC10806819 DOI: 10.1136/bmjopen-2023-074562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE When considering proposals to improve diets, it is important to understand how factors like price and income can affect saturated fat (SF) intake and demand. In this study, we examine and estimate the influence of price and income on intake across 160 countries, by age and sex, and derive sensitivity measures (price elasticities) that vary by age, sex and world region. DESIGN We econometrically estimate intake responsiveness to income and prices across countries, accounting for differences by world region, age and sex. Intake data by age, sex and country were obtained from the 2018 Global Dietary Database. These data were then linked to global price data for select food groups from the World Bank International Comparison Programme and income data from the World Development Indicators Databank (World Bank). RESULTS Intake differences due to price were highly significant, with a 1% increase in price associated with a lower SF intake (% energy/d) of about 4.3 percentage points. We also find significant differences across regions. In high-income countries, median (age 40) intake reductions were 1.4, 0.8 and 0.2 percentage points, given a 1% increase in the price of meat, dairy, and oils and fats, respectively. Price elasticities varied with age but not sex. Intake differences due to income were insignificant when regional binary variables were included in the analysis. CONCLUSION The results of this study show heterogeneous associations among prices and intake within and across countries. Policymakers should consider these heterogeneous effects as they address global nutrition and health challenges.
Collapse
Affiliation(s)
- Amelia Ahles
- Texas A&M University, College Station, Texas, USA
| | - Andrew Muhammad
- The University of Tennessee Institute of Agriculture, Knoxville, Tennessee, USA
| | | | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Josh Erndt-Marino
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Laranjo L, Lanas F, Sun MC, Chen DA, Hynes L, Imran TF, Kazi DS, Kengne AP, Komiyama M, Kuwabara M, Lim J, Perel P, Piñeiro DJ, Ponte-Negretti CI, Séverin T, Thompson DR, Tokgözoğlu L, Yan LL, Chow CK. World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update. Glob Heart 2024; 19:8. [PMID: 38273995 PMCID: PMC10809857 DOI: 10.5334/gh.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/27/2024] Open
Abstract
Background Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper. Results Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.
Collapse
Affiliation(s)
- Liliana Laranjo
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Marie Chan Sun
- Department of Medicine, University of Mauritius, Réduit, Mauritius
| | | | - Lisa Hynes
- Croí, the West of Ireland Cardiac & Stroke Foundation, Galway, Ireland
| | - Tasnim F. Imran
- Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, US
| | - Dhruv S. Kazi
- Department of Medicine (Cardiology), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, US
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Jeremy Lim
- Global Health Dpt, National University of Singapore Saw Swee Hock School of Public Health, Singapore
| | - Pablo Perel
- Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine and World Heart Federation, London, UK
| | | | | | | | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, United Kingdom
- European Association of Preventive Cardiology, Sophia Antipolis, UK
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
| | - Clara K. Chow
- Faculty of Medicina and Health, Westmead Applied Research Centre, University of Sydney, Australia
| |
Collapse
|
12
|
Djojosoeparto SK, Poelman MP, Eykelenboom M, Beenackers MA, Steenhuis IHM, van Stralen MM, Olthof MR, Renders CM, van Lenthe FJ, Kamphuis CBM. Do financial constraint and perceived stress modify the effects of food tax schemes on food purchases: moderation analyses in a virtual supermarket experiment. Public Health Nutr 2024; 27:e38. [PMID: 38224250 PMCID: PMC10897579 DOI: 10.1017/s1368980024000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases. DESIGN Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5-8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised. SETTING Virtual supermarket. PARTICIPANTS Dutch adults (n 386). RESULTS Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress. CONCLUSION Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.
Collapse
Affiliation(s)
- Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Chair group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Michelle Eykelenboom
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mariëlle A Beenackers
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ingrid HM Steenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Margreet R Olthof
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carlijn BM Kamphuis
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
13
|
Lee MM, Barrett JL, Kenney EL, Gouck J, Whetstone LM, McCulloch SM, Cradock AL, Long MW, Ward ZJ, Rohrer B, Williams DR, Gortmaker SL. A Sugar-Sweetened Beverage Excise Tax in California: Projected Benefits for Population Obesity and Health Equity. Am J Prev Med 2024; 66:94-103. [PMID: 37553037 PMCID: PMC10840962 DOI: 10.1016/j.amepre.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Amid the successes of local sugar-sweetened beverage (SSB) taxes, interest in state-wide policies has grown. This study evaluated the cost effectiveness of a hypothetical 2-cent-per-ounce excise tax in California and its implications for population health and health equity. METHODS Using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model, tax impacts on health, health equity, and cost effectiveness over 10 years in California were projected, both overall and stratified by race/ethnicity and income. Expanding on previous models, differences in the effect of intake of SSBs on weight by BMI category were incorporated. Costing was performed in 2020, and analyses were conducted in 2021-2022. RESULTS The tax is projected to save $4.55 billion in healthcare costs, prevent 266,000 obesity cases in 2032, and gain 114,000 quality-adjusted life years. Cost-effectiveness metrics, including cost/quality-adjusted life year gained, were cost saving. Spending on SSBs was projected to decrease by $33 per adult and $26 per child overall in the first year. Reductions in obesity prevalence for Black and Hispanic Californians were 1.8 times larger than for White Californians, and reductions for adults with lowest incomes (<130% Federal Poverty Level) were 1.4 times the reduction among those with highest incomes (>350% Federal Poverty Level). The tax is projected to save $112 in obesity-related healthcare costs per $1 invested. CONCLUSIONS A state-wide SSB tax in California would be cost saving, lead to reductions in obesity and improvement in SSB-related health equity, and lead to overall improvements in population health. The policy would generate more than $1.6 billion in state tax revenue annually that can also be used to improve health equity.
Collapse
Affiliation(s)
- Matthew M Lee
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, Massachusetts.
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Jessie Gouck
- California Department of Public Health, Sacramento, California
| | | | - Stephanie M McCulloch
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Michael W Long
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Benjamin Rohrer
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
14
|
Widarjono A, Afin R, Kusnadi G, Firdaus MZ, Herlinda O. Taxing sugar sweetened beverages in Indonesia: Projections of demand change and fiscal revenue. PLoS One 2023; 18:e0293913. [PMID: 38157352 PMCID: PMC10756547 DOI: 10.1371/journal.pone.0293913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/22/2023] [Indexed: 01/03/2024] Open
Abstract
The global trend of diets high in sugar sweetened beverages (SSB) is associated with a high risk of obesity and non-communicable diseases (NCDs). To reduce SSB consumption on a population level, SSB taxes have become a popular policy solution. In Indonesia, although the prevalence of obesity has doubled in the past decade (11.7% in 2010 to 21.8% in 2018), SSB taxes have not yet been implemented. Utilizing the 2021 Indonesian household socioeconomic survey (SUSENAS), this study estimated price elasticities and projected the plausible effects of implementing an SSB tax on consumers' demand for SSBs and the associated government revenue using the Quadratic Almost Ideal Demand System (QUAIDS) model. Five SSB groups were studied: 1) manufactured liquid milk; 2) sweetened condense milk; 3) instant coffee; 4) tea drinks and fizzy drinks with CO2; 5) fruit juices, "health" drinks, and energy drinks. The overall results showed that the non-milk SSB groups were price elastic. Probing deeper into the substitutions for SSB across categories, we found both substitutionary and complementary effects. Our analysis revealed that increasing SSB prices by 20% would reduce the demand for SSBs on average by 17.5% (14.3%-18.6% for each SSB group) and generate additional state revenue up to IDR 3,628.3 billion per year (approximately US$ 238.5 million or 0.2% of total tax revenue in 2022). Considering the health and economic impacts of high consumption of SSBs, this study provides empirical evidence that imposing taxes on SSBs could be an effective measure to reduce public consumption and to generate tax revenue for financing health programs that address obesity and NCDs in Indonesia.
Collapse
Affiliation(s)
- Agus Widarjono
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Rifai Afin
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Gita Kusnadi
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | | | - Olivia Herlinda
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| |
Collapse
|
15
|
Kumar A, Kulchar RJ, Khadka N, Smith C, Mukherjee P, Rizal E, Sokal-Gutierrez K. Maternal-child consumption of ultra-processed foods and sugar-sweetened beverages in informal settlements in Mumbai, India. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:142. [PMID: 38093384 PMCID: PMC10720234 DOI: 10.1186/s41043-023-00486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition. METHODS This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay-milk, soda, tea with sugar, sweets, and chips/biscuits-using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups. RESULTS Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with children's frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store. CONCLUSION Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal-child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit children's consumption of unhealthy foods and beverages from an early age.
Collapse
Affiliation(s)
- Aarti Kumar
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Rachel J Kulchar
- University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Nehaa Khadka
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
- Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Charlotte Smith
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | | | - Erika Rizal
- Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | | |
Collapse
|
16
|
Ritter PI. Soda expansion in the tropics: The effect on obesity rates among women without piped water at home. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101274. [PMID: 37574609 DOI: 10.1016/j.ehb.2023.101274] [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: 01/26/2022] [Revised: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023]
Abstract
Obesity rates and soda consumption are increasing at a worrisome pace in developing countries. In particular, soda companies seem to be targeting areas with poor access to clean water. This paper exploits a natural experiment in Peru and finds evidence that changes in the price of soda generate important effects in terms of obesity among individuals without piped water at home. These significant effects are driven by a combination of a large effect in the consumption of soda and an effect close to zero in the consumption of potential substitutes high in calories. This paper also provides some evidence that a reduction in price of soda reduces diarrhea prevalence, suggesting that some individuals substitute away contaminated water. This evidence suggests that soda taxes might be particularly beneficial among this population in terms of the prevention of obesity and possibly related diseases such as diabetes and cardiovascular diseases. The potential trade-off between obesity and diarrhea needs to be investigated in greater depth.
Collapse
Affiliation(s)
- Patricia I Ritter
- Department of Economics, University of Connecticut, 365 Fairfield Way, Unit 1063, Storrs, CT 06269-1063, United States of America.
| |
Collapse
|
17
|
Reyes-García A, Junquera-Badilla I, Batis C, Colchero MA, Miranda JJ, Barrientos-Gutiérrez T, Basto-Abreu A. How Could Taxes on Sugary Drinks and Foods Help Reduce the Burden Of Type 2 Diabetes? Curr Diab Rep 2023; 23:265-275. [PMID: 37695402 DOI: 10.1007/s11892-023-01519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW Taxes on sugary drinks and foods have emerged as a key strategy to counteract the alarming levels of diabetes worldwide. Added sugar consumption from industrialized foods and beverages has been strongly linked to type 2 diabetes. This review provides a synthesis of evidence on how taxes on sugary products can influence the onset of type 2 diabetes, describing the importance of the different mechanisms through which the consumption of these products is reduced, leading to changes in weight and potentially a decrease in the incidence of type 2 diabetes. RECENT FINDINGS Observational studies have shown significant reductions in purchases, energy intake, and body weight after the implementation of taxes on sugary drinks or foods. Simulation studies based on the association between energy intake and type 2 diabetes estimated the potential long-term health and economic effects, particularly in low- and middle-income countries, suggesting that the implementation of sugary food and beverage taxes may have a meaningful impact on reducing type 2 diabetes and complications. Public health response to diabetes requires multi-faceted approaches from health and non-health actors to drive healthier societies. Population-wide strategies, such as added sugar taxes, highlight the potential benefits of financial incentives to address behaviors and protective factors to significantly change an individual's health trajectory and reduce the onset of type 2 diabetes worldwide, both in terms of economy and public health.
Collapse
Affiliation(s)
- Alan Reyes-García
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Isabel Junquera-Badilla
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Carolina Batis
- CONACYT - Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
An R, Yang Y, Batcheller Q, Zhou Q. Sentiment Analysis of Tweets on Soda Taxes. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:633-639. [PMID: 36812042 DOI: 10.1097/phh.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CONTEXT As a primary source of added sugars, sugar-sweetened beverage (SSB) consumption may contribute to the obesity epidemic. A soda tax is an excise tax charged on selling SSBs to reduce consumption. Currently, 8 cities/counties in the United States have imposed soda taxes. OBJECTIVE This study assessed people's sentiments toward soda taxes in the United States based on social media posts on Twitter. DESIGN We designed a search algorithm to systematically identify and collect soda tax-related tweets posted on Twitter. We built deep neural network models to classify tweets by sentiments. SETTING Computer modeling. PARTICIPANTS Approximately 370 000 soda tax-related tweets posted on Twitter from January 1, 2015, to April 16, 2022. MAIN OUTCOME MEASURE Sentiment associated with a tweet. RESULTS Public attention paid to soda taxes, indicated by the number of tweets posted annually, peaked in 2016, but has declined considerably ever since. The decreasing prevalence of tweets quoting soda tax-related news without revealing sentiments coincided with the rapid increase in tweets expressing a neutral sentiment toward soda taxes. The prevalence of tweets expressing a negative sentiment rose steadily from 2015 to 2019 and then slightly leveled off, whereas that of tweets expressing a positive sentiment remained unchanged. Excluding news-quoting tweets, tweets with neutral, negative, and positive sentiments occupied roughly 56%, 29%, and 15%, respectively, during 2015-2022. The authors' total number of tweets posted, followers, and retweets predicted tweet sentiment. The finalized neural network model achieved an accuracy of 88% and an F1 score of 0.87 in predicting tweet sentiments in the test set. CONCLUSIONS Despite its potential to shape public opinion and catalyze social changes, social media remains an underutilized source of information to inform government decision making. Social media sentiment analysis may inform the design, implementation, and modification of soda tax policies to gain social support while minimizing confusion and misinterpretation.
Collapse
Affiliation(s)
- Ruopeng An
- Brown School, Washington University in St Louis, St Louis, Missouri
| | | | | | | |
Collapse
|
20
|
Temple NJ. A Proposed Strategy against Obesity: How Government Policy Can Counter the Obesogenic Environment. Nutrients 2023; 15:2910. [PMID: 37447235 DOI: 10.3390/nu15132910] [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: 05/01/2023] [Revised: 06/25/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
An epidemic of obesity emerged in the USA in 1976-1980. The epidemic then spread to many other Westernized nations. Many interventions have been carried out with the goal of lowering the prevalence of obesity. These have mostly taken the form of various types of health promotion (i.e., providing people with education, advice, and encouragement). These actions have achieved, at most, only limited success. A strategy with a better chance of success starts with the recognition that the fundamental cause of obesity is that we live in an obesogenic environment. It is therefore necessary to change the environment so that it fosters a generally healthy lifestyle, thereby leading to enhanced health for the population, including improved weight control. A major goal is to increase the intake of healthy foods (especially fruit, vegetables, and whole grains), while decreasing intake of unhealthy foods (especially ultra-processed foods such as sugar). This will require major changes of many government policies. Some of the required policies are as follows. Schools should implement policies that create a healthy environment for children. For example, they should adopt a policy that only foods of high nutritional quality are sold in vending machines or given to students within school meals. Policies need to go well beyond the school setting; a broad strategy is needed that creates a healthy environment for children. Another important policy is the manipulation of food prices in order to shift the diet toward healthy foods. This requires using subsidies to lower the price of healthy foods, while adding a tax to less healthy foods to increase the price. This policy has been implemented in many cities and countries in the form of a tax on sugar-sweetened beverages (SSBs). The advertising of unhealthy foods (including fast-food restaurants) should be banned, especially where children and adolescents are the major target. Such a ban could be extended to a complete ban on all advertising for unhealthy foods, including that directed at adults. The proposed policy measures are likely to be strongly opposed by food corporations.
Collapse
Affiliation(s)
- Norman J Temple
- Centre for Science, Athabasca University, Athabasca, AB T9S 3A3, Canada
| |
Collapse
|
21
|
Pepe RB, Lottenberg AM, Fujiwara CTH, Beyruti M, Cintra DE, Machado RM, Rodrigues A, Jensen NSO, Caldas APS, Fernandes AE, Rossoni C, Mattos F, Motarelli JHF, Bressan J, Saldanha J, Beda LMM, Lavrador MSF, Del Bosco M, Cruz P, Correia PE, Maximino P, Pereira S, Faria SL, Piovacari SMF. Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022). Diabetol Metab Syndr 2023; 15:124. [PMID: 37296485 DOI: 10.1186/s13098-023-01037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.
Collapse
Affiliation(s)
- Renata Bressan Pepe
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Ana Maria Lottenberg
- Laboratório de Lipides (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
- Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), Rua Mato Grosso 306 - cj 1711, Sao Paulo, SP, 01239-040, Brazil.
| | - Clarissa Tamie Hiwatashi Fujiwara
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Mônica Beyruti
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Dennys Esper Cintra
- Centro de Estudos em Lipídios e Nutrigenômica - CELN - University of Campinas, Campinas, SP, Brazil
| | - Roberta Marcondes Machado
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Alessandra Rodrigues
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Natália Sanchez Oliveira Jensen
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Ariana Ester Fernandes
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Carina Rossoni
- Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fernanda Mattos
- Programa de Obesidade e Cirurgia Bariátrica do Hospital Universitário Clementino Fraga Filho da UFRJ, Rio de Janeiro, RJ, Brazil
| | - João Henrique Fabiano Motarelli
- Núcleo de Estudos e Extensão em Comportamento Alimentar e Obesidade (NEPOCA) da Universidade de São Paulo - FMRP/USP, Ribeirão Preto, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | | | - Lis Mie Masuzawa Beda
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Maria Sílvia Ferrari Lavrador
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mariana Del Bosco
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Patrícia Cruz
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Priscila Maximino
- Instituto PENSI - Fundação José Luiz Egydio Setúbal, Instituto Pensi, Fundação José Luiz Egydio Setúbal, Hospital Infantil Sabará, São Paulo, SP, Brazil
| | - Silvia Pereira
- Núcleo de Saúde Alimentar da Sociedade Brasileira de Cirurgia Bariátrica e Metabólica, São Paulo, Brazil
| | | | | |
Collapse
|
22
|
Hajishafiee M, Kapellas K, Listl S, Pattamatta M, Gkekas A, Moynihan P. Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective. BMC Public Health 2023; 23:986. [PMID: 37237341 DOI: 10.1186/s12889-023-15884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose-response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available. METHODS The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence. RESULTS From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period. CONCLUSION Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.
Collapse
Affiliation(s)
| | - Kostas Kapellas
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Madhuri Pattamatta
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Athanasios Gkekas
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Paula Moynihan
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
| |
Collapse
|
23
|
Barry LE, Kee F, Woodside J, Clarke M, Cawley J, Doherty E, Crealey GE, Duggan J, O'Neill C. An umbrella review of the effectiveness of fiscal and pricing policies on food and non-alcoholic beverages to improve health. Obes Rev 2023:e13570. [PMID: 37095626 DOI: 10.1111/obr.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/03/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
Poor quality diets represent major risk factors for the global burden of disease. Modeling studies indicate a potential for diet-related fiscal and pricing policies (FPs) to improve health. There is real-world evidence (RWE) that such policies can change behavior; however, the evidence regarding health is less clear. We conducted an umbrella review of the effectiveness of FPs on food and non-alcoholic beverages in influencing health or intermediate outcomes like consumption. We considered FPs applied to an entire population within a jurisdiction and included four systematic reviews in our final sample. Quality appraisal, an examination of excluded reviews, and a literature review of recent primary studies assessed the robustness of our results. Taxes and, to some extent, subsidies are effective in changing consumption of taxed/subsidized items; however, substitution is likely to occur. There is a lack of RWE supporting the effectiveness of FPs in improving health but this does not mean that they are ineffective. FPs may be important for improving health but their design is critical. Poorly designed FPs may fail to improve health and could reduce support for such policies or be used to support their repeal. More high-quality RWE on the impact of FPs on health is needed.
Collapse
Affiliation(s)
- Luke E Barry
- Centre for Public Health, Queen's University Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, UK
| | - Jayne Woodside
- Centre for Public Health, Queen's University Belfast, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, UK
| | - John Cawley
- Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
| | - Edel Doherty
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Grainne E Crealey
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Jim Duggan
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Co. Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, UK
| |
Collapse
|
24
|
Herbozo S, Brown KL, Burke NL, LaRose JG. A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions. Curr Obes Rep 2023; 12:24-35. [PMID: 36729299 PMCID: PMC9894524 DOI: 10.1007/s13679-023-00493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions. RECENT FINDINGS Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.
Collapse
Affiliation(s)
- Sylvia Herbozo
- Department of Surgery, Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Illinois at Chicago, Chicago, USA.
- Department of Psychiatry and Behavioral Sciences and Department of Surgery, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL, 60612, USA.
| | - Kristal Lyn Brown
- Division of General Internal Medicine, School of Medicine, The Johns Hopkins University, Baltimore, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, The Bronx, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, USA
| |
Collapse
|
25
|
Headey DD, Ecker O, Comstock AR, Ruel MT. Poverty, price and preference barriers to improving diets in sub-Saharan Africa. GLOBAL FOOD SECURITY 2023; 36:100664. [PMID: 36937376 PMCID: PMC10015269 DOI: 10.1016/j.gfs.2022.100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
Suboptimal diets are the most important preventable risk factor for the global burden of non-communicable diseases. The EAT-Lancet reference diet was therefore developed as a benchmark for gauging divergence from healthy eating standards. However, no previous research has comprehensively explored how and why this divergence exists in poorer countries undergoing nutrition transitions. This study therefore analyzes dietary patterns and drivers of the demand for nutritious foods using nationally representative household surveys from Ethiopia, Kenya, Tanzania, and Uganda. We show how barriers to dietary convergence stem from combinations of poverty, high relative food prices and weak preferences for some specific healthy foods. The article concludes by discussing interventions for strengthening consumer demand for healthy diets in Africa.
Collapse
|
26
|
Ghodsi D, Haghighian-Roudsari A, Khoshfetrat M, Abdollah-PouriHosseini SF, Babapour M, Esfarjani F, Ajami M, Zargaraan A, Mohammadi-Nasrabadi F. Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households? Front Nutr 2023; 10:1035094. [PMID: 36814511 PMCID: PMC9939810 DOI: 10.3389/fnut.2023.1035094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
Objective This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households. Methods The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications. Results Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated. Conclusion The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.
Collapse
Affiliation(s)
- Delaram Ghodsi
- Department of Nutrition Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Haghighian-Roudsari
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MohammadReza Khoshfetrat
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Fatemeh Abdollah-PouriHosseini
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Babapour
- Department of Economics, Allameh Tabataba’i University, Tehran, Iran
| | - Fatemeh Esfarjani
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ajami
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azizollaah Zargaraan
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Azizollaah Zargaraan,
| | - Fatemeh Mohammadi-Nasrabadi
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Fatemeh Mohammadi-Nasrabadi,
| |
Collapse
|
27
|
Flynn J. Do sugar-sweetened beverage taxes improve public health for high school aged adolescents? HEALTH ECONOMICS 2023; 32:47-64. [PMID: 36180999 DOI: 10.1002/hec.4609] [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: 10/19/2021] [Revised: 07/13/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Sugar-sweetened beverage taxes have become an increasingly popular policy to combat the worldwide obesity epidemic, but relatively little is known about their impact on health outcomes, particularly among high school aged students. In this paper, I use public-use data from the Youth Risk Behavioral Surveillance System to determine whether high school students living in three of the American cities which have implemented Sugar-sweetened beverage taxes have experienced public health improvements. Using an event-study design that compares outcomes in treated districts to a group of similar control districts, I find reductions in soda consumption in Philadelphia and average body mass index in Philadelphia, San Francisco and Oakland, with suggestive evidence that the improvements are concentrated among female and non-white respondents in both cases.
Collapse
Affiliation(s)
- James Flynn
- Economics Department, University of Colorado, Boulder, Colorado, USA
| |
Collapse
|
28
|
Kooshkebaghi M, Dargahi H, Emamgholipour S. The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study. BMC Public Health 2022; 22:2307. [PMID: 36494705 PMCID: PMC9733354 DOI: 10.1186/s12889-022-14673-w] [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: 09/21/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system. MATERIALS AND METHODS This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted. FINDINGS In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health. CONCLUSION Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.
Collapse
Affiliation(s)
- Mahdi Kooshkebaghi
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Emamgholipour
- grid.411705.60000 0001 0166 0922Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
29
|
Shakiba M, Iranparvar P, Jadidfard MP. The impact of sugar-sweetened beverages tax on oral health-related outcomes: a systematic review of the current evidence. Evid Based Dent 2022:10.1038/s41432-022-0830-1. [PMID: 36477678 DOI: 10.1038/s41432-022-0830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/15/2022] [Indexed: 06/17/2023]
Abstract
Objective To provide a systematic overview of the impact of taxing sugar-sweetened beverages (SSBs) on oral health-related outcomes.Data sources For this PRISMA-compliant review, we searched PubMed, Scopus, Embase, Web of Science and Cochrane Central for relevant studies published from database inception to 27 August 2020.Data selection and extraction Two reviewers assessed the abstracts and then the full text of the studies. Primary studies that evaluated the impact of any kind of SSB tax on oral health-related outcomes (that is, decayed, missing and filled teeth, caries increment and dental treatment costs) were included.Data synthesis Of 503 search results, five studies met the inclusion criteria. All five were modelling studies, from which four studies predicted an SSB tax to have a positive impact on oral health-related outcomes, whereas one study in a developing country did not find an SSB tax to be solely successful. According to three studies, the younger population and men are likely to benefit the most from such a tax. One study demonstrated the benefits of an SSB tax to be potentially more significant among low-income individuals.Conclusion While no empirical studies are available to support the benefits of an SSB tax, the studies covered in this review altogether anticipate a positive impact. Furthermore, this review discusses some of the obstacles and limitations of implementing such a tax predicted by the included studies.
Collapse
Affiliation(s)
- Maryam Shakiba
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran, Iran
| | - Pouria Iranparvar
- Cochrane Iran Associate Centre, National Institute for Medical Research Development, Tehran, Iran
| | - Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
30
|
Chatelan A, Rouche M, Dzielska A, Fismen AS, Kelly C, Pedroni C, Desbouys L, Castetbon K. 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. Public Health Nutr 2022; 26:1-12. [PMID: 36321519 PMCID: PMC9989715 DOI: 10.1017/s1368980022002361] [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: 02/18/2022] [Revised: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
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 2001-2002 and 2017-2018 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 2001-2002 to 2017-2018). PARTICIPANTS Nationally representative samples of 13-year- and 15-year-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) and 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 and 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 or 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.
Collapse
Affiliation(s)
- Angeline Chatelan
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Manon Rouche
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| | - Anna Dzielska
- Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | - Anne-Siri Fismen
- Department of Health Promotion, Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Camille Pedroni
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| | - Lucille Desbouys
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| | - Katia Castetbon
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| |
Collapse
|
31
|
Smith NR, Grummon AH, Ng SW, Wright ST, Frerichs L. Simulation models of sugary drink policies: A scoping review. PLoS One 2022; 17:e0275270. [PMID: 36191026 PMCID: PMC9529101 DOI: 10.1371/journal.pone.0275270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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). DISCUSSION 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.
Collapse
Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| |
Collapse
|
32
|
Kooshkebaghi M, Emamgholipour S, Dargahi H. Explaining specific taxes management and use in the health sector: a qualitative study. BMC Health Serv Res 2022; 22:1220. [PMID: 36180837 PMCID: PMC9524337 DOI: 10.1186/s12913-022-08556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 09/08/2022] [Indexed: 01/22/2023] Open
Abstract
Background and aim Being the major source of revenue and essential economic tool for policymakers to improve public health, taxes contribute to government spending on the development of health care facilities and services. Given the financial challenges facing the health sector together with the public health issues that affect each society, placing specific taxes on some goods, services, and activities can be effective in this regard. The study aims to explain the various dimensions of specific taxes in the health sector and management of these resources in order to achieve the health system goals. Materials and methods This study with a qualitative research design was conducted using semi-structured interviews with open-ended questions in 2020–2021. In total, 38 managers, policymakers, economists, key experts, and other individuals, as informants, were interviewed. Purposive and snowball with maximum variation was also employed. As well, content analysis was utilized to shed light on the data. The transcribed interviews were further imported into MAXQDA for extracting and classifying the relevant codes. Findings In this study, 5 main themes and 23 subthemes were labeled. The main themes accordingly included “Objectives and Conditions of Specific Health Taxes”, “Earmarked Taxes”, “Taxes on Goods and Measures of Harmful to Health”, “Value-Added Taxes”, and “Green Taxes”. Discussion and conclusion Considering the specific taxes in the health sector, i.e., taxes on goods and measures of harmful to health, value-added taxes, and green taxes, all taxation and pricing policies need to take account of the effects as well as the advantages and disadvantages of types of taxes, a country’s economic structure, the conditions of industries and manufacturing enterprises, cultural aspects in society, and peoples’ socioeconomic status.
Collapse
Affiliation(s)
- Mahdi Kooshkebaghi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Emamgholipour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
33
|
Irani F, Coquoz E, von Wolff M, Bitterlich N, Stute P. Awareness of non-communicable diseases in women: a cross-sectional study. Arch Gynecol Obstet 2022; 306:801-810. [PMID: 35426002 PMCID: PMC9411077 DOI: 10.1007/s00404-022-06546-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Chronic non-communicable diseases (NCD) are the major reason for death, morbidity, loss of independency and public health cost. NCD prevalence could be significantly reduced by adopting a healthy lifestyle. This cross-sectional cohort study (online survey) in 221 women aimed to assess NCD awareness, knowledge about NCD prevention and willingness to adopt a healthier lifestyle in women. Overall, NCD awareness level was quite high with, however, information mainly originating from lay media, probably being one reason for false estimations of age groups mainly affected by NCD, impact of NCD on quality of life, NCD mortalities, and the extent of NCD prevention by lifestyle interventions, respectively. Furthermore, also due to mainly lay media, half of women knew online NCD risk calculators, most of them would like to know their NCD risk, but only few had been offered NCD risk calculation by their physician. The mean threshold for willing to adopt a healthier lifestyle was a roughly calculated 37% 5-10 years risk to develop a certain NCD. Acceptance of non-pharmacological interventions for NCD prevention was high, however, major barriers for not implementing a healthier lifestyle were lack of expert information and lack of time. In conclusion, future public health strategies should focus on distributing better understandable and correct information about NCD as well as meeting the individuals' request for personalized NCD risk calculation. Furthermore, physicians should be better trained for personalized NCD prevention counseling.
Collapse
Affiliation(s)
- Fiona Irani
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Eloïse Coquoz
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | | | - Petra Stute
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.
- Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital Inselspital, Friedbuehlstrasse 19, 3010, Bern, Switzerland.
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Segal AB, Olney J, Case KK, Sassi F. The benefits and challenges of taxing sugar in a small island state: an interrupted time series analysis. Int J Behav Nutr Phys Act 2022; 19:69. [PMID: 35705983 PMCID: PMC9202202 DOI: 10.1186/s12966-022-01308-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/24/2022] [Indexed: 12/21/2022] Open
Abstract
Background Beverage and food taxes have become a popular ‘best buy’ public health intervention in the global battle to tackle noncommunicable diseases. Though many countries have introduced taxes, mainly targeting products containing sugar, there is great heterogeneity in tax design. For taxes levied as import tariffs, there is limited evidence of effectiveness in changing the price and sale of taxed products, while the evidence base is stronger for excise taxes levied as a fixed amount per quantity of product. This paper examines the effect of the Bermuda Discretionary Foods Tax, which was based on import tariff changes, on retail prices and sales of sugar-sweetened beverages (SSBs), and on selected fruits and vegetables that benefited from a tariff reduction. Methods We used weekly electronic point-of-sale data from a major food retailer in Bermuda. We assessed historical weekly sales and price data using an interrupted time series design on 2,703 unique products between the dates of January 2018 through January 2020, covering 103 weeks. Results By January 2020, the average price per ounce of SSBs increased by 26.0%, while the price of untaxed beverages (including waters and non-added sugar drinks) remained constant. The increasing price of SSBs was the sole observable structural driver of SSB market share, responsible for a decrease in the market share by nearly eight percentage points by the end of the study period. The subsidy on fruits and vegetables was ineffective in changing prices and sales, due to the relatively small 5% import tax decrease. Conclusions The tax was largely passed through to consumers. However, several factors mitigated the impact of the tax on the prices paid for SSBs by consumers, including the specific design of the tax, price promotions and consumer responses. The experience of Bermuda provides important lessons for the planning of similar taxes in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01308-x.
Collapse
Affiliation(s)
- Alexa Blair Segal
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Jack Olney
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Kelsey K Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| |
Collapse
|
36
|
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] [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.
Collapse
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
| |
Collapse
|
37
|
Andreyeva T, Marple K, Moore TE, Powell LM. Evaluation of Economic and Health Outcomes Associated With Food Taxes and Subsidies: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2214371. [PMID: 35648401 PMCID: PMC9161015 DOI: 10.1001/jamanetworkopen.2022.14371] [Citation(s) in RCA: 2] [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: 12/30/2022] Open
Abstract
IMPORTANCE Fiscal policy is a promising approach to incentivizing better food choices and reducing the burden of chronic disease. To inform guidelines on using fiscal policies, including taxes and subsidies, to promote health, the World Health Organization commissioned a systematic review and meta-analysis of the worldwide literature on the outcomes of such policies for food products. OBJECTIVE To assess the outcomes of implemented food taxes and subsidies for prices, sales, consumption, and population-level diet and health. DATA SOURCES Eight bibliographic databases were searched for peer-reviewed literature and 14 data sources along with governmental websites were searched for grey literature that were published from database inception through June 1, 2020. There were no language and setting restrictions. STUDY SELECTION Only primary studies of implemented food taxes and subsidies were considered for inclusion. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. A 3-level random-effects model was used to conduct a meta-analysis of sales and consumption outcomes of fruit and vegetable subsidies. Other outcomes were analyzed in a narrative synthesis. MAIN OUTCOMES AND MEASURES Study estimates in the meta-analysis were combined using a price elasticity measure for sales and consumption outcomes. Heterogeneity was assessed using the I2 statistic and τ2. Studies varied in how diet and health were measured. RESULTS A total of 54 articles were included in the systematic review, of which 15 studies were included in the meta-analysis. Most food subsidies targeted fruits and vegetables and populations with low income, whereas the evidence on food taxes was primarily from the nonessential energy-dense food tax in Mexico. Sales of subsidized fruits and vegetables increased significantly, with an estimated price elasticity of demand of -0.59 (95% CI, -1.04 to -0.13 [P = .02]; 95% prediction interval, -2.07 to 0.90; I2 = 92.4% [95% CI, 89.0%-94.8%; P < .001]), suggesting inelastic demand. There was no significant change in the consumption of subsidized fruits and vegetables, with an estimated price elasticity of demand of -0.17 (95% CI, -0.49 to 0.15 [P = .26]; 95% prediction interval, -1.01 to 0.67; I2 = 76.2% [95% CI, 54.3%-87.6%; P < .001]). Food excise taxes were associated with higher prices and reduced sales. Evidence was limited on the differential outcomes of food taxes and subsidies across subpopulations. CONCLUSIONS AND RELEVANCE Results of this systematic review and meta-analysis indicated that fruit and vegetable subsidies were associated with a moderate increase in fruit and vegetable sales. Further research is warranted to understand the implications of food taxes and subsidies for population-level consumption, diet, and health outcomes.
Collapse
Affiliation(s)
- Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Hartford
| | - Keith Marple
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Timothy E. Moore
- Statistical Consulting Services, Center for Open Research Resources and Equipment, University of Connecticut, Storrs
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago
| |
Collapse
|
38
|
Bragg MA, Rummo PE, Greene T, Arshonsky J, Anekwe AV, Mezzacca TA, Farley SM. Beverage Availability and Price: Variations by Neighborhood Poverty Level in New York City. Health Equity 2022; 6:322-329. [PMID: 35557551 PMCID: PMC9081063 DOI: 10.1089/heq.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: To describe the variability in the availability and price of sugary drinks, low-calorie drinks, and water/seltzer across high- and low-poverty census tracts in the five boroughs of New York City (NYC). Design: Cross-sectional study. Our primary analysis compared the overall sample of beverages. Secondary analyses included tests for differences in the availability of beverage categories by neighborhood poverty level. Setting: We collected data from 106 stores (31 supermarkets, 29 convenience stores, 29 pharmacies, 9 Targets, and 8 Dollar Trees) in NYC. Fifty-four stores were located in high-poverty census tracts and 52 were located in low-poverty census tracts. Results: The mean Price per 0.03-liter of sugary drinks across the sample was $0.08, which was significantly higher than the price of low-calorie drinks ($0.07, p=0.01) but not different from water/seltzer ($0.08, p=0.65). Sugary drinks and water/seltzer were available in 91% of retailers, and low-calorie drinks were available in 87% of retailers. There was no statistical difference in availability of sugary drinks compared with low-calorie drinks or water/seltzer overall or within high- or low-poverty census tracts. Analyzed by store type, the mean price per ounce of sugary drinks differed significantly from water/seltzer at convenience stores, pharmacies, and Target stores (bodegas: $0.08 vs. $0.09, p=0.03; pharmacies: $0.11 vs. $0.08, p=0.02; Target stores: $0.07 vs. $0.09, p=0.01). Conclusions: Sugary drinks were available in most food retail settings in NYC, with little variation by census tract poverty level. Interventions that raise the price of sugary drinks to make healthier alternatives, such as water, the more affordable option should be considered.
Collapse
Affiliation(s)
- Marie A Bragg
- Department of Population Health, New York University School of Medicine, New York, New York, USA.,New York University College of Global Public Health, New York, New York, USA
| | - Pasquale E Rummo
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Tenay Greene
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Josh Arshonsky
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Amaka V Anekwe
- New York City Department of Health and Mental Hygiene, Bureau of Chronic Disease Prevention and Tobacco Control, Long Island City, New York, USA
| | | | - Shannon M Farley
- ICAP, Columbia University, Columbia University Mailman School of Public Health, New York, NY USA
| |
Collapse
|
39
|
Vellakkal S, Khan Z, Alavani H, Fledderjohann J, Stuckler D. Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature. Public Health 2022; 207:73-81. [PMID: 35567826 DOI: 10.1016/j.puhe.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN This study was a systematic review of the literature. METHODS We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
Collapse
Affiliation(s)
- S Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India.
| | - Z Khan
- IIPH Bhubaneshwar, Bhubaneshwar, Odisha, India
| | - H Alavani
- Department of Economics and Finance, BITS Pilani, KK Birla Goa Campus, Zuarinagar, Goa, India
| | - J Fledderjohann
- Department of Sociology, Lancaster University, Lancaster, UK
| | - D Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| |
Collapse
|
40
|
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. Public Health Nutr 2022; 25:1105-1117. [PMID: 34728000 PMCID: PMC9991614 DOI: 10.1017/s1368980021004547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket. DESIGN 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. SETTING Three-dimensional virtual supermarket. PARTICIPANTS Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394). RESULTS 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). CONCLUSIONS 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.
Collapse
|
41
|
Royo-Bordonada MÁ, Fernández-Escobar C, Gil-Bellosta CJ, Ordaz E. Effect of excise tax on sugar-sweetened beverages in Catalonia, Spain, three and a half years after its introduction. Int J Behav Nutr Phys Act 2022; 19:24. [PMID: 35279194 PMCID: PMC8917362 DOI: 10.1186/s12966-022-01262-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The 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.
Methods
We 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.
Results
As 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.
Conclusions
The 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.
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Sugar-sweetened beverages, effects on appetite and public health strategies to reduce the consumption among children: a review. Porto Biomed J 2022; 7:e172. [PMID: 35146179 PMCID: PMC8824388 DOI: 10.1097/j.pbj.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
Sugar-sweetened beverages (SSBs) consumption have been of public health concern and a target of interventions due to their high consumption and burden in health-related consequences, particularly in children and adolescents. SSBs provide high energy intake with low nutritional value and are a major contributor for added and free sugars intake of Portuguese in all age-groups, especially adolescents. Despite its recognized effect on weight gain, it might also disrupt appetite regulation. Research on the effect of SSBs on appetitive traits is still scarce and unclear, and the current knowledge of these potential effects will be discussed in this review. This review also aims to describe public health strategies implemented to decrease SSBs consumption among children, particularly in Portugal, such as: (i) implemented taxation measures and its impact in sales and in preventable cases of disease and death, (ii) marketing regulations applied to children and adolescents, and ultimately (iii) the intention of application of a single Front-of-Package labeling system in all countries, aiming to increase consumers’ food literacy.
Collapse
|
44
|
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.
Collapse
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
| |
Collapse
|
45
|
Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, Gale CP, Maggioni AP, Petersen SE, Huculeci R, Kazakiewicz D, de Benito Rubio V, Ignatiuk B, Raisi-Estabragh Z, Pawlak A, Karagiannidis E, Treskes R, Gaita D, Beltrame JF, McConnachie A, Bardinet I, Graham I, Flather M, Elliott P, Mossialos EA, Weidinger F, Achenbach S. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J 2022; 43:716-799. [PMID: 35016208 DOI: 10.1093/eurheartj/ehab892] [Citation(s) in RCA: 301] [Impact Index Per Article: 150.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries. METHODS AND RESULTS Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures. CONCLUSION Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.
Collapse
Affiliation(s)
- Adam Timmis
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Panos Vardas
- Hygeia Hospitals Group, HHG, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Hugo Katus
- Department of Internal Medicine and Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aldo P Maggioni
- Research Center of Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Radu Huculeci
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Barbara Ignatiuk
- Division of Cardiology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | | | - Agnieszka Pawlak
- Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roderick Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Timisoara, Romania
| | - John F Beltrame
- University of Adelaide, Central Adelaide Local Health Network, Basil Hetzel Institute, Adelaide, Australia
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Ian Graham
- Tallaght University Hospital, Dublin, Ireland
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Franz Weidinger
- Department of Internal Medicine and Cardiology, Klinik Landstrasse, Vienna, Austria
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
46
|
Gračner T, Marquez-Padilla F, Hernandez-Cortes D. Changes in Weight-Related Outcomes Among Adolescents Following Consumer Price Increases of Taxed Sugar-Sweetened Beverages. JAMA Pediatr 2022; 176:150-158. [PMID: 34902003 PMCID: PMC8669601 DOI: 10.1001/jamapediatrics.2021.5044] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Following the implementation of a tax on sugar-sweetened beverages (SSBs) in Mexico in 2014, SSB prices increased by about 10% on average, but differently across cities. It remains unclear how observed SSB price changes are associated with adolescent weight-related outcomes. OBJECTIVE To compare weight-related outcomes among adolescents living in cities with differential SSB price changes before and after the SSB tax was implemented in Mexico. DESIGN, SETTING, AND PARTICIPANTS Associations between differential SSB price changes and changes in weight-related outcomes were examined overall and by sex among 12 654 adolescents aged 10 to 18 years born between 1999 and 2002 living in 39 cities in Mexico. Multivariate regressions with individual fixed effects were applied on longitudinal individual-level yearly clinical data (height and weight) from 2012 to 2017 collected by the Instituto Mexicano del Seguro Social (IMSS) and merged with city-level SSB price data from 2011 to 2016 collected by the National Institute of Statistics and Geography (INEGI). Data were analyzed from July 2018 to July 2021. EXPOSURES Yearly city-level changes in SSB prices between 2011 and 2016. MAIN OUTCOMES AND MEASURES Age- and sex-specific body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile and indicator for overweight or obesity if BMI was at or above the 85th percentile. RESULTS Before 2014, 46% of 12 654 adolescents (6850 girls and 5804 boys) included in this study had obesity or overweight. The mean (SD) age was 11.38 (1.08) years. Among girls, a 10% SSB price increase was associated with a 1.3 percentage point absolute decrease (95% CI, -2.19 to -0.36; P = .008) or a 3% relative decrease in overweight or obesity prevalence within 2 years of a price change. For girls with BMI at or above the 75th percentile pretax, this price increase was associated with a 0.59 lower BMI percentile (95% CI, -1.08 to -0.10; P = .02) or a 0.67% relative decrease. Improved outcomes for girls were observed in cities where price increases were greater than 10% after the tax. No such associations were observed for boys. CONCLUSIONS AND RELEVANCE In this study, increased SSB prices were associated with decreased overweight or obesity prevalence among girls but not among boys. Improvements in outcomes were small, and mostly observed for girls with heavier weight and in cities where price increases after the tax were greater than 10%.
Collapse
|
47
|
Hasan MM, Ahmed S, Soares Magalhaes RJ, Fatima Y, Biswas T, Mamun AA. Double burden of malnutrition among women of reproductive age in 55 low- and middle-income countries: progress achieved and opportunities for meeting the global target. Eur J Clin Nutr 2022; 76:277-287. [PMID: 34040202 PMCID: PMC8152189 DOI: 10.1038/s41430-021-00945-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine trends and projections of underweight (Body Mass Index, BMI < 18.5 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) in women of reproductive age in 55 low- and middle-income countries (LMICs). METHODS We used data from 2,337,855 women aged 15-49 years from nationally representative Demographic and Health Survey conducted between 1990 and 2018. Bayesian linear regression analyses were performed. RESULTS During 1990-2018, the prevalence of underweight decreased in 35 countries and overweight increased in 50 countries. The highest underweight increase was in Morocco (5.5%) and overweight in Nepal (12.4%). In 2030, >20% of women in eight LMICs will be underweight, with Madagascar (36.8%), Senegal (32.2%), and Burundi (29.2%) projected to experience the highest burden of underweight. Whereas >50% of women in 22 LMICs are projected to be overweight, with Egypt (94.7%), Jordan (75.0%), and Pakistan (74.1%) projected to have the highest burden of overweight. 24 LMICs are projected to experience the double burden of malnutrition (both underweight and overweight >20%) in 2030. Noticeable variations in underweight and overweight were observed across wealth, residence, education, and age of women, with a higher rate of overweight in high-income, high-education, and urban women. These inequalities have widened in many countries and are projected to continue. The probability of eradicating overweight and underweight is nearly 0% for all countries by 2030, except Egypt is on track to eradicate underweight. CONCLUSIONS Although the prevalence of underweight declined, this decline has been superseded by the dramatic increase of overweight. None of the 55 LMICs is likely to eradicate malnutrition in women by 2030.
Collapse
Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia.
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia.
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ricardo J Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, 4825, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| |
Collapse
|
48
|
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.
Collapse
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
- * E-mail:
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States of America
| |
Collapse
|
49
|
Bucher Della Torre S, Moullet C, Jotterand Chaparro C. Impact of Measures Aiming to Reduce Sugars Intake in the General Population and Their Implementation in Europe: A Scoping Review. Int J Public Health 2022; 66:1604108. [PMID: 35095383 PMCID: PMC8791851 DOI: 10.3389/ijph.2021.1604108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/30/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives: Implementing public health measures is necessary to decrease sugars intake, which is associated with increased risk of noncommunicable diseases. Our scoping review aimed to identify the types of measures implemented and evaluated to decrease sugars intake in the population and to assess their impact. Methods: Following a review of systematic reviews (SRs) published in 2018, we systematically searched new SR (May 2017–October 2020) in electronic databases. We also searched the measures implemented in Europe in the NOURISHING database. Two researchers selected the reviews, extracted and analysed the data. Results: We included 15 SRs assessing economic tools (n = 5), product reformulation and labels/claims (n = 5), and educational/environmental interventions (n = 7). Economic tools, product reformulation and environmental measures were effective to reduce sugar intake or weight outcomes, while labels, education and interventions combining educational and environmental measures found mixed effects. The most frequently implemented measures in Europe were public awareness, nutritional education, and labels. Conclusion: Among measures to reduce sugar intake in the population, economic tools, product reformulation, and environmental interventions were the most effective, but not the more frequently implemented in Europe.
Collapse
|
50
|
Rubini A, Vilaplana-Prieto C, Flor-Alemany M, Yeguas-Rosa L, Hernández-González M, Félix-García FJ, Félix-Redondo FJ, Fernández-Bergés D. Assessment of the Cost of the Mediterranean Diet in a Low-Income Region: Adherence and Relationship with Available Incomes. BMC Public Health 2022; 22:58. [PMID: 35012491 PMCID: PMC8751306 DOI: 10.1186/s12889-021-12433-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background The Mediterranean Diet (MD) is recognized as heart-healthy, but the economic cost associated with this type of diet has scarcely been studied. The objective of the present study is to explore the cost and adherence of a low-income region population to the MD and its relationship with income. Methods A population-based study was carried out on 2,833 subjects between 25 and 79 years of age, 54% women, selected at random from the municipalities of Vegas Altas, La Siberia and La Serena in the province of Badajoz, Extremadura (Spain). Average monthly cost of each product included in the MD was computed and related to adherence to the MD using the Panagiotakos Index and average disposable income. Results The monthly median cost was 203.6€ (IQR: 154.04-265.37). Food-related expenditure was higher for men (p<0.001), age cohort between 45 and 54 years (p<0.013) and those living in urban areas (p<0.001). A positive correlation between food-related expenditure and the MD adherence was found. Monthly median cost represents 15% of average disposable income, ranging between 11% for the group with low MD adherence and 17% for the group with high MD adherence. Conclusions The monthly cost of the MD was positively correlated with the degree of adherence to this dietary pattern. Given that the estimated monthly cost is similar to that of other Spanish regions with a higher income level, the economic effort required to be able to afford the Mediterranean diet is higher. This may represent a barrier to access, which should be analyzed in detail by public decision-makers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12433-w.
Collapse
Affiliation(s)
- Alessia Rubini
- Research Unit of Don Benito-Villanueva de la Serena Health Area, Calle Sierra Nevada, 10, 06700, Villanueva de la Serena, Spain.,University institute for Biosanitary Research of Extremadura (INUBE), Badajoz, Spain
| | | | | | - Lorena Yeguas-Rosa
- University institute for Biosanitary Research of Extremadura (INUBE), Badajoz, Spain
| | - Miriam Hernández-González
- Research Unit of Don Benito-Villanueva de la Serena Health Area, Calle Sierra Nevada, 10, 06700, Villanueva de la Serena, Spain.,University institute for Biosanitary Research of Extremadura (INUBE), Badajoz, Spain
| | | | - Francisco Javier Félix-Redondo
- University institute for Biosanitary Research of Extremadura (INUBE), Badajoz, Spain.,Medical Manager of the General Directorate of Health Assistance, Extremadura Health Service, Mérida, Spain
| | - Daniel Fernández-Bergés
- Research Unit of Don Benito-Villanueva de la Serena Health Area, Calle Sierra Nevada, 10, 06700, Villanueva de la Serena, Spain. .,University institute for Biosanitary Research of Extremadura (INUBE), Badajoz, Spain.
| |
Collapse
|