Modelling the Health Impact of an English Sugary Drinks Duty at National and Local Levels.
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SUBMITTER: Collins B
PROVIDER: S-EPMC4486083 | biostudies-literature | 2015
REPOSITORIES: biostudies-literature
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Modelling the Health Impact of an English Sugary Drinks Duty at National and Local Levels.
Collins Brendan B Capewell Simon S O'Flaherty Martin M Timpson Hannah H Razzaq Abdul A Cheater Sylvia S Ireland Robin R Bromley Helen H
PloS one 20150629 6
<h4>Background</h4>Increasing evidence associates excess refined sugar intakes with obesity, Type 2 diabetes and heart disease. Worryingly, the estimated volume of sugary drinks purchased in the UK has more than doubled between 1975 and 2007, from 510 ml to 1140 ml per person per week. We aimed to estimate the potential impact of a duty on sugar sweetened beverages (SSBs) at a local level in England, hypothesising that a duty could reduce obesity and related diseases.<h4>Methods and findings</h4 ...[more]
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Project description:BackgroundPictorial warnings on tobacco products are promising for motivating behavior change, but few studies have examined pictorial warnings for sugary drinks, especially in naturalistic environments. This study aimed to examine the impact of pictorial warnings on parents' purchases of sugary drinks for their children in a naturalistic store laboratory.Methods and findingsParents of children ages 2 to 12 (n = 325, 25% identifying as Black, 20% Hispanic) completed a shopping task in a naturalistic store laboratory in North Carolina. Participants were randomly assigned to a pictorial warnings arm (sugary drinks displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (sugary drinks displayed a barcode label). Parents selected 1 beverage and 1 snack for their child, as well as 1 household good; one of these items was selected for them to purchase and take home. The primary outcome was whether parents purchased a sugary drink for their child. Secondary outcomes included reactions to the trial labels, attitudes toward sugary drinks, and intentions to serve their child sugary drinks. Pictorial warnings led to a 17-percentage point reduction in purchases of sugary drinks (95% CI for reduction: 7% to 27%), with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm (p = 0.002). The impact of pictorial warnings on purchases did not differ by any of the 13 participant characteristics examined (e.g., race/ethnicity, income, education, and age of child). Pictorial warnings also led to lower calories (kcal), purchased from sugary drinks (82 kcal in the control arm versus 52 kcal in the pictorial warnings arm, p = 0.003). Moreover, pictorial warnings led to lower intentions to serve sugary drinks to their child, feeling more in control of healthy eating decisions, greater thinking about the harms of sugary drinks, stronger negative emotional reactions, greater anticipated social interactions, lower perceived healthfulness of sugary drinks for their child, and greater injunctive norms to limit sugary drinks for their child (all p < 0.05). There was no evidence of difference between trial arms on noticing of the labels, appeal of sugary drinks, perceived amount of added sugar in sugary drinks, risk perceptions, or perceived tastiness of sugary drinks (all p > 0.05).ConclusionsPictorial warnings reduced parents' purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US.Trial registrationThe trial design, measures, power calculation, and analytic plan were registered before data collection at www.clinicaltrials.gov NCT04223687.
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Project description:BackgroundWith the increasing concerns about the health and economic burden attributed to sugar-sweetened beverages (SSBs) consumption, SSB taxation has been proposed and implemented in many countries. Many previous economic evaluations of SSB taxation have shown that this kind of policy is cost-effective. However, the magnitude of impact varies. This study aims to design a comprehensive model to estimate the impact and cost-effectiveness of the SSB tax in Canada.MethodsA proportional multi-state life table-based Markov model was chosen to estimate the impacts of SSB tax in Canada. The health-related quality of life (including disability-adjusted life years (DALYs) and quality-adjusted life years (QALYs)), the costs (including health care costs and intervention costs), and the tax revenue were the main health and economic outcomes. We compared the simulated SSB tax with the current practice from the public health care payer perspective, and the tax was applied to the 2015 adult Canadian population up to 100 years. The economic model was built following guidelines from the Canadian Agency for Drugs and Technologies in Health.ResultsAfter implementing a CAD$0.015/oz SSB tax, 282,104 cases of overweight and obesity, 210,542 cases of diseases, and 2,189 deaths could be prevented. The simulated SSB tax has the potential to avert 2.3 million DALYs, gain 1.5 million QALYs, and save CAD$32,583 million in health care costs in a lifetime period. The incremental cost-effectiveness ratio for the SSB tax was CAD$ -24,933/QALY. The SSB tax with different tax levels (CAD$0.01/oz and CAD$0.02/oz) remained cost-effective.ConclusionImplementing the SSB tax in Canada is a potential cost-effective policy option for reducing obesity and related chronic diseases. The model built in this study provides a more accurate estimate of health and economic impact of SSB tax and could be used to estimate other sugar tax options.
| S-EPMC9648777 | biostudies-literature
Project description:BackgroundIn March, 2016, the UK Government proposed a tiered levy on sugar-sweetened beverages (SSBs; high tax for drinks with >8 g of sugar per 100 mL, moderate tax for 5-8 g, and no tax for <5 g). We estimate the effect of possible industry responses to the levy on obesity, diabetes, and dental caries.MethodsWe modelled three possible industry responses: reformulation to reduce sugar concentration, an increase of product price, and a change of the market share of high-sugar, mid-sugar, and low-sugar drinks. For each response, we defined a better-case and worse-case health scenario. We developed a comparative risk assessment model to estimate the UK health impact of each scenario on prevalence of obesity and incidence of dental caries and type 2 diabetes. The model combined data for sales and consumption of SSBs, disease incidence and prevalence, price elasticity estimates, and estimates of the association between SSB consumption and disease outcomes. We drew the disease association parameters from a meta-analysis of experimental studies (SSBs and weight change), a meta-analysis of prospective cohort studies (type 2 diabetes), and a prospective cohort study (dental caries).FindingsThe best modelled scenario for health is SSB reformulation, resulting in a reduction of 144 383 (95% uncertainty interval 5102-306 743; 0·9%) of 15 470 813 adults and children with obesity in the UK, 19 094 (6920-32 678; incidence reduction of 31·1 per 100 000 person-years) fewer incident cases of type 2 diabetes per year, and 269 375 (82 211-470 928; incidence reduction of 4·4 per 1000 person-years) fewer decayed, missing, or filled teeth annually. An increase in the price of SSBs in the better-case scenario would result in 81 594 (3588-182 669; 0·5%) fewer adults and children with obesity, 10 861 (3899-18 964; 17·7) fewer incident cases of diabetes per year, and 149 378 (45 231-262 013; 2·4) fewer decayed, missing, or filled teeth annually. Changes to market share to increase the proportion of low-sugar drinks sold in the better-case scenario would result in 91 042 (4289-204 903; 0·6%) fewer adults and children with diabetes, 1528 (4414-21 785; 19·7) fewer incident cases of diabetes per year, and 172 718 (47 919-294 499; 2·8) fewer decayed, missing, or filled teeth annually. The greatest benefit for obesity and oral health would be among individuals aged younger than 18 years, with people aged older than 65 years having the largest absolute decreases in diabetes incidence.InterpretationThe health impact of the soft drinks levy is dependent on its implementation by industry. Uncertainty exists as to how industry will react and about estimation of health outcomes. Health gains could be maximised by substantial product reformulation, with additional benefits possible if the levy is passed on to purchasers through raising of the price of high-sugar and mid-sugar drinks and activities to increase the market share of low-sugar products.FundingNone.
| S-EPMC5543265 | biostudies-literature
Project description:Evidence about the health problems associated with sugary drink consumption is well-established. However, little is known about which sugary drink health harms are most effective at changing consumers' behavior. We aimed to identify which harms people were aware of and most discouraged them from wanting to buy sugary drinks. Participants were a national convenience sample of diverse parents (n = 1,058), oversampled for Latino parents (48%). Participants rated a list of sugary drink-related health harms occurring in children (7 harms) and in adults (15 harms). Outcomes were awareness of each harm and how much each harm discouraged parents from wanting to purchase sugary drinks. Most participants were aware that sugary drinks contribute to tooth decay in children (75%) and weight gain in both children (73%) and adults (69%). Few participants were aware that sugary drinks contribute to adult infertility (16%), arthritis (18%), and gout (18%). All health harms were rated highly in terms of discouraging parents from wanting to buy sugary drinks (range: 3.59-4.11 on a 1-5 scale), with obesity, pre-diabetes, and tooth decay eliciting the highest discouragement ratings. Harm-induced discouragement was higher for participants who were aware of more health harms (B = 0.05, p < 0.0001), identified as female (B = 0.15 compared to male, p = 0.02), or had an annual household income of $50,000 or more (B = 0.16 compared to less than $50,000, p = 0.03). These findings suggest health messages focused on a variety of health harms could raise awareness and discourage sugary drink purchases.
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Project description:Campaigns to improve beverage consumption typically focus on discouraging unhealthy beverages (e.g., soda), encouraging healthy beverages (e.g., water), or both. It remains unclear which of these strategies is most effective. We recruited a national convenience sample of U.S. parents of children ages 2-12 (n = 1078, 48% Latino[a]) to complete an online survey in 2019. We randomly assigned participants to view: 1) a control message, 2) a soda discouragement message, 3) a water encouragement message, or 4) both soda discouragement and water encouragement messages shown side-by-side in random arrangement. Intervention messages mimicked New York City's "Pouring on the Pounds" campaign. Participants rated messages on perceived effectiveness for discouraging soda consumption and encouraging water consumption (1-5 response scales) and reported feelings and intentions about drinking soda and water (1-7 scales). Compared to those with no exposure, participants who viewed the soda discouragement message reported higher perceived discouragement from drinking soda (Average Differential Effect [ADE] = 1.18), more negative feelings toward drinking soda (ADE = 0.83) and stronger intentions to avoid drinking soda (ADE = 0.45) (ps < 0.001). The soda discouragement message also exerted beneficial effects on perceived effectiveness, feelings, and intentions related to water consumption (ADEs = 0.33-0.68; ps < 0.001). Exposure to the water encouragement message had beneficial effects on outcomes related to water consumption (ADEs = 0.28-0.81, ps < 0.001), but limited impact on outcomes related to soda consumption. Across outcomes, results indicated diminishing returns from exposure to both message types. Messaging campaigns discouraging unhealthy beverages may be more promising for improving beverage consumption than messages only promoting healthier beverages.
| S-EPMC9898202 | biostudies-literature
Project description:Sugary drink warnings are a promising policy for reducing sugary drink consumption, but it remains unknown how to design warnings to maximize their impact overall and among diverse population groups, including parents of Latino ethnicity and parents with low English use. In 2019, we randomized US parents of children ages 2-12 (n = 1078, 48% Latino ethnicity, 13% low English use) to one topic (one of four warnings, or a neutral control), which they viewed on three designs (text-only, icon, and graphic) to assess reactions to the various warnings on sugary drinks. All warning topics were perceived as more effective than the control (average differential effect [ADE] ranged from 1.77 to 1.84 [5-point Likert scale], all p < .001). All warning topics also led to greater thinking about harms of sugary drinks (all p < .001) and lower purchase intentions (all p < .01). Compared to text-only warnings, icon (ADE = 0.18) and graphic warnings (ADE = 0.30) elicited higher perceived message effectiveness, as well as greater thinking about the harms of sugary drinks, lower perceived healthfulness, and lower purchase intentions (all p < .001). The impact of icon warnings (vs. text warnings) was stronger for parents with low English use, compared to those with high English use (p = .024). Similarly, the impact of icon (vs. text warnings) was stronger for Latino parents than non-Latino parents (p = .034). This experimental study indicates that many warning topics hold promise for behavior change and that including images with warnings could increase warning efficacy, particularly among Latino parents and parents with low English use. Clinical Trial Registration: NCT04382599.
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Project description:BackgroundChildren's food preference and intake patterns are affected by parental child feeding practices. The objective was to determine patterns of food parenting practices regarding junk food and sugary drinks (JS) and investigate their associations with demographic characteristics and dietary intake in a large cohort of parents and their children (12-17 years).MethodsDyadic survey data from the cross-sectional, internet-based Family Life, Activity, Sun, Health, and Eating Study, conducted in 2014, were analyzed using latent class analysis to identify patterns of use for six JS parenting practices - negative emotions, restriction, monitoring, availability, modeling, and child involvement - based on parent and child report. Model covariates included self-reported parent and child sex, age (child only), body mass index category (based on height and weight), added sugars intake, and legitimacy of parental authority.ResultsBased on 1657 parent-child dyads, five parenting practice patterns were identified representing different levels of practice use - Complete Influencers (28%; reference class), Indifferent Influencers (21%), Negative Influencers (20%), Minimal Influencers (18%), and Disagreeing Influencers (13%). Compared to older child dyads, younger child dyads were less likely to belong to Indifferent and Minimal Influencers (79 and 63% lower odds, respectively). Greater parent added sugars intake increased the odds of belonging to Indifferent and Negative Influencers (4 and 5% higher for every teaspoon increase, respectively) while greater child added sugars intake decreased the odds of belonging to Minimal Influencers (6% lower for every teaspoon increase). Compared to dyads with high scores, dyads with low child scores for legitimacy of parental authority regarding JS were 18 times as likely to belong to Disagreeing Influencers.ConclusionsThe study findings suggest that parents utilize distinct patterns of feeding practices regarding JS ranging from use of many practices, use of some practices, to low use of any practice, with differential associations with parent and child intakes of added sugars. Counseling or intervening with parents to use a mix of structure practices, such as availability and modeling, to positively influence their child's and possibly their own intake of sugary snacks and drinks may prove more efficacious than use of coercive control practices, such as negative emotions.
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Project description:ObjectiveTo determine the modifiable factors influencing well-being in boys and girls by accounting for deprivation, ethnicity and clustering within local authorities.MethodsWe used data from a very large nationally representative survey, the What About Youth study involving 120 115 adolescents aged 15 years. Our outcome measure of mental well-being was the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Potential explanatory factors included substance abuse, screen time, eating habits, reading, bullying, sleeping pattern, physical activity and area-level deprivation. We ran unadjusted and adjusted multilevel models for each explanatory factor, after adjusting for ethnicity, deprivation and including a random effect for the local authority.ResultsBoys had a higher overall mean WEMWBS score than girls (p<0.0001). In the adjusted model, each of multiple risk behaviours, eating habits, sleep, bullying, physical activity, screen-time and reading were independently associated with mental well-being in both boy and girls (p<0.0001 for both). Sleep and eating behaviours had a stronger association in both sexes than bullying, physical activity and screen time. Young people from black ethnic groups had significantly higher well-being in both sexes. Deprivation was not associated with well-being among boys but was among girls.ConclusionThe largest contributors to adolescent well-being appear to be sleep, eating behaviours and bullying when considered in a multivariable framework. While adolescents from black ethnic groups had higher overall well-being scores, area deprivation did not affect male well-being but had a small effect on female well-being. Future longitudinal studies and health policies need to consider a range of behavioural factors to drive improvements in adolescent well-being.
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