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Using nutritional survey data to inform the design of sugar-sweetened beverage taxes in low-resource contexts: a cross-sectional analysis based on data from an adult Caribbean population.

Accepted version
Peer-reviewed

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Article

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Abstract

OBJECTIVE: Sugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax would differentiate between high-sugar SSBs and low-sugar SSBs. We evaluated these three considerations using pre-existing nutritional survey data in a developing economy setting. METHODS: We used data from a nationally representative cross-sectional survey in Barbados (2012-2013, prior to SSB tax implementation). Data were available on 334 adults (25-64 years) who completed two non-consecutive 24-hour dietary recalls. We estimated the prevalence of SSB consumption and its contribution to total energy intake, overall and stratified by taxable status. We assessed the percentage of SSB-derived free sugars subject to the tax and identified the consumption-weighted sugar concentration of SSBs, stratified by taxable status. FINDINGS: Accounting for sampling probability, 88.8% of adults (95% CI 85.1 to 92.5) reported SSB consumption, with a geometric mean of 2.4 servings/day (±2 SD, 0.6, 9.2) among SSB consumers. Sixty percent (95% CI 54.6 to 65.4) of SSB-derived free sugars would be subject to the tax. The tax did not clearly differentiate between high-sugar beverages and low-sugar beverages. CONCLUSION: Given high SSB consumption, targeting SSBs was a sensible strategy in this setting. A substantial percentage of free sugars from SSBs were not covered by the tax, reducing possible health benefits. The considerations proposed here may help policymakers to design more effective SSB taxes.

Description

Keywords

epidemiology, health policy, nutrition, public health, Adult, Barbados, Beverages, Caribbean Region, Cross-Sectional Studies, Humans, Nutrition Surveys, Sugar-Sweetened Beverages, Taxes

Journal Title

BMJ Open

Conference Name

Journal ISSN

2044-6055
2044-6055

Volume Title

10

Publisher

BMJ

Rights

All rights reserved
Sponsorship
Medical Research Council (MR/K023187/1)
Wellcome Trust (087636/Z/08/Z)
Economic and Social Research Council (ES/G007462/1)
Department of Health (via National Institute for Health Research (NIHR)) (PHR Project: 16/49/01)
Department of Health (via National Institute for Health Research (NIHR)) (16/130/01)
Medical Research Council (MC_UU_12015/5)
MRC (MC_UU_00006/7)
MRC (MC_UU_00006/3)
The overall evaluation received support from the Canadian International Development Research Centre (grant no. 107604-001) and from the US Center for Disease Control and Prevention (TEPHINET). MA is funded through a Gates Cambridge PhD Scholarship, and received travel funding from Robinson College, the Global Food Security Fund, the Luca D’Agliano Scholarship, the Yates Unilever Fund and the Smuts Memorial Fund. JA is funded by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. FI was funded by the Medical Research Council Epidemiology Unit Core Support (MC_UU_12015/5). Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The Health of the Nation Study and the Barbados Salt Intake Study received funding from The Ministry of Health of the Government of Barbados.