Tax awareness and perceived cost of sugar-sweetened beverages in four countries between 2017 and 2019: findings from the international food policy study.

Change log
Acton, Rachel B 
Vanderlee, Lana 
Kirkpatrick, Sharon I 
Pedraza, Lilia S 

BACKGROUND: The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects-via awareness of the tax-may impact the effectiveness of SSB taxes on consumer purchases. OBJECTIVE: The study sought to examine perceived cost of SSBs, tax awareness, and changes in beverage purchasing over time and across four countries with and without SSB taxes. METHODS: The study used data from the 2017, 2018 and 2019 waves of the International Food Policy Study. Annual cross-sectional online surveys were conducted in Australia, Mexico, UK and US, which captured perceived cost of SSBs relative to non-SSBs in all countries (with Australia as a no-tax comparator), and measures of tax awareness and participants' reported changes in beverage purchasing in response to SSB taxes in Mexico (tax implemented in 2014), UK (tax implemented in 2018) and US (subnational taxes since 2015). Logistic regression models evaluated the measures across years and socio-demographic groups. RESULTS: Perceived cost of SSBs relative to non-SSBs was higher in Mexico (all three years) and the UK (2018 and 2019 following tax implementation) than Australia and the US. Tax awareness was higher in UK than Mexico, and decreased over time among Mexican respondents. Patterns of reported beverage purchasing changes in response to the tax were similar across Mexico, UK and US, with the largest changes reported by Mexican respondents. Respondents with characteristics corresponding to lower socioeconomic status were less likely to be aware of an SSB tax, but more likely to perceive SSBs to cost more than non-SSBs and report changes in purchasing in response to the tax, where there was one. CONCLUSIONS: This study suggests that in countries where a national SSB tax was present (Mexico, UK), perceived cost of SSBs and tax awareness were higher compared to countries with no SSB tax (Australia) or subnational SSB taxes (US), respectively, and suggests that perceived cost and tax awareness represent distinct constructs. Improving the 'signalling effect' of existing SSB taxes may be warranted, particularly in tax settings where consumer behaviour change is a policy objective.

Journal Title
Int J Behav Nutr Phys Act
Conference Name
Journal ISSN
Volume Title
BioMed Central
Medical Research Council (MR/K023187/1)
MRC (MC_UU_00006/7)
Wellcome Trust (087636/Z/08/Z)
Economic and Social Research Council (ES/G007462/1)
Funding for the International Food Policy Study was provided by a Canadian Institutes of Health Research (CIHR) Project Grant, with additional support from an International Health Grant, The Public Health Agency of Canada (PHAC), and a CIHR-PHAC Applied Public Health Chair (DH). JA & MW are supported by the Medical Research Council (grant number MC_UU_00006/7) and the Centre for Diet and Activity Research (CEDAR), a UKCRC funded Centre of Public Health Research Excellence. Funding for CEDAR from Cancer Research UK, British Heart Foundation, Economic and Social Research Council (grant number ES/G007462/1), Medical Research Council (grant number MR/K023187/1), National Institute for Health Research, and Wellcome Trust (grant number 087636/Z/08/Z) is gratefully acknowledged. The funding body had no role in the design of the study, the collection, analysis, or interpretation of data, or in the writing or decision to submit the manuscript for publication.