From measurement to policy: Sugar-sweetened beverages as a public health nutrition target

Abstract

Sugar-sweetened beverages (SSB), or beverages with added caloric sweetener, have become a staple of the American diet with the industrialization of food. However, consuming SSB is associated with increased risk of diet-related chronic diseases, including cardiovascular disease and type 2 diabetes. Given these harms, accurate measurement of SSB intake and understanding ways to reduce SSB intake are needed to improve diet quality and prevent disease. SSB taxes are an effective way to reduce SSB purchasing. To further understand SSB taxes and purchasing, I developed an experimental marketplace, or a virtual storefront, in study 1. Participants purchased less SSB when SSB were taxed, helping to validate the paradigm. In study 2, I used the experimental marketplace to examine how different tax bases, or sets of products taxed, influenced beverage purchasing. Taxes on SSB or both SSB and non-sugar sweetened beverages were similarly effective in reducing SSB purchasing. In study 2, I also examined if the effect of taxes on SSB purchasing depended on individual characteristics relevant to health equity, including household income and level of SSB intake, finding larger reductions for people who drink more SSB. In study 3, I examined the reliability of a tool to assess beverage intake across household income levels. Measurements were correlated across time for both income groups, but intake was significantly higher for the first measurement. Overall, this work contributes to better understanding of SSB as a target in public health nutrition, including development of measurement tools and evaluation of reduction policies.