RESUMO
BACKGROUND: Evidence suggests reducing consumption of sugar-sweetened beverages is important to reducing weight gain and chronic disease risk. Indonesia's large population is a growing market for sugar-sweetened beverages. Taxation to reduce consumption is of interest, but considered fiscally regressive. Little is known about differential effects between income groups in low-income countries. METHODS: This modelling study uses a proportional multistate life table to model reduced daily energy intake following a $0.30 per litre tax on sugar-sweetened beverages and subsequent shifts in Body Mass Index (BMI) distribution for income groups in Indonesia. Energy balance equations calculate reduced BMI. Reduced incidence of type 2 diabetes mellitus, ischaemic heart disease and stroke is determined from the relative risk of the BMI shift and subsequent health-adjusted life years gained calculated. RESULTS: The tax's effect was greater for higher income quintiles than lower. Energy intake reduced most in higher income quintiles. Cases of overweight and obesity for women decreased by approximately 15 000 in the lowest income quintile, but 417 000 for the highest. For men, this was 12 000 and 415 000. Over 25 years, 63 000 cases of diabetes were averted in the lowest quintile and 1 487 000 in the highest. Similar magnitudes were observed for stroke and ischaemic heart disease. Tax paid over 25 years was $0.5 billion for the lowest income quintile and $15.1 billion for the highest. CONCLUSION: Sugar-sweetened beverage taxation can help to reduce the number of overweight and obese, and prevent over a million cases of diabetes in Indonesia. Higher income groups would benefit more than lower income groups. The tax would raise $920 million in the first year and $27.3 billion over 25 years.
RESUMO
This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach's alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.
