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

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.

Mexican households' food shopping patterns in 2015: analysis following nonessential food and sugary beverage taxes.

OBJECTIVE: To examine patterns of taxed and untaxed food and beverage shopping across store types after Mexico's sugary drink and non-essential food taxes, the nutritional quality of these patterns and the socio-economic characteristics associated with them. DESIGN: We performed k-means cluster analyses using households' percentage of food and beverage purchases from each store type (i.e. convenience stores, traditional shops (e.g. bodegas, tiendas, mom-and-pop shops), supermarkets, wholesalers and others). We calculated adjusted mean proportions of taxed and untaxed products (ml or g/capita per d) purchased in each pattern. We studied the associations between households' SES and shopping patterns using multinomial logistic regressions. Within shopping patterns, we obtained mean volumes and proportions of taxed and untaxed food and beverage subgroups and calculated the proportion of products purchased at each store type. SETTING: Mexico. PARTICIPANTS: Urban Mexican households (n 5493) from the Nielsen Mexico Consumer Panel Survey 2015. RESULTS: We found four beverage shopping patterns and three food shopping patterns, driven by the store type where most purchases were made. For beverages, 48 % of households were clustered in the Traditional pattern and purchased the highest proportion of taxed beverages. Low-SES households had the highest probability of clustering in the Traditional beverage shopping pattern. For foods, 35 % of households were clustered into the Supermarket pattern. High-SES households had the highest probability of clustering in the Supermarket food shopping pattern. CONCLUSIONS: The combination of store types where Mexican households purchase packaged foods and beverages varies. However, households in all shopping patterns and SES purchase taxed beverages mainly at traditional stores. Store-level strategies should be developed to intervene on traditional stores to improve the healthfulness of purchases.

The caloric and sugar content of beverages purchased at different store-types changed after the sugary drinks taxation in Mexico.

BACKGROUND: Following the 2014 sugary drinks tax implementation in Mexico, promising reduction in the volume of purchases of taxed beverages were observed overall and at different store-types. However, the tax's effects on purchasing patterns of calories and sugar remain unclear. METHODS: Using longitudinal data from Mexican households (n = 7038), we examined changes in volume, calories and total sugar of packaged beverages purchased from 2012 to 2016 overall and by store-type. We used fixed effects models to estimate means for volume, calories, and sugar of households. To address the potential selectivity from households shopping at different stores, we calculated inverse probability weights to model the purchases changes over time by store-type. RESULTS: For taxed beverages, the volume of purchases declined by - 49 ml and -30 ml in the first year and second year post tax (2014 and 2015, respectively), while purchases leveled off in the third year of the tax (2016). Calories and sugar from taxed beverage purchases decreased over time, with the majority of the declines occurring in the first two years post-tax implementation. The volume of untaxed beverage purchases increased, whereas changes in calories and total sugar of untaxed beverages were minimal. Store level purchases of taxed beverages significantly decreased in the first two years post taxation (2014 and to 2015) only in supermarkets and traditional stores. The steepest declines in purchases of taxed beverages in 2014 were observed at supermarkets (- 40 ml or - 45%). The volume of purchases of untaxed beverages increased over time in almost all store-types, while calories and sugar minimally decreased over time. CONCLUSION: Although the Mexican tax on SSBs has lowered the purchases of sugary drinks 3 years after the tax implementation, the tax should be strengthened and store-specific interventions should be implemented to further reduce SSBs purchases in the Mexican population.

Improvements in the nutritional quality of US young adults based on food sources and socioeconomic status between 1989-1991 and 2011-2014.

BACKGROUND: Fast food and other away from home food sources are linked with poorer diet quality and adverse health outcomes. The diet quality of young adults, major consumers of fast food, is understudied in terms of long-term shifts based on food sources for key subpopulation disparities. METHODS: The study included young adults ages 18-39 (n = 8012) from the Continuing Survey of Food Intakes by Individuals 1989-1991 (n = 4217) and the National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 (n = 3795). We stratified individuals based on their combination of food sources, race/ethnicity, and socioeconomic status. Using 24-h dietary recall data, we measured diet quality with the Healthy Eating Index-2015 (HEI-2015). Differences in diet quality were determined using 95% confidence intervals. RESULTS: Overall, diet quality increased across all food sources between the 1989-1991 and 2011-2014 surveys. The restaurant category overtook the at home category as the healthiest food source, while the fast food category remained the unhealthiest on days it was consumed. Vegetable intake decreased, while added sugar intake increased across all sources. Non-Hispanic whites and non-Hispanic blacks experienced similar increases in HEI-2015 scores across all food sources except restaurants, while Mexican American diet quality remained unchanged. Although all income levels experienced an increase in diet quality, the disparity between low- and high-income groups increased considerably. CONCLUSIONS: US young adults consume healthier foods from all food sources, however, fast food consumers have significantly lower quality in the remainder of their diets. Additionally, Mexican Americans and low-income individuals emerge as high-risk groups for poor diet quality.

Mexican Households' Purchases of Foods and Beverages Vary by Store-Type, Taxation Status, and SES.

Where people shop for food is often linked to the healthiness of food purchases. In Mexico, no research has examined the connection between where people shop, what they buy, and their socioeconomic status (SES). Mexico's sugary beverage and junk food taxes have made households decrease purchases of taxed products. However, whether households have changed where they shop is unknown. To address this gap, we use a repeated cross-sectional analysis of household packaged food and beverage purchases from the Nielsen Mexico Consumer Panel Survey from 2012 to 2015 (n > 5500 households). We examine changes in the volume of the purchase of taxed and untaxed products from different store-types (i.e., convenience stores, supermarkets, traditional retailers, wholesalers, home water-delivery, and others) by SES using multivariate linear regression models. Results show that high-SES households purchased more foods and beverages at all store-types except for low-SES who purchased the most foods and taxed beverages at traditional retailers. Purchases of taxed foods and beverages from traditional retailers significantly decreased for low-SES and middle-SES households and from supermarkets for middle-SES and high-SES households. Purchases of untaxed beverages from wholesalers significantly increased for middle-SES households and from convenience stores for high-SES households. Our findings suggest that consumers choose different stores to purchase beverages than to purchase foods and that taxes may have differentially affected each store-type.

Energy, added sugar, and saturated fat contributions of taxed beverages and foods in Mexico.

OBJECTIVE: To estimate the dietary contribution of taxed beverages and foods. MATERIALS AND METHODS: Using 24-hour diet recall data from the Ensanut 2012 (n=10 096), we estimated the contribution of the items which were taxed in 2014 to the total energy, added sugar, and saturated fat intakes in the entire sample and by sociodemographic characteristics. RESULTS: The contributions for energy, added sugar, and saturated fat were found to be 5.5, 38.1, and 0.4%, respectively, for the taxed beverages, and 14.4, 23.8, and 21.4%, respectively, for the taxed foods. Children and adolescents (vs. adults), medium and high socioeconomic status (vs. low), urban area (vs. rural), and North and Center region (vs. South) had higher energy contribution of taxed beverages and foods. The energy contribution was similar between males and females. CONCLUSIONS: These taxes covered an important proportion of Mexicans' diet and therefore have the potential to improve it meaningfully.

Energy, added sugar, and saturated fat contributions of taxed beverages and foods in Mexico / Contribución de energía, azúcar añadido y grasa saturada de las bebidas y alimentos con impuesto en México

Abstract: Objective: To estimate the dietary contribution of taxed beverages and foods. Materials and methods: Using 24-hour diet recall data from the Ensanut 2012 (n=10 096), we estimated the contribution of the items which were taxed in 2014 to the total energy, added sugar, and saturated fat intakes in the entire sample and by sociodemographic characteristics. Results: The contributions for energy, added sugar, and saturated fat were found to be 5.5, 38.1, and 0.4%, respectively, for the taxed beverages, and 14.4, 23.8, and 21.4%, respectively, for the taxed foods. Children and adolescents (vs. adults), medium and high socioeconomic status (vs. low), urban area (vs. rural), and North and Center region (vs. South) had higher energy contribution of taxed beverages and foods. The energy contribution was similar between males and females. Conclusions: These taxes covered an important proportion of Mexicans' diet and therefore have the potential to improve it meaningfully.

Resumen: Objetivo: Estimar la contribución dietética de las bebidas y alimentos con impuesto. Material y métodos: Con el recordatorio de 24-horas de la Ensanut 2012 (n=10 096), estimamos la contribución de los productos con impuesto en 2014 al consumo total de energía, azúcar añadido y grasa saturada en toda la muestra y por sociodemográficos. Resultados: La contribución de energía, azúcar añadido y grasa saturada fue 5.5, 38.1 y 0.4%, respectivamente, para bebidas con impuesto y 14.4, 23.8 y 21.4%, respectivamente, para alimentos con impuesto. Los niños y adolescentes (vs. adultos), nivel socioeconómico medio y alto (vs. bajo), área urbana (vs. rural), y región Norte y Centro (vs. Sur) tuvieron una contribución de energía mayor de bebidas y alimentos con impuesto. La contribución fue similar entre hombres y mujeres. Conclusión: Estos impuestos cubren una proporción importante de la dieta mexicana y por lo tanto tienen el potencial de mejorarla de manera relevante.

Adherence to Dietary Recommendations for Food Group Intakes Is Low in the Mexican Population.

BACKGROUND: Given the high prevalence of obesity and noncommunicable diseases in Mexico and the key role of dietary quality in these conditions, it is important to determine Mexicans' adherence to dietary recommendations. OBJECTIVE: Our aim was to estimate the percentage of the Mexican population who adhere to dietary recommendations for key food groups. METHODS: We analyzed 7983 participants aged ≥5 y from the nationally representative Mexican National Health and Nutrition Survey 2012. Dietary intake data were collected by using one 24-h recall and a repeated 24-h recall in 9% of the sample. We used the National Cancer Institute method for episodically consumed foods, which uses a 2-part (probability and amount) mixed regression model to estimate the usual intake distribution and its association with sociodemographic variables. RESULTS: For the food groups that are encouraged, only 1-4% of the population (range across sex and age groups) reached the recommended intake of legumes, 4-8% for seafood, 7-16% for fruit and vegetables, and 9-23% for dairy. For food groups that are discouraged, only 10-22% did not exceed the recommended upper limit for sugar-sweetened beverages, 14-42% for high saturated fat and/or added sugar (HSFAS) products, and 9-50% for processed meats, whereas the majority (77-93%) did not exceed the limit for red meat. A lower proportion of adolescents than children and adults adhered to recommendations for several food groups. Participants with higher socioeconomic status (SES) and living in urban areas consumed more (probability of consuming and/or amount consumed) fruit and vegetables, dairy, and HSFAS products, but they consumed fewer legumes than those of lower SES and living in rural areas. CONCLUSIONS: These results reveal the poor dietary quality of the Mexican population and the urgent need to shift these habits. If current intakes continue, the burden of disease due to obesity and noncommunicable chronic diseases will likely remain elevated in the Mexican population.