Impact of the announcement and implementation of the UK Soft Drinks Industry Levy on sugar content, price, product size and number of available soft drinks in the UK, 2015-19: A controlled interrupted time series analysis.

BACKGROUND: Dietary sugar, especially in liquid form, increases risk of dental caries, adiposity, and type 2 diabetes. The United Kingdom Soft Drinks Industry Levy (SDIL) was announced in March 2016 and implemented in April 2018 and charges manufacturers and importers at £0.24 per litre for drinks with over 8 g sugar per 100 mL (high levy category), £0.18 per litre for drinks with 5 to 8 g sugar per 100 mL (low levy category), and no charge for drinks with less than 5 g sugar per 100 mL (no levy category). Fruit juices and milk-based drinks are exempt. We measured the impact of the SDIL on price, product size, number of soft drinks on the marketplace, and the proportion of drinks over the lower levy threshold of 5 g sugar per 100 mL. METHODS AND FINDINGS: We analysed data on a total of 209,637 observations of soft drinks over 85 time points between September 2015 and February 2019, collected from the websites of the leading supermarkets in the UK. The data set was structured as a repeat cross-sectional study. We used controlled interrupted time series to assess the impact of the SDIL on changes in level and slope for the 4 outcome variables. Equivalent models were run for potentially levy-eligible drink categories ('intervention' drinks) and levy-exempt fruit juices and milk-based drinks ('control' drinks). Observed results were compared with counterfactual scenarios based on extrapolation of pre-SDIL trends. We found that in February 2019, the proportion of intervention drinks over the lower levy sugar threshold had fallen by 33.8 percentage points (95% CI: 33.3-34.4, p < 0.001). The price of intervention drinks in the high levy category had risen by £0.075 (£0.037-0.115, p < 0.001) per litre-a 31% pass through rate-whilst prices of intervention drinks in the low levy category and no levy category had fallen and risen by smaller amounts, respectively. Whilst the product size of branded high levy and low levy drinks barely changed after implementation of the SDIL (-7 mL [-23 to 11 mL] and 16 mL [6-27ml], respectively), there were large changes to product size of own-brand drinks with an increase of 172 mL (133-214 mL) for high levy drinks and a decrease of 141 mL (111-170 mL) for low levy drinks. The number of available drinks that were in the high levy category when the SDIL was announced was reduced by 3 (-6 to 12) by the implementation of the SDIL. Equivalent models for control drinks provided little evidence of impact of the SDIL. These results are not sales weighted, so do not give an account of how sugar consumption from drinks may have changed over the time period. CONCLUSIONS: The results suggest that the SDIL incentivised many manufacturers to reduce sugar in soft drinks. Some of the cost of the levy to manufacturers and importers was passed on to consumers as higher prices but not always on targeted drinks. These changes could reduce population exposure to liquid sugars and associated health risks.

Changes to the littered cigarette pack environment in New York City between 2011 and 2015.

INTRODUCTION: Imposing policies that increase tobacco prices is a key strategy for reducing smoking prevalence, although it may result in more cigarette trafficking. In 2013, New York City (NYC) passed the Sensible Tobacco Enforcement (STE) law requiring cigarettes be sold for a minimum price of $10.50 per pack. To evaluate whether cigarette price increases changed patterns of behaviour related to cigarette tax evasion, we examined littered pack study data from 2011 and 2015. METHODS: Littered cigarette packs were collected from a random sample of NYC census tracts in 2011 and 2015. The proportions of cigarette packs with proper local, known non-local, foreign or unknown, and no tax stamp were calculated. Changes in volume, source and consumption of domestically trafficked cigarettes over time were estimated. RESULTS: In 2011, 255 packs with cellophane were collected; in 2015, 226 packs with cellophane were collected. Packs without proper local stamp increased from 60.7% in 2011 to 76.3% in 2015 (p<0.05) and those with foreign or unknown stamp increased from 11.6% in 2011 to 31.4% in 2015 (p<0.05). The percentage of domestically sourced packs attributed to domestic trafficking increased significantly from a range of 47.9% to 52.8% in 2011 to a range of 59.4% to 63.2% in 2015. CONCLUSION: While the trafficking rate among domestically sourced cigarettes increased between 2011 and 2015 (before and after the STE minimum price floor on cigarette packs was in place), there was a decline in total consumption of domestically trafficked cigarettes due to a significant increase in consumption of foreign-sourced cigarettes. Jurisdictions considering price measures should bolster monitoring and enforcement efforts to maximise public health impact. Given the interstate nature of cigarette trafficking in the USA, Federal intervention would be optimal.

Appetite for health-related food taxes: New Zealand stakeholder views.

There is increasing discussion globally of the value of health-related food taxes and subsidies to address obesity and noncommunicable diseases. In order for such policies to be successful it is important to understand the positions of key stakeholders. This research investigated New Zealand (NZ) stakeholders' views on the feasibility and acceptability of selected health-related food taxes and subsidies over the next 5 to 10 years. Twenty semi-structured interviews were undertaken by telephone from November 2014 to May 2015. The purposive sample of key stakeholders included politicians, bureaucrats, public health experts, food industry leaders and consumer representatives. Prior to interviews participants were sent summary information on the estimated impacts of a range of health-related food taxes and subsidies on dietary intake and mortality. According to key stakeholders there appears to be little appetite for taxes on foods high in saturated fat or salt in NZ. Stakeholders largely agreed that a tax on sugar-sweetened beverages (SSBs) and a subsidy on fruit and vegetables were both feasible and likely acceptable. There was strong support for starting with a SSBs tax, possibly framed around protecting children and dental health. Addressing obesity and noncommunicable diseases is a multidimensional challenge. A tax on SSBs and a subsidy on fruit and vegetables, possibly in tandem, could be part of the solution in NZ. There is growing interest in, and evidence for, health-related taxes and subsidies internationally. Given the critical role of stakeholder support for such policies similar research on stakeholders' views may assist the implementation of health-related food taxes and subsidies in other jurisdictions.

Changing damaging beverage behavior: your CDA at work.

The California Dental Association's vision statement places promoting the public's oral health as a top priority of the association. The past 10 years have seen CDA and CDA Foundation activities collectively improve the public's oral health in a multitude of ways. Some have been directed specifically at reducing the detrimental effects the consumption of beverages with high sugar content and carbonation has on oral health.

Dentists in double trouble: the (un)fairness of punishing for the same mistake twice.

BACKGROUND: and Overview. Many state dental practice acts allow for the suspension or revocation of a dentist's license on the basis of a previous conviction for illegal behavior, even if the behavior is not related to the practice of dentistry. Penalizing a dentist twice for the same behavior appears to violate the legal principle "ne bis in idem"-that is, no double penalty for the same socially undesirable behavior. However, disciplinary measures are not intended primarily to penalize the offender but rather to protect the public and the reputation of the profession. In this article, the authors review various cases in which boards disciplined convicted dentists and propose criteria for discerning between situations in which such "double trouble" is fair and unfair. CONCLUSIONS: and Practice Implications. The authors conclude that such disciplinary actions are fair only if four criteria concerning the following are fulfilled: the relationship between the dentist's illegal behavior and dental treatment or privileges of the dentist; the severity of the crime; the frequency of the illegal behavior; and the balance between crime and punishment.

Asset protection: why a preventive approach is the best insurance against liability.

BACKGROUND: Asset-protection planning is critical for people in high-risk professions, such as dentistry. Planning requires a careful weighing of risks, such as the risk of a lawsuit versus that of relinquishing control of assets. The authors examine several lawful techniques that may protect a dentist's assets from claims of future creditors. CONCLUSIONS: Asset-protection planning, if done early and with the guidance of an attorney well-versed in the subject, can help deter creditors from claims resulting from malpractice suits, divorce, business partner disputes, bad investments, poor tax planning or a combination of these. Practice Implications. Careful planning can minimize the risk to a dentist's personal assets and the assets of the practice resulting from a lawsuit or other liabilities.

Seller beware.

Any dentist thinking of retiring needs to plan for the event, and that planning should include how to maximise Capital Gains Tax retirement relief. With assets having to be held for 10 years prior to retirement, that planning should start when the dentist reaches 45 years of age. As every dentist's circumstances are different, it is a tax that can become complicated. The best advice is to review your tax planning with your dental accountant as early as possible, and ensure you make the most of your practice assets.

The sugar tax - An opportunity to advance oral health.

The new sugar tax was recently announced by Government, aiming to combat obesity through investment in school sports. Dental professionals should seize this rare opportunity to raise awareness of the other adverse effects of sugar; young children continue to suffer alarmingly high rates of dental cavities in the UK. A significant amount of money raised through the levy must be reinvested into ensuring fluoride toothpaste is more affordable. Since daily use of fluoride toothpaste is the most effective evidence-based oral health preventative measure that is widely used, this should receive tax exemption status from the government as a means of universal oral health prevention. There must also be a re-investment in innovative oral health education so that the next generation of children will alter their mind set about sugar. Oral health prevention advice must be tightly integrated into general health messages.

Securing your family's future: the value of estate planning.

BACKGROUND: The authors provide an overview of general estate planning considerations, including minimization of federal estate taxes, estate planning techniques to be used to meet specific goals, and guidelines to ensure a well-drafted and well-organized plan. They also stress the importance of planning for incapacity. CONCLUSIONS: A well-thought-out and sound estate plan protects assets, minimizes estate taxes, ensures appropriate distribution to designated beneficiaries and prepares family members and business partners. In developing an estate plan, dentists should seek professional advice from a qualified attorney and a certified financial planner. Practice Implications. A sound estate plan should address business continuation or disposition with respect to the dental practice.

International control of smoking and the US experience.

International data demonstrate convincingly that lung cancer death rates follow and parallel cigarette smoking prevalence rates in both men and women. Effective control of lung cancer and the many other diseases associated with smoking can be achieved only by continued reductions in smoking prevalence in developed countries and the arrestment of smoking in developing countries. Smoking control strategies can take the form of prevention programs, cessation programs, regulatory and legislative measures, and modifications in tobacco product composition. Because of uncertainties surrounding the efficacies of specific smoking control approaches, the National Cancer Institute recently initiated a major intervention research program to identify and assess the most promising strategies to reduce smoking prevalence in the general public and high-risk populations; heavy smokers, blacks, Hispanics, women, youth, and smokeless tobacco users. By 1990, trial results will be available to allow systematic application of smoking control strategies (demonstrations) using physicians and dentists, mass media, school programs, self-help materials, and the community as a laboratory. For a number of reasons, such approaches are strongly recommended over efforts to reduce cigarette tar and nicotine levels as the primary focus of lung cancer control.

VAT for dental practices--a short guide.

There have been many stories concerning VAT and dental practices over the past year, sometimes true but often distorting the facts. This article attempts to document the current state of play so that practitioners can make their own decision on registration.