Evaluation of Changes in Prices and Purchases Following Implementation of Sugar-Sweetened Beverage Taxes Across the US.

Importance: Sugar-sweetened beverage (SSB) taxes are promoted as key policies to reduce cardiometabolic diseases and other conditions, but comprehensive analyses of SSB taxes in the US have been difficult because of the absence of sufficiently large data samples and methods limitations. Objective: To estimate changes in SSB prices and purchases following SSB taxes in 5 large US cities. Design, Setting, and Participants: In this cross-sectional study with an augmented synthetic control analysis, changes in prices and purchases of SSBs were estimated following SSB tax implementation in Boulder, Colorado; Philadelphia, Pennsylvania; Oakland, California; Seattle, Washington; and San Francisco, California. Changes in SSB prices (in US dollars) and purchases (volume in ounces) in these cities in the 2 years following tax implementation were estimated and compared with control groups constructed from other cities. Changes in adjacent, untaxed areas were assessed to detect any increase in cross-border purchases. Data used for this analysis spanned from January 1, 2012, to February 29, 2020, and were analyzed between June 1, 2022, and September 29, 2023. Main Outcomes and Measures: The main outcomes were the changes in SSB prices and volume purchased. Results: Using nutritional information, 5500 unique universal product codes were classified as SSBs, according to tax designations. The sample included 26 338 stores-496 located in treated localities, 1340 in bordering localities, and 24 502 in the donor pool. Prices of SSBs increased by an average of 33.1% (95% CI, 14.0% to 52.2%; P < .001) during the 2 years following tax implementation, corresponding to an average price increase of 1.3¢ per oz and a 92% tax pass-through rate from distributors to consumers. SSB purchases declined in total volume by an average of 33.0% (95% CI, -2.2% to -63.8%; P = .04) following tax implementation, corresponding to a -1.00 price elasticity of demand. The observed price increase and corresponding volume decrease immediately followed tax implementation, and both outcomes were sustained in the months thereafter. No evidence of increased cross-border purchases following tax implementation was found. Conclusions and Relevance: In this cross-sectional study, SSB taxes led to substantial, consistent declines in SSB purchases across 5 taxed cities following price increases associated with those taxes. Scaling SSB taxes nationally could yield substantial public health benefits.

Adolescent Total and Mental Health-Related Emergency Department Visits During the COVID-19 Pandemic.

Importance: Previous research has assessed changes in pediatric and adolescent health care utilization during the COVID-19 pandemic; however, less is known regarding how the pandemic affected adolescents' use of emergency care, specifically for mental health (MH). Objective: To determine how adolescents (ages 12-17 years), compared with other age groups, sought help in emergency departments (EDs) in general and for MH conditions during the COVID-19 pandemic. Design and Setting: In this cross-sectional study, National Syndromic Surveillance Program data and the Centers for Disease Control and Prevention Mental Health, version 1, query were used to track patterns in weekly adolescent ED visits by region across the 10 US Department of Health and Human Services regions from January 2019 through December 2021. Data analysis was performed in April and May 2023. Main Outcomes and Measures: Total ED visits, MH-related ED visits, and the proportion of total ED visits that were MH related by week-region. Results: Both weekly regional ED visits and MH-related ED visits dropped after the onset of the pandemic. Because total ED visits dropped more than MH-related ED visits, the proportion of MH-related ED visits increased for the adolescent group. Total ED visits only returned to prepandemic weekly levels (2019: mean [range], 7358 [715-25 908] visits) in the middle of 2021 (overall in 2021: mean [range], 6210 [623-25 777] visits). Mental health-related visits also dropped in 2020 but rebounded to prepandemic weekly levels (2019: mean [range], 634 [56-1703] visits) by the end of 2020 (mean [range], 533 [39-1800] visits). Conclusions and Relevance: This cross-sectional study suggests that families' perceptions of the need for emergent MH care were reduced during the pandemic by less than their perception of the need for emergency care overall. Emergency departments should be equipped to provide critical care specifically for adolescents facing MH emergencies.

Trends in depression risk before and during the COVID-19 pandemic.

Using 11 years of the U.S. Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System survey data set for 2011 to 2021, we track the evolution of depression risk for U.S. states and territories before and during the COVID-19 pandemic. We use these data in conjunction with unemployment and COVID case data by state and by year to describe changes in the prevalence of self-reported diagnosis with a depressive disorder over time and especially after the onset of COVID in 2020 and 2021. We further investigate heterogeneous associations of depression risk by demographic characteristics. Regression analyses of these associations adjust for state-specific and period-specific factors using state and year-fixed effects. First, we find that depression risk had been increasing in the US in years preceding the pandemic. Second, we find no significant average changes in depression risk at the onset of COVID in 2020 relative to previous trends, but estimate a 3% increase in average depression risk in 2021. Importantly, we find meaningful variation in terms of changes in depression risk during the pandemic across demographic subgroups.

Evaluation of the sugar-sweetened beverage tax in Oakland, United States, 2015-2019: A quasi-experimental and cost-effectiveness study.

BACKGROUND: While a 2021 federal commission recommended that the United States government levy a sugar-sweetened beverage (SSB) tax to improve diabetes prevention and control efforts, evidence is limited regarding the longer-term impacts of SSB taxes on SSB purchases, health outcomes, costs, and cost-effectiveness. This study estimates the impact and cost-effectiveness of an SSB tax levied in Oakland, California. METHODS AND FINDINGS: An SSB tax ($0.01/oz) was implemented on July 1, 2017, in Oakland. The main sample of sales data included 11,627 beverage products, 316 stores, and 172,985,767 product-store-month observations. The main analysis, a longitudinal quasi-experimental difference-in-differences approach, compared changes in beverage purchases at stores in Oakland versus Richmond, California (a nontaxed comparator in the same market area) before and 30 months after tax implementation (through December 31, 2019). Additional estimates used synthetic control methods with comparator stores in Los Angeles, California. Estimates were inputted into a closed-cohort microsimulation model to estimate quality-adjusted life years (QALYs) and societal costs (in Oakland) from 6 SSB-associated disease outcomes. In the main analysis, SSB purchases declined by 26.8% (95% CI -39.0 to -14.7, p < 0.001) in Oakland after tax implementation, compared with Richmond. There were no detectable changes in purchases of untaxed beverages or sweet snacks or purchases in border areas surrounding cities. In the synthetic control analysis, declines in SSB purchases were similar to the main analysis (-22.4%, 95% CI -41.7% to -3.0%, p = 0.04). The estimated changes in SSB purchases, when translated into declines in consumption, would be expected to accrue QALYs (94 per 10,000 residents) and significant societal cost savings (>$100,000 per 10,000 residents) over 10 years, with greater gains over a lifetime horizon. Study limitations include a lack of SSB consumption data and use of sales data primarily from chain stores. CONCLUSIONS: An SSB tax levied in Oakland was associated with a substantial decline in volume of SSBs purchased, an association that was sustained more than 2 years after tax implementation. Our study suggests that SSB taxes are effective policy instruments for improving health and generating significant cost savings for society.

Preferences for sustainability and supply chain worker conditions: Evidence during COVID-19.

Given coronavirus 2019 (COVID-19), we empirically investigate whether consumers are willing to pay for greater sustainability and safer working conditions in food supply chains. We elicit consumer valuation via two consumer choice survey experiments and revealed preferences using mixed Logit discrete choice models. We find that consumers have a significant positive average valuation towards sustainability, but may require an average compensation to choose products produced under safer working conditions. Policy implications suggest a market-based potential to nudge consumer segments who desire value congruence in their diet, namely, by revealing information through labeling.