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Promotion of Healthy Eating Through Public Policy

A Controlled Experiment

      Background

      To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown.

      Purpose

      In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies.

      Methods

      From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase “less healthy” on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January–July 2012, at the single-item and transaction levels.

      Results

      There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, p<0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage point decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11–14 fewer calories (9%–11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction.

      Conclusions

      Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%–20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy.
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      References

        • Glickman D.
        • Parker L.
        • Sim L.
        • Cook H.
        • Miller E.
        Accelerating progress in obesity prevention: solving the weight of the nation.
        National Academies Press, Washington DC2012
        • Harnack L.J.
        • French S.A.
        • Oakes J.M.
        • Story M.T.
        • Jeffery R.W.
        • Rydell S.A.
        Effects of calorie labeling and value size pricing on fast food meal choices: results from an experimental trial.
        Int J Behav Nutr Phys Act. 2008; 5: 63
        • Elbel B.
        • Kersh R.
        • Brescoll V.
        • Dixon L.
        Calorie labeling and food choices: a first look at the effects on low-income people in New York City.
        Health Aff. 2009; 28: w1110-w1121
        • Elbel B.
        • Gyamfi J.
        • Kersh R.
        Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment.
        Int J Obes. 2011; 35: 493-500
        • Vadiveloo M.
        • Dixon L.
        • Elbel B.
        Consumer purchasing patterns in response to calorie labeling legislation in New York City.
        Int J Behav Nutr Phys Act. 2011; 8: 51
        • Frieden T.
        • Dietz W.
        • Collins J.
        Reducing childhood obesity through policy change: acting now to prevent obesity.
        Health Aff. 2010; 29: 357-363
        • Fishman P.A.
        • Ebel B.E.
        • Garrison M.M.
        • Christakis D.A.
        • Wiehe S.E.
        • Rivara F.P.
        Cigarette tax increase and media campaign cost of reducing smoking-related deaths.
        Am J Prev Med. 2005; 29: 19-26
        • Adams E.K.
        • Markowitz S.
        • Kannan V.
        • Dietz P.M.
        • Tong V.T.
        • Malarcher A.M.
        Reducing prenatal smoking: the role of state policies.
        Am J Prev Med. 2012; 43: 34-40
        • Zhang B.
        • Cohen J.
        • Ferrence R.
        • Rehm J.
        The impact of tobacco tax cuts on smoking initiation among Canadian young adults.
        Am J Prev Med. 2006; 30: 474-479
      1. CDC. Reducing tobacco use: a report of the Surgeon General. Atlanta GA: DHHS, 2000.

        • IOM
        Ending the tobacco problem: a blueprint for the nation.
        National Academies Press, Washington DC2007
        • Brownell K.
        • Farley T.
        • Willett W.
        • et al.
        The public health and economic benefits of taxing sugar-sweetened beverages.
        N Engl J Med. 2009; 361: 1599-1605
        • Stanford D.
        Anti-obesity soda tax fails as lobbyists spend millions: retail.
        Bloomberg Businessweek. 2010; : 13
      2. Yale Rudd Center for Food Policy & Obesity. Legislation trends: sugar-sweetened beverages/taxes. www.yaleruddcenter.org/legislation/legislation_trends.aspx.

        • Villanueva T.
        European nations launch tax attack on unhealthy foods.
        Can Med Assoc J. 2011; 183: E1229-E1230
        • Mytton O.
        • Clarke D.
        • Rayner M.
        Taxing unhealthy food and drinks to improve health.
        BMJ. 2012; 344: E2931
      3. French Republic, Ministry of Budget, Public Accounts and Reform of the State. Contributions of drinks and liquids for sugar-sweetened and artificially-sweetened drinks: indirect contributions. Circular 2012. Jan 24. NOR: BCRD 1202351C. . circulaire.legifrance.gouv.fr/pdf/2012/01/cir_34494.pdf

      4. Nielsen ScanTrak Convenience Index. 100 kg Sale Volume. 2011 Jul 17 – 2012 Jul 15.

      5. Pedersen TS, Jensen K, Rørvig M, Legarth M, Mikkelsen BB. Suggestions for a parliamentary resolution on the abolition of tax on saturated fat (the fat tax). www.ft.dk/samling/20121/beslutningsforslag/b3/index.htm.

        • Barry C.L.
        • Niederdeppe J.
        • Gollust S.E.
        Taxes on sugar-sweetened beverages: results from a 2011 national public opinion survey.
        Am J Prev Med. 2013; 44: 158-163
        • Dorfman L.
        Talking about sugar sweetened-beverage taxes: will actions speak louder than words?.
        Am J Prev Med. 2013; 44: 194-195
        • Andreyeva T.
        • Long M.
        • Brownell K.
        The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food.
        Am J Public Health. 2010; 100: 216-222
        • Epstein L.H.
        • Dearing K.K.
        • Roba L.G.
        • Finkelstein E.
        The influence of taxes and subsidies on energy purchased in an experimental purchasing study.
        Psychol Sci. 2010; 21: 406-414
        • Epstein L.
        • Jankowiak N.
        • Nederkoorn C.
        • et al.
        Experimental research on the relation between food price changes and food-purchasing patterns: a targeted review.
        Am J Clin Nutr. 2012; 95: 789-809
        • Jue J.J.
        • Press M.J.
        • McDonald D.
        • et al.
        The impact of price discounts and calorie messaging on beverage consumption: a multi-site field study.
        Prev Med. 2012; 55: 629-633
      6. Smith T, Lin B, Lee J. Taxing caloric sweetened beverages: potential effects on beverage consumption, calorie intake, and obesity. U.S. Department of Agriculture, Economic Research Service. Economic Research Report No.: ERR–100.

        • Sturm R.
        • Powell L.
        • Chriqui J.
        • Chaloupka F.
        Soda taxes, soft drink consumption, and children’s body mass index.
        Health Aff. 2010; 29: 1052-1058
        • Powell L.
        • Chaloupka F.
        Food prices and obesity: evidence and policy implications for taxes and subsidies.
        Milbank Q. 2009; 87: 229-257
        • Kim D.
        • Kawachi I.
        Food taxation and pricing strategies to “thin out” the obesity epidemic.
        Am J Prev Med. 2006; 30: 430-437
        • Eyles H.
        • Ni Mhurchu C.
        • Nghiem N.
        • Blakely T.
        Food pricing strategies, population diets, and non-communicable disease: a systematic review of simulation studies.
        PLoS Med. 2012; 9: e1001353
        • Brownell K.
        • Frieden T.
        Ounces of prevention—the public policy case for taxes on sugared beverages.
        N Engl J Med. 2009; 360: 1805-1808
        • Finkelstein E.
        • Zhen C.
        • Nonnemaker J.
        • Todd J.
        Impact of targeted beverage taxes on higher- and lower-income households.
        Arch Intern Med. 2010; 170: 2028-2034
        • Dharmasena S.
        • Capps O.J.
        Intended and unintended consequences of a proposed national tax on sugar-sweetened beverages to combat the U.S. obesity problem.
        Health Econ. 2012; 21: 669-694
        • Wang Y.
        • Coxson P.
        • Shen Y.
        • Goldman L.
        • Bibbins-Domingo K.
        A penny-per-ounce tax on sugar-sweetened beverages would cut health and cost burdens of diabetes.
        Health Aff. 2012; 31: 199-207
        • Marshall T.
        Exploring a fiscal food policy: the case of diet and ischaemic heart disease.
        BMJ. 2000; 320: 301-305
        • Mytton O.
        • Gray A.
        • Rayner M.
        • Rutter H.
        Could targeted food taxes improve health?.
        J Epidemiol Community Health. 2007; 61: 689-694
        • Andreyeva T.
        • Chaloupka F.
        • Brownell K.
        Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue.
        Prev Med. 2011; 52: 413-416
        • Schroeter C.
        • Lusk J.
        • Tyner W.
        Determining the impact of food price and income changes on body weight.
        J Health Econ. 2008; 27: 45-68
        • Chetty R.
        • Looney A.
        • Kroft K.
        Salience and taxation: theory and evidence.
        Am Econ Rev. 2009; 99: 1145-1177
        • Decicca P.
        • Kenkel D.
        • Mathios A.
        • Shin Y.
        • Lim J.
        Youth smoking, cigarette prices, and anti-smoking sentiment.
        Health Econ. 2008; 17: 733-749
        • Carroll G.
        • Choi J.
        • Laibson D.
        • Madrian B.
        • Metrick A.
        Optimal defaults and active decisions.
        Q J Econ. 2009; 124: 1639-1674
      7. Alabama State Board of Education. Alabama’s healthy snack standards for food and beverages at school. 2005. cnp.alsde.edu/NutritionPolicy/AlaHealthySnackStandards.pdf.

      8. State of California. The Pupil Nutrition, Health, and Achievement Act of 2001. SB 19. Article 2.5. Section 49430.

        • French S.
        • Hannan P.
        • Harnack L.
        • et al.
        Pricing and availability intervention in vending machines at four bus garages.
        J Occup Environ Med. 2010; 52: S29-S33
        • McCarthy D.
        • Mueller K.
        The New York City Health and Hospitals Corporation: transforming a public safety net delivery system to achieve higher performance. The Commonwealth Fund..
        Commission on a High Performance Health System. October 2008;
      9. New York State Department of Health. New York State Minority Health Surveillance Report. 2007 Sep. www.health.ny.gov/statistics/community/minority/docs/surveillance_report_2007.pdf.

      10. Wartella E. Lichtenstein A. Yaktine A. Nathan R. National Academies Press, Washington DC2011
        • Elbel B.
        Consumer estimation of recommended and actual calories at fast food restaurants.
        Obesity. 2011; 19: 1971-1978
        • Finkelstein A.
        E-Z tax: tax salience and tax rates.
        Q J Econ. 2009; 124: 969-1010
        • Ogden C.
        • Lamb M.
        • Caroll M.
        • Flegal K.
        Obesity and socioeconomic status in adults: U.S. 2005-2008. NCHS data brief No. 50.
        National Center for Health Statistics, Hyattsville MD2010