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Simulating the Impact of Sugar-Sweetened Beverage Warning Labels in Three Cities

  • Bruce Y. Lee
    Correspondence
    Address correspondence to: Bruce Y. Lee, MD, MBA, Global Obesity Prevention Center at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore MD 21205-2179
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Marie C. Ferguson
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Daniel L. Hertenstein
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Atif Adam
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Eli Zenkov
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
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  • Peggy I. Wang
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Michelle S. Wong
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Joel Gittelsohn
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Yeeli Mui
    Affiliations
    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Shawn T. Brown
    Affiliations
    Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, Maryland

    Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Published:December 14, 2017DOI:https://doi.org/10.1016/j.amepre.2017.11.003

      Introduction

      A number of locations have been considering sugar-sweetened beverage point-of-purchase warning label policies to help address rising adolescent overweight and obesity prevalence.

      Methods

      To explore the impact of such policies, in 2016 detailed agent-based models of Baltimore, Philadelphia, and San Francisco were developed, representing their populations, school locations, and food sources, using data from various sources collected between 2005 and 2014. The model simulated, over a 7-year period, the mean change in BMI and obesity prevalence in each of the cities from sugar-sweetened beverage warning label policies.

      Results

      Data analysis conducted between 2016 and 2017 found that implementing sugar-sweetened beverage warning labels at all sugar-sweetened beverage retailers lowered obesity prevalence among adolescents in all three cities. Point-of-purchase labels with 8% efficacy (i.e., labels reducing probability of sugar-sweetened beverage consumption by 8%) resulted in the following percentage changes in obesity prevalence: Baltimore: −1.69% (95% CI= −2.75%, −0.97%, p<0.001); San Francisco: –4.08% (95% CI= −5.96%, −2.2%, p<0.001); Philadelphia: −2.17% (95% CI= −3.07%, −1.42%, p<0.001).

      Conclusions

      Agent-based simulations showed how warning labels may decrease overweight and obesity prevalence in a variety of circumstances with label efficacy and literacy rate identified as potential drivers. Implementing a warning label policy may lead to a reduction in obesity prevalence. Focusing on warning label design and store compliance, especially at supermarkets, may further increase the health impact.
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