Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA Netw Open. 2021 Jun 1;4(6):e2113527. doi: 10.1001/jamanetworkopen.2021.13527.
The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items.
To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties.
Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods.
Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001).
This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.
重要性：在长期和小型独立食品零售商店中，甜味饮料税与饮料和高糖食品价格和购买量之间的关系研究不足，而在这些商店中，加糖和人工甜味饮料是最常购买的商品之一。
目的：研究宾夕法尼亚州费城实施每盎司 1.5 美分的含糖和人工甜味饮料消费税是否与 2 年来小型独立商店中饮料价格和购买量的持续变化以及饮料和高糖食品（糖果、甜零食）购买量的持续变化有关。
设计、地点和参与者：这是一项使用差异中的差异方法的横断面研究，比较了费城和马里兰州巴尔的摩（无税对照）独立商店在税收实施前（2017 年 1 月 1 日）和实施后 2 年内（税收实施后）的饮料和高糖食品（糖果、甜零食）的饮料价格和购买量变化，税收实施后）。还对费城邻近县的独立商店进行了价格比较。
主要结果和测量：征税和未征税饮料的平均价格（以每液盎司美分为单位）变化、征税和未征税饮料的平均购买液盎司数以及饮料和高糖食品购买的总卡路里数变化。
结果：与巴尔的摩独立商店相比，费城征税饮料价格每液盎司上涨 2.06 美分（95%置信区间，1.75 至 2.38 美分；P<0.001），实施税收后 2 年内有 137%的税收转嫁给了价格，而未征税饮料价格没有统计学意义上的变化。共有 116 家独立商店和 4738 名顾客购买（1950 名[41.2%]为女性；4351 名[91.8%]年龄在 18 岁或以上；1006 名[21.2%]为白人顾客，3185 名[67.2%]为黑人顾客）参与了价格和购买比较。征税饮料的购买量下降了 6.1 液盎司（95%置信区间，-9.9 至-2.4 液盎司；P<0.001），与巴尔的摩相比，费城下降了 42%；未征税饮料的购买量没有显著变化。尽管收入和客户教育水平的邻里调节作用不显著，但探索性分层分析表明，在低收入社区购物的顾客征税饮料购买量下降幅度更大（-7.1 液盎司；95%置信区间，-13.0 至-1.1 液盎司；P=0.001），教育水平较低的个体（-6.9 液盎司；95%置信区间，-12.5 至-1.3 液盎司；P=0.001）。
结论和相关性：这项横断面研究发现，甜味饮料税与价格上涨和购买量下降有关。饮料消费税可能是一种可持续减少独立商店中加糖饮料和糖摄入的有效政策，在低收入地区和教育程度较低的顾客中，减少幅度较大。
