Impact of Sugary Beverage Taxes on Weight and Health Outcomes after 3-5 Years

项目总结 尽管肥胖流行病在美国和其他发达国家得到了广泛宣传，但其流行率 仍然有增无减。在美国，近20%的儿童和青少年和40%的成年人患有肥胖症，我们 面临公共卫生危机。黑人、西班牙裔和社会经济地位低的人不成比例 受影响。需要采取多层次、多管齐下的方法来遏制这一流行病。推荐一个 方法是以人口为基础的战略，使人们更容易做出更健康的选择。一 这样的策略是通过征税来减少含糖饮料(SSB)的消费。不仅是因为 SSB是美国饮食中添加糖的最大贡献者，一直与肥胖及其共病有关， 但全国调查数据显示，1/2的成年人和2/3的年轻人每天至少消费一种SSB。如果 税收可以减少SSB的消费，这意味着肥胖率将会下降，与肥胖相关的 疾病。在加利福尼亚州伯克利(第一个征收SSB税的城市[2015])，SSB销售额下降了9.6%，SSB 在税收实施后的第一年，消费下降了19.8%。有迹象表明，影响是 低收入社区的比例更高。我们建议对社会保障税对体重的自然实验进行评估 青年和成人的变化，并探讨对糖化血红蛋白(HbA1c)水平和 糖尿病前期成人队列中的糖尿病发病率。奥克兰、奥尔巴尼和旧金山也 对大量居民为患者的SSB城市征收消费税(约23万 北加州凯撒永久居民(KPNC)的成年人和50,000名青年)。使用我们的电子医疗 记录(EMR)，我们将检查身体质量指数(BMI；kg/m2)轨迹、HbA1c水平和 使用两种不同的分析(合成对照和差异)，在SSB税收开始之前和之后的糖尿病 不同之处)来优化我们结果的严谨性。居住在加利福尼亚州北部和南部的KP患者 与征收SSB税的城市相当的加利福尼亚州城市将被用作控制措施。我们假设有一个城市 与对照相比，SSB税将在BMI、HbA1c和糖尿病发病率方面经历有利的变化 城市。我们的具体目标是1)检查BMI轨迹和超重流行率的差异，以及 加州城市青少年和成年人分别实施SSB税前后的肥胖问题 加和不加SSB税。2)评估青年和成年人的特征，如年龄、种族/族裔、体重指数 类别和社区的社会经济状况可能会修正社会保障税对BMI和 超重和肥胖的流行。3)探讨平均糖化血红蛋白水平与糖尿病发病率的差异 在年龄/性别/种族/体重指数和社区社会经济状况相匹配的成年人队列中 居住和不居住在社保局税务城市的糖尿病前期患者。这些信息是用来指导健康倡导者的 以及政策制定者关于SSB税在预防肥胖方面的作用。

PROJECT SUMMARY Despite widespread publicity of the obesity epidemic in the US and other developed countries, its prevalence remains unabated. With almost 20% of children and adolescents and 40% of adults in the US with obesity, we face a public health crisis. Blacks, Hispanics, and people with low socioeconomic status are disproportionately affected. Multi-level and multi-pronged approaches are needed to stem this epidemic. One recommended approach is population-based strategies that make it easier for people to make more healthful choices. One such strategy is imposing taxes to reduce consumption of sugar-sweetened beverages (SSB). Not only are SSB the largest contributor of added sugar in the US diet and have been tied to obesity and its comorbidities, but national survey data suggest that ½ of adults and 2/3 of youth consume at least one SSB on a given day. If taxes can reduce SSB consumption, it follows that obesity prevalence will fall, along with obesity-related diseases. In Berkeley, CA (the first city to levy a SSB tax [in 2015]) SSB sales declined 9.6% and SSB consumption declined 19.8% in the first year after tax implementation. There are indications that effects were greater in low-income neighborhoods. We propose to evaluate the natural experiment of SSB taxes on weight change in youth and adults and to explore possible effects on glycated hemoglobin (HbA1c) levels and diabetes incidence among a cohort of adults with prediabetes. Oakland, Albany, and San Francisco have also levied an excise tax on SSB – cities in which a large number of residents are patients (approximately 230,000 adults and 50,000 youth) of Kaiser Permanente Northern California (KPNC). Using our electronic medical records (EMR), we will examine body mass index (BMI; kg/m2) trajectories, HbA1c levels, and incidence of diabetes prior and after initiation of SSB taxes, using two different analyses (synthetic controls and differences in differences) to optimize the rigor of our results. KP patients living in Northern California and Southern California cities comparable to cities with a SSB tax will be used as controls. We hypothesize that cities with a SSB tax will experience favorable changes in BMI, HbA1c, and diabetes incidence compared with comparison cities. Our specific aims are to 1) Examine differences in BMI trajectories and prevalence of overweight and obesity before and after implementation of a SSB tax among youth and adults separately in California cities with and without a SSB tax. 2) Assess how youth and adult characteristics, such as age, race/ethnicity, BMI category, and neighborhood socioeconomic status, may modify the impact of SSB taxes on BMI and prevalence of overweight and obesity. 3) Explore differences in mean HbA1c levels and diabetes incidence among an age/sex/race/BMI and neighborhood socioeconomic status matched cohort of adults with prediabetes who live and do not live in SSB tax cities. This information is needed to guide health advocates and policy makers with respect to the role of SSB taxes in obesity prevention.