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

项目摘要 尽管肥胖流行病在美国和其他发达国家得到了广泛的宣传， 仍然没有减弱。美国有近20%的儿童和青少年以及40%的成年人患有肥胖症， 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地 影响。需要采取多层次和多管齐下的办法来遏制这一流行病。一个推荐 一种方法是基于人口的战略，使人们更容易做出更健康的选择。一 这种战略是征税，以减少含糖饮料的消费。不仅 SSB是美国饮食中添加糖的最大贡献者，与肥胖及其合并症有关， 但全国调查数据表明，一半的成年人和2/3的青年人在某一天至少食用一种SSB。如果 税收可以减少SSB消费，因此肥胖患病率将下降，沿着与肥胖相关的 疾病在加利福尼亚州伯克利（2015年第一个征收SSB税的城市），SSB销售额下降了9.6%，SSB销售额下降了9.6%。 消费在税收实施后的第一年下降了19.8%。有迹象表明， 在低收入社区更大。我们建议评估自然实验的SSB税的重量 在青年和成人中的变化，并探索对糖化血红蛋白（HbA 1c）水平的可能影响， 糖尿病前期成人队列中的糖尿病发病率。奥克兰、奥尔巴尼和旧金山弗朗西斯科也有 对SSB征收消费税，SSB是指居民中有大量患者的城市（约230，000 成年人和50，000名青少年）的Kaiser Permanente北方加州（KPNC）。使用我们的电子医疗 我们将检查体重指数（BMI; kg/m2）轨迹、HbA 1c水平和 糖尿病之前和之后开始SSB税，使用两种不同的分析（综合控制和差异 在差异），以优化我们的结果的严谨性。居住在北方加州和南方的KP患者 与SSB税城市相当的加州城市将用作对照。我们假设， 与对照组相比，SSB税将使BMI、HbA 1c和糖尿病发生率发生有利变化 城市我们的具体目标是：1）检查BMI轨迹和超重患病率的差异， 加州城市分别对青少年和成年人实施SSB税前后的肥胖情况 有没有SSB税2)评估青年和成人特征，如年龄、种族/民族、BMI 类别和社区社会经济地位，可能会修改SSB税对BMI的影响， 超重和肥胖的流行率。3)探索平均HbA 1c水平和糖尿病发病率的差异 在年龄/性别/种族/BMI和社区社会经济地位匹配的成年人队列中， 糖尿病前期的人生活和不生活在SSB税收城市。需要这些信息来指导健康倡导者 和政策制定者关于SSB税在预防肥胖中的作用。

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.