Evaluating the influence of a beverage tax on health outcomes

项目总结 人们对减少含糖饮料(SSB)摄入量的政策相当感兴趣。1月1日， 2017年费城成为美国第二个也是迄今为止最大的实施含糖饮料的城市 SSB和无糖饮料的消费税均为每液盎司1.5美分。有确凿的证据表明 饮料消费税可以导致SSB购买量的大幅减少，但迫切需要 了解这是否会转化为健康结果的改善。没有这个证据，我们就不会 了解社会保障税是否是预防和减少肥胖及其相关慢性病的有效方法， 还有龋齿。本应用程序的总体目标是确定 费城对成人和青少年体重增加、2型糖尿病和口腔健康征收饮料税。这个 这项提议的理由是基于强有力的行为数据，即费城加糖饮料税 减少SSB购买和建模研究表明，此类税收将导致健康状况改善 结果，包括肥胖、2型糖尿病和龋齿的减少，特别是在以下人群中 冒着儿童和成人的风险。因此，我们的中心假设是费城对SSB和减肥饮料征税 随着时间的推移，成年人和年轻人的体重增加和龋齿会减少 费城与控制地点的对比。我们的具体目标是评估社会保障局税收的有效性 通过分析电子健康记录数据预防青少年(目标1)和成年人(目标2)体重增加 使用自然的实验设计。为了达到这些目标，我们将使用电子健康记录数据来 比较43,589名儿童和青少年的纵向队列中BMI z得分随时间的变化 在费城和117,850名青年在未纳税的邻近县(对照组)税后3-5年。我们 还将研究费城108,862名成年人和185,360名成年人的BMI变化 在未纳税、周边县(对照组)税后3-5年。这些目标涉及重要的 关于饮料税对BMI的影响的悬而未决的问题，BMI是终生慢性病的主要预测指标 疾病。我们的第三个目标是评估社会保障局税在改善青少年口腔健康方面的成效，以及 通过使用自然实验设计分析电子口腔健康记录，在费城的成年人。至 为了实现这一目标，我们将检查费城5,189名成年人和1,462名青少年以及3,554名青少年的牙科记录 未纳税的周边县的成年人和1003名青年(对照组)。如果两者之间存在关系 税收和口腔健康的改善，这将是第一个发现饮食和口腔健康之间联系的研究 干预和改善口腔健康。这项研究将提供关于一个人的影响的至关重要的信息 解决不良饮食习惯的最重要的政策之一。通过评估费城的有效性 税收促进人口健康，这项工作将为其他考虑征税的地方提供关键信息 改善健康状况。

PROJECT SUMMARY There is considerable interest in policies to reduce sugar-sweetened beverage (SSB) intake. On January 1, 2017 Philadelphia became the second U.S. city and the largest to date to implement a sweetened beverage excise tax of 1.5 cents per fluid ounce on both SSBs and diet drinks. There is compelling evidence that beverage excise taxes can lead to large reductions in purchases of SSBs, but there is a critical need to understand whether this translates into improvements in health outcomes. Without this evidence, we will not know if SSB taxes are an effective method of preventing and reducing obesity, its associated chronic diseases, and dental caries. The overall objectives of this application are to determine the long-term influence of the Philadelphia beverage tax on adult and youth weight gain, type 2 diabetes status, and oral health. The rationale for this proposal is based on strong behavioral data that the Philadelphia sweetened beverage tax decreased SSB purchases and modeling studies that suggest such taxes will lead to improved health outcomes, including reductions in obesity, type 2 diabetes, and dental caries, especially for subgroups of at- risk children and adults. Therefore, our central hypothesis is that the Philadelphia tax on SSBs and diet drinks will be associated with less weight gain and fewer dental caries over time among adults and youth in Philadelphia compared to control locations. Our specific aims are to evaluate the effectiveness of an SSB tax on preventing weight gain among youth (Aim 1) and adults (Aim 2) by analyzing electronic health record data using a natural experiment design. To accomplish these aims, we will use electronic health record data to compare changes in BMI z- scores over time among a longitudinal cohort of 43,589 children and adolescents in Philadelphia and 117,850 youth in the untaxed neighboring counties (control group) 3-5 years after tax. We will also examine change in BMI for a longitudinal cohort of 108,862 adults in Philadelphia and 185,360 adults in the untaxed, surrounding counties (control group) 3-5 years post-tax. These aims address important unanswered questions about the impact of the beverage tax on BMI, a major predictor of lifelong chronic disease. Our third aim is to evaluate the effectiveness of an SSB tax on improving oral health among youth and adults in Philadelphia by analyzing electronic oral health records using a natural experiment design. To accomplish this aim, we will examine dental records on 5,189 adults and 1,462 youth in Philadelphia and 3,554 adults and 1,003 youth in untaxed, surrounding counties (control group). If there is a relationship between the tax and oral health improvements, this would be the first study finding an association between a dietary intervention and improved oral health. This study will deliver vitally important information on the effects of one of the most significant policies to address poor dietary habits. By evaluating the effectiveness of Philadelphia’s tax on improving population health, this work will offer key information to other places considering taxes to improve health.