Evaluating the influence of a beverage tax on health outcomes

项目摘要 人们对减少含糖饮料（SSB）摄入量的政策非常感兴趣。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甜味饮料的城市。 对SSB和减肥饮料征收每盎司1.5美分的消费税。有令人信服的证据表明 饮料消费税可以导致SSB的购买量大幅减少，但迫切需要 了解这是否转化为健康结果的改善。如果没有这些证据， 知道SSB税是否是预防和减少肥胖及其相关慢性疾病的有效方法， 和龋齿。本申请的总体目标是确定 费城饮料税对成人和青年体重增加，2型糖尿病状态和口腔健康的影响。的 这一建议的理由是基于强有力的行为数据，费城甜饮料税 减少SSB购买和建模研究表明，这种税收将导致改善健康 结果，包括肥胖，2型糖尿病和龋齿的减少，特别是对于at- 儿童和成人的风险。因此，我们的中心假设是，费城对SSB和减肥饮料的税收 随着时间的推移，在成年人和青年人中， 费城与对照组比较。我们的具体目标是评估SSB税的有效性 通过分析电子健康记录数据，防止青年（目标1）和成年人（目标2）体重增加 使用自然实验设计。为了实现这些目标，我们将使用电子健康记录数据， 比较了43,589名儿童和青少年的BMI z分数随时间的变化 在费城和117，850青年在免税邻近县（对照组）3-5年后的税。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 在未征税的周边县（对照组），税后3-5年。这些目标涉及重要的 关于饮料税对BMI的影响的未回答的问题，BMI是终身慢性疾病的主要预测因素。 疾病我们的第三个目标是评估SSB税对改善青少年口腔健康的有效性， 通过分析电子口腔健康记录使用自然实验设计在费城的成年人。到 为了实现这一目标，我们将检查费城5,189名成年人和1,462名青年的牙科记录， 成年人和1,003名未纳税的青年，周围的县（对照组）。如果有一个关系， 税收和口腔健康的改善，这将是第一个研究发现饮食之间的联系， 干预和改善口腔健康。这项研究将提供至关重要的信息， 解决不良饮食习惯的最重要政策。通过评估费城 这项工作将为其他考虑征税的地方提供关键信息， 增进健康。

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.