Tax awareness and perceived cost of sugar-sweetened beverages in four countries between 2017 and 2019: findings from the international food policy study

Abstract

Background: The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects-via awareness of the tax-may impact the effectiveness of SSB taxes on consumer purchases.

Objective: The study sought to examine perceived cost of SSBs, tax awareness, and changes in beverage purchasing over time and across four countries with and without SSB taxes.

Methods: The study used data from the 2017, 2018 and 2019 waves of the International Food Policy Study. Annual cross-sectional online surveys were conducted in Australia, Mexico, UK and US, which captured perceived cost of SSBs relative to non-SSBs in all countries (with Australia as a no-tax comparator), and measures of tax awareness and participants' reported changes in beverage purchasing in response to SSB taxes in Mexico (tax implemented in 2014), UK (tax implemented in 2018) and US (subnational taxes since 2015). Logistic regression models evaluated the measures across years and socio-demographic groups.

Results: Perceived cost of SSBs relative to non-SSBs was higher in Mexico (all three years) and the UK (2018 and 2019 following tax implementation) than Australia and the US. Tax awareness was higher in UK than Mexico, and decreased over time among Mexican respondents. Patterns of reported beverage purchasing changes in response to the tax were similar across Mexico, UK and US, with the largest changes reported by Mexican respondents. Respondents with characteristics corresponding to lower socioeconomic status were less likely to be aware of an SSB tax, but more likely to perceive SSBs to cost more than non-SSBs and report changes in purchasing in response to the tax, where there was one.

Conclusions: This study suggests that in countries where a national SSB tax was present (Mexico, UK), perceived cost of SSBs and tax awareness were higher compared to countries with no SSB tax (Australia) or subnational SSB taxes (US), respectively, and suggests that perceived cost and tax awareness represent distinct constructs. Improving the 'signalling effect' of existing SSB taxes may be warranted, particularly in tax settings where consumer behaviour change is a policy objective.

Keywords: Awareness; Nutrition policy; Perceived cost; Sugar-sweetened beverages; Tax.

Fig. 1

Unadjusted percentages of participants reporting drinks with sugar cost more than drinks without sugar (weighted). Legend: Unadjusted percentages of participants in Australia, Mexico, the United Kingdom and the United States reporting that drinks with sugar cost ‘a little’ or ‘a lot’ more than drinks without sugar in 2017, 2018 and 2019 (weighted). Error bars represent 99% confidence intervals

Fig. 2

Unadjusted percentages of participants who reported being aware of a tax on sugary drinks (weighted). Legend: Unadjusted percentages of participants in Mexico, the United Kingdom and the United States who reported being aware of a special tax on sugary drinks, across available years of data (weighted). Error bars represent 99% confidence intervals. Note: Tax awareness was only queried in countries following the implementation of an SSB tax (2017, 2018 and 2019 in Mexico; 2018 and 2019 in the UK; and 2019 in the US)

Fig. 3

Unadjusted percentages of participants reporting ‘buy less’ or ‘buy more’ taxed and untaxed beverages (weighted). Error bars represent 99% confidence intervals. Legend: Unadjusted percentages of participants responding that the SSB tax led them to ‘buy less’ or ‘buy more’ taxed and untaxed beverages, among those who reported being aware of an SSB tax in Mexico, the United Kingdom and the United States, averaged across all available years of data (weighted). Note: Changes in beverage purchasing was only queried in countries following the implementation of an SSB tax (2017, 2018 and 2019 in Mexico; 2018 and 2019 in the UK; and 2019 in the US)