Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data

This is the final published version. Available from BMJ Publishing Group via the DOI in this record.Background Taxing soft-drinks may reduce their purchase, but assessing the impact on health demands wider consideration on alternative beverage choices. Effects on alcoholic drinks are of particular concern, as many contain similar or greater amounts of sugar than soft-drinks and have additional health harms. Changes in consumption of alcoholic drinks may reinforce or negate the intended effect of price changes for soft-drinks. Methods A partial demand model, adapted from the Almost Ideal Demand System, was applied to Kantar Worldpanel data from 31 919 households from January 2012 to December 2013, covering drink purchases for home consumption, providing ~6million purchases aggregated into 11 groups, including three levels of soft-drink, three of other non-alcoholic drinks and five of alcoholic drinks. Results An increase in the price of high-sugar drinks leads to an increase in the purchase of lager, an increase in the price of medium-sugar drinks reduces purchases of alcoholic drinks, while an increase in the price of diet/ low-sugar drinks increases purchases of beer, cider and wines. Overall, the effects of price rises are greatest in the low-income group. Conclusion Increasing the price of soft-drinks may change purchase patterns for alcohol. Increasing the price of medium-sugar drinks has the potential to have a multiplier-effect beneficial to health through reducing alcohol purchases, with the converse for increases in the price of diet-drinks. Although the reasons for such associations cannot be explained from this analysis, requiring further study, the design of fiscal interventions should now consider these wider potential outcomes.UK Department of Health Policy Research ProgrammeMedical Research Council (MRC

1006. ANTHORRHIZA ECHINELLA: An ant‐plant of the Rubiaceae

The rare ant-plant Anthorrhiza echinella C.R.Huxley & Jebb from Papua New Guinea is described and illustrated. The outlook of the species and the importance of ex situ conservation strategies for this and other ant-plants are discussed in the context of botanic garden collections. Based on the plant's likely current distribution, we have assessed the species under the IUCN Red List as Endangered (EN) under criteria B1ab(iii) + 2ab(iii)

Getting to the Left of SHARP: Lessons Learned from West Point\u27s Efforts to Combat Sexual Harassment and Assault

View the Executive SummaryOn July 26, 1948, President Harry Truman signed Executive Order 9981, ending the practice of segregating the military services by race. That same year, the Army allowed women to join the services on an equal basis with men. Both of these steps preceded the larger societal changes that allowed fully equal treatment of all types of American citizens in military service. Just over 2 years ago, Congress repealed the Don’t Ask, Don’t Tell policy, allowing for gays and lesbians to openly take their place in the military. Our procedures and policies for successful gender integration have grown and evolved. The authors share five principles for leaders and commanders on the prevention of sexual harassment and assault, as well as associated “Tips” for implementation: (1) Leaders identify and break chains of circumstance; (2) Education is preferable to litigation; (3) What’s electronic is public; (4) Don’t ignore pornography; and, (5) Unit climate is the commander’s responsibility. These principles and their associated tips are not panaceas, and these recommendations are submitted for discussion and feedback.https://press.armywarcollege.edu/monographs/1468/thumbnail.jp

A health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study

Background In March, 2016, the UK government proposed a tiered levy on sugar-sweetened beverages (SSBs; high, moderate, and no tax for drinks with >8g, 5g to 8g, and <5g sugar per 100ml). We estimate the effect of possible industry responses to the levy on obesity, diabetes, and dental caries. Methods We modelled three possible industry responses: (1) reformulation to reduce sugar concentration, (2) increasing product price, and (3) changing the market share of high-, mid-, and low-sugar drinks. For each response, we defined a better and worse case health scenario. We developed a comparative risk assessment model to estimate the UK health impact of each scenario. Findings The best modelled scenario for health is SSB reformulation, resulting in 144,000 (95% uncertainty interval: 5,100 to 306,700) fewer adults and children with obesity in the UK, 19,000 (6,900 to 32,700) fewer incident cases of diabetes per year, and 269,000 (82,200 to 470,900) fewer decayed, missing, or filled teeth annually. Increasing the price of SSBs and changes to market share to increase the proportion of low-sugar drinks sold would also result in population health benefits, but to a lesser extent. The greatest benefit for obesity and oral health would be among individuals under 18 years, with people over 65 years experiencing the largest absolute decreases in diabetes incidence. Interpretation The health impact of the soft drink levy is dependent on its implementation by industry. There is uncertainty as to how industry will react and in the estimation of health outcomes. Health gains could be maximised by significant product reformulation with additional benefits possible if the levy is passed onto purchasers through raising the price of high- and mid-sugar drinks, and through activities to increase the market share of low-sugar products.RT and AK have previously done work on sugar-sweetened beverage taxes funded by the Union of European Soft Drinks Associations. MR is chair of Sustain and the Children's Food Campaign, which have campaigned for sugar drink taxes in the UK. MR is funded by the British Heart Foundation, grant number 006/PSS/CORE/2016/OXFORD. ADMB and OTM are members of the Faculty of Public Health, which has a position statement supporting sugary drink taxes. ADMB is funded by the Wellcome Trust, grant number 102730/Z/13/Z. OTM is a member of the UK Health Forum, which has also supported a UK sugar drinks tax. OTM is supported by a Wellcome Trust Clinical Doctoral Fellowship. SAJ was the independent Chair of the Department of Health Public Health Responsibility Deal Food Network from 2010 to 2015. SAJ is funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Oxford. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research, or the Department of Health. PS is funded by the British Heart Foundation, grant number FS/15/34/31656. TB is funded the Health Research Council of New Zealand (16/443). AE declares no competing interests

A low-energy total diet replacement programme demonstrates a favourable safety profile and improves liver disease severity in non-alcoholic steatohepatitis

Objective: Low-energy diets are used to treat obesity and diabetes, but there are fears that they may worsen liver disease in patients with nonalcoholic steatohepatitis (NASH) and significant-to-advanced fibrosis. Methods: In this 24-week single-arm trial, 16 adults with NASH, fibrosis, and obesity received one-to-one remote dietetic support to follow a low-energy (880 kcal/d) total diet replacement program for 12 weeks and stepped food reintroduction for another 12 weeks. Liver disease severity was blindly evaluated (magnetic resonance imaging proton density fat fraction [MRI-PDFF], iron-corrected T1 [cT1], liver stiffness on magnetic resonance elastography [MRE], and liver stiffness on vibration-controlled transient elastography [VCTE]). Safety signals included liver biochemical markers and adverse events. Results: A total of 14 participants (87.5%) completed the intervention. Weight loss was 15% (95% CI: 11.2%–18.6%) at 24 weeks. Compared with baseline, MRI-PDFF reduced by 13.1% (95% CI: 8.9%–16.7%), cT1 by 159 milliseconds (95% CI: 108–216.5), MRE liver stiffness by 0.4 kPa (95% CI: 0.1–0.8), and VCTE liver stiffness by 3.9 kPa (95% CI: 2.6–7.2) at 24 weeks. The proportions with clinically relevant reductions in MRI-PDFF (≥30%), cT1 (≥88 milliseconds), MRE liver stiffness (≥19%), and VCTE liver stiffness (≥19%) were 93%, 77%, 57%, and 93%, respectively. Liver biochemical markers improved. There were no serious intervention-related adverse events. Conclusions: The intervention demonstrates high adherence, favorable safety profile, and promising efficacy as a treatment for NASH