How should we evaluate sweetened beverage tax policies? A review of worldwide experience.

Funder: Bloomberg PhilanthropiesFunder: Bill and Melinda Gates FoundationFunder: Laura and John Arnold FoundationFunder: Consejo Nacional de Ciencia y TecnologíaFunder: Instituto Nacional de Salud PublicaOver 45 jurisdictions globally have implemented sweetened beverage taxes. Researchers and policymakers need to assess whether and how these taxes change beverage demand and supply, their intended and unanticipated health, economic and equity impacts. Lessons from such evaluations can maximise the policies' success and impact on non-communicable disease prevention globally. We discuss key theoretical, design and methodological considerations to help policymakers, funders and researchers commission and conduct rigorous evaluations of these policies and related disease prevention efforts. We encourage involving the perspectives of various stakeholders on what evaluations are needed given the specific context, what data and methods are appropriate, readily available or can be collected within time and budget constraints. A logic model /conceptual system map of anticipated implications across sectors and scales should help identify optimal study design, analytical techniques and measures. These models should be updated when synthesising findings across diverse methods and integrating findings across subpopulations using similar methods

HIV prevention cost-effectiveness: a systematic review

BackgroundAfter more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008.MethodsSystematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY).ResultsWe found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita).ConclusionThere are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the AIDS epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning

Sugar-sweetened beverage tax: The authors reply

A study using manufacturing data showed that sales of sugar-sweetened beverages in Mexico fell 7.3 percent on average two years after the tax was implemented, compared to the period 2007–13.1 These results align with those in our article (Mar 2017), which estimated changes in beverage purchases in a representative sample of urban households, and illustrate the robustness of our findings

Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study

STUDY QUESTION: What has been the effect on purchases of beverages from stores in Mexico one year after implementation of the excise tax on sugar sweetened beverages? METHODS: In this observational study the authors used data on the purchase of beverages in Mexico from January 2012 to December 2014 from an unbalanced panel of 6253 households providing 205 112 observations in 53 cities with more than 50 000 inhabitants. To test whether the post-tax trend in purchases was significantly different from the pretax trend, the authors used a difference in difference fixed effects model, which adjusts for both macroeconomic variables that can affect the purchase of beverages over time, and pre-existing trends. The variables used in the analysis included demographic information on household composition (age and sex of household members) and socioeconomic status (low, middle, and high). The authors compared the predicted volumes (mL/capita/day) of taxed and untaxed beverages purchased in 2014-the observed post-tax period-with the estimated volumes that would have been purchased if the tax had not been implemented (counterfactual) based on pretax trends. STUDY ANSWER AND LIMITATIONS: Relative to the counterfactual in 2014, purchases of taxed beverages decreased by an average of 6% (-12 mL/capita/day), and decreased at an increasing rate up to a 12% decline by December 2014. All three socioeconomic groups reduced purchases of taxed beverages, but reductions were higher among the households of low socioeconomic status, averaging a 9% decline during 2014, and up to a 17% decrease by December 2014 compared with pretax trends. Purchases of untaxed beverages were 4% (36 mL/capita/day) higher than the counterfactual, mainly driven by an increase in purchases of bottled plain water. WHAT THIS STUDY ADDS: The tax on sugar sweetened beverages was associated with reductions in purchases of taxed beverages and increases in purchases of untaxed beverages. Continued monitoring is needed to understand purchases longer term, potential substitutions, and health implications. FUNDING, COMPETING INTERESTS, DATA SHARING: This work was supported by grants from Bloomberg Philanthropies and the Robert Wood Johnson Foundation and by the Instituto Nacional de Salud Pública and the Carolina Population Center. The authors have no competing interests. No additional data are available

Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza

Background In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known as swine flu, in Mexico. Influenza A (H1N1) subtype viruses have rarely predominated since the 1957 pandemic. The analysis of epidemic pneumonia in the absence of routine diagnostic tests can provide information about risk factors for severe disease from this virus and prospects for its control. Methods From March 24 to April 29, 2009, a total of 2155 cases of severe pneumonia, involving 821 hospitalizations and 100 deaths, were reported to the Mexican Ministry of Health. During this period, of the 8817 nasopharyngeal specimens that were submitted to the National Epidemiological Reference Laboratory, 2582 were positive for S-OIV. We compared the age distribution of patients who were reported to have severe pneumonia with that during recent influenza epidemics to document an age shift in rates of death and illness. Results During the study period, 87% of deaths and 71% of cases of severe pneumonia involved patients between the ages of 5 and 59 years, as compared with average rates of 17% and 32%, respectively, in that age group during the referent periods. Features of this epidemic were similar to those of past influenza pandemics in that circulation of the new influenza virus was associated with an off-season wave of disease affecting a younger population. Conclusions During the early phase of this influenza pandemic, there was a sudden increase in the rate of severe pneumonia and a shift in the age distribution of patients with such illness, which was reminiscent of past pandemics and suggested relative protection for persons who were exposed to H1N1 strains during childhood before the 1957 pandemic. If resources or vaccine supplies are limited, these findings suggest a rationale for focusing prevention efforts on younger populations

Changes in Prices After an Excise Tax to Sweetened Sugar Beverages Was Implemented in Mexico: Evidence from Urban Areas

In 2014 an excise tax to non-alcoholic sweetened beverages (SSB) was implemented in Mexico. The objective of this paper is to study whether and to what degree these taxes passed-through onto SSB prices in urban areas overall and by region, type of beverage and package size. Prices were obtained from the National Institute of Statistics and Geography from 2011 to 2014. We applied a pre-post quasi-experimental approach using fixed effects models. In sensitivity analysis we applied other model specifications to test the robustness of the findings and we also present weighted estimations based on household purchases. The dependent variables are real prices of a specific beverage category; the main independent variables are dummies for each month of 2014, and the models adjust for time trends and seasonality. Results suggest that the SSB tax passed along to consumers for all SSBs and we found overshifting for the carbonated SSBs. A greater effect is seen among the small package sizes, and we see heterogeneous effects by region. Estimating the effect of the tax on prices is important to understand the potential effect on consumption

PENGARUH METODE ECOLA (EXTENDING CONCEPTH TRHOUGH LANGUAGE ACTIVITIES) DALAM PEMBELAJARAN MEMBACA KRITIS TAJUK RENCANA

Penelitian ini bertujuan untuk memperoleh gambaran secara objektif tentang ada tidaknya perbedaan yang signifikan antara kemampuan siswa dalam membaca kritis tajuk rencana atau teks editorial kelas eksperimen dengan menggunakan metode ECOLAdan kelas kontrol dengan metode ceramah. Populasi dalam penelitian ini adalah seluruh siswa kelas VIII SMP Negeri 16 Bandung ajaran tahun 2015/2016. Sampel dalam penelitian ini adalah dua kelas yang dipilih secara purposive sampling, yakni pertimbangan dalam mengambil sampel tersebut, disebabkan kelas VIII G dan VIII H memiliki rata-rata nilai yang hampir sama dalam pembelajaran bahasa Indonesia dilihat dari Ujian Tengah Semester. Kelas yang digunakan adalah kelas VIII H sebagai kelas eksperimen dan kelas VIII G sebagai kelas kontrol. Penelitian ini menggunakan metode eksperimen kuasi dengan desain penelitian Nonequivalent Control Group Design. Pada desain ini dilakukan tes awal dan tes akhir di kelas eksperimen dan kelas kontrol. Pengolahan data dilakukan uji realibilitas antar penimbang, uji normalitas, homogenitas, dan hipotesis. Berdasarkan hasil penelitian, didapatkan bahwa nilai rata-rata kelas eksperimen lebih tinggi daripada nilai rata-rata kelas kontrol. Rata-rata nilai tes awal kelas eksperimen yaitu 63 dan nilai rata-rata tes akhir 82. Sedangkan rata-rata nilai tes awal kontrol yaitu 54 dan rata-rata nilai tes akhir 66. Berdasarkan perolehan nilai tersebut didapatkan perbedaan nilai rata-rata kelas eksperimen 19 dan perbedaan nilai rata-rata kelas kontrol yaitu 13. Berdasarkan hasil pengujian hipotesis diperoleh nilaithitung= 5,01>ttabel = 1,99866, maka Ho ditolak dan Ha diterima. Hal ini menunjukkan bahwa metode ECOLA berpengaruh dan dapat digunakan dalam pembelajaran membaca kritis tajuk rencana. ;--- This research aims toget the objective informationwhether there is a significance differences or not between students’ abilityin editorial critical reading text in an experimental class using ECOLA methodwith a control class using lecture method. The population of the research are all students of VIII grade class of16 Junior High School of Bandung in 2015/2016 school year.The sample are two classes of students which are selected through purposive sampling, consideringG and H class have a same average scoresin Indonesia Language subject,taken from Mid-Semester Test score. The H class was the experimental classand the G class control. The research utilizes a quasi-experimental methodwithNonequivalent Control Group Designwith a pre and a post-test. Reliability test was employed between counselor, normalcy test, homogenates, andhypothesis. The result shows that the average score of experimental classis higher than the control class. The experimental class’ average pre-test score was 63 the post-test was 82 whilethe control class’ average pre-test score was 54 andpost-test score was 66. The difference between pre and post-test of experimental class was 19 and control class was 13. Hypothesis test result shows thatthitung = 5,01>ttabel= 1,99866, then Hois rejectedand Hais accepted. It concludes thatECOLAis influential and implementable in editorial critical reading

The effect of income and occupation on body mass index among women in the Cebu Longitudinal Health and Nutrition Surveys (1983-2002)

We assessed the effects of changes in income and occupational activities on changes in body weight among 2952 non-pregnant women enrolled in the Cebu Longitudinal Health and Nutrition Surveys between 1983 and 2002. On average, body mass index (BMI) among women occupied in low activities was 0.29 kg/m2 (standard error 0.11) larger compared to women occupied in heavy activities. BMI among women involved in medium activities was on average 0.12 kg/m2 (standard error 0.05) larger compared to women occupied in heavy activities. A one-unit increase in log household income in the previous survey was associated with a small and positive change in BMI of 0.006 kg/m2 (standard error 0.02) but the effect was not significant. The trend of increasing body mass was higher in the late 1980s than during the 1990s. These period effects were stronger for the women who were younger at baseline and for women with low or medium activity levels. Our analysis suggests a trend in the environment over the last 20 years that has increased the susceptibility of Filipino women to larger body mass.Cebu Philippines Body mass index (BMI) Income Occupation Panel methods Women Activity