A Multimethod Approach to Evaluating a Threshold-Based Sugar-Sweetened Beverage Tax in South Africa: Changes in Dietary Intake, Behavioral Drivers, and the News Media

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  • March 2, 2021
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  • Essman, Michael
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
Abstract
  • In April 2018, the South African government implemented the first sugar-sweetened beverage (SSB) tax to be based on sugar per gram for drinks with more than 4g sugar/100mL, to reduce rising SSB consumption and associated chronic diseases. SSB taxes have been shown to reduce purchases, but few studies have included dietary intake data. Thus, it is unclear the extent to which SSB taxes are associated with changes in SSB intake, and whether these changes are driven more by behavioral shifts or reformulation. In addition, it is unclear whether other factors, like SSB knowledge or risk perception, modify these effects. Finally, national SSB taxes occur in a broader social environment, whereby media sources select which topics garner the most attention and how they should be understood, thereby influencing public knowledge about the policy which could change dietary intake. Using repeated cross-sectional survey data collected from approximately 2,500 young adults living in Langa, South Africa and annually updated food composition tables, we examined pre-post tax changes in taxed and untaxed beverage intake, changes in drivers of behavioral change, and whether they moderated the effects of the tax on taxed beverage intake. We also conducted a quantitative media content analysis to examine how news media represented the tax. After the tax, taxed beverage energy intake declined by 24% due to behavioral change and an additional 8% due to reformulation. Most behavioral drivers were not strongly linked to taxed beverage intake, had small post-tax changes, and did not appear to modify the tax effect. Our media analysis found industry expressed no support for the HPL, whereas academics, government, and other sources mainly expressed support. Health reasons were the most common justifications for support, and economic harms were the most common justifications for opposition. This work demonstrates the threshold-based SSB tax successfully affected both behavior and industry reformulation, thereby refuting industry claims identified in our media content analysis that the tax would not change SSB intake. However, our results on behavioral drivers suggest further work is needed to understand the effects of mass media, including news and targeted campaigns, on behavioral drivers of SSB consumption.
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Advisor
  • Taillie, Lindsey Smith
  • Popkin, Barry M
  • Adair, Linda
  • Dillman-Carpentier, Francesca
  • Pettifor, Audrey
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2020
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