Abstract
Background
US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed.
Objectives
We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and its combination with fruit and vegetable (FV) subsidies targeted to low-income households, on SSB and FV purchases of lower and higher SSB purchasers.
Design
We considered a one-cent-per-ounce SSB tax and two FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies’ differential effects.
Results
Higher-SSB purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 vs. 0.5 oz/day at percentile 25; p < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate.
Conclusions
SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels pre-policy. Expanding taxes beyond SSBs, larger FV subsidies, or subsidies beyond FVs, particularly for low-income households with children, may be more effective.