DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20211769

A cross-sectional study on awareness and perceptions regarding taxation and health warnings and factors influencing decreased consumption of sugar sweetened beverages among medical students of Bhopal, India with respect to future implementation of such policies

Soumya K. Mandal, G. Revadi, Darshan Parida, Sembagamuthu Sembiah, Anindo Majumdar

Abstract


Background: Consumption of excessive sugar sweetened beverages (SSBs) has been linked to non-communicable diseases. It is imperative to understand the perceptions regarding taxation and health warnings amongst the medical students, since they are important stakeholders and as there is some evidence that the government may introduce these soon. Objective was to document the awareness and perceptions about taxation and health warnings on SSBs and the predictors of decreasing consumption of SSBs with regards to their future implementation.

Methods: This cross-sectional study was conducted among all the undergraduate medical students of a premier teaching hospital of central India during October and November 2019. A web-based self-administered semi-structured questionnaire was used for data collection using Kobo toolbox. Data were analysed using the SPSS software version 24 (IBM SPSS).

Results: About three fourths of the study participants were not aware of any taxes on SSBs and had never seen any health warning on SSB packaging. Multivariable logistic regression analysis showed that those aged ≥ 20 were not in favour of decreasing SSB consumption if health warning is present. Participants who were females, whose fathers were professionals, had consumed SSB in the previous seven days, were aware of taxes and those with inadequate sleep were not in favour of decreasing SSB consumption if taxes are increased.

Conclusions: There is a need to include health education regarding the harmful effects of consumption of SSBs and to make aware of the benefits of the taxes and warning labels beginning from school days and continued during medical schools.


Keywords


Awareness, Pictorial, Perception, Sugar sweetened beverages, Students, Warning labels

Full Text:

PDF

References


CDC. Sugar Sweetened Beverage Intake,” Centers for Disease Control and Prevention, Oct. 23, 2018. Available at https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html. Accessed on 17 March 2019.

Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667-75.

Morenga LT, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ. 2013;346:11-6.

Guideline: sugars intake for adults and children. Available at https:// www. who. int/publications/i/item/9789241549028. Accessed on 3 September 2020.

Imamura F. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015;351:3576-9.

Xi B. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr. 2015;113(5):709-17.

Uwaifo GI. Beware energy drinks: a case of a toxic triad syndrome in a diabetic patient with nonalcoholic fatty liver disease. Am J Med Sci. 2019;358(4):304-11.

Ja W, Ea L, Ad S. The sugar-sweetened beverage wars: public health and the role of the beverage industry. Curr Opin Endocrinol Diabetes Obes. 2013;5:401-6.

Basu S, Vellakkal S, Agrawal S, Stuckler D, Popkin B, Ebrahim S. Averthing obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study. PLoS Med. 2014;11(1):e1001582.

WHO. WHO calls on countries to reduce sugars intake among adults and children. Available at https://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/. Accessed on 3 September 2020.

Andreyeva T, Chaloupka FJ, Brownell KD. Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue. Prev Med. 2011;52(6):413-6.

Escobar MA, Veerman JL, Tollman SM, Bertram MY, Hofman KJ. Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. BMC Public Health. 2013;13(1):1072.

Jou J, Techakehakij W. International application of sugar-sweetened beverage (SSB) taxation in obesity reduction: factors that may influence policy effectiveness in country-specific contexts. Health Policy. 2012;107(1):83-90.

Roberto CA, Wong D, Musicus A, Hammond D. The influence of sugar-sweetened beverage health warning labels on parents’ choices. Pediatrics. 2015;137(2):2015-3185.

GST: Prices of soft drinks to increase 5-10% - The Economic Times. Available at https://economictimes.indiatimes.com/industry/cons-products/fmcg/prices-of-soft-drinks-to-increase-5-10/articleshow/58753124.cms?from=md. Accessed 21 September 2020.

FSSAI: FSSAI calls for colour-coded labels on products with high fat, sugar content. Available at https://economictimes.indiatimes.com/industry/cons-products/food/fssai-calls-for-colour-coded-labels-on-products-with-high-fat-sugar-content/articleshow/69967254.cms?from=mdr. Accessed on 21 September 2020.

KoBoToolbox. Data Collection Tools for Challenging Environments. KoBoToolbox. Available at https://kobotoolbox.org/. Accessed on 17 July 2020.

Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh’s scale updated for 2019. J Family Med Primary Care. 2019;8(6):1846.

Goods-rates-booklet-03July2017.pdf. Available at http://gstcouncil.gov.in/sites/default/files/NOTIFICATION%20PDF/goods-rates-booklet-. Accessed on 14 June 2020.

Teng AM, Jones AC, Mizdrak A, Signal L, Genç M, Wilson N. Impact of sugar-sweetened beverage taxes on purchases and dietary intake: Systematic review and meta-analysis. Obesity Rev. 2019;20(9):1187-204.

Silver LD. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: a before-and-after study. PLoS Med. 2017;14(4):1022-9.

Krukowski C, Conley K, Sterling M, Rainville A. A qualitative study of adolescent views of sugar-sweetened beverage taxes, Michigan, 2014. Preventing Chronic Dis. 2016;13:150-63.

Horst B, Kremers S, Ferreira I, Singh A, Oenema A, Brug J. Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents. Health Educ Res. 2007;22(2):295-304.

Bruijn GJ, Putte G. Adolescent soft drink consumption, television viewing and habit strength. Investigating clustering effects in the Theory of Planned Behaviour. Appetite. 2009;53(1):66-75.

Stacey N, Summan A, Tugendhaft A, Laxminarayan R, Hofman K. Simulating the impact of excise taxation for disease prevention in low-income and middle-income countries: an application to South Africa. BMJ Glob Health. 2018;3(1):568-75.

Veerman VL, Sacks G, Antonopoulos N, Martin J. The impact of a tax on sugar-sweetened beverages on health and health care costs: a modelling study. PLOS ONE. 2016;11(4):e0151460.

Meyer MT, Mytton O, Adams J. Public responses to proposals for a tax on sugar-sweetened beverages: a thematic analysis of online reader comments posted on major UK news websites. PLoS ONE. 2017;12:e0186750,

Miller C. When we were young, it really was a treat; now sugar is just the norm every day a qualitative study of parents’ and young adults’ perceptions and consumption of sugary drinks. Health Promotion J Australia. 2020;31(1):47-57.

Falbe J, Thompson HR, Patel A, Madsen KA. Potentially addictive properties of sugar-sweetened beverages among adolescents. Appetite. 2019;133:130-7.

Bray GA, Popkin PM. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care. 2014;37(4):950-6.

The effect of graphic warnings on sugary-drink purchasing. Available at https:/ /journals. sagepub.com/doi/10.1177/0956797618766361 Accessed on 15 June 2020.

Bollard T, Maubach N, Walker N, Mhurchu CN. Effects of plain packaging, warning labels, and taxes on young people’s predicted sugar-sweetened beverage preferences: an experimental study. Int J Behavioral Nutrition Physical Activity. 2016;13(1):95.

Gray JP, Karnon J, Blackwell L. Sugar consumption from beverages and the potential effects of a text-based information label. Australian New Zealand J Public Health. 2011;35(1):88-9.

Popova L, Nonnemaker J, Taylor N, Bradfield B, Kim A. Warning labels on sugar-sweetened beverages: an eye tracking approach. Am J Health Behav. 2019;43(2):406-19.

Mantzari E, Vasiljevic M, Turney I, Pilling M, Marteau T. Impact of warning labels on sugar-sweetened beverages on parental selection: An online experimental study. Prev Med Rep. 2018;12:259-67.