City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile
Main finding · Mean change in BMI percentileResult — go to the resultDifference-in-differences −1.64 percentage points 95% CI −3.10 to −0.17Authors' conclusion
In this cohort study, SSB excise taxes were associated with lower BMI percentile among youth. Policymakers should consider implementing SSB excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years.
Study context
- Population
- Kaiser Permanente members aged 2 to 19 years at baseline with continuous residence in selected California cities and ≥1 pretax and ≥1 posttax body mass index (BMI) in the electronic health record; 2009–2020
- Participants
- 44,771 vs 345,428
- Exposure
- Cities with sugar-sweetened beverage (SSB) excise taxes vs matched control cities
- SSB tax citiesn = 44,771
- Control citiesn = 345,428reference
- Outcome
- CDC age- and sex-specific BMI percentiles and percentage of youth with overweight or obesity
- Follow-up
- Before tax implementation through 4 to 6 years after
Methodological detailsdifference-in-differences analysis, demographically matched control cities, synthetic control sensitivity analysis
- Difference-in-differences analysis
- Demographically matched control cities
- Synthetic control sensitivity analysis
Main finding
Mean change in BMI percentile · after SSB tax implementation
Difference-in-differences
−1.64 percentage points
95% CI −3.10 to −0.17
As reported in the abstract
Observational data: associations, not effects.
Further findings
Overweight or obesity and obesity, overall
- No significant overall difference in % of youth with overweight or obesity or with obesity vs control cities
BMI percentile by age group (difference-in-differences (DID))
- Age 2-5 years in 2017, DID
- −2.06 percentage points (95% CI, −4.04 to −0.09)
- Age 6-11 years in 2017, DID
- −2.79 percentage points (95% CI, −4.29 to −1.30)
- Exposure vs control cities
% with overweight or obesity by age group (DID)
- Age 2-5 years, DID
- −5.46 percentage points (95% CI, −8.47 to −2.44)
- Age 6-11 years, DID
- −4.23 percentage points (95% CI, −6.90 to −1.57)
- Exposure vs control cities
% with obesity by age group (DID)
- Age 2-5 years, DID
- −1.87 percentage points (95% CI, −3.36 to −0.38)
- Age 6-11 years, DID
- −1.85 percentage points (95% CI, −3.46 to −0.24)
- Exposure vs control cities
Mean BMI percentile change by sex and race
- Male youth
- −1.98 percentage points (95% CI, −3.48 to −0.48)
- Asian youth
- −1.63 percentage points (95% CI, −3.10 to −0.16)
- White youth
- −2.58 percentage points (95% CI, −4.11 to −1.10)
- vs control cities
White youth: % with overweight or obesity and % with obesity
- % with overweight or obesity
- −3.73 percentage points (95% CI, −6.11 to −1.35)
- % with obesity
- −2.78 percentage points (95% CI, −4.18 to −1.37)
- Exposure vs control cities
Original publication
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