Janas Harrington

HRB CHDR Workshop December 2nd, 2016 Email:j.harrington@ucc.ie

Twitter:@janasharrington

@hrbchdr

A Sugar Sweetened Beverage Tax in a Complex System

Irish response to obesity

Rationale and evidence for a tax

• Link between sugar in beverages and obesity

• Support for and effectiveness of a tax is controversial • Positive support and effect e.g. Mexico

• Industry-funded research no effect

• Closer to home: • ‘Fuzzy thinking on fizzy drinks’ (Irish Times, May 24th, 2016)

• System thinking

• Does it work or does it contribute?

Questions?

• How will the effectiveness of the tax be assessed? • How do we know if it is successful?

• Do we have robust baseline data from which to assess the impact?

• What data currently exists?

• What data is accessible?

• Do we have data from all necessary domains in the system? • How do we know what to measure in the system?

Data, data, data

Aim

• Provide evidence of the magnitude of the consumption of SSBs in Ireland prior to the introduction of a tax

• Identify the energy contribution of SSBs to overall energy intake

• To explore the association between SSB consumption and overweight and obesity

Cork Children’s Lifestyle Study

• Cross sectional study of children from 3rd and 4th classes in Cork City and County

• Study primarily focussed on lifestyle choices, dietary habits and physical activity patterns

• Ethical approval from the Clinical Research Ethics Committee, UCC

CCLaS study methods Food intake

• 3 day food diary

Physical activity

• 7 day accelerometer

Questionnaires

• Principal

• Study child

• Parent/guardian

Physical measures

• Height & weight

• Waist circumference

• Mid upper arm circum.

• Skinfold thickness

• Blood pressure

Urine Samples

• Spot & 24 hour samples

• Na, K, Creat, Urea, Osmo

Sampling and recruitment in the CCLaS study

Pre-pilot study Convenience sampling,

2 city schools (100% school RR) and 55 children participated (53% child

RR)

Pilot study 3 city schools from PPS sample and 85 children participated (56% child

RR)

Main study 22 schools (8 PPS city, 3 rural & 11

purposively sampled city schools) and 935 children participated (67% child

RR)

Overall study response 27 schools (RR 59%)

1075 participants (RR 65.5%)

Sampling frame 56 eligible schools

(51 urban and 5 rural schools)

Current analysis based on 724 plausible energy reporters

Results

• One in 4 children were overweight or obese (total sample) • Rates lower in plausible energy reporters (18%)

• Plausible Energy reporters majority (82%) were SSB consumers

• Mean daily intakes=328 mls (SD 233ml)

Plausible Reporters

N=724

Normal* N=586

Overweight/ Obese* N=131

INDIVIDUAL FACTORS N %

SSD Consumer 591 81.7 471 80.5 115 87.8

SSD (ml) Mean, median,

(sd)

328.1, 267.3, (233.8) 315.4, 262.7 (222.0) 383.1, 316.7, (273.9)

SSD (kcal) Mean, median,

(sd)

116.0, 84, (133.6) 106.8, 78.0, (98.4) 155.3, 99.7, (224.6)

SSD % kcal Mean, median,

(sd)

6.1, 4.6, (5.7) 5.8, 4.4, (4.9) 7.6, 5.3, (7.9)

SSD (sugars) Mean, median,

(sd)

27.1, 18.6, (33.1) 24.8, 17.5, (24.1) 36.6, 22.8, (56.0)

SSD % sugars Mean, median,

(sd)

22.1. 19.0, (16.9) 21.1, 18.0, (16.3) 26.1, 21.4, (19.3)

OR P 95% CI

Low consumers (n=204)

- - -

Non-consumers

(n=132)

0.7 0.5 0.3-1.8

High consumers

(n=387)

1.9 0.04 1.0-3.5

Fully adjusted model

Adjusted for sex, parental education, physical activity, tv viewing, energy intake

Low consumers classified as intakes of <200ml/day High consumers classified as intakes of >200ml/day

Implications

• Support interventions targeted at reducing consumption of SSBs

• Not an all or nothing approach, reduction rather than abstinence

• Potential to have a measurable effect on the scale of obesity epidemic

Data, data, data

• Consumption

• Expenditure

• Individual

• Point of sale data

Data, data, data

What’s missing?

• Media discourse

• Public discourse

• Environment • Physical exposures

• Advertising

• Other gaps?