Public support for a sugar-sweetened beverage tax and pro-tax messages in a Mid-Atlantic US state.

In the USA, obesity has emerged as a critical public health issue over the past three decades as its prevalence has more than doubled in adults and tripled in children(1,2). Sugar-sweetened beverage (SSB) consumption is considered an important driver of the obesity epidemic(3) as intake leads to weight gain(4–6) and as consumption rates in children and adults have almost tripled since the 1970s(7). Many US states and localities have sought to reduce SSB consumption by increasing taxes on these beverages; however, to date, no US jurisdiction has successfully enacted a tax. Numerous studies have estimated the potential effect of a tax on SSB consumption and the prevalence of obesity, primarily for taxes that would be higher than the current state sales tax on these beverages in the range of a penny-per-ounce or more(8–12). While studies have examined the potential effect of an SSB tax(8–12), few studies have explored public knowledge and attitudes towards an SSB tax(13–15). Although several public opinion polls have been conducted and published in the grey literature, their findings on overall support were mixed(16–20). A Pew Research Center report polled Americans in October 2013 and found that 63 % believed obesity has societal consequences; however, only 35 % of respondents favoured an SSB tax(16). Among the few peer-reviewed studies, a 2013 article by Barry et al. examined the SSB tax arguments that resonated with US adults, finding greater agreement with anti-tax compared with pro-tax arguments overall(13). Gollust et al. conducted a national survey in 2012, finding that 22 % of respondents supported SSB taxes(14). The authors found that Democrats, young adults (18–29 years), individuals with a college education and those who have a negative opinion towards the beverage industry had higher levels of support(14). Rivard et al. studied consumption patterns, knowledge of SSB harms and public support for an SSB tax across the USA in 2012 and found that 36 % of adults supported SSB taxes(15). Young adults (18–25 years), those with at least some college and non-obese individuals (BMI < 30.0 kg/m2) were more likely to support the tax(15). Prior studies focused on SSB taxes and tax messages in national samples and found limited support. Public opinion surveys can contribute to public health practice and advocacy around policy making, including SSB taxes(21). However, the current literature may be limited by its national focus because studies are unable to explore more nuanced characteristics of supporters and opponents within particular regions or states. The present study builds on the existing literature by examining a comprehensive set of characteristics of supporters of an SSB tax, pro-tax messages and SSB consumption reduction messages. The study addressed three research questions: (i) What are the characteristics of supporters and opponents of a state-level SSB tax? (ii) What are the characteristics of individuals persuaded and not persuaded by messages about reducing SSB consumption? (iii) What are the characteristics of supporters and opponents of pro-SSB tax messages? We hypothesized that individuals who believe SSB are associated with obesity, believe that an SSB tax will be effective at reducing consumption or are concerned with childhood obesity will be more likely to support the SSB tax, and that Republicans and SSB consumers will be less likely to support the tax. Second, we hypothesized that adults with higher education or those who believe SSB are associated with obesity will be more likely to favour one or more of the SSB consumption or pro-SSB tax messages.