Awareness, attitudes and response to the sugar-sweetened beverage tax among consumers in Pietermaritzburg, KwaZulu-Natal.
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Introduction: Obesity and overweight have been identified as serious health problems both globally and in South Africa. One of the contributing factors to this epidemic is the consumption of sugar-sweetened beverages (SSBs), high in sugar and energy. Sugar-sweetened beverages are defined as: ‘beverages that contain added caloric sweeteners such as sucrose, high fructose corn syrup or fruit juice concentrates’ and include soft drinks, fruit drinks, sports/energy drinks, vitamin water drinks, sweetened ice tea and lemonade. The South African Minister of Finance implemented the sugar-sweetened beverage (SSB) tax on 01 April 2018, as part of a multidisciplinary strategy to alleviate the obesity problem. The tax is calculated according to the direct proportion of added sugar at 2.1 cents per gram of sugar that exceeds 4 g per 100 ml, resulting in an approximate 20% increase in the price of SSBs. Given that the SSB tax is relatively new in South Africa, there is a need to assess the awareness, attitudes and responses of South African consumers to the tax. Aim: This study aimed to assess the awareness, attitudes and response to the sugar-sweetened beverage tax among consumers in Pietermaritzburg, KwaZulu-Natal. Objectives: (i) To determine if consumers in Pietermaritzburg, KwaZulu-Natal are aware of the SSB tax (ii) To determine the demographic characteristics of consumers who are aware of the SSB tax in Pietermaritzburg, KwaZulu-Natal (iii) To determine the attitudes of consumers in Pietermaritzburg, KwaZulu-Natal towards the SSB tax (iv) To determine the response of consumers in Pietermaritzburg, KwaZulu-Natal to the SSB tax, in terms of purchasing behaviour. Methods: An observational cross-sectional study was conducted at seven shopping centres in Pietermaritzburg, using a self-administered questionnaire, developed for this study. The questionnaire was used to gather data on demographic characteristics, awareness and response to the SSB tax. Data was analysed using the IBM Statistical Package for Social Science (SPSS) version 23.0. Results: The participants were mostly 18-30 year old Indian or African consumers, with a low income and in possession of a matric certificate or tertiary qualification. A significant number of consumers were aware of the South African SSB tax (58.1%; n=229), however, almost half did not know when it was implemented (47.6%; n=109). Indian and white consumers were significantly more aware of the SSB tax compared to African consumers (p<0.0005). In addition, awareness increased according to income level (more than R40 000 per month) and age (31-50 year olds) (p<0.0005). The consumers were divided in their attitudes towards the SSB tax. Nearly equal amounts of participants were in agreement (35.8%; n=141) or disagreement (37.0%; n=146) with the SSB tax. Furthermore, many believed that it would benefit the country in terms of the economy or health (43.6%; n=100). However, some felt that they could not afford the tax (21.8%; n=50) or felt that the money would go to the government and not benefit the public (12.7%; n=29). Many also believed that the South African economy would be negatively affected in terms of job losses (41.1%; n=162). However, there was neither significant agreement nor significant disagreement that the SSB tax would reduce obesity or consumption rates of SSBs. In addition, many indicated that the government should not interfere with the beverage choices of South Africans (41.9%; n=165). About half of the participants stated that they would make healthier beverage choices, following the implementation of the SSB tax (53.6%; n=211). Moreover, half of the consumers indicated that they would opt for water (50.8%; n=200). Other common alternatives included 100% fruit juice (49.2%; n=194) and milk and milk products (30.2%; n=119). Finally, most participants suggested that they would like the government to help reduce the prevalence of obesity by supporting an increase in nutrition education (27.3%; n=68) and physical activity (22.5%; n=56). Conclusion: This study aimed to assess the awareness, attitudes and response to the SSB tax among consumers in Pietermaritzburg, KwaZulu-Natal. The majority of the consumers were aware of the South African SSB tax; however, almost half did not know when it was implemented. Indian and White consumers, between the ages of 31 and 50 years old, earning more than R40 000 per month, were the most aware of the South African SSB tax. Half of the consumers were in favour of the SSB tax and felt that it would improve health. The same number also indicated that they would choose water as an alternative, if SSBs were no longer affordable to them, followed by 100% fruit juice and milk and milk products. The differences in attitudes towards the SSB tax show that there is a need for consumers to know more about the SSB tax. Hence, more awareness campaigns are required. Future research should investigate the impact of the SSB tax on health, obesity rates and the economy.