title: Promotion of healthy eating through public policy: a controlled experiment.
abstract: BACKGROUND
  To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown.
  
  
  OBJECTIVE
  In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies.
  
  
  METHODS
  From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase "less healthy" on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January-July 2012, at the single-item and transaction levels.
  
  
  RESULTS
  There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, p<0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage point decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11-14 fewer calories (9%-11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction.
  
  
  CONCLUSIONS
  Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%-20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy.
authors.affiliation: Departments of Population Health and Medicine, School of Medicine, New York University, New York, New York. Electronic address: brian.elbel@nyumc.org.
authors.forename: Brian
authors.initials: B
authors.lastname: Elbel
authors.affiliation: Departments of Population Health and Medicine, School of Medicine, New York University, New York, New York.
authors.forename: Glen B
authors.initials: GB
authors.lastname: Taksler
authors.affiliation: Steinhardt School, New York University, New York, New York.
authors.forename: Tod
authors.initials: T
authors.lastname: Mijanovich
authors.affiliation: Departments of Population Health and Medicine, School of Medicine, New York University, New York, New York.
authors.forename: Courtney B
authors.initials: CB
authors.lastname: Abrams
authors.affiliation: Wagner School of Public Service, New York University, New York, New York.
authors.forename: L B
authors.initials: LB
authors.lastname: Dixon
mesh_terms: D001628:Beverages / Q000191:economics / Q000592:standards; D003132:Commerce / Q000191:economics / Q000331:legislation & jurisprudence; D005247:Feeding Behavior; D005502:Food / Q000191:economics / Q000592:standards*; D005515:Food Labeling; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D013660:Taxes / Q000331:legislation & jurisprudence