Schoolchildren's support for taxation of sugar-sweetened beverages in Hong Kong

Abstract

Aims: To determine school children's attitudes towards sugar tax in Hong Kong and to identify variations in support of sugar tax with respect to dietary behaviour, dietary knowledge, sugar knowledge, sugar literacy, and demographic factors. Methods: A cross-sectional survey was conducted among secondary school children in Hong Kong. Students’ dietary behaviour, dietary knowledge, sugar knowledge and sugar literacy were determined. In addition, students’ attitude towards sugar taxation and other health protective policy measures were assessed. Variations in support of sugar tax were determined through bivariate and regression model analyses. Results: The response rate to our project was 96.5% (720/746). Dietary behaviour scores were generally unfavourable (mean 0.9, SD 0.9 (4.0)), with most (74.3%, 535) reporting to snack in between meals. Dietary knowledge scores were generally poor (mean 2.4, SD 0.9 (/4.0)), and specifically relating to knowledge of energy per unit mass in different macronutrients (28.7%, 207). Sugar knowledge scores were generally poor (mean 1.0, SD 1.0 (/3.0)), with less than one in three students providing the correct answer for the recommended daily sugar intake in grams (29.7%, 214). Sugar literacy scores were satisfactory with the mean score of (mean 3.3, SD 1.0 (/5.0)) and 47.2% (340) attained a score of 4.0 out of 5.0 in sugar literacy. Three quarters (75.7%, 545) were in support of taxing to protect public health. Approximately 1-in-5 (21.2%, 153) agreed that taxing sugar-sweetened beverages (SSBs) was appropriate to protect public health. Bivariate analyses identified significant variations with respect to demographics: Class (dietary knowledge, p<0.001, sugar literacy, p<0.001 and sugar tax policy, p<0.001); and gender (dietary behaviour, p<0.001, sugar knowledge, p<0.001 and sugar tax policy, p<0.05). Regression analyses identified that those who supported taxing products that were detrimental to health were more likely to support SSBs: OR 4.52 (95% CI 2.29, 8.90) than those who did not support taxing products that were detrimental to health. Females were less likely to support sugar taxation than males: OR 0.63 (95% CI 0.43, 0.92). Those who felt it was the government’s responsibility for protecting population’s health were more likely to support the SSB tax: OR 6.80 (95% CI 3.10, 14.97). Conclusions: Among school children participants of our project, there was strong support for taxing products that were detrimental to health, but less so for taxing sugar sweetened beverages. Variations in support for sugar taxation existed among the school children with respect to gender (females less likely to support SSB tax), support of taxation of products detrimental to health and the attitude that the government had a responsibility for population health.