Small Sales Taxes Are Ineffective in Curbing Children's Soda Consumption
Soda and other sugar-sweetened drinks have contributed to the rise of childhood obesity in the United States. Interventions to improve children's diets and anti-obesity initiatives frequently target these drinks, which contain substantial calories but otherwise have no nutritional value. Although there have been heated debates about excise taxes, paralleling tobacco taxes, there is little empirical evidence on the potential effects of such taxes. A study team led by RAND Health economist Roland Sturm examined the likely effects of small taxes by considering existing variation in sales taxes across states. In 2007, 28 states taxed soda at a higher rate than other types of food sold in grocery stores, at rates ranging from 3.5 to 7 percent. Details about state soda taxes were compared to information about weight and soda consumption among 7,300 children enrolled in the Early Childhood Longitudinal Study, a national survey that has collected health and demographic information from a group of children over many years. The study found that small taxes on soda did not substantially reduce soda consumption or obesity rates. For subgroups of at-risk children, however—children who were already overweight, came from low-income families, watched a lot of television, or were African American—these small tax rates appear to have a greater effect, possibly because these children also had higher levels of consumption.
The researchers concluded that for a soda tax to have a noticeable effect on children's consumption, it would need to be much higher—in the range of 20 percent. Small taxes may raise funds, but they do not affect consumption let alone excess weight gain. If the goal is to discourage consumption, a tax should be structured so that the price increases are immediately visible to consumers—for example, as an excise tax that would increase shelf prices rather than as a sales tax collected at the cash register.
Multiple Anxiety Disorders Can Significantly Impair Mental and Physical Functioning
Anxiety disorders are among the most common mental health conditions in the United States. About 18 percent of Americans suffer from an anxiety disorder each year, and almost 29 percent will experience an anxiety disorder at some time. Prior studies have shown that people with anxiety disorders experience difficulty in functioning and increased disability compared to people without these disorders. However, little is known about the relative effects of different anxiety disorders or the effect of multiple anxiety disorders. A study led by RAND researcher Cathy Sherbourne examined the effect of anxiety disorders in primary care outpatients. Researchers examined information about the mental and physical functioning and disability of 1,004 patients diagnosed with one or more of these disorders: panic disorder, generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder.
Two key findings emerged. First, patients with only one anxiety disorder (about 43 percent of the sample) showed relatively small differences in impairment. Those with social anxiety disorder were the most impaired, while those with general anxiety were the least impaired. However, the effects of a single disorder across all the conditions showed more similarities than differences. Second, the burden of disability was greater as the number of anxiety disorders increased. More than half of patients in the sample (57 percent) had more than one anxiety disorder; 38 percent had two disorders, 16 percent three, and 3 percent all four. In particular, patients with multiple anxiety disorders had a significantly higher rate of depression than did those with only one anxiety disorder: 88 percent compared with 56 percent. The researchers concluded that focusing on the unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders. Further, the findings underscore the seriousness of social anxiety disorder and suggest a potential need for further screening and outreach to identify cases and enhance patients' access to care.
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Cathy Donald Sherbourne
Cathy Donald Sherbourne is a medical sociologist and health services researcher specializing in health outcome measurement for both adults and children with a focus on mental health issues. Sherbourne has been the primary sociologist working on health status measurement, satisfaction, and the analyses of life stress, social and role functioning, social support, and mental health status for several of RAND's large-scale health policy evaluations. She has had extensive experience in the development of self-report health and satisfaction measures for children and adults. She served as a member of an Institute of Medicine's committee to develop an agenda for health outcomes research for the elderly. Sherbourne has experience in design and implementation of quality improvement interventions for depression and anxiety disorders, including development of intervention and data collection instruments, development of new statistical methodologies, and data analysis.
Read more about Cathy D Sherbourne »
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