摘要：Objectives. This study explored the use of strategic messaging by proponents of sugar-sweetened beverage (SSB) taxation to influence public opinion and shape the policy process, emphasizing the experiences in El Monte and Richmond, California, with SSB tax proposals in 2012. Methods. We conducted 18 semistructured interviews with key stakeholders about the use and perceived effectiveness of messages supporting and opposing SSB taxation, knowledge sharing among advocates, message dissemination, and lessons learned from their messaging experiences. Results. The protax messages most frequently mentioned by respondents were reinvesting tax revenue into health-related programs and linking SSB consumption to health outcomes such as obesity and diabetes. The most frequently mentioned antitax messages addressed negative economic effects on businesses and government restriction of personal choice. Factors contributing to perceived messaging success included clearly defining “sugar-sweetened beverage” and earmarking funds for obesity prevention, incorporating cultural sensitivity into messaging, and providing education about the health effects of SSB consumption. Conclusions. Sugar-sweetened beverage taxation has faced significant challenges in gaining political and public support. Future campaigns can benefit from insights gained through the experiences of stakeholders involved in previous policy debates. The prevalence of obesity in the United States is among the highest worldwide, reaching 35.7% of adults and 16.9% of children from 2009 to 2010. 1,2 Cardiovascular disease, type 2 diabetes, and certain cancers are strongly associated with obesity, which accounted for an estimated $147 billion in national medical spending in 2008. 3,4 Sugar-sweetened beverages (SSBs) are gaining policy attention as a result of reported links between their consumption and weight gain, metabolic syndrome, and type 2 diabetes. 5–8 Evidence also shows an association between decreasing SSB consumption and weight loss among children and adolescents. 9–11 One proposed policy solution to reduce the consumption of SSBs is to tax them. 12,13 Since 2009, 22 states and 6 cities have introduced SSB tax proposals. Only one state has succeeded in passing a tax sufficiently large to plausibly affect consumption: Washington’s 2010 penny-per-ounce excise tax, which was repealed by popular referendum the following year. 14 One reason for this lack of success is limited public support. A 2012 national survey showed that 62% of Americans somewhat or strongly opposed SSB taxes, with 37% strongly opposed. 15 However, polls suggest that support increases when tax revenue is earmarked for health-related programs 16,17 and that certain protax arguments (e.g., SSBs being the largest contributor to obesity) are more credible than others. 18 Strategic messaging (or “framing”) is used to emphasize certain aspects of issues in policy debates, shaping public views and policymaking processes. 19,20 The messages used to support or oppose SSB taxation therefore may affect its political viability. Messaging campaigns were particularly salient in 2 California cities during 2012. On their November 2012 ballots, El Monte and Richmond proposed measure H and measure C, both business license fees of $0.01 per ounce for SSBs sold or provided within city limits. Both were accompanied by complementary resolutions recommending the use of tax revenue for health-related initiatives. 21,22 After heated campaigns, both measures were defeated, with 77% of El Monte and 67% of Richmond voters in opposition. 23 We explored the use of strategic messaging for SSB taxation with an emphasis on the 2012 experiences of El Monte and Richmond. We interviewed stakeholders in California and across the country to identify commonly used messages and lessons learned about messaging from past advocacy campaigns. With 12 states and 2 cities proposing SSB tax legislation in 2013 or 2014 legislative cycle 14 and more likely to follow, analyzing the experiences from previous campaigns can yield lessons for shaping future policy approaches to reducing SSB consumption.
