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We read with interest the article byPomeranz et al.1 on the legal and administrative feasibility of implementing a federal junk food and sugar-sweetened beverage (SSB) tax. As the authors indicate, such a tax could improve diets on an un- precedented scale. In addition, this tax could generate data to advance research and evidence-based policies.

Surveys are traditionally used in epidemio- logical studies of food and beverage con- sumption,2–4 but population-level data may offer more comprehensive and reliable evi- dence regarding such trends. If designed and implementedeffectively,thejunkfoodandSSB tax could provide an invaluable tool to public health researchers, epidemiologists, and poli- cymakers seeking to understand the effects of thetaxandotherinterventionsonconsumption over time. Excise tax revenues are correlated with, or even proportional to, consumer de- mand for a particular good or service. We re- cently demonstrated this approach with indoor

tanning service excise tax revenues to estimate national trends in the prevalence of indoor tanning.5 Similarly, revenue data could be used to approximate junk food and SSB consump- tion over time. Alternatively, tax legislation could mandate reporting of the quantity of junk food and SSBs sold.

As mentioned by the authors, an excise tax could be levied anywhere along the supply chain, from suppliers and manufac- turers to distributors and retailers. As the end of this chain, retail sales are the best ap- proximation of junk food and SSB con- sumption. Thus, a point-of-sale tax may provide more reliable and timely data on consumption than a manufacturer tax, which would tax junk food and SSBs not yet purchased by consumers. Moreover, retailers could more easily report the geographic location of sales, permitting determination of regional consumption pat- terns. With this information, researchers could analyze the effects of various state and local public health interventions.

Despite these advantages, a point-of-sale tax might be more administratively com- plex given the higher market fragmenta- tion in the grocery industry than in food manufacturing. Regardless of which entities are taxed, food sales in different product or nutrition categories would ideally be re- ported separately to provide more detailed consumption data.

We commend the authors for advancing the discussion on how innovative tax policies could improve public health. A federal junk food and SSB tax has the potential to simul- taneously deter unhealthy behaviors among consumers and illuminate consumption trends as a means of informing policy.

Kishore L. Jayakumar, BS Jules B. Lipoff, MD

ABOUT THE AUTHORS Both authors are with the Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Correspondence should be sent to Jules B. Lipoff, MD, University of Pennsylvania, Department of Dermatology, Penn

Medicine University City, 3737 Market St, Suite 1100, Philadelphia, PA 19104 (e-mail: [email protected] edu). Reprints can be ordered at by clicking the “Reprints” link.

This letter was accepted March 30, 2018. doi: 10.2105/AJPH.2018.304451

CONTRIBUTORS The authors contributed equally to the conception of this letter. K. L. Jayakumar drafted the letter. J. B. Lipoff critically revised the letter for important intellectual content.

ACKNOWLEDGMENTS Kishore L. Jayakumar is an enrolled agent licensed by the Internal Revenue Service.

REFERENCES 1. Pomeranz JL, Wilde P, Huang Y, Micha R, Mozaffarian D. Legal and administrative feasibility of a federal junk food and sugar-sweetened beverage tax to improve diet. Am J Public Health. 2018;108(2):203–209.

2. Han E, Powell LM. Consumption patterns of sugar sweetened beverages in the United States. J Acad Nutr Diet. 2013;113(1):43–53.

3. Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999–2010. Am J Clin Nutr. 2013;98(1):180–188.

4. Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D. Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation. 2015;132(8):639– 666.

5. Jayakumar KL, Lipoff JB. Tax collections and spend- ing as a potential measure of health policy association with indoor tanning, 2011–2016. JAMA Dermatol. 2018; Epub ahead of print.


We agree with Lipoff et al. that in ad-dition to reducing consumption and generating revenue, a federal tax on junk food and sugar-sweetened beverages (SSBs) would produce unique data to advance re- search and further support evidence-based policy. We also empathize with the view that “retail sales are the best [sales] approxi- mation of consumption,” and a point-of-sale (POS) tax “may provide more reliable and timely data” than taxes administered further up the distribution chain. Yet, as described in the following paragraphs, a manufacturer excise tax for junk food and SSBs is pref- erable to support healthier diets and for

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e18 Letters and Responses Jayakumar and Lipoff AJPH July 2018, Vol 108, No. 7

several legal and administrative feasibility reasons, whereas a POS tax has important limitations.

The vast majority of federal excise taxes are levied on manufacturers (including producers and importers).1 All proposed federal SSB tax bills utilized a manufacturer excise tax.2 Because manufacturers directly experience the tax, this also encourages reformulation.1 Moreover, manufacturers would be responsible for the tax regardless of where the food is ultimately sold. A manufacturer excise tax facilitates more consistent prices across retailers, who might otherwise differentially alter retail prices on the basis of a POS tax. Taxing manufacturers also avoids the burden of identifying every purveyor type, such as supermarkets, convenience stores, movie theaters, cafeterias, vending machines, fast food restaurants, and others.

As Lipoff et al. acknowledge, collection of a federal POS food and beverage tax would create tremendous new administra- tive burdens. The Internal Revenue Service confirmed that identifying taxpayers for the POS indoor tanning excise tax has been challenging.3 And there are hundreds of thousands more food retailers than tanning providers.4

A POS tax would also implicate policy concerns for the Supplemental Nutrition Assistance Program (SNAP), under which Congress prohibits states and locales from collecting taxes on food purchased with benefits. Although a federal POS tax would not formally fall into this pro- hibition, it would undermine the rationale for the policy: to avoid reducing the “food purchasing power” of program participants by dedicating SNAP dollars to tax pay- ments.5 A manufacturer excise tax minimizes this concern and would raise prices for all consumers.

Since publication of our article, the fed- eral government has not proposed a junk food or SSB tax, but 2 states, Michigan and Arizona, have preempted, or pro- hibited, local governments from enacting such a tax to support public health. Taxing for public health is an evidence-based strategy to improve health, reduce dispar- ities, generate revenue, and support data collection and research, and governments

should embrace, rather than preempt, such policies.6

Jennifer L. Pomeranz, JD, MPH Renata Micha, RD, PhD

Dariush Mozaffarian, MD, DrPH

ABOUT THE AUTHORS Jennifer L. Pomeranz is with the College of Global Public Health at New York University, New York, NY. Renata Micha and Dariush Mozaffarian are with the Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA.

Correspondence should be sent to Jennifer L. Pomeranz, College of Global Public Health, New York University, 715 Broadway, 10th Floor, New York, NY 10003 ([email protected] edu). Reprints can be ordered at by clicking the “Reprints” link.

This letter was accepted March 31, 2018. doi: 10.2105/AJPH.2018.304452

CONTRIBUTORS All authors contributed equally to this letter.

REFERENCES 1. Pomeranz JL, Wilde P, Huang Y, Micha R, Mozaffarian D. Legal and administrative feasibility of a federal junk food and sugar-sweetened beverage tax to improve diet. Am J Public Health. 2018;108(2):203–209.

2. SWEET Act, HR 1687, 114th Cong (2015–2016). Available at: congress/house-bill/1687/text. Accessed March 26, 2018.

3. Treasury Inspector General for Tax Administration. Affordable Care Act: the number of taxpayers filing tanning excise tax returns is lower than expected, refer- ence number: 2011-40-115; September 22, 2011. Available at: auditreports/2011reports/201140115fr.pdf. Accessed March 26, 2018.

4. US Department of Agriculture. 2017 SNAP retailer management year end summary. Available at: https:// SNAP-Retailer-Management-Year-End-Summary.pdf. Accessed March 26, 2018.

5. Pomeranz JL. Implications of the Supplemental Nu- trition Assistance Program tax exemption on sugar- sweetened beverage taxes. Am J Public Health. 2015; 105(11):2191–2193.

6. Pomeranz JL, Mozaffarian D, Micha R. The potential for federal preemption of state and local sugar-sweetened beverage taxes. Am J Prev Med. 2017;53(5):740–743.


July 2018, Vol 108, No. 7 AJPH Pomeranz et al. Letters and Responses e19

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