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Objectives. We assessed the short-term ability to increase retail prices of the first US 1-cent-per-ounce excise tax on the distribution of sugar-sweetened beverages (SSBs), which was implemented in March 2015 by Berkeley, California. Methods. In 2014 and 2015, we examined pre- to posttax price changes of SSBs and non-SSBs in a variety of retailers in Berkeley and in the comparison cities Oakland and San Francisco, California. We examined price changes by beverage, brand, size, and retailer type. Results. For smaller beverages (≤ 33.8 oz), price increases (cents/oz) in Berkeley relative to those in comparison cities were 0.69 (95% confidence interval [CI] = 0.36, 1.03) for soda, 0.47 (95% CI = 0.08, 0.87) for fruit-flavored beverages, and 0.47 (95% CI = 0.25, 0.69) for SSBs overall. For 2-liter bottles and multipacks of soda, relative price increases were 0.46 (95% CI = 0.03, 0.89) and 0.49 (95% CI = 0.21, 0.77). We observed no relative price increases for nontaxed beverages overall. Conclusions. Approximately 3 months after the tax was implemented, SSB retail prices increased more in Berkeley than in nearby cities, marking a step in the causal pathway between the tax and reduced SSB consumption.

Background Social norms can influence individual health behaviors. Shifts in social norms for smoking were critical for the effectiveness of tobacco control efforts such as excise taxes. Sugar-sweetened beverage (SSB) excise taxes have been implemented in municipalities across the United States to reduce SSB intake and improve health. We sought to identify trends in social norms and attitudes about healthfulness of sugar-sweetened beverage (SSB) consumption in the California Bay Area and examine whether social norms and attitudes changed following SSB taxes. Methods Data came from annual (2016–2019, 2021) cross-sectional surveys ( n  = 9128) in lower-income neighborhoods in Oakland, San Francisco, Berkeley, and Richmond. We assessed overall trends and compared pre-post tax changes in Oakland and San Francisco with comparison cities. Results We observed a 28% reduction in social norms for SSB consumption (people’s perceptions of peers’ consumption) and variable reductions in attitudes about the healthfulness of SSBs. Relative to comparison cities, post-tax, perceptions of peers’ consumption of sports drinks declined in Oakland; attitudes about the healthfulness of sugar-sweetened fruit drinks declined in San Francisco. Conclusions Among lower-income populations, social norms and attitudes towards the healthfulness of SSBs meaningfully declined over time, with smaller tax-related effects. SSB taxes as well as the local media attention they generate appear to affect people’s perceptions of SSBs. Pairing SSB taxes with messaging campaigns may be more effective in de-normalizing SSB consumption.

Objectives. To evaluate the impact of the excise tax on sugar-sweetened beverage (SSB) consumption in Berkeley, California, which became the first US jurisdiction to implement such a tax ($0.01/oz) in March 2015. Methods. We used a repeated cross-sectional design to examine changes in pre- to posttax beverage consumption in low-income neighborhoods in Berkeley versus in the comparison cities of Oakland and San Francisco, California. A beverage frequency questionnaire was interviewer administered to 990 participants before the tax and 1689 after the tax (approximately 8 months after the vote and 4 months after implementation) to examine relative changes in consumption. Results. Consumption of SSBs decreased 21% in Berkeley and increased 4% in comparison cities (P = .046). Water consumption increased more in Berkeley (+63%) than in comparison cities (+19%; P < .01). Conclusions. Berkeley’s excise tax reduced SSB consumption in low-income neighborhoods. Evaluating SSB taxes in other cities will improve understanding of their public health benefit and their generalizability.

Objectives. To estimate changes in sugar-sweetened beverage (SSB) and water consumption 3 years after an SSB tax in Berkeley, California, relative to unexposed comparison neighborhoods. Methods. Data came from repeated annual cross-sectional beverage frequency questionnaires from 2014 to 2017 in demographically diverse Berkeley (n = 1513) and comparison (San Francisco and Oakland; n = 3712) neighborhoods. Pretax consumption (2014) was compared with a weighted average of 3 years of posttax consumption. Results. At baseline, SSBs were consumed 1.25 times per day (95% confidence interval [CI] = 1.00, 1.50) in Berkeley and 1.27 times per day (95% CI = 1.13, 1.42) in comparison city neighborhoods. When we adjusted for covariates, consumption in Berkeley declined by 0.55 times per day (95% CI = −0.75, −0.35) for SSBs and increased by 1.02 times per day (95% CI = 0.54, 1.50) for water. Changes in consumption in Berkeley were significantly different from those in the comparison group, which saw no significant changes. Conclusions. Reductions in SSB consumption were sustained in demographically diverse Berkeley neighborhoods over the first 3 years of an SSB tax, relative to comparison cities. These persistent, longer-term reductions in SSB consumption suggest that SSB taxes are an effective policy option for jurisdictions focused on improving public health.

There is a lack of qualitative research developing sugar-sweetened beverage (SSB) warning labels with their intended end users. We sought to identify promising SSB warning elements for improving label effectiveness and for future testing in policy and institutional settings. Mixed methods design using ten focus groups, a design task and a survey. The design task was used to generate ideas for an icon that would dissuade SSB consumption. The survey and focus group guide assessed participant perceptions of SSB warning label mock-ups of text (loss frame, gain frame and loss frame with attribution), colour and icon options. Three large public universities in California from February to March 2018. Young adult SSB consumers (n 86) enrolled in one of three diverse California public universities. Participants perceived the following elements as most effective for reducing SSB consumption: loss-frame text with attribution to a credible source, yellow and red colour for label background and an image or icon to accompany the text. Preferred images included sugar near or inside of an SSB, intuitive shapes like a triangle with exclamation mark or octagon and a visual indicator of SSB sugar content compared with recommended limits. Support was high for using SSB warning labels in university cafeterias and on bottles/cans. Loss-frame text with a credible source, yellow or red label colour and icons could potentially enhance effectiveness of SSB warning labels and warrant further testing.

As resources for health promotion become more constricted, it is increasingly important to collaborate across sectors, including the private sector. Although many excellent models for cross-sector collaboration have shown promise in the health field, collective impact (CI), an emerging model for creating larger scale change, has yet to receive much study. Complementing earlier collaboration approaches, CI has five core tenets: a shared agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and a central infrastructure. In this article, we describe the CI model and its key dimensions and constructs. We briefly compare CI to community coalition action theory and discuss our use of the latter to provide needed detail as we apply CI in a critical case study analysis of the Tenderloin Healthy Corner Store Coalition in San Francisco, California. Using Yin's multimethod approach, we illustrate how CI strategies, augmented by the community coalition action theory, are being used, and with what successes or challenges, to help affect community- and policy-level change to reduce tobacco and alcohol advertising and sales, while improving healthy, affordable, and sustainable food access. We discuss the strengths and weaknesses of CI as a framework for health promotion, as well as the benefits, challenges, and initial outcomes of the healthy retail project and its opportunities for scale-up. Implications for health promotion practice and research also are discussed.

Objectives. To assess the impact of the world's first mandatory healthy checkout policy on added sugars, sodium, and other nutrients available at retail checkouts in Berkeley, California. Methods. We collected data on food and beverage facings before (2021) and after (2022) policy implementation in 23 Berkeley (8786 facings) and 75 California comparison stores (40 617 facings). Our analysis used difference-in-differences models. Results. Between 2021 and 2022, there was a 70% reduction in added sugars per serving of food and beverage facings (b = 0.30; 95% confidence interval [CI] = 0.15, 0.59) and a 53% reduction in sodium per serving of beverage facings (b = 0.47; 95% CI = 0.28, 0.81) at Berkeley checkouts relative to comparison city checkouts. There was a 41% reduction in saturated fat and a 47% increase in fiber per serving of food and beverage facings (b = 0.59; 95% CI = 0.44, 0.79 and b = 1.47; 95% CI = 1.05, 2.06, respectively). Conclusions. One year after implementation, the policy reduced added sugars and saturated fat per serving of food and beverage facings, reduced sodium per serving of beverage facings, and increased fiber per serving of food and beverage facings. Public Health Implications. Healthy checkout policies have potential to increase the healthfulness of checkout food environments. (Am J Public Health. Published online ahead of print August 14, 2025:e1-e13. https://doi.org/10.2105/AJPH.2025.308159).Objectives. To assess the impact of the world's first mandatory healthy checkout policy on added sugars, sodium, and other nutrients available at retail checkouts in Berkeley, California. Methods. We collected data on food and beverage facings before (2021) and after (2022) policy implementation in 23 Berkeley (8786 facings) and 75 California comparison stores (40 617 facings). Our analysis used difference-in-differences models. Results. Between 2021 and 2022, there was a 70% reduction in added sugars per serving of food and beverage facings (b = 0.30; 95% confidence interval [CI] = 0.15, 0.59) and a 53% reduction in sodium per serving of beverage facings (b = 0.47; 95% CI = 0.28, 0.81) at Berkeley checkouts relative to comparison city checkouts. There was a 41% reduction in saturated fat and a 47% increase in fiber per serving of food and beverage facings (b = 0.59; 95% CI = 0.44, 0.79 and b = 1.47; 95% CI = 1.05, 2.06, respectively). Conclusions. One year after implementation, the policy reduced added sugars and saturated fat per serving of food and beverage facings, reduced sodium per serving of beverage facings, and increased fiber per serving of food and beverage facings. Public Health Implications. Healthy checkout policies have potential to increase the healthfulness of checkout food environments. (Am J Public Health. Published online ahead of print August 14, 2025:e1-e13. https://doi.org/10.2105/AJPH.2025.308159).

Objectives. To identify lessons learned from implementation of the nation’s first sugar-sweetened beverage (SSB) excise tax in 2015 in Berkeley, California. Methods. We interviewed city stakeholders and SSB distributors and retailers (n = 48) from June 2015 to April 2017 and analyzed records through January 2019. Results. Lessons included the importance of thorough and timely communications with distributors and retailers, adequate lead time for implementation, advisory commissions for revenue allocations, and funding of staff, communications, and evaluation before tax collection begins. Early and robust outreach about the tax and programs funded can promote and sustain public support, reduce friction, and facilitate beverage price increases on SSBs only. No retailer reported raising food prices, indicating that Berkeley’s SSB tax did not function as a “grocery tax,” as industry claimed. Revenue allocations totaled more than $9 million for public health, nutrition, and health equity through 2021. Conclusions. The policy package, context, and implementation process facilitated translating policy into public health outcomes. Further research is needed to understand long-term facilitators and barriers to sustaining public health benefits of Berkeley’s tax and how those differ from facilitators and barriers in jurisdictions facing significant industry-funded repeal efforts.