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Portuguese Tax on sugar-sweetened beverages: children's consumption trends (COSI PORTUGAL 2019-2022) and social media advertising

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Introduction: Reducing sugar consumption is a cost-effective strategy to combat childhood obesity. The World Health Organization (WHO) recommends fiscal policies, such as the increase of the price of sugar-sweetened beverages (SSBs) to reduce its intake. In Portugal, the SSB tax (2017 revised in 2019) led to declining sales and nutritional reformulation. The WHOĀ“s Childhood Obesity Surveillance Initiative (COSI) Portugal provides data on SSB consumption trends among primary-school children, enabling policy evaluation. However, marketing remains a key driver of children's food choices, with SSBs heavily promoted on digital platforms. Aims: To analyze trends in children SSBs consumption, before and after the tax, and characterize SSB-related social media marketing content from the most advertised brands to children. Methodology: Data from COSI Portugal 2019 and 2022 (repeated cross-sectional design) were analyzed. Nationally representative samples of 6–8-year-old children completed a family questionnaire, reporting SSB consumption frequency. Additionally, using the WHO CLICK framework, the 21 most frequently advertised food and beverage brands to 3–16-year-old children sample were identified, and their Instagram posts (2022) were examined for SSB presence and compliance with the Portuguese Nutrient Profile Model (PT-NPM). Results: In 2019, 85.4% of children consumed SSBs, with 71.3% drinking up to 3 days/week (3dw) and 14.1% over 4 days/week (4+w). After the revised tax, in 2022, consumption slightly declined to 84.2% (69.1% 3dw and 15.1% 4+w). Regarding digital advertisements, 337 Instagram posts were analyzed, 106 contained foods/beverages classified under PT-NPM. Among them, 30 (28.3%) featured SSBs, yet only one met PT-NPM criteria. Conclusions: While the SSB tax implementation suggests a contribution to a reduction in consumption, intake remains high, in children. Additionally, SSBs continue to be marketed on digital platforms by brands exposed to children. These findings highlight the need for more comprehensive policy action including marketing regulations to protect children from exposure to SSB content.

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Children Sugar COSI Sugar-Sweetened Beverages Estilos de Vida e Impacto na SaĆŗde Portugal

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