Understanding Food Choices in Saudi Arabia- Taxes

NCT05429528 | Completed

• 1 other identifier: 7202186
• Study Type: interventional
• Target: 2,490
• Locations: 1 country
• Sites: 1

Brief Summary

Using a 3-arm randomized controlled trial, the investigators aim to rigorously evaluate the effects of two different taxation policies on diet quality. The first is an implicit sales tax that will be levied only on beverages in a manner that mirrors the current Kingdom of Saudi Arabia (KSA) beverage taxes and the second is an explicit Nutri-Score (NS) based tiered tax that is levied on all food and beverage products. The investigators will use an experimental online grocery store, called NUSMart, which is similar in design to commercial web-based grocery stores to test these two taxation policies. Participants will be randomly assigned to one of the following arms and asked to complete a one-time hypothetical shop. Arm 1 (Control): Participants will experience a default version of NUSMart which replicates the traditional shopping experience of online grocery stores with no FOP labels. Arm 2 (Implicit Tax): Same as Arm 1 NUSMart except that an implicit tax will be levied only on beverages: a 50% sales tax on carbonated drinks and sugar-sweetened beverages (SSBs) and 100% tax on energy drinks (milk, milk-based products, and natural fruit juice are excluded). Arm 3 (Explicit Tiered Tax): Same as Arm 1 NUSMart except that an explicit tiered tax based on (underlying) NS is levied on (sale price of) all food and beverages. NS assesses overall nutritional quality of products on the basis of 7 nutrients (calories, saturated fats, sugar, salt, fiber, protein and percentage of fruits, vegetables and nuts) from A to E (best to worst). In this arm, the investigators implement a 20% sales tax on the retail price for NS D beverages and 10% for NS D foods along with a 50% sales tax on NS E beverages and 20% on NS E foods. The investigators hypothesize the following: Hypothesis 1: Diet quality of food purchases, measured by the weighted average Nutri-Score point, will be highest in the explicit tiered tax arm, followed by the implicit tax arm, followed by the control. Hypothesis 2: Average calories, sugar, sodium, and saturated fat per serving will be lowest in the explicit tiered tax arm, followed by the implicit tax arm, followed by the control.

Conditions

Diet, Healthy

Keywords

Implicit/ Explicit Tax; Sugar-sweetened beverages tax; Diet quality; Online grocery shopping; Kingdom of Saudi Arabia

Outcome Measures

Primary Outcomes (1)

• Value of Nutri-Score

  Diet quality measured by the weighted (by the number of servings) average of all purchased products' Nutri-Score for the shopping trip. Nutri-Score is a holistic dietary index based on the British Food Standard Agency Nutrient Profiling System that grades food and beverage products from A to E where A indicates the highest nutritional quality and E indicates the lowest nutritional quality.

  After completion of data collection, an average of about 5 months

Secondary Outcomes (1)

• Quantity of other Nutrients

  After completion of data collection, an average of about 5 months

Study Arms (3)

Control Arm (Arm 1)

NO INTERVENTION

Participants will experience a default version of NUSMart which replicates the traditional shopping experience of online grocery stores with no FOP labels.

Implicit Tax Arm (Arm 2)

EXPERIMENTAL

Similar to Arm 1 except that an implicit tax is levied on qualifying beverages.

Behavioral: Implicit Tax

Explicit Tiered Tax Arm (Arm 3)

EXPERIMENTAL

Similar to Arm 1 except that an explicit tiered tax is levied on qualifying food and beverage products.

Behavioral: Explicit Tiered Tax

Interventions

Implicit Tax BEHAVIORAL

This will be levied only on certain beverage categories: a 50% tax on the sales prices of carbonated drinks and sugar-sweetened beverages (SSBs) and 100% tax on the sales prices of energy drinks (milk, milk-based products, and natural fruit juice are excluded).

Implicit Tax Arm (Arm 2)

Explicit Tiered Tax BEHAVIORAL

This is an explicit tiered tax based on (underlying) Nutri-Score (NS) grades which will be levied on all food and beverages. In this arm, the investigators implement a 20% sales tax on the retail price for NS D beverages and 10% for NS D foods along with a 50% sales tax on NS E beverages and 20% on NS E foods. The NS labels will not be displayed.

Explicit Tiered Tax Arm (Arm 3)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• People who are KSA (Kingdom of Saudi Arabia) citizens
• Age of 18 and above,
• Arabic speakers, and
• A weekly primary grocery shopper for their households can participate in this study.

You may not qualify if:

• People who are not KSA citizens,
• Under 18 years of age,
• Cannot speak Arabic, or
• Are not weekly primary grocery shoppers for their households cannot participate in this study.

Sponsors & Collaborators

• Duke-NUS Graduate Medical School: lead
• World Bank: collaborator
• Public Health Authority of Saudi Arabia: collaborator

Study Sites (1)

Duke-NUS Graduate Medical School

Singapore, 169857, Singapore

Location

Study Officials

• Eric A Finkelstein, PhD MHA

  Duke-NUS Graduate Medical School

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: June 19, 2022
• First Posted: June 23, 2022
• Study Start: December 28, 2022
• Primary Completion: July 31, 2023
• Study Completion: July 31, 2023
• Last Updated: October 23, 2023

Record last verified: 2023-10

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)