Setting: Communities & Government

Brief: Sugar-Sweetened Beverage Excise Tax in the City of San José

Posted on January 12, 2026

This material was developed at the Harvard T.H. Chan School of Public Health in collaboration with the County of Santa Clara Public Health Department through participation in the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This material was funded by USDA’s Supplemental Nutrition Assistance Program, an equal opportunity provider. This material is intended for educational use only.

This brief summarizes a CalFresh Healthy Living-CHOICES Project Learning Collaborative Partnership model, a cost-effectiveness analysis examining a sugar-sweetened beverage (SSB) excise tax in the City of San José. The model assessed the health impact and cost-effectiveness of a $0.02 per ounce excise tax in the City of San José. Read more in the full brief.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Citation

Cholette V, Coxe N, Shir A, Gacutan-Galang J, Beccarelli M, Evans LW, Pugliese J, Gouck J, Barrett JL, McCulloch SM, Garrone ME, Cradock AL. Sugar-Sweetened Beverage Excise Tax in the City of San José {Issue Brief}. County of Santa Clara Public Health Department, San José, CA, and the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership; December 2025.

The design for this brief and its graphics were developed by partners at Headlands Marketing.

Learn more about the CalFresh Healthy Living CHOICES Project.

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Brief: Safe Routes to School in San Mateo County

Posted on January 12, 2026

Crossing guards and children walking to school

This material was developed at the Harvard T.H. Chan School of Public Health in collaboration with San Mateo County Health through participation in the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This material was funded by USDA’s Supplemental Nutrition Assistance Program, an equal opportunity provider. This material is intended for educational use only.

This brief summarizes a CalFresh Healthy Living-CHOICES Project Learning Collaborative Partnership model examining Safe Routes to School (SRTS) and the School Travel Fellowship (STF) in San Mateo County. SRTS enables and encourages students to walk and bike to school, improving health, safety, and community well-being, while reducing traffic and emissions. Read more in the full brief.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Citation

Watkins J, Vallez-Kelly T, Sanchez L, Ibarra M, Chan C, Gacutan-Galang J, Beccarelli M, Evans LW, Pugliese J, Gouck J, McCulloch SM, Barrett JL, Garrone ME, Cradock AL. Safe Routes to School in San Mateo County {Issue Brief}. San Mateo County Health, San Mateo, CA, and the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership; December 2025.

The design for this brief and its graphics were developed by partners at Headlands Marketing.

Learn more about the CalFresh Healthy Living CHOICES Project.

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Brief: Safe Routes to School in Ravenswood City and South San Francisco Unified School Districts in San Mateo County

Posted on January 12, 2026

This brief summarizes a CalFresh Healthy Living-CHOICES Project Learning Collaborative Partnership model examining Safe Routes to School (SRTS) and the School Travel Fellowship (STF) in Ravenswood City and South San Francisco Unified school districts. SRTS promotes walking and biking by implementing projects that improve health, safety, and well-being while reducing traffic congestion and emissions. Read more in the full brief.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Citation

Watkins J, Vallez-Kelly T, Sanchez L, Ibarra M, Chan C, Gacutan-Galang J, Beccarelli M, Evans LW, Pugliese J, Gouck J, McCulloch SM, Barrett JL, Garrone ME, Cradock AL. Safe Routes to School in Ravenswood City and South San Francisco Unified School Districts in San Mateo County {Issue Brief}. San Mateo County Health, San Mateo, CA, and the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership; December 2025.

The design for this brief and its graphics were developed by partners at Headlands Marketing.

Learn more about the CalFresh Healthy Living CHOICES Project.

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Brief: CalFresh Fruit & Vegetable EBT Program in Santa Clara County

Posted on January 12, 2026

Young father taking his two kids shopping at a local co-op grocery store. The oldest is pointing at organic beets.

This brief summarizes a CalFresh Healthy Living-CHOICES Project Learning Collaborative Partnership model examining the CalFresh (federally, the Supplemental Nutrition Assistance Program, SNAP) Fruit & Vegetable EBT program in Santa Clara County. This model examined the health impacts of expanding the CalFresh Fruit & Vegetable EBT Program throughout Santa Clara County. Read more in the full brief.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Citation

Cholette V, Coxe N, Shir A, Gacutan-Galang J, Beccarelli M, Evans LW, Pugliese J, Gouck J, Barrett JL, McCulloch SM, Garrone ME, Xiao Y, Cradock AL. CalFresh Fruit & Vegetable EBT Program in Santa Clara County {Issue Brief}. County of Santa Clara Public Health Department, San José, CA, and the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership; December 2025.

The design for this brief and its graphics were developed by partners at Headlands Marketing.

Learn more about the CalFresh Healthy Living CHOICES Project.

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Brief: Sugar-Sweetened Beverage Excise Tax in the City of Los Angeles

Posted on January 12, 2026

This material was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Los Angeles County Department of Public Health through participation in the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This material was funded by USDA’s Supplemental Nutrition Assistance Program, an equal opportunity provider. This material is intended for educational use only.

This brief summarizes a CalFresh Healthy Living–CHOICES Project Learning Collaborative Partnership model of a $0.02-per-ounce volume excise tax on sugar-sweetened beverages (SSBs) in the City of Los Angeles. The SSB tax, which would be administered by the city, aims to reduce consumption of SSBs. Read more in the full brief.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Citation

Vos K, Caldwell J, Sklyar L, Shah D, Kuo T, Gacutan-Galang J, Beccarelli M, Evans LW, Pugliese J, Gouck J, Barrett JL, McCulloch SM, Garrone ME, Cradock AL. Sugar-Sweetened Beverage Excise Tax in the City of Los Angeles {Issue Brief}. Los Angeles County Department of Public Health, Los Angeles, CA, and the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership; December 2025.

The design for this brief and its graphics were developed by partners at Headlands Marketing.

Learn more about the CalFresh Healthy Living CHOICES Project.

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Brief: Sugar-Sweetened Beverage Excise Tax in Unincorporated Areas of Los Angeles County

Posted on January 8, 2026

Shopping for liter-sized bottles of soda in the grocery store

This brief summarizes a CalFresh Healthy Living-CHOICES Project Learning Collaborative Partnership model of a $0.02-per-ounce volume excise tax on sugar-sweetened beverages (SSBs) in unincorporated Los Angeles County. The tax, which would be administered by the county, aims to reduce consumption of SSBs. Read more in the full brief.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Citation

Vos K, Caldwell J, Sklyar L, Shah D, Kuo T, Gacutan-Galang J, Beccarelli M, Evans LW, Pugliese J, Gouck J, Barrett JL, McCulloch SM, Garrone ME, Cradock AL. Sugar-Sweetened Beverage Excise Tax in Unincorporated Areas of Los Angeles County {Issue Brief}. Los Angeles County Department of Public Health, Los Angeles, CA, and the CalFresh Healthy Living-Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership; December 2025.

The design for this brief and its graphics were developed by partners at Headlands Marketing.

Learn more about the CalFresh Healthy Living CHOICES Project.

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Cost-effectiveness and health equity improvements from excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program

Posted on September 8, 2025

This study estimates the cost-effectiveness of excluding sugar-sweetened beverages from eligible purchases in the Supplemental Nutrition Assistance Program and its potential impact on health equity.

Musicus AA, Barrett JL, McCulloch SM, Long MW, Ward ZJ, Cradock AL, Bleich SN, Gortmaker SL. Cost-effectiveness and health equity improvements from excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program. Am J Prev Med. 2025, In press. doi:10.1016/j.amepre.2025.108082. Epub 2025 Sep 8.

Abstract

Background

Although interventions to change nutrition policies, systems, and environments (PSE) for children are generally cost effective for preventing childhood obesity, existing evidence suggests that nutrition education curricula, without accompanying PSE changes, are more commonly implemented.

Introduction

Excluding sugar-sweetened beverages (SSBs) from eligible purchases in the Supplemental Nutrition Assistance Program (SNAP) has been proposed as a strategy to improve diet quality and health. This study estimates the cost-effectiveness of this policy and its potential impact on health equity.

Methods

The Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation and systematic review process was used in 2024 to estimate the potential impact of excluding SSBs from SNAP-eligible purchases over a ten-year period (2023-2032) for the U.S. population. Health outcomes related to excess weight, costs, and relative changes in obesity prevalence by income, race, and ethnicity group in 2032 were estimated.

Results

The policy is projected to be cost-saving, prevent 279,000 cases of obesity (95% UI: 149,000−446,000), and contribute 115,000 (95% UI: 60,100−187,000) quality-adjusted life years gained over ten years among SNAP participants. The policy could save an estimated $2.75 billion in healthcare costs related to excess weight over ten years, resulting in $3.35 in healthcare cost savings per dollar spent on implementation. Reductions in obesity prevalence were estimated to be 3.5 times greater among individuals with income ≤130% of the federal poverty level compared to the overall mean, and 3-3.5 times greater among non-Hispanic Black and Hispanic individuals compared to non-Hispanic white individuals.

Conclusions
Excluding SSBs from SNAP-eligible purchases could be a cost-saving strategy to improve health and health equity between income, racial, and ethnic groups. The U.S. Department of Agriculture could use pilot studies to test the real-world effects of excluding SSBs from SNAP.

Keywords
health equity; cost-effectiveness; Supplemental Nutrition Assistance Program; nutrition policy; sugar-sweetened beverages

Funding

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute under Award Number R01HL146625, the Centers for Disease Control and Prevention under Award Number U48DP006376, and The JPB Foundation. Dr. Musicus’ time on this work was supported by NIH grants T32CA057711 and T32HL098048. The content of this paper is solely the responsibility of the authors and does not necessarily represent the represent the official views of the Centers for Disease Control and Prevention or any of the other funders. The funders had no role in the study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication. Dr. Musicus is also affiliated with the Center for Science in the Public Interest (CSPI), but this work was completed entirely within her Harvard affiliation and does not reflect the views of CSPI. No financial disclosures were reported by the authors of this paper.

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Coffee Chat: MAPPing Partners to Create Healthier Communities

Posted on May 29, 2025

In this coffee chat hosted by the CHOICES Community of Practice, we welcomed back Anna Clayton, Senior Program Analyst at the National Association of County and City Health Officials, who shared resources available through the Mobilizing for Action through Planning and Partnerships (MAPP 2.0) framework, including tools to help you think broadly about partners to engage as well as ways to leverage existing work to address priorities.

View the resource round-up from this coffee chat

Download the May 2025 coffee chat presentation slides

Disclaimer: Our guest speakers share their own perspectives and do not speak for Harvard.

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Coffee Chat: Promoting Healthy Beverage Consumption Among School-Age Children & Adolescents: New Expert-Backed Recommendations

Posted on March 31, 2025

In this coffee chat hosted by the CHOICES Community of Practice, Megan Lott, Deputy Director of Healthy Eating Research at the Duke Global Health Institute, walked through these new recommendations and shared resources that can be used to provide guidance for parents, caregivers, and public health professionals.

View the resource round-up from this coffee chat

Download the March 2025 coffee chat presentation slides

Disclaimer: Our guest speakers share their own perspectives and do not speak for Harvard.

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Cost-effectiveness of mandating calorie labels on prepared foods in supermarkets

Posted on October 17, 2024

This study determines the cost-effectiveness of the requirement for chain food establishments—including supermarkets—to display calorie labels on prepared (i.e., ready-to-eat) foods since 2018.

Grummon AH, Barrett JL, Block JP, McCulloch S, Bolton A, Dupuis R, Petimar J, Gortmaker SL. Cost-effectiveness of mandating calorie labels on prepared foods in supermarkets. Am J Prev Med. 2024 Oct, doi: 10.1016/j.amepre.2024.10.007.

Abstract

Introduction

The US has required chain food establishments—including supermarkets—to display calorie labels on prepared (i.e., ready-to-eat) foods since 2018. Implementation of this supermarket calorie labeling policy reduced purchases of prepared foods from supermarkets, but it remains unknown whether the policy is cost-effective.

Methods

In 2023-2024, this study applied the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model to estimate the effects of the supermarket calorie labeling policy on health, costs, and cost-effectiveness over 10 years (2018-2027) for the US population. The model projected benefits overall and among racial, ethnic, and income subgroups. Sensitivity analyses varied assumptions about the extent to which consumers replace calorie reductions from prepared foods with calories from other sources (i.e., caloric compensation).

Results

From 2018-2027, the supermarket calorie labeling policy was projected to save $348 million in healthcare costs (95% Uncertainty Interval [UI]: $263-426 million), prevent 21,700 cases of obesity (95% UI: 18,200-25,400), including 3,890 cases of childhood obesity (95% UI: 2,680-5,120), and lead to 15,100 quality-adjusted life years (QALYs) gained across the US population (95% UI: 10,900-20,500). The policy was projected to prevent cases of obesity and childhood obesity across all racial, ethnic, and income groups. The policy was projected to be cost-saving when assuming low and moderate caloric compensation and cost-effective when assuming very high caloric compensation.

Conclusions

A policy requiring calorie labels on prepared foods in supermarkets was projected to be cost-saving or cost-effective and lead to reductions in obesity across all racial, ethnic, and income groups.

Keywords
calorie labels; food policy; cost-effectiveness; obesity; simulation

Funding

This research was supported in part by a grant from the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases to Jason P. Block (R01 DK115492) and the NIH National Heart, Lung and Blood Institute at the National Institutes of Health (R01 HL14662501), the JPB Foundation (Grant no 1085) and the Centers for Disease Control and Prevention (CDC, U48 DP006376). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, JPB Foundation, or CDC. The funders had no role in the study design; collection, analysis, or interpretation of the data; writing the manuscript; or the decision to submit the paper for publication.

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