incentives to engage in healthy behaviors and disincentives to practice risky ones, but also notes that these taxes can be inequitable and regressive.
Most of the public health experience with manipulating economic factors to encourage healthy behaviors or to discourage risky behaviors has been related to excise tax policy on products like tobacco, gasoline, and alcohol. Because of the popularity of increasing tobacco taxes as a public health strategy and the parallels that are frequently drawn between tobacco tax policy and a possible similar tax scheme for certain foods, the following section highlights some of the specific aspects of the taxation of tobacco products.
Tobacco products, like most consumer products, have been shown to be price sensitive; as price increases, consumption decreases. Children have been shown to be most price sensitive, with an approximate 7 percent decrease in consumption for every 10 percent increase in price (DHHS, 2000). As a result of this well-established price elasticity, an excise tax increases on tobacco products has been a common and popular way to reduce adolescent tobacco use, and to increase much-needed state revenue. In 2002-2003, nearly half the states increased their excise tax on tobacco products (Campaign for Tobacco Free Kids, 2004). Some states have earmarked or dedicated a portion of the excise tax increase for tobacco prevention or health promotion programs. This approach of excise tax increase and earmarking for prevention programs could be considered to help prevent childhood obesity, especially because one of the most frequently heard argument for not removing vending machines and soft drinks from schools is concerns about loss of much-needed revenue.
It is likely that the same strategy for calorie-dense and low-nutritional-quality foods would have the same effect as seen for tobacco—as price increases, consumption falls. However, it is also likely that efforts to tax these products would be even more difficult than taxing tobacco products. In California, an effort to levy a one-cent excise tax on soft drinks to compensate for the lost revenue from removing soft drinks from vending machines in schools had to be removed in order for the vending machine legislation to pass. Internationally, a plan to tax foods such as dairy products, pastries, chocolates, pizzas, and burgers at a higher rate than other food products was briefly considered, then dismissed as unworkable by the British government (Food Navigator, 2004). Jacobson and Brownell (2000) suggest that to avoid the possible negative reaction to the levying of large excise taxes on soft drinks and snack foods, municipalities should consider small tax increases, and the proceeds from these increases should be used to fund health promotion programs, including subsidizing the availability of healthier food choices. The American Public Health Association adopted a similar policy recommendation at its 2003 annual meeting (APHA, 2003).
In addition to considering excise taxes on calorie-dense or low-nutri-