PROJECT SUMMARY There is considerable interest in policies to reduce sugar-sweetened beverage (SSB) intake. On January 1, 2017 Philadelphia became the second U.S. city and the largest to date to implement a sweetened beverage excise tax of 1.5 cents per fluid ounce on both SSBs and diet drinks. There is compelling evidence that beverage excise taxes can lead to large reductions in purchases of SSBs, but there is a critical need to understand whether this translates into improvements in health outcomes. Without this evidence, we will not know if SSB taxes are an effective method of preventing and reducing obesity, its associated chronic diseases, and dental caries. The overall objectives of this application are to determine the long-term influence of the Philadelphia beverage tax on adult and youth weight gain, type 2 diabetes status, and oral health. The rationale for this proposal is based on strong behavioral data that the Philadelphia sweetened beverage tax decreased SSB purchases and modeling studies that suggest such taxes will lead to improved health outcomes, including reductions in obesity, type 2 diabetes, and dental caries, especially for subgroups of at- risk children and adults. Therefore, our central hypothesis is that the Philadelphia tax on SSBs and diet drinks will be associated with less weight gain and fewer dental caries over time among adults and youth in Philadelphia compared to control locations. Our specific aims are to evaluate the effectiveness of an SSB tax on preventing weight gain among youth (Aim 1) and adults (Aim 2) by analyzing electronic health record data using a natural experiment design. To accomplish these aims, we will use electronic health record data to compare changes in BMI z- scores over time among a longitudinal cohort of 43,589 children and adolescents in Philadelphia and 117,850 youth in the untaxed neighboring counties (control group) 3-5 years after tax. We will also examine change in BMI for a longitudinal cohort of 108,862 adults in Philadelphia and 185,360 adults in the untaxed, surrounding counties (control group) 3-5 years post-tax. These aims address important unanswered questions about the impact of the beverage tax on BMI, a major predictor of lifelong chronic disease. Our third aim is to evaluate the effectiveness of an SSB tax on improving oral health among youth and adults in Philadelphia by analyzing electronic oral health records using a natural experiment design. To accomplish this aim, we will examine dental records on 5,189 adults and 1,462 youth in Philadelphia and 3,554 adults and 1,003 youth in untaxed, surrounding counties (control group). If there is a relationship between the tax and oral health improvements, this would be the first study finding an association between a dietary intervention and improved oral health. This study will deliver vitally important information on the effects of one of the most significant policies to address poor dietary habits. By evaluating the effe...