Examining attitudes toward a proposed sugar-sweetened beverage tax among urban Indigenous adults: a qualitative study using a decolonizing lens

Maria Kisselgoff; Michael Redhead Champagne; Riel Dubois; Lorna Turnbull; Jeff LaPlante; Annette Schultz; Andrea Bombak; Natalie Riediger

doi:10.9778/cmajo.20230025

Article Figures & Tables

Tables

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Table 1:

Demographic characteristics of participants

Characteristic	No. (%) n = 20
Gender
Female	10 (50)
Male	8 (40)
Two-spirit	2 (10)
Age range, yr
20–34	12 (60)
35–49	6 (30)
50–65	2 (10)
Mean age	34
Ethnicity
First Nation	15 (75)
Métis	4 (20)
Indigenous	1 (5)
Highest level of education
Completed primary school	1 (5)
Some secondary school	4 (20)
Completed secondary school	11 (55)
Completed trade/technical school or college diploma	4 (20)
Completed university degree	0
Current employment status
Not working in the labour force	15 (75)
Working full time in the labour force	4 (20)
Retired or semiretired, or working part time in labour force	1 (5)
Self-rated health
Excellent, very good or good	17 (85)
Fair or poor	3 (15)

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Table 2:

Thematic analysis results with exemplar quotations

Theme	Subtheme	Categories	Quotation
Government is not trustworthy	Taxing experiences	Lack of transparency	“The tax money is supposed to be used for something positive that people want, but it’s not most of time. Or you just don’t know where the heck it’s gone. Maybe it doesn’t even matter, but it should be taxed to avoid people from buying it, but then again, maybe just leave it alone because I don’t know where the money is going anyway.” (Dakota)
		Token gestures	“They always have everything for hotels, or potholes, or whatever, or licences, or some parks, or some stupid thing.” (Carolyn)
		Not accountable	“My opinion would only change once it was happening, you know. I, I don’t trust anything the government says … we can say whatever we want to say but until the action is put into it, it doesn’t really mean anything, you know? … . That’s from my own life experience as an Indigenous woman … . Otherwise our Indigenous communities would have drinking running water already, you know.” (Louise)
	Taxes are financial siphons	Other government priorities	“Knowing government, a lot of times it’s either to balance other areas of the budget, but sometimes it’s a lot of bullshit and then it goes directly back to privileged communities, or it goes to things in which this community don’t value as much.” (Gavin)
		Higher SES neighbourhoods
		Pocketed by those in power	“Just put it in their pockets. They always do. Government’s greasy, man.” (Tyler)
	Misinformed “do gooders”	Paternalistic	“… and then to tax that, to make that person who already is — have their own issues and they’re coping with it, with food and then you tax their sugary beverages then … that actually is like almost like a punishment. It’s um … its uh, like condescending and authority in the sense that like, like they are trying to be parental. Right? It’s gross.” (Amanda)
		Out of touch	“I think that it’s kind of like elitist in a lot of times. It’s always like the do-gooders within politics or within activism that say those kinds of things. Not really realizing like those folks are still going to buy it no matter what.” (Gavin)
		True benefactors	“The more people that would be deterred are those that have the more healthy coping habits, or the people to have accessibility to those things. This area would be impacted more, and it doesn’t address any underlying things. It’s the same.” (Gavin)
Taxes are ineffective and lead to inequitable outcomes	Ineffective	Does not address determinants of sugar-sweetened beverage consumption	“You will do whatever you need to do to fix that feeling, you know. To fill that feeling up, that void, that sugar your body needs at that time. You’ll do whatever you need to do, to do that. So I feel like people are still going to … . They’re still gonna buy pop. I don’t think it’s … that’s gonna change at all. It’s not gonna change how much pop or how much sugary drinks are being sold. That’s not gonna change either.” (Louise)
		Negligible increase in price	“It’s always, it’s increased, and if they put a little bit more of the tax on there, on the sugar, then what’s the difference of that? The only difference is somebody’s making money, as in the end somewhere else down the line. That’s what it is. And I mean, that’s all, hey, that’s what I see. Like, because most of us are low income. So like, it, we, it would, um, have us spend a little bit more. But like I said, I don’t think it would stop us from buying it.” (Charlotte)
		Substitution	“Um, but they’re not … I don’t think like one family is gonna completely cut out a, a habit that they had for years, so it’s gonna be like … . Um, they’re gonna buy it, but for a cheaper price somewhere else or deal somewhere.” (Diane)
	Inequitable socially	Signalling/stigmatizing	“I think it would like make people aware that, well, it’s unhealthy and if you’re gonna pay more for it, maybe it’s a good idea to quit.” (Beverly)
		Destabilizing	“What the hell? I do not like that. Because like, what if I don’t have the exact change of what I wanted and then all of a sudden I need to have more than I don’t have. And I won’t be able to get it. Which would suck and I would be mad.” (Shelly)
		Reinforcing social differences	“It makes you look at even more at the people that have what you don’t have. Why do they get to live that good fucking life and I have to sit here in my front yard with a shovel to make sure that nobody’s going to bust in my front door because they’re living in survival mode? You know, we … Like it’s just … It blows my mind. … . And, um, it’s really hurtful as a single parent knowing that if this tax goes up, like I already struggle with feeding my kids. I already struggle with making sure that we’re getting by, you know, just everyday things.” (Louise)
	Inequitable economically	Hurt pockets	“I think it [sugar-sweetened beverage tax] would hurt all of our pockets, definitely … so maybe a tax would, like, have to, like I said, if they gonna get taxed on it, maybe they’d have to, like, cut something else off in their, in their monthly budget, or their weekly budget or whatever, how they’re doing it.” (Carolyn)
		Less for other obligations	“More priority on pop, less priority on everything else they have to buy. Basically just that. Like if pop goes up, pop’s still cheaper, pop’s still more accessible. To them, it’s still more norm. So if they’re spending more money on pop, and that little extra money they might have been able to use on more, like, healthier groceries, that’s just canceled.” (Gavin)
		Risky acquisition	“People will go out of their way to find that extra money, that extra whatever-it-is, to still maintain their pop addiction, their sugar addiction. It is an addiction.” (Louise)
		Rich richer (intersects with subcategory True benefactors)	“The more people that would be deterred are those that have the more healthy coping habits, or the people to have accessibility to those things. This area would be impacted more, and it doesn’t address any underlying things. It’s the same.” (Gavin)
Indigenous self-determination is critical			“Where we’re pushed to make, uh, a choice from two bad choices so that we’re doing it to ourselves, so that ultimately, nobody else is responsible, right? Like, the government isn’t responsible for putting these taxes on things that we really need and not putting taxes on stuff we don’t need. You know, it’s self-elimination. It’s, it’s, uh … . There’s a certain word for it I can’t think of, but, like, um. They are... We’re wiping ourselves out. We’re wiping ourselves out, we’re wiping each other out, so that it’s just less, you know, less dirt on somebody else’s hands, right? Because ‘we did it to ourselves,’ quotation marks. I have big bunny ears here happening. You know, it’s the same with, with addiction. You know, they … . They’re gonna keep putting shit out on the streets so that we’re consuming it ourselves as our own choice but we’re being pushed to do that, right? Like, we, like, it’s, yeah … . Sorry. Just, uh.” (Louise)
Indigenous self-determination is critical			“… it has to have a positive effect in the mind of Indigenous people, because I think people are aware of the, impact of diabetes in their families. So I think if it is seen as preventing more complications due to diabetes, uh, people are more likely to support it than if it was going into something that was seen as directly beneficial to the community.” (Alan)