BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SB 203    
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          |AUTHOR:        |Monning                                        |
          |---------------+-----------------------------------------------|
          |VERSION:       |April 6, 2015                                  |
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          |HEARING DATE:  |April 22, 2015 |               |               |
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          |CONSULTANT:    |Reyes Diaz                                     |
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           SUBJECT  :  Sugar-sweetened beverages: safety warnings.

           SUMMARY  :  Establishes the Sugar-Sweetened Beverages Safety Warning Act,  
          to be administered by the Department of Public Health, and  
          requires a safety warning on all sealed sugar-sweetened beverage  
          containers, as specified. Requires the warning label to be  
          posted in a place that is easily visible at the  
          point-of-purchase of an establishment where a beverage container  
          is not filled by the consumer.

          Existing law:
          1.Establishes the Department of Public Health (DPH) to protect  
            and improve the health of communities through education,  
            promotion of healthy lifestyles, and research for disease and  
            injury prevention.

          2.Establishes the Sherman Food, Drug, and Cosmetic Law (Sherman  
            Act), which is administered by DPH, to regulate the contents,  
            packaging, labeling, and advertising of food, drugs, and  
            cosmetics in California. 

          3.Allows DPH, upon the request of a health officer, to authorize  
            the local health department of a city, county, city and  
            county, or local health district to enforce the provisions of  
            the Sherman Act and its regulations that pertain to retail  
            food establishments, as defined, if DPH determines that the  
            local health department has sufficient personnel with adequate  
            training to do so, and requires that the enforcement be  
            limited to the area under the jurisdiction of the local health  
            department.
          
          This bill:
          1.Establishes the Sugar-Sweetened Beverages Safety Warning Act  







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            (SSBSWA) whereby a person, as defined, is prohibited from  
            distributing, selling, or offering for sale in the state  
            sugar-sweetened beverages (SSBs) in a sealed beverage  
            container; in a multipack of sealed beverage containers; in  
            concentrate form, as defined; on the premises where a vending  
            machine or beverage dispensing machine, as defined, is  
            located; and where SSBs are sold in unsealed beverage  
            containers unless the container bears a safety warning, as  
            specified, or the  safety warning is posted on the premises,  
            as specified, and otherwise meets all the requirements of this  
            bill. 

          2.Defines "sugar-sweetened beverage" as any sweetened  
            non-alcoholic beverage, carbonated or non-carbonated, sold for  
            human consumption that has added caloric sweeteners and  
            contains 75 calories or more per 12 fluid ounces. Specifies  
            that SSBs do not include any beverage containing 100 percent  
            natural fruit juice or natural vegetable juice with no added  
            caloric sweeteners; any liquid product commonly referred to as  
            a dietary aid; any product for consumption by infants and that  
            is commonly referred to as infant formula; or any beverage  
            whose principal ingredient by weight is animal milk or a milk  
            substitute. Defines "animal milk" as natural liquid milk  
            secreted by an animal and consumed by humans, including  
            natural milk concentrate and dehydrated natural milk, whether  
            or not reconstituted. Defines "milk substitute" as a  
            plant-based beverage in which principal ingredients by weight  
            are (1) water and (2) grains, nuts, legumes, or seeds,  
            including, without limitation, almond, coconut, flax,  
            hazelnut, oat, rice, and soy milks.

          3.Defines "non-alcoholic beverage" as any beverage that contains  
            less than one-half of one percent alcohol per volume. Defines  
            "caloric sweetener" as any substance containing calories  
            suitable for human consumption that humans perceive as sweet  
            and includes, without limitation, sucrose, fructose, glucose,  
            and other sugars and fruit juice concentrates. Defines  
            "caloric" as a substance that adds calories to the diet of a  
            person who consumes that substance.

          4.Requires the safety warning to read "STATE OF CALIFORIA SAFETY  
            WARNING: Drinking beverages with added sugar(s) contributes to  
            obesity, diabetes, and tooth decay" on the front of SSB sealed  
            beverage containers, separate and apart from all other  
            information, on a contrasting background, and entirely in bold  








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            type; to be affixed to an SSB beverage container in a manner  
            that it cannot be removed without thorough application of  
            water or other solvents if the warning is not printed directly  
            on a sealed container; to be printed on at least two sides of  
            an SSB multipack and on each individual sealed container  
            inside the multipack; and to be printed on the front of the  
            packaging of a concentrate, as defined.

          5.Requires every person who owns, leases, or otherwise legally  
            controls the premises where a vending machine or beverage  
            dispensing machine is located, or where SSBs are sold in an  
            unsealed container, to place, or cause to be placed, a safety  
            warning a) on the exterior of any vending machine that  
            includes SSBs, b) on the exterior of any self-serve beverage  
            dispensing machine, and,  c) at the point-of-purchase where  
            any consumer purchases an SSB in an unsealed beverage  
            container, when the container is filled by an employee of a  
            food establishment rather than by the consumer.

          6.Allows DPH to assess a civil penalty of not less than $50 but  
            no greater than $500 for any violation of the SSBSWA or any  
            regulation by DPH. Specifies that a person is not to be found  
            in violation of the SSBSWA more than once during any one  
            inspection visit.

          7.Creates in the State Treasury the Sugar-Sweetened Beverages  
            Safety Warning Fund consisting of moneys collected for the  
            violation of the SSBSWA, which is to be appropriated by the  
            Legislature for allocation to DPH for the purpose of enforcing  
            the SSBSWA.

          8.Requires DPH to adopt regulations to implement the SSBSWA.  
            Allows the department to adopt regulations to develop new  
            language for the safety warning, after appropriate  
            investigation and consultation with the State Health Officer.

          9.Makes findings and declarations about obesity and type 2  
            diabetes rates and resulting health costs in the state, as  
            well as the link among obesity, diabetes, and dental caries  
            and SSB consumption.

          10.Specifies that the provisions of the SSBSWA are severable and  
            that any provision or its application that is held invalid  
            cannot affect other provisions or applications that can be  
            given effect without the invalid provision or application.








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           FISCAL  
          EFFECT  :  This bill has not been analyzed by a fiscal committee.

           COMMENTS  :
          1.Author's statement.  According to the author, California is in  
            the midst of an obesity and diabetes epidemic that is wreaking  
            havoc on the public's health. SSBs are a major contributor to  
            the problem. SB 203 would provide information to consumers to  
            make informed choices by requiring warning labels-similar to  
            those on tobacco and alcohol-that explain the proven health  
            risks associated with drinking SSBs. The science is clear and  
            conclusive. Overwhelming research has unequivocally shown that  
            SSBs are major contributors to obesity, diabetes, and tooth  
            decay, which cost California billions of dollars in health  
            care and lost productivity annually.

            Nearly 40 percent of California children are currently  
            overweight or obese. Liquid sugar has a unique role in driving  
            today's skyrocketing cases of preventable diabetes.  
            Individuals who drink one or two sugary drinks per day have a  
            26 percent higher risk for developing type 2 diabetes. If  
            current trends are not reversed, it is predicted that one in  
            three children-and nearly half of Latino and African-American  
            children-born in the year 2000 will develop type 2 diabetes in  
            their lifetime. SSBs are the biggest contributor of added  
            calories in the American diet and are unique in not providing  
            any nutritional value.
            
          2.SSB consumption.  According to the U.S. Department of  
            Agriculture, in 2009, Americans consumed 13.8 billion gallons  
            of SSBs, which equates to nearly 45 gallons per capita  
            annually of SSBs with added caloric sweeteners. According to  
            the UCLA Center for Health Policy Research, in California, 41  
            percent of children ages 2-11 and 62 percent of adolescents  
            ages 12-17 drink at least one SSB every day.  In addition, 24  
            percent of adults drink at least one SSB on average per day.  
            Adults who drink SSBs occasionally (not every day) are 15  
            percent more likely to be overweight or obese, and adults who  
            drink one or more SSBs per day are 27 percent more likely to  
            be overweight or obese than adults who do not. According to a  
            report produced by the Robert Wood Johnson Scholar's Program,  
            SSBs were the single largest contributor to energy intake  
            during the last decade, and SSB consumption has increased by  
            almost 500 percent during the past 50 years.








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          3.Obesity and other chronic diseases. DPH issued a study, The  
            Burden of Chronic Disease and Injury, in 2013 that highlights  
            some of the leading causes of death, such as heart disease,  
            cancer, stroke, and respiratory disease, all of which have a  
            strong connection to obesity. Diabetes is another serious  
            chronic disease stemming from obesity that adversely affects  
            quality of life and results in serious medical costs. The last  
            decade has witnessed a 32 percent rise in diabetes prevalence,  
            affecting some 3.9 million people and costing upwards of $24  
            billion per year. According to the Centers for Disease Control  
            and Prevention, more than one-third of U.S. adults are obese,  
            and approximately 12.5 million children and adolescents ages 2  
            to 19 years are obese. Research indicates a tripling in the  
            youth obesity rate over the past three decades. While this  
            increase has stabilized between the years 2005 and 2010, in  
            2010, 38 percent of public school children were overweight and  
            obese. Overweight youth face increased risks for many serious  
            detrimental health conditions that do not commonly occur  
            during childhood, including high cholesterol and type 2  
            diabetes. Additionally, more than 80 percent of obese  
            adolescents remain obese as adults.
          
          4.Consumer view of SSBs. In February 2014, the Field Research  
            Corporation released a poll of 1,002 registered voters in  
            California on behalf of The California Endowment. The poll  
            found that, statewide, 74 percent of voters support a  
            requirement that beverage companies post health warning labels  
            on SSBs to alert consumers that their daily consumption  
            contributes to diabetes, obesity, and tooth decay. The  
            requirement also carries strong bipartisan support. The poll  
            also found that nearly two in three voters continue to support  
            taxing the sale of SSBs and to use the proceeds for school  
            nutrition and physical activity programs for kids and  
            distributing the revenues to schools, public health  
            departments, and local community programs across the state  
            based on each community's diabetes and obesity rates, so  
            places with higher rates would get more. Further, the poll  
            found that seven in 10 Californians support changing the rules  
            governing the food assistance program so that recipients  
            cannot use the food assistance benefit to buy SSBs.
          
            The Rudd Center for Food Policy & Obesity at the University of  
            Connecticut released a study in which 982 parents with at  
            least one child aged two to 17, from an ethnically diverse  








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            population sample, were asked about SSBs. The survey found  
            that one-third or more of parents relied on packing claims,  
            such as "low-calorie," "real/natural," and "vitamin C," to  
            influence SSB purchasing decisions. Many parents believe that  
            SSBs with such marketing claims, which may imply they provide  
            essential nutrition, are a healthy option for their children,  
            particularly flavored waters and fruit and sports drinks.
          
          5.Nutrition Facts label update. In February 2014, the FDA  
            announced an update to the Nutrition Facts label on food  
            packages to reflect new public health and scientific  
            information, including evidence on nutrition, obesity, and  
            chronic diseases. According to the FDA Web site, the update  
            will reflect amounts of food people are actually eating and  
            drinking now as opposed to 20 years ago when the Nutrition  
            Facts label was first introduced. The FDA further states that  
            serving sizes must be based on amounts of food and drink that  
            people customarily consume, not on what people should be  
            eating. People are generally eating more today than 20 years  
            ago. The FDA set current reference values in 1994, based  
            primarily on Nationwide Food Consumption Surveys conducted in  
            1977-78 and 1987-88, according to the FDA's Web site. The FDA  
            states that the pending changes reflect new dietary  
            recommendations, consensus reports, and national survey data  
            and also reflect input obtained through four advance notices  
            of proposed rulemaking and numerous citizens' petitions. 

            According to the FDA, Americans on average eat 16 percent of  
            their total calories from added sugars, the major sources  
            being soda, energy and sports drinks, grain-based desserts,  
            sugar-sweetened fruit drinks, dairy-based desserts, and candy.  
            The proposed requirement to declare "added sugars" in addition  
            to the total sugar requirement on the Nutrition Facts label  
            was decided after taking into account new data and  
            information, including U.S. consensus reports and  
            recommendations, a citizen's petition, and public comments,  
            according to the FDA.

            In an April 2015 email from Nutrition Programs staff in the  
            Office of Nutrition, Labeling, and Dietary Supplements, FDA  
            Center for Food Safety and Applied Nutrition, the FDA states  
            that it is working on drafting a final rule for the Nutrition  
            Facts label regulation. Final rules become effective 60 days  
            after the final rule's publication in the Federal Register  
            with a compliance date two years after the effective date,  








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            according to the FDA.
          
          6.Providing understandable caloric information to consumers. A  
            study published in December 2014 in the American Journal of  
            Public Health, "Reducing [SSB] Consumption by Providing  
            Caloric Information: How Black Adolescents Alter their  
            Purchases and Whether the Effects Persist," concluded that one  
            promising environmental program to reduce consumption of SSBs  
            is to provide consumers with easily interpretable caloric  
            information. In an area with six corner stores close to middle  
            and high schools in Maryland, consumers were presented with  
            information about caloric intake on signs posted on the  
            stores' beverages cases that included the time necessary to  
            burn off those calories in the form of a physical activity,  
            such as running or walking. When provided with easily  
            understandable caloric information, consumers purchased  
            smaller servings of SSBs, switched from an SSB to a beverage  
            with no calories, or opted not to purchase a beverage at all.  
            The study found that providing the easily understandable  
            caloric information had a persistent effect on reducing SSB  
            purchases for approximately six weeks after the signs with the  
            caloric information were removed.

          7.Related legislation. AB 1357 (Bloom), establishes the Children  
            and Family Health Promotion Program within DPH and consists of  
            a competitive grant process in which grants are awarded to  
            counties, cities, nonprofit organizations, community-based  
            organizations, and licensed clinics that seek to invest in  
            childhood obesity and diabetes prevention activities and oral  
            health programs. This bill makes legislative findings and  
            declarations relating to the consumption of SSBs, childhood  
            obesity, and dental disease. AB 1357 is set for hearing in the  
            Assembly Health Committee on April 21, 2015.
          
            SCR 34 (Monning), proclaims the month of September 2015, and  
            each year thereafter, as Childhood Obesity Awareness Month,  
            and expresses the Legislature's support of various programs  
            that work to reduce obesity among children, including those  
            that increase access to affordable healthful foods and  
            beverages and provide less access to high-calorie foods and  
            SSBs. SCR 34 has been ordered to third reading in the Senate.
            
          8.Prior legislation. SB 1000 (Monning), of 2014, was identical  
            to this bill. SB 1000 failed passage in the Assembly Health  
            Committee.








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            SB 622 (Monning), of 2013, would have enacted the Sweetened  
            Beverage Tax Law, which imposed a one-cent per fluid ounce tax  
            on any beverage that adds caloric sweeteners, such as sodas,  
            energy drinks, sweet teas, and sports drinks. SB 622 would  
            have required funds generated by the Sweetened Beverage Tax to  
            be directed to the newly created Children's Health Promotion  
            Fund and allocated to statewide childhood obesity prevention  
            activities and programs. SB 622 was held under submission in  
            the Senate Appropriations Committee.
            
            AB 1746 (Williams), of 2012, would have, commencing July 1,  
            2013, restricted the sale of electrolyte replacement beverages  
            in middle schools and high schools to specified times before  
            and after school. AB 1746 was held under submission in the  
            Assembly Appropriations Committee.
            
            AB 669 (Monning), of 2011, was SB 622's predecessor.  AB 669  
            was held in the Assembly Revenue and Taxation Committee.

            AB 2100 (Coto), of 2010, would have imposed a one cent tax per  
            teaspoon of added sweetener in a bottled sweetened beverage or  
            in a sweetened concentrate. AB 2100 was held in the Assembly  
            Revenue and Taxation Committee. 

            SB 1210 (Florez), of 2010, was a measure similar to SB 622.   
            SB 1210 was placed on the former Senate Revenue and Taxation  
            Committee's suspense file. 
            
          9.Support.  Supporters of the bill argue that consumption of  
            SSBs has been linked to the development of obesity, diabetes,  
            and tooth decay, as well as other health-related issues. They  
            state that the prevalence of overweight children has more than  
            quadrupled and that research indicates taste preference and  
            lifelong habits are formed in early childhood. Supporters  
            further argue that health-relates illnesses linked to SSB  
            consumption are having a disastrous effect on public health  
            and health care costs, citing that the average cost for a  
            hospitalization of a patient with diabetes is about $2,200  
            more than for patients without diabetes.

          10.Opposition.  Opponents argue that this bill exposes  
            manufacturers and retailers of SSBs to significant liability  
            and litigation just because a consumer chose to consume an  
            SSB. They also claim that this bill would have a negative  








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            impact on jobs in the state and say that education, rather  
            than regulation, should be the goal in providing consumers  
            with information about SSBs. The California/Nevada Beverage  
            Association cites a recent RAND Corp. study on the fast-food  
            ban in South Los Angeles that concluded there is no simple  
            resolution to a complex public health challenge like obesity  
            and diabetes. 
          
           SUPPORT AND OPPOSITION  :
          Support:  California Black Health Network (cosponsor)
                    California Center for Public Health Advocacy  
                    (cosponsor)
                    Health Officers Association of California (cosponsor)
                    Latino Health Access (cosponsor)
                    Action Network
                    Alameda County Board of Supervisors
                    AltaMed Health Services Corporation
                    American Cancer Society Cancer Action Network
                    American Diabetes Association
                    American Federation of State, County and Municipal  
                    Employees, AFL-CIO
                    American Heart Association/American Stroke Association
                    Asian Law Alliance
                    Asian and Pacific Islander American Health Forum
                    Asian and Pacific Islander Obesity Prevention Alliance
                    Berkeley Media Studies Group
                    Blue Shield of California
                    California Academy of Family Physicians
                    California Academy of Physician Assistants
                    California Association for Health, Physical Education,  
                    Recreation and Dance
                    California Chapter of the American Association of  
                    Clinical Endocrinologists
                    California Chapter of the American College of  
                    Cardiology
                    California Children's Hospital Association
                    California Chiropractic Association
                    California Dental Association
                    California Dental Hygienists' Association
                    California Dietetic Association
                    California Food Policy Advocates
                    California Immigrant Policy Center
                    California Medical Association
                    California Naturopathic Doctors Association
                    California Nurses Association/National Nurses United








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                    California Pan-Ethnic Health Network
                    California Park & Recreation Society
                    California Pharmacists Association
                                                                              California Physical Therapy Association
                    California Primary Care Association
                    California Project LEAN (Leaders Encouraging Activity  
                    and Nutrition)
                    California Public Health Association - North
                    California Rural Legal Assistance Foundation
                    California School-Based Health Alliance
                    California School Nurses Organization
                    California State Alliance of YMCAs
                    California WIC Association
                    Center for Collaborative Solutions
                    Center for Communications, Health & the Environment
                    Center for Ecoliteracy
                    Center for Science in the Public Interest
                    Central California Alliance for Health
                    ChangeLab Solutions
                    Charles R. Drew University of Medicine and Science
                    Children Now
                    Children's Hospital Oakland
                    City of Richmond
                    City of South El Monte
                    Community Bridges
                    Contra Costa County      
                    Councilmember Laurie Capitelli, City of Berkeley
                    Cultiva La Salud
                    Day One
                    Diabetes Coalition of California
                    Dignity Health
                    First 5 Association of California
                    First 5 Monterey County
                    47 Games, Inc.
                    Having Our Say Coalition
                    Health Access California
                    Health Improvement Partnership of Santa Cruz County 
                    Healthy & Active Before 5
                    Hunger Action Los Angeles
                    Junior League of Monterey County
                    Khmer Girls in Action
                    Latino Coalition for a Healthy California
                    Latino Health Access
                    Lucille Packard Children's Hospital Stanford
                    Maternal and Child Health Access








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                    Napa County Board of Supervisors
                    National Coalition for 100 Black Women Sacramento
                    Network of Ethnic Physician Organizations
                    Pacoima Beautiful
                    Physicians for Social Responsibility
                    Prevention Institute
                    Public Health Institute
                    Roots of Change
                    San Diego Hunger Coalition
                    San Francisco Medical Society
                    San Francisco Unified School District
                    Santa Clara County Board of Supervisors
                    Santa Monica Family YMCA
                    SEIU California
                    Shape Up San Francisco Coalition
                    South Asian Network
                    Southern California Public Health Association
                    Strategic Alliance for Healthy Food and Activity  
                    Environments
                    Sunnyvale School District Board of Education
                    UCLA           Housing & Hospitality Services  
                    Department
                    Venice Family Clinic
                    Vice Mayor Linda Maio, City of Berkeley
                    YMCA of Burbank California
                    YMCA of the Central Coast
                    YMCA of the Channel Islands
                    YMCA of Greater Long Beach
                    YMCA of Greater Whittier
                    YMCA of Metropolitan Los Angeles
                    YWCA of Watsonville
                    Zion Hill Baptist Church
                    One individual

          Oppose:   CalAsian Chamber of Commerce
                    California Automatic Vendors Council
                    California Chamber of Commerce
                    California Grocers Association
                    California Hotel and Lodging Association
                    California Hispanic Chambers of Commerce
                    California Independent Oil Marketers Association
                    California League of Food Processors
                    California Manufacturers and Technology Association
                    California/Nevada Beverage Association
                    California Retailers Association








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                    California Restaurant Association
                    California Service Station and Auto Repair Association
                    California Teamsters Public Affairs Council
                    California Travel Association
                    Can Manufacturers Association
                    Civil Justice Association of California
                    Grocery Manufacturers Association
                    International Franchise Association
                    Juice Products Association
                    Los Angeles Area Chamber of Commerce
                    Los Angeles County Business Federation
                    National Automatic Merchandising Association
                    National Federation of Independent Business
                    SPI: The Plastic Industry Trade Association
                    Valley Industry and Commerce Association
                    7-Eleven

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