Summary of findings 4. Economic tools compared to no or alternative intervention.

C Economic tools compared to no or alternative intervention in children, youth and adults: impact on primary outcomes
Outcomes (follow‐up) No. of clusters or participants No. of studies Certainty of Evidence	Impact
C.1 Price increases on SSB
SSB sales (4 to 12 months) 1 store, 7 leisure centres and 37 restaurants in 29 cities 3 ITS studies ⊕⊕⊕⊝ MODERATa	Cornelsen 2017 (SSB items sold per customer): −9% (95% CI −15 to −3) Blake 2018 (volume of red‐labelled beverages):−28% (95% CI −32 to −23) Breeze 2018 (volume of SSB sold per attendance): −27% (95% CI −59 to −3)
Total beverage sales and revenueb (4 to 12 months) 1 convenience store and 7 leisure centres 2 ITS studies ⊕⊕⊝⊝ LOW	Blake 2018 (total revenue from beverage sales): −10% (95% CI −14 to −7) Breeze 2018 (total cold beverage unit sales): −5% (P > 0.05)
Stakeholder discontentb (4 months) 1 convenience store 1 ITS study ⊕⊕⊝⊝ LOW	Blake 2018 reports that "[t]he issue of customer complaints was a strong sub‐theme from the qualitative interviews of store and hospital staff. (…) [O]ngoing concerns about customer perceptions of the store and the long‐term impact on the business were expressed by all staff interviewees”
C.2 Financial incentives to purchase low‐calorie beverages implemented through supermarket loyalty cards
SSB sales (3 to 6 months) 1750 customers of 3 supermarket chains 3 RCTs ⊕⊕⊝⊝ LOWc,d	Ball 2015 (self‐reported SSB intake): +10 ml/day (95% CI 0 to 20) Ball 2015 (SSB purchases): +55 ml/day (95% CI −7 to 117) Ni Mhurchu 2010 (energy density of beverages purchased): −0.1 MJ/kg (95% CI −0.4 to 0.2) Franckle 2018 (number of red‐labelled beverages purchased per month): −0.14 beverage items/month (95% CI −0.8 to 0.6)
Purchases of less‐healthy products (6 months) 1028 customers of 1 supermarket chain 1RCT ⊕⊕⊝⊝ LOWc,d	Ni Mhurchu 2010 (purchases of less‐healthy products, including foods and beverages): +0.07 kg/week (95% CI −0.15 to 0.29)
C.3 Price discounts on low‐calorie beverages in community stores
SSB sales (6 months) 8515 inhabitants of 20 remote indigenous communities 1 cluster‐RCT ⊕⊕⊝⊝ LOWe,f	Brimblecombe 2017 (SSB sales): +6% (95% CI −3 to 15)
Total energy content of grocery purchasesb (6 months) 8515 inhabitants of 20 remote indigenous communities 1 cluster‐RCT ⊕⊕⊝⊝ LOWe,f	Brimblecombe 2017 reports that "[t]here have been concerns that total calories purchased might increase with price subsidies on healthy foods thereby potentially negating health gains. Our findings add to this evidence because we observed increases (albeit non‐significant) in the volume of other food purchases and increases in energy and sodium (due to its ubiquity in the food supply) during and after the price discount. Similar increases in purchases were observed for both healthy and less healthy food groups"
Taxation of SSB
Not included in this review (for a forthcoming Cochrane Review on taxation of SSB see Heise 2016, for existing systematic reviews on taxation of SSB see Backholer 2016, Cabrera Escobar 2013 and Nakhimovsky 2016)
CI: Confidence interval; ITS: interrupted‐time‐series study; RCT: randomised controlled trial; SSB: sugar‐sweetened beverages

^aUpgraded by one level for dose‐response gradient and magnitude of effect: For effects on SSB sales we noticed a dose‐response gradient, and deemed the magnitude of the effect to be large for the two studies in which a relatively larger price increase was applied.
 ^bOutcomes included as potential adverse outcomes.
 ^cDowngraded for risk of bias: In Ball 2015, Ni Mhurchu 2010 and Franckle 2018 participants were not blinded, and outcome data were either self‐reported or assessed through loyalty cards, which may have been used selectively by the participants. Ball 2015 notes that SSB purchases were highly variable at baseline, with the highest values in the control group, and that the observed effects may be explained by a regression to the mean.
 ^dDowngraded for imprecision: The 95% CIs of the primary outcome measure of interest to this review reported by Ball 2015, Franckle 2018 and Ni Mhurchu 2010 are large and include zero.
 ^eDowngraded for risk of bias:Brimblecombe 2017 used a stepped‐wedge design, and all stores received the intervention, but at different time points. The study does not report if stores receiving the intervention later (i.e. serving as controls for longer) differed from those receiving it earlier with regard to baseline outcome measurements and other characteristics. We therefore judged the study to be at unclear risk of bias for baseline differences between intervention and control groups.
 ^fDowngraded for imprecision: The CIs reported by Brimblecombe 2017 for beverage sales are large and include zero.