Tarra L Penney

• PhD, Epidemiology and Public Health
• Professor (Associate) at York University

Background FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved o...

Although the theory and methods of legal epidemiology—the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population—have been well developed in the context of domestic law, the challenges posed by shifting the frame of analysis to the global legal space have not yet been full...

Background: Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-infor...

Background Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more difficult to contain, there is a need for effective preventive interventions that reduce the risk of zoonotic spillover events. Public policies can play a key role in prev...

Introduction The wildlife trade is an important arena for intervention in the prevention of emerging zoonoses, and leading organisations have advocated for more collaborative, multi-sectoral approaches to governance in this area. The aim of this study is to characterise the structure and function of the network of transnational organisations that i...

Background Consumption of sugar-sweetened beverages (SSBs) is associated with weight, weight gain and incidence of a number of chronic diseases. The World Health Organization recommends taxation on SSBs to reduce consumption. In 2018 the United Kingdom introduced the Soft Drinks Industry Levy (SDIL), a tiered tax on manufacturers and importers of S...

Introduction Evolving human–wildlife interactions have contributed to emerging zoonoses outbreaks, and pandemic prevention policy for wildlife management and conservation requires enhanced consideration from this perspective. However, the risk of unintended consequences is high. In this study, we aimed to assess how unrecognised complexity and syst...

Background Children’s exposure to sugary beverage advertising may have changed during the COVID-19 pandemic due to shifts in media habits, which could subsequently have influenced intake. This study aimed to examine: 1) children’s frequency and setting of exposure to advertisements of sugary beverages in six countries before and during the COVID-19...

Objective: The UK Soft Drinks Industry Levy (SDIL) (announced in March 2016; implemented in April 2018) aims to incentivise reformulation of soft drinks to reduce added sugar levels. The SDIL has been applauded as a policy success, and it has survived calls from parliamentarians for it to be repealed. We aimed to explore parliamentary reaction to t...

Background: Takeaway food is often high in calories and served in portion sizes that exceed public health recommendations for fat, salt and sugar. This food is widely accessible in the neighbourhood food environment. As of 2019, of all local authorities in England (n=325), 41 had adopted urban planning interventions that can allow them to manage th...

Background Antibiotic resistance (ABR) has emerged as a major threat to health. Properly informed decisions to mitigate this threat require surveillance systems that integrate information on resistant bacteria and antibiotic use in humans, animals, and the environment, in line with the One Health concept. Despite a strong call for the implementatio...

Background Corruption exists at all levels of our global society and is a potential threat to food security, food safety, equity, and social justice. However, there is a knowledge gap in the role and impact of corruption within the context of the global food system. We aimed to systematically review empirical literature focused on corruption in the...

Objective To determine changes in household purchases of drinks 1 year after implementation of the UK soft drinks industry levy (SDIL). Design Controlled interrupted time series. Participants Households reporting their purchasing to a market research company (average weekly n=22 091), March 2014 to March 2019. Intervention A two-tiered tax levie...

Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of S...

Objectives The UK Soft Drinks Industry Levy (SDIL), implemented in 2018, has been successful in reducing the sugar content and purchasing of soft drinks, with limited financial impact on industry. Understanding the views of food and drink industry professionals involved in reacting to the SDIL is important for policymaking. However, their perceptio...

One Health is recognized as an increasingly important approach to global health. It has the potential to inform interventions and governance approaches to prevent future pandemics. Successfully implementing the One Health approach in policy will require active engagement from the public, which begs the question: how aware is the public of One Healt...

Background: Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (phase 1) in October 2018, and...

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Background The UK Soft Drinks Industry Levy (SDIL) was announced in March 2016, became law in April 2017, and was implemented in April 2018. Empirical analyses of commercial responses have not been undertaken to establish the scale, direction or nuance of industry media messaging around fiscal policies. We aimed to develop a detailed understanding...

Introduction The increasing incidence of pathogen transmission from animals to humans (zoonotic spillover events) has been attributed to behavioural practices and ecological and socioeconomic change. As these events sometimes involve pathogens with epidemic or pandemic potential, they pose a serious threat to population health. Public policies may...

Introduction: Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (Phase 1) in October 2018, and...

Objective Cannabis use may reduce the effectiveness of antipsychotic medication and treatment adherence in schizophrenia patients. This study examined the impact of cannabis legalization on cannabis-related acute care among schizophrenia patients. Methods Using health administrative data in Ontario, 119,848 individuals who were diagnosed with schiz...

Legalization of recreational cannabis in Ontario included the legalization of flower and herbs (Phase 1, October 2018), and was followed by the deregulation of cannabis retailers and sales of edibles (Phase 2, February 2020). Research on the impact of cannabis legalization on acute care utilization is nascet; no research has investigated potential...

Background The UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, is a fiscal policy to incentivise reformulation of eligible soft drinks. We aimed to explore perceptions of sugar, sugary drinks and the SDIL among adolescents in the UK post-implementation. Methods 23 adolescents aged 11–14 years participate...

Objectives We aimed to identify when and how integration should take place within evaluations of complex population health interventions (PHIs). Study design Descriptive analytical approach. Methods We draw on conceptual insights that emerged through (1) a working group on integration and (2) a diverse range of literature on case studies, small-n...

Background: Diets that reduce reliance on animal-source foods are recommended in some contexts. Objectives: This study aimed to compare proportions of respondents who reported following meat-reduced dietary practices (i.e., vegetarian, vegan or pescatarian diets) and/or making efforts to reduce animal-source foods, and to examine sociodemographi...

Background: The World Health Organization (WHO) recommends that countries implement fiscal policies to reduce the health impacts of sugary drinks. Few studies have fully examined the responses of industry to these policies, and whether they support or undermine health benefits of sugary drinks taxes. We aimed to explore the changes that sugary dri...

Background Announced in March 2016 and implemented in April 2018, the UK Soft Drinks Industry Levy (SDIL) aims to incentivise the reformulation of soft drinks. The SDIL has successfully decreased the amount of sugar in UK soft drinks, and purchased in soft drinks. Consequently, the SDIL has been widely applauded as a policy success. SSB taxation in...

Background Soft drinks consumption is a key target area of the UK Childhood Obesity strategy, with 36% of young people reporting consuming sugary drinks 2–4 times per week. The Soft Drinks Industry Levy (SDIL) was implemented in the UK in April 2018 to help tackle this issue and is designed to incentivise the reformulation of eligible soft drinks....

Introduction: Given the complex causal origins of many non-communicable diseases (NCDs), and the complex landscapes in which policies designed to tackle them are made and unfold, the need for systems thinking and complexity science (STCS) in developing effective policy solutions has been emphasised. While numerous methods informed by STCS have bee...

Background While foodwork (tasks required to access food, including home food preparation) in the UK declined toward the end of the 20th century, it is not known whether this trend has continued into the 21st century. While evidence suggests many people feel they lack the time to cook, it is not known whether this is attributable to increasing dema...

Objectives To determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation. Design Repeat cross-sectional online survey. Setting The UK. Participants UK respondents to the International Food...

Consuming sugar-sweetened beverages (SSBs) has been associated with increased rates of obesity and type 2 diabetes, making SSBs an increasingly popular target for taxation. In addition to changing prices, the introduction of an SSB tax may convey information about the health risks of SSBs (a signalling effect). If SSB taxation operates in part by p...

While previous work has provided a foundation for understanding the importance of the links between time use and diet, there has been little done to link time use to health outcomes. In this study, time use and self-rated health variables from the 2015 Time Use Cycle of Statistics Canada's General Social Survey are used to explore whether there are...

Pablo Monsivais and colleagues reflect on the evidence for interventions to improve access to healthy food and discuss considerations for evidence generation

Objective To determine changes in household purchases of drinks and confectionery one year after implementation of the UK soft drinks industry levy (SDIL). Design Controlled interrupted time series analysis. Participants Members of a panel of households reporting their purchasing on a weekly basis to a market research company (average weekly numb...

Introduction Applying a complex systems perspective to public health evaluation may increase the relevance and strength of evidence to improve health and reduce health inequalities. In this review of methods, we aimed to: (i) classify and describe different complex systems methods in evaluation applied to public health; and (ii) examine the kinds o...

Background Sugar-sweetened beverage (SSB) consumption is positively associated with obesity, type 2 diabetes and cardiovascular disease. The World Health Organization recommends that member states implement effective taxes on SSBs to reduce consumption. The UK Soft Drinks Industry Levy (SDIL) is a two tiered tax, announced in March 2016 and impleme...

Background Public health evaluation methods have been criticized for being overly reductionist and failing to generate suitable evidence for public health decision-making. A “complex systems approach” has been advocated to account for real world complexity. Qualitative methods may be well suited to understanding change in complex social environment...

Background: Increased time spent on home food preparation is associated with higher diet quality, but a lack of time is often reported as a barrier to this practice. We compared time use in individuals who do more versus less foodwork (tasks required to feed ourselves and our households, including home food preparation). Methods: Cross-sectional...

Background Dietary sugar, especially in liquid form, increases risk of dental caries, adiposity, and type 2 diabetes. The United Kingdom Soft Drinks Industry Levy (SDIL) was announced in March 2016 and implemented in April 2018 and charges manufacturers and importers at £0.24 per litre for drinks with over 8 g sugar per 100 mL (high levy category),...

On 16th March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use 'event study' methodology to assess the likely financial effect of the SDIL on parts of the soft drin...

Early adulthood is a time when individuals go through important life transitions, such as moving from high school into higher education or employment, but the impact of these life transitions on changes in body weight, diet, and physical activity is not known. We searched six electronic databases to July 2019 for longitudinal observational studies...

Background In 2018, the UK government introduced a Soft Drinks Industry Levy (SDIL) to reduce the consumption of sugary drinks and their health consequences. Taxes on sugary drinks might prompt changes in associated marketing, but whether and how this happens, and the implications for health, are unclear. To inform exploration of changes in sugary...

Abstract Background Evidence suggests eating home-prepared food (HPF) is associated with increased dietary quality, while dietary quality varies across socio-demographic factors. Although it has been hypothesised that variation in HPF consumption between population sub-groups may contribute to variation in dietary quality, evidence is inconclusive....

Rationale The UK Soft Drinks Industry Levy (SDIL) was introduced in response to evidence on the role of sugary drinks in obesity, diabetes and tooth decay. The levy is two-tiered: £0.24/L for drinks containing >8 g/100 ml of added sugar and £0.18/L for drinks containing 5–8 g sugar/100 ml, and directed at manufacturers and importers of soft drinks,...

Background There has been a growth in interest in applying systems thinking to public health research: including greater consideration of the complex and changing nature of real-world environments within which public health interventions take place. In this paper we present the results from a critical review that asked the question: how can a syste...

Background Finding an association between a policy and an effect in an observational study is not enough to prove a causal relationship. Impact evaluations may be strengthened by developing an understanding of the causal explanation(s) behind an association. Here, we assess the feasibility of using process tracing (PT). While PT has been applied to...

Supporting the implementation of school food and nutrition policies is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and p...

Objectives To answer four questions: What are attitudes, knowledge and social norms around sugar-sweetened beverages (SSBs)? What are current levels of trust in messages on SSBs? What is current support for, and perceived effectiveness of, the UK soft drinks industry levy (SDIL)? What is the association between attitudes, knowledge, social norms, t...

Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Such policies can improve equitable access, resources, and supports for healthy eating. However, despite the potential impact of SFNPs, several implementation barriers have been reported. T...

Background Despite inconclusive evidence, the idea that a lack of home food preparation and skills is a limiting factor in achieving a healthy diet is widespread. Cooking skills interventions proliferate, and several countries now mention cooking in their dietary guidelines. The aim of this study was to determine whether substantial consumption of...

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducte...

Background There has been a growth in interest in applying systems thinking to public health research, including greater consideration of the complex and changing nature of real-world environments where public health interventions take place. We aimed to assess how a systems approach could be applied in the context of public health evaluation. Met...

Background Despite inconclusive evidence, the idea that home food preparation and skills are a limiting factor in achieving a healthy diet is widespread, and corresponding skills interventions and dietary guidelines proliferate. The aim of this study was to determine whether eating home-prepared (HP) food is a necessary condition for high dietary q...

This study explored staff and service users’ views on a selection of candidate wellbeing questionnaires for use by a UK-based healthcare provider, Nuffield Health, that is embarking on a programme to monitor the impact of their services on wellbeing. Ten stakeholder focus groups were conducted with 64 staff and service users, in addition to three i...

Background Within the context of a global movement toward taxes on sugary drinks, the Soft Drinks Industry Levy (SDIL) is unique in its construction – a two-tiered levy that aims to encourage industry to reformulate soft drinks. Industry decisions regarding reformulation will directly influence the health impacts of the levy, however how these reac...

Background: Integrated knowledge translation (IKT) is encouraged in population health intervention research (PHIR) to ensure the co-production of policy-relevant research, yet there is little published literature that reports its implementation and outcomes. The purpose of this study was to describe and evaluate the IKT approach used in a school-b...

Background: Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity. Objective: The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the u...

Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1–6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008–2014) were used to ex...

Table S1: Medline search strategy Table S2: Data conversion and assumptions for each paper included in graphs and/or meta‐analysis Table S3: Quality assessment tool for longitudinal observational studies of diet Figure S1: Forest plot depicting % energy from added sugar or sucrose and study weighting for all studies reporting on change in intake of...

Abstract Background Retail food environments (foodscapes) are a recognised determinant of eating behaviours and may contribute to inequalities in diet. However, findings from studies measuring socioeconomic inequality in the foodscape have been mixed, which may be due to methodological differences. The aim of this cross-sectional study was to compa...

BACKGROUND: Retail food environments (foodscapes) are a recognised determinant of eating behaviours and may contribute to inequalities in diet. However, findings from studies measuring socioeconomic inequality in the foodscape have been mixed, which may be due to methodological differences. The aim of this cross-sectional study was to compare expos...

Background Intake of added sugar among adolescents is generally above recommended levels. Added sugar intake has been associated with weight gain and cardiometabolic risk factors during adolescence. Dietary habits developed during this period may persist into adulthood, increasing chronic disease risk in later life. A better understanding of the un...

A health promoting schools (HPS) approach is hypothesized to influence student health and wellbeing by promoting a ‘school ethos’ that reflects the physical environment, social relations, organisational structure, policies and practices within schools. This complex set of factors makes health promoting school ethos (HPSE) challenging to define and...

Introduction: Eating meals away from home has been associated with the consumption of unhealthy foods and increased body weight. However, more rigorous assessment of the contribution of different types of away-from-home food establishments to overall diet quality and obesity is minimal. This study examined usage of these food establishments, accor...

Added sugar intake during adolescence has been associated with weight gain and cardiometabolic risk factors. Moreover, dietary habits may persist into adulthood, increasing chronic disease risk in later life. This systematic review investigated changes in intake of added sugars between the ages of 13 and 30 years. Literature databases were searched...

With 796,500 places available for children in England, pre-school nurseries could serve as an important setting for population-wide dietary intervention. It is critical to understand the determinants of healthy food provision in this setting, which may include access to food stores. This study examined the association between objective, GIS-derived...

Background Late adolescence to early adulthood is a period of lifestyle change and personal development which may influence dietary behaviour. Understanding dietary trajectories across this age range may help in targeting interventions appropriately. This scoping review aimed to assess how longitudinal change in diet is conceptualised and measured...

Late adolescence to early adulthood is a period of lifestyle change and personal development which may influence dietary behaviour. Understanding dietary trajectories across this age range may help in targeting interventions appropriately. This scoping review aimed to assess how longitudinal change in diet is conceptualised and measured between the...

A Health promoting schools (HPS) approach aims to make schools a healthy place through a holistic approach that promotes a supportive ‘school ethos’ and emphasizes improvements in physical, social, and emotional well-being and educational outcomes. A HPS initiative in rural Nova Scotia (Canada) provided an opportunity for a population-level natural...

Health-promoting schools (HPS) is an effective approach to enhance the health and well-being of children and youth, but its measurement remains a challenge considering contextual differences across school environments. The purpose of this study was to qualitatively explore the physical features of the school environment through photographs of schoo...

To review the literature and describe the current evidence demonstrating the link between healthy eating, physical activity and school performance in children and youth

Local food environments have been linked with dietary intake and obesity in adults. However, overall evidence remains mixed with calls for increased theoretical and conceptual clarity related to how availability of neighbourhood food outlets, and within-outlet food options, influence food purchasing and consumption. The purpose of this work is to d...

Solving complex problems such as preventing chronic diseases introduces unique challenges for the creation and application of knowledge, or knowledge to action (KTA). KTA approaches that apply principles of systems thinking are thought to hold promise, but practical strategies for their application are not well understood. In this paper we report t...

Introduction La résolution de problèmes complexes du type de la prévention des maladies chroniques présente des défis particuliers pour la création et le transfert de connaissances, soit le passage de la connaissance à l’action (PCA). Les approches axées sur le PCA respectant les principes de la pensée systémique sont jugées prometteuses, mais les...

A Health at Every Size (HAES) approach has been proposed to address weight bias and stigma in individuals living with obesity, and more recently articulated as a promising public health approach beyond the prevailing focus on weight status as a health outcome. The purpose of this article is to examine our understanding of HAES within the context of...

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for grant...

The prevention of childhood obesity is a global priority. However, a range of complex social and environmental influences is implicated in the development of obesity and chronic disease that goes beyond the notion of individual choice. A population-level approach recognises the importance of access to and availability of healthy foods outside the h...

This paper provides an overview of a new section of Current Obesity Reports, called Health Services and programs. This new section seeks to better understand the problems within health systems around obesity management and prevention and to discuss the latest research on solutions. There are few health system issues that are quite as controversial...

Background: Rates of overweight and obesity are now considered to be epidemic. Few studies have examined the spatial distribution of overweight and obesity at the community level, an area of geography recommended for prevention and intervention. Therefore, the present study aimed to examine the spatial variation of overweight and obesity using com...

In response to the growing concern of children’s health, many local governments have responded by implementing health promotion policies that support a health promoting schools (or comprehensive school health) approach. The purpose of this study is to explore the context and nature of policies that relate to health promoting schools in Nova Scotia....