Research Paper Outline Assignment | Online Assignment

Instructions Research Paper Outline on Type I and II Diabetes Mellitus This assignment will help you organize and develop your research paper due for the Unit VI assignment. Your outline should be at least two pages (in addition to your title and reference pages). Your title and reference pages do not count toward the total page requirement. Your outline should include: An introductory paragraph introducing your topic. Ensure you have supporting evidence and all headings and subheadings show parallelism. All topics mentioned in the Unit VI Research Paper instructions. Refer to your Unit VI Research paper assignment instructions on how the assignment should be setup. Include four to six current sources (published within the last five years). These can be your original sources you listed in the Unit II annotated bibliography or you can include new ones. Make sure you make any corrections from the feedback given in Unit II. Note that the reference citations are in alphabetical order A title and reference page that follows correct APA format. You must use at least two articles from any of the CSU Online Library databases to create your annotated bibliography. The remaining sources may include the textbook and other credible websites other than Wikipedia. You must follow APA formatting for all of your sources for your references. View a tutorial on how to develop and organize an effective outline. You will NOT be writing the actual research paper in this unit. You will submit this outline to your instructor for review and feedback. Resources The following resource(s) may help you with this assignment. Citation Guide CSU Online Library Research Guide Submit Writing Center Request I include the annotated bibliography for the reference

http://libguides.columbiasouthern.edu/biology

Citation Guide – 6th Edition
This document covers certain citation formats addressed in the 6th edition of the Publication Manual of the American Psychological Association (APA) but is not a complete guide. Should you have any questions, please contact the CSU Success Center/Writing Center by email at teamsucceed@columbiasouthern.edu or by phone at 1-800-977-8449 ext. 6538.
For all rules and requirements of APA, please refer to the 6th edition of the Publication Manual of the American Psychological Association, which can be purchased through the American Psychological Association at http://apastyle.org/manual/index.aspx.
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Contents
What is APA format and why is it used? …………………………………………………………………………………….. 4
Citing Sources……………………………………………………………………………………………………………………………. 5
Citations in Text ………………………………………………………………………………………………………………………. 5
Examples of text citations ……………………………………………………………………………………………………… 6
Example of block quote text citation ………………………………………………………………………………………. 7
Reference List …………………………………………………………………………………………………………………………. 7
Examples of reference list entries …………………………………………………………………………………………… 8
Selecting Appropriate Research Sources …………………………………………………………………………………… 13
Formatting ………………………………………………………………………………………………………………………………. 13
Document formatting in APA style ………………………………………………………………………………………….. 13
Steps for document formatting …………………………………………………………………………………………………. 14
Specific formatting steps for documents ……………………………………………………………………………………. 17
Library Resources and Services for CSU Students ……………………………………………………………………. 18
Sample Essay …………………………………………………………………………………………………………………………… 19
Sample Research Paper ……………………………………………………………………………………………………………. 20
References ……………………………………………………………………………………………………………………………….. 21
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What is APA format and why is it used?
The American Psychological Association is a professional organization representing psychologists in the United States. APA format is a set of rules developed to assist with writing and the citing of sources, a format which helps to prevent plagiarism and to acknowledge the original author of the information used. It is meant to provide a concise and standardized citation format for written assignments (e.g., essays, research papers, article critiques, etc.) and is used for ALL Columbia Southern University courses.
In educational institutions, plagiarism is a problem of great concern. According to Aaron (2007) in The Little, Brown Compact Handbook, the word “plagiarism” is derived from a Latin word meaning to kidnap or to abduct (p. 424). Plagiarism is stealing someone else’s work and passing it off as one’s own. In many other cultures, plagiarizing is encouraged because it demonstrates familiarity and respect for the work of noted writers. However, in the United States and at Columbia Southern University, plagiarism is considered fraud and can have serious consequences.
Plagiarism can be deliberate or accidental: Deliberate plagiarism includes directly copying, summarizing, or paraphrasing a source without giving credit to the author or putting it in quotation marks. This type of plagiarism also includes turning in a paper that has been bought, written by another student, or copied from another source. Accidental plagiarism is when a writer uses another author’s thoughts or ideas without realizing credit must be provided. This includes working in groups and submitting the same answers as other students, forgetting to place quotation marks around a direct quotation, omitting a text citation for a summary or a paraphrase, and omitting a text citation for the ideas of another writer. Accidental plagiarism also includes submitting an assignment that has already been previously submitted in another course. Unfortunately, both types of plagiarism can result in a failing grade, suspension from the university, or even expulsion.
There are a few ways students can avoid plagiarism. The primary way to avoid plagiarism is to simply cite any ideas that are not one’s own. Citations help readers to locate the sources used in a paper. Citations should not only be used for direct quotes, but they should also be provided when information is paraphrased or summarized from another author. Paraphrasing a source’s material is a good way to avoid copying directly from an outside source and possibly being reprimanded. If any questions or concerns arise about APA format, please feel free to contact the CSU Writing Center by email at teamsucceed@columbiasouthern.edu or by phone at 1-800-977-8449 ext. 6538.
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Citing Sources
When writing a paper in APA 6th edition style, there are two specific ways to cite the information that is used: within the text and in the reference list at the end of the paper. Citations are utilized when a phrase, a piece of specific information, or a sequence of sentences is drawn from an outside source. To meet APA requirements specified for CSU written essay responses, one must include text citations and a reference list if any outside sources are used. For formal papers (e.g., research papers, article critiques, etc.), follow all guidelines listed in this handout. For all rules and requirements of APA, please refer to the 6th edition of the Publication Manual of the American Psychological Association, which can be purchased through the American Psychological Association at http://apastyle.org/manual/index.aspx.
Citations in Text
 A text citation should be used when a phrase, a piece of specific information, an idea, or a hypothesis is drawn from an outside source.
 Text citations are also required when putting the author’s information in your own words (paraphrasing).
 Citing helps to prevent plagiarism, and it acknowledges the original author of the information used.
 Text citations and reference citations must always correspond; each text citation must have a matching reference citation and vice-versa. APA uses the author-year method of citation.
 It is standard practice for the period at the end of the sentence to be placed after the last parentheses of the text citation. An exception is made if inserting a direct quote that contains more than 40 words; in this instance, the period is placed directly before the text citation.
Paraphrased Information
When paraphrasing or summarizing a source provide the author’s last name and year of publication (separated by a comma).While it is not required for paraphrased passages, providing a page number in addition to the author and year is encouraged, as it might help the reader locate the relevant information. If page numbers are added when paraphrasing, make sure page numbers are continuously added for consistency. When in doubt, make sure to consult with your faculty member to determine his or her preference on adding page numbers in citations.
Direct Quotations
If utilizing a direct quote, this must be indicated by placing the passage in quotation marks. Further, the specific page number is always required. If there is no page number for the source you are using, as this is the case for many electronic sources, provide the paragraph number in its place. Use the abbreviation para.
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Examples of text citations Reference Type Examples of text citations Paraphrased information from one author It has been found … can be concluded (Simpson, 2007). According to Simpson (2007), … can cause problems. Other people say… based on Simpson (2007). Paraphrased information from two authors There are … at this point (Stemmer & Tisdale, 2008). Stemmer and Tisdale (2008) mention …. a set of styles. This plan will ….. according to Stemmer and Tisdale (2008). Paraphrased information from three to five authors A meal …. can be tasted (Brown, Collins, & Makel, 2001). **After the first citation is used, shorten to first author’s last name et al. Once decided….can be taught (Brown et al., 2001). Paraphrased information from six or more authors **For six or more authors, use first author’s last name et al. each time. When stating…. can be located (Padgett et al., 2004). Padgett et al. (2004) explain … is further noted. Direct quotation less than 40 words “It is amazing…with confidence” (OSHA, 2010, p. 121). According to Davis and Dudley (2005), “We are….to save” (para. 5). “What is lost…come at all” (Ingram et al., 2001, pp. 8-9). Paraphrased information with no author listed When using data …. can be seen (“Title of Document,” 2003). If information is … was conquered (“Driving and Talking,” 2004). According to “Leadership Versus Management” (2001), …. is an art form. Information from a secondary source It can be found … in Stemmer’s work (as cited in Pratt, 2008). **Add the page number if you use a direct quote from Stemmer found in Pratt’s work. According to Stemmer’s work (as cited in Pratt, 2008), “ ..…” (p. 65). Information via personal communication **Personal communication should only be listed in the text, not on the reference list. J. M. Newsome (personal communication, May 30, 2008) expressed … …of time (V. P. DeLuca, personal communication, November 9, 2007). Information found in classical works **Classical works should only be listed in the text, not on the reference list. …will have everlasting life (John 3:16 New Revised Standard Version). …as read in the Bible in John 3:16 (New Revised Standard Version).
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Direct Quotations of 40 or more words
Block quotations (quotes that contain 40 words or more) are formatted differently, as they have no quotation marks. In formal writing, block quotations are acceptable, although their use should not be in excess. While block quotes are accepted in formal writing, the use of them in essay responses is not encouraged due to the length of the assignment. Block quotations are indented an additional .5” and double spaced. As previously mentioned, the period is placed before the citation.
Example of block quote text citation Block Quotation Example The solutions proposed by a number of advocacy groups underscore this interest in political and cultural change. A report outlined trends that may have contributed to the childhood obesity crisis. This includes food advertising for children as well as a reduction in physical education classes and after-school athletic programs, an increase in the availability of sodas and snacks in public schools, the growth in the number of fast-food outlets, and the increasing number of highly processed high-calorie and high-fat grocery products. (Kaiser, 2004, pp. 1-2)
Reference List
The reference list is of the utmost importance, as it allows the reader to access the sources cited in the text and enables the student writer to give credit where credit is due. For this reason, the references should contain accurate information, as well as proper punctuation and spelling. References will follow the conclusion of any APA document. For each reference listed, there will be at least one corresponding text citation in the document. Examples of reference source formatting can be found on the following pages.
 If there is a digital object identifier (DOI) available, include that in the reference. The DOI is precisely used to give the reader information about where the document can be found on the Internet. The DOI is typically located near the copyright notice on the first page of the electronic journal article. In the case that there is no DOI, provide the name of the database or homepage URL of the web page where you found the article. (Please note the DOI, when available, is required in doctoral courses.)
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 Multiple citations containing the same author and year should be listed alphabetically by the title of the book or article. A lowercase a, b, c, etc. should be placed after the year to distinguish between the entries. This is also used in the text citations. For example:
Smith, J. (2013a). How to groom cats. New York, NY: Garden Press.
Smith, J. (2013b). How to groom dogs. New York, NY: Garden Press.
Examples of reference list entries Reference List What to include Information and Examples General Referencing Information  When listing the author on the reference list, the last name should be first, followed by the author’s first and middle (if applicable) initials. Ex: Smith, J. R.  References should be placed in alphabetical order by the first author’s last name, by associates (if the work is authorized by an organization), or by anonymous. Anonymous should only be listed as the author if it is signed as such.  If a particular person did not create the document being cited, use the organization that created the document.  The document title can be substituted as the author if no author is provided. In this case, the first word of the title will dictate the alphabetical placement (a, an, and the notwithstanding).  The letters “n.d.” (no date) can be utilized if the source listed has no listed date. Substitute “n.d.” where the date would normally go. Ex: Smith, R. T. (n.d.)…  Professional credentials should not be used on the reference page (i.e. Ph.D.).  References beginning with numerals should have the numerals spelled out.
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Reference List What to include Information and Examples General Referencing Information (continued)  States should be identified with their two letter abbreviations (e.g. AL, MS, and NY).  Spell out cities and countries outside the United States. Books  In a book or journal, magazine, or newspaper article title on the reference list, only capitalize the first word of the title, proper nouns, and the first word after a colon or dash.  Journal articles and books only require the listing of the year, rather than the entire date.  Book and periodical titles should be italicized within the reference list. Book Author(s). (date of publication). Book title. City, State of publication: Publisher. Book Examples: Duenwald, M., Ronald, R. P., & Smith, J. W. (2004). Addiction and environmental change. Boston, MA: Pearson Education. Norman, D. J. (2002). The cat in the hat: Psychological process of younglings. New York, NY: Grumble & Grumble. Periodicals: Journals, magazines, and newspaper articles  For the title of the actual journal, magazine, or newspaper, use standard title capitalization. Capitalize all words with the exception of conjunctions, articles, and short propositions; however, capitalize all words that have four letters or more.  Magazine articles, newsletters, and newspaper articles require the listing of the entire date (month or month and day). Ex: (2001, May) or (2001, May 2)  Journal articles and books only require the year.
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Reference List What to include Information and Examples Periodicals: Journals, magazines, and newspaper articles continued  For journal articles, there is no need to write out the words volume, issue, p., or pp. Providing the actual numbers in correct order will suffice.  Book and periodical titles should be italicized within the reference list. Printed journal Author(s). (date of publication). Article title. Journal Title, volume (issue), page numbers. Online journal Author(s). (date of publication). Article title. Journal Title, volume (issue), page numbers. Retrieved from information (DOI, URL, or database) Journal Examples: Stanton, G. C. (2008). Education in the minds of millions. Education Quarterly, 5(13), 567-580. Geller, F., & Frank, P. T. (2005). North land icebergs. Science Weekly, 5(8), 55-70. http://doi.org/10.1123/j.2354-6970.20 05.29384 Note: DOI information is required for doctoral courses where available. Smith, J. E. (2003). Addiction and environmental change. Journal of Personality and Social Psychology, 66(3), 47-68. Retrieved from http://www.apa.org/pubs/journals/psp/ Smith, J. E. (2003). Addiction and environmental change. Journal of Personality and Social Psychology, 66(3), 47-68. Retrieved from Business Source Complete database.
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Reference List What to include Information and Examples Personal conversations, emails, interviews, and letters (Do not include on the reference page.)  Due to retrieval inability, personal conversations, emails, interviews, and letters should not be listed on the reference page. Instead, cite personal communication in the text. For an example, see the chart on page 6 (information via personal communication). Websites  For Internet sources that end with a URL or a DOI, do not add a period after the URL or DOI. Otherwise, the period might be mistaken as part of the URL.  To ensure accuracy, the direct URL should always be tested prior to submission. Website Author(s). (date of publication). Title of page. Retrieved from information (including direct URL) Website Examples: Cain, A., & Burris, M. (1999). Investigation of the use of mobile phones while driving. Retrieved from http://www.cutr.eng.usf.edu/its /mobile_phone_text.htm **If there is not an author listed, you can use the company that created the website. Occupational Safety & Health Administration. (2004). OSHA directorate of training and education. Retrieved from http://www.osha.gov/index.html PowerPoint slides  PowerPoint references are very simple, with only four pieces of information.  The PowerPoint format description in brackets is used because the format is something out of the ordinary. Other times this format is used is for blog posts and lecture notes.
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Reference List What to include Information and Examples PowerPoint slides continued PowerPoint Author(s). (date of publication). Title of slideshow [Format of document]. Retrieved from information PowerPoint Examples: Sprott, J. C. (2000). Is global warming for real? [PowerPoint slides]. Retrieved from http://sprott.physics.wisc.edu/lectures.ppt **If there is no author, list the title of the document first. How to succeed in business [PowerPoint slides]. (n.d.). Retrieved from http://online.columbiasouthern.edu /webapps.jsp Newspaper  Precede page numbers for newspaper articles with p. or pp.  If an article appears on discontinuous pages, give all page numbers, and separate the numbers with a comma (e.g., pp. C1, C4, C6–B9). Newspaper Author(s). (exact date of publication). Title of article. Newspaper Title, pp. or Retrieved from information Newspaper Example: Janega, J. (2014, February 17). Growth questions worth asking. The Chicago Tribune. Retrieved from http://bluesky .chicagotribune.com/originals/chi-business-growth-questions-bsi,0,0.storygallery?track=bluesky-ct-head#introduction Fitzpatrick, A. J. (2011, September 3). What affects U.S. economic growth? The Daily Record, pp. B2, B4.
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Selecting Appropriate Research Sources
In academic writing, certain types of resources are considered acceptable. All sources mentioned in this guide are sources that are considered to be academic sources. If you have any questions regarding acceptable and unacceptable sources or how different types of sources (e.g., databases, journals, peer reviews, etc.) can be used, please contact the CSU Library. Additional information about the CSU Library can be found on page 18 of this guide.
Formatting
When writing any type of formal paper (e.g. research papers, articles critiques, case studies, etc.), the document should have text citations and a reference list and should be formatted in accordance to APA format. The following are specific instructions on how to set up a document in APA format using Microsoft Word:
Document formatting in APA style General Formatting Information Margins  All margins (top, bottom, and sides) should be set at one inch.  Microsoft Word allows the user to set the margin at a default of one inch on all sides. Alignment/ Line Spacing  All documents following APA guidelines are required to be flush-left style and double-spaced throughout the entire document.  Additional spacing should not be used between headings and paragraphs. Font Type and Size  The preferred font type is Times New Roman.  Additionally, APA requires the font size to be 12 point. Paragraph Indention  All papers typed in APA format require the first line of each paragraph to be indented .5”.  This can easily be done by striking TAB on the keyboard. Page Header (Running head)  The page header should be found at the top of each page of the APA document.  The page header consists of both the running head and the page number.  The running head should be flush-left style and one-half inch

Carbonating the household diet: a Pakistani tale
Biplab K Datta* and Muhammad Jami Husain
Global Noncommunicable Diseases Branch, Division of Global Health Protection, Center for Global Health, Centers for
Disease Control and Prevention, Atlanta, GA, USA
Submitted 17 June 2019: Final revision received 3 October 2019: Accepted 10 October 2019: First published online 20 March 2020
Abstract
Objective: Carbonated beverage consumption is associated with various adverse
health conditions such as obesity, type 2 diabetes and CVD. Pakistan has a high
burden of these health conditions. At the same time, the carbonated beverage
industry is rapidly growing in Pakistan. In this context, we analyse the trends
and socioeconomic factors associated with carbonated beverage consumption
in Pakistan.
Design: We use six waves of the cross-sectional household surveys from
2005–2006 to 2015–2016 to analyse carbonated beverage consumption. We
examine the trends in carbonated beverage consumption-prevalence for different
economic groups categorised by per capita household consumption quintiles.
We estimate the expenditure elasticity of carbonated beverages for these
groups using a two-stage budgeting system framework. We also construct
concentration curves of carbonated beverage expenditure share to analyse the
burden of expenditure across households of different economic status.
Setting: Pakistan.
Participants: Nationally representative sample of households in respective
survey waves.
Results: We find that the wealthier the household, the higher is the prevalence of
carbonated beverage consumption, and the prevalence has increased for all
household groups over time. From the expenditure elasticity analysis, we
observe that carbonated beverages are becoming an essential part of food consumption
particularly for wealthier households. And, lastly, poorer households
are bearing a larger share of carbonated beverage expenditure in 2014–2016 than
that in 2006–2008.
Conclusion: Carbonated beverages are becoming an increasingly essential part
of household food consumption in Pakistan. Concerns about added sugar intake
can prompt consideration of public health approaches to reduce dietary causes of
the disease burden in Pakistan.
Keywords
Carbonated beverages
Soft drinks
Pakistan
Expenditure elasticity
Frequent intake of sugar-sweetened beverages (SSB) is a
major risk factor associated with obesity, type 2 diabetes
and CVD, kidney diseases, non-alcoholic liver disease,
gout (a type of arthritis), tooth decay and cavities(1–7).
Obesity is a growing public health concern in Pakistan.
With nearly one in every four adult (age >20) males and
one in every three adult (age >20) females being overweight
or obese, the country ranked ninth in the world
in the number of individuals with obesity(8). A large number
of Pakistanis also suffer from diabetes mellitus, an epidemic
that is emerging rapidly in recent years. A recent study
reports 11 % pre-diabetes and 17 % type 2 diabetes prevalence
in the population aged >20 years in Pakistan(9).
The burden of CVD in Pakistan is also high. CVD is the
number one cause of death in Pakistan and accounted
for 29 % of the total deaths in 2016(10). SSB, being closely
associated with these health conditions, have important
policy relevance for population health in Pakistan.
SSB refer to any beverage with added sugar or other
sweeteners, including soda, pop, cola, tonic, fruit punch,
lemonade (and other ‘ades’), sweetened powdered drinks
as well as sports and energy drinks. Carbonated beverages,
commonly known as soda or soft drinks, are the most
consumed type of SSB in Pakistan. Data from the Pakistan
household income expenditure surveys(11–16), used in the
current study, show that carbonated beverages constitute
nearly 60–70% of the household-level consumption
of non-alcoholic beverages (see online supplementary
Public Health Nutrition: 23(9), 1629–1637 doi:10.1017/S1368980019004348
*Corresponding author: Email BDatta@cdc.gov
© Centers for Disease Control and Prevention 2020. This is a work of the U.S. Government and is not subject to copyright protection in the
United States.
material, Supplemental Table 1 for details). Carbonated
beverage industry is also an important and thriving manufacturing
sector, which is a major source of revenue for the
Government of Pakistan in the form of federal excise duty
and domestic sales tax(17). Despite being a sizable economic
sector on one side and an important public health issue on
the other side, there is lack of analyses on the trends and
other socioeconomic aspects of carbonated beverage
consumption in Pakistan. In this paper, we analyse the
household-level consumption of carbonated beverages over
a decade (i.e., 2006–2016) to better understand the socioeconomic
factors associated with carbonated beverage consumption,
which could inform policy-makers to promote
health awareness and adopt other preventive measures.
Several studies show the increasing global trends and
regional heterogeneity in SSB consumption in recent
years(18,19). Several other studies provide country-specific
elasticity estimates of SSB(20–23). Demand for cola carbonates
is rapidly growing in Pakistan, escalating the battle
for market share among the major global cola producers(24);
yet, no in-depth analysis of household-level carbonated
beverage consumption is available for Pakistan. The production
of carbonated beverages in Pakistan has been
increasing gradually over time, accompanied by a declining
trend in real price (Fig. 1). Together it contributed in
greater affordability of carbonated beverages in Pakistan.
Though the real price shows some upward trend in recent
years (2015–2016), it is still way below the price in 2006. A
study showed that SSB became more affordable in Pakistan
from 1990 to 2016 as the real price of SSB decreased by $US
3·84 (constant 2010 dollars) during that period(25). In this
context, studying the socioeconomic aspects of carbonated
beverages consumption in Pakistan is crucial for public
health interventions to prevent and control obesity, type
2 diabetes, CVD and other adverse health conditions.
Using data from the household income expenditure
surveys, the current study aimed to, first, analyse the trend
in carbonated beverage consumption across households of
different economic status over a decade (from 2006 to
2016); second, estimate the expenditure elasticity of
carbonated beverages for different income groups; third,
analyse the evolution of expenditure elasticities over time;
and fourth, analyse the carbonated beverage expenditure
share burden across income groups over time.
Methods
Data
We use data from the 2005–2006, 2007–2008, 2010–
2011, 2011–2012, 2013–2014 and 2015–2016 waves of
the Pakistan Household Integrated Economic Survey
(HIES)(11–16). HIES is a stratified two-stage nationally representative
survey that covers a large number of rural and
urban households from twenty-seven administrative
divisions of Pakistan in four provinces(16). HIES provides
detailed information on household food and non-food
consumption, including fortnightly (2 weeks) consumption
(quantity and expenditure) of carbonated beverages.
According to the Pakistani standards, carbonated beverages
are defined as non-alcoholic beverages that contain
dissolved carbon dioxide with addition of mineral salts,
sugar and/or other sweetener, flavours, colours and other
food additives(26). We derived households’ monthly
180 200 220 240 260
Rs. per crate of twenty-four bottles (constant 2008 prices)
9000 14 000 19 000 24 000 29 000
Production (’00 thousand litres)
2006 2008 2010 2012 2014 2016
Fig. 1 (colour online) Price and production of carbonated beverages in Pakistan. Production data are obtained from quantum index of
large-scale manufacturing industries reported by the Pakistan Bureau of Statistics, and from the Industrial Commodity Statistics
Database of the United Nations Statistics Division. Nominal price data are obtained from the Pakistan Statistical Year Book.
Prices are of crate of 24 bottles of Coca Cola and 7 Up. Constant prices are obtained using annual consumer price index (CPI) measures.
, production; , price
1630 BK Datta and M Jami Husain
carbonated beverage consumption using the fortnightly
expenditure data reported in HIES.
Consumption trend
We examine the trends in household-level prevalence
of carbonated beverage consumption from 2006 to 2016.
To smooth out short-term fluctuations, we pooled two
consecutive HIES cohorts of 2005–2006 and 2007–2008,
2010–2011 and 2011–2012, and 2013–2014 and 2015–
2016 into three time periods – 2006–2008, 2011–2012,
2014–2016 – and compared prevalence across the time
periods. We analysed the consumption trend by household’s
economic status. We categorised households by
monthly household expenditure per capita quintiles
and compared prevalence across quintiles. We then compared
mean expenditure share of carbonated beverages
as a percentage of monthly food expenditure across
quintiles and time periods. We also examined the trends
in mean consumption quantity per capita and the mean
expenditure per litre.
Expenditure elasticity estimation
We used a two-stage budgeting system methodology(27) for
estimating expenditure elasticity of carbonated beverages
in Pakistan. In the first stage, we categorised household
consumptions in several broad groups (e.g., food, clothing,
housing, etc.) and estimated expenditure elasticity of the
broad food category. In the second stage, we estimated
expenditure elasticity of carbonated beverages within the
broad food category. The idea behind the two-stage budgeting
is that households first decide how much to spend
on each broad category and then allocate spending for
within-category consumption in the second stage. A similar
method was applied by Menezes et al.(28) for estimating
elasticities for food products in Brazil.
Household expenditures in HIES are categorised into
eleven broad categories, which are food, tobacco, clothing,
housing, education, fuel and utilities, personal care, transportation,
recreation, medical spending, and miscellaneous.
Food items are categorised in sixteen sub-categories, which
are dairy, meat and fish, fresh fruits, dried fruits and nuts,
vegetables, condiments and spices, sugar, readymade
food, baked and fried products, cereals, legumes, edible
oil and fats, tea and coffee, carbonated beverages, other
non-alcoholic beverages, and miscellaneous food items.
Hence, we estimated a systemof eleven equations in the first
stage, and another system of sixteen equations in the second
stage. The miscellaneous category in both first and second
stage was omitted to satisfy the summation restriction
(i.e., category expenditure shares add up to 1). Like the
consumption trend analysis, we estimated the equations
for three time periods by pooling two rounds ofHIES in each
period.
We estimated a Quadratic Almost Ideal Demand
System (QAIDS) proposed by Banks et al.(29) using the
seemingly unrelated regression (SUR) model. The
empirical analysis was conducted using Stata 13.1. We
assumed that commodities areweakly separable in household’s
utility function and estimated the following equation
in the first stage:
wij ¼ 0 þ 1 ln Yi þ 2ðln YiÞ2 þ Xi3
þX
d
X
t
dtDivisiond Yeart þ “ij; (1)
where wij is the expenditure share of j th category of
household i; ln Yi is the log of total monthly expenditure
(constant 2008 Rs.) of non-durable commodities; Xi is a
vector of household-specific sociodemographic characteristics;
Divisiond Yeart is the division–year fixed effect;
and ϵij is the idiosyncratic error term. Since we do not
observe prices faced by the households, following the lead
of Deaton(30), we utilised spatial variation in commodity
prices across administrative divisions over time. We
assumed that all households located in division d in year
t faced similar prices for commodity j. Therefore, along
with other division-level unobserved factors (e.g., food
habits, social norms, etc.), division–year fixed effects
accounted for prices in the regression. A squared term
of log expenditure, (ln Yi)2, was added in the model to
allow for commodities deemed a necessity or luxury
depending on household i’s expenditure level. The vector
Xi includes controls for household’s urban or rural residence,
dwelling type, occupancy status, source of drinking
water, whether the household has gas connection, type of
toilet used, type of sewerage system, whether the household
receives remittance from abroad, whether the
household receives government cash transfer, whether
the household produces food crops, whether the household
owns poultry, whether the household owns livestock,
whether the household takes loan to finance consumption
expenditure during the survey period, share of children
aged under 5, share of elderly (age >65), whether the
household has school-going (6–14) children, whether
the household has reproductive-age female (15–49), share
of adult male (age >18), household size and household
head’s education. These covariates were included in the
model to account for household-specific behaviours
that may impact certain commodity consumption, and to
obtain more precise estimates of α1 and α2. The coefficient
estimates of α1 and α2 jointly determine, along with
the level of expenditure Y, the marginal effect of log of
total household expenditure on household’s expenditure
share of a certain broad category. In the context of our
study, the coefficients alone were not meaningfully interpretable,
rather they were later used to estimate expenditure
elasticities.
Expenditure elasticity describes how responsive the
households are in adjusting consumption of a certain commodity,
following any changes in household income or
expenditure. The higher the expenditure elasticity, the
Carbonated beverage consumption in Pakistan 1631
larger is the responsiveness of quantity demanded to any
change in expenditure or income. Higher (>1) expenditure
elasticity means the commodity is a luxury item in household’s
consumption basket. An increase in expenditure in
such case is associated with more than a proportionate
increase in quantity demanded. Conversely, a decrease
in expenditure elasticity, therefore, refers to relatively less
responsiveness of quantity demanded, meaning consumers
do not change their consumption by much following
any changes in expenditure. An expenditure elasticity <1
means the commodity is a necessity in household’s consumption
basket.
Using the estimates of α1 and α2 of the respective period,
we estimated expenditure elasticities for each quintile for
each of the three periods. The expenditure elasticity of
the jth commodity for the qth quintile, ηjq, was calculated
using equation (2):
jq ¼ 1 þ 1
wjq
1 þ 22ln Yq ; (2)
where wjq is the jth commodity’s mean expenditure share at
the qth quintile, and ln Yq is the mean log monthly expenditure
at the qth quintile. We assumed that households do
not move across quintiles during the two survey cohort
periods. We also calculated ηj for all households, where
wj and ln Y are averaged over the full sample for respective
periods.
A similar specification like equation 1 was estimated in
the second stage, where wij was replaced with fik, the food
expenditure share of the kth food category; and Yi was
replaced with Fi, the monthly food expenditure. The
expenditure elasticity of the kth food category of q th
quintile, η(j)kq, was then estimated using equation (2),
respectively replacing w with f and Y with F. Following
Carpentier and Guyomard(31), the total expenditure elasticity
of the kth food category, Ek, was then calculated using
the following formula:
Ekq ¼ jq ð jÞkq: (3)
In the ‘Results’ section, we report the expenditure
elasticity of food, ηFood, from the first stage estimation;
within food category expenditure elasticity of carbonated
beverages, η(Food)CB, from second stage estimation; and
the total expenditure elasticity of carbonated beverage,
ECB, calculated using the estimates from the first and
second stage elasticities. We compared the total expenditure
elasticities across three time periods and across
quintiles.
Expenditure share burden
Finally, we examined how the expenditure share of
carbonated beverage consumption was spread across
households of different economic status (e.g., poor v. rich)
over the periods. We organised households by per
capita consumption percentile in each period and calculated
the share of carbonated beverage spending for each
percentile. We then generated concentration curves by
plotting the cumulative expenditure share against household
consumption per capita percentile for each period.
A point (p,s) on the concentration curve of a period, where
p and s refer to the coordinates of horizontal and vertical
axes, respectively, can be interpreted as s % of the carbonated
beverage expenditure share in that period being
borne by the bottom p % of all households. We compared
the concentration curves of 2006–2008, 2011–2012 and
2014–2016 to examine how the burden of carbonated
beverage expenditure changed over time.
Results
HIES provided household-level consumption information
of 15 453, 15 512, 16 341, 15 807, 17 991 and 24 238 households
in respective survey waves. The household-level
prevalence of carbonated beverage consumption is
reported in Table 1. For each period, it was evident that
higher the quintile (i.e., wealthier the household), the
higher the consumption prevalence. The difference in
Table 1 Household-level carbonated beverage consumption prevalence and expenditure share
Proportion of households consuming carbonated beverages (%)
Average expenditure* as a share of
food expenditure (%)
2006–2008 2011–2012 2014–2016 2006–2008 2011–2012 2014–2016
% 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI
Quintile 1 9·24 8·54, 9·94 14·25 13·39, 15·10 17·08 16·23, 17·93 0·12 0·11, 0·13 0·16 0·15, 0·17 0·10 0·10, 0·11
Quintile 2 16·2 15·28, 17·11 21·95 20·95, 22·94 26·97 26·02, 27·93 0·19 0·18, 0·20 0·24 0·23, 0·25 0·16 0·15, 0·17
Quintile 3 23·51 22·45, 24·58 28·99 27·89, 30·09 35·33 34·30, 36·35 0·28 0·27, 0·30 0·31 0·30, 0·32 0·21 0·20, 0·22
Quintile 4 31·29 30·08, 32·50 39·77 38·54, 41·00 44·69 43·64, 45·73 0·36 0·35, 0·38 0·42 0·40, 0·44 0·26 0·25, 0·27
Quintile 5 51·25 49·97, 52·52 59·26 58·04, 60·48 59·71 58·71, 60·70 0·66 0·63, 0·68 0·64 0·62, 0·66 0·32 0·31, 0·33
All 25·79 25·29, 26·28 32·55 32·04, 33·07 37·75 37·29, 38·21 0·32 0·31, 0·33 0·35 0·34, 0·36 0·22 0·21, 0·22
*Calculation of average expenditure share includes both user and non-user households.
1632 BK Datta and M Jami Husain
prevalence between the top (fifth) and the bottom (first)
quintile was >40 percentage points. The prevalence
gradually increased over time for every household group.
During 2006–2008, around 26 % of the households in
Pakistan consumed carbonated beverages, which increased
by >10 percentage points in 2014–2016. The increase
in prevalence was the highest for the fourth quintile
(13·4 percentage points) and lowest for the first quintile
(7·8 percentage points).
The average carbonated beverage expenditure share
also demonstrated a similar pattern that higher the quintile,
the higher the expenditure share (Table 1). However,
unlike the prevalence, the average expenditure share
decreased from 2006–2008 to 2014–2016. In Table 2, we
further explore this issue by examining trends in consumption
per capita and average unit expenditure. We found
that average per capita monthly carbonated beverage
consumption increased from 0·85 litre in 2006–2008 to
1·03 litre in 2014–2016, whereas average expenditure
per litre decreased from Rs. 39 to Rs. 31·5 during the same
period. Together this suggests that the decrease in average
expenditure share over time was due to a decrease in
average unit expenditure and not because of decrease in
quantity consumed.
The expenditure elasticity results are presented in
Table 3. The higher the absolute values of elasticity, the
greater the responsiveness of households to an increase
or decrease in household expenditure. It showed that a
1 % increase in household expenditure is associated with,
respectively, 1·66 and 1·36 % increase in expenditure for
carbonated beverages in Pakistan in 2006–2008 and
2014–2016. Decline in elasticity values meant that carbonated
beverages have become relatively an integral part of
household consumption over the years. We found that
the expenditure elasticities of carbonated beverages were
positive for all quintiles, and the higher the quintile, the
lower the expenditure elasticity at every period. This meant
that an increase in household expenditure (income) at the
bottom quintile would result in a relatively larger increase
in quantity demanded of carbonated beverages, compared
with that at the upper quintiles. This suggests that
carbonated beverage consumption in Pakistan is strongly
associated with households’ economic status and becomes
a relatively necessary part of households’ diet as expenditure
(income) increases.
The expenditure elasticity of the broad food category
does not change much over time (for all quintiles). The
within-food category expenditure elasticities of carbonated
beverages, on the other hand, showed changes over
time for all household quintiles. The within-food category
elasticity changes were, therefore, the main driver of
changes in estimated total elasticities. The total expenditure
elasticity of carbonated beverages decreased by
0·30 percentage points from 2006–2008 to 2014–2016.
The decrease occurred for all quintiles and was the highest
for the first quintile (0·71 percentage points) and lowest for
Table 2 Per capita consumption and average unit expenditure of households consuming carbonated beverages
Consumption per capita* (l) Average unit expenditure per litre† (constant 2008 Rs.)
2006–2008 2011–2012 2014–2016 2006–2008 2011–2012 2014–2016
% 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI
Quintile 1 0·35 0·33, 0·36 0·34 0·33, 0·35 0·48 0·46, 0·50 40·15 39·47, 40·84 45·68 44·19, 47·16 32·15 31·54, 32·76
Quintile 2 0·43 0·41, 0·44 0·46 0·44, 0·47 0·61 0·59, 0·62 39·44 38·85, 40·03 43·86 42·75, 44·96 31·95 31·53, 32·37
Quintile 3 0·54 0·52, 0·56 0·58 0·56, 0·59 0·76 0·74, 0·78 39·19 38·71, 39·68 42·49 41·54, 43·43 31·53 31·19, 31·87
Quintile 4 0·71 0·62, 0·80 0·72 0·70, 0·74 0·95 0·93, 0·97 38·42 38·02, 38·82 41·07 40·28, 41·86 31·34 31·04, 31·65
Quintile 5 1·31 1·26, 1·37 1·28 1·24, 1·31 1·54 1·50, 1·57 38·79 38·47, 39·11 38·68 38·11, 39·26 31·11 30·87, 31·35
All 0·85 0·82, 0·88 0·82 0·81, 0·84 1·03 1·02, 1·05 38·97 38·77, 39·17 41·27 40·89, 41·66 31·45 31·30, 31·60
*Consumption per capita was calculated by dividing the monthly consumption quantity (in litres) by household size.
†Average unit expenditure was calculated by dividing monthly consumption expenditure by monthly consumption quantity. Constant Rs. were obtained using general Consumer Price Index measures.
Carbonated beverage consumption in Pakistan 1633
the fifth quintile (0·11 percentage points). The expenditure
elasticity for the fifth quintile became <1 in 2014–2016,
suggesting that carbonated beverage became a necessary
commodity for wealthier households in Pakistan. We also
estimated the elasticities without controlling for household
characteristics, and the unadjusted estimates were found
very similar to the adjusted estimates presented in Table 3
(see online supplementary material, Supplemental Table 2
for unadjusted elasticity estimates).
Finally, the analysis of expenditure burden share is
presented in Fig. 2. The distant the concentration curve
from the equality line, the lesser the bottom x% of the
households’ share in carbonated beverage consumption.
We found that the concentration curve has gradually
shifted upward over time, that is, got closer to the equality
line, meaning the bottom x% of the households are bearing
a greater share of carbonated beverage expenditure in
2014–2016 than that in 2006–2008. The bottom 30 %households
bore 9·2 % of the expenditure share in 2006–2008,
which increased to 11·6 % in 2011–2012 and further
increased to 13·2 % in 2014–2016. For the bottom 50 %
households, it increased from 21·4 to 25·3 to 27·7 % during
the same periods. Hence, not only more poorer households
were consuming carbonated beverages in Pakistan
in recent years, the expenditure share burden of carbonated
beverage spending of poorer households had
increased as well. This shift in burden over time may have
detrimental consequences on poorer households, who
otherwise could have spent the money on other
food items.
0 10 20 30 40 50 60 70 80 90 100
Cumulative carbonated beverage consumption share (%)
0 10 20 30 40 50 60 70 80 90 100
Cumulative household count (%)
Fig. 2 (colour online) Concentration curve of expenditure
share. Cumulative household count is based on household’s
economic status in ascending order. x% in the horizontal axis
refers to poorest x% households. , 2006–2008;
, 2011–2012; , 2014–2016; , equality
line
Table 3 Expenditure elasticity estimates
Expenditure elasticity of food (ηFood)
Within-food category expenditure elasticity of carbonated
beverages (η(Food)CB)
2006–2008 2011–2012 2014–2016 2006–2008 2011–2012 2014–2016 Total expenditure elasticity (ECB)*
% 95%CI† % 95%CI† % 95%CI† % 95%CI† % 95%CI† % 95%CI† 2006–2008 2011–2012 2014–2016
Q1 0·88 0·87, 0·88 0·89 0·88, 0·90 0·87 0·86, 0·87 3·70 3·52, 3·87 2·59 2·42, 2·76 2·93 2·82, 3·03 3·24 2·31 2·53
Q2 0·86 0·85, 0·86 0·87 0·86, 0·88 0·85 0·84, 0·85 2·67 2·56, 2·77 2·01 1·91, 2·11 2·02 1·96, 2·08 2·28 1·75 1·72
Q3 0·84 0·83, 0·85 0·85 0·85, 0·86 0·83 0·83, 0·84 2·12 2·05, 2·18 1·76 1·69, 1·84 1·70 1·66, 1·75 1·78 1·50 1·42
Q4 0·82 0·81, 0·82 0·83 0·82, 0·84 0·81 0·81, 0·82 1·87 1·82, 1·92 1·55 1·5, 1·61 1·47 1·44, 1·51 1·53 1·29 1·20
Q5 0·72 0·71, 0·73 0·75 0·74, 0·76 0·76 0·75, 0·76 1·47 1·44, 1·5 1·35 1·31, 1·39 1·26 1·23, 1·29 1·06 1·01 0·95
All 0·83 0·83, 0·84 0·84, 0·85 0·83 0·82, 0·83 2·00 1·94, 2·06 1·68 1·61, 1·74 1·65 1·61, 1·7 1·66 1·42 1·36
*ECB is the product of ηF and η(F)CB.
†95% CI were calculated using the delta method.
1634 BK Datta and M Jami Husain
Discussion
Our analyses provide evidence on two important aspects of
household-level prevalence of carbonated beverage consumption
in Pakistan. First, we found the prevalence had
a strong association with households’ economic status.
The wealthier the household, the higher the prevalence
of carbonated beverage consumption. And second, the
prevalence had increased for all household groups
(e.g., poor, middle class, rich) over time. Our analyses
also inform two vital socioeconomic observations related
to carbonated beverage consumption. First, carbonated
beverages have gradually become an integral part of
Pakistani diet, and particularly for the rich households, it
became an essential consumption good. And second,
poorer households bore a larger share of carbonated
beverage expenditure in 2015–2016 than a decade ago.
These results have important socioeconomic and public
health considerations.
Over the years, expenditure elasticities of carbonated
beverages in Pakistan have been gradually declining for
all income groups. For example, at the bottom quintile, a
1% increase in expenditure in 2006–2008 was associated
with 3·24% increase in quantity demanded, which
decreased to 2·53 % in 2014–2016 – a relatively lower
degree of response,meaning consumers changed consumption
by a lower amount than that in 2006–2008 due to the
same change in real expenditure (income). This suggests
that carbonated beverages have become a relatively essential
good in Pakistan over time. This is a serious public
health concern since sugar-sweetened carbonated beverage
consumption is associated with various adverse health
conditions.
Though several studies have estimated the price
elasticities of SSB(21–23), very few provided estimates of
expenditure elasticities. One study on soft drinks consumption
in Guatemala reported an expenditure elasticity
estimate of 0·99(20). This estimate is lower than our overall
expenditure elasticity estimate of 1·36 in 2014–2016, but
very close to that (0·95) for the wealthiest households during
the same period. Future research in this area, using data
from various other countries, will facilitate cross-country
comparison of expenditure elasticities, and will enhance
our understanding of this issue in the global context.
The finding that poorer households are bearing a
larger share of carbonated beverages in 2014–2016 than
in 2006–2008 raises equity concerns. Since the expenditure
elasticities of food remained unchanged over time, poorer
households were likely to substitute other food consumptions
with carbonated beverages. If they substituted
carbonated beverages with some nutritious food items
like milk, then that could adversely affect health outcomes,
particularly for the children. HIES data show that expenditure
on dairy products as a percentage of total food
expenditure for the bottom quintile decreased from 17 %
in 2006–2008 to 14 % in 2014–2016, indicating a possibility
of substitution. The increase in consumption prevalence
for the poorer households may also increase the risk of
associated adverse health conditions. Studies showed that
medication expenditures of major non-communicable
diseases (e.g., blood pressure, diabetes) are strongly associated
with incurring catastrophic health expenditures in
Pakistan(32). Carbonated beverage-attributable health conditions,
thus, could further aggravate the poor households’
quality of life.
Lichtenstein(33) argues that enough evidence on the
adverse effects of SSB has already been documented,
and now it is time to focus on understanding the drivers
of SSB consumption, so that efforts can be made to fix
the bigger public health problem without any further delay.
Our study has great relevance to this view as we assessed
the socioeconomic factors associated with householdlevel
carbonated beverage consumption in Pakistan. Our
expenditure elasticity estimations for different periods
and for different economic groups portrayed a reliable
depiction of the evolution of carbonated beverage consumption
in Pakistan by controlling for a rich set of
socioeconomic variables. Thus, our findings provide
insights for effective public health policy interventions.
One limitation of our study is the lack of actual price
data, which we proxied by assuming that households
residing within an administrative division in the survey
year faced similar product pricing. Though we obtained
unit values by dividing expenditure amount by quantity
consumed, we did not treat these values as prices because
of endogeneity concerns emanating from measurement
errors and ignoring quality variations. Knowing the actual
price data could deliver more precise estimates. Second,
HIES does not provide information on different types
and brands of carbonated beverages consumed by the
households. Some of the carbonated beverages consumed
by households may be unsweetened and diet or lowcalorie
beverages, which we could not distinguish in our
analysis. Third,we analysed the household-level consumption
of carbonated beverages and could not derive the
individual-level consumption. Behavioural determinants
of carbonated beverage consumption could be useful in
designing targeted awareness campaigns and prevention
programmes for certain demographic groups (e.g., teenagers).
However, our data do not permit individual-level
or within-household consumption of carbonated beverages.
Future research in addressing this gap will be very
helpful.
Conclusion
Our analyses generated evidence on the trends and
economic group-specific patterns of carbonated beverage
consumption. These findings could be utilised as background
information to initiate efforts for reducing carbonated
beverage consumption. Efforts may include promoting
Carbonated beverage consumption in Pakistan 1635
behavioural changes through awareness campaigns or
influencing consumption through fiscal interventions like
taxation. Imposing tax on sugary beverages may lead to a
reduction in consumption andmight also result in healthcare
cost savings(34,35). Though Pakistan has a federal excise duty
and general sales tax on carbonated beverages, the existing
tax rates may not be adequate to curb carbonated beverage
consumption. We observed a declining trend in real prices
(measured by average per unit expenditure) of carbonated
beverages over time, which may escalate consumption
prevalence. Policy-makers in Pakistan may, therefore, need
to re-assess the tax structure associated with carbonated
beverages to decrease affordability and, thereby, reduce
consumption.
Acknowledgements
Acknowledgements: We are grateful to Curtis Blanton,
Patricia Richter, Deliana Kostova and three anonymous
referees for their helpful comments. Financial support:
This research received no specific grant from any funding
agency, commercial or not-for-profit sectors. Conflict of
interest: None. Authorship: B.K.D. formulated the research
questions, carried out empirical analysis and contributed to
writing. M.J.H. contributed to study design, data analysis
and writing. Ethics of human subject participation: Not
required as the study used publicly available secondary
data. Disclaimer: The findings and conclusions in this
report are those of the authors and do not necessarily
represent the official position of the Centers for Disease
Control and Prevention.
Supplementary material
For supplementary material accompanying this paper visit
https://doi.org/10.1017/S1368980019004348.
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