Community-Based Intervention to Promote Awareness and Implementation Accuracy of Food and Beverage Tax Policies in Stores on Navajo Nation

Background. Unhealthy food and beverage taxes are gaining global momentum, but implementation complexities at the retailer level are poorly understood. The only such policy in the United States, a 2014 Navajo Nation legislation, applies a 2% tax to unhealthy foods and beverages, while exempting healthy foods and beverages from their 6% Navajo sales tax. In 2019, approximately half of small stores had not implemented both taxes correctly, primarily the tax exemption. Therefore, this study aimed to provide culturally-informed promotional materials to enhance implementation accuracy in these stores and test the impact. Methods. Stores (N = 20) were randomly assigned to receive early promotional materials versus a waitlist group. Three to 6 months later, we visited all stores to purchase healthy and less healthy items, at which time waitlist stores received materials. Implementation accuracy of the junk food tax and exemption were tracked and compared. Results. Overall implementation accuracy of both taxes increased from 0% to 20% at follow-up (p = .013). Tax waiver accuracy increased from 5% to 30% (p = .065). Comparing intervention versus waitlist stores, we observed no difference in implementation of tax exemption and a non-significant increase in accuracy of added tax on unhealthy foods and beverages (90% vs. 70%, p = .284). The study process revealed strengths and barriers to impactful store outreach. Discussion. Grounded in community partnership, we explored a promotional outreach strategy to enhance accurate implementation of Navajo Nation food and beverage taxes. Our findings suggest store outreach and promotional materials could address confusion issues, while barriers related to store capacity merit further exploration.