memo To: City of Seattle Office of City Auditor (OCA) From: Nadine Chan, Assistant Chief, Public Health - Seattle and King County Date: June 21, 2019 Re: Final 2019 Sweetened Beverage Tax (SBT) Evaluation Plan Dear Office of City Auditor, I am submitting for OCA’s acceptance the final 2019 detailed evaluation plan for the evaluation of the Sweetened Beverage Tax (Ordinance 125324). This package includes updates to the plan submitted on June 5, 2019 to Section 3 as noted in parentheses below. Sections: 0. Budget and project memo 1. Store audit 2. Child cohort 3. Norms and attitudes (see Appendix 1 and Appendix 2 with updated final survey questions) 4. Revenues 5. Health records Sincerely, Nadine L. Chan, PhD, MPH Assistant Chief of Assessment, Policy Development and Evaluation Public Health – Seattle and King County Enclosures Evaluation Budget (Year 2 Post-Tax) SWEETENED BEVERAGE TAX EVALUATION (2019) Project Memo: Evaluation of Seattle’s Sweetened Beverage Tax Ordinance Year 2 Budget Year 2 Post-Tax Evaluation Budget and Notes (2019) • • Propose to analyze HYS data in year 4, pending availability of HYS data to be collected in 2020. Dr. Lisa Powell secured non-City funds to purchase and analyze retail scanner data (two years pre- and posttax) and will release findings when available. Store Audits at 24 months (Section 1.1) • • • Research Coordinator (hiring, training, quality assurance, data management) Data Collection & Outreach (180 stores & restaurants in Seattle and 180 stores & restaurants in comparison areas; time/personnel, travel, printing, tablets, outreach and partnering with community agencies) Incentives for stores Jobs and revenue (feasibility) (Section 1.2) • Research Coordinator Cohort at 24 months (Section 2) • • Retention and Data Collection Incentives & Supplies Secondary data analyses: Health records (feasibility) (Section 3) • Research and IT staff: feasibility (access and assessment of data) from local health systems (e.g., Seattle Children’s, UW, and Kaiser Permanente) $65,827 $34,687 $140,471 $5,078 Norms and attitudes poll (Section 6.2) $85,828 Analysis, Interpretation, Dissemination: $84,269 Contract Fees, Overhead, Other: $20,200 • • Data Collection (professional survey research firm to sample and survey approximately 800 people in Seattle and 800 people in the comparison area) Data analysis and interpretation, report writing, information and report dissemination, participation in Bloomberg Evaluation Advisory Committee meetings, participation at national conference, open source publication Total Direct Costs: Indirect rate @15% (MTDC): Total: 5/3/2019 $436,360 $63,640 $500,000 ***This is a working document that may be updated as the project evolves *** 1 Project Memo: Evaluation of Seattle’s Sweetened Beverage Tax Ordinance Year 2 Budget Year 2 (2019) Store Audits at 24 months Cohort at 24 months Norms and Attitudes Jobs and revenue feasibility Explore feasibility of longitudinal health record data (e.g., Kaiser/Children’s/UW) Travel to Bloomberg Advisory EAC meeting Travel to scientific conferences for dissemination (one conference for 3); International Journal of Behavioral and Physical Activity: open-access publication costs Year 3 (2020) Final report of conditions 24 months after the implementation of the Sweetened Beverage Tax Jobs and revenue analysis (pending status of 2019 analyses) Health record data (pending determination of feasibility in 2019) Travel to Bloomberg Advisory EAC meeting Travel to scientific conferences for dissemination Year 4 (2021) Jobs and revenue analysis Secondary data analysis (pending access to 2020 HYS data) Travel to Bloomberg Advisory EAC meeting Travel to scientific conferences for dissemination 5/3/2019 ***This is a working document that may be updated as the project evolves *** 2 Draft 2019 Project Memo: Year 2 Post-Tax (2019) Evaluation of Sweetened Beverage Tax Ordinance MEMO AND BUDGET FOR YEAR 2 POST-TAX (2019) SBT EVALUATION PREPARED BY: PUBLIC HEALTH – SEATTLE AND KING COUNTY AND UNIVERSITY OF WASHINGTON Project Memo: Year 2 Post-Tax (2019) Evaluation of Sweetened Beverage Tax Ordinance Ordinance 125324 imposes a 1.75-cent-per-ounce tax on sugary beverages and requires evaluation of tax impacts on 1) economic outcomes (such as household food expenditures, beverage prices and sales, jobs, and store revenues), 2) health behaviors (such as dietary purchases and consumption), 3) intermediate health outcomes, 4) identification and assessment of food deserts in the city, and 5) the effectiveness and efficiency of the foodbank network in the city. The evaluation shall also assess, but not be limited to, the process of implementing the tax. On August 7, 2017, City Council reviewed the proposal for the full evaluation and approved the budget for the baseline (2017) evaluation activities. This memo describes the budget and evaluation activities for 2019 - the second year the tax ordinance will be implemented. Brief overview of proposed evaluation for year 2 (2019) Prioritizing time-sensitive activities to understand the two-year impact of the ordinance, we propose: 1. Evaluation of the impact of the tax on economic outcomes 1.1 Evaluate the impact of the tax on taxed and untaxed beverage prices. We will return to retail stores audited at baseline to track change in price of taxed and untaxed beverages at 24 months post-tax throughout the city of Seattle and our comparison area, oversampling stores in lower-income neighborhoods. We will compare findings to data collected pre-tax as well as 6 months and 12 months post-tax. Smaller, independently owned stores, particularly racial/ethnic minority-owned businesses, are represented in the sample. We will include data from store owners who may have limited English proficiency. Importantly, store audits are the only way to collect data from smaller independent stores. This portion of the evaluation is timesensitive, requiring data collection in 2019. 1.2 Evaluate the impact of the tax on jobs and business revenues The beverage industry has claimed that the Philadelphia tax had caused significant job losses and business revenue. It is important that any negative unintended consequences of the tax be systematically investigated. We will obtain data on business revenue from the Washington State Department of Revenue and evaluate the impact of the tax on relevant business revenue. We will link our data on food store information to identify stores in which beverages are likely a large component of revenue. The State releases data 9-12 months after they are collected. Because of the lag time, we delayed these analyses until 2019. 1.3 Evaluate the impact of the tax on beverage sales Purchased data on retail sales transactions from large retailers can be used to evaluate changes in sales of taxed and untaxed beverages using millions of transactions in the Seattle market area and a comparison market during the two years before and after tax implementation. These data will enable an analysis of whether people purchase taxed beverages outside the borders of Seattle. We are not requesting funds for this component as we have learned that in 2018, Dr. Lisa Powell secured non-City funds to acquire data 2 years before and 2 years post-tax and to conduct analyses. Dr. Powell will release findings when available. 2. Evaluation of the tax on health behaviors The tax will improve health to the extent that consumption of sugary drinks declines. We will assess the tax impact on consumption among children by following a sample of 300 Seattle children and 300 from a comparison area over time and contrast how consumption of sugary beverages, and added sugars from all sources, changes in Seattle to any changes in the comparison area. This would address a key gap in knowledge as no sugary drink tax studies have evaluated the impacts among children. Following the same children before and after the tax allows 5/3/2019 ***This is a working document that may be updated as the project evolves *** 1 Project Memo: Year 2 Post-Tax (2019) Evaluation of Sweetened Beverage Tax Ordinance for a better control of biasing factors as well as better statistical power to detect effects. We will focus on low-income children and their families so that we can expand our knowledge of how the tax affects vulnerable populations. To study the two-year impact of the tax, we will interview children (aged 7-17) and their parents in Seattle and a comparison area at 24 months post-tax. We will compare findings to data collected pre-tax as well as 6 months and 12 months post-tax. This portion of the evaluation is time-sensitive, requiring data collection in 2019. 3. Evaluate the impact of the tax on intermediate health outcomes We propose to leverage currently collected data to examine the impacts of the tax on populationlevel rates of being overweight or obese (as measured by the body mass index z-score). In 2019, we propose to explore the feasibility of access to electronic medical record data on body mass index to determine if there is sufficient sample of Seattle and comparison data among Kaiser Permanente members and Children’s Hospital members. If determined to be feasible, we propose to include analyses of health records data in 2020. This is not time-sensitive: we propose to conduct analyses in 2021 of self-reported data among low-income children participating in the Supplemental Nutrition Assistance Program (SNAP); Women, Infants and Children (WIC); and of school-aged children participating in the Healthy Youth Survey (including HYS data collected in 2020). 4. Assessment of food deserts in the city We completed this body of work in 2018. 5. Assessment of the effectiveness and efficiency of the foodbank network in the city We completed this body of work in 2018. 6. Assessment of the process of implementing the tax 6.1 Qualitative assessment of key stakeholder perceptions and experiences We completed this body of work in 2017. 6.2 Impact of the tax on norms and attitudes. An unanswered question is whether heightened attention to the adverse health effects of sugary drinks generated during adoption and implementation of a tax, independent of the tax effects on prices, leads to lower consumption. We conducted a telephone survey at baseline to assess the norms and attitudes around sugary beverages (e.g., perceived effects on health, how much consumption is acceptable, etc.). We propose to repeat the survey in 2019 and compare findings to data collected pre-tax. This portion of the evaluation is time-sensitive, requiring data collection in 2019. Deliverables from Year 2 Data Collection The study team will provide a report documenting initiation and completion of data collection activities by July 2020. We propose to submit final reports of the conditions 24 months after implementation of the Sweetened Beverage Tax by December 2020 (as part of proposed scope of work for 2020). 5/3/2019 ***This is a working document that may be updated as the project evolves *** 2 SECTION 1 Store audits (Year 2 Post-Tax) METHODS AND DATA COLLECTION INSTRUMENTS (2019) We will return to retail stores audited at baseline to track change in the prices of taxed and untaxed beverages at 24 months post-tax throughout the city of Seattle and our comparison area, oversampling stores in lower-income neighborhoods. We will compare findings to data collected pre-tax as well as 6 months and 12 months post-tax. Smaller, independently owned stores, particularly racial/ethnic minority-owned businesses, are represented in the sample. We will include data from store owners who may have limited English proficiency. Importantly, store audits are the only way to collect data from smaller independent stores. Notable changes to this section Store audits will be repeated at 24 months post-tax. All methods utilized at 6-months and 12-months post-tax will be utilized at 24-months post-tax. There are no notable changes to methods or the survey instruments for this component of the evaluation. Please refer to methods and data collection instruments described in year 1 evaluation plan. SECTION 2 Child cohort (Year 2 Post-Tax) METHODS AND DATA COLLECTION INSTRUMENTS (2019) To study the two-year impact of the tax, we will interview children (aged 7-17) and their parents in Seattle and a comparison area at 24 months post-tax. We will compare findings to data collected pretax as well as 6 months and 12 months post-tax. Notable changes to this section Since the 24-month assessment is the last follow-up for the child cohort, in order to contextualize the overall child cohort findings, we are planning to ask questions about the sugary beverage tax and its perceived impact on the consumption of different beverages. These questions will be informed by the norms and attitudes survey findings, the Community Advisory Board, as well as existing relevant questions from evaluations of SBTs in other places. See below for detailed methods and data collection instruments. Child Cohort Methods Overview It is critical to examine shifts in beverage consumption as a result of implementing a sugary beverage tax (SBT). Many of the prior and on-going evaluations of the impact of sugary beverage taxes elsewhere have examined whether consumption of sugary beverages decreases (and other beverage consumption increases) after the introduction of the SBT. However, most consumption evaluations have focused on adults, so our understanding of the impact on children’s consumption is limited. In addition, evaluations have generally not examined whether consumption of other components of the diet that often contribute to overall sugar consumption (e.g., sweetened cereal, baked goods) or more healthful aspects of diet (e.g., fruits, vegetables) change as a result of implementing a SBT. Finally, given developmental and secular trends in beverage consumption, it is important to examine change in beverage consumption and dietary patterns over time among children exposed to the SBT relative to otherwise similar children not exposed to the SBT, so that any changes in exposed children are more attributable to the SBT rather than other factors that influence beverage and food consumption. The objective of the Seattle child cohort component of the overall sugary beverage tax evaluation plan is to examine the relative change over time in children’s beverage consumption and other aspects of their diet. Methods To address this objective, we are employing a quasi-experimental observational cohort study design, using surveys to collect information about children’s beverage consumption, other aspects of children’s diet, and household information. The child cohort includes children 7-10 years old or 12-17 years old, with one child per household. There is a gap in the age (11 year olds) because of a difference in survey methodology based on child age (see below). Children (and a parent/caregiver) who live in the city of Seattle and children (and a parent/caregiver) living outside Seattle but nearby are eligible. Children living in Seattle will be considered exposed to the SBT. Children living in non-Seattle areas (primarily Kent, Renton, Auburn, and Federal Way) will be considered unexposed to the SBT. We chose nearby cities to keep the same other regional factors that might influence consumption (e.g., same media market), but that are not adjacent to Seattle to decrease the likelihood of exposure to the tax (e.g., living outside, but shopping in Seattle). Because low-income populations, as compared to their higher income counterparts, are more likely to consume sugary beverages and be sensitive to taxes and related price increases, our sampling strategy only includes families who report being <312% of the Federal Poverty Line. This was selected because families below this level are eligible for WA Apple Health (Medicaid) insurance for their children. In addition, we were looking predominantly for those who might be impacted by an SBT, so focused our recruitment/enrollment only on children who reported (or whose parent reported about the child) that they consumed sugary drinks. To expand our inclusion, we offer multiple methods for families to participate, including through phone, web-based, and in-person. The in-person recruitment/enrollment has been in various locations, including but not limited to: food banks, health care clinics, events at public housing facilities and community centers, churches, and community events. Phone and web-based recruitment/enrollment has been through direct calling/texting, social media, and advertisements. To date, our community partners have substantially helped us in outreach to families and children. To encourage diversity and inclusion, the phone-based options are available in three languages (English, Spanish, Vietnamese), the web-based Last Edited: 6/21/2019 2 P age option is available two languages (English, Spanish), and in-person materials or translation has been available in four languages (English, Spanish, Vietnamese, Somali). Our goal at baseline was to recruit/enroll up to 300 children/families in Seattle and 300 children/families in non-Seattle areas. We are conducting surveys with the same children/families at baseline, 6 months after the start of SBT implementation, 12 months after SBT implementation, and 24 months after SBT implementation. At each time point, a survey will be completed regarding 1) detailed information about the frequency and volume of the child’s consumption of different types of beverages and 2) a dietary screener questionnaire which examines the frequency of fruits and vegetables and consumption of various other foods that are known to contribute added sugar to children’s diets. For children 7-10 years old at baseline, the parent/caregiver will complete these beverage and diet surveys regarding the child’s consumption. For children 12-17 years old at baseline, the child will complete these surveys. In addition, at each time point the parent/caregiver will complete 1) a survey about the household (e.g., demographic information, food insecurity questions) and 2) a survey regarding detailed information about their own beverage consumption (similar to the one about the child’s beverage consumption). To incentivize enrollment in the child cohort, children/families are provided $50 for completing the surveys at each time point. Update for year 2 evaluation The child cohort component of the SBT evaluation will re-contact participants in the cohort who were eligible and completed baseline assessments to complete similar measures at the 24-month time point. Thus, we will attempt to re-contact baseline participants regardless of their 6-month and 12-month participation. Similar to the 12-month time point, families will be encouraged to complete the 24-month measures on their baseline anniversary date (e.g., if completed baseline on December 8, 2018, will be asked to complete the 24-month assessment on December 8, 2019) to better control for seasonal and other potential influences (e.g., holidays) on beverage and food consumption. Measures For comparability purposes, the child cohort component will use similar, if not the same, measures as the baseline, 6-month, and 12-month time point. This will include the same measures previously used to collect 1) detailed information about the frequency and volume of the child’s and parent’s consumption of different types of beverages and 2) a dietary screener questionnaire which examines the frequency of children’s consumption of fruits and vegetables and consumption of various other foods that are known to contribute added sugar to children’s diets. Parents will complete a survey regarding the household (e.g., food security, participation in food assistance programs, frequency of shopping at different stores), similar to the prior household survey measures. Analysis Data will be regularly reviewed by the study team to ensure consistency and accuracy. Baseline: We will perform descriptive analysis on all variables first, with a particular focus on the outcomes of children’s sugary drink consumption, other drink consumption, and added sugars from food. Continuous variables will be summarized using means, medians, standard deviations, minimum and maximum. Categorical variables will be summarized using frequencies and proportions. We will Last Edited: 6/21/2019 3 P age examine missing data on all variables. We will then examine bivariate relationships among variables (e.g., relationship between child and parent sugary drink consumption; relationship between parent education and child sugary drink consumption), using cross-tables and chi-squared tests on categorical variables, t-tests on a continuous variable and a categorical variable, and correlation coefficients on two continuous variables. Longitudinal: We will explore the change in children’s sugary drink consumption (overall and among taxed and untaxed sugary drinks), other drink consumption, and added sugars from food (and other aspects of diet derived from the screener) comparing children living in Seattle to children living in non-Seattle areas using regression-based difference-in-difference models. In addition, we will test for heterogeneity in the associations by income and race/ethnicity. Limitations 1. Our baseline goal was to recruit the total 600 families before January 1, 2018 when the SBT was implemented in Seattle. However, in addition to the already short timeline (starting in October 2017 after human subjects research approval), there were numerous challenges to recruitment and enrollment, particularly enrolling families who met our lower income and sugary drink consumption criteria. This required more focus and dedication to ensuring that the majority of the planned Seattle children/families were recruited and enrolled prior to the SBT implementation date. We were successful in this, but our recruitment and enrollment of children/families in the unexposed cities continued through the end of January 2018. 2. We had originally planned to include food store receipt data collection in conjunction with the surveys in order to better examine sugary and other drink purchases, but it became clear early in recruitment/enrollment that this would decrease the number of children/families willing to enroll (particularly in the short baseline timeframe) and the resources needed to obtain these receipts would detract from getting the survey data and likely exceed our budget. 3. Reliance on self- or parent-report of beverage and food consumption is subject to recall, social desirability, and other biases. In addition, no existing beverage consumption questionnaire would allow us to readily and completely distinguish between the types of beverages that are subject to Seattle’s SBT (e.g., prepared versus unprepared sports drinks), so we had to modify an existing reliable and validated measures of beverage consumption with no time for further reliability or validity testing. Last Edited: 6/21/2019 4 P age SeaSAW Screening Questionnaire ID#________________ Thank you for your interest in the Seattle Area Shopping and Wellness or SeaSAW Study! To see if your family is eligible, we need to ask you a few questions. 1. What is your child’s age? 7-10 or 12-17 (if multiple eligible children, choose one with closest birthday to today) 2. What is your home address (including zip code)? Street address: ______________________________, Unit #: _______________________________ City: _______________________, State:_______, Zipcode: ___________________ 3. Does your child live in your residence on average five days per week or more? a. Yes b. No 4. Are you planning on moving out of the area (King County) anytime in the next 1-2 years? a. Yes b. No 5. How many adults (including yourself) live in your household? _______ adults 6. How many children under 18 live in your household? ________ children 7. Please reference the chart below and tell us if your total gross annual household income (before taxes and other things taken out) including all sources of income for your household is above or below the annual or monthly income associated with your household size. a. Above b. Below Household Size 1 2 3 4 5 6 7 8 9 10 Annual $37,627.20 $50,668.80 $63,710.40 $76,752.00 $89,793.60 $102,835.20 $115,876.80 $128,918.40 $145,236.00 $161,553.60 Monthly $3,135.60 $4,222.40 $5,309.20 $6,396.00 $7,482.80 $8,569.60 $9,656.40 $10,743.20 $12,103.00 $13,462.80 1 For the following questions, please answer what is most accurate for your child (if parent) or you (if adolescent) in the past week: Never or almost never Less than 1 time per week 1-2 times per week 3-4 times per week 5 or more times per week 9. Eat at restaurants? 1 2 3 4 5 10. Eat food served from a school cafeteria? 1 2 3 4 5 11. Not counting restaurants or school, how many times did your child (you) meals away from home (e.g., friends home, other family members’ home)? 1 2 3 4 5 How often did your child (you): 12. Does your child ever drink sugary beverages like: regular soda/pop (such as Coke or Sprite), fruit-flavored drinks (like Sunny Delight), coffee or tea drinks with added sugar (like Starbucks Frappucinnos, Arizona Iced Tea, Chai Tea, bubble tea), or regular sports drinks or energy drinks (such as Gatorade or Red Bull)? a.Yes b. No Please Provide Your Contact Information: Parent First Name: _______________________________, Parent Last Name: ______________________________ Parent Phone:_______________________________, Parent Email: _______________________________________ 2 Confidential SeaSAW 6 Month Page 1 of 6 Dietary Screener English Record ID __________________________________ How old are you/is your child in years? 7 8 9 10 12 13 14 Are you/is your child male or female? 15 16 17 18 Male Female Dietary Screener Questionnaire During the past month, how often did your child (you) eat hot or cold cereals? Never- Go to question #4 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, what kind of cereal did your child (you) usually eat? (enter into text field) __________________________________ If there was another kind of cereal that your child (you) usually ate during the past month, what kind was it? (enter into text box, if none, leave blank) __________________________________ During the past month, how often did your child (or you) have any milk (either to drink or on cereal)? Include regular milks, chocolate or other flavored milks, lactosefree milk, buttermilk. Please do not include soy milk or small amounts of milk in coffee or tea. Never- Go to question #8 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2-3 times per day 4-5 times per day 6 or more times per day Decline to answer During the past month, what kind of milk did your child (you) usually drink? Whole or regular milk 2% fat or reduced fat milk 1%, 1/2%, or low fat milk Fat free, skim or nonfat milk Soy milk Other kind of milk Other Milk Description 03/27/2018 10:01am __________________________________ www.projectredcap.org Confidential Page 2 of 6 During the past month, how often did your child (you) drink regular soda or pop that contains sugar? Do not include diet soda. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2-3 times per day 4-5 times per day 6 or more times per day Decline to answer During the past month, how often did your child (you) drink 100% pure fruit juices such as orange, mango, apple, grape and pineapple juices? Do not include fruitflavored drinks with added sugar or fruit juice you made at home and added sugar to. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2-3 times per day 4-5 times per day 6 or more times per day Decline to answer During the past month, how often did your child (you) drink coffee or tea that had sugar or honey added to it? Include coffee and tea you sweetened yourself and presweetened tea and coffee drinks such as Arizona Iced Tea and Frappuccino. Do not include artificially sweetened coffee or diet tea. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2-3 times per day 4-5 times per day 6 or more times per day Decline to answer During the past month, how often did your child (you) drink sweetened fruit drinks, sports or energy drinks, such as KoolAid, lemonade, HiC, cranberry drink, Gatorade, Red Bull or Vitamin Water? Include fruit juices you made at home and added sugar to. Do not include diet drinks or artificially sweetened drinks. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2-3 times per day 4-5 times per day 6 or more times per day Decline to answer During the past month, how often did your child (you) eat fruit? Include fresh, frozen or canned fruit. Do not include juices. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer 03/27/2018 10:01am www.projectredcap.org Confidential Page 3 of 6 During the past month, how often did your child (you) eat a green leafy or lettuce salad, with or without other vegetables? Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat any kind of fried potatoes, including french fries, home fries, or hash brown potatoes? Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat any other kind of potatoes, such as baked, boiled, mashed potatoes, sweet potatoes, or potato salad? Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat refried beans, baked beans, beans in soup, pork and beans or any other type of cooked dried beans? Do not include green beans. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat brown rice or other cooked whole grains, such as bulgur, cracked wheat, or millet? Do not include white rice. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer 03/27/2018 10:01am www.projectredcap.org Confidential Page 4 of 6 During the past month, not including what your child (you) just told me about (green salads, potatoes, cooked dried beans), how often did you eat other vegetables? Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) have Mexicantype salsa made with tomato? Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat pizza? Include frozen pizza, fast food pizza, and homemade pizza. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) have tomato sauces such as with spagetti or noodles or mixed into foods such as lasagna? Do not include tomato sauce on pizza. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat any kind of cheese? Include cheese as a snack, cheese on burgers, sandwiches, and cheese in foods such as lasagna, quesadillas, or casseroles. Do not include cheese on pizza. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer 03/27/2018 10:01am www.projectredcap.org Confidential Page 5 of 6 During the past month, how often did your child (you) eat red meat, such as beef, pork, ham, or sausage? Do not include chicken, tu rkey or seafood. Include red meat you had in sandwiches, lasagna, stew, and other mixtures. Red meats may also include veal, lamb, and any lunch meats made with these meats. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat any processed meat, such as bacon, lunch meats, or hot dogs? Include processed meats you had in sandwiches, soups, pizza, casseroles, and other mixtures. Processed meats are those preserved by smoking, curing, or salting, or by the addition of preservatives. Examples are: ham, bacon, pastrami, salami, sausages, bratwursts, frankfurters, hot dogs, and spam. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat whole grain bread including toast, rolls and in sandwiches? Whole grain breads include whole wheat, rye, oatmeal and pumpernickel. Do not include white bread. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat chocolate or any other types of candy? Do not include sugarfree candy. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat doughnuts, sweet rolls, Danish, muffins, pan dulce, or poptarts? Do not include sugarfree items. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer 03/27/2018 10:01am www.projectredcap.org Confidential Page 6 of 6 During the past month, how often did your child (you) eat cookies, cake, pie or b rownies? Do not include sugarfree kinds. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat ice cream or other frozen desserts? Do not include sugarfree kinds. Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer During the past month, how often did your child (you) eat popcorn? Never 1 time last month 2-3 times last month 1 time per week 2 times per week 3-4 times per week 5-6 times per week 1 time per day 2 or more times per day Decline to answer 03/27/2018 10:01am www.projectredcap.org #3 Beverage Consumption Questionnaire for Child Cohort (SeaSAW) Updated 12.21.17 We want to learn about the types and amounts of different beverages that your child drinks. I am going to read a list of beverages and want to find out how often your child has had the beverage in the past month. If they drink something at least once a week, I will ask about how much they usually have each time they drink that type of beverage. For example, if your child drinks fruit juice as part of a snack after school each school day but does not drink it any other time throughout the day or on the weekend, you would tell me she drinks it 5 times each week. Do not count beverages used in cooking or other preparations such as milk in cereal. There are no right or wrong answers. We want to get an honest picture of what your child drinks. A) How Often Do You Drink It? (Choose One) Type of Beverage Never or less than 1 time per week- go to next beverage 1 time per week 2-3 times per week 4-6 times per week 1 time per day 2+ times per day B) 3+ times per day Less than 6 fl oz (3/4 cup) Size of most juice boxes 1. Tap water → 2. Plain bottled water (e.g., Aquafina, Dasini, Smart Water) → 3. Flavored water without added sugar or other caloric sweeteners (e.g., coconut water; club soda or bubbly water; aqua frescas without sugar or other caloric sweeteners such as honey) or other flavored waters with low or no calories (e.g., La Croix, Mio, Vitamin Water Zero, Sobe Life Water) 4. 100% Fruit juice (e.g., orange, apple, Honest Kids) 5. Fruit-flavored drinks with added sugar that are ready to drink – in bottle/can or from a drink fountain/dispenser (e.g., lemonade, Sunny Delight, Hawaiian Punch) How Much Each Time? (Choose One) → → → 8 fl oz (1 cup) 12 fl oz (1 ½ cups) Size of a regular can of soda/pop 16 fl oz (2 cups) Size of most sports drinks or bottled drinks More than 20 fl oz cups (2 ½ cups) Type of Beverage Never or less than 1 time per week- go to next beverage 1 time per week 2-3 times per week 4-6 times per week 1 time per day 2+ times per day 3+ times per day Less than 6 fl oz (3/4 cup) Size of most juice boxes 6. Fruit-flavored drinks that are low or no calorie either ready to drink (e.g., Ice) or from a powder (e.g., Crystal Light) 7. Regular milk with no added sugar (cow, almond, or other plant or nut milks)(e.g., 2% milk, Silk Unsweetened Almond Milk) → 8. Flavored milk (e.g., chocolate, strawberry, horchata, or sweetened vanilla almond milk) → 9. Regular soft drinks, soda, or pop (e.g., Coke, Pepsi Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper); not including diet soda → 10. Diet or low or no calorie soft drinks, soda, or pop (e.g., Coke Zero Sugar, Diet Pepsi) → 11. Tea or coffee drink with sugar or syrups added (in bottle/can or prepared by barista or seller) (e.g. Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mocha, or bubble teas) or hot chocolate 12. Tea or coffee drink you/your child prepared to which you added sugar, honey, or syrups 13. Tea or coffee drink (prepared by you/your child, by a barista or seller, or in a bottle/can) with low or no calorie sweetener or flavoring added 14. Tea or coffee without sugar or other flavorings or sweeteners added (plain or with milk/cream) (made at home or purchased) → → → → 8 fl oz (1 cup) 12 fl oz (1 ½ cups) Size of a regular can of soda/pop 16 fl oz (2 cups) Size of most sports drinks or bottled drinks More than 20 fl oz cups (2 ½ cups) Type of Beverage Never or less than 1 time per week- go to next beverage 1 time per week 2-3 times per week 4-6 times per week 1 time per day 2+ times per day 3+ times per day Less than 6 fl oz (3/4 cup) Size of most juice boxes 15. Regular energy drinks (e.g., Red Bull, Rockstar, Monster) → 16. Low or no calorie energy drinks (e.g., Red Bull Sugar Free, Monster Zero) → 17. Regular sports drinks that are ready to drink – from a bottle or drink fountain/dispenser (e.g., Gatorade, Powerade, Vitamin Water) → 18. Low or no calorie sports drinks (e.g., Gatorade G2) → 19. Fruit-flavored drinks or sports drinks prepared by you/your child (e.g., Kool Aid, made-frompowder lemonade or Gatorade) → 20. Are there any other beverages you have consumed in the past month that we did not already capture?Other ________________ → 21. Other _________________ → 22. Other _________________ → 23. Other ________________ → 8 fl oz (1 cup) 12 fl oz (1 ½ cups) Size of a regular can of soda/pop 16 fl oz (2 cups) Size of most sports drinks or bottled drinks For ‘Other’; get as complete a description as possible including brand, name of beverage, and any other information the child/parent can recall about the beverage (if applicable, have them retrieve the can/bottle/box if it is readily available) More than 20 fl oz cups (2 ½ cups) #1 Beverage Consumption Questionnaire for Child Cohort (SeaSAW) PARENT Updated 01 12 2018 We want to learn about the types and amounts of different beverages that you drink. Please choose the best answer for each of the questions below. If you drink something at least once a week, please answer how much you usually have each time you drink that type of beverage. For example, if you drink fruit juice as part of a snack after work each weekday day but do not drink it any other time throughout the day or on the weekend, you would choose 5 times each week. Do not count beverages used in cooking or other preparations such as milk in cereal or in coffee. There are no right or wrong answers. We want to get an honest picture of what you drink. A) How Often Do You Drink It? (Choose One) Type of Beverage Never or less than 1 time per week- go to next beverage 1 time per week 2-3 times per week 4-6 times per week 1 time per day 2+ times per day B) How Much Each Time? (Choose One) 3+ times per day Less than 6 fl oz (3/4 cup) Size of most juice boxes 1. Tap water → 2. Plain bottled water (e.g., Aquafina, Dasini, Smart Water) → 3. Flavored water without added sugar or other caloric sweeteners (e.g., coconut water; club soda or bubbly water; aqua frescas without sugar or other caloric sweeteners such as honey) or other flavored waters with low or no calories (e.g., La Croix, Mio, Vitamin Water Zero, Sobe Life Water) 4. 100% Fruit juice (e.g., orange, apple, Honest Kids) 5. Fruit-flavored drinks with added sugar that are ready to drink – in bottle/can or from a drink fountain/dispenser (e.g., lemonade, Sunny Delight, Hawaiian Punch) → → → 8 fl oz (1 cup) 12 fl oz (1 ½ cups) Size of a regular can of soda/pop 16 fl oz (2 cups) Size of most sports drinks or bottled drinks More than 20 fl oz cups (2 ½ cups) Type of Beverage Never or less than 1 time per week- go to next beverage 1 time per week 2-3 times per week 4-6 times per week 1 time per day 2+ times per day 3+ times per day Less than 6 fl oz (3/4 cup) Size of most juice boxes 6. Fruit-flavored drinks that are low or no calorie either ready to drink (e.g., Ice) or from a powder (e.g., Crystal Light) 7. Regular milk with no added sugar (cow, almond, or other plant or nut milks)(e.g., 2% milk, Silk Unsweetened Almond Milk) → 8. Flavored milk (e.g., chocolate, strawberry, horchata, or sweetened vanilla almond milk) → 9. Regular soft drinks, soda, or pop (e.g., Coke, Pepsi Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper); not including diet soda → 10. Diet or low or no calorie soft drinks, soda, or pop (e.g., Coke Zero Sugar, Diet Pepsi) → 11. Tea or coffee drink with sugar or syrups added (in bottle/can or prepared by barista or seller) (e.g. Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mocha, or bubble teas) or hot chocolate 12. Tea or coffee drink you/your child prepared to which you added sugar, honey, or syrups 13. Tea or coffee drink (prepared by you/your child, by a barista or seller, or in a bottle/can) with low or no calorie sweetener or flavoring added 14. Tea or coffee without sugar or other flavorings or sweeteners added (plain or with milk/cream) (made at home or purchased) → → → → 8 fl oz (1 cup) 12 fl oz (1 ½ cups) Size of a regular can of soda/pop 16 fl oz (2 cups) Size of most sports drinks or bottled drinks More than 20 fl oz cups (2 ½ cups) Type of Beverage 15. Regular energy drinks (e.g., Red Bull, Rockstar, Monster) Never or less than 1 time per week- go to next beverage 1 time per week 2-3 times per week 4-6 times per week 1 time per day 2+ times per day 3+ times per day Less than 6 fl oz (3/4 cup) Size of most juice boxes → 16. Low or no calorie energy drinks (e.g., Red Bull Sugar Free, Monster Zero) 17. Regular sports drinks that are ready to drink – from a bottle or drink fountain/dispenser (e.g., Gatorade, Powerade, Vitamin Water) → 18. Low or no calorie sports drinks (e.g., Gatorade G2) → 19. Fruit-flavored drinks or sports drinks prepared by you/your child (e.g., Kool Aid, made-frompowder lemonade or Gatorade) → 20. Beer, Ales, Wine Coolers, Non-Alcoholic or Light Beer. → 21. Hard Liquor (shots, rum, tequila, etc.) 22. Wine (red, white, or rose) 23. Are there any other beverages you have consumed in the past month that we did not already capture? → → → Other ________________ 24. Other _________________ → 8 fl oz (1 cup) 12 fl oz (1 ½ cups) Size of a regular can of soda/pop 16 fl oz (2 cups) Size of most sports drinks or bottled drinks More than 20 fl oz cups (2 ½ cups) 25. Other _________________ → 26. Other ________________ → For ‘Other’; provide as complete a description as possible including brand, name of beverage, and any other information. ID#____________, Date ___________ 1 #2 SeaSAW Household Information Survey It is important for us to know who is in the SeaSAW study. As with all the information we collect, this household and personal information will be kept confidential and not linked to you or anyone in your family. We will not share this information with anyone else and we will combine this information with the hundreds of other children and families in SeaSAW when we report findings. About your child: What is your child’s birthdate? _________________ What is your child gender? Male Female Self-identify________________________ Is your child of Hispanic or Latino origin? (Check all that apply.) NOT HISPANIC/LATINO MEXICAN/ MEXICAN AMERICAN/ CHICANO CUBAN CENTRAL AMERICAN DOMINICAN SOUTH AMERICAN SPANIARD LATIN AMERICAN PUERTO RICAN OTHER HISPANIC/LATINO What race(s) do you consider your child? (Check all that apply.) AFRICAN AMERICAN/ BLACK/AFRICAN ALASKA NATIVE WHITE/CAUCASIAN ASIAN INDIAN CAMBODIAN CHINESE FILIPINO HMONG INDONESIAN JAPANESE KOREAN LAOTIAN MALAYSIAN PAKISTANI SINGAPOREAN TAIWANESE THAI VIETNAMESE OTHER ASIAN NATIVE HAWAIIAN FIJIAN GUAMANIAN or CHAMORRO MARIANA ISLANDER MELANESIAN MICRONESIAN SAMOAN TONGAN OTHER PACIFIC ISLANDER WASHINGTON INDIAN OTHER AMERICAN INDIAN What is your child’s current height? ______inches or _______ cm What is your child’s current weight? ______ lbs or _______ kg 2 About parent (you): Age of Parent/Caregiver: _________ Gender of Parent or Caregiver: Male Female Self-identify________________________ Are you of Hispanic or Latino origin? (Check all that apply.) NOT HISPANIC/LATINO MEXICAN/ MEXICAN AMERICAN/CHICANO CUBAN CENTRAL AMERICAN DOMINICAN SOUTH AMERICAN SPANIARD LATIN AMERICAN PUERTO RICAN OTHER HISPANIC/LATINO What race(s) do you consider yourself? (Check all that apply.) AFRICAN AMERICAN/ BLACK ALASKA NATIVE WHITE/CAUCASIAN ASIAN INDIAN CAMBODIAN CHINESE FILIPINO HMONG INDONESIAN JAPANESE KOREAN LAOTIAN MALAYSIAN PAKISTANI SINGAPOREAN TAIWANESE THAI VIETNAMESE OTHER ASIAN NATIVE HAWAIIAN FIJIAN GUAMANIAN or CHAMORRO MARIANA ISLANDER MELANESIAN MICRONESIAN SAMOAN TONGAN OTHER PACIFIC ISLANDER WASHINGTON INDIAN OTHER AMERICAN INDIAN Do you speak a language other than English at home? Yes No If yes, what language do you primary speak at home? _____________________ If yes, how well do feel that you speak English? Very well Well Not well Not at all What was your highest education level you completed? Did not complete high school 3 Completed high school or got a GED Some college or vocational training Completed college or university Completed graduate or professional degree What is the highest level of education among all the adults in your household? (Choose one) Did not complete high school Completed high school or got a GED Some college or vocational training Completed college or university Completed graduate or professional degree What is your current employment status? Unemployed Full-time caregiver or stay-at-home parent Employed full-time Employed part-time Temporary unemployed or looking for work Permanently disabled and not working Retired and currently not working On temporary medical leave Do you rent or own the house or apartment you currently live in? Rent Own Other What is your marital status? Married or living with partner Widowed/divorced/separated Single and never married 4 About Your Household Where you Shop: When you OR THE MAIN FOOD SHOPPER IN YOUR HOME go food shopping, how often do you go to each of these types of stores? Never or <1 time per month 1 time per month 1 time every other week 1 time per week 2+ times per week 11. Large supermarket such as Safeway, QFC, Fred Meyer, Albertsons, Whole Foods 1 2 3 4 5 12. Warehouse store such as Costco 1 2 3 4 5 13. Small to medium grocery store, such as Trader Joes, Red Apple, or corner market 1 2 3 4 5 14. Ethnic market or ethnic grocery store such as Uwajimaya 1 2 3 4 5 15. Discount/bargain store such as Grocery Outlet 1 2 3 4 5 16. Convenience Store, such as 7-11 or AM/PM 1 2 3 4 5 17. Farmer’s market or produce stand 1 2 3 4 5 Do you receive any federal or state assistance or benefits (please check all that apply) None SNAP WIC TANF Unemployment Insurance Other: ______________________ If yes, on what day of the month do you receive your benefit? ____________ How many people (including yourself, adults, and children) generally eat dinner or an evening meal at/from your home on average day? ________ people 5 We would like to get a better sense of your household income. Please think about the income that all earners in your household make combined. Is it easier for you to think about this for the whole year or monthly? (use the corresponding list). I am going to start reading some income ranges to you, please say ‘stop’ when we get to the range that best fits your [monthly or yearly] household income: Monthly Yearly <$500 <$6000 500 –under 1000 6000 –under 12,000 1000 –under 2000 12000 –under 24,000 2000 –under 3000 24,000 –under 36,000 3000 –under 4000 36,000 –under 48,000 4000 –under 5000 48,000 –under 60,000 5000 –under 6000 60,000 –under 72,000 6000 –under 7000 72,000 –under 84,000 7000 – under 8000 84,000 –under 96,000 8000 – under9000 96,000 –under 108,000 9000 – under 10000 108,000 –under120,000 >10000 >120,000 SECTION 3 Norms and attitudes (Year 2 Post-Tax) METHODS AND DATA COLLECTION INSTRUMENTS (2019) To study whether the implementation of the sugary beverage tax changes norms and attitudes around sugary beverage consumption, we will survey adults in Seattle and a comparison area at two years post-tax. We will compare findings to data collected pre-tax. Notable changes to this section Several additional questions have been added to the endline survey, in Seattle order to assess: 1) exposure to the tax or its campaigns; 2) changes in behavior as a result of the sugary beverage tax or its campaigns; 3) residents’ preferences as to how the tax revenue will be used. The full revised survey instruments are in Appendix 1 (Seattle) and Appendix 2 (Comparison). See below for details. Adult Survey: Norms and Attitudes Methods Overview Seven U.S. cities have now implemented sugary beverage taxes and many more are considering raising the prices of sugary beverages through taxes as a strategy to reduce their consumption. Limited prior research suggests that that sugary beverage tax messages affect public beliefs around healthfulness and that the public has varying levels of agreement with the tax itself. However, prior evaluations of sugary beverage taxes have yet to explore whether heightened attention towards sugary beverage consumption, due to the implementation of the tax, changes the public perception around sugary beverage consumption. The objective of this survey is to examine whether the implementation of the sugary beverage tax changes norms and attitudes around sugary beverage consumption and primarily focuses on three questions of interest: • What is the public perception of the sugary beverage tax over time? • Does the tax change public perception of the healthfulness of sugary beverages? • What is the public perception on the effects of the tax on people and businesses in Seattle over time? Data Collection Procedures To answer the aforementioned research questions, we will employ an observational, repeat cross-sectional study design where we will survey Seattle and a comparison group at two time points. We identified a comparison group, comprised of two areas of the U.S., that we determined to be similar to Seattle in their economic, political, and demographic characteristics, based on a comparison of demographic characteristics from the American Community Survey (ACS). The comparison area is comprised of individuals from Minneapolis, MN and the combined region of Rockville and Bethesda, MD and Arlington, VA (henceforth referred to as D.C. metro). We previously employed a mixed-mode survey, administered via the web and telephone to adults (aged 18+) in Seattle prior to the implementation of the tax (2017) and surveyed comparison area residents between December 2017 and January 2018. Data were collected with the assistance of a professional survey research firm, Ironwood Insights, LLC. Ironwood identified and recruited participants in Seattle and the comparison area based on participants’ zip code of residence and their demographic characteristics (e.g. race/ethnicity). We will survey Seattle and comparison area residents again, post-tax implementation, as early as May 2019. Recruitment and Sample Characteristics We previously surveyed 851 Seattle residents and 863 comparison area residents. We designed the survey to be able to test whether opinions about the tax were different for lower-income versus higher-income populations because low-income populations, as compared to their higher income counterparts, are more likely to consume sugary beverages. Therefore, our sampling strategy aimed to collect a large sample of low-income adults. Low-income was defined as < 260% of the Federal Poverty Line. In Seattle, of our total sample of 851 adults, we recruited 395 low-income adults (47% “low-income”) at baseline. In the comparison area, we recruited 410 low-income adults (48% “low-income”). To reach these targets, after meeting quota for above 260% FPL, we closed the phone and web survey to this group and focused on recruiting residents whose household incomes were below 260% FPL. We will employ a similar screening process at endline to ensure that our sample includes an adequate number of lower-income residents, both in Seattle (N = 400 “low-income, 800 total) and the comparison area (N= 400 “low-income”, 800 total). Last Edited: 6/21/2019 2 P age We also aimed to recruit a sample that is generally racially/ethnically representative of Seattle and the comparison area. Race/ethnicity was self-reported, based on CDC categories. In Seattle, we recruited a sample that was 73% NH-White, 8% NH-Black, 9% NH-Asian, and 7% Hispanic, similar to proportions reported in the ACS. Likewise, we recruited a sample that was generally racially/ethnically representative of the comparison areas combined (63% NH-White, 8% NH-Black, 9% NH-Asian, and 15% Hispanic). Similar to our recruitment procedures for lower-income individuals, once we reached quotas for NHWhites, we screened out NH-whites, to facilitate the recruitment a representative sample of NH-Blacks, NH-Asians, and Hispanics in each geographic area. We will employ a similar screening process at endline to ensure that our sample is generally racially/ethnically representative of Seattle and the comparison area. To recruit a diverse sample, both in terms of income and race/ethnicity, we also offered the phone-based survey in two languages (English, Spanish) and the web-based survey in three languages (English, Spanish, Vietnamese). Surveys were translated by a translation service and reviewed by two native speakers for both Spanish and Vietnamese. The same languages will be offered at endline. Survey Questions We gathered questions from various sources in order to align with previous data collection efforts (e.g. questions from surveys in Berkeley, CA, Philadelphia, PA, and previously fielded in Seattle polls [2017 and 2014]). After collating questions from all sources, we assessed question overlap and relevance to our survey, as well as sought some input from the community advisory board. The survey queried individuals on questions in the following six domains: (1) current consumption of sugary beverages (1-item); (2) norms and attitudes towards the tax itself (4-items)(e.g. individuals’ knowledge of tax and their approval/disapproval of tax); (3) norms and attitudes on unintended impacts (6-items)(e.g. intention to cross-border shop, perceptions on economic impacts, perceptions on regressivity of the tax); (4) norms and attitudes towards the healthfulness of sugary beverages (24-items)(e.g. perceptions of specific health effects, such as obesity or diabetes); (5) perceptions on government regulation of individual behaviors (1item); and (6) demographic characteristics (12-items). The survey was designed to be 15 minutes to complete, due to minimize cost and respondent burden; at baseline, the survey took approximately 14 minutes, on average. In Seattle, participants were queried specifically about the tax that was to be implemented on January 1, 2018. In the comparison area, participants were queried about sugary beverage taxes more generally. In this survey, we described the tax itself (e.g. cents per oz), explained what the tax revenue would be used for (e.g. increased access to healthier food) and then asked participants’ opinion about the tax itself using a four-category Likert scale with response options of strongly approve, somewhat approve, somewhat disapprove, and strongly disapprove. Then, to assess participants’ perceptions about the health and economic impacts of the tax, each participant was read two statements and asked to indicate if the first statement was much or somewhat closer or the second statement was much or somewhat closer to her/his belief. For example, participants were asked whether the statement I will travel to another city to buy sugary drinks so I don't have to pay the tax was somewhat or much closer to their own view as compared to the statement I will not travel to another city to buy sugary drinks because of the tax. For simplifying the reporting of the results, we collapsed the responses from four-category variables to two-category variables, since preliminary analyses indicated that the direction of the associations and statistical significance were similar when using a two- or four-category variable. “Strongly” and “somewhat” agree were collapsed into “agree”, “strongly” and “somewhat” disagree were collapsed into “disagree”. Similarly, “somewhat” and “much” closer for the matched pair statements were collapsed to capture Last Edited: 6/21/2019 3 P age respondents’ agreement with that statement. Respondents were also given the option to report “don’t know” or “refuse”. Several additional questions have been added to the endline survey, in Seattle order to assess: 1) exposure to the tax or its campaigns; 2) changes in behavior as a result of the sugary beverage tax or its campaigns; 3) residents’ preferences as to how the tax revenue will be used. Appendix 1 and Appendix 2 details the full revised instruments for Seattle and comparison area, respectively. Analysis Baseline We assessed the following using descriptive statistics in both Seattle and the comparison area: 1) overall approval of the sugary beverage tax; 2) perceptions of the health impacts of the sugary beverage tax, 3) perceptions of the economic impacts of the sugary beverage tax; and 4) consumption and perceived healthfulness of sugary beverages. In Seattle, we also reported respondents’ perceptions on tax impacts and the healthfulness of sugary beverages stratified by income (lower- versus higher-income) and race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic Other, and Hispanic). All results were weighted to be representative of the populations in Seattle and comparison areas. We created survey weights using the raking method, a post-stratification procedure whereby the adjusted weights add up to the known population totals (as determined by the 5-year ACS). The raking method is based on the iterative proportional fitting algorithm first proposed by Deming and Stephan (1940). It is a stepwise adjustment of survey sampling weights to achieve known population margins. Data were weighted by race/ethnicity (NH white, NH Black, NH Asian, NH Other, Hispanic), age (18-65, 65 +), sex (male, female), and household income (< 30K, 30 – 59K, 60K +). For our comparison area, the derived weight is a weighted average based on the prevalence of the characteristic in the ACS and the number of individuals from each area in our data. 1 Endline We will explore the following, comparing Seattle to comparison area participations, using regressionbased difference-in-difference models: 1) approval of the sugary beverage tax; 2) perceptions of the health impacts of the sugary beverage tax; 3) perceptions of the economic impacts of the sugary beverage tax; and 4) consumption and perceived healthfulness of sugary beverages. In addition, we will test for heterogeneity in the associations by income and race/ethnicity. Endline results will be weighted to be representative of the populations in Seattle and comparison areas. Limitations Because we used a survey company to recruit participants and administer our survey, our sample consists of people who participate in existing panels. Thus, this method of data collection may introduce selection bias (i.e. attract those that are more inclined to participant in surveys and/or research). It is plausible that 1 The percent of participants in our comparison areas was as follows: 53% resided in Minneapolis Minnesota, 21% resided in Rockville, Maryland, 7% resided in Bethesda, Maryland, and 19% resided in Arlington, Virginia. Therefore, the prevalence of non-Hispanic Blacks (for example) was multiplied as follows: 0.53 for Minneapolis, 0.21 for Rockville, 0.07 for Bethesda, and 0.19 for Arlington so that the derived weight sums to 100% and is a weighted average based on the prevalence of the characteristic in the ACS and the number of individuals from each area in our data. Last Edited: 6/21/2019 4 P age respondents may answer questions about healthfulness of sugary beverages in a way that is socially desirable, thus introducing social desirability bias. Our study may not be generalizable beyond Seattle (and comparison areas). Our baseline data is cross-sectional and our endline analyses will rely on data from repeat cross-sections, rather than longitudinal data; thus, unmeasured or residual confounding are possible. Finally, we also cannot assess whether respondents and non-responders differed substantially in terms of their demographic characteristics or in their support for sugary beverage taxes. If responding to the survey is correlated with opinions about the sugary beverage tax, it could bias the study findings. Last Edited: 6/21/2019 5 P age Appendix 1. Seattle Norms and Attitudes Survey Phone Version 6 (6/21/2019) Hello, my name is ___________. I’m working with the University of Washington and I am looking for someone to answer some questions about the sugary drink tax that was implemented in January 2018 in Seattle. There are no right or wrong answers and your answers will be kept confidential. Do you have a few minutes to answer some brief questions? INTERVIEWER NOTE: if needed, the survey will take about 15 minutes to complete. Screener Questions First, I’d like to ask you a few questions about your household to make sure you are eligible for this survey. 1. Can you tell me what zip code you live in? _______________________ INTERVIEWER NOTES: IF respondent does not live in any of the zip codes listed below, TERMINATE IF respondent lives in a zip code entirely within city limits CONTINUE If respondent lives in zip code that borders Northern city limits ask question 2 If respondent lives in zip code that borders Southern city limits as question 3 If DK OR REFUSED - TERMINATE Zip codes clearly in Seattle city limits: 98101, 98102, 98103, 98104, 98105, 98107, 98109, 98112, 98115, 98116, 98119, 98121, 98122, 98125, 98126, 98134, 98144, 98154, 98164, 98174, 98177, 98195, 98199 Zip codes the overlap Seattle city limits in North: 98133, 98117 Zip codes the overlap Seattle city limits in South: 98146, 98136, 98106, 98108, 98118, 98178 2. Do you live above or below 145th street?  Above [TERMINATE]  Below [CONTINUE] DK/REFUSED - TERMINATE 3. Do you live within Seattle city limits?  No [TERMINATE]  Yes [CONTINUE] DK / REFUSED - TERMINATE 4. Are you of Hispanic or Latino origin? (Check all that apply)  No, not of Hispanic, Latino or Spanish origin  Yes, Mexican, Mexican American or Chicano  Yes, Puerto Rican  Yes, Cuban  Yes, another Hispanic, Latino or Spanish origin  DON’T KNOW  REFUSED 5. What race(s) do you consider yourself? (Check all that apply)  White  Black or African American  American Indian or Alaska Native (ASSIGN TO OTHER)  Asian  Native Hawaiian or Other Pacific Islander (ASSIGN TO OTHER)  Other _________________________  DON’T KNOW - TERMINATE  REFUSED - TERMINATE 6. How many adults (including yourself) live in your household? _______ adults IF DK/REFUSED - TERMINATE 7. How many children under 18 live in your household? ________ children IF DK/REFUSED TERMINATE 8. Is your total annual household income above or below_________ per year? IF DK/REFUSED TERMINATE INTERVIEWER NOTE: use chart to get household size specific value for 260% FPL for this household  Above (“high” income)  Below (“low” income) PROGRAMMING INSTRUCTIONS Household Size Add Q2+Q3 1 2 3 4 5 6 Domain 1: Current Consumption Annual 260% Insert in Q8 $ 32,472 $ 43,968 $ 55,464 $ 66,948 $ 78,444 $ 89,940 INTERVIEWER: READ DRINK TYPES IN BOLD ONLY – READ BRANDS IN PARENTHESIS ONLY IF NEEDED Because we will be talking today about sugary drinks, I want to start off by telling you what we mean when we refer to sugary drinks. Sugary drinks include regular soft drinks, soda or pop (such as Coke, Pepsi, Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper), fruit-flavored drinks (such lemonade, Sunny Delight, Hawaiian Punch), sports drinks (such as Gatorade, Powerade), sweetened teas or coffees (such as Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mochas, or bubble teas), and energy drinks (such as Red Bull, Rockstar, Monster). They do NOT include milk, 100% fruit juice, diet drinks, or artificially sweetened drinks. To start off, I’m interested in learning about whether you drink sugary drinks. 1. During the past 30 days, did you drink sugary drinks never or less than 1 time per week, 1 time per week, 2-6 times per week, 1 time per day, or 2 or more times per day?  Never or less than 1 time per week  1 time per week  2-6 times per week  1 time per day  2 or more times per day  Don't know  REFUSED 2. Have you changed how much you drink sugary drinks in the last year?  Yes  if yes,  More  Less  No  Don’t know  REFUSED INTERVIEWER NOTE: Skip questions 3-5 if respondent answered, “no” to question 2 or “yes and MORE” to question 2. 3. Was the sugary drink tax and/or its campaign one of the reasons you drank less?  Yes  No  Don’t know  REFUSED 4. What is the primary reason you have changed what you drink in the last year?  Health  Sugary drink tax  Cost  Taste  Convenience  Other  Don’t know  REFUSED INTERVIEWER and PROGRAMMING NOTE: Can select multiple options to # 5. 5. If you now drink something instead of a sugary drink, which of the following do you drink instead: tap water, filtered tap water, bottled water, unflavored milk, unsweetened coffee or tea, or diet drinks?  Tap water  Filtered tap water  Bottled water (READ ONLY IF NECESSARY e.g., Aquafina, Dasani, Smart Water, La Croix, Mio)  Unflavored Milk  Unsweetened coffee or tea  Diet drinks (READ ONLY IF NECESSARY e.g. Diet coke, Coke Zero Sugar, Diet Pepsi)  None, respondent does not drink other drinks instead of sugary drinks  Don’t know  REFUSED Domain 2: Norms/Attitudes towards tax itself Next, I’d like to tell you a little bit about the new tax on sugary drinks in Seattle. On January 1, 2018, the City of Seattle started taxing sugary drinks. In Seattle, large distributors now pay a 1.75 cents per ounce tax on sugary drinks. Taxed beverages include drinks that have added sugar. The tax does NOT include diet beverages, 100% fruit juices, or milk products. Money from the tax will help give more people access to healthy and affordable food, expand early education for pre-school aged kids, and help high school graduates enter college. 6. Have you heard of this tax, yes or no?  Yes  No  Don’t know  REFUSED INTERVIEWER NOTE: Skip question 7 if respondent answered, “no” to question 6. 7. In your own words, what has been your experience with Seattle’s sugary drink tax? 8. Based on what you know, do you strongly disapprove, somewhat disapprove, somewhat approve, strongly approve of this tax?  Strongly disapprove  Somewhat disapprove  Somewhat approve  Strongly approve  Don’t know  REFUSED INTERVIEWER NOTE: Skip questions 9-10 if respondent answered, “no” to question 6. 9. In past 6 months, have you seen, heard, or read anything POSITIVE about the sugary drink tax?  Yes  No  Don’t know  REFUSED 10. In past 6 months, have you seen, heard, or read anything NEGATIVE about the sugary drink tax?  Yes  No  Don’t know  REFUSED 11. I’m going to read you pairs of statements that people have made about this new tax on sugary drinks. After I read each pair, please tell me which statement is closer to your own view, even if neither is exactly right. (INTERVIEWER PROMPT) Which statement comes closer to your own view? ____ 11A 1. This tax WILL improve public health in Seattle. 2. This tax will NOT improve public health in Seattle. ____ 11B 1. This tax WILL improve the health and well-being of children in Seattle. 2. This tax will NOT improve the health and well-being of children in Seattle. (AFTER CHOICE IS MADE, INTERVIEWER PROBE:) Is that MUCH closer or SOMEWHAT closer?  FIRST statement is MUCH closer  FIRST statement is SOMEWHAT closer  SECOND statement is MUCH closer  SECOND statement is SOMEWHAT closer  Don’t know  REFUSED Domain 3: Unintended Impacts Now, I’d like to ask a few questions on how the new tax on sugary drinks might be affecting people and businesses in Seattle. 12. Like I did earlier, I’m going to read you pairs of statements that people have made about this tax on sugary drinks. After I read each pair, please tell me which statement is closer to your own view, even if neither is exactly right. (INTERVIEWER PROMPT) Which statement comes closer to your own view? Statement 1: This tax WILL be more burdensome for people with low-income and people of color in Seattle. ____ 12A Statement 2: This tax WILL NOT be more burdensome for people with lowincome and people of color in Seattle. Statement 1: This tax WILL improve health and well-being for people with low-income and people of color. ____ 12B ____ 12C ____ 12D ____ 12E Statement 2: This tax WILL NOT improve health and well-being for people with low-income and people of color. Statement 1: I travel to another city to buy sugary drinks so I don’t have to pay the tax. Statement 2: I do NOT travel to another city to buy sugary drinks because of the tax. Statement 1: This tax will have a POSITIVE effect on Seattle's economy. Statement 2: This tax will have a NEGATIVE effect on Seattle's economy. Statement 1: This tax WILL have a negative effect on small businesses in Seattle. Small businesses may lose money and could even go out of business because of the tax. Statement 2: This tax will NOT have negative effects on small businesses in Seattle. It’s not likely that businesses will lose money or go out of business because of the tax. Statement 1: This tax WILL result in job loss in Seattle. ____ 12F ____ 12G Statement 2: This tax will NOT result in job loss in Seattle. Statement 1: This tax WILL have a negative impact on my family's finances Statement 2: This tax will NOT have a negative impact on my family's finances. ____12H Statement 1: This tax will have a POSITIVE impact on people with lowincome and people of color’s health and well-being and help them access affordable, healthy food in Seattle. Statement 2: This tax will have a NEGATIVE impact on people with lowincome and people of color’s finances, will drive up the cost of living for those who can least afford to pay the tax, and further increase income inequality. (AFTER CHOICE IS MADE, INTERVIEWER PROBE:) Is that MUCH closer or SOMEWHAT closer?  FIRST statement is MUCH closer  FIRST statement is SOMEWHAT closer  SECOND statement is MUCH closer  SECOND statement is SOMEWHAT closer  Don’t know  REFUSED Domain 4: Norms/Attitudes towards healthfulness of sugary drinks INTERVIEWER: READ DRINK TYPES IN BOLD ONLY – READ BRANDS IN PARENTHESIS ONLY IF NEEDED Remembering back to how I defined sugary drinks earlier, I am now going to read you some statements about how sugary drinks affect health. Would it help if I repeated the definition? (INTERVIEWER NOTE: IF YES, read: Sugary drinks include regular soft drinks, soda or pop (such as Coke, Pepsi, Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper), fruit-flavored drinks (such lemonade, Sunny Delight, Hawaiian Punch), sports drinks (such as Gatorade, Powerade), sweetened teas or coffees (such as Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mochas, or bubble teas), and energy drinks (such as Red Bull, Rockstar, Monster). They do NOT include milk, 100% fruit juice, diet drinks, or artificially sweetened drinks.) 13. Using a scale of 1 to 4, where 1 means Strongly Disagree and 4 means Strongly Agree, how much do you agree or disagree with the following statements. [READ EACH STATEMENT; REPEAT SCALE AS NEEDED] Responses are:  Strongly disagree  Somewhat disagree  Somewhat agree  Strongly agree  Don’t know  REFUSED INTERVIEWER: READ ‘DRINKING SUGARY DRINKS’ WITH FIRST STATEMENT – THEN REPEAT ONLY AS NECESSARY… i. Drinking sugary drinks causes serious health problems. ii. Drinking sugary drinks significantly raises a person’s chances of dental health problems, including cavities and tooth decay. iii. Drinking sugary drinks significantly raises a person’s chances of obesity. iv. Drinking sugary drinks significantly raises a person’s chances of diabetes. v. Drinking sugary drinks significantly raises a person’s chances of heart disease. 14. Using the same scale of 1 means strongly Disagree and 4 means Strongly Agree, how much do you agree or disagree that consuming excessive amounts of sugar from any source, not only from drinks but also from foods such as cookies or cereals, can lead to serious health problems.  Strongly disagree  Somewhat disagree  Somewhat agree  Strongly agree  Don’t know  REFUSED 15. Now, thinking about how sugary drinks affect health, what is the MOST people should drink them? READ IF NECESSARY: Please tell me if it’s never or less than 1 time per week, 1 time per week, 2-6 times per week, 1 time per day, or 2 or more times per day.  Never or less than 1 time per week 1 time per week  2-6 times per week  1 time per day  2 or more times per day  Don't know  REFUSED 16. Next, I am going to read a list of the types of sugary drinks. Please tell me whether you think regularly drinking each type of drink doesn’t increase, probably increases, or definitely increases a person’s chances of developing health problems like diabetes or becoming overweight. (INTERVIEWER NOTE: READ ITEMS IN RANDOM ORDER – READ BRANDS IN PARENTHESIS ONLY IF NECESSARY) i. ii. iii. iv. Regular soft drinks, soda or pop, not including diet (e.g. Coke, Pepsi, Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper) Fruit-Flavored drinks (e.g. lemonade, Sunny Delight, Hawaiian Punch) Sports drinks (e.g. Gatorade, Powerade) Sweetened teas or coffees (e.g. Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mocha, or bubble teas) v. Energy drinks (e.g. Red Bull, Rockstar, Monster) Responses for each drink are:  Doesn’t increase  Probably increases  Definitely increases  Don’t know  REFUSED Programming Note. Deleted prior questions 10 and 11 on substitution Domain 5: Norms/attitudes towards government regulation of individual behaviors 17. Similar to prior questions, I'm going to read you a pair of statements. After I read both statements please tell me which one comes closer to your own view, even if neither is exactly right. (INTERVIEWER PROMPT) Which statement comes closer to your own view? Statement 1: Under this tax, people still have the CHOICE to drink what they want. Statement 2: This tax significantly LIMITS people's ability to choose what they drink. (AFTER CHOICE IS MADE, INTERVIEWER PROBE:) Is that MUCH closer or SOMEWHAT closer?  FIRST statement MUCH closer  FIRST statement SOMEWHAT closer  SECOND statement MUCH closer  SECOND statement SOMEWHAT closer  Don’t know  REFUSED Domain 6: Opinions on Tax Revenues 18. Money from the sugary drink tax has been used to improve food access and expand services and support for young children (from birth to age 3), for people with lower-incomes, and for people of color in Seattle. Do you think these are the right priorities to invest money that comes from the tax?  Yes  SKIP to question 19  No  what do you suggest is a better area to invest tax revenue? [open ended] 19. To address food access, the money raised by the tax may be used to fund the following initiatives. How would you rank these initiatives, with 1 being most important and 4 being the least important: ____ Vouchers to low-income residents so they can buy more fruits and vegetables ____ Funds to improve the quality of food offered to lower income children in childcare programs, schools, and after-school programs ____ Food banks and meal programs ____ Community led organizations working to increase access to healthy food. 20. To address early childhood development, the money raised by the tax may be used to fund the following initiatives. How would you rank these initiatives, with 1 being most important and 4 being the least important: ____ Vouchers/subsidies to lower-income, working families to help them afford childcare ____ Funds to support child development training and coaching for childcare providers, to improve the quality of care they provide to young children ____ Funds for specialized support to families with young children who have developmental delays ____ Provide basic supplies directly to low-income families such as, clothes, maternity supplies, diapers, books. Domain 7: Conclusion and Demographics 21. After hearing more about the tax, let me ask you again, do you strongly disapprove, somewhat disapprove, somewhat approve, or strongly approve of this tax?  Strongly disapprove  Somewhat disapprove  Somewhat approve  Strongly approve  Don’t know  REFUSED Finally, I want to ask you a few questions about yourself and your household. 22. What is your age?  18-30  31-40  41-50  51-64  65+  REFUSED 23. What is your gender?  Male  Female  Self-identify (Specify:_______________  REFUSED 24. What was your highest education level you completed?  Some high school  Completed high school  Some college or vocational training  Completed college or university  Completed graduate or professional degree  REFUSED 25. What is your marital status?  Married  Widowed/divorced/separated  Single and never married  Living with partner  REFUSED 26. Now, we don’t want to know your exact income, but just roughly, could you tell me if your annual household income before taxes is:  <$30,000  $30,000-$59,999  $60,000-$89,999  $90,000-$120,000  >$120,000  DON’T KNOW  REFUSED 27. Can you tell me if you have been covered by Medicaid in the last 12 months?  Yes  No  DON’T KNOW  REFUSED 28. Generally speaking, do you think of yourself as (ROTATE) a Democrat, an Independent, a Republican, or what?  Democrat  Independent  Republican  Other (SPECIFY)  DON’T KNOW  REFUSED 29. To help us make sure people from all Seattle neighborhoods are included in this survey, we would like to know the nearest intersection to your home. Please name the two cross-streets of this intersection. What is the name of the first street? ___________________________ INTERVIEWER NOTE: Confirm street spelling and directionals (e.g. N, S, NW, NE) What is the name of the second street?_________________________ INTERVIEWER NOTE: Confirm street spelling and directionals (e.g. N, S, NW, NE) CLOSING: Those are all of our questions. Thank you for taking the time to complete our survey. Appendix 2. Comparison Norms and Attitudes Survey Phone Version 4 (6/21/2019) Hello, my name is ___________. I’m working with the University of Washington and I am looking for someone to answer some questions about the sugary drink taxes. There are no right or wrong answers and your answers will be kept confidential. Do you have a few minutes to answer some brief questions? INTERVIEWER NOTE: if needed, the survey will take about 15 minutes to complete. Screener Questions First, I’d like to ask you a few questions about your household to make sure you are eligible for this survey. 1. Can you tell me what zip code you live in? _______________________ (PROGRAMMING – LIST ATTACHED TO END OF DOCUMENT) INTERVIEWER NOTES: IF respondent does not live in any of the zip codes listed below, TERMINATE If DK OR REFUSED - TERMINATE 2. Are you of Hispanic or Latino origin? (Check all that apply)  No, not of Hispanic, Latino or Spanish origin  Yes, Mexican, Mexican American or Chicano  Yes, Puerto Rican  Yes, Cuban  Yes, another Hispanic, Latino or Spanish origin  DON’T KNOW  REFUSED 3. What race(s) do you consider yourself? (Check all that apply)  White  Black or African American  American Indian or Alaska Native (ASSIGN TO OTHER)  Asian  Native Hawaiian or Other Pacific Islander (ASSIGN TO OTHER)  Other _________________________  DON’T KNOW - TERMINATE  REFUSED - TERMINATE 4. How many adults (including yourself) live in your household? _______ adults IF DK/REFUSED - TERMINATE 5. How many children under 18 live in your household? ________ children IF DK/REFUSED TERMINATE 6. Is your total annual household income above or below_________ per year? IF DK/REFUSED TERMINATE INTERVIEWER NOTE: use chart to get household size specific value for 260% FPL for this household  Above (“high” income)  Below (“low” income) PROGRAMMING INSTRUCTIONS Household Size Add Q2+Q3 1 2 3 4 5 6 Annual 260% Insert in Q8 $ 32,472 $ 43,968 $ 55,464 $ 66,948 $ 78,444 $ 89,940 Domain 1: Current Consumption INTERVIEWER: READ DRINK TYPES IN BOLD ONLY – READ BRANDS IN PARENTHESIS ONLY IF NEEDED Because we will be talking today about sugary drinks, I want to start off by telling you what we mean when we refer to sugary drinks. Sugary drinks include regular soft drinks, soda or pop (such as Coke, Pepsi, Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper), fruit-flavored drinks (such lemonade, Sunny Delight, Hawaiian Punch), sports drinks (such as Gatorade, Powerade), sweetened teas or coffees (such as Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mochas, or bubble teas), and energy drinks (such as Red Bull, Rockstar, Monster). They do NOT include milk, 100% fruit juice, diet drinks, or artificially sweetened drinks. To start off, I’m interested in learning about whether you drink sugary drinks. 1. During the past 30 days, did you drink sugary drinks never or less than 1 time per week, 1 time per week, 2-6 times per week, 1 time per day, or 2 or more times per day?  Never or less than 1 time per week  1 time per week  2-6 times per week  1 time per day  2 or more times per day  Don't know  REFUSED 2. Have you changed how much you drink sugary drinks in the last year?  Yes  if yes,  More  Less  No  Don’t know  REFUSED INTERVIEWER NOTE: Skip questions 3-5 if respondent answered, “no” to question 2 or “yes and MORE” to question 2. 3. Were sugary drink taxes and/or their campaigns one of the reasons you drank less?  Yes  No  Don’t know  REFUSED 4. What is the primary reason you have changed what you drink in the last year?  Health  Sugary drink taxes  Cost  Taste  Convenience  Other  Don’t know  REFUSED INTERVIEWER and PROGRAMMING NOTE: Can select multiple options to # 5. 5. If you now drink something instead of a sugary drink, which of the following do you drink instead: tap water, filtered tap water, bottled water, unflavored milk, unsweetened coffee or tea, or diet drinks?  Tap water  Filtered tap water  Bottled water (READ ONLY IF NECESSARY e.g., Aquafina, Dasani, Smart Water, La Croix, Mio)  Unflavored Milk  Unsweetened coffee or tea  Diet drinks (READ ONLY IF NECESSARY e.g. Diet coke, Coke Zero Sugar, Diet Pepsi)  None, respondent does not drink other drinks instead of sugary drinks  Don’t know  REFUSED Domain 2: Norms/Attitudes towards tax itself Next, I’d like to ask you a little bit about taxes on sugary drinks. Seven U.S. cities have now implemented sugary drink taxes. For example, in one city, large distributors now pay a 1.75 cents per ounce tax on sugary drinks. Taxed drinks include drinks that have added sugar. The tax will NOT include diet drinks, 100% fruit juices, or milk products. Money from the tax will help give more people access to healthy and affordable food, expand early education for pre-school aged kids, and help high school graduates enter college. 6. Have you heard of this kind of tax, yes or no?  Yes  No  Don’t know  REFUSED INTERVIEWER NOTE: Skip question 7 if respondent answered, “no” to question 6. 7. In your own words, what has been your experience with sugary drink taxes? 8. Based on what you know, would you strongly disapprove, somewhat disapprove, somewhat approve, strongly approve of this tax in your city/in [city of respondent] ?  Strongly disapprove  Somewhat disapprove  Somewhat approve  Strongly approve  Don’t know  REFUSED 9. In past 6 months, have you seen, heard, or read anything POSITIVE about sugary drink taxes?  Yes  No  Don’t know  REFUSED 10. In past 6 months, have you seen, heard, or read anything NEGATIVE about sugary drink taxes?  Yes  No  Don’t know  REFUSED 11. I’m going to read you pairs of statements that people have made about these taxes on sugary drinks. After I read each pair, please tell me which statement is closer to your own view, even if neither is exactly right. (INTERVIEWER PROMPT) Which statement comes closer to your own view? ____ 11A 1. These taxes WOULD improve public health. 2. These taxes WOULD NOT improve public health. ____ 11B 1. These taxes WOULD improve the health and well-being of children. 2. These taxes WOULD NOT improve the health and well-being of children. (AFTER CHOICE IS MADE, INTERVIEWER PROBE:) Is that MUCH closer or SOMEWHAT closer?  FIRST statement is MUCH closer  FIRST statement is SOMEWHAT closer  SECOND statement is MUCH closer  SECOND statement is SOMEWHAT closer  Don’t know  REFUSED Domain 3: Unintended Impacts Now, I’d like to ask a few questions on how these new taxes on sugary drinks might affect people and businesses. 12. Like I did earlier, I’m going to read you pairs of statements that people have made about sugary drink taxes. After I read each pair, please tell me which statement is closer to your own view, even if neither is exactly right. (INTERVIEWER PROMPT) Which statement comes closer to your own view? Statement 1: These taxes WILL be more burdensome for people with lowincome and people of color. ____ 12A Statement 2: These taxes WILL NOT be more burdensome for people with low-income and people of color. Statement 1: These taxes WILL improve health and well-being for people with low-income and people of color. ____ 12B Statement 2: These taxes WILL NOT improve health and well-being for people with low-income and people of color. ____ 12C ____ 12D ____ 12E Statement 1: I WOULD travel to another city to buy sugary drinks so I don’t have to pay the tax. Statement 2: I WOULD NOT travel to another city to buy sugary drinks because of the tax. Statement 1: These taxes WOULD have a POSITIVE effect on the economy. Statement 2: These taxes WOULD have a NEGATIVE effect on the economy. Statement 1: These taxes WOULD have a negative effect on small businesses. Small businesses may lose money and could even go out of business because of the tax. Statement 2: These taxes WOULD NOT have negative effects on small businesses. It’s not likely that businesses will lose money or go out of business because of the tax. Statement 1: These taxes WOULD result in job loss. ____ 12F Statement 2: These taxes WOULD NOT result in job loss. ____ 12G Statement 1: These taxes WOULD have a negative impact on my family's finances Statement 2: These taxes WOULD NOT have a negative impact on my family's finances. ____12H Statement 1: These taxes would have a POSITIVE impact on low-income and minority people’s health and well-being and help them access affordable, healthy food. Statement 2: These taxes would have a NEGATIVE impact on low-income and minority people’s finances, would drive up the cost of living for those who can least afford to pay the tax, and further increase income inequality. (AFTER CHOICE IS MADE, INTERVIEWER PROBE:) Is that MUCH closer or SOMEWHAT closer?  FIRST statement is MUCH closer  FIRST statement is SOMEWHAT closer  SECOND statement is MUCH closer  SECOND statement is SOMEWHAT closer  Don’t know  REFUSED Domain 4: Norms/Attitudes towards healthfulness of sugary drinks INTERVIEWER: READ DRINK TYPES IN BOLD ONLY – READ BRANDS IN PARENTHESIS ONLY IF NEEDED Remembering back to how I defined sugary drinks earlier, I am now going to read you some statements about how sugary drinks affect health. Would it help if I repeated the definition? (INTERVIEWER NOTE: IF YES, read: Sugary drinks include regular soft drinks, soda or pop (such as Coke, Pepsi, Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper), fruit-flavored drinks (such lemonade, Sunny Delight, Hawaiian Punch), sports drinks (such as Gatorade, Powerade), sweetened teas or coffees (such as Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mochas, or bubble teas), and energy drinks (such as Red Bull, Rockstar, Monster). They do NOT include milk, 100% fruit juice, diet drinks, or artificially sweetened drinks.) 13. Using a scale of 1 to 4, where 1 means Strongly Disagree and 4 means Strongly Agree, how much do you agree or disagree with the following statements. [READ EACH STATEMENT; REPEAT SCALE AS NEEDED] Responses are:  Strongly disagree  Somewhat disagree  Somewhat agree  Strongly agree  Don’t know  REFUSED INTERVIEWER: READ ‘DRINKING SUGARY DRINKS’ WITH FIRST STATEMENT – THEN REPEAT ONLY AS NECESSARY… i. Drinking sugary drinks causes serious health problems. ii. Drinking sugary drinks significantly raises a person’s chances of dental health problems, including cavities and tooth decay. iii. Drinking sugary drinks significantly raises a person’s chances of obesity. iv. Drinking sugary drinks significantly raises a person’s chances of diabetes. v. Drinking sugary drinks significantly raises a person’s chances of heart disease. 14. Using the same scale of 1 means strongly Disagree and 4 means Strongly Agree, how much do you agree or disagree that consuming excessive amounts of sugar from any source, not only from drinks but also from foods such as cookies or cereals, can lead to serious health problems.  Strongly disagree  Somewhat disagree  Somewhat agree  Strongly agree  Don’t know  REFUSED 15. Now, thinking about how sugary drinks affect health, what is the MOST people should drink them? READ IF NECESSARY: Please tell me if it’s never or less than 1 time per week, 1 time per week, 2-6 times per week, 1 time per day, or 2 or more times per day.  Never or less than 1 time per week 1 time per week  2-6 times per week  1 time per day  2 or more times per day  Don't know  REFUSED 16. Next, I am going to read a list of the types of sugary drinks. Please tell me whether you think regularly drinking each type of drink doesn’t increase, probably increases, or definitely increases a person’s chances of developing health problems like diabetes or becoming overweight. (INTERVIEWER NOTE: READ ITEMS IN RANDOM ORDER – READ BRANDS IN PARENTHESIS ONLY IF NECESSARY) i. ii. iii. iv. v. Regular soft drinks, soda or pop, not including diet (e.g. Coke, Pepsi, Sprite, Root Beer, Orange Soda, Jarritos, Dr. Pepper) Fruit-Flavored drinks (e.g. lemonade, Sunny Delight, Hawaiian Punch) Sports drinks (e.g. Gatorade, Powerade) Sweetened teas or coffees (e.g. Arizona Iced Tea, Snapple, Pure Leaf, Starbucks Frappuccino, mocha, or bubble teas) Energy drinks (e.g. Red Bull, Rockstar, Monster) Responses for each drink are:  Doesn’t increase  Probably increases  Definitely increases  Don’t know  REFUSED Programming Note. Deleted prior questions 10 and 11 on substitution Domain 5: Norms/attitudes towards government regulation of individual behaviors 17. Similar to prior questions, I'm going to read you a pair of statements. After I read both statements please tell me which one comes closer to your own view, even if neither is exactly right. (INTERVIEWER PROMPT) Which statement comes closer to your own view? Statement 1: Under these taxes, people would still have the CHOICE to drink what they want. Statement 2: These taxes would significantly LIMIT people's ability to choose what they drink. (AFTER CHOICE IS MADE, INTERVIEWER PROBE:) Is that MUCH closer or SOMEWHAT closer?  FIRST statement MUCH closer  FIRST statement SOMEWHAT closer  SECOND statement MUCH closer  SECOND statement SOMEWHAT closer  Don’t know  REFUSED Domain 6: Opinions on Tax Revenues 18. Money from sugary drink taxes has been used to improve food access and expand services and support for young children (from birth to age 3), for people with lower-incomes, and for people of color. Do you think these are the right priorities to invest money that comes from these taxes?  Yes  SKIP to question 19  No  what do you suggest is a better area to invest tax revenue? [open ended] 19. To address food access, the money raised by sugary beverage taxes may be used to fund the following initiatives. How would you rank these initiatives, with 1 being most important and 4 being the least important: ____ Vouchers to low-income residents so they can buy more fruits and vegetables ____ Funds to improve the quality of food offered to lower income children in childcare programs, schools, and after-school programs ____ Food banks and meal programs ____ Community led organizations working to increase access to healthy food. 20. To address early childhood development, the money raised by sugary beverage taxes may be used to fund the following initiatives. How would you rank these initiatives, with 1 being most important and 4 being the least important: ____ Vouchers/subsidies to lower-income, working families to help them afford childcare ____ Funds to support child development training and coaching for childcare providers, to improve the quality of care they provide to young children ____ Funds for specialized support to families with young children who have developmental delays ____ Provide basic supplies directly to low-income families such as, clothes, maternity supplies, diapers, books. Domain 7: Conclusion and Demographics 21. After hearing more about these taxes, let me ask you again, would you strongly disapprove, somewhat disapprove, somewhat approve, or strongly approve of this tax in your city/in [city of respondent]?  Strongly disapprove  Somewhat disapprove  Somewhat approve  Strongly approve  Don’t know  REFUSED Finally, I want to ask you a few questions about yourself and your household. 22. What is your age?  18-30  31-40  41-50  51-64  65+  REFUSED 23. What is your gender?  Male  Female  Self-identify (Specify:_______________  REFUSED 24. What was your highest education level you completed?  Some high school  Completed high school  Some college or vocational training  Completed college or university  Completed graduate or professional degree  REFUSED 25. What is your marital status?  Married  Widowed/divorced/separated  Single and never married  Living with partner  REFUSED 26. Now, we don’t want to know your exact income, but just roughly, could you tell me if your annual household income before taxes is:  <$30,000  $30,000-$59,999  $60,000-$89,999  $90,000-$120,000  >$120,000  DON’T KNOW  REFUSED 27. Can you tell me if you have been covered by Medicaid in the last 12 months?  Yes  No  DON’T KNOW  REFUSED 28. Generally speaking, do you think of yourself as (ROTATE) a Democrat, an Independent, a Republican, or what?  Democrat  Independent  Republican  Other (SPECIFY)  DON’T KNOW  REFUSED 29. To help us make sure people from all neighborhoods are included in this survey, we would like to know the nearest intersection to your home. Please name the two cross-streets of this intersection. What is the name of the first street? ___________________________ INTERVIEWER NOTE: Confirm street spelling and directionals (e.g. N, S, NW, NE) What is the name of the second street?_________________________ INTERVIEWER NOTE: Confirm street spelling and directionals (e.g. N, S, NW, NE) CLOSING: Those are all of our questions. Thank you for taking the time to complete our survey. ZIP CODE LIST Minneapolis, MN ZIP County 55401 Hennepin 55402 Hennepin 55403 Hennepin 55404 Hennepin 55405 Hennepin 55406 Hennepin 55407 Hennepin 55408 Hennepin 55409 Hennepin 55410 Hennepin 55411 Hennepin 55412 Hennepin 55413 Hennepin 55414 Hennepin 55415 Hennepin 55416 Hennepin 55417 Hennepin 55418 Hennepin 55419 Hennepin 55420 Hennepin 55421 Anoka 55422 Hennepin 55423 Hennepin 55424 Hennepin 55425 Hennepin 55426 Hennepin 55427 Hennepin 55428 Hennepin 55429 Hennepin 55430 Hennepin 55431 Hennepin 55432 Anoka 55433 Anoka 55434 Anoka 55435 Hennepin 55436 Hennepin 55437 Hennepin State MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN 55438 55439 55440 55441 55442 55443 55444 55445 55446 55447 55448 55449 55450 55454 55455 55458 55459 55460 55467 55470 55472 55473 55474 55478 55479 55480 55483 55484 55485 55486 55487 55488 Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Anoka Anoka Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin Hennepin MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN Arlington, VA ZIP County 22201 Arlington 22202 Arlington 22203 Arlington 22204 Arlington 22205 Arlington 22206 Arlington 22207 Arlington 22209 Arlington 22210 Arlington 22211 Arlington 22212 Arlington 22213 Arlington 22214 Arlington 22215 Arlington 22216 Arlington 22217 Arlington 22219 Arlington 22222 Arlington 22225 Arlington 22226 Arlington 22227 Arlington 22230 Arlington 22240 Arlington 22241 Arlington 22242 Arlington 22243 Arlington 22244 Arlington 22245 Arlington 22246 Arlington State VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA Rockville, MD ZIP County 20847 Montgomery 20848 Montgomery 20849 Montgomery 20850 Montgomery 20851 Montgomery 20852 Montgomery 20853 Montgomery 20854 Montgomery 20855 Montgomery 20857 Montgomery 20859 Montgomery State MD MD MD MD MD MD MD MD MD MD MD Bethesda, MD ZIP County 20810 Montgomery 20811 Montgomery 20813 Montgomery 20814 Montgomery 20815 Montgomery 20816 Montgomery 20817 Montgomery 20824 Montgomery 20825 Montgomery 20827 Montgomery 20889 Montgomery 20892 Montgomery 20894 Montgomery State MD MD MD MD MD MD MD MD MD MD MD MD MD SECTION 4 Revenues (feasibility) DATA SOURCES AND METHODS (2019) We propose to investigate whether the SBT is associated with changes in small store revenue using data on business income from the Washington State Department of Revenue. We will compare the change in total business income before and after the tax implementation for convenience stores in Seattle compared to convenience stores in other south King County cities. Although the data are publicly available by request, we do not yet have the data for this analysis and, therefore, this study will begin as a feasibility study. See below for details. Revenues Study (Feasibility) Overview The goal of this component of the evaluation is to assess whether Seattle’s Sweetened Beverage Tax (SBT) is associated with changes in revenue for small stores that sell beverages. As with any policy, it is possible that there could be unintended consequences of the SBT. One potential unintended consequence would be a loss in store revenues. This could happen if customers decrease their purchasing of taxed beverages and do not replace spending with goods of the same value. We propose to investigate whether the SBT is associated with changes in small store revenue using data on business income from the Washington State Department of Revenue. We will compare the change in total business income before and after the tax implementation for convenience stores in Seattle compared to convenience stores in other south King County cities. Data Sources Washington State Department of Revenue. We have requested access to the microdata from the Washington State Department of Revenue as suggested by our colleagues at UW who previously secured access to this data as part of another project. We propose to use the business income subject to B&O tax from this data source as a measure of business revenue. Whereas certain goods, such as groceries, are not subject to a sales tax, nearly all businesses are subject to the B&O tax, which is a gross receipts tax. Alternative measures could include Gross Business Revenue or the B&O tax itself. We have talked with Dave Hennes and colleagues in the City of Seattle Budget Office and FAS and they offered perspective on which variables to use based on their experience and they kindly offered to answer questions and weigh in on the best variables to use once we have the data. King County Categorized Food Permit List. We will use the King County Categorized Food Permit List to identify small businesses that would be the most likely to be impacted by the tax—small stores that sell beverages, such as convenience stores or small grocery stores. We have access to this permit list and have worked with it previously. Our intention is to either request that DOR send us deidentified data for the list of approximately 100-200 convenience stores from our categorized list of stores in Seattle and our comparison area in southern King County (Kent, Auburn and Federal Way) or send data with address and name information that we can link to the King County Categorized Food Permit List in order to subset stores who likely do a substantial amount of their business in beverages. Variables Dependent Variables. We are interested in whether business revenue changes as a result of the SBT. Our main dependent variable will be business income subject to the B&O tax, which is a gross receipts tax. Alternative measures could include Gross Business Revenue or the B&O tax itself. Independent variables. The independent variable of interest is the Sweetened Beverage Tax, which was implemented in Seattle (but not in the comparison area) on January 1st 2018. We will classify businesses in Seattle and revenue collected after January 1 2018 as being exposed to the tax. Covariates. We will include indicator variables for each store (“store fixed effects”) to control for baseline differences in business income. Last Edited: 6/21/2019 2 P age Data Analysis Plan. We will examine the change in business income among small stores in Seattle before and after the SBT compared to the change in business income among small stores in the comparison area over the same period of time. The trends in the comparison area are meant to control for any secular changes in business income that are not due to the SBT. The change in Seattle will represent changes above and beyond those seen in the comparison area. Specifically, we will run ordinary least squares models with standard errors adjusting for clustering at the store level of the general form: Yit = β0 + β1(city)i + β2(time)t + β3(cityiXtimet) + β4(store)i + εit , where, Yit is the business income of store i at time t. City is an indicator variable that takes the value of 1 for observations in Seattle and 0 for observations in the comparison area; this controls for baseline differences in business income between Seattle and the comparison area. Time is an indicator variable that takes the value of 1 for business income measured in the post-tax period and 0 for business income measured in the pre-tax period; this controls for the time trend we would have expected to see had Seattle not implemented the tax. The coefficient on the interaction between city and time (cityXtime), β3, is the difference-in-difference estimator. It estimates the average change in prices in Seattle above and beyond the change in prices in the comparison area and is our estimate of the association between the tax and business income. β4 is the indicator variable for each store to control for differences in baseline income by store. Limitations We do not yet have the data for this analysis and, therefore, this study will begin as a feasibility study. Our colleagues at UW have previously requested the individual business-level data from WA DOR. Their request was approved and they felt confident that we should be able to obtain this data as well. That said, without having the data in hand, we only have limited knowledge of the variables available and the degree to which data will be complete. We have consulted briefly with Dave Hennes and colleagues in the City of Seattle who have helped us identify the variables that will likely be the most useful and reliable. They have also generously offered to answer questions and offer advice based on their tax knowledge and expertise once we do have the data. Additionally, there are a number of factors that will make attributing any changes seen specifically to the tax somewhat difficult. One, because we will only have total business revenue and we will not have information on revenue from beverages specifically, we will not be able to look specifically at revenue from beverages, which would be the most likely revenue affected by the tax. At the same time, looking at total business revenue is arguably the more policy-relevant outcome, since business owners will not necessarily be negatively affected if consumers decide to purchase other items in the store instead of taxed beverages. Two, we will not be able to examine profits; instead we are limited to using revenue data. Three, there may be a number of factors unrelated to the SBT that could influence business revenue. We will include the comparison area as a control group to attempt to control for these factors to the best of our ability. For instance, minimum wage changed in Seattle during the same period; however, it also changed in our comparison area to a roughly equal degree, proportionally, so this should not confound our results. The rapid economic growth in Seattle is hard to match, however, by Last Edited: 6/21/2019 3 P age choosing nearby, but not bordering, southern King County cities, we should be able to capture and control for a fairly similar level of economic growth. Additional feasibility studies We will additionally explore the feasibility of examining whether employment in relevant industries is affected by the SBT as a second possible unintended consequence of the tax. The academic team evaluating the tax in Philadelphia has performed a similar analysis by using unemployment claims. We will determine whether we can access similar data in Seattle to assess this outcome, using the difference-in-difference approach with a similar comparison group, as described above. Summary of milestones for revenues feasibility study Phase 1: Determine whether planned analysis is feasible using Department of Revenue Data 1. Complete Data Sharing Agreement Request form 2. Receive data, examine data, clean data 3. After becoming familiar with what data is available and which variables are reliable, conference with advisors such as Anirban Basu, Lisa Powell, Dave Hennes, Jennie Romich to consult on feasibility and limitations of proceeding with the study. 4. If not feasible with Department of Revenue data, determine whether business revenue can be accessed via any other data sources 5. Look into potential data sources for unemployment analysis Phase 2: If determined feasible, proceed to descriptive and preliminary analyses 1. Preliminary and descriptive analyses for feedback to advisors Phase 3: If confident that results are reliable and meaningful, proceed with final analyses and interpretation 1. Final analyses and interpretation Last Edited: 6/21/2019 4 P age SECTION 5 Health records (feasibility) METHODS (2019) We propose to leverage currently collected data to examine the impacts of the tax on population-level rates of being overweight or obese (as measured by the body mass index z-score). In 2019, we propose to explore the feasibility of access to electronic medical record data on height and weight data to determine if there is sufficient sample of Seattle and comparison data among Kaiser Permanente members and Children’s Hospital members. If determined to be feasible, we propose to include analyses of medical records data in 2020. See below for a brief description of feasibility activities. Health Records (Feasibility) Overview The purpose of the health records feasibility work is to identify whether existing local electronic health records are available to explore whether the Seattle SBT results in longitudinal changes in child and adult weight status among children and adults living in Seattle versus outside of Seattle in the surrounding area. For example, while we may continue to see increasing rates of obesity in Seattle and comparison areas, do we see a slower acceleration in Seattle than in the comparison area? While electronic health records are not publicly available, the research team has made connections with local health systems who are open to exploring this opportunity. If determined to be feasible, we propose to include analyses of medical records data in 2020. Feasibility Activities 1. Connect with various sources of electronic health records to gauge the availability and accessibility of children’s and adults’ height and weight information (e.g., Seattle Children’s, Kaiser Permanente, UW, other health systems) 2. Examine the sample size estimates from these electronic health records for children and adults living in Seattle versus the surrounding area 3. Determine the available sample size for different frequency of longitudinal height and weight measurements among children and adults (e.g., 1 or 2 or 3 or more measurements within 2 years prior to Seattle SBT) 4. Evaluate the availability of critical descriptive and potential confounding variables (e.g., socioeconomic status, race, ethnicity) in the electronic health records 5. Creation of a health records feasibility report including information about the benefits and limitations of electronic health records data and sources Last Edited: 6/21/2019 2 P age