The Sweetened Beverage Tax in Cook County, Illinois: Lessons From a Failed Effort.

To describe the public health and policy lessons learned from the failure of the Cook County, Illinois, Sweetened Beverage Tax (SBT). This retrospective, mixed-methods, qualitative study involved key informant (KI) and discussion group interviews and document analysis including news media, court documents, testimony, letters, and press releases. Two coders used Atlas.ti v.8A to analyze 321 documents (from September 2016 through December 2017) and 6 KI and discussion group transcripts (from December 2017 through August 2018). Key lessons were (1) the SBT process needed to be treated as a political campaign, (2) there was inconsistent messaging regarding the tax purpose (i.e., revenue vs public health), (3) it was important to understand the local context and constraints, (4) there was implementation confusion, and (5) the media influenced an antitax backlash. The experience with the implementation and repeal of the Cook County SBT provides important lessons for future beverage tax efforts. Beverage taxation efforts need to be treated as political campaigns requiring strong coalitions, clear messaging, substantial resources, and work within the local context.