Evaluating the Impact of the Healthy Beverage Executive Order for City Agencies in Boston, MA

Introduction. Intake of sugar-sweetened beverages (SSB) is associated with negative health impacts. Access to healthier beverage alternatives may be promoted by policies such as the Healthy Beverages Executive Order (HBEO) established by Boston’s Mayor Menino, which directed city departments to eliminate the sale of SSB on city property.  This study evaluates the impact of the HBEO, implemented in October 2011 with “traffic light signage” and educational materials at point-of-purchase.

Methods.  Researchers collected data on the number of beverages for sale before (n=977) and two years after (n=841) HBEO implementation as well as price, brand, and size using an environmental audit tool at all access points (n=30) at multiple city agency locations (n=71) in Boston.  Nutrient data, including calories and sugar content, were obtained from manufacturer websites and used to determine HBEO beverage traffic light classification category. Change in calories, sugar and the proportion of beverages by traffic light classification at access points before and after HBEO implementation were examined using regression methods.

Results. Average per beverage sugar grams (-14; p<.0001) and calories (-53; p<.0001) decreased following the implementation of the HBEO. The average proportion of high sugar (“red”) beverages available per access point declined dramatically (-31%; p<0.0001) while healthier options increased significantly (+29%; p<0.0001). City agencies were significantly more likely to offer only healthier beverages for sale after HBEO implementation (OR 8.5; 95% CI 2.4 to 30.5.

Discussion. Policies such as the HBEO can promote changes that make healthy beverage options more accessible on city-owned properties at low cost.