title: Evaluating the Impact of the Healthy Beverage Executive Order for City Agencies in Boston, Massachusetts, 2011-2013.
abstract: BACKGROUND
  Intake of sugar-sweetened beverages (SSBs) is associated with negative health effects. Access to healthy beverages may be promoted by policies such as the Healthy Beverage Executive Order (HBEO) established by former Boston mayor Thomas M. Menino, which directed city departments to eliminate the sale of SSBs on city property. Implementation consisted of "traffic-light signage" and educational materials at point of purchase. This study evaluates the impact of the HBEO on changes in beverage availability.
  
  
  METHODS
  Researchers collected data on price, brand, and size of beverages for sale in spring 2011 (899 beverage slots) and for sale in spring 2013, two years after HBEO implementation (836 beverage slots) at access points (n = 31) at city agency locations in Boston. Nutrient data, including calories and sugar content, from manufacturer websites were used to determine HBEO beverage traffic-light classification category. We used paired t tests to examine change in average calories and sugar content of beverages and the proportion of beverages by traffic-light classification at access points before and after HBEO implementation.
  
  
  RESULTS
  Average beverage sugar grams and calories at access points decreased (sugar, -13.1 g; calories, -48.6 kcal; p<.001) following the implementation of the HBEO. The average proportion of high-sugar ("red") beverages available per access point declined (-27.8%, p<.001). Beverage prices did not change over time. City agencies were significantly more likely to sell only low-sugar beverages after the HBEO was implemented (OR = 4.88; 95% CI, 1.49-16.0).
  
  
  CONCLUSIONS
  Policies such as the HBEO can promote community-wide changes that make healthier beverage options more accessible on city-owned properties.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115. Email: acradock@hsph.harvard.edu.
authors.forename: Angie L
authors.initials: AL
authors.lastname: Cradock
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Kenney
authors.affiliation: Chronic Disease Prevention and Control, Boston Public Health Commission, Boston, Massachusetts.
authors.forename: Anne
authors.initials: A
authors.lastname: McHugh
authors.affiliation: Intergovernmental Relations, Boston Public Health Commission, Boston, Massachusetts.
authors.forename: Lisa
authors.initials: L
authors.lastname: Conley
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Mozaffarian
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Reiner
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
mesh_terms: D000818:Animals; D001628:Beverages / Q000145:classification / Q000191:economics / Q000600:supply & distribution*; D001900:Boston; D002253:Carbonated Beverages / Q000145:classification / Q000191:economics / Q000600:supply & distribution; D002947:Cities / Q000331:legislation & jurisprudence*; D003116:Color; D003132:Commerce / Q000331:legislation & jurisprudence; D002149:Energy Intake; D005500:Follow-Up Studies; D005509:Food Dispensers, Automatic / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005522:Food Services / Q000331:legislation & jurisprudence* / Q000592:standards; D033161:Government Regulation; D006284:Health Plan Implementation; D006801:Humans; D040541:Marketing / Q000331:legislation & jurisprudence; D018673:Nutrition Policy; D009753:Nutritive Value; D011356:Product Labeling / Q000145:classification / Q000379:methods*; D011633:Public Facilities / Q000331:legislation & jurisprudence; D013549:Sweetening Agents / Q000145:classification
chemical_list: D013549:Sweetening Agents