Category Archives: Publication Released

STUDY: Boston’s executive beverage policy decreased sugary drinks and increased availability of healthier drinks in city-owned properties.

A study by the HPRC, working with the Boston Public Health Commission, evaluated the impact of the Healthy Beverage Executive Order for city agencies in Boston and found that the policy decreased the availability of sugary drinks, and that healthier, low-sugar beverages were more likely to be available for sale.

HBEO Evaluation Graphic_v3

In 2011, Boston’s former mayor, Thomas M. Menino, issued the Healthy Beverages Executive Order (HBEO), directing city departments to eliminate the sale of SSBs from city-funded events, vending machines, and from cafés or cafeterias on city property. The HBEO standards (developed by the Boston Public Health Commission) identified categories of beverages, which were visualized on point-of-decision consumer education materials through a “traffic-light” system (i.e. red designates “drink rarely, if at all,” yellow designates “drink occasionally,” and green designates “drink plenty” or “healthy choice”). HPRC researchers collected baseline data on price, brand, and size of beverages for sale at the time the HBEO was issued.

HBEO stoplight posterTwo years later, the HPRC set out to evaluate whether access to healthy beverages had increased in Boston city agencies. Across 22 properties with 31 beverage access points (including vending machines, cafés, and cafeterias) the average calories per beverage sold decreased by almost 50 kcal, and the average sugar content decreased by 13 grams from baseline to follow-up. Researchers also found that the average proportion of high-sugar (“red”) beverages available per access point declined by nearly 30 percent, and city agencies were significantly more likely to sell only low-sugar beverages. There was no change in beverage prices.

“Health promotion strategies like the HBEO can make healthier beverage choices more accessible for Boston’s employees and residents,” said lead author Dr. Angie Cradock, co-director of the HPRC at the Harvard T.H. Chan School of Public Health. “We know this because after the policy was issued, healthier beverage options increased significantly in vending machines, cafeterias, and cafés on city properties. It’s exciting to see a city that really makes an effort to support the health of its residents.”

Boston joins a growing number of communities in promoting healthful vending initiatives to positively impact access to healthy options in community settings.

Cradock AL, Kenney EL, McHugh A, Conley L, Mozaffarian RS, Reiner JF, et al. Evaluating the Impact of the Healthy Beverage Executive Order for City Agencies in Boston, Massachusetts, 2011–2013. Prev Chronic Dis 2015;12:140549.

STUDY: “Grab a Cup, Fill It Up!” Low-cost strategy increases student water intake during school lunch

A study by HPRC and Boston Public Schools found that a low-cost intervention to promote the convenience of drinking water in schools nearly doubled the percentage of students drinking water, and increased the amount of water consumed. 


The Healthy, Hunger-Free Kids Act of 2010 required that schools participating the National School Lunch Program provide water to students during lunchtime. In many school cafeterias, water fountains are the current default for providing drinking water to students—though the presence of these fountains doesn’t necessarily translate to easy access or convenience, and students may not find the water appealing. The study evaluated the impact of the Boston Public Schools “Grab a Cup, Fill It Up” campaign, a cafeteria-based intervention featuring signage promoting water and installation of disposable cups near water fountains. The percentage of students drinking water more than doubled in intervention schools, and students drank significantly more water and had fewer sugary drinks with their lunch as a result of the intervention.  

Picture4Promoting water in a positive light may have helped entice students to drink, but it also seems that simply making it easier for kids to drink played a big role,” said lead author Erica Kenney, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health. “We found that most students were not drinking water during lunch, and that it’s really not that easy to get a lot to drink from a fountain – we estimated that when most students drink straight from the fountain, they typically only consume about two ounces – the same amount in a little condiment cup. But when schools made it easier for students to drink by providing a five ounce cup, more students opted to drink – and they drank more water than they would have without the cups. If we want to help children drink more water, we need to do more than just depend on fountains, and cups are a simple and relatively inexpensive place to start.”

Researchers analyzed average consumption per lunch period, observing 179 lunches with 1,599 instances of students drinking water in 10 BPS schools over 47 days at baseline; and 180 lunches with 2,021 instances of students drinking water in 10 schools over 48 days at follow-up. In addition to increasing water intake in the student body, the study found that as more students consumed water during lunch, fewer were observed drinking sugar-sweetened beverages or 100% juice.

WaterPosterSplashAlong with the instillation of cup dispensers and recyclable cups, simple posters encouraging students to drink water and directing students to a water source location were displayed in cafeterias. The cost of this intervention averaged less than once cent per student, per day.

When over half of all US children and adolescents are not adequately hydrated at any given time, this study shows that a relatively simple, inexpensive strategy to improve drinking water’s convenience and appeal can increase student water consumption.

Check out these resources to increase water access for children in your school or program:


Kenney EL, Gortmaker SL, Carter JE, Howe CW, Reiner JF, Cradock AL. Grab a Cup, Fill It Up! An Intervention to Promote the Convenience of Drinking Water and Increase Student Water Consumption During School Lunch. American Journal of Public Health. 2015. e-View Ahead of Print.

STUDY: A validated tool to effectively assess nutrition and physical activity environments and behaviors in after school settings.

An HPRC study found that the Out-of-School Nutrition and Physical Activity Observational Practice Assessment Tool (OSNAP-OPAT) can assist researchers and practitioners in validly assessing nutrition and physical activity environments and behaviors in afterschool settings. Continue reading

HPRC study demonstrates sustainable approach to addressing overweight risk among children

Primary care is an opportune setting to contribute to obesity prevention and treatment. However, there is limited evidence for effective and sustainable interventions in primary care. The Maine Youth Overweight Collaborative (MYOC) successfully affected office systems, provider behavior, and patient experience, back in 2009.

This follow-up study by HPRC’s Dr. Steven Gortmaker and Dr. Michele Polacsek found myoc sustainable improvements in clinical decision support and family management of risk behaviors within a primary-care-based approach to addressing overweight risk among children and youth. Continue reading

“Impact of the Boston Active School Day Policy to Promote Physical Activity Among Children”

A study by HPRC’s Dr. Angie Cradock, Jessica Barrett, and Dr. Steven Gortmaker found that Active School Day implementation increased student moderate-to-vigorous physical activity levels and decreased sedentary time during school at modest cost.

The study took place in six elementary schools with three matched pairs and included 455 consenting fourth- and fifth-grade students in Boston, Massachusetts, from February to June 2011.