Healthy beverage initiatives in higher education: an untapped strategy for health promotion

Sugar-sweetened beverages (SSB) are the largest source of added sugar and a leading contributor of dietary energies(1). Intake of SSB promotes dental caries, obesity and obesityrelated comorbidities (type 2 diabetes, abnormal cholesterol and fatty liver disease) and is associated with a higher risk of mortality(2,3). The COVID-19 pandemic has increased the urgency of strategies such as SSB reduction, to prevent obesity and related comorbidities. Obesity has been identified as an independent risk factor for susceptibility to infection and severity of illness from the severe acute respiratory syndrome coronavirus-2(4). Given the second pandemic of ‘covibesity’ that is looming, there is no time like the present to think creatively about prevention(5). In their article, ‘TheUniversity of British ColumbiaHealthy Beverage Initiative: Changing the beverage landscape on a large postsecondary campus’, Sebastiano et al. describe the evaluation of a campus Healthy Beverage Initiative (HBI)(6). The HBI included (1) renegotiation of the campus beverage contract to allow for limited marketing of SSB, (2) a multi-media campaign to promote intake of tap water and (3) removal of SSB from a residential hall. The study found that the HBI did not lead to a decrease in beverage revenue or result in compensatory purchases of SSB from nearby retail locations that continued to sell SSB. There was also little resistance to the HBI efforts from students, faculty and staff(6). This university-wide effort naturally flows froma longhistory of successful efforts to reduce SSB consumption through environmental interventions in primary and secondary schools. In an effort to reduce consumption of SSB among children to promote lifelong health, many jurisdictions globally have passed policies to restrict SSB access in schools(7). In the USA, for example, the 2010 Healthy, Hunger-Free Kids Act established national nutrition standards (Smart Snacks) for all foods and beverages sold in schools(8). With regard to beverages, Smart Snacks standards do not allow SSB (except flavored milks) in elementary or middle schools and only allow low-energy drinks with added sugar (a maximum of 167·36 kJ (40 kcal) per 8 oz or < 251·04 kJ (60 kcal) per 12 oz) in high schools. Studies suggest that healthy snack and beverage standards, including Smart Snacks, can decrease consumption of SSB and may be cost effective(9,10). Despite such benefits, there has been limited adoption of beverage standards in postsecondary educational settings. Although previous studies, primarily conducted in primary and secondary school settings, suggest that SSB restrictions can reduce intake of SSB, bundled initiatives are likely needed to achieve the substantial reductions in SSB intake that can significantly impact health(11,12). Here we highlight effective strategies to reduce SSB intake, gleaned from previous school and home-based studies, that hold promise for future HBI in post-secondary educational settings(13). One such strategy is to pair an SSB sales ban with an initiative that increases healthy beverage alternatives. Limited studies in primary and secondary schools suggest that increasing access to appealing, safe drinking water is a promising strategy for promoting intake of water(14–16), reducing intake of SSB(14,17) and preventing obesity(18,19). Coupling SSB sales bans with increased access to drinking water may also help in increasing the acceptability of bans. Indeed, in their study, Sebastiano et al. found that increasing access to free drinkingwater wasmost popular among a range of HBI initiatives proposed(6). In previous studies, installing drinking water sources, such as reusable water bottle stations that have more appeal and function, has beenmore effective for increasing water intake than traditional drinking fountains(15,16,18,19). Providing drinking vessels is another important approach for encouraging water intake(14). As a part of their sustainability efforts, the University of Michigan instituted a comprehensive programme that included (1) installing over 300 reusable water bottle filling stations across the campus, (2) implementing a campaign to promote use of reusable water bottles and (3) supplying all incoming freshman with a reusable water bottle. A longitudinal evaluation of the initiative found that it was successful in decreasing the use of single-use bottled water and increasing the use of reusable water bottles among students(20). According to data from the National Health and Nutrition Examination Survey, rates of tap water avoidance are increasing, particularly following the Flint drinking water crisis which exposed Detroit residents to unsafe levels of lead, a potent neurotoxin(21,22). While the majority of tap water in developed countries is regularly tested for Public Health Nutrition: 24(1), 136–138 doi:10.1017/S1368980020003766