Implementation evaluation of a healthy beverage default policy in Illinois

At least 25 cities and counties and four states have implemented a healthy beverage default policy to reduce children's intake of sweetened drinks. Compliance evaluations of these policies have shown that implementation has been incomplete and inconsistent. This study describes implementation of a 2021 Illinois policy requiring healthy beverage defaults with restaurant kids' meals, identifies barriers and facilitators, and gathers lessons learned to improve implementation.

Data were collected from 2024 to 2025, 2-3 years after the policy implementation deadline and one year after a compliance evaluation. Data sources included policy documents (n = 50), restaurant menu board audits (n = 32), interviews with restaurant managers (n = 33), and in-depth interviews with staff from state and local health agencies, restaurant groups, industry trade associations, and public health advocacy organizations (n = 15). Descriptive statistics were calculated from survey data and qualitative data were coded using a deductive approach and thematically analyzed.

Implementation facilitators included alignment with existing restaurant practices and industry initiatives, strong inter-organizational partnerships, and supply chain efficiencies at chain restaurants. Barriers included inadequate communication about the policy to restaurant staff, policy ambiguity, inadequate guidance and infrastructure for monitoring and enforcement, limited nutrition knowledge of health inspectors, and rulemaking delays. Practices to improve implementation included consulting health agencies' offices of food protection during policy formulation, defining key terms in the statute, offering nutrition expertise to health inspectors, and providing adequate guidance and infrastructure for monitoring and enforcement.

Findings explain results from evaluations of similar policies and can improve future policy implementation.