PROJECT SUMMARY Sugar-sweetened beverages (SSBs) are the largest source of added sugar in the diets of children and are associated with childhood obesity. SSB consumption is disproportionately high among low-income, minority children. As of 2022, 29 jurisdictions in the United States (US) have passed laws requiring restaurants to offer healthy default beverages (HDBs; i.e., water, milk, 100% juice) with children’s meals with the goal of reducing SSB consumption and obesity among children. Yet, effectiveness, factors that impact implementation, and equitable reach of these policies have not been fully studied. Addressing this gap, we propose to evaluate the Healthy Kids’ Beverage Menu Ordinance passed in New Orleans, Louisiana. New Orleans, located in the state with the third-highest prevalence of childhood obesity, is the first city in the Southern US to enact such a policy. This proposal presents a study of the implementation process, effectiveness, and reach of the ordinance in a region of the United States with some of the highest rates of childhood obesity. The project is guided by the RE- AIM/PRISM framework, using approaches from implementation science to contextualize the ordinance’s reach and effectiveness, including its influence on health equity. Using a prospective, quasi-experimental design, we will determine changes in default beverage offerings with children’s meals, restaurant compliance, and populations reached through a controlled, difference-in-difference analysis of children’s menus in a random sample of restaurants in New Orleans and the comparison city of Baton Rouge before policy implementation and 18 and 30 months after enactment (Aim 1). We will also measure the effect of the ordinance on children’s beverage purchases as part of restaurant meals by analyzing the amount of SSBs and calories from SSBs purchased for children residing in New Orleans, compared to purchases for children in the comparison city 18 and 30 months after policy implementation (Aim 2). To contextualize the outcomes, we will define contextual and restaurant-level factors influencing policy implementation and effectiveness by conducting a qualitative, longitudinal assessment of the design, implementation, and sustainability of the policy using in-depth interviews with restaurant staff and key policy stakeholders along with an ongoing document review, covering the pre- implementation period through 36-months after implementation (Aim 3). Our team is collecting baseline data related to Aims 1 and 2, and initial documents for Aim 3. The proposed study will make a significant contribution to our understanding of how policies influence food environments for obesity prevention among children. The ability to explore the HDB ordinance over time will provide important insights for lawmakers that may inform future policy design to improve effectiveness. The project will also offer a critical regional perspective to this growing body of research at a location with ...