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Garvey KA, Edwards MA, Blacker LS, Hecht CE, Parks JL, Patel AI. A Comprehensive Examination of the Contaminants in Drinking Water in Public Schools in California, 2017-2022. Public Health Rep 2024; 139:369-378. [PMID: 37667618 PMCID: PMC11037221 DOI: 10.1177/00333549231192471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES Reports of unsafe school drinking water in the United States highlight the importance of ensuring school water is safe for consumption. Our objectives were to describe (1) results from our recent school drinking water sampling of 5 common contaminants, (2) school-level factors associated with exceedances of various water quality standards, and (3) recommendations. METHODS We collected and analyzed drinking water samples from at least 3 sources in 83 schools from a representative sample of California public schools from 2017 through 2022. We used multivariate logistic regression to examine school-level factors associated with lead in drinking water exceedances at the American Academy of Pediatrics (AAP) recommendation level (1 part per billion [ppb]) and state action-level exceedances of other contaminants (lead, copper, arsenic, nitrate, and hexavalent chromium). RESULTS No schools had state action-level violations for arsenic or nitrate; however, 4% had ≥1 tap that exceeded either the proposed 10 ppb action level for hexavalent chromium or the 1300 ppb action level for copper. Of first-draw lead samples, 4% of schools had ≥1 tap that exceeded the California action level of 15 ppb, 18% exceeded the US Food and Drug Administration (FDA) bottled water standard of 5 ppb, and 75% exceeded the AAP 1 ppb recommendation. After turning on the tap and flushing water for 45 seconds, 2%, 10%, and 33% of schools exceeded the same standards, respectively. We found no significant differences in demographic characteristics between schools with and without FDA or AAP exceedances. CONCLUSIONS Enforcing stricter lead action levels (<5 ppb) will markedly increase remediation costs. Continued sampling, testing, and remediation efforts are necessary to ensure drinking water meets safety standards in US schools.
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Affiliation(s)
- Kelly A. Garvey
- Bren School of Environmental Science & Management, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Marc A. Edwards
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | | | - Christina E. Hecht
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, Oakland, Oakland, CA, USA
| | - Jeffrey L. Parks
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Anisha I. Patel
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
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2
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Chriqui JF, Leider J, Turner L, Piekarz-Porter E, Schwartz MB. State Wellness Policy Requirement Laws Matter for District Wellness Policy Comprehensiveness and Wellness Policy Implementation in the United States. Nutrients 2021; 13:E188. [PMID: 33435387 PMCID: PMC7827171 DOI: 10.3390/nu13010188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Beginning with the school year 2006-2007, U.S. school districts participating in the federal Child Nutrition Programs were required to adopt and implement a local wellness policy (LWP) that included goals and/or standards for nutrition education, school meals, other foods sold or served in schools, and physical activity. A primary challenge with LWPs has been inconsistent implementation. This study examined whether state wellness policy requirement laws and district LWP comprehensiveness influence district level implementation, using law/policy data from the National Wellness Policy Study and school food authority (SFA)-reported district LWP implementation from the School Nutrition and Meal Cost Study. Generalized linear and structural equation models were used, controlling for SFA and district characteristics. SFAs in states with wellness policy requirement laws (vs. those in states without) reported implementing significantly more practices (59.56% vs. 44.57%, p < 0.01). State wellness policy requirement laws were associated with district LWP comprehensiveness (coeff.: 0.463; 95% CI: 0.123, 0.803) and district-level implementation (coeff.: 1.392; 95% CI: 0.299, 2.485). District LWP comprehensiveness was associated with district implementation (coeff.: 0.562; 95% CI: 0.072, 1.053), but did not mediate the state law-district implementation relationship. This study highlights the important role that state laws and district LWPs can play in facilitating wellness policy implementation.
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Affiliation(s)
- Jamie F. Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA;
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Julien Leider
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID 83725, USA;
| | - Elizabeth Piekarz-Porter
- Division of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA;
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL 60608, USA;
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Obesity, Department of Human Development and Family Sciences, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103, USA;
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Moreno GD, Schmidt LA, Ritchie LD, McCulloch CE, Cabana MD, Brindis CD, Green LW, Altman EA, Patel AI. A cluster-randomized controlled trial of an elementary school drinking water access and promotion intervention: Rationale, study design, and protocol. Contemp Clin Trials 2020; 101:106255. [PMID: 33370616 DOI: 10.1016/j.cct.2020.106255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Promoting water consumption among children in schools is a promising intervention to reduce sugar-sweetened beverage (SSB) intake and achieve healthful weight. To date, no studies in the United States have examined how a school-based water access and promotion intervention affects students' beverage and food intake both in and out of school and weight gain over time. The Water First trial is intended to evaluate these interventions. METHODS Informed by the PRECEDE-PROCEED model and Social Cognitive Theory, the Water First intervention includes: 1) installation of lead-free water stations in cafeterias, physical activity spaces, and high-traffic common areas in lower-income public elementary schools, 2) provision of cups/reusable water bottles for students, and 3) a 6-month healthy beverage education campaign. A five year-long cluster randomized controlled trial of 26 low-income public elementary schools in the San Francisco Bay Area is examining how Water First impacts students' consumption of water, caloric intake from foods and beverages, and BMI z-score and overweight/obesity prevalence, from baseline to 7 months and 15 months after the start of the study. Intervention impact on outcomes will be examined using a difference-in-differences approach with mixed-effects regression accounting for the clustering of students in schools and classrooms. DISCUSSION This paper describes the rationale, study design, and protocol for the Water First study. If the intervention is effective, findings will inform best practices for implementing school water policies, as well as the development of more expansive policies and programs to promote and improve access to drinking water in schools.
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Affiliation(s)
- Gala D Moreno
- School of Medicine, University of California, San Francisco, USA
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Anthropology, History and Social Medicine, University of California, San Francisco, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Michael D Cabana
- Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Montefiore, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, Bixby Center for Global Reproductive Health, Departments of Pediatrics and Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA
| | - Lawrence W Green
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Emily A Altman
- School of Public Health, University of California, Berkeley, USA
| | - Anisha I Patel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Department of Pediatrics, School of Medicine, Stanford University, USA.
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Patel AI, Hecht CE, Cradock A, Edwards MA, Ritchie LD. Drinking Water in the United States: Implications of Water Safety, Access, and Consumption. Annu Rev Nutr 2020; 40:345-373. [PMID: 32966189 DOI: 10.1146/annurev-nutr-122319-035707] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent water quality crises in the United States, and recognition of the health importance of drinking water in lieu of sugar-sweetened beverages, have raised interest in water safety, access, and consumption. This review uses a socioecological lens to examine these topics across the life course. We review water intakes in the United States relative to requirements, including variation by age and race/ethnicity. We describe US regulations that seek to ensure that drinking water is safe to consume for most Americans and discuss strategies to reduce drinking water exposure to lead, a high-profile regulated drinking water contaminant. We discuss programs, policies, and environmental interventions that foster effective drinking water access, a concept that encompasses key elements needed to improve water intake. We conclude with recommendations for research, policies, regulations, and practices needed to ensure optimal water intake by all in the United States and elsewhere.
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Affiliation(s)
- Anisha I Patel
- Division of General Pediatrics, Stanford University, Palo Alto, California 94305, USA
| | - Christina E Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
| | - Angie Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Marc A Edwards
- Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California 94704, USA;
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Kenney EL, Daly JG, Lee RM, Mozaffarian RS, Walsh K, Carter J, Gortmaker SL. Providing Students with Adequate School Drinking Water Access in an Era of Aging Infrastructure: A Mixed Methods Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010062. [PMID: 31861778 PMCID: PMC6981468 DOI: 10.3390/ijerph17010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/29/2022]
Abstract
Ensuring students’ access to safe drinking water at school is essential. However, many schools struggle with aging infrastructure and subsequent water safety problems and have turned to bottled water delivery systems. Little is known about whether such systems are feasible and effective in providing adequate student water access. This study was a mixed-methods investigation among six schools in an urban district in the U.S. with two types of water delivery systems: (1) tap water infrastructure, with updated water fountains and bottle fillers, and (2) bottled water coolers. We measured students’ water consumption and collected qualitative data from students and teachers about their perceptions of school drinking water. Student water consumption was low—between 2.0 (SD: 1.4) ounces per student and 2.4 (SD: 1.1) ounces per student during lunch. Students and teachers reported substantial operational hurdles for relying on bottled water as a school’s primary source of drinking water, including difficulties in stocking, cleaning, and maintaining the units. While students and teachers perceived newer bottle filler units positively, they also reported a distrust of tap water. Bottled water delivery systems may not be effective long-term solutions for providing adequate school drinking water access and robust efforts are needed to restore trust in tap water.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
- Correspondence: ; Tel.: +1-617-384-8722
| | - James G. Daly
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
| | - Rebekka M. Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
| | - Rebecca S. Mozaffarian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
| | - Katherine Walsh
- Department of Facilities Management, Boston Public Schools, 1216 Dorchester Ave, Dorchester, MA 02125, USA;
| | - Jill Carter
- Office of Social Emotional Learning and Wellness Instruction & Policy, Boston Public Schools, 2300 Washington Street, Roxbury, MA 02119, USA;
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (J.G.D.); (R.M.L.); (R.S.M.); (S.L.G.)
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Kenney EL, Cradock AL, Long MW, Barrett JL, Giles CM, Ward ZJ, Gortmaker SL. Cost-Effectiveness of Water Promotion Strategies in Schools for Preventing Childhood Obesity and Increasing Water Intake. Obesity (Silver Spring) 2019; 27:2037-2045. [PMID: 31746555 DOI: 10.1002/oby.22615] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to estimate the cost-effectiveness and impact on childhood obesity of installation of chilled water dispensers ("water jets") on school lunch lines and to compare water jets' cost, reach, and impact on water consumption with three additional strategies. METHODS The Childhood Obesity Intervention Cost Effectiveness Study(CHOICES) microsimulation model estimated the cost-effectiveness of water jets on US childhood obesity cases prevented in 2025. Also estimated were the cost, number of children reached, and impact on water consumption of the installation of water jets and three other strategies. RESULTS Installing water jets on school lunch lines was projected to reach 29.6 million children (95% uncertainty interval [UI]: 29.4 million-29.8 million), cost $4.25 (95% UI: $2.74-$5.69) per child, prevent 179,550 cases of childhood obesity in 2025 (95% UI: 101,970-257,870), and save $0.31 in health care costs per dollar invested (95% UI: $0.15-$0.55). In the secondary analysis, installing cup dispensers next to existing water fountains was the least costly but also had the lowest population reach. CONCLUSIONS Installating water jet dispensers on school lunch lines could also save almost half of the dollars needed for implementation via a reduction in obesity-related health care costs. School-based interventions to promote drinking water may be relatively inexpensive strategies for improving child health.
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Affiliation(s)
- Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Lawman HG, Lofton X, Grossman S, Root M, Perez M, Tasian G, Patel A. A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers. Contemp Clin Trials 2019; 79:14-20. [PMID: 30771559 PMCID: PMC6499604 DOI: 10.1016/j.cct.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Improving children's tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. METHODS The "Hydrate Philly" intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling "hydration stations", conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n = 28 centers) of the intervention's impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6-12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. DISCUSSION Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study. ClinicalTrials.gov Registration: #NCT03637465.
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Affiliation(s)
- Hannah G Lawman
- Philadelphia Department of Public Health, Philadelphia, PA, USA.
| | - Xavier Lofton
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara Grossman
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Mica Root
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Meka Perez
- Philadelphia Department of Public Health, Philadelphia, PA, USA; Philadelphia Parks and Recreation Department, Philadelphia, PA, USA
| | - Gregory Tasian
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anisha Patel
- School of Medicine, Stanford University, Stanford, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Cradock AL, Everett Jones S, Merlo C. Examining differences in the implementation of school water-quality practices and water-access policies by school demographic characteristics. Prev Med Rep 2019; 14:100823. [PMID: 30847271 PMCID: PMC6389728 DOI: 10.1016/j.pmedr.2019.100823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/04/2019] [Accepted: 02/06/2019] [Indexed: 11/28/2022] Open
Abstract
Ensuring safe, accessible drinking water in schools is a national health priority. The objective of this study was to identify whether there are differences in water quality, availability, and education- related practices in schools by demographic characteristics. In 2017-2018, we analyzed data from the 2014 School Health Policies and Practices Study (SHPPS), a nationally representative, cross-sectional survey of US schools. Analyses examined differences in water-related practices by school characteristics. Response rates for the 3 questionnaires used in this analysis ranged from 69%-94% (Ns ranged from 495 to 577). We found that less than half of schools flush drinking water outlets after periods of non-use (46.4%), conduct periodic inspections that test drinking water outlets for lead (45.8%), and require staff training on drinking water quality (25.6%). Most schools teach the importance of water consumption (81.1%) and offer free drinking water in the cafeteria (88.3%). Some water-related school practices differed by school demographic characteristics though no consistent patterns of associations by school characteristics emerged. In US schools, some water quality-related practices are limited, but water availability and education-related practices are more common. SHPPS data suggest many schools would benefit from support to implement best practices related to school-drinking water.
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Affiliation(s)
- Angie L Cradock
- Prevention Research Center on Nutrition and Physical Activity, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA, USA
| | - Sherry Everett Jones
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS E75, Atlanta, GA, 30329, USA
| | - Caitlin Merlo
- Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-6, Atlanta, GA 30341, USA
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Strategies to reduce sugar-sweetened beverage consumption and increase water access and intake among young children: perspectives from expert stakeholders. Public Health Nutr 2018; 21:3440-3449. [DOI: 10.1017/s1368980018002604] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesTo summarize stakeholder recommendations and ratings of strategies to reduce sugar-sweetened beverage (SSB) consumption and increase water access and intake among young children (0–5 years).DesignTwo online surveys: survey 1 asked respondents to recommend novel and innovative strategies to promote healthy beverage behaviour; survey 2 asked respondents to rank each of these strategies on five domains (overall importance, feasibility, effectiveness, reach, health equity). Open-ended questions were coded and analysed for thematic content.SettingUsing a snowball sampling approach, respondents were invited to complete the survey through an email invitation or an anonymous listserv link. Of the individuals who received a private email invitation, 24 % completed survey 1 and 29 % completed survey 2.SubjectsSurvey 1 (n 276) and survey 2 (n 182) included expert stakeholders who work on issues related to SSB and water consumption.ResultsSix overarching strategies emerged to change beverage consumption behaviours (survey 1): education; campaigns and contests; marketing and advertising; price changes; physical access; and improving the capacity of settings to promote healthy beverages. Labelling and sugar reduction (e.g. reformulation) were recommended as strategies to reduce SSB consumption, while water testing and remediation emerged as a strategy to promote water intake. Stakeholders most frequently recommended (survey 1) and provided higher ratings (survey 2) to strategies that used policy, systems and/or environmental changes.ConclusionsThe present study is the first to assess stakeholder opinions on strategies to promote healthy beverage consumption. This knowledge is key for understanding where stakeholders believe resources can be best utilized.
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Wong JMW, Ebbeling CB, Robinson L, Feldman HA, Ludwig DS. Effects of Advice to Drink 8 Cups of Water per Day in Adolescents With Overweight or Obesity: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:e170012. [PMID: 28264082 PMCID: PMC5530362 DOI: 10.1001/jamapediatrics.2017.0012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Health care professionals commonly recommend increased water consumption, typically to 8 cups per day, as part of a weight-reducing diet. However, this recommendation is based on limited evidence and virtually no experimental data from the pediatric population. OBJECTIVE To compare 2 standardized weight-loss diets among adolescents with overweight or obesity, either with or without additional advice and behavioral support to increase habitual water intake to 8 cups per day. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical, parallel-group trial was conducted between February 2, 2011, and June 26, 2014, at Boston Children's Hospital, Boston, Massachusetts, among 38 adolescents with overweight or obesity who reported drinking 4 cups or less of water per day. INTERVENTIONS All participants in both groups received similar weight-reducing interventions, differentiated by advice about water intake (the water group received advice to increase water intake to 8 cups per day; the control group did not receive such advice) but controlled for other dietary recommendations and treatment intensity. The interventions included dietary counseling, daily text messages, and a cookbook with health guides. To support adherence to 8 cups of water per day, the water group received well-defined messages about water through counseling and daily text messages, a water bottle, and a water pitcher with filters. MAIN OUTCOMES AND MEASURES The primary outcome was 6-month change in body mass index z score. Data analyses followed the intention-to-treat principle. RESULTS All 38 participants (27 girls and 11 boys; mean [SD] age, 14.9 [1.7] years) completed the study. Both groups reported drinking approximately 2 cups of water per day at baseline. Self-reported change in water intake at 6 months was greater in the water group (difference from baseline, 2.8 cups per day [95% CI, 1.8 to 3.8]; P < .001) compared with that in the control group (difference from baseline, 1.2 cups per day [95% CI, 0.2 to 2.2]; P = .02) (difference between groups, 1.6 cups per day [95% CI, 0.2 to 3.0 cups per day]; P = .03). The 6-month change in body mass index z score did not differ between the water group (difference from baseline, -0.1 [95% CI, -0.2 to -0.0]; P = .005) and the control group (difference from baseline, -0.1 [95% CI, -0.2 to -0.0]; P = .008) (difference between groups, -0.0 [95% CI, -0.1 to 0.1]; P = .88). CONCLUSIONS AND RELEVANCE Advice and behavioral supports to consume 8 cups of water per day in the context of a weight-reducing diet did not affect body weight among adolescents with overweight or obesity. Despite intensive behavior supports, few adolescents achieved the target of 8 cups of water per day. Environmental interventions to reduce barriers to water consumption at school may be necessary in future research of the feasibility and effectiveness to achieve the target of an intake of 8 cups of water per day in adolescents. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01044134.
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Affiliation(s)
- Julia M. W. Wong
- New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, Boston, Massachusetts2Clinical Nutrition and Risk Factor Modification Center, St Michael’s Hospital, Toronto, Ontario, Canada3now also with Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Cara B. Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, Boston, Massachusetts
| | - Lisa Robinson
- New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, Boston, Massachusetts4now with Shape Up Somerville, Somerville, Massachusetts
| | - Henry A. Feldman
- Clinical Research Center, Boston Children’s Hospital, Boston, Massachusetts
| | - David S. Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital, Boston, Massachusetts
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Lee RM, Okechukwu C, Emmons KM, Gortmaker SL. Impact of implementation factors on children's water consumption in the Out-of-School Nutrition and Physical Activity group-randomized trial. ACTA ACUST UNITED AC 2016; 2014:79-101. [PMID: 25530242 DOI: 10.1002/yd.20105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
National data suggest that children are not consuming enough water. Experimental evidence has linked increased water consumption to obesity prevention, and the National AfterSchool Association has named serving water as ones of its standards for healthy eating and physical activity in out-of-school time settings. From fall 2010 to spring 2011, twenty Boston afterschool program sites participated in the Out-of-School Nutrition and Physical Activity (OSNAP) initiative, a group-randomized trial investigating nutrition and physical activity policies and practices that promote child health. Researchers used data from OSNAP to study the key factors that influence the implementation of practices that promote water intake. Aspects of the organizational capacity of the afterschool programs, characteristics of the providers, and the community context were hypothesized to impact changes in children's water consumption. This chapter demonstrates the effectiveness of an afterschool intervention on increases in children's water consumption. It also outlines the substantial influence that implementation factors can have on the effectiveness of an obesity prevention intervention, highlighting the importance of understanding how interventions are delivered in real-world settings.
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Affiliation(s)
- Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard School of Public Health
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Patel AI, Grummon AH, Hampton KE, Oliva A, McCulloch CE, Brindis CD. A Trial of the Efficacy and Cost of Water Delivery Systems in San Francisco Bay Area Middle Schools, 2013. Prev Chronic Dis 2016; 13:E88. [PMID: 27390074 PMCID: PMC4951080 DOI: 10.5888/pcd13.160108] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION US legislation requires that schools offer free drinking water where meals are served. However, little information is available about what types of water delivery systems schools should install to meet such requirements. The study objective was to examine the efficacy and cost of 2 water delivery systems (water dispensers and bottleless water coolers) in increasing students' lunchtime intake of water in low-income middle schools. METHODS In 2013, twelve middle schools in the San Francisco Bay Area participated in a cluster randomized controlled trial in which they received 6 weeks of promotional activities, received provision of cups, and were assigned to 1 of 2 cafeteria water delivery systems: water dispensers or bottleless water coolers (or schools served as a control). Student surveys (n = 595) and observations examined the interventions' effect on students' beverage intake and staff surveys and public data assessed intervention cost. RESULTS Analysis occurred from 2013 through 2015. Mixed-effects logistic regression, accounting for clustering and adjustment for student sociodemographic characteristics, demonstrated a significant increase in the odds of students drinking water in schools with promotion plus water dispensers and cups (adjusted odds ratio = 3.1; 95% confidence interval, 1.4-6.7; P = .004) compared with schools with traditional drinking fountains and no cups or promotion. The cost of dispenser and bottleless water cooler programs was similar ($0.04 per student per day). CONCLUSION Instead of relying on traditional drinking fountains, schools should consider installing water sources, such as plastic dispensers with cups, as a low-cost, effective means for increasing students' water intake.
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Affiliation(s)
- Anisha I Patel
- Division of General Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, Suite 245, Mailbox 0503, San Francisco, CA 94118
| | - Anna H Grummon
- Division of General Pediatrics, University of California, San Francisco, California
| | | | - Ariana Oliva
- California Food Policy Advocates, Oakland, California
| | - Charles E McCulloch
- Division of Biostatistics, University of California, San Francisco, California
| | - Claire D Brindis
- Division of General Pediatrics, Philip R. Lee Institute for Health Policy Studies, and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California
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Kenney EL, Gortmaker SL, Cohen JFW, Rimm EB, Cradock AL. Limited School Drinking Water Access for Youth. J Adolesc Health 2016; 59:24-9. [PMID: 27235376 PMCID: PMC4920716 DOI: 10.1016/j.jadohealth.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies. METHODS We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014. RESULTS On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17). CONCLUSIONS School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access.
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Affiliation(s)
- Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Juliana F W Cohen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Health Sciences, Merrimack College, North Andover, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Kenney EL, Gortmaker SL, Carter JE, Howe MCW, 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. Am J Public Health 2015; 105:1777-83. [PMID: 26180950 DOI: 10.2105/ajph.2015.302645] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated a low-cost strategy for schools to improve the convenience and appeal of drinking water. METHODS We conducted a group-randomized, controlled trial in 10 Boston, Massachusetts, schools in April through June 2013 to test a cafeteria-based intervention. Signage promoting water and disposable cups were installed near water sources. Mixed linear regression models adjusting for clustering evaluated the intervention impact on average student water consumption over 359 lunch periods. RESULTS The percentage of students in intervention schools observed drinking water during lunch nearly doubled from baseline to follow-up compared with controls (+ 9.4%; P < .001). The intervention was associated with a 0.58-ounce increase in water intake across all students (P < .001). Without cups, children were observed drinking 2.4 (SE = 0.08) ounces of water from fountains; with cups, 5.2 (SE = 0.2) ounces. The percentage of intervention students observed with sugar-sweetened beverages declined (-3.3%; P < .005). CONCLUSIONS The current default of providing water through drinking fountains in cafeterias results in low water consumption. This study shows that an inexpensive intervention to improve drinking water's convenience by providing cups can increase student water consumption.
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Affiliation(s)
- Erica L Kenney
- Erica L. Kenney, Steven L. Gortmaker, Jennifer F. Reiner, and Angie L. Cradock are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. At the time of the study, Caitlin W. Howe was and Jill E. Carter is with the Health and Wellness Department, Boston Public Schools, Dorchester, MA
| | - Steven L Gortmaker
- Erica L. Kenney, Steven L. Gortmaker, Jennifer F. Reiner, and Angie L. Cradock are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. At the time of the study, Caitlin W. Howe was and Jill E. Carter is with the Health and Wellness Department, Boston Public Schools, Dorchester, MA
| | - Jill E Carter
- Erica L. Kenney, Steven L. Gortmaker, Jennifer F. Reiner, and Angie L. Cradock are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. At the time of the study, Caitlin W. Howe was and Jill E. Carter is with the Health and Wellness Department, Boston Public Schools, Dorchester, MA
| | - M Caitlin W Howe
- Erica L. Kenney, Steven L. Gortmaker, Jennifer F. Reiner, and Angie L. Cradock are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. At the time of the study, Caitlin W. Howe was and Jill E. Carter is with the Health and Wellness Department, Boston Public Schools, Dorchester, MA
| | - Jennifer F Reiner
- Erica L. Kenney, Steven L. Gortmaker, Jennifer F. Reiner, and Angie L. Cradock are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. At the time of the study, Caitlin W. Howe was and Jill E. Carter is with the Health and Wellness Department, Boston Public Schools, Dorchester, MA
| | - Angie L Cradock
- Erica L. Kenney, Steven L. Gortmaker, Jennifer F. Reiner, and Angie L. Cradock are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. At the time of the study, Caitlin W. Howe was and Jill E. Carter is with the Health and Wellness Department, Boston Public Schools, Dorchester, MA
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Kenney EL, Long MW, Cradock AL, Gortmaker SL. Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009-2012. Am J Public Health 2015; 105:e113-8. [PMID: 26066941 DOI: 10.2105/ajph.2015.302572] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the hydration status of US children and adolescents. METHODS The sample included 4134 participants aged 6 to 19 years in the National Health and Nutrition Examination Survey from 2009 to 2012. We calculated mean urine osmolality and the proportion with inadequate hydration (urine osmolality > 800 mOsm/kg). We calculated multivariable regression models to estimate the associations between demographic factors, beverage intake, and hydration status. RESULTS The prevalence of inadequate hydration was 54.5%. Significantly higher urine osmolality was observed among boys (+92.0 mOsm/kg; 95% confidence interval [CI] = 69.5, 114.6), non-Hispanic Blacks (+67.6 mOsm/kg; 95% CI = 31.5, 103.6), and younger children (+28.5 mOsm/kg; 95% CI = 8.1, 48.9) compared with girls, Whites, and older children, respectively. Boys (OR = 1.76; 95% CI = 1.49, 2.07) and non-Hispanic Blacks (odds ratio [OR] = 1.34; 95% CI = 1.04, 1.74) were also at significantly higher risk for inadequate hydration. An 8-fluid-ounce daily increase in water intake was associated with a significantly lower risk of inadequate hydration (OR = 0.96; 95% CI = 0.93, 0.98). CONCLUSIONS Future research should explore drivers of gender and racial/ethnic disparities and solutions for improving hydration status.
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Affiliation(s)
- Erica L Kenney
- Erica L. Kenney, Michael W. Long, Angie L. Cradock, and Steven L. Gortmaker are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Michael W Long
- Erica L. Kenney, Michael W. Long, Angie L. Cradock, and Steven L. Gortmaker are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Angie L Cradock
- Erica L. Kenney, Michael W. Long, Angie L. Cradock, and Steven L. Gortmaker are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Steven L Gortmaker
- Erica L. Kenney, Michael W. Long, Angie L. Cradock, and Steven L. Gortmaker are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
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Wilking CL, Cradock AL, Gortmaker SL. Harnessing the public health power of model codes to increase drinking water access in schools and childcare. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43 Suppl 1:69-72. [PMID: 25846169 DOI: 10.1111/jlme.12220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drinking water is an important health behavior to support overall child health. Research indicates that children are consuming too little water and too many sugary drinks. Overconsumption of sugary drinks increases child risk for the epidemics of obesity and diet-related chronic diseases like type-II diabetes, stroke, and heart disease. Increasing access to appealing, low-cost drinking water in schools and childcare where children spend much of their time supports efforts to reduce sugary drink consumption. Drinking water infrastructure is key to water access in childcare and schools. In 2012-2013, almost one-third of permanent U.S. school buildings had plumbing systems in fair or poor condition, and almost 40 percent had major renovations or repairs planned.3 Basic plumbing standards for new construction and major renovations or repairs are contained in state and local plumbing codes, and many of these codes are derived from model codes established by private organizations. This article describes the model code process and intervention points where the public health community can work to improve plumbing standards in school buildings and childcare centers.
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Affiliation(s)
- Cara L Wilking
- At the time of the writing of this article, was a senior staff attorney at the Public Health Advocacy Institute at Northeastern University School of Law, Boston, MA
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Patel AI, Hecht K, Hampton KE, Grumbach JM, Braff-Guajardo E, Brindis CD. Tapping into water: key considerations for achieving excellence in school drinking water access. Am J Public Health 2014; 104:1314-9. [PMID: 24832141 PMCID: PMC4056210 DOI: 10.2105/ajph.2013.301797] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined free drinking water access in schools. METHODS We conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements. RESULTS No schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California's school water policy (72%-83%; P < .048). Barriers to improving school water included cost of programs and other pressing concerns. CONCLUSIONS Awareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access.
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Affiliation(s)
- Anisha I Patel
- At the time of the study, Anisha I. Patel, Jacob M. Grumbach, and Claire D. Brindis were with the Division of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Kenneth Hecht and Ellen Braff-Guajardo were with California Food Policy Advocates, Oakland. Karla E. Hampton was with Changelab Solutions, Oakland
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18
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Onufrak SJ, Park S, Wilking C. Student-reported school drinking fountain availability by youth characteristics and state plumbing codes. Prev Chronic Dis 2014; 11:E60. [PMID: 24742393 PMCID: PMC3992292 DOI: 10.5888/pcd11.130314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Caloric intake among children could be reduced if sugar-sweetened beverages were replaced by plain water. School drinking water infrastructure is dictated in part by state plumbing codes, which generally require a minimum ratio of drinking fountains to students. Actual availability of drinking fountains in schools and how availability differs according to plumbing codes is unknown. Methods We abstracted state plumbing code data and used the 2010 YouthStyles survey data from 1,196 youth aged 9 through 18 years from 47 states. We assessed youth-reported school drinking fountain or dispenser availability and differences in availability according to state plumbing codes, sociodemographic characteristics, and area-level characteristics. Results Overall, 57.3% of youth reported that drinking fountains or dispensers in their schools were widely available, 40.1% reported there were only a few, and 2.6% reported that there were no working fountains. Reported fountain availability differed significantly (P < .01) by race/ethnicity, census region, the fountain to student ratio specified in plumbing codes, and whether plumbing codes allowed substitution of nonplumbed water sources for plumbed fountains. “Widely available” fountain access ranged from 45.7% in the West to 65.4% in the Midwest and was less common where state plumbing codes required 1 fountain per more than 100 students (45.4%) compared with 1 fountain per 100 students (60.1%) or 1 fountain per fewer than 100 students (57.6%). Conclusion Interventions designed to increase consumption of water may want to consider the role of plumbing codes in availability of school drinking fountains.
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Affiliation(s)
- Stephen J Onufrak
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Obesity Prevention and Control Branch, 4770 Buford Hwy, NE, MS K-77, Atlanta, GA 30341. E-mail:
| | - Sohyun Park
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cara Wilking
- Northeastern University School of Law, Boston, Massachusetts
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Hood NE, Turner L, Colabianchi N, Chaloupka FJ, Johnston LD. Availability of drinking water in US public school cafeterias. J Acad Nutr Diet 2014; 114:1389-95. [PMID: 24726348 DOI: 10.1016/j.jand.2014.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
This study examined the availability of free drinking water during lunchtime in US public schools, as required by federal legislation beginning in the 2011-2012 school year. Data were collected by mail-back surveys in nationally representative samples of US public elementary, middle, and high schools from 2009-2010 to 2011-2012. Overall, 86.4%, 87.4%, and 89.4% of students attended elementary, middle, and high schools, respectively, that met the drinking water requirement. Most students attended schools with existing cafeteria drinking fountains and about one fourth attended schools with water dispensers. In middle and high schools, respondents were asked to indicate whether drinking fountains were clean, and whether they were aware of any water-quality problems at the school. The vast majority of middle and high school students (92.6% and 90.4%, respectively) attended schools where the respondent perceived drinking fountains to be clean or very clean. Approximately one in four middle and high school students attended a school where the survey respondent indicated that there were water-quality issues affecting drinking fountains. Although most schools have implemented the requirement to provide free drinking water at lunchtime, additional work is needed to promote implementation at all schools. School nutrition staff at the district and school levels can play an important role in ensuring that schools implement the drinking water requirement, as well as promote education and behavior-change strategies to increase student consumption of water at school.
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Patel AI, Shapiro DJ, Wang YC, Cabana MD. Sociodemographic characteristics and beverage intake of children who drink tap water. Am J Prev Med 2013; 45:75-82. [PMID: 23790991 PMCID: PMC4452285 DOI: 10.1016/j.amepre.2013.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 12/14/2012] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Tap water provides a calorie-free, no-cost, environmentally friendly beverage option, yet only some youth drink it. PURPOSE To examine sociodemographic characteristics, weight status, and beverage intake of those aged 1-19 years who drink tap water. METHODS National Health and Nutrition Examination Survey data (2005-2010) were used to examine factors associated with tap water consumption. A comparison was made of beverage intake among tap water consumers and nonconsumers, by age, race/ethnicity, and income. RESULTS Tap water consumption was more prevalent among school-aged children (OR=1.85, 95% CI=1.47, 2.33, for those aged 6-11 years; OR=1.85, 95% CI=1.32, 2.59, for those aged 12-19 years) as compared to those aged 1-2 years. Tap water intake was less prevalent among girls/women (OR=0.76, 95% CI=0.64, 0.89); Mexican Americans (OR=0.32, 95% CI=0.23, 0.45); non-Hispanic blacks (OR=0.48, 95% CI=0.34, 0.67); and others (OR=0.50, 95% CI=0.36, 0.68) as compared to whites; Spanish speakers (OR=0.72, 95% CI=0.55, 0.95); and among referents with a lower than Grade-9 education (OR=0.52, 95% CI=0.31, 0.88); Grade 9-11 education (OR=0.50, 95% CI=0.32, 0.77); and high school/General Educational Development test completion (OR=0.50, 95% CI=0.33, 0.76), as compared to college graduates. Tap water consumers drank more fluid (52.5 vs 48.0 ounces, p<0.01); more plain water (20.1 vs 15.2 ounces, p<0.01); and less juice (3.6 vs 5.2 ounces, p<0.01) than nonconsumers. CONCLUSIONS One in six children/adolescents does not drink tap water, and this finding is more pronounced among minorities. Sociodemographic disparities in tap water consumption may contribute to disparities in health outcomes. Improvements in drinking water infrastructure and culturally relevant promotion may help to address these issues.
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Affiliation(s)
- Anisha I Patel
- Department of Pediatrics, Columbia Mailman School of Public Health, New York, New York; Philip R. Lee Institute for Health Policy Studies, Columbia Mailman School of Public Health, New York, New York.
| | - Daniel J Shapiro
- Philip R. Lee Institute for Health Policy Studies, Columbia Mailman School of Public Health, New York, New York
| | - Y Claire Wang
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York
| | - Michael D Cabana
- Department of Pediatrics, Columbia Mailman School of Public Health, New York, New York; Philip R. Lee Institute for Health Policy Studies, Columbia Mailman School of Public Health, New York, New York; Epidemiology and Biostatistics, University of California, San Francisco, California
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Gortmaker SL, Story M. Nutrition policy research that can lead to reduced childhood obesity in the U.S. Am J Prev Med 2012; 43:S149-51. [PMID: 22898165 DOI: 10.1016/j.amepre.2012.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 05/21/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Steven L Gortmaker
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.
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Greenlund KJ, Giles WH. The Prevention Research Centers program: translating research into public health practice and impact. Am J Prev Med 2012; 43:S91-2. [PMID: 22898167 PMCID: PMC4547344 DOI: 10.1016/j.amepre.2012.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 05/18/2012] [Accepted: 06/07/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia 30341, USA.
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Creating supportive nutrition environments for population health impact and health equity: an overview of the Nutrition and Obesity Policy Research and Evaluation Network's efforts. Am J Prev Med 2012; 43:S85-90. [PMID: 22898166 DOI: 10.1016/j.amepre.2012.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/04/2012] [Accepted: 06/08/2012] [Indexed: 11/24/2022]
Abstract
Childhood obesity is a major threat to individual health and society overall. Policies that support healthier food and beverage choices have been endorsed by many decision makers. These policies may reach a large proportion of the population or in some circumstances aim to reduce nutrition disparities to ensure health equity. The Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) evaluates policy as a tool to improve food and beverage environments where Americans live, work, play, and learn. The network aspires to address research and evaluation gaps related to relevant policies, create standardized research tools, and help build the evidence base of effective policy solutions for childhood obesity prevention with a focus on reach, equity, cost effectiveness, and sustainability.
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Giles CM, Kenney EL, Gortmaker SL, Lee RM, Thayer JC, Mont-Ferguson H, Cradock AL. Increasing water availability during afterschool snack: evidence, strategies, and partnerships from a group randomized trial. Am J Prev Med 2012; 43:S136-42. [PMID: 22898163 DOI: 10.1016/j.amepre.2012.05.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/17/2012] [Accepted: 05/24/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Providing drinking water to U.S. children during school meals is a recommended health promotion strategy and part of national nutrition policy. Urban school systems have struggled with providing drinking water to children, and little is known about how to ensure that water is served, particularly in afterschool settings. PURPOSE To assess the effectiveness of an intervention designed to promote water as the beverage of choice in afterschool programs. DESIGN The Out of School Nutrition and Physical Activity Initiative (OSNAP) used a community-based collaboration and low-cost strategies to provide water after school. A group RCT was used to evaluate the intervention. Data were collected in 2010-2011 and analyzed in 2011. SETTING/PARTICIPANTS Twenty afterschool programs in Boston were randomized to intervention or control (delayed intervention). INTERVENTION Intervention sites participated in learning collaboratives focused on policy and environmental changes to increase healthy eating, drinking, and physical activity opportunities during afterschool time (materials available at www.osnap.org). Collaboration between Boston Public Schools Food and Nutrition Services, afterschool staff, and researchers established water-delivery systems to ensure children were served water during snack time. MAIN OUTCOME MEASURES Average ounces of water served to children per day was recorded by direct observation at each program at baseline and 6-month follow-up over 5 consecutive school days. Secondary measures directly observed included ounces of other beverages served, other snack components, and water-delivery system. RESULTS Participation in the intervention was associated with an increased average volume of water served (+3.6 ounces/day; p=0.01) during snack. On average, the intervention led to a daily decrease of 60.9 kcals from beverages served during snack (p=0.03). CONCLUSIONS This study indicates the OSNAP intervention, including strategies to overcome structural barriers and collaboration with key actors, can increase offerings of water during afterschool snack. OSNAP appears to be an effective strategy to provide water in afterschool settings that can be helpful in implementing new U.S. Department of Agriculture guidelines regarding water availability during lunch and afterschool snack.
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Affiliation(s)
- Catherine M Giles
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.
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Farley TA, Van Wye G. Reversing the obesity epidemic: the importance of policy and policy research. Am J Prev Med 2012; 43:S93-4. [PMID: 22898168 DOI: 10.1016/j.amepre.2012.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 05/18/2012] [Accepted: 06/07/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas A Farley
- New York City Department of Health and Mental Hygiene, Queens, New York 11101, USA.
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