1
|
Child Lead Screening Behaviors and Health Outcomes Following the Flint Water Crisis. J Racial Ethn Health Disparities 2023; 10:418-426. [PMID: 35041153 DOI: 10.1007/s40615-022-01233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is little research on lead (Pb) screening behaviors and outcomes and possible health sequelae of children in Flint, Michigan in the years following the city's 2014 water crisis, which included widespread tap water contamination with elevated levels of heavy metals and other environmental contaminants. METHODS Between June and November 2019, we collected and analyzed cross-sectional data on Flint children's demographics and self-report of screenings of blood lead levels (BLLs) and results and various potential water contamination-related health symptoms and outcomes. We calculated descriptive statistics to summarize the prevalence of health outcomes and screenings in children, and fit multivariable models using generalized estimating equations to characterize the association between baseline traits and health symptoms and outcomes in children. RESULTS A total of 244 children (mean age 8.6 ± 4.8) were included in the analysis. Overall, 76.6% of the children were reported to have been screened for elevated BLLs after the water source switch. In total, after the water source switch, 25.0% of children were reported as having clinician-diagnosed elevated BLLs. Overall, 43.9% of children experienced hyperactivity, 39.3% had emotional agitation, 29.1% had comprehension issues/learning delays, while 38.9% of children had skin rashes and 10.7% experienced hair loss. A child having elevated BLLs also significantly increased the odds of experiencing adverse cognitive/behavioral outcomes (comprehension issues/learning delays OR = 4.0, hyperactivity OR = 6.6, emotional agitation OR = 3.5). CONCLUSION Child BLL screening following the crisis initiation was moderate, and BLLs and potential water contamination-related morbidity outcomes appeared heightened. Further research is needed to contextualize epidemiologic factors contributing to BLL screening patterns and results and the potential water contamination-associated sequelae observed here.
Collapse
|
2
|
Montagnino E, Lytle DA, Rose J, Cwiertny D, Whelton AJ. School and childcare center drinking water: Copper chemistry, health effects, occurrence, and remediation. AWWA WATER SCIENCE 2022; 4:e1270. [PMID: 35865674 PMCID: PMC9286453 DOI: 10.1002/aws2.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
The study goal was to better understand the risks of elevated copper levels at US schools and childcare centers. Copper health effects, chemistry, occurrence, and remediation actions were reviewed. Of the more than 98,000 schools and 500,000 childcare centers, only 0.2% had copper water testing data in the federal Safe Drinking Water Information System database. Of the facilities designated public water systems, about 13% had reported an exceedance. Schools that were not designated a public water system (PWS) also had exceedances. Few studies document levels in schools and childcare centers. Widely different sampling and remedial actions were reported. Flushing contaminated water was the most evaluated remedial action but was unreliable because copper quickly rebounded when flushing stopped. Building water treatment systems have been used, but some were not capable of making the water safe. The health risk was difficult to determine due to the limited occurrence data and lack of best management practice studies. A national drinking water testing campaign and field studies are recommended.
Collapse
Affiliation(s)
| | | | - Joan Rose
- Michigan State UniversityEast LansingMichiganUSA
| | - David Cwiertny
- Department of Civil and Environmental EngineeringUniversity of IowaIowa CityIowaUSA
- Center for Health Effects of Environmental ContaminationUniversity of IowaIowa CityIowaUSA
- Public Policy CenterUniversity of IowaIowa CityIowaUSA
| | - Andrew J. Whelton
- Lyles School of Civil Engineering and Division of Environmental and Ecological EngineeringPurdue UniversityWest LafayetteIndianaUSA
- Center for Plumbing SafetyPurdue UniversityWest LafayetteIndianaUSA
| |
Collapse
|
3
|
Lavallee S, Latchmore T, Hynds PD, Brown RS, Schuster-Wallace C, Anderson SD, Majury A. Drinking Water Consumption Patterns among Private Well Users in Ontario: Implications for Exposure Assessment of Waterborne Infection. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2021; 41:1890-1910. [PMID: 33438270 DOI: 10.1111/risa.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/17/2020] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Understanding the water consumption patterns within a specific population informs development of increasingly accurate, spatially specific exposure and/or risk assessment of waterborne infection. The current study examined the consumption patterns of private well users in Ontario while considering potentially influential underlying sociodemographics, household characteristics, and experiential factors. A province-wide online survey was circulated between May and August 2018 (n = 1,162). Overall, 81.5% of respondents reported daily well water consumption (i.e., tap water). Results indicate a mean daily well water consumption rate of 1,132 mL/day (SD = 649 mL/day) among well water consumers. Gender was significantly associated with well water consumption, with higher consumption rates found among female respondents. The experience of acute gastrointestinal illness (AGI) symptoms or diagnosis in the past 12 months did not impact the volume of water consumed, suggesting that experiencing previous AGI does not decrease consumption volumes, and therefore exposure over time. Significantly higher rates of well water consumption were found among respondents who reported previous testing or ongoing water treatment. Approximately 45.5% of survey respondents who stated that they do not consume well water selected bottled water as their primary household drinking water supply. Bottled water consumption was also not associated with previous AGI experiences. Findings will inform future quantitative microbial risk assessments associated with private well water use by providing spatially and demographically specific estimates of well water consumption.
Collapse
Affiliation(s)
- Sarah Lavallee
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
| | - Tessa Latchmore
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
| | - Paul D Hynds
- Environmental Sustainability & Health Institute, Technological University Dublin, Dublin, Ireland
| | - R Stephen Brown
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
| | - Corinne Schuster-Wallace
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anna Majury
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
- Public Health Ontario, Kingston, Ontario, Canada
| |
Collapse
|
4
|
Abstract
OBJECTIVE As tap water distrust has grown in the USA with greater levels among Black and Hispanic households, we aimed to examine recent trends in not drinking tap water including the period covering the US Flint Water Crisis and racial/ethnic disparities in these trends. DESIGN Cross-sectional analysis. We used log-binomial regressions and marginal predicted probabilities to examine US nationally representative trends in tap and bottled water consumption overall and by race/ethnicity. SETTING The National Health and Nutrition Examination Survey data, 2011-2018. PARTICIPANTS Nationally representative sample of 9439 children aged 2-19 years and 17 268 adults. RESULTS Among US children and adults, respectively, in 2017-2018 there was a 63 % (adjusted prevalence ratio (PR): 1·63, 95 % CI (1·25, 2·12), P < 0·001)) and 40 % (PR: 1·40, 95 % CI (1·16, 1·69), P = 0·001)) higher prevalence of not drinking tap water compared to 2013-2014 (pre-Flint Water Crisis). For Black children and adults, the probability of not drinking tap water increased significantly from 18·1 % (95 % CI (13·4, 22·8)) and 24·6 % (95 % CI (20·7, 28·4)) in 2013-2014 to 29·3 % (95 % CI (23·5, 35·1)) and 34·5 % (95 % CI (29·4, 39·6)) in 2017-2018. Among Hispanic children and adults, not drinking tap water increased significantly from 24·5 % (95 % CI (19·4, 29·6)) and 27·1 % (95 % CI (23·0, 31·2)) in 2013-2014 to 39·7 % (95 % CI (32·7, 46·8)) and 38·1 % (95 % CI (33·0, 43·1)) in 2017-2018. No significant increases were observed among Asian or White persons between 2013-2014 and 2017-2018. Similar trends were found in bottled water consumption. CONCLUSIONS This study found persistent disparities in the tap water consumption gap from 2011 to 2018. Black and Hispanics' probability of not drinking tap water increased following the Flint Water Crisis.
Collapse
|
5
|
Williams N, Mann G, Cafer A, Evers C, Kaiser K. “Bring back the salad bar”: perceptions of health in rural delta middle school students. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1894298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Natalie Williams
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS 38677, USA
| | - Georgianna Mann
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS 38677, USA
| | - Anne Cafer
- University of Mississippi, University, MS 38677543, Lamar Hall, USA
| | - Charles Evers
- School of Medicine, 1670 University Blvd, University of Alabama, Birmingham, USA
| | - Kimberly Kaiser
- Department of Legal Studies, M302 Mayes, University of Mississippi, University, MS 38677, USA
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Collier DN, Robinson A, Mitra S, Taft N, Raad A, Hudson S, Young JW, Lazorick S. Tapping Out: Influence of Organoleptic and Perceived Health Risks on Bottled Versus Municipal Tap Water Consumption Among Obese, Low Socioeconomic Status Pediatric Patients. EXPOSURE AND HEALTH 2020; 12:179-186. [PMID: 33313440 PMCID: PMC7731727 DOI: 10.1007/s12403-019-00302-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/20/2018] [Accepted: 02/07/2019] [Indexed: 05/29/2023]
Abstract
A variety of endocrine disrupting chemicals (EDCs), including some known to be obesogenic, can be found in household wastewater. Many are only partially treated by wastewater treatment and drinking water purification systems and can enter municipal drinking water supplies. We evaluated drinking water consumption habits in a cohort of obese pediatric patients to determine the percentage that might avoid exposure to EDCs from drinking municipal tap water. Obese (BMI ≥ 95th percentile) children presenting to an obesity clinic serving a largely poor and rural population were studied. Self-reported race/ethnicity, insurance status and details concerning type and volume of water consumed were obtained from their medical records. Most homes were supplied with municipal, rather than private well water (90.6% vs. 9.4%, respectively). A majority (76.4%) of patients with municipal water as their water supply only drank bottled water. "Taste" and "Health Concerns" were the most commonly endorsed reasons for eschewing tap water. Bottled water consumption among low socioeconomic status patients may reduce their risk for exposure to EDCs in municipal tap water. Further studies are needed to confirm the generalizability of this observation.
Collapse
Affiliation(s)
- David N. Collier
- Department of Pediatrics, Brody School of Medicine East Carolina University, Greenville, North Carolina, USA
- Pediatric Healthy Weight Research and Treatment Center, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
- Center for Health Disparities East Carolina University, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
- Integrated Health Sciences Facility Core, Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA
| | - Aaron Robinson
- Pediatric Healthy Weight Research and Treatment Center, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Siddhartha Mitra
- Integrated Health Sciences Facility Core, Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA
- Department of Geological Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Natalie Taft
- Department of Pediatrics, Brody School of Medicine East Carolina University, Greenville, North Carolina, USA
- Pediatric Healthy Weight Research and Treatment Center, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Alice Raad
- Pediatric Healthy Weight Research and Treatment Center, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Suzanne Hudson
- Department of Biostatistics, East Carolina University, Greenville, North Carolina, USA
| | - Jessica Webb Young
- Department of Pediatrics, Levine Children’s Hospital at Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Suzanne Lazorick
- Department of Pediatrics, Brody School of Medicine East Carolina University, Greenville, North Carolina, USA
- Pediatric Healthy Weight Research and Treatment Center, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| |
Collapse
|
8
|
Lawman HG, Grossman S, Lofton X, Tasian G, Patel AI. Hydrate Philly: An Intervention to Increase Water Access and Appeal in Recreation Centers. Prev Chronic Dis 2020; 17:E15. [PMID: 32078503 PMCID: PMC7085906 DOI: 10.5888/pcd17.190277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Previous interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp. Methods Recreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance. Results Results showed increased water use (b = 8.6, 95% CI, 4.2–13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2–16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff’s past 30-day SSB consumption frequency decreased (b = −34.8, 95% CI, −67.7 to −1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004–0.76, P = .06) than control sites. Conclusion Although providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake.
Collapse
Affiliation(s)
- Hannah G Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania.,Division of Chronic Disease Prevention, Philadelphia Department of Public Health, 1101 Market St, 9th Flr, Philadelphia, PA 19107.
| | - Sara Grossman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Xavier Lofton
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Gregory Tasian
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anisha I Patel
- School of Medicine, Stanford University, Stanford, California.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| |
Collapse
|
9
|
Vieux F, Maillot M, Rehm CD, Barrios P, Drewnowski A. Trends in tap and bottled water consumption among children and adults in the United States: analyses of NHANES 2011-16 data. Nutr J 2020; 19:10. [PMID: 31996207 PMCID: PMC6990513 DOI: 10.1186/s12937-020-0523-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Dietary Guidelines for Americans 2015-20 recommend choosing water in place of sugar-sweetened beverages (SSB). This study examined water consumption patterns and trends among children and adults in the US. METHODS Dietary intake data for 7453 children (4-18y) and 15,263 adults (>19y) came from two 24 h dietary recalls in three cycles of the National Health and Nutrition Examination Survey (NHANES 2011-2016). Water was categorized as tap or bottled (plain). Other beverages were assigned to 15 categories. Water and other beverage intakes (in mL/d) were analyzed by sociodemographic variables and sourcing location. Consumption time trends from 2011 to 2016 were also examined. Total water intakes from water, other beverages and moisture from foods (mL/d) were compared to Dietary Reference Intakes (DRI) for water. RESULTS Total dietary water (2718 mL/d) came from water (1066 mL/d), other beverages (1036 mL/d) and from food moisture (618 mL/d). Whereas total water intakes remained stable, a significant decline in SSB from 2011 to 2016 was fully offset by an increase in the consumption of plain water. The main sources of water were tap at home (288 mL/d), tap away from home (301 mL/d), and bottled water from stores (339 mL/d). Water and other beverage consumption patterns varied with age, incomes and race/ethnicity. Higher tap water consumption was associated with higher incomes, but bottled water was not. Non-Hispanic whites consumed most tap water (781 mL/d) whereas Mexican Americans consumed most bottled water (605 mL/d). Only about 40% of the NHANES sample on average followed US recommendations for adequate water intakes. CONCLUSION The present results suggest that while total water intakes among children and adults have stayed constant, drinking water, tap and bottled, has been replacing SSB in the US diet.
Collapse
Affiliation(s)
- Florent Vieux
- MS-Nutrition, 27 bld Jean Moulin Faculté de Médecine la Timone, Laboratoire C2VN, 13385, Marseille, cedex 5, France
| | - Matthieu Maillot
- MS-Nutrition, 27 bld Jean Moulin Faculté de Médecine la Timone, Laboratoire C2VN, 13385, Marseille, cedex 5, France
| | - Colin D Rehm
- Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, 10467, USA
| | | | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA, 98195, USA.
| |
Collapse
|
10
|
Patel AI, Hecht AA, Hampton KE, Hecht C, Buck S. Agua4All: Providing Safe Drinking Water in Rural California Communities. Prev Chronic Dis 2019; 16:E151. [PMID: 31726021 PMCID: PMC6880921 DOI: 10.5888/pcd16.190165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Drinking water instead of sugar-sweetened beverages may reduce obesity and dental caries. Tap water is more affordable and sustainable than bottled water and more likely to contain fluoride, which prevents caries. To address inequities in access to safe tap water, cross-sector partners established the Agua4All safe drinking-water program in 2 rural San Joaquin Valley, California, communities. The program's objective was to examine Agua4All's feasibility, acceptability, and effect on water intake. METHODS We provided bottle-filling stations dispensing safe water at 12 sites in 2 communities and provided limited promotional support. To compare the effect of different levels of promotion, sites in 1 community also received a promotions toolkit, a stipend, and assistance in developing and conducting their own promotional activities (site-led promotion). Beverage intake at sites was observed at baseline (pre-installation), at time 1 (post-installation), and at times 2 and 3 (post-promotion). Flowmeters tracked water dispensings. Staff interviews examined implementation barriers and facilitators. RESULTS From baseline to time 3, a nonsignificant increase (21.16%) occurred in the proportion of people drinking water at sites with water stations and site-led promotion compared with sites with water stations and limited promotion (5.13%) (P = .14). Mean daily gallons of water taken from stations per site was 3.61 (standard deviation, 3.84). Most staff members (77%) at the sites preferred water stations to traditional drinking fountains. CONCLUSION Bottle-filling stations with safe water and site-led promotion are a promising strategy for increasing water intake in communities without safe tap water. Larger studies should examine the effects of such stations on intake of sugar-sweetened beverages and on overall health.
Collapse
Affiliation(s)
- Anisha I Patel
- Division of General Pediatrics, Stanford University, Medical School Office Building, 1265 Welch Road, Stanford, CA 94305. .,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Amelie A Hecht
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Christina Hecht
- Nutrition Policy Institute at the University of California, Division of Agriculture and Natural Resources, Oakland, California
| | - Sarah Buck
- RCAP Inc., Washington, District of Columbia.,Rural Community Assistance Corporation, Sacramento, California
| |
Collapse
|
11
|
Cradock AL, Poole MK, Agnew KE, Flax C, Plank K, Capdarest-Arest N, Patel AI. A systematic review of strategies to increase drinking-water access and consumption among 0- to 5-year-olds. Obes Rev 2019; 20:1262-1286. [PMID: 31250960 DOI: 10.1111/obr.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 12/12/2022]
Abstract
The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years.
Collapse
Affiliation(s)
- Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary Kathryn Poole
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaylan E Agnew
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Chasmine Flax
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kaela Plank
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, CA, USA
| | | | - Anisha I Patel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Department of Pediatrics, Stanford University, Stanford, CA, USA
| |
Collapse
|
12
|
Franse CB, Wang L, Constant F, Fries LR, Raat H. Factors associated with water consumption among children: a systematic review. Int J Behav Nutr Phys Act 2019; 16:64. [PMID: 31409359 PMCID: PMC6693220 DOI: 10.1186/s12966-019-0827-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/29/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Water is recommended as the main beverage for daily fluid intake. Previous systematic reviews have studied the consumption of sugar-sweetened beverages (SSBs) among children, but none have focused on water consumption. Insight into factors that are associated with children's water intake is needed to inform the development of interventions aimed at the promotion of water consumption. The objective of this review was therefore to summarize the current evidence on factors associated with water consumption among children aged 2 to 12 years. METHODS A systematic literature search in seven electronic databases was conducted in May, 2018 and retrieved 17,850 unique records. Two additional studies were identified by hand-searching references of included articles. Studies were selected if they had a cross-sectional or longitudinal study design, focused on children aged 2-12 years and published in an English language peer-reviewed journal. Participants from clinical populations, studies that included data of < 10 participants and non-human studies were excluded. RESULTS A total of 63 articles met inclusion criteria and were included in the analysis. We identified 76 factors that were investigated in these studies; 17/76 were investigated in a longitudinal study. There was evidence of positive associations between water consumption and child's self-efficacy, parental education level, parental self-efficacy, use of feeding practices such as restriction or encouraging healthy eating and study year. Evidence was inconsistent (< 60% of studies reported an association) for child's age, sex, BMI, consumption of SSBs and ethnic background of the parent. There was no evidence (≤33% of studies reported an association) of associations between consumption of milk or juice, parental emotional-, modelling- or instrumental feeding practices, eating school lunch or outside temperature and water consumption. The remaining 54 factors were investigated in fewer than three studies. CONCLUSIONS There is some evidence for an association between potentially modifiable parental and child-related factors and water consumption. However, most factors identified in this review were only studied by one or two studies and most studies were cross-sectional. More longitudinal research is necessary to investigate environmental, parental and child-related factors associated with water consumption that are currently under-studied and could further inform intervention strategies. TRIAL REGISTRATION PROSPERO ID# CRD42018093362 , registered May 22, 2018.
Collapse
Affiliation(s)
- Carmen B. Franse
- Department of Public Health, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - L. Wang
- Department of Public Health, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | | | - Lisa R. Fries
- Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| |
Collapse
|
13
|
Patel AI, Schmidt LA. Water Access in the United States: Health Disparities Abound and Solutions Are Urgently Needed. Am J Public Health 2019; 107:1354-1356. [PMID: 28787195 DOI: 10.2105/ajph.2017.303972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anisha I Patel
- Anisha I. Patel is with the Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF). Laura A. Schmidt is with the Department of Anthropology, History, and Social Medicine and the Philip R. Lee Institute for Health Policy Studies at UCSF
| | - Laura A Schmidt
- Anisha I. Patel is with the Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF). Laura A. Schmidt is with the Department of Anthropology, History, and Social Medicine and the Philip R. Lee Institute for Health Policy Studies at UCSF
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Sanders AE, Slade GD. Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water. Am J Prev Med 2018; 54:157-163. [PMID: 29191396 PMCID: PMC5783762 DOI: 10.1016/j.amepre.2017.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/04/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study's purpose is to determine whether nonconsumption of tap water is associated with lower prevalence of elevated blood lead levels and higher prevalence of dental caries in children and adolescents. METHODS Cross-sectional data from the National Health and Nutrition Examination Survey 2005-2014 recorded drinking water source (n=15,604) and blood lead levels (n=12,373) for participants aged 2-19 years, and dental caries experience for the 2011-2014 subset (n=5,677). The threshold for elevated blood lead level was ≥3 μg/dL. A binary outcome indicated presence or absence of dental caries experience. Multivariable generalized linear models estimated adjusted prevalence ratios with 95% confidence limits. RESULTS In analysis conducted in 2017, 15% of children and adolescents did not drink tap water, 3% had elevated blood lead levels ≥3 μg/dL, and 50% had dental caries experience. Children and adolescents who did not drink water were less likely than tap water drinkers to have an elevated blood lead level (adjusted prevalence ratios=0.62, 95% confidence limits=0.42, 0.90). Nonconsumers of tap water were more likely to have dental caries (adjusted prevalence ratios=1.13, 95% confidence limits=1.03, 1.23). Results persisted after adjustment for other covariates and using a higher threshold for elevated blood lead level. CONCLUSIONS In this nationally representative U.S. survey, children and adolescents who did not drink tap water had lower prevalence of elevated blood lead levels and higher prevalence of dental caries than those who drank tap water.
Collapse
Affiliation(s)
- Anne E Sanders
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Gary D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
17
|
Disparities in plain, tap and bottled water consumption among US adults: National Health and Nutrition Examination Survey (NHANES) 2007-2014. Public Health Nutr 2018; 21:1455-1464. [PMID: 29388529 DOI: 10.1017/s1368980017004050] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Differences in bottled v. tap water intake may provide insights into health disparities, like risk of dental caries and inadequate hydration. We examined differences in plain, tap and bottled water consumption among US adults by sociodemographic characteristics. DESIGN Cross-sectional analysis. We used 24 h dietary recall data to test differences in percentage consuming the water sources and mean intake between groups using Wald tests and multiple logistic and linear regression models. SETTING National Health and Nutrition Examination Survey (NHANES), 2007-2014. SUBJECTS A nationally representative sample of 20 676 adults aged ≥20 years. RESULTS In 2011-2014, 81·4 (se 0·6) % of adults drank plain water (sum of tap and bottled), 55·2 (se 1·4) % drank tap water and 33·4 (se 1·4) % drank bottled water on a given day. Adjusting for covariates, non-Hispanic (NH) Black and Hispanic adults had 0·44 (95 % CI 0·37, 0·53) and 0·55 (95 % CI 0·45, 0·66) times the odds of consuming tap water, and consumed B=-330 (se 45) ml and B=-180 (se 45) ml less tap water than NH White adults, respectively. NH Black, Hispanic and adults born outside the fifty US states or Washington, DC had 2·20 (95 % CI 1·79, 2·69), 2·37 (95 % CI 1·91, 2·94) and 1·46 (95 % CI 1·19, 1·79) times the odds of consuming bottled water than their NH White and US-born counterparts. In 2007-2010, water filtration was associated with higher odds of drinking plain and tap water. CONCLUSIONS While most US adults consumed plain water, the source (i.e. tap or bottled) and amount differed by race/Hispanic origin, nativity status and education. Water filters may increase tap water consumption.
Collapse
|
18
|
Ritchie LD, Yoshida S, Sharma S, Patel A, Vitale EH, Hecht K. Drinking water in California child care sites before and after 2011-2012 beverage policy. Prev Chronic Dis 2015; 12:E89. [PMID: 26043304 PMCID: PMC4456856 DOI: 10.5888/pcd12.140548] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Drinking water is promoted to improve beverage nutrition and reduce the prevalence of obesity. The aims of this study were to identify how water was provided to young children in child care and to determine the extent to which water access changed after a federal and state child care beverage policy was instituted in 2011 and 2012 in California. Methods Two independent cross-sectional samples of licensed child care providers completed a self-administered survey in 2008 (n = 429) and 2012 (n = 435). Logistic regression was used to analyze data for differences between 2008 and 2012 survey responses, after adjustment for correlations among the measurements in each of 6 child care categories sampled. Results A significantly larger percentage of sites in 2012 than in 2008 always served water at the table with meals or snacks (47.0% vs 28.0%, P = .001). A significantly larger percentage of child care sites in 2012 than in 2008 made water easily and visibly available for children to self-serve both indoors (77.9% vs 69.0%, P = .02) and outside (78.0% vs 69.0%, P = .03). Sites that participated in the federal Child and Adult Care Food Program had greater access to water indoors and outside than sites not in the program. In 2012 most (76.1%) child care providers reported no barriers to serving water to children. Factors most frequently cited to facilitate serving water were information for families (39.0% of sites), beverage policy (37.0%), and lessons for children (37.9%). Conclusion Water provision in California child care improved significantly between samples of sites studied in 2008 and 2012, but room for improvement remains after policy implementation. Additional training for child care providers and parents should be considered.
Collapse
Affiliation(s)
- Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin St, Ste 10123, Oakland, CA 94607.
| | - Sallie Yoshida
- Sarah Samuels Center for Public Health Research and Evaluation, Oakland, California
| | - Sushma Sharma
- Atkins Center for Weight and Health, University of California, Berkeley, California. Dr Sharma is now affiliated with Dallas-Fort Worth Hospital Council Foundation, Irving, Texas
| | - Anisha Patel
- School of Medicine, University of California, San Francisco, California
| | | | - Ken Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| |
Collapse
|
19
|
Ritchie LD, Sharma S, Gildengorin G, Yoshida S, Braff-Guajardo E, Crawford P. Policy Improves What Beverages Are Served to Young Children in Child Care. J Acad Nutr Diet 2015; 115:724-730. [DOI: 10.1016/j.jand.2014.07.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
|
20
|
van Erp B, Webber WL, Stoddard P, Shah R, Martin L, Broderick B, Induni M. Demographic factors associated with perceptions about water safety and tap water consumption among adults in Santa Clara County, California, 2011. Prev Chronic Dis 2014; 11:E98. [PMID: 24921901 PMCID: PMC4060877 DOI: 10.5888/pcd11.130437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to examine differences in tap water consumption and perceptions of bottle versus tap water safety for Hispanics and non-Hispanic whites, as well as associations with other demographic characteristics. Data are from the Santa Clara County, California, Dietary Practices Survey (2011; N = 306). We used logistic regression to examine associations between demographic characteristics and 1) perceptions that bottled water is safer than tap and 2) primarily consuming tap water. Hispanics were less likely than non-Hispanic whites to primarily drink tap water (OR = 0.33; 95% CI, 0.11–0.99), although there was no significant difference in perceptions that bottled water is safer between these groups (OR = 0.50; 95% CI, 0.11–2.27). Hispanics may be an important population for interventions promoting tap water consumption.
Collapse
Affiliation(s)
- Brianna van Erp
- Santa Clara County Public Health Department, 976 Lenzen Ave, San Jose, CA 95126. E-mail:
| | - Whitney L Webber
- Santa Clara County Public Health Department, San Jose, California
| | - Pamela Stoddard
- Santa Clara County Public Health Department, San Jose, California
| | - Roshni Shah
- Santa Clara County Public Health Department, San Jose, California
| | - Lori Martin
- Santa Clara County Public Health Department, San Jose, California
| | - Bonnie Broderick
- Santa Clara County Public Health Department, San Jose, California
| | - Marta Induni
- Survey Research Group, Public Health Institute, Sacramento, California
| |
Collapse
|
21
|
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.
Collapse
|
22
|
Patel AI, Bogart LM, Klein DJ, Cowgill B, Uyeda KE, Hawes-Dawson J, Schuster MA. Middle school student attitudes about school drinking fountains and water intake. Acad Pediatr 2014; 14:471-7. [PMID: 25169158 PMCID: PMC4193898 DOI: 10.1016/j.acap.2014.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/19/2014] [Accepted: 05/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe middle school student attitudes about school drinking fountains, investigate whether such attitudes are associated with intentions to drink water at school, and determine how intentions relate to overall water intake. METHODS Students (n = 3211) in 9 California middle schools completed surveys between 2009 and 2011. We used multivariate linear regression, adjusting for school sociodemographic characteristics, to examine how attitudes about fountains (5-point scale; higher scores indicating more positive attitudes) were associated with intentions to drink water at school and how intentions to drink water at school were related to overall water intake. RESULTS Mean age of students was 12.3 (SD = 0.7) years; 75% were Latino, 89% low income, and 39% foreign born. Fifty-two percent reported lower than recommended overall water intake (<3 glasses/day), and 30% reported that they were unlikely or extremely unlikely to drink water at school. Fifty-nine percent reported that school fountains were unclean, 48% that fountain water does not taste good, 33% that fountains could make them sick, 31% that it was not okay to drink from fountains, and 24% that fountain water is contaminated. In adjusted analyses, attitudes about school drinking fountains were related to intentions to drink water at school (β = 0.41; P < .001); intentions to drink water at school were also associated with overall water intake (β = 0.20; P < .001). CONCLUSIONS Students have negative attitudes about school fountains. To increase overall water intake, it may be important to promote and improve drinking water sources not only at school but also at home and in other community environments.
Collapse
Affiliation(s)
- Anisha I. Patel
- Division of General Pediatrics, University of California, San Francisco, CA
| | - Laura M. Bogart
- Division of General Pediatrics, Boston Children’s Hospital Boston, Boston, MA,Harvard School of Public Health, Boston, MA
| | - David J. Klein
- Division of General Pediatrics, Boston Children’s Hospital Boston, Boston, MA
| | - Burt Cowgill
- Department of Health Policy and Management, Fielding School of Public Health University of California, Los Angeles, Los Angeles, CA
| | - Kimberly E. Uyeda
- Student Health and Human Services, Los Angeles Unified School District, Los Angeles, CA
| | | | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital Boston, Boston, MA,Harvard School of Public Health, Boston, MA
| |
Collapse
|