School Water Access, Food and Beverage Intake, and Obesity
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      It is widely argued that the promotion of water consumption, as an alternative to
      sugar-sweetened beverages, can assist in childhood obesity prevention efforts. Yet no studies
      have tested this argument in real world schools where flavored milk or juices are available.
      This trial will fill gaps by examining how promoting fresh water intake-both in schools that
      do and do not provide access to caloric beverages -impacts children's consumption of food and
      beverages both during and outside of school, and obesity.
    

Detailed description: 
      Maintaining a healthy weight is important for young children because childhood obesity is
      predictive of adult obesity and related chronic illness. Intake of sugar-sweetened beverages
      (SSBs: sodas, flavored milks, fruit-flavored drinks, and other drinks with added sugar) is a
      major contributor to obesity. This is particularly true for low income children who are more
      likely to drink SSBs and to be obese. Children spend substantial time in schools where they
      consume up to 50% of daily calories, including those from SSBs. Consequently, many obesity
      prevention efforts have targeted reductions in SSB intake in schools. Recently, scientific
      authorities have also recommended that schools improve the availability of potable and free
      drinking water - a healthy alternative to SSBs - as a low-cost and feasible obesity
      prevention strategy. Emerging policies also mandate water access in schools; but
      implementation is poor. Although the 2010 Healthy, Hunger-Free Kids Act requires schools
      participating in federal meal programs to provide free potable water where meals are served,
      25% of US schools still fail to do so. And even in schools that offer free water, drinking
      fountains may be avoided due to concerns about cleanliness or sub-standard water quality.
      While promotion of drinking water intake in schools is a plausible obesity prevention
      strategy, no large studies have systematically examined how this tactic can change children's
      overall dietary patterns and obesity rates in schools that offer SSBs and juices. This
      study's central hypothesis is that in elementary schools, increased access to fresh water and
      rigorous promotion of its consumption will reduce student intake of caloric beverages,
      thereby leading to lower rates of obesity. This hypothesis will be tested through a
      cluster-randomized trial in 26 low-income elementary schools in the San Francisco Bay Area,
      in which 13 schools will receive a water promotion intervention and 13 schools will serve as
      controls. The intervention, based on Social Cognitive Theory and the PRECEDE-PROCEED Model
      and cultivated in the investigators' prior developmental studies, promotes water consumption
      by: 1) installing lead-free water stations in cafeterias, physical activity spaces and
      high-traffic common areas, 2) providing cups and reusable water bottles for students, and 3)
      conducting a 6-month health education campaign that includes a kick-off play, class lessons,
      family homework activities, signage, and rewards. From baseline to 7 and 15 months after the
      start of the intervention, researchers measure differences in: 1) water intake (observations
      and measurements of water taken from water sources) 2) water and SSB intake via beverage
      frequency questionnaires and 3) overweight/obesity prevalence between students in
      intervention and control schools. Total caloric intake from foods and beverages (24-hour food
      and beverage diaries) are measured at baseline and 7 months only due to budget cuts and their
      resource intensiveness. If the proposed school water intervention is effective, school
      officials will have a feasible and low-cost obesity prevention tool. US schools will soon be
      federally mandated to reevaluate their wellness policies in order to implement new food and
      beverage regulations. This study presents a timely opportunity to provide leaders with an
      evidence-based strategy for improving student nutrition and health.
    

Intervention name(s): Water First
Intervention type(s): Behavioral
Intervention description(s): The Water First intervention consists of increased access to safe and appealing drinking water in schools, school-wide promotion to increase students' intake of water, and education directed to 4th grade students and their families to increase intake of water.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: water; sugar-sweetened beverages; schools