Healthy Hydration Pilot in Elementary Schools

Study Overview
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Brief Summary
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This study will pilot a school-based stakeholder-informed hydration intervention and examine its feasibility and preliminary efficacy.

Detailed Description
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Adequate water intake plays an important role in maintaining children's overall health, cognitive performance, fine motor skills and visual attention. It also plays a role in the maintenance of healthy weight. Many children do not consume sufficient water, especially in school. There is also potential that by providing enhanced access to water, there will be corresponding decreases in sugary beverage intake. Sugary beverages have been implicated as major contributors of excessive sugar and calorie intake in children, leading to multiple health concerns, such as type 2 diabetes, overweight and obesity, and dental caries. Schools are an optimal environment to increase children's water intake. Healthy hydration is a priority for Richmond Public School (RPS), as they recently adopted a new hydration policy into their school wellness policy, with hydration stations installed in all RPS schools. The purpose of this study is to determine the feasibility of a school-based hydration intervention. This study will pilot a school-based stakeholder-informed hydration intervention and examine its feasibility and preliminary efficacy.

Official Title
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Addressing Root Causes of Under-hydration in School: A Stakeholder Collaborative Pilot Study

Conditions
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Hydration, Dental Caries, Body Mass Index

Intervention / Treatment
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* Behavioral: Hydration Intervention
* Other: Control - Assessments Only


Participation Criteria
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Eligibility Criteria
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Inclusion: Lunchroom observations: All students (K-5th) who eat lunch in the cafeteria on assessment days are eligible for lunchroom observations (observing what beverages are selected and presence of water bottles) BMI and dental caries assessments: 1) student is in the 3rd grade; 2) English or Spanish speaking. Student surveys: Students in 4th-5th grade are eligible to complete surveys assessing beverage intake and perceptions of hydration practices at RPS. Staff surveys: All staff in the target schools will be eligible to complete the School Environment Survey. Exclusion: Lunchroom observations: None. BMI and dental caries assessments: Students are ineligible if they: 1) are non-English or non-Spanish speaking; 2) have a medical condition that precludes drinking water or that can put them at risk for failure to thrive or poor weight gain, 2) are unable to complete assessments due to developmental delays, 3) plan to move from the school district during the study period. Student surveys: Students in 4th-5th grade who are unable to complete surveys due to developmental delays will be ineligible. Staff surveys: None.

Ages Eligible for Study
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Minimum Age: 4 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hydration Intervention<br>Students and staff at the intervention school will receive a school-based hydration intervention that includes a student-developed marketing campaign and incentivizes water bottles in school. | Behavioral: Hydration Intervention<br>* Teacher & student ambassadors: serve as hydration role models, identify Hydration Heroes, monitor filter lights on hydration stations, & update the water meter visual. Kick-off event: event to kick off the hydration intervention to include water bottles distribution with a station to personalize, experiential activities, and information about the intervention. Social marketing: student-developed marketing campaign Make water your superpower will be placed in high-traffic areas of the school. Hydration Headquarters will be located in the lunchroom displaying a water meter illustrating bottle refills from the school's hydration stations. Behavioral reinforcement: on random days, students drinking water and/or with a water bottle will receive small incentives. Education and outreach: Hydration Tip Sheets, hydration signage in classrooms, and hydration trivia on hydration stations. Teachers will deliver 1 hydration lesson per month that align with Standards of Learning.<br>|
| Placebo Comparator: Control<br>Students and staff at the control school will participate in assessments only. | Other: Control - Assessments Only<br>* Assessments only<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recruitment of student ambassadors | Ability to recruit the required number of students at start of trial. | pre-intervention to baseline | 
| Retention of student ambassadors | Measured by percentage of students retained. | 4 months | 
| School personnel satisfaction | Measured via surveys. | Baseline and post (month 4) | 
| Implementation of intervention | Percentage of intervention activities conducted per protocol | 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Water bottle usage | % of students with water bottles in school | Baseline, months 1, 2, & 3, post (month 4) | 
| Hydration station usage | Ounces of water per student per day measured by hydration station flow meters. | Baseline, months 1, 2, & 3, post (month 4) | 
| Sugar-sweetened beverages at lunch | % of students with sugar-sweetened beverages at lunch | Baseline, months 1, 2, & 3, post (month 4) | 
| Dental caries status | measured by a modified International Caries Detection and Assessment System (ICDAS) | Baseline and post (month 4) | 
| Body Mass Index | NHANES Anthropometry methods used to measure height and weight | Baseline and post (month 4) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hydration, Water bottle, Sugary Beverages