Obesity
Conditions
Keywords
water, sugar-sweetened beverages, schools
Brief 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.
Interventions
BEHAVIORALWater First
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.
Sponsors
University of California, San Francisco
University of California
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
9 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* 4th grade students, students in 4th grade combination classes who speak English or Spanish and who don't have health conditions that preclude intake of water * School administrators and food service directors at study schools
Exclusion criteria
* Students not in the 4th grade or 4th grade combination classes * Students who do not speak English or Spanish
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Baseline, 7-months, and 15-months after the start of the study. | Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Baseline, 7-months, and 15-months after the start of the study. | Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. |
| BMI Percentile,Mean(SD) | Baseline, 7-months, and 15-months after the start of the study. | Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. |
| BMI, Mean (SD) | Baseline, 7-months, and 15-months after the start of the study. | Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. |
| BMI Z-score, Mean (SD) | Baseline, 7-months, and 15-months after the start of the study. | Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. BMI z-scores (or standard deviation scores) are used in anthropometry to quantify a measurement's distance from the mean. The measurement is obtained using the sex, age, weight and height of the participants. The z-score is based on United States Centers for Disease Control and Prevention growth references for children. A z-score of 0 reflects the 50th percentile based on the reference growth charts. For example, a z-score of 1.5 indicates a child is 1.5 standard deviations above the average value, whereas a z-score of -1.5 means a child is 1.5 standard deviations below the average value. |
| Water Intake - Grams Consumed | Baseline and 7-months | Food and beverage diaries will be used to calculate daily water intake. |
| Beverage Intake | Baseline, 7-months, and 15-months after the start of the study. | Beverage intake frequency questionnaires will be used to calculate past-week frequency of beverages consumed (times per day). |
| Water Intake | Baseline, 7-months, and 15-months after the start of the study. | Direct observations of water consumed at lunchtime, 4th-grade physical education (PE) classes, and recess. Researchers tallied the number of students using water sources and the student census in the area to estimate the proportion using stations or fountains. |
| Caloric Intake | Baseline and 7-months after the start of the study | Food and beverage diaries will be used to calculate daily caloric intake from foods and beverages. |
Other
| Measure | Time frame | Description |
|---|---|---|
| School Policies and Practices | Baseline and 15-months after the start of the study | School administrators and food service director surveys of nutrition and physical activity policies and practices at schools |
Countries
United States
Participant flow
Recruitment details
Cluster-randomized trial: participants were enrolled from schools that were randomized to receive the intervention, or no intervention.
Pre-assignment details
1861 students and adults signed consent; 564 students and adults could not be in the study due to pandemic school closures.
Participants by arm
| Arm | Count |
|---|---|
| Water Access and Promotion - Students Schools receive installation of water stations in high traffic areas, schoolwide promotion, and 4th graders receive a curricula focused on increasing intake of water (intervention group). | 677 |
| Water Access and Promotion - School Personnel Schools receive installation of water stations in high traffic areas, schoolwide promotion (intervention group). School personnel complete surveys on school policies and procedures. | 10 |
| Control - Students Schools do not receive an intervention. | 572 |
| Control - School Personnel Schools do not receive an intervention. School personnel complete surveys on school policies and procedures. | 12 |
| Food Service Directors District-level Food Service Directors complete surveys on school policies and procedures. | 13 |
| Total | 1,284 |
Baseline characteristics
| Characteristic | Control - Students | Total | Water Access and Promotion - Students | Control - School Personnel | Food Service Directors | Water Access and Promotion - School Personnel |
|---|---|---|---|---|---|---|
| Age, Continuous | 9.6 years STANDARD_DEVIATION 0.4 | 9.6 years STANDARD_DEVIATION 0.4 | 9.6 years STANDARD_DEVIATION 0.4 | — | — | — |
| Race/Ethnicity, Customized Race and ethnicity, No (%) Mexican American, Latino, Hispanic | 337 Participants | 792 Participants | 455 Participants | — | — | — |
| Race/Ethnicity, Customized Race and ethnicity, No (%) Non-Hispanic Asian | 94 Participants | 174 Participants | 80 Participants | — | — | — |
| Race/Ethnicity, Customized Race and ethnicity, No (%) Non-Hispanic Black | 25 Participants | 51 Participants | 26 Participants | — | — | — |
| Race/Ethnicity, Customized Race and ethnicity, No (%) Non-Hispanic White | 45 Participants | 88 Participants | 43 Participants | — | — | — |
| Race/Ethnicity, Customized Race and ethnicity, No (%) Other (including American Indian or Alaska Native) | 71 Participants | 144 Participants | 73 Participants | — | — | — |
| Region of Enrollment United States | 572 Participants | 1284 Participants | 677 Participants | 12 Participants | 13 Participants | 10 Participants |
| Sex: Female, Male Female | 274 Participants | 616 Participants | 318 Participants | 6 Participants | 13 Participants | 5 Participants |
| Sex: Female, Male Male | 298 Participants | 668 Participants | 359 Participants | 6 Participants | 0 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 680 | 0 / 10 | 0 / 582 | 0 / 12 | 0 / 13 |
| other Total, other adverse events | 0 / 680 | 0 / 10 | 0 / 582 | 0 / 12 | 0 / 13 |
| serious Total, serious adverse events | 1 / 680 | 0 / 10 | 0 / 582 | 0 / 12 | 0 / 13 |
Outcome results
Primary
Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85%
Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual.
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Water Access and Promotion - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Baseline | 335 Participants |
| Water Access and Promotion - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Month 7 | 315 Participants |
| Water Access and Promotion - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Month 15 | 274 Participants |
| Control - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Baseline | 273 Participants |
| Control - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Month 7 | 263 Participants |
| Control - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 85% | Month 15 | 262 Participants |
Comparison: Analysis of between group change from baseline to 7 months.p-value: 0.6895% CI: [0.2, 2.9]Mixed Models Analysis
Comparison: Analysis of between group change from baseline to 15 monthsp-value: 0.01795% CI: [0.03, 0.7]Mixed Models Analysis
Secondary
Beverage Intake
Beverage intake frequency questionnaires will be used to calculate past-week frequency of beverages consumed (times per day).
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | Beverage Intake | SSB - month 15 | 2.1 times per day | Standard Deviation 2.8 |
| Water Access and Promotion - Students | Beverage Intake | Water - month 7 | 7.1 times per day | Standard Deviation 5.2 |
| Water Access and Promotion - Students | Beverage Intake | Juice - month 15 | 0.5 times per day | Standard Deviation 1 |
| Water Access and Promotion - Students | Beverage Intake | Flavored milk - baseline | 0.5 times per day | Standard Deviation 0.9 |
| Water Access and Promotion - Students | Beverage Intake | Water - month 15 | 6.2 times per day | Standard Deviation 4.7 |
| Water Access and Promotion - Students | Beverage Intake | Flavored milk - month 7 | 0.4 times per day | Standard Deviation 0.7 |
| Water Access and Promotion - Students | Beverage Intake | Juice - baseline | 0.8 times per day | Standard Deviation 1.1 |
| Water Access and Promotion - Students | Beverage Intake | Flavored milk - month 15 | 0.4 times per day | Standard Deviation 0.8 |
| Water Access and Promotion - Students | Beverage Intake | SSB - baseline | 3.5 times per day | Standard Deviation 4.2 |
| Water Access and Promotion - Students | Beverage Intake | Plain milk - baseline | 1.2 times per day | Standard Deviation 1.4 |
| Water Access and Promotion - Students | Beverage Intake | Water - baseline | 6.1 times per day | Standard Deviation 4.3 |
| Water Access and Promotion - Students | Beverage Intake | Plain milk - month 7 | 1.2 times per day | Standard Deviation 1.6 |
| Water Access and Promotion - Students | Beverage Intake | SSB - month 7 | 2.4 times per day | Standard Deviation 3.5 |
| Water Access and Promotion - Students | Beverage Intake | Plain milk - month 15 | 1.1 times per day | Standard Deviation 1.4 |
| Water Access and Promotion - Students | Beverage Intake | Juice - month 7 | 0.6 times per day | Standard Deviation 1 |
| Control - Students | Beverage Intake | Plain milk - month 15 | 1.0 times per day | Standard Deviation 1.2 |
| Control - Students | Beverage Intake | Juice - month 7 | 0.6 times per day | Standard Deviation 0.8 |
| Control - Students | Beverage Intake | Water - baseline | 5.7 times per day | Standard Deviation 4.2 |
| Control - Students | Beverage Intake | Water - month 7 | 5.2 times per day | Standard Deviation 3.9 |
| Control - Students | Beverage Intake | Water - month 15 | 4.8 times per day | Standard Deviation 3.8 |
| Control - Students | Beverage Intake | SSB - baseline | 3.5 times per day | Standard Deviation 4.2 |
| Control - Students | Beverage Intake | SSB - month 7 | 2.8 times per day | Standard Deviation 3.7 |
| Control - Students | Beverage Intake | SSB - month 15 | 2.2 times per day | Standard Deviation 2.9 |
| Control - Students | Beverage Intake | Juice - month 15 | 0.5 times per day | Standard Deviation 0.9 |
| Control - Students | Beverage Intake | Flavored milk - baseline | 0.5 times per day | Standard Deviation 0.9 |
| Control - Students | Beverage Intake | Flavored milk - month 7 | 0.4 times per day | Standard Deviation 0.8 |
| Control - Students | Beverage Intake | Flavored milk - month 15 | 0.4 times per day | Standard Deviation 0.9 |
| Control - Students | Beverage Intake | Plain milk - baseline | 1.1 times per day | Standard Deviation 1.3 |
| Control - Students | Beverage Intake | Plain milk - month 7 | 1.0 times per day | Standard Deviation 1.2 |
| Control - Students | Beverage Intake | Juice - baseline | 0.8 times per day | Standard Deviation 1.1 |
Comparison: Analysis of between group change in water intake from baseline to 7 months.p-value: <0.00195% CI: [13.1, 34.2]Mixed Models Analysis
Comparison: Analysis of between group change in water intake from baseline to 15 months.p-value: 0.00495% CI: [4.5, 25.9]Mixed Models Analysis
Comparison: Analysis of between group change in SSB intake from baseline to 7 months.p-value: 0.06395% CI: [-15.7, 0.4]Mixed Models Analysis
Comparison: Analysis of between group change in SSB intake from baseline to 15 months.p-value: 0.5695% CI: [-11.7, 6.9]Mixed Models Analysis
Comparison: Analysis of between group change in juice intake from baseline to 7 months.p-value: 0.6895% CI: [-4.3, 7]Mixed Models Analysis
Comparison: Analysis of between group change in juice intake from baseline to 15 months.p-value: 0.6695% CI: [-7.4, 5]Mixed Models Analysis
Comparison: Analysis of between group change in flavored milk intake from baseline to 7 months.p-value: 0.07995% CI: [-8.3, 0.5]Mixed Models Analysis
Comparison: Analysis of between group change in flavored milk intake from baseline to 15 months.p-value: 0.2695% CI: [-8, 2.3]Mixed Models Analysis
Comparison: Analysis of between group change in plain milk intake from baseline to 7 months.p-value: 0.295% CI: [-2.2, 11.5]Mixed Models Analysis
Comparison: Analysis of between group change in plain milk intake from baseline to 15 months.p-value: 0.5195% CI: [-4.4, 9.6]Mixed Models Analysis
Secondary
BMI, Mean (SD)
Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual.
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | BMI, Mean (SD) | Baseline | 20.4 kg/m^2 | Standard Deviation 4.6 |
| Water Access and Promotion - Students | BMI, Mean (SD) | Month 7 | 20.9 kg/m^2 | Standard Deviation 4.7 |
| Water Access and Promotion - Students | BMI, Mean (SD) | Month 15 | 21.4 kg/m^2 | Standard Deviation 5.1 |
| Control - Students | BMI, Mean (SD) | Baseline | 20.1 kg/m^2 | Standard Deviation 4.6 |
| Control - Students | BMI, Mean (SD) | Month 7 | 20.5 kg/m^2 | Standard Deviation 4.7 |
| Control - Students | BMI, Mean (SD) | Month 15 | 21.2 kg/m^2 | Standard Deviation 4.9 |
Comparison: Analysis of between group change from baseline to 7 months.p-value: 0.4695% CI: [-0.06, 0.1]Mixed Models Analysis
Comparison: Analysis of between group change from baseline to 15 months.p-value: 0.895% CI: [-0.2, 0.1]Mixed Models Analysis
Secondary
BMI Percentile,Mean(SD)
Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual.
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | BMI Percentile,Mean(SD) | Month 15 | 73.5 BMI-for-age/sex percentile | Standard Deviation 28 |
| Water Access and Promotion - Students | BMI Percentile,Mean(SD) | Baseline | 73.2 BMI-for-age/sex percentile | Standard Deviation 28.1 |
| Water Access and Promotion - Students | BMI Percentile,Mean(SD) | Month 7 | 73.7 BMI-for-age/sex percentile | Standard Deviation 27.1 |
| Control - Students | BMI Percentile,Mean(SD) | Baseline | 71.9 BMI-for-age/sex percentile | Standard Deviation 28.7 |
| Control - Students | BMI Percentile,Mean(SD) | Month 7 | 71.8 BMI-for-age/sex percentile | Standard Deviation 28.4 |
| Control - Students | BMI Percentile,Mean(SD) | Month 15 | 72.9 BMI-for-age/sex percentile | Standard Deviation 28.5 |
Comparison: Analysis of between group change from baseline to 7 months.p-value: 0.5795% CI: [-0.6, 1]Mixed Models Analysis
Comparison: Analysis of between group change from baseline to 15 months.p-value: 0.495% CI: [-1.5, 0.6]Mixed Models Analysis
Secondary
BMI Z-score, Mean (SD)
Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual. BMI z-scores (or standard deviation scores) are used in anthropometry to quantify a measurement's distance from the mean. The measurement is obtained using the sex, age, weight and height of the participants. The z-score is based on United States Centers for Disease Control and Prevention growth references for children. A z-score of 0 reflects the 50th percentile based on the reference growth charts. For example, a z-score of 1.5 indicates a child is 1.5 standard deviations above the average value, whereas a z-score of -1.5 means a child is 1.5 standard deviations below the average value.
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | BMI Z-score, Mean (SD) | Baseline | 0.9 z-score | Standard Deviation 1.1 |
| Water Access and Promotion - Students | BMI Z-score, Mean (SD) | Month 7 | 0.9 z-score | Standard Deviation 1.1 |
| Water Access and Promotion - Students | BMI Z-score, Mean (SD) | Month 15 | 0.9 z-score | Standard Deviation 1.1 |
| Control - Students | BMI Z-score, Mean (SD) | Baseline | 0.8 z-score | Standard Deviation 1.1 |
| Control - Students | BMI Z-score, Mean (SD) | Month 7 | 0.8 z-score | Standard Deviation 1.1 |
| Control - Students | BMI Z-score, Mean (SD) | Month 15 | 0.9 z-score | Standard Deviation 1.1 |
Comparison: Analysis of between group change from baseline to 7 months.p-value: 0.9395% CI: [-0.03, 0.03]Mixed Models Analysis
Comparison: Analysis of between group change from baseline to 15 months.p-value: 0.3695% CI: [-0.06, 0.02]Mixed Models Analysis
Secondary
Caloric Intake
Food and beverage diaries will be used to calculate daily caloric intake from foods and beverages.
Time frame: Baseline and 7-months after the start of the study
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | Caloric Intake | Total - baseline | 1636 kcal/day | Standard Deviation 796 |
| Water Access and Promotion - Students | Caloric Intake | Total - month 7 | 1610 kcal/day | Standard Deviation 805 |
| Water Access and Promotion - Students | Caloric Intake | Food - baseline | 1371 kcal/day | Standard Deviation 705 |
| Water Access and Promotion - Students | Caloric Intake | Food - month 7 | 1380 kcal/day | Standard Deviation 727 |
| Water Access and Promotion - Students | Caloric Intake | Beverage - baseline | 265 kcal/day | Standard Deviation 214 |
| Water Access and Promotion - Students | Caloric Intake | Beverage - month 7 | 229 kcal/day | Standard Deviation 227 |
| Water Access and Promotion - Students | Caloric Intake | Sugar-sweetened beverage (SSB) - baseline | 223 kcal/day | Standard Deviation 205 |
| Water Access and Promotion - Students | Caloric Intake | SSB - month 7 | 190 kcal/day | Standard Deviation 199 |
| Control - Students | Caloric Intake | SSB - month 7 | 214 kcal/day | Standard Deviation 223 |
| Control - Students | Caloric Intake | Total - baseline | 1699 kcal/day | Standard Deviation 727 |
| Control - Students | Caloric Intake | Beverage - baseline | 265 kcal/day | Standard Deviation 212 |
| Control - Students | Caloric Intake | Total - month 7 | 1676 kcal/day | Standard Deviation 782 |
| Control - Students | Caloric Intake | Sugar-sweetened beverage (SSB) - baseline | 223 kcal/day | Standard Deviation 204 |
| Control - Students | Caloric Intake | Food - baseline | 1434 kcal/day | Standard Deviation 654 |
| Control - Students | Caloric Intake | Beverage - month 7 | 251 kcal/day | Standard Deviation 231 |
| Control - Students | Caloric Intake | Food - month 7 | 1425 kcal/day | Standard Deviation 696 |
Comparison: Analysis of between group change in total kcal intake from baseline to 7 months.p-value: 0.795% CI: [-5.3, 8.5]Mixed Models Analysis
Comparison: Analysis of between group change in intake of food kcal from baseline to 7 months.p-value: 0.3595% CI: [-3.9, 12]Mixed Models Analysis
Comparison: Analysis of between group change in intake of beverage kcal from baseline to 7 months.p-value: 0.3595% CI: [-29.2, 8.8]Mixed Models Analysis
Comparison: Analysis of between group change in SSB kcal from baseline to 7 months.p-value: 0.1895% CI: [-37.8, 9.6]Mixed Models Analysis
Secondary
Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No.
Trained research staff will measure students' heights and weights as outlined in the National Health and Nutrition Examination Survey Anthropometry Procedures Manual.
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Water Access and Promotion - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Baseline | 222 Participants |
| Water Access and Promotion - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Month 7 | 202 Participants |
| Water Access and Promotion - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Month 15 | 179 Participants |
| Control - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Baseline | 165 Participants |
| Control - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Month 7 | 159 Participants |
| Control - Students | Number of Participants With Age- and Sex-adjusted BMI% Greater Than or Equal to 95%. Yes or No. | Month 15 | 144 Participants |
Comparison: Analysis of between group change from baseline to 7 months.p-value: 0.2495% CI: [0.07, 2]Mixed Models Analysis
Comparison: Analysis of between group change from baseline to 15 months.p-value: 0.9895% CI: [0.1, 7]Mixed Models Analysis
Secondary
Water Intake
Direct observations of water consumed at lunchtime, 4th-grade physical education (PE) classes, and recess. Researchers tallied the number of students using water sources and the student census in the area to estimate the proportion using stations or fountains.
Time frame: Baseline, 7-months, and 15-months after the start of the study.
Population: Data were collected from students from participating schools, whether the students were enrolled in the study, or not. For each observation type (lunchtime, PE class, and recess) and period, the number estimated in the census at each respective time point are included in the analysis. Outcome measure data were not collected from adults.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | Water Intake | Lunch - month 7 | 38.3 observations | Standard Deviation 15.9 |
| Water Access and Promotion - Students | Water Intake | Recess - month 15 | 8.8 observations | Standard Deviation 3.1 |
| Water Access and Promotion - Students | Water Intake | Recess - baseline | 6.5 observations | Standard Deviation 3.4 |
| Water Access and Promotion - Students | Water Intake | PE class - baseline | 66.6 observations | Standard Deviation 87.8 |
| Water Access and Promotion - Students | Water Intake | Lunch - month 15 | 9.2 observations | Standard Deviation 7.7 |
| Water Access and Promotion - Students | Water Intake | PE class - month 7 | 89.6 observations | Standard Deviation 58.7 |
| Water Access and Promotion - Students | Water Intake | Recess - month 7 | 29.3 observations | Standard Deviation 36.5 |
| Water Access and Promotion - Students | Water Intake | PE class - month 15 | 95.0 observations | Standard Deviation 56.2 |
| Water Access and Promotion - Students | Water Intake | Lunch - baseline | 3.5 observations | Standard Deviation 6.1 |
| Control - Students | Water Intake | PE class - month 15 | 43.1 observations | Standard Deviation 38.1 |
| Control - Students | Water Intake | Lunch - baseline | 3.7 observations | Standard Deviation 6.1 |
| Control - Students | Water Intake | Lunch - month 7 | 3.6 observations | Standard Deviation 4.7 |
| Control - Students | Water Intake | Lunch - month 15 | 3.2 observations | Standard Deviation 3.1 |
| Control - Students | Water Intake | Recess - baseline | 6.1 observations | Standard Deviation 4.5 |
| Control - Students | Water Intake | Recess - month 7 | 6.6 observations | Standard Deviation 4.1 |
| Control - Students | Water Intake | Recess - month 15 | 3.3 observations | Standard Deviation 3 |
| Control - Students | Water Intake | PE class - baseline | 47.4 observations | Standard Deviation 32.2 |
| Control - Students | Water Intake | PE class - month 7 | 53.2 observations | Standard Deviation 65.6 |
Comparison: Analysis of between group change in water intake from water source at lunch from baseline to 7 months.p-value: <0.00195% CI: [21.2, 42.2]Mixed Models Analysis
Comparison: Analysis of between group change in water intake from water source during lunch from baseline to 15 months.p-value: 0.2295% CI: [-3, 13.5]Mixed Models Analysis
Comparison: Analysis of between group change in water intake from water source at recess from baseline to 7 months.p-value: 0.0295% CI: [2.6, 33.3]Mixed Models Analysis
Comparison: Analysis of between group change in water intake from water source at recess from baseline to 15 months.p-value: 0.4895% CI: [-8, 19.2]Mixed Models Analysis
Comparison: Analysis of between group change in water intake from water source at PE from baseline to 7 months.p-value: 0.1495% CI: [-9.4, 99.8]Mixed Models Analysis
Comparison: Analysis of between group change in water intake from water source at PE from baseline to 15 months.p-value: 0.1695% CI: [-11, 96.2]Mixed Models Analysis
Secondary
Water Intake - Grams Consumed
Food and beverage diaries will be used to calculate daily water intake.
Time frame: Baseline and 7-months
Population: Outcome measure data were collected from students only. Participants with data at each respective time point are included in the analysis.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Water Access and Promotion - Students | Water Intake - Grams Consumed | Baseline | 414 grams/day | Standard Deviation 443 |
| Water Access and Promotion - Students | Water Intake - Grams Consumed | Month 7 | 462 grams/day | Standard Deviation 576 |
| Control - Students | Water Intake - Grams Consumed | Baseline | 454 grams/day | Standard Deviation 441 |
| Control - Students | Water Intake - Grams Consumed | Month 7 | 441 grams/day | Standard Deviation 472 |
Comparison: Analysis of between group change from baseline to 7 months.p-value: 0.5995% CI: [-20.6, 49.9]Mixed Models Analysis
Other Pre-specified
School Policies and Practices
School administrators and food service director surveys of nutrition and physical activity policies and practices at schools
Time frame: Baseline and 15-months after the start of the study