202332 Barriers to increasing drinking water availability in school cafeterias

Monday, November 9, 2009: 8:50 AM

Anisha I. Patel, MD, MSPH , Pediatrics, Health Services, University of California at Los Angeles, Los Angeles, CA
Laura M. Bogart, PhD , Children's Hospital Boston/Harvard Medical School, Harvard University, Boston, MA
Kimberly Uyeda, MD, MPH , Student Medical Services, Los Angeles Unified School District, Los Angeles, CA
Marc Elliot, PhD , Health, RAND, Santa Monica, CA
David Klein, MS , Department of Medicine, Children's Hospital Boston/Harvard Medical School, Harvard University, Boston, MA
Mark A. Schuster, MD, PhD , Dept. of Medicine, Children's Hospital Boston/Harvard Medical School, Harvard University, Boston, MA
Background: Recognizing the health benefits of drinking water, the Institute of Medicine recommends that water be freely accessible in schools. When we attempted to offer water in a school cafeteria during an obesity intervention, school staff and administrators expressed reluctance due to concerns regarding cost, labor, regulations, and decreased student milk consumption.

Purpose: To examine barriers associated with increasing the availability of clean, palatable drinking water in one Los Angeles middle school.

Significance: Although some schools serve water in cafeterias, no research examines barriers schools face with such efforts.

Methodology: We conducted a 5-week intervention including provision of cold, filtered drinking water in the school cafeteria and distribution of reusable water bottles. We assessed potential barriers to intervention implementation including cost and cafeteria labor. Because school staff were concerned that serving water may decrease milk consumption, we assessed milk intake through cafeteria records and student surveys at intervention and comparison schools.

Results: Average amount of water taken from dispensers was 18 gallons/day (SD=19). Estimated annual cost is $2000/school. Cafeteria labor was 21 minutes/day (SD=11). Controlling for baseline milk consumption yesterday, intervention students did not have lower odds of drinking cafeteria milk than comparison students (OR=0.96, 95% CI 0.69-1.32). Despite cost and labor, the school still serves water one-year post intervention.

Conclusions/Recommendations: Schools can overcome barriers associated with offering students drinking water in cafeterias. Despite concerns, offering water in cafeterias did not decrease student milk consumption. School districts may consider instituting policies and programs to encourage water availability in school cafeterias.

Learning Objectives:
1.Describe barriers to increasing the availability of drinking water in school cafeterias. 2.Discuss how a community-academic research team overcame barriers and developed a sustainable intervention to offer safe, palatable drinking water in one Los Angeles middle school cafeteria.

Keywords: Water, School-Based Programs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a fellow in the RWJ Clinical Scholars Program, my research has focused on the provision of safe, palatable drinking water in schools. I have conducted qualitative and quantitative studies in this topic area and have been directly supervised by senior mentors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.