Increasing student water consumption during school meals: A group-randomized, controlled trial

Introduction. Increasing children’s water consumption has gained attention as an important public health strategy. However, U.S. children currently consume little water and substantial sugary beverages. Improving drinking water access and promoting water in schools may be a key intervention strategy.

Methods. We conducted a group-randomized, controlled trial in 10 schools in Boston, MA in spring 2013 to test a cafeteria-based intervention to improve water access and consumption. The intervention was co-developed with the Boston Public Schools and consisted of simple promotional signage posted near water access points, installing cup-holders next to cafeteria water access points, and stocking disposable cups. The percentage of students consuming water and other beverages during each lunch period and average ounces of water consumed were directly observed for five days at both baseline and follow-up. Mixed linear regression models adjusting for clustering were used to test for intervention impact.

Results. The percentage of students who took water during lunch nearly doubled in intervention schools compared to control schools (+9.4 percent, p<0.001) from baseline to follow-up. The average volume of water consumed per student also significantly increased, by 0.55 ounces per student (p<0.001). The percentage of students observed with sugar-sweetened beverages declined by 3.3 percentage points (p<0.005) in intervention versus control schools.

Discussion. This study shows that an inexpensive, low-resource intervention that increases student access to lunch-time drinking water can result in significant increases in the percent of students drinking water, the amount of water consumed, and decreases in observed sugary beverages.