IntroductionRecent legislation requires schools to provide free drinking water in food service areas (FSAs). Our objective was to describe access to water at baseline and student water intake in school FSAs and to examine barriers to and strategies for implementation of drinking water requirements.
ResultsFourteen of 24 schools offered free water in FSAs; 10 offered water via fountains, and 4 provided water through a nonfountain source. Four percent of students drank free water at lunch; intake at elementary schools (11%) was higher than at middle or junior high schools (6%) and high schools (1%). In secondary schools when water was provided by a nonfountain source, the percentage of students who drank free water doubled. Barriers to implementation of water requirements included lack of knowledge of legislation, cost, and other pressing academic concerns. No wellness policies included language about water in FSAs.
In September 2010, California enacted SB 1413, legislation requiring schools to provide access to free drinking water during mealtimes in school food service areas (FSAs), locations where meals are served or eaten, by July 1, 2011 (11). In December 2010, the President signed the Healthy, Hunger-Free Kids Act of 2010 (Act), which included a similar provision requiring access to free drinking water in US public schools where meals are served (12).
The observational tool assessed the following domains: free drinking water access and quality, student drinking water intake in FSAs, and bottled water and other beverages available for purchase. We also reviewed school documents to assess school drinking water policies.
Two observers used the tool to code access to free drinking water, characterized as the school locations where drinking water was available (ie, FSAs) and the type of water source available (eg, fountains, water dispensers). Observers also documented drinking water quality by coding the temperature (1 = very cold, 2 = cold, 3 = room temperature, 4 = warm), clarity (1 = clear, 2 = cloudy, 3 = yellow, 4 = brown), and flow strength (1 = high, 2 = medium, 3 = low, 4 = none) of free drinking water in school FSAs. Observers also characterized the cleanliness of the drinking water sources (1 = very clean, 2 = clean, 3 = unclean, 4 = very unclean).
Observers assessed student intake of water in FSAs by counting the number of students who drank free drinking water in the FSA during all lunch periods on an observation day. Although students may eat lunch in locations throughout the campus, it is impractical to ensure that drinking water is accessible in all of these locations. For these reasons, we defined an FSA as an area within 100 feet of where reimbursable meals were served. The water source observed was the one closest to the FSA. We estimated the percentage of students observed drinking water at lunch by dividing the number of students observed drinking water at lunch by the daily attendance.
At schools with free water in FSAs, only 4% of the 11,226 students in daily attendance were observed drinking free water at lunch. The percentage was highest in elementary schools, followed by middle and then high schools (Figure 1). In the schools that did provide water in FSAs, most provided water of good overall quality; the mean water temperature was cold (1.9), the mean water clarity was clear (1), mean water flow was of medium strength (1.8), and mean cleanliness of the water delivery system was very clean to clean (1.6). Only 1 school dispensed water that was not cold or very cold and only 2 schools dispensed water of low or no strength. Although all water delivery systems in school FSAs were described as clean, 2 fountains contained gum and 1 fountain contained a small amount of dirt.
Among wellness policies for the 20 school districts represented in our study (4 schools were in duplicate districts), 11 included language related to drinking water (Table 3), but none specifically mentioned that free drinking water should be available in FSAs. Three district wellness policies contained water-related language in more than 1 thematic area (eg, water allowable as a competitive beverage, provision of water with snacks). Only half of schools that offered water via a nonfountain source had water-related language in their wellness policy.
This study, conducted after enactment but before implementation of federal and state requirements regarding water in FSAs and the first peer-reviewed study to examine water access in school FSAs (16), demonstrated that nearly half of schools did not have free water available in FSAs and that drinking fountains were the most common water source.
Tap water from a fountain was the most common source of free water available in study school FSAs. Only a few schools offered free bottled water with meals. In most secondary schools, bottled water was available as a competitive beverage (19,20). The price of bottled water ($0.92 per bottle) could prevent students, particularly those of lower socioeconomic status, from purchasing water at school on a frequent enough basis to meet recommendations for adequate water intake.
Given that a large number of schools did not have free water in FSAs before the corresponding legislation went into effect, schools may need assistance in meeting the requirements. A major barrier is a lack of knowledge of drinking water requirements among school administrators. Although SB 1413 and the Act passed in fall of 2010 and received media coverage, many administrators were not aware of the legislation. One contributing factor could be that federal and state and agencies (US Department of Agriculture, California Department of Education) did not provide schools with guidance until April 2011 (21,22). However, partnering with statewide associations of teachers, school nurses, as well as school boards may be an effective strategy for disseminating legislative information.
Approximately half of schools had access to free drinking water in school FSAs before implementation of drinking water requirements, and in such schools, only 1 in 25 students drank the water. Increasing student water intake in schools requires a multipronged approach, which includes not only environmental changes (eg, installation of more appealing water delivery systems, such as hydration stations or dispensers), but also the promotion to encourage intake of water instead of SSBs.
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