Access to Water in High Schools

Principal Investigator: Donna B. Johnson, RD, PhDResearch Coordinator/Project Manager: Mary Podrabsky,

MPH, RD

Supported by grant 71640 from the Robert Wood Johnson Foundation through its Healthy Eating Research Program

PurposeDescribe sources and types of water and SSB available to HS students on campus and characteristics of free water access points

Explore perceptions of school administrators about access to water in school

Study Settings19 High Schools throughout King

County, Washington3 High FRPE (>66%); 10 Medium

FRPE (34-66%); 6 Low FRPE (0-33%)Representing 9 school districts

Describe sources and types of water and SSB

October 2014-February 2015Inventoried all water sources – used

Harvard water access audit tool: quality characteristics include water appearance, temperature and flow

Inventory of all beverages sold in schoolsFocus groups of students to explore sources

of all water and sugary beverages consumed at school

Quality of Water SourcesHigh Quality:• Good flow rate, clarity,

smell, color, temperature PLUS good appearance*

Medium Quality:• Good flow rate, clarity,

smell and color PLUS good temperature

Low Quality:• Good flow rate, clarity,

smell and color

*Absence of:• Stains/Dirty/Rusty/Slime/Mold/Mildew• Trash/Food/Hair/Gum in Basin• Clogged or Slow Drain• Mucus/spit in basin• Missing

Part(s)• Barrier to access Point

Total "Functioning"

Did Not Meet Lowest Quality Standard

Low Quality

Medium Quality

High Quality

0 2 4 6 8 10 12 14 16 18

12.5

8

4.5

1.7

1.3

14.2

11.1

3.7

0.1

0

15.6

9.5

4.7

1.1

0.2

Average Number of Water Sources Meeting Quality Standards by FRPL Eligibility - Per 1000 Students

High FRPL (>66%) Medium FRPL (34-66%) Low FRPL (0-33%)

No significant difference

High quality fountain and bottle filler

• 294 Water Fountains• 24 Hydration Stations• 1 Water Cooler• 1 Sink

39%

38%

19%4%

Appearance

Good (No unappealing characteristics)Fair (At least one un-appealing characteris-tic)Poor (Several unappeal-ing characteristics)Not Working

22%

37%

37%

4%

Temperature

Cold MediumWarm Not Working

32%

61%

3% 4%

Flow Rate

Fast Medium SlowNot Working

Nutrition Standards for Beverages in Schools

Starting 2014-15 School year:Plain water – carbonated or non-concarbonatedUnflavored low fat milkUnflavored or flavored fat free milk and milk

alternatives100% fruit or vegetable juice

High Schools only:Calorie free beverages up to 20 oz

Includes beverages containing < 5 cal/8 oz or ≤ 20 cal/20 oz

Low calorie beverages up to 12 oz ≤40 cal/8 oz or ≤ 60 cal/12 oz*

*regular soda typically contains 140-170 calories/12 oz

Beverage Inventory

All slots

Sugar-sweetened beverages

Water

Other beverages

0 50 100 150 200 250 300

82.4

20.1

23.5

38.8

80

9.5

14.2

56.3

87.2

9.4

30.5

47.3

Number of Slots of Beverages for Purchase Per 1000 Students

Low FRPL % Medium FRPL % High FRPL %

*

* Includes diet drinks, white milk, 100% juice, flavored water

Number of Schools with Sugar-Sweetened vs. No Sugar Added Beverages Available by Beverage Sale Point (n=19)

Beverage Category Available on Campus

Vending Machine A la Carte School Store

Sugar Sweetened Beverages

Milk, flavored 5 3 0 3

Juice Drinks 6 2 4 3

Water 2 2 1 1

Sports & Energy 12 6 7 3

Teas, Cocoa, Coffee 5 2 4 1

Soda 7 6 3 0

Other 1 0 0 1

Beverages without Added Sugar

Milk, plain 3 0 1 3

100% Juice 16 6 11 7

Juice Drinks 9 0 9 5

Sports & Energy 13 12 7 4

Teas, Cocoa, Coffee 8 1 7 1

Water 19 19 12 7

Diet Soda 11 11 6 1

Number of Schools with Sugar-Sweetened vs. No Sugar Added Beverages Available by Beverage Sale Point. Sugar-sweetened beverages are defined as beverages with any sugar except for plain milks and 100% juices, both of which contain naturally occurring sugars but no added sugars. Beverages without added sugar include all beverages with no sugar plus all plain milks and 100% fruit juices.

11 Student Focus GroupsMost students in the groups reported not using

water fountains in schoolMain complaints: water tastes bad, water is warm

and fountains are dirtyStudents know where the “good” fountains/bottle

fillers are in the school…if they existSome students report that if they want good

water at lunch, they have to buy itStudents report that if water at school was free,

cold and tasted good, they would drink it more often

Perceptions of School Principals13 out of 19 Principals from the

study schools participated in interviews

Key ThemesMost schools do not have written policies related to water access.

There are however, many unwritten policies related to access to water.

Teachers have discretion about what beverages are allowed in classrooms.

Key Themes…continuedPrincipals are not aware of specific cleaning

practices for water access sources or testing requirements.

Principals are not aware of the HHFKA requirement for water in meal areas but when it is described, they indicate that their school is in compliance.

Principals don’t know what the standard should be in terms of student/fountain ratio.

Older buildings are frequently blamed for the poor condition of fountains .

Principals have ideas about how to encourage water consumption in schools.

Statement # of Principals Who Agree

(N=13)Good hydration is related to academic performance. 11

Good hydration is important to health. 13

If we improved the number and quality of drinking water outlets in our school, our students would drink more water.

9

Schools have a role in encouraging students to drink water. 11

What our students drink during the school day is important to me. 12

Parents of our students care about what their students drink at school. 5

It is important to consider the number of calories in drinks. 12

As a principal, there are things I could do to make it easier for students to drink water.

9

Students have a right to drink whatever they want at school. (excluding alcoholic beverages).

6

It is part of my job to assure that students have access to quality water at school.

12

In Summary…….Quality of water access sources is poor –

there is plenty of room for improvement.Schools are not in compliance with HHFKA

Smart Snacks guidelines.Poor quality of water access is not just an

issue with high FRPL schools.Principals care about this issue.There are many policy opportunities around

access to water in schools.

QUESTIONS?Mary Podrabsky, MPH, RDDirector of School and Community InitiativesCenter for Public Health NutritionClinical Instructor, Nutritional SciencesUniversity of Washingtonvoice:  206-221-4528marypod@uw.edu

Donna B. Johnson, PhD, RDProfessor, Nutritional Sciences ProgramUniversity of Washingtonvoice:  206-685-1068djohn@uw.edu