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.
Observations of students indicated that the percentage of students drinking water in FSAs was higher in schools with younger children and among schools with nonfountain sources of water. As suggested in previous studies, students may choose not to drink from fountains because they perceive water from fountains as unclean or unsafe to drink or because fountains have genuine problems (eg, unclean, in disrepair, dispense unpalatable water, permit only small sips) (14
). Because fountains in this study were in good condition, we hypothesize that low student intake of water from fountains may be due to student preferences for other beverages or for water from alternative drinking water delivery systems, rather than because of poor water quality. Previous studies suggest that providing appealing water may increase student water intake (9
). Further understanding what types of water delivery systems are most appealing to students of different ages is essential to increasing students’ water intake.
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
). 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
). However, partnering with statewide associations of teachers, school nurses, as well as school boards may be an effective strategy for disseminating legislative information.
Because schools participating in federal child nutrition programs (eg, NSLP) must implement school wellness policies, which include goals and action steps for school-based activities that promote student wellness, such policies can be leveraged to assist schools in improving FSA drinking water provision. In our analysis, no wellness policies mentioned provision of free drinking water in school FSAs and only 3 policies included language about drinking water provision that encompassed more than 1 theme. No studies have examined wellness policies for language regarding school FSA water access. A 2008–2009 national study of school wellness policies showed that only 12% to 13% of schools had language regarding free water availability throughout the school day (23
). On the basis of these limited studies, developing more comprehensive school wellness policy language regarding water access may help improve drinking water access and intake in schools (24
However, having comprehensive water language in school wellness policies may not be sufficient to ensure that safe and appealing drinking water is available on school campuses. Ongoing implementation and monitoring is needed to ensure continued access to free drinking water. As seen in this study, schools that provided a nonfountain water source often had a “water champion” who was essential to developing and sustaining drinking water programs. These champions, who were all food service directors in this study, went beyond the letter of the law to provide students with water that was more appealing than water provided via a fountain. Prioritizing drinking water for school-level policy bodies such as wellness committees or coordinated school health councils may help to institutionalize such water champions. Because water is a topic that spans multiple disciplines, parents, facilities managers, teachers, and food services directors can all champion water in schools, preferably working together toward achieving this shared aim.
This study has several limitations. Although the use of observations instead of self-report is a strength, the observational methods limited the sample size and confined the study to a single California region. Another limitation is the poor response rate. Schools, in particular schools with poor drinking water access, may have been hesitant to participate in the study because of the observational component and the desire to remain inconspicuous. If this was the case, water access in FSAs may be lower than that reported in this study. In calculating the percentage of students who drank free water during mealtimes, we used student daily attendance as the denominator. In some schools, particularly high schools, students may have eaten meals off campus or in other areas of the schools, so we may have underestimated student consumption of free water at lunch. Finally, although in previous studies we examined students’ perspectives regarding access to drinking water in schools (14
), we did not do so in this study.
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.