Content area
Abstract
Background: Water is the ideal source of hydration with several health benefits. Water can be substituted for sugar-sweetened beverages (SSB) to decrease energy intake and other negative health consequences of SSBs. Increasing access to water is considered a successful strategy to decrease SSB consumption, but there has been little research to show the association. The purpose of this study is to explore access to water, SSB consumption and the relationships between them.
Methods: This cross-sectional study, combined data from an inventory of water and SSB access in 37 low-income secondary schools with data from the Washington State Healthy Youth Survey 2010, to examine the associations between school beverage environments and youth SSB consumption. Descriptive analyses were used to characterize access to SSBs using the number of slots of SSB in vending machines and other sources per 1000 students and access to water using the number of functional water stations per 1000 students. The quality of each water station was also used in the analysis by assigning each station a score of zero to four, based on the number of positive attributes of each station (water temperature less than 15 °C, odor-free, well-maintained, fast flowing water). Simple linear regression and multiple linear regression models were used to examine the associations between access to water, quality of water stations and SSB consumption. Regression models also examined the influence of socioeconomic status, using the percent of students eligible for Free and Reduced-Price Lunch (% FRPL), on these relationships.
Results: Access to high quality water stations was limited. The average quality scores for water stations in twenty-nine schools were less than two, and eight other schools' scores were between 2 and 2.6; High schools had higher access to SSBs compared to middle schools. Eleven out of 20 middle schools had zero access to SSBs, while this was only the case for one high school; Access to water was negatively associated with SSB consumption during the past day in high schools (p<0.05), but not in middle schools; The %FRPL at the school and access to water were negatively related in high schools (P<0.05) but not middle schools. Also, % FRPL at the school and SSB consumption during the past day were positively related both in middle and high schools (p<0.05, p<0.01); Adjusting the association between water access and SSB consumption for % FRPL, made the result no longer significant.
Conclusions: There is a need to improve access to water in schools. There is also a need to improve the quality of the water stations. Low access to water combined with high access to SSBs could contribute to a student choosing SSBs as a source of hydration, especially in low-income high schools. Improving water access can be aligned with other approaches to decrease SSB consumption. However, the reasons for SSB consumption and inadequate water intake are poorly understood, and more research is needed.
