摘要：Objectives. We examined free drinking water access in schools. Methods. We conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements. Results. No schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California’s school water policy (72%–83%; P < .048). Barriers to improving school water included cost of programs and other pressing concerns. Conclusions. Awareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access. Consumption of water is associated with a number of health benefits, including a reduction in energy intake and obesity prevention, dental caries reduction (with fluoridated tap water), and improved cognitive functioning among children. 1–11 Access to free, potable, and appealing drinking water in schools is important because children spend substantial time in school settings, and students may come to school already dehydrated. 12,13 Policymakers have responded to concerns regarding the association of intake of sugar-sweetened beverages, such as sodas and sports drinks, with health conditions such as obesity and dental caries by passing legislation that restricts sales of sugar-sweetened beverages in schools. 14 Such policy has led to a change in the product mix of beverages that are available for purchase in schools, including an increase in access to bottled water. 14,15 In some cases, bottled water available for purchase may be the only source of potable drinking water in certain school locations, thus creating a conspicuous inequity in which water may only be accessible to students with the means to purchase it. Having schools offer free single-use bottled water to students also poses environmental concerns, particularly for schools that do not recycle used plastic bottles on campus. 16 Although historically some states did specify that a certain number of water access points (i.e., drinking fountains) be available per a certain number of students, there was generally no guidance regarding the location of those fountains. 17 However, now both federal and some state laws require that free water be available in cafeteria areas. 18–20 In September 2010, California enacted SB 1413, legislation that requires kindergarten to 12th grade public schools to provide access to free drinking water during meal times in school food service areas (FSAs), defined in California law as locations where meals are served or eaten. 18 In December 2010, the president signed the Healthy, Hunger-Free Kids Act of 2010, which includes a provision requiring access to free drinking water where meals are served (but not where they are consumed). 19 In small studies conducted primarily in California to examine water access in schools, drinking fountains—the primary source of free water access in most schools—were perceived to be inadequate by students, parents, and school staff. 21–24 Drinking fountains were viewed as nonfunctional, unclean, having a low flow rate, or dispensing unpalatable water, thereby discouraging student water intake. By contrast, in emerging studies, nonfountain sources of drinking water, such as insulated coolers or built-in water dispensers or stations, appeared to encourage student water consumption. 25–27 Unavailability of free drinking water in key school locations such as cafeterias, gyms, and classrooms where students eat, are active, and learn is cited as another barrier to water access at school. 21 There have been no comprehensive large-scale cross-sectional studies that examine free drinking water access in schools. To gain a better understanding of this issue, we conducted phone interviews with school administrators from a representative sample of public schools in California that spanned from pre- to postimplementation of the 2010 California state water-in-schools regulation. The main objectives of this study were to describe free drinking water access in schools by source (e.g., water fountain, pitcher) and school location, as well as to examine school-level characteristics associated with schools that have excellent drinking water access. We also sought to understand how water access in FSAs changed from pre- to postimplementation of the water-in-FSAs regulation. In addition, we asked questions about barriers to improving water availability that would inform our recommendations for ways to increase drinking water access in school settings. On the basis of prior literature, we hypothesized the following: (1) few schools would have nonfountain sources of drinking water, (2) free water would be most readily accessible in common areas of the schools (i.e., hallways), and (3) schools serving higher-income students would have better drinking water access.
