摘要：Objectives. We determined the influence of “water jets” on observed water and milk taking and self-reported fluid consumption in New York City public schools. Methods. From 2010 to 2011, before and 3 months after water jet installation in 9 schools, we observed water and milk taking in cafeterias (mean 1000 students per school) and surveyed students in grades 5, 8, and 11 (n = 2899) in the 9 schools that received water jets and 10 schools that did not. We performed an observation 1 year after implementation (2011–2012) with a subset of schools. We also interviewed cafeteria workers regarding the intervention. Results. Three months after implementation we observed a 3-fold increase in water taking (increase of 21.63 events per 100 students; P < .001) and a much smaller decline in milk taking (-6.73 events per 100 students; P = .012), relative to comparison schools. At 1 year, relative to baseline, there was a similar increase in water taking and no decrease in milk taking. Cafeteria workers reported that the water jets were simple to clean and operate. Conclusions. An environmental intervention in New York City public schools increased water taking and was simple to implement. Water intake is essential for many human biological and biochemical processes. 1 To maintain a body water balance, the National Academy of Sciences recommends adequate intake level for water in any form (solid foods and beverages including plain water) for adolescents aged 14 to 18 years at 3.3 liters per day for boys and 2.3 liters per day for girls. 1 According to the 2005–2006 National Health and Nutrition Examination Survey, adolescent boys aged between 14 and 18 years consumed 2.89 (95% confidence interval [CI] = 2.65, 3.13) liters of water and girls consumed 1.97 (95% CI = 1.84, 2.10) liters of water on average. 2 Both were below the recommended cutoff. In addition, studies have shown that hydration is associated with improved memory recall, 3,4 and fluoridated water intake with the prevention of dental caries. 5 Drinking water is a healthy no-calorie replacement for sugar-sweetened beverages (SSBs), 6 which have been linked to obesity, dental caries, and displacement of nutrient-rich foods among children. 7–9 Decreasing the daily amount of SSBs consumed is associated with lower total caloric consumption and reduced obesity prevalence. 10,11 In New York City, the obesity rate among young children (kindergarten through 8th grade) is nearly 21%. 12,13 To address this, New York City has recently implemented a multifaceted approach to obesity reduction and prevention that includes an initiative to encourage water consumption, including a mayoral requirement that all city agencies, childcare centers, and public schools have water available at all meals. As part of the Healthy, Hunger Free Kids Act passed by Congress in 2010, 14 all schools are required to make plain drinking water available to students at no cost during the lunch meal periods in the locations where meals are served, and during the School Breakfast Program when breakfast is served in the cafeteria. Furthermore, the US Department of Agriculture has proposed a new rule to implement local school wellness policies to provide water and maintain water fountains in schools. 15 In 2008, pursuant to a mayoral executive order, New York City became the first major city in the country to mandate a set of food and beverage nutrition standards governing all city agencies, including public schools. This policy included procurement, service, and vending standards. Beverage vending in schools limited calories to 10 calories per 8 ounces in elementary schools and 25 calories per 8 ounces in high schools with no artificial sugar added. To meet the city’s goal of increasing student water consumption, in 2010 the Fund for Public Health in New York, an arm of the New York City Department of Health and Mental Hygiene (DOHMH), received funding to provide “water jets” (drinking water dispensers) to 140 schools across the city from the Communities Putting Prevention to Work grant from the Centers for Disease Control and Prevention. Water jets are large, clear plastic jugs with push levers that dispense cooled, aerated tap water (similar to slushy machines found in convenience stores) that are placed near the lunch line in the school cafeteria. To assess the impact of the new water jets, New York University, the DOHMH, and the Centers for Disease Control and Prevention conducted an evaluation during the 2010–2011 school year with a subset of 9 schools that received the water dispensers and 10 comparison schools. The water jets were installed with no other school-based activities to promote water drinking; disposable cups were available next to the jet at all schools. We note that New York City water is delivered from sources in upstate New York essentially lead-free, but because lead introduction is possible from pipes, water in schools is periodically tested. Previous studies (using mainly self-report data or studies based in Europe) have provided preliminary evidence that water in schools could prevent overweight and help children maintain healthy weight. 16–18 Potential changes in milk intake as result of increased water availability are a potential concern, however, because of the nutrients that milk confers to children. The current study, to our knowledge, is the first to look at the impact of providing elementary-school students, middle-school students, and high-school students with increased water access, with no promotions or parallel interventions. Thus, this evaluation study set out to address 4 research objectives: (1) determine whether the introduction of water jets increases students’ objectively measured taking of water for consumption, (2) determine whether the introduction of water jets has an impact on the students’ taking of milk for consumption, (3) evaluate whether the introduction of water jets improves students’ opinions of water, and (4) assess the cafeteria staff’s experience with the water jets.
