1. Principal Investigator: Donna B. Johnson, RD, PhD Research Coordinator/Project Manager: Mary Podrabsky, MPH, RD Supported by grant 71640 from the Robert Wood Johnson Foundation through its Healthy Eating Research Program

2. Purpose Describe 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

3. Study Settings 19 High Schools throughout King County, Washington 3 High FRPE (>66%); 10 Medium FRPE (34- 66%); 6 Low FRPE (0-33%) Representing 9 school districts

4. Describe sources and types of water and SSB October 2014-February 2015 Inventoried all water sources – used Harvard water access audit tool: quality characteristics include water appearance, temperature and flow Inventory of all beverages sold in schools Focus groups of students to explore sources of all water and sugary beverages consumed at school

5. Quality of Water Sources High 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 No significant difference

6. High quality fountain and bottle filler

7. 294 Water Fountains 24 Hydration Stations 1 Water Cooler 1 Sink

8. Nutrition Standards for Beverages in Schools Starting 2014-15 School year: Plain water – carbonated or non-concarbonated Unflavored low fat milk Unflavored or flavored fat free milk and milk alternatives 100% 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

9. Beverage Inventory * Includes diet drinks, white milk, 100% juice, flavored water

10. Number of Schools with Sugar-Sweetened vs. No Sugar Added Beverages Available by Beverage Sale Point (n=19) Beverage Category Available on Campus Vending MachineA la CarteSchool Store Sugar Sweetened Beverages Milk, flavored5303 Juice Drinks6243 Water2211 Sports & Energy12673 Teas, Cocoa, Coffee5241 Soda7630 Other1001 Beverages without Added Sugar Milk, plain3013 100% Juice166117 Juice Drinks9095 Sports & Energy131274 Teas, Cocoa, Coffee8171 Water19 127 Diet Soda11 61 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. 11 Student Focus Groups Most students in the groups reported not using water fountains in school Main complaints: water tastes bad, water is warm and fountains are dirty Students know where the “good” fountains/bottle fillers are in the school…if they exist Some students report that if they want good water at lunch, they have to buy it Students report that if water at school was free, cold and tasted good, they would drink it more often

12. Perceptions of School Principals 13 out of 19 Principals from the study schools participated in interviews Key Themes Most 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.

13. Key Themes…continued Principals 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.

14. 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

15. 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.

16. QUESTIONS? Mary Podrabsky, MPH, RD Director of School and Community Initiatives Center for Public Health Nutrition Clinical Instructor, Nutritional Sciences University of Washington voice: 206-221-4528 marypod@uw.edu Donna B. Johnson, PhD, RD Professor, Nutritional Sciences Program University of Washington voice: 206-685-1068 djohn@uw.edu