A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers

Abstract

Introduction Improving children’s tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. Methods The “Hydrate Philly” intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling “hydration stations”, conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n=28 centers) of the intervention’s impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6–12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. Discussion Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study.

Opposing Consumption Trends for Sugar-Sweetened Beverages and Plain Drinking Water: Analyses of NHANES 2011–16 Data

“…Many initiatives have focused on tap water describing it as “the perfect, no-cost, no-calorie beverage, and it comes right out of the kitchen tap” ( 25 ). Providing tap water to children is another initiative ( 26 , 27 ).…”

In‐Home Tap Water Consumption Trends Changed Among U.S. Children, but Not Adults, Between 2007 and 2016

“…prime examples of using grassroots campaigns and randomized interventions to attempt to increase confidence in the municipal water system and encourage tap water intake (Bate, 2019;Lawman et al, 2019;Lawman et al, 2020).…”

Agua4All: Providing Safe Drinking Water in Rural California Communities

“…This study is one of the first to evaluate the effect of providing water access and promotion interventions in nonschool community settings (18). Previous evaluations of increased access to water bottle–filling stations in schools and in Philadelphia community recreation centers led to increases in water use from stations of approximately 10 to 15 gallons per day and increases in intake of 10% to 20%, which is within the range of effects observed in this study (14,15) (H. Lawman, personal communication, March 14, 2019).…”

“…Increased accessibility of appealing, safe tap water in schools has increased water intake (14,15,16,17), reduced SSB intake (15), and reduced obesity (16,17). Few studies have examined the effect of similar models in nonschool settings (18), and no study has investigated the effect of such programs in US communities with contaminated drinking water.…”