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Prev Chronic Dis. 2016 Jul 7;13:E88. doi: 10.5888/pcd13.160108.

A Trial of the Efficacy and Cost of Water Delivery Systems in San Francisco Bay Area Middle Schools, 2013.

Author information

Division of General Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, Suite 245, Mailbox 0503, San Francisco, CA 94118.Email:
Division of General Pediatrics, University of California, San Francisco, California.
Enigami Ventures, LLC, Richmond, California.
California Food Policy Advocates, Oakland, California.
Division of Biostatistics, University of California, San Francisco, California.
Division of General Pediatrics, Philip R. Lee Institute for Health Policy Studies, and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, California.



US legislation requires that schools offer free drinking water where meals are served. However, little information is available about what types of water delivery systems schools should install to meet such requirements. The study objective was to examine the efficacy and cost of 2 water delivery systems (water dispensers and bottleless water coolers) in increasing students' lunchtime intake of water in low-income middle schools.


In 2013, twelve middle schools in the San Francisco Bay Area participated in a cluster randomized controlled trial in which they received 6 weeks of promotional activities, received provision of cups, and were assigned to 1 of 2 cafeteria water delivery systems: water dispensers or bottleless water coolers (or schools served as a control). Student surveys (n = 595) and observations examined the interventions' effect on students' beverage intake and staff surveys and public data assessed intervention cost.


Analysis occurred from 2013 through 2015. Mixed-effects logistic regression, accounting for clustering and adjustment for student sociodemographic characteristics, demonstrated a significant increase in the odds of students drinking water in schools with promotion plus water dispensers and cups (adjusted odds ratio = 3.1; 95% confidence interval, 1.4-6.7; P = .004) compared with schools with traditional drinking fountains and no cups or promotion. The cost of dispenser and bottleless water cooler programs was similar ($0.04 per student per day).


Instead of relying on traditional drinking fountains, schools should consider installing water sources, such as plastic dispensers with cups, as a low-cost, effective means for increasing students' water intake.

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