title: A study of the association between children's access to drinking water in primary schools and their fluid intake: can water be 'cool' in school?
abstract: BACKGROUND
  Water is essential for health. The 'Water is Cool in School' campaign promoted improved drinking water access in UK schools. Implementation has been patchy, and impact has not been studied. The aim of this study is to determine whether fluid intake and frequency of toilet visits are associated with children's access to drinking water in the classroom.
  
  
  METHODS
  A total of 145 schoolchildren in Year 2 (aged 6-7 years) and 153 in Year 5 (aged 9-10 years) classes were studied in six Southampton schools. Total fluid intake and toilet visits were recorded during one school day. Schools were recruited according to drinking policy: 'prohibited access' = water prohibited in classroom; 'limited access' = water allowed in classroom but not on the desk; and 'free access' = water bottle encouraged on the desk. Data were analysed on an intention-to-treat basis.
  
  
  RESULTS
  In total, 120 children in prohibited access, 91 in limited access and 87 in free access settings were recruited. Total fluid intake was significantly higher in Year 2 free access schools (geometric mean 293, range 104-953 mL) compared with prohibited access schools (geometric mean 189, range 0-735 mL, P=0.046), in Year 5 free access schools (geometric mean 489, range 88-1200 mL) compared with prohibited access schools (geometric mean 206, range 0-953 mL, P=0.001), and in free access versus limited access schools (geometric mean 219, range 0-812 mL, P=0.003). A total of 81% and 80% of children in prohibited and limited access schools, respectively, consumed below the minimum recommended amount of total fluid at school, compared with 46.5% in the free access schools. In total, 34.6% of children did not use the toilets at all during the school day. There was no trend observed between water access and frequency of toilet visits (median of 1 trip for each group, P=0.605).
  
  
  CONCLUSIONS
  Most children have an inadequate fluid intake in school. Free access to drinking water in class is associated with improved total fluid intake. Primary schools should promote water drinking in class.
authors.affiliation: School of Medicine, University of Southampton, Southampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kaushik
authors.forename: M A
authors.initials: MA
authors.lastname: Mullee
authors.forename: T N
authors.initials: TN
authors.lastname: Bryant
authors.forename: C M
authors.initials: CM
authors.lastname: Hill
mesh_terms: D002648:Child; D003681:Dehydration / Q000523:psychology*; D004326:Drinking; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D012574:Schools; D006113:United Kingdom; D014881:Water Supply / Q000592:standards