title: Student-reported school drinking fountain availability by youth characteristics and state plumbing codes.
abstract: BACKGROUND
  Caloric intake among children could be reduced if sugar-sweetened beverages were replaced by plain water. School drinking water infrastructure is dictated in part by state plumbing codes, which generally require a minimum ratio of drinking fountains to students. Actual availability of drinking fountains in schools and how availability differs according to plumbing codes is unknown.
  
  
  METHODS
  We abstracted state plumbing code data and used the 2010 YouthStyles survey data from 1,196 youth aged 9 through 18 years from 47 states. We assessed youth-reported school drinking fountain or dispenser availability and differences in availability according to state plumbing codes, sociodemographic characteristics, and area-level characteristics.
  
  
  RESULTS
  Overall, 57.3% of youth reported that drinking fountains or dispensers in their schools were widely available, 40.1% reported there were only a few, and 2.6% reported that there were no working fountains. Reported fountain availability differed significantly (P < .01) by race/ethnicity, census region, the fountain to student ratio specified in plumbing codes, and whether plumbing codes allowed substitution of nonplumbed water sources for plumbed fountains. "Widely available" fountain access ranged from 45.7% in the West to 65.4% in the Midwest and was less common where state plumbing codes required 1 fountain per more than 100 students (45.4%) compared with 1 fountain per 100 students (60.1%) or 1 fountain per fewer than 100 students (57.6%).
  
  
  CONCLUSIONS
  Interventions designed to increase consumption of water may want to consider the role of plumbing codes in availability of school drinking fountains.
authors.affiliation: Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Obesity Prevention and Control Branch, 4770 Buford Hwy, NE, MS K-77, Atlanta, GA 30341. E-mail: seo5@cdc.gov.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Onufrak
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sohyun
authors.initials: S
authors.lastname: Park
authors.affiliation: Northeastern University School of Law, Boston, Massachusetts.
authors.forename: Cara
authors.initials: C
authors.lastname: Wilking
mesh_terms: D000293:Adolescent; D002648:Child; D003625:Data Collection; D060766:Drinking Water; D006801:Humans; D012498:Sanitary Engineering / Q000331:legislation & jurisprudence* / Q000592:standards*; D012574:Schools; D014481:United States
chemical_list: D060766:Drinking Water
references.citation: Nutr Rev. 2006 Oct;64(10 Pt 1):457-64
references.pmid: 17063927
references.citation: Pediatrics. 2009 Apr;123(4):e661-7
references.pmid: 19336356
references.citation: Prev Chronic Dis. 2011 May;8(3):A60
references.pmid: 21477500
references.citation: Arch Pediatr Adolesc Med. 2009 Apr;163(4):336-43
references.pmid: 19349562
references.citation: Public Health Nutr. 2014 Jan;17(1):179-85
references.pmid: 23098620
references.citation: Am J Prev Med. 2012 Sep;43(3 Suppl 2):S95-101
references.pmid: 22898169
references.citation: Adv Nutr. 2011 May;2(3):293-4
references.pmid: 22332062
references.citation: Prev Chronic Dis. 2012;9:E121
references.pmid: 22765930
references.citation: J Toxicol Clin Toxicol. 2004;42(3):287-94
references.pmid: 15362596
references.citation: J Acad Nutr Diet. 2012 Sep;112(9):1421-1427
references.pmid: 22749261