title: Drinking water in California child care sites before and after 2011-2012 beverage policy.
abstract: BACKGROUND
  Drinking water is promoted to improve beverage nutrition and reduce the prevalence of obesity. The aims of this study were to identify how water was provided to young children in child care and to determine the extent to which water access changed after a federal and state child care beverage policy was instituted in 2011 and 2012 in California.
  
  
  METHODS
  Two independent cross-sectional samples of licensed child care providers completed a self-administered survey in 2008 (n = 429) and 2012 (n = 435). Logistic regression was used to analyze data for differences between 2008 and 2012 survey responses, after adjustment for correlations among the measurements in each of 6 child care categories sampled.
  
  
  RESULTS
  A significantly larger percentage of sites in 2012 than in 2008 always served water at the table with meals or snacks (47.0% vs 28.0%, P = .001). A significantly larger percentage of child care sites in 2012 than in 2008 made water easily and visibly available for children to self-serve both indoors (77.9% vs 69.0%, P = .02) and outside (78.0% vs 69.0%, P = .03). Sites that participated in the federal Child and Adult Care Food Program had greater access to water indoors and outside than sites not in the program. In 2012 most (76.1%) child care providers reported no barriers to serving water to children. Factors most frequently cited to facilitate serving water were information for families (39.0% of sites), beverage policy (37.0%), and lessons for children (37.9%).
  
  
  CONCLUSIONS
  Water provision in California child care improved significantly between samples of sites studied in 2008 and 2012, but room for improvement remains after policy implementation. Additional training for child care providers and parents should be considered.
authors.affiliation: Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin St, Ste 10123, Oakland, CA 94607. Email: Lorrene.Ritchie@ucop.edu.
authors.forename: Lorrene D
authors.initials: LD
authors.lastname: Ritchie
authors.affiliation: Sarah Samuels Center for Public Health Research and Evaluation, Oakland, California.
authors.forename: Sallie
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Atkins Center for Weight and Health, University of California, Berkeley, California. Dr Sharma is now affiliated with Dallas-Fort Worth Hospital Council Foundation, Irving, Texas.
authors.forename: Sushma
authors.initials: S
authors.lastname: Sharma
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: Anisha
authors.initials: A
authors.lastname: Patel
authors.affiliation: California Food Policy Advocates, Oakland, California.
authors.forename: Elyse Homel
authors.initials: EH
authors.lastname: Vitale
authors.affiliation: Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California.
authors.forename: Ken
authors.initials: K
authors.lastname: Hecht
mesh_terms: D001628:Beverages / Q000592:standards* / Q000600:supply & distribution; D002140:California; D002656:Child Day Care Centers / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004034:Diet Surveys; D060766:Drinking Water / Q000592:standards*; D035082:Federal Government; D063105:Food Assistance / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D019983:Guideline Adherence; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D062407:Meals; D018673:Nutrition Policy / Q000639:trends*; D015397:Program Evaluation; D057566:Self Report; D013219:State Government
chemical_list: D060766:Drinking Water