title: Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity.
abstract: OBJECTIVE
  Decreasing the amount of caloric beverages consumed and simultaneously increasing water consumption is important to promoting child health and decreasing the prevalence of childhood obesity.
  
  
  OBJECTIVE
  To estimate the impact of water jets (electrically cooled, large clear jugs with a push lever for fast dispensing) on standardized body mass index, overweight, and obesity in elementary school and middle school students. Milk purchases were explored as a potential mechanism for weight outcomes.
  
  
  METHODS
  This quasi-experimental study used a school-level database of cafeteria equipment deliveries between the 2008-2009 and 2012-2013 and included a sample of 1227 New York, New York, public elementary schools and middle schools and the 1,065,562 students within those schools.
  
  
  METHODS
  Installation of water jets in schools.
  
  
  METHODS
  Individual body mass index (BMI) was calculated for all students in the sample using annual student-level height and weight measurements collected as part of New York's FITNESSGRAM initiative. Age- and sex-specific growth charts produced by the Centers for Disease Control and Prevention were used to categorize students as overweight and obese. The hypothesis that water jets would be associated with decreased standardized BMI, overweight, and obesity was tested using a difference-in-difference strategy, comparing outcomes for treated and nontreated students before and after the introduction of a water jet.
  
  
  RESULTS
  This study included 1 065 562 students within New York City public elementary schools and middle schools. There was a significant effect of water jets on standardized BMI, such that the adoption of water jets was associated with a 0.025 (95% CI, -0.038 to -0.011) reduction of standardized BMI for boys and a 0.022 (95% CI, -0.035 to -0.008) reduction of standardized BMI for girls (P < .01). There was also a significant effect on being overweight. Water jets were associated with a 0.9 percentage point reduction (95% CI, 0.015-0.003) in the likelihood of being overweight for boys and a 0.6 percentage reduction (95% CI, 0.011-0.000) in the likelihood of being overweight for girls (P < .05). We also found a 12.3 decrease (95% CI, -19.371 to -5.204) in the number of all types of milk half-pints purchased per student per year (P < .01).
  
  
  CONCLUSIONS
  Results from this study show an association between a relatively low-cost water availability intervention and decreased student weight. Milk purchases were explored as a potential mechanism. Additional research is needed to examine potential mechanisms for decreased student weight, including reduced milk taking, as well as assessing impacts on longer-term outcomes.
authors.affiliation: Maxwell School, Syracuse University, Syracuse, New York.
authors.forename: Amy Ellen
authors.initials: AE
authors.lastname: Schwartz
authors.affiliation: New York University Institute for Education and Social Policy, New York.
authors.forename: Michele
authors.initials: M
authors.lastname: Leardo
authors.affiliation: New York University Institute for Education and Social Policy, New York.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Aneja
authors.affiliation: New York University School of Medicine, New York 4New York University Robert F. Wagner Graduate School of Public Service, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Elbel
mesh_terms: D000293:Adolescent; D000818:Animals; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior; D004326:Drinking; D060766:Drinking Water; D004779:Environment Design; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008892:Milk / Q000706:statistics & numerical data; D009519:New York City; D063766:Pediatric Obesity / Q000175:diagnosis / Q000517:prevention & control*; D012572:School Health Services
chemical_list: D060766:Drinking Water