title: Limited School Drinking Water Access for Youth.
abstract: Providing children and youth with safe, adequate drinking water access during school is essential for health. This study used objectively measured data to investigate the extent to which schools provide drinking water access that meets state and federal policies.
  
  
  
  We visited 59 middle and high schools in Massachusetts during spring 2012. Trained research assistants documented the type, location, and working condition of all water access points throughout each school building using a standard protocol. School food service directors (FSDs) completed surveys reporting water access in cafeterias. We evaluated school compliance with state plumbing codes and federal regulations and compared FSD self-reports of water access with direct observation; data were analyzed in 2014.
  
  
  
  On average, each school had 1.5 (standard deviation: .6) water sources per 75 students; 82% (standard deviation: 20) were functioning and fewer (70%) were both clean and functioning. Less than half of the schools met the federal Healthy Hunger-Free Kids Act requirement for free water access during lunch; 18 schools (31%) provided bottled water for purchase but no free water. Slightly over half (59%) met the Massachusetts state plumbing code. FSDs overestimated free drinking water access compared to direct observation (96% FSD reported vs. 48% observed, kappa = .07, p = .17).
  
  
  
  School drinking water access may be limited. In this study, many schools did not meet state or federal policies for minimum student drinking water access. School administrative staff may not accurately report water access. Public health action is needed to increase school drinking water access.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Electronic address: ekenney@hsph.harvard.edu.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Kenney
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Health Sciences, Merrimack College, North Andover, Massachusetts.
authors.forename: Juliana F W
authors.initials: JF
authors.lastname: Cohen
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Angie L
authors.initials: AL
authors.lastname: Cradock
mesh_terms: D000293:Adolescent; D060766:Drinking Water / Q000592:standards*; D005522:Food Services / Q000592:standards; D006801:Humans; D062409:Lunch; D008404:Massachusetts; D018673:Nutrition Policy / Q000331:legislation & jurisprudence; D011634:Public Health; D012574:Schools / Q000592:standards* / Q000706:statistics & numerical data; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D060766:Drinking Water
keywords: Adolescents; Drinking water; Policy; Schools