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Accepted manuscript

The Impact of a Water Promotion and Access Intervention on Elementary School Students in the Presence of Food Insecurity

Published online by Cambridge University Press:  22 November 2024

Leslie Gerstenfeld ,
Lauren Blacker ,
Charles E. McCulloch ,
Lorrene Ritchie Open the ORCID record for Lorrene Ritchie [Opens in a new window] ,
Valeria Ordonez ,
Laura Schmidt  and
Anisha Patel
Leslie Gerstenfeld*
Affiliation:
Philip R. Lee Institute for Health Policy Studies, 490 Illinois Street, University of California, San Francisco, San Francisco, CA, 94158
Lauren Blacker
Affiliation:
RUSH University Medical College, 600 S Paulina St Suite 524, Chicago, IL 60612
Charles E. McCulloch
Affiliation:
Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, 550 16th Street #2430, San Francisco, CA 94158
Lorrene Ritchie
Affiliation:
Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, 1111 Franklin Street, Office 11309, Oakland, CA 94607
Valeria Ordonez
Affiliation:
Stanford Department of Pediatrics, 3351 El Camino Real Ste 100, Atherton, CA 94027
Laura Schmidt
Affiliation:
Philip R. Lee Institute for Health Policy Studies, 490 Illinois Street, University of California, San Francisco, San Francisco, CA, 94158 Department of Humanities and Social Sciences, University of California, San Francisco
Anisha Patel
Affiliation:
Stanford Department of Pediatrics, 3351 El Camino Real Ste 100, Atherton, CA 94027
*
Corresponding author: Leslie Gerstenfeld, Email: leslie.gerstenfeld@ucsf.edu, Mailing Address: 490 Illinois Street, University of California, San Francisco, San Francisco, CA, 94158, Telephone: (415) 476-4921, Fax NA
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Abstract

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Objective:

School-based interventions encouraging children to replace sugar-sweetened beverages (SSBs) with water show promise for reducing child overweight. However, students with child food insecurity (CFI) may not respond to nutrition interventions like children who are food-secure.

Design:

The Water First cluster randomized trial found that school water access and promotion prevented child overweight and increased water intake. This secondary analysis used mixed-effects regression to evaluate the interaction between the Water First intervention and food insecurity, measured using the Child Food Security Assessment, on child weight status (anthropometric measurements) and dietary intake (student 24-hour recalls).

Setting:

Eighteen elementary schools (serving ≤ 50% children from low-income households), in which drinking water had not been previously promoted, in the San Francisco Bay Area.

Participants:

Students in fourth-grade classes (n=1056).

Results:

Food insecurity interacted with the intervention. Among students with no CFI, the intervention group had a lower prevalence of obesity from baseline to 7 months (-0.04, confidence interval [CI] -0.08 to 0.01) compared to no CFI controls (0.01, CI -0.01 to 0.04) (p=0.04). Among students with high CFI, the intervention group had a pronounced increase in the volume of water consumed between baseline and 7 months (86.2%, CI 21.7 to 185.0%) compared to high CFI controls (-13.6%, CI -45.3 to 36.6%) (p=0.02).

Conclusions:

Addressing food insecurity in the design of water promotion interventions may enhance the benefit to children, reducing the prevalence of obesity.

Type
Research Paper
Information
Public Health Nutrition , Accepted manuscript , pp. 1 - 21
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Authors 2024