Water Toolkit Att B

Increasing Access
to Drinking Water
in Schools

National Center for Chronic Disease Prevention and Health Promotion
Division of Population Health

For more information please contact:

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Population Health
School Health Branch
1600 Clifton Road NE
Atlanta, GA 30333
1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348
[email protected]
www.cdc.gov/healthyyouth/npao
www.cdc.gov/bam

Suggested Citation

Centers for Disease Control and Prevention. Increasing Access to Drinking Water in Schools.
Atlanta GA: US Dept. of Health and Human Services; 2014.

Web site addresses of nonfederal organizations are provided solely as a service to readers.
Provision of an address does not constitute an endorsement of this organization by CDC or the
federal government, and none should be inferred. CDC is not responsible for the content of
other organizations’ Web pages.

Contents
Background.......................................................................................................................... 5
Needs Assessment............................................................................................................... 9
• Assess policies and practices.
• Review water testing requirements and recommendations.
• Assess the school water environment.
• Assess student and stakeholder perceptions of drinking water.
• Identify key water champions.
Develop a School Water Access Plan.................................................................................. 19
Put the Water Access Plan Into Action ............................................................................... 23
• Budget for necessary supplies and repairs.
• Gather partners to help support the effort.
• Choose a water delivery method.
• Identify personnel needs and training.
• Develop water promotion strategies.
• Include strategies to sustain water access.
Evaluate Progress .............................................................................................................. 33
Appendices ....................................................................................................................... 37
• Appendix 1: School Drinking Water Needs Assessment Checklist and Planning Guide.
• Appendix 2: Diagram of Water Testing in Schools.
• Appendix 3: Examples of Water Dispensers for Schools.
• Appendix 4: Strategies to Overcome Potential Challenges.
• Appendix 5: Water Access Key Stakeholder Interview Questions.
References ........................................................................................................................ 49

3

4

Background

6

Background
Why provide access to drinking water in schools?
Drinking water can contribute to good health, and schools are in a unique position to
promote healthy, dietary behaviors, including drinking water. More than 95% of children and
adolescents are enrolled in schools, and students typically spend at least 6 hours at school each
day.1 Ensuring that students have access to safe, free drinking water throughout the school
environment gives them a healthy alternative to sugar-sweetened beverages before, during,
and after school. Access to safe, free drinking water helps to increase students’ overall water
consumption, maintain hydration, and reduce energy intake, if substituted for sugar-sweetened
beverages.2-4 In addition, adequate hydration may improve cognitive function among children
and adolescents, which is important for learning.5-9 Drinking water, if fluoridated, also plays a
role in preventing dental caries (cavities).10

Are schools required to provide access to drinking water?
The United States Department of Agriculture (USDA) requires that schools participating in the
National School Lunch Program (NSLP) make plain (i.e., no flavoring, additives, or carbonation)
drinking water available to students at no cost during the lunch meal periods at the locations
where meals are served.11 Schools must also make drinking water available during the School
Breakfast Program (SBP), when breakfast is served in the cafeteria. Schools that participate
in the Afterschool Snack Program are encouraged to provide drinking water when snacks are
served. Water is not considered part of the reimbursable meal, and there is no separate funding
for providing drinking water. Funds from the nonprofit food service account may be used to
pay for some costs of providing the water, including cups and pitchers. The USDA has issued
guidance on this requirement, including information on determining allowable costs.12,13 Schools
can consult their state education or agriculture agencies with additional questions about meeting
these requirements. States, school districts, and individual schools may have additional policies
and regulations requiring drinking water in schools.

Are there recommendations for schools on providing drinking water to
students?
In addition to federal requirements for providing students with access to drinking water, there
are other recommendations related to water access in schools.The Institute of Medicine and the
Centers for Disease Control and Prevention recommend that plain drinking water be available
throughout the school day at no cost to students, and if other beverages are available or sold
during the school day, they should only include plain water (i.e., no flavoring, additives, or
carbonation), fat-free or low-fat milk, and 100% fruit juice in specified portions.14,15 Similar
recommendations are promoted in several voluntary school recognition programs, including the
Alliance for a Healthier Generation’s Healthy Schools Program and USDA’s Healthier US School
Challenge (HUSSC).16,17 The American Academy of Pediatrics (AAP) also recommends the
following: (a) Children and adolescents should be taught to drink water routinely as an initial
beverage of choice as long as daily dietary caloric and other nutrient (e.g., calcium, vitamins)
needs are being met; (b) Water is also generally the appropriate first choice for hydration before,
during, and after most exercise regimens, and (c) Children should have free access to water,
particularly during school hours.18
7

The Water Access in Schools Tool Kit contains the following three major
components—
1. A description of key steps schools can take to meet federal requirements for drinking water
during the meal periods, as well as to make drinking water available and accessible across the
school campus, including the following:
• Conducting a needs assessment of current
drinking water policies and practices.
• Developing a school water access plan.
• Implementing the school water access
plan.
• Evaluating the success of the water access
plan.
2. A School Drinking Water Needs Assessment
Checklist and Planning Guide (Appendix
1) to guide schools through the process of
assessing current policies and practices related
to water, developing and prioritizing actions
to increase access to drinking water, and
evaluating changes.
3. Key resources for promoting water
consumption and making water more
available and accessible among school
settings.

Who should use this tool kit?
This tool kit can be used by school health councils, nutrition services providers, principals,
teachers, parents, and other school staff who are interested in increasing access to drinking water.
In addition, other stakeholders may choose to use the tool kit, such as public health partners,
community members, and university staff, to support the implementation and evaluation of
these efforts among schools.

8

Needs Assessment

10

Needs Assessment

Needs Assessment
Because every school is different, it is important to spend time thinking through what specific
changes to water accessibility are needed. Consider the resources available to make the changes,
and what training and promotion will help ensure that the changes to provide and encourage
water intake are successful.
The needs assessment process includes the following: (a) assessing policies and practices related
to water access; (b) reviewing water testing requirements and recommendations; (c) conducting
an assessment of the school’s water access points; (d) assessing students’ and other stakeholders’
perceptions about the drinking water; and (e) identifying key personnel to become water access
champions.
Key individuals who might be involved in the needs assessment process include school
administrative personnel, the school business office staff, the facilities division staff of the
school, school food service staff, school nurses, students, families, community members,
members of the school health council or school health team, and other health and nutrition
agency representatives. The School Drinking Water Needs Assessment Checklist and Planning
Guide (Appendix 1) can be used to review key questions about current drinking water policies,
practices, and environments.
Although the needs assessment process outlined in this tool kit is specifically focused
on improving drinking water access, CDC’s School Health Index (http://www.cdc.gov/
healthyyouth/shi) can be used to assess overall school health policies and practices, including
some aspects related to drinking water access. The School Health Index and the Water Access in
Schools Tool Kit can complement each other and help schools address water access, in addition
to other school health priorities.

Step 1: Assess state, district, and school policies and practices related to
water access.
Overview

Policies about water access before, during, and after school may be established at the federal,
state, and local levels. For example, there is a federal requirement for schools to provide drinking
water during breakfast and lunch meal periods.11 Most states have plumbing codes that establish
a minimum number of water fountains per number of students. Districts participating in the
NSLP are required to have a local school wellness policy (LWP), which may include goals for
drinking water, such as making drinking water available in multiple locations throughout the
school environment—not just in eating areas—and ensuring that students and staff have access
to safe drinking water throughout the school day, including after-school settings.19,20
Federal, state, and local water policies may address food service areas (e.g., cafeterias) or the
entire school campus. Policies that address food service areas can be found on local school
district Web sites or by contacting the nutrition services division for the entire school district.
To learn more about building-wide policies, the district environmental health officer, business
office, or the facilities division of the school may be contacted.
Needs Assessment

11

The School Drinking Water Needs Assessment Checklist and Planning Guide (Appendix 1) can
be used to assess school policies and practices for the following areas:
Food Service Areas

• Availability of water during meal periods (as required by USDA).
• State laws or policies requiring drinking water to be provided during meals and snacks
that exceed USDA requirements.
• School district policies requiring water to be provided during meals and snacks that
exceed USDA requirements.
• Sanitary code specific to food service areas.
» The state may have requirements for how to properly clean and maintain water
access points, which are implemented by the local health departments.
• Standard Operating Procedures (SOPs) for placement, filling, and cleaning of water
dispensers in the cafeteria.
» Schools may have SOPs that detail how to properly clean, sanitize, and maintain
water access points, specifically in food service areas, including who is responsible
for conducting each step. SOPs should align with sanitary code requirements,
including cleaning and flushing the fountains, bulk water dispensers, or other water
access points.
Campus-Wide

• Safe Drinking Water Act (SDWA).
» Federal regulations for schools that have their own water source (i.e., a well).
• State and local plumbing codes.
» Most state and some local municipalities have plumbing codes for schools that
require a specific number of water access points based on the number of students
(e.g., 1 fountain per 100 students). Schools can contact their local building inspector
for plumbing code information and standards.
• State laws or regulations relevant to water access in schools.
» Some states (e.g., Massachusetts, West Virginia) have policies that require students to
have access to drinking water during the school day, as well as during before-school
and after-school activities.
• School district policies.
» School districts may also have policies related to drinking water access, including
allowing students to bring fillable water containers to class, providing cups at water
access points, and marketing or promoting drinking water during the school day
or at school-sponsored events and activities. Schools that have known water quality
problems may also have district policies governing the purchase, placement, and
distribution of bottled water dispensers needed to replace plumbed fountains that
have been taken out of service.
12

Needs Assessment

• SOPs for water delivery devices.
» For water access points outside the food service areas, schools may have SOPs
outlining the steps needed to properly clean, sanitize, and maintain water access
points, including who is responsible for conducting each step.
• State or local laws or regulations that support community water fluoridation.
» Reporting requirements to state or local authorities about facilities that include
plumbing systems.
» Schools may have an annual facilities inventory or have an annual building condition
report that can be referenced.
Additional Resources

• Environmental Protection Agency (EPA)—Water in Schools and Childcare Facilities.
http://water.epa.gov/infrastructure/drinkingwater/schools/guidance.cfm
• USDA—Memorandum on Water Availability During Meal Service.
http://www.fns.usda.gov/sites/default/files/SP28-2011_osr.pdf
• USDA—Local School Wellness Policy.
http://www.fns.usda.gov/tn/Healthy/wellnesspolicy.html
• CDC—Local School Wellness Policy.
http://www.cdc.gov/healthyyouth/npao/wellness.htm
• CDC—My Water’s Fluoride.
http://apps.nccd.cdc.gov/MWF/Index.asp
• WellSAT—School Wellness Policy Evaluation Tool, by Robert Wood Johnson Foundation.
http://wellsat.org/
• National Policy and Legal Analysis Network—How to Enforce a Wellness Policy: A Guide for
Parents and Community Advocates.
http://changelabsolutions.org/sites/changelabsolutions.org/files/EnforceWellnssPlcy_
FactSheet_web_FINAL_090219.pdf
• ChangeLab Solutions—Water Access in Schools: Model Wellness Policy Language.
http://changelabsolutions.org/publications/wellness-policy-water
Examples of Successful Water Access Wellness Policies

Schools throughout the country have adopted a variety of policies and practices to improve
access to drinking water on campus. The following example illustrates a district that includes
language on access to drinking water in the district wellness policy:
• Earlimart School District in California adopted a wellness policy that requires water
to be accessible throughout the school day, as well as during before-school and
after-school activities. It allows students to take water into the classroom in capped
containers, and it also includes provisions on periodic maintenance of water fountains
and testing of water sources.
http://www.californiaprojectlean.org/docuserfiles/Case%20Studies_Earlimart-Final.pdf
Needs Assessment

13

Step 2: Review federal, state, and local water testing requirements and
recommendations.
Overview

Schools are responsible for providing safe drinking water. Drinking water comes into the school
facilities from either (a) a public water supplier (e.g., water utilities or water suppliers, such as cities,
towns, and water districts) or (b) an on-site water system (e.g., a well). In the United States, most
school districts (80%) get their drinking water from a community or municipal source.21 There are
different testing requirements for schools depending on the source of the drinking water.
Schools using local public water supplier

Federal law does not require schools using a local
public water supplier (e.g., municipal water system)
to regularly test the water because the public water
supplier is required to regularly test the water to
ensure that it meets federal and state drinking water
standards for contaminants, including bacteria
and certain chemicals. However, even if the water
meets federal and state standards, the water pipes
and plumbing fixtures in the schools can affect the
quality of the water. Therefore, the Environmental
Protection Agency (EPA) recommends that all
schools routinely test drinking water for lead
and perform regular maintenance to ensure that
drinking water is safe.
Schools that would like to test water for lead
should contact the lead officer for the local health
department or the municipal water provider for
information about certified laboratories that can
test for lead. In some cases, the municipal water
provider may be able to conduct the lead testing for schools. Schools could conduct their own
testing by having the facilities division take samples from the school and sending the samples
to a private laboratory. The EPA has guidance for schools that use a local public water supplier:
http://water.epa.gov/infrastructure/drinkingwater/schools/upload/epa816b13002.pdf.
Schools that are a public water system

Schools that get drinking water from an on-site water source (e.g., well) and serve at least 25
people are considered a public water system and required to comply with a series of federal
testing rules and regulations under the Safe Drinking Water Act (SDWA), including the EPA’s
Lead and Copper Rule requirements. At minimum, states have to meet the federal SDWA
requirements but may have stricter requirements. If lead and copper levels exceed specified
levels, then other actions may need to be taken, such as water quality parameter testing or
corrosion control treatment. The EPA has guidance for schools that are a public water system:
http://water.epa.gov/infrastructure/drinkingwater/schools/upload/epa816b13001.pdf.
14

Needs Assessment

Guidance for all schools

Students, parents, teachers, or other administrative officials may want to learn about the quality
of the water within their school, especially if the school is in an older building. If there are
concerns about water quality, contact the school district’s facilities division to determine if a
plumbing inspection is warranted, or if further action such as testing needs to be conducted. A
list of resources for how to pursue water quality testing is provided at the end of this section. In
addition, Appendix 2 provides an overview of how to get started on testing water in schools.
Additional Resources

• EPA guidance for schools on testing drinking water, correcting water quality problems
when they exist, and communicating drinking water testing results and actions to
communities:
http://www.epa.gov/safewater/schools/guidance.html
• EPA quick reference guide for lead and copper testing in schools:
http://www.epa.gov/safewater/schools/pdfs/lead/qrg_lcr_schools.pdf
• EPA guidance for reducing lead in drinking water in schools: http://www.epa.gov/ogwdw/
schools/pdfs/lead/toolkit_leadschools_guide_3ts_leadschools.pdf

Examples of District Water Testing Procedures

• This case study demonstrates how Stoughton Public Schools in Stoughton,
Massachusetts, approached testing water in their schools:
http://water.epa.gov/infrastructure/drinkingwater/schools/casestudy_
stoughtonschools.cfm
• Los Angeles Unified School District has a Web site dedicated to lead testing results:
http://www.lausd-oehs.org/drinkingwater_listschools.asp

Needs Assessment

15

Step 3: Learn more about the school water environment.
Conducting an assessment of the current drinking water environment will help identify where
changes may be needed. The following list of questions can be used to begin thinking through an
assessment process. Schools can use the School Drinking Water Needs Assessment Checklist and
Planning Guide provided in Appendix 1 to conduct a more detailed assessment of the current
drinking water environment.
Key Assessment Questions (reference the School Drinking Water Needs Assessment Checklist
and Planning Guide)
• What kind of information does your school
or district already collect regularly about the
condition of the school building? Does your
facilities, maintenance, or environmental
health division collect or maintain records of
water access points or water quality testing
results in your school district or individual
school building?
Some states require annual facilities inventories,
and some cities require annual school building
condition reports to the city council. Therefore,
information on the current school water
environment may already be available.
• How many drinking water access points are there
within the school? Where are the water access
points currently located within the school? How
many are accessible to students during the school
day and during after-school hours?
Water access points may include water fountains,
water coolers, hydration stations, and other water
filling stations, but should not include bottled
water for sale because not all students may be able to purchase bottled water. Examples of
different types of drinking water access points can be found in Appendix 3.
• What is the fountain-to-student ratio in your school? Does it meet the state plumbing
code requirements?
Schools can contact their local building inspector for plumbing code information and
standards.
• Are drinking water access points clean and operating properly?
Important elements to assess here include (a) clarity of the water; (b) cleanliness (i.e., any
visible dirt, gum, or trash); (c) actual delivery of water (i.e., Is water coming out?); (d)
temperature of the water (i.e., Is it cold?); and (e) sufficient water pressure to maintain an
adequate stream of water to drink from or fill a cup or water bottle. If the school relies on
bulk bottled water dispensers, determine if they are routinely sanitized, and if cups are
provided and routinely restocked.
• Are cups provided at water access points?
Students tend to drink more water when cups are provided.22
16

Needs Assessment

Step 4: Assess students’ and other stakeholders’ perceptions about current
drinking water and about providing drinking water in the school.
Overview

An assessment of students’ and other stakeholders’ (e.g., school administrators, staff, health and
nutrition agency representatives, and families) perceptions about the current drinking water can
help guide what changes are needed, as well as address misperceptions about drinking water.
Students have expressed a variety of opinions about drinking water at school, including concerns
about inadequate numbers of fountains, inconvenient fountain locations, water safety, broken
or dirty water fountains, poor water taste, warm water, unappealing water color, and possibly
some general bias against tap water.22-25 School officials also express a variety of concerns about
improving drinking water in schools, including costs for labor and equipment to update and
maintain existing fountains and for introducing new water access points (e.g., serving water in
pitchers at lunch, installing filters on fountains), a possible decrease in competitive beverage sales
that often fund school extracurricular activities, and a reduction in milk consumption among
students.23 Suggestions for addressing some common concerns are listed in Appendix 4.
Key assessment components

• Depending on available resources, schools may want to conduct a general survey about
perceptions of drinking water among students and other stakeholders. Questions can
include accessibility of school drinking water, attitudes about drinking water, including
perceptions of tap water taste, health, and safety, barriers to drinking water, and ways to
promote drinking water, in particular, tap water.23 An example of a stakeholder interview
questionnaire that can be adapted and used is provided in Appendix 5.
• Schools can engage existing student groups who might be interested in water issues.
Sports teams, environmental clubs, and other groups may be interested in gathering
information from their fellow students to share with the school about how they perceive
water access and what changes they would like to see happen to improve water access.
Example of Engaging Students

• At Del Norte High School in Crescent City, California, a group of students came
together to help improve access to drinking water in their school. The group
came together in response to the poor status of water fountains in their schools.
Students reported that there was gum, trash, and sometimes tobacco spit in the
water fountains, and that the water was often lukewarm, leaving the students
to buy water rather than drink from the fountain. The group met with the
school board to present several alternate solutions to improving drinking water
consumption, such as installing water-bottle filling stations, and is investigating
funding sources to implement possible solutions.

Needs Assessment

17

Step 5: Identify key water access champions.
Overview

Water access champions are individuals or groups who support student access to drinking water
before, during, and after school. These champions can help develop and implement a drinking
water access plan.
Key assessment components

• Who are the water access champions in the school?
Key water access champions may include parents, school wellness coordinators, facilities
managers, teachers, nurses, principals, health education and physical education teachers,
students, food service directors, and community members including physicians, dentists,
and other dental health care personnel.
• What are the potential roles of the water access champions?
There are many important roles that water access champions can have to support drinking
water access. For example, the school wellness coordinator could bring together a group of
individuals to conduct the needs assessment process, develop the school water access plan,
and implement the plan. The school principal can help get staff and community support
and commitment for the water access plan, and allocate resources to implement the plan.

18

Needs Assessment

Develop a School
Water Access Plan

20

Develop a School Water Access Plan

Once the assessment of the school’s water policies and practices has been completed, the next
step is to develop a drinking water access plan. The purpose of developing a plan is to
• Identify strengths and opportunities for improvement in providing access to and
consumption of drinking water.
• Develop a list of recommended actions to address policy and practice needs for providing
access to and consumption of drinking water.
• Rank the list of actions so that the top priorities are addressed first.
Using Appendix 1, read and respond to the two planning questions to identify strengths and
areas for improvement, develop a list of recommended actions, and rank the list of actions. These
priority actions can then be used to create goals and objectives for implementation.

Planning Question 1
On the basis of the results from the School Drinking Water Needs Assessment,
what are the strengths and areas for improvement in providing access to and
consumption of drinking water?

As guided in Appendix 1, make a list of the strengths and weaknesses from the needs assessment
process. Examples of weaknesses could include the following:
• Water fountains do not work properly or are inadequate in number or location to meet
students’ needs.
• School’s water has been tested, but results are not communicated to parents, students, or
school staff.
• School does not allow students to bring refillable bottles to school.
• Students or parents have a negative impression of tap water taste or quality.

Develop a School Water Access Plan

21

Planning Question 2
What are the recommended actions to address the identified weaknesses?

On the basis of the weaknesses identified in Planning Question 1, make a list of recommended
actions to improve drinking water access in the template provided in Appendix 1, and select at
least one priority action from the list. Although the number of priority actions will vary for each
school, it is recommended to identify between one and three priority actions. Examples could
include the following:
• Work with facilities staff to ensure that water fountains are cleaned regularly and working
properly.
• Form a student committee to help implement a drinking water campaign at school.
• Develop a capital improvement plan to secure funds to install new water access points.
• Revise the district wellness policy to allow students to carry water bottles with them at
school.
• Consider revising school policies (e.g. disciplinary code) to allow refillable bottles.

Creating Goals and Objectives
Use the Goals and Objectives Template provided in Appendix 1 to identify goals and objectives
for each of the priority actions that were identified. Remember to develop specific, measurable,
achievable, realistic, and time-phased (SMART) objectives, and identify an individual or group
of individuals who will be responsible for helping to implement each of the objectives.

22

Develop a School Water Access Plan

Put the Water
Access Plan
Into Action

24

Put the Water Access Plan into Action

Once the plan has been developed, including goals and objectives, then begin to implement
the water access plan. Depending on the goals and objectives that are identified, additional
steps may be needed to implement the water access plan. This section will cover the following
implementation strategies to help schools achieve the goals and objectives:
• Seek opportunities for funding.
• Gather partners to support the effort.
• Select a water delivery method.
• Identify personnel needs and training.
• Develop water promotion strategies.
• Address sustaining the water access plan long-term.

Key Considerations
Budget for necessary supplies and repairs, and seek additional funding
opportunities, if needed.

Schools consider incorporating certain costs involved with improving water access into their
annual budgets. Funding may be needed for installation of new water access points (e.g.,
water fountains, water dispensers, hydration stations), buying cups to be kept at water access
points (unless the school has the students bringing their own containers), maintaining water
access points (e.g., a water dispenser may require filter changes every few months), testing of
drinking water, repair (e.g., old drinking water-related infrastructure), removing drinking water
contaminants (e.g., filter certified to remove lead), and supporting labor costs to maintain water
sources.25,26 If the provision of drinking water in your school is beyond the district’s current
means, consider including these improvements in the school’s long-term school modernization
plans as a worthwhile investment.
Other options for funding school waterrelated programs include the following:
• School food service funds, (if the
water access point is in the food
service area).
• Federal, state, or municipal funding.
• Foundation grants.
• Partnership with private industry
(e.g., reusable water bottle
companies).
• Parent Teacher Association (PTA)
fundraiser.

Put the Water Access Plan into Action

25

Examples of Obtaining Funding for Water Access and Promotion in Schools

• Several public schools in New York City received financial assistance from the city
departments of education and health to install water jets in their school cafeterias.
• One school district in California purchased reusable water bottles for students with
funding from the California Nutrition Network, a group of local, state, and national
partners working to promote increased fruit and vegetable consumption and physical
activity among low-income communities.
• As part of a pilot program, students and staff in the Los Angeles Unified School District
in California received reusable water bottles to encourage water consumption throughout
the school day. A well-known maker of reusable bottles donated the water bottles for the
program.
• In Utah, a filter manufacturer provides and maintains filters for 18,000 drinking
fountains in more than 750 public schools throughout the state at no cost to schools.

Gather partners who could help support this effort.
In addition to key stakeholders necessary to the entire planning and implementation process
(e.g., school health councils, parents, community members), there are many people and
organizations who share the common goal of promoting access to drinking water.
Key partners may include the following:
Drinking Water Agencies and Associations

• Association of State Drinking Water Administrators
• Association of Metropolitan Water Agencies
• National Rural Water Association
• Rural Community Assistance Partnership
• Water Quality Association
• Water Quality Research Foundation
• Local chapter of the American Water Works Association
• Local water district or local water utility company
Health Professionals, Agencies, and Associations

• Association of State and Territorial Health Officials
• Dentists and other oral health professionals, physicians, and dieticians
• Public health departments
Youth Advocacy Programs and Education Associations

• Youth development programs (e.g., Girls and Boy Scouts, 4H)
• Parent Teacher Associations (PTA)
26

Put the Water Access Plan into Action

Others

• School facilities and custodial staff
• State department of environmental protection
• Foundations interested in health issues
Example of Building Partnerships

• Louisville Water and Jefferson County Public Schools in Louisville, Kentucky, worked
together to create Louisville Pure Tap drinking water fill stations with signage
promoting water above the fill stations (produced by Louisville Water).
http://www.louisvillepuretap.com/

Choose a water delivery method.
Once you know the current water environment at your school, one potential priority action
might be to install new water access points in the school or to retrofit existing fountains. This
decision will depend on where the water access points will be located and the available budget.
If any construction or remodeling is being considered, involve the school facilities staff in the
planning process.
Step 1: Know the available budget.

Although all new water access options will require some initial funding to implement, there is
evidence that water provision options that rely on tap water have lower long-term costs.26 In
addition, cups (e.g., reusable, recyclable, or compostable) or reusable water bottles for students
should be considered in the water access budget. See Appendix 3 for examples of different
methods for providing water.
Step 2: Decide where the water access points will be located.

Schools may consider the following criteria when deciding where access points will be located:
• Does the age and layout of the building allow for new access points to be installed?
• Will students have access to the water at any time during the school day?
• Is the potential access point in an area of the school where water may be in higher demand,
such as near gymnasiums or lunchrooms?
• Is there access to plumbing for a water source and drainage?
• Is there access to electricity to chill water?
• Is there a solid wall behind the fountain? Solid walls may be more difficult and costly to
open for new installations.
Knowing where water access points will be located will help to determine whether a plumbed
access point or nonplumbed access point will be the most appropriate. Plumbed access points,
such as water fountains and water bottle filling stations and some models of water coolers,
require direct access to the building’s water pipes, whereas nonplumbed access points (e.g.,
pitchers) do not require direct access to the water pipes.
Put the Water Access Plan into Action

27

Step 3: Consider providing cups or allowing the use of reusable water bottles.

In addition to providing the water source, it is important to consider the types of containers
students will use to drink the water. For example, it is recommended that cups be made available
at water access locations. Providing cups helps students drink more water.22 Some schools may
opt for compostable or recyclable cups to decrease landfill waste. If recyclable cups are provided,
it is important to ensure that the school has a system in place to ensure that the cups are recycled
properly.
Using reusable water bottles is another option for helping students to drink water at school.
Reusable water bottles can help reduce waste from single-use plastic bottles and cups and allows
students to have access to water throughout the school day. Students should be reminded to
bring their water bottles with them each day, label them with their names, and take them home
to be washed regularly.

Identify Personnel Needs and Training.
Depending on how the school chooses to address water access, there are questions related to
staffing that will need to be addressed:
• Is additional staff time needed to maintain existing and new water access points?
Additional staff time may be needed to maintain existing and new water access points to
ensure that they are functioning properly, regularly sanitized and cleaned, have adequate
water pressure, and to clean up spills. In addition, school staff can help ensure that cups are
available and properly disposed of and refill nonplumbed water sources.22
• Is there language in labor contracts related to lifting heavy containers and cleaning
or maintaining water fountains, and should such language be included if it doesn’t
currently exist?
Food carts can be used to move water dispensers, if needed.
• What training is needed for school staff?
School staff may require training on different aspects of providing drinking water in
schools. School nutrition staff may require training on how to provide and maintain
drinking water access points in the cafeteria in compliance with the sanitary code,
including how to disassemble and sanitize new equipment. Principals and other staff (e.g.,
counselors, physical education teachers, and athletic coaches) may require training on
how to promote drinking water among students throughout the school day and during
physical activity. Teachers may require training on the health benefits of drinking water
and how to promote drinking water among students, such as through inclusion of benefits
of water consumption in health education and other subject area lesson plans. Training
may also be needed on how to address students who abuse the privilege of having water
in the classroom or at recess (e.g., filling the water bottles with other types of beverages).
Custodial staff may require training on how to maintain and clean water fountains or water
dispensers, as well as perform basic repairs, if needed. Further, local health inspectors may
require or recommend additional training for school staff, such as water testing or flushing
protocol, if needed.

28

Put the Water Access Plan into Action

Develop Water Promotion Strategies.
It is important to promote water for overall health and as a healthy beverage option.
Interventions that have improved drinking water access with concurrent education (e.g., by
teachers) to change beverage preferences have been more effective at increasing water intake.3, 22
Promotion efforts may include the following:
• Placing signs or posters near water fountains and dispensers.
• Including messages about the benefits of water in school newsletters and communication
materials sent to parents and families.
• Listing water as an available beverage on the school meals menu.
• Including content about water into lesson plans. For example, messages about the health
benefits or environmental aspects of drinking water can be included in lesson plans for various
subjects (e.g., math, biology, health and other curricula) and for students of various ages.
• Engaging students in water promotion activities. Engaging students in the development of water
promotion campaigns can help obtain support from the greater student body. For example, host
a competition where students create posters and videos describing why they like to drink water.
It could be helpful to develop a promotion plan. When developing a promotion plan, consider
addressing the following:
• Identify key locations to promote water.
This could be near water access points, in the school cafeteria, in school hallways, and in
the school newsletter and other materials to parents.
• Determine the audience for the messages.
Primary audiences can include students, parents, teachers, food service directors, and other
school administrators.
• Determine the key messages.
Promotional efforts may focus on one or more key messages related to water, including the
following:
» The importance of water for overall health.
» That fluoridated water prevents tooth decay in people of all ages.
» Water as the optimal beverage to quench thirst.
» The health benefits of replacing calorically sweetened beverages with water.
» The quality and safety of tap water.
» The environmental benefits of drinking tap water instead of bottled beverages,
including bottled water.
» The cost savings of drinking tap water compared with other beverages.
• Determine if there is enough money to support water promotion.
Funding may be needed to create flyers, fund water promotion contests among students,
create placards and billboards, or place posters on buses.
Put the Water Access Plan into Action

29

Examples of Water Promotion Campaigns

• Drink Up
http://www.youarewhatyoudrink.org/
• Bay Area, California Soda Free Summer
http://www.sodafreesummer.org/
• Rethink Your Drink
http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/rethink_your_drink.pdf
• Take Back the Tap
http://www.foodandwaterwatch.org/water/take-back-the-tap/
• Water First, Think Your Drink
http://www.wecanky.com/waterfirstthinkdrink.html
• Potter the Otter
http://www.potterloveswater.com/
• Drinking Water Week
http://www.awwa.org/resources-tools/public-affairs/public-affairs-events/drinkingwater-week.aspx
• Turlock Unified School District ‘Real. Fresh’ campaign
http://www.youtube.com/watch?v=2vhIDrWBoGo
• Los Angeles Unified School District SNaX Project
http://www.cdc.gov/prc/stories-prevention-research/stories/snax-for-everyone.htm

Additional Resources

• California Department of Education.
http://www.cde.ca.gov/ls/nu/he/water.asp

30

Put the Water Access Plan into Action

Include strategies in your plan to sustain water access once changes in the
school are made.
School water champions play an important role in ensuring that water access efforts continue to
be implemented. Suggestions for sustaining water access in school include the following:
• Adding language about water access to district policies.
All school districts that participate in federal child nutrition program (e.g., National School
Lunch Program, School Breakfast Program) are required to have a local school wellness
policy (LWP) that includes goals that promote student wellness. Consider attending the
district’s school wellness council meetings to discuss the importance of addressing water in
the LWP and helping to revise policy language to incorporate water. Examples of language
that could be incorporated in a LWP include the following:27
» Provide all students and employees with access to clean, safe, palatable drinking
water free of charge at every district facility, including cafeteria and eating areas,
classrooms, hallways, play yards and athletic fields, and faculty lounges throughout
the school day and at before- and after-school activities
» Allow students to bring drinking water from home and to take water into the
classroom, provided that the water is in a clear, capped container, such as a water
bottle, to prevent spills.
» Encourage school administrators, teachers, and building staff to model healthy
behavior, including drinking tap water.
» Require repairs to bring school buildings into compliance with state and local
plumbing codes and relevant state laws.
» Establish hygiene standards for water access points, including how often they should
be cleaned.
» Promote water through multiple methods, including providing cups at water access
points.

Put the Water Access Plan into Action

31

• Ensuring that district maintenance and food service policies specify who is
responsible for maintaining the water access points, including the frequency of cleaning
and maintaining water fountains or other water sources, the frequency of testing water for
contaminants, as well as flushing water outlets after periods of no use, such as weekends or
school vacations, and spot checks to ensure implementation of policies.
• Promoting water access by using posters, signs, newsletters, and announcements will
encourage students and school staff to continue to use water access points.
• Sharing success stories in the local newspaper, school Web site and social media,
newsletters, and school board meetings can help other schools in their efforts to improve
access to drinking water.

32

Put the Water Access Plan into Action

Evaluate Progress

34

Evaluation Plan

Evaluation is a process that can be used to assess and improve policies and practices among
school settings, including access to drinking water. Evaluation can help access to drinking water
policies and practices by identifying strengths and weakness, developing plans for improvement,
improving the implementation of policies and practices, and measuring changes in the school
environment, as well as the dietary habits of students and staff.
Evaluation activities vary for the purpose, design, and resources required. There are two main
types of evaluation: process and outcome. Process evaluation aims to assess the extent to which
a policy, program, or practice has been implemented as intended, and can help identify ways to
improve implementation in the future. Schools may consider assessing the following as part of
the process evaluation:
• Were water access points added in the school setting? If so, how many?
• Are cups provided at water access points? If so, how many cups were used? What was the
cost of providing the cups?
• Where in the school were water access points added? Was one location used more than
another?
• Have water promotion efforts been implemented? If so what are they?
• Has language on water access been added to the local school wellness policy or other
school policy?
• Have school staff received training on providing, maintaining, and promoting drinking
water in schools?
Outcome evaluation is used to assess if specific changes occurred as a result of implementing
policies or practices. Depending on how many resources a school has for evaluation activities,
a school may consider evaluating the following
outcomes:
• Have students’ perceptions of access to water
among school settings changed?
• Have students’ attitudes and preferences related
to water changed?
• Have students’ consumption of water and other
beverages changed?
It is important to plan an evaluation that can be
used to further improve policies and practices. This
includes identifying what will be evaluated, how the
evaluation will be conducted, who will conduct the
evaluation, who will analyze the data, how the data
will be reported, and available resources. The goals
and objectives that have been developed as part of
the water access implementation plan will guide the
evaluation design, including what information should
Evaluation Plan

35

be collected. Common data collection methods include questionnaires, interviews, focus groups,
document reviews (e.g., policy analysis) and observations. Use of more than one source of data
may be needed to measure specific goals and objectives.
At a minimum, schools should revisit their completed Water Access Goals and Objectives
template annually to monitor progress. If an objective was not met, discuss why it wasn’t met,
and what might be needed to ensure that it can be met in the future. If it is determined that the
objective is still important and can likely be achieved, consider adding it as an objective for the
following year. Schools may consider partnering with evaluators at universities, local or county
health departments, school districts, or state departments of education and health to identify
methods and resources for conducting a more complex evaluation of their water access efforts.
Additional information about conducting a successful evaluation is available:
• http://managementhelp.org/evaluation/program-evaluation-guide.htm.
• http://www.cdc.gov/eval/framework/index.htm.

36

Evaluation Plan

Appendices

38

Appendices

Appendix 1: School Drinking Water Needs Assessment Checklist and
Planning Guide
The School Drinking Water Needs Assessment Checklist and Planning Guide is designed to help schools
identify strengths, areas for improvement, and priority actions, and to develop measurable goals and objectives for
improving access to and consumption of drinking water.
Respond to each question in the School Drinking Water Needs Assessment Checklist. In the notes section of the
checklist, capture additional details or clarifying comments. For example, if your school district is working on
developing a local school wellness policy that would incorporate language on student access to water fountains or
filling stations throughout the school day, you might make note of the steps being taken to achieve that, or the barriers
that make it difficult to achieve. Those notes will help guide you in developing your goals and objectives.
After completing the School Drinking Water Needs Assessment Checklist, two planning questions are provided to
help guide further action to promote drinking water access within your school.
School Drinking Water Needs Assessment
Checklist

Response
options
Yes

Notes

No

Step 1: Assess state, district, and school policies and practices related to water access.
Food Service Areas
a.

Does the school provide students with access to drinking
water during the meal periods, as required by USDA?

b.

Is there a state requirement that students have access to
drinking water during meals and snacks?

c.

Is there a district policy requiring water to be provided during
meals and snacks (e.g., Local School Wellness Policy)?

d.

Does the district or school have Standard Operating
Procedures (SOPs) for placement, filling, and cleaning of
bulk bottled water dispensers in the cafeteria?

Other Areas in the School
e.

What are the state or local plumbing codes and requirements
for the number of water access points? What is the
fountains-to-students ratio in your school? Does it meet the
plumbing code requirements?

f.

Are there state or local sanitary codes for cleaning and
maintaining drinking fountains, water containers, hydration
stations, and other methods for delivering drinking water?

g.

Does the school district have policies related to drinking water
access? Policies may address providing students with access to
water fountains or water filling stations throughout the school,
allowing students to bring fillable water containers to class,
allowing students to get up to get a drink of water during
class, providing cups at water access points, and marketing or
promoting drinking water during the school day or at schoolsponsored events and activities.

Step 2: Review states and local water testing requirements and recommendations.
a.

Does your school meet the definition of a public water
system and, therefore, comply with the Safe Drinking Water
Act (SDWA)?

b.

If so, does it meet all federal and state standards under the
SDWA?

Appendices

39

School Drinking Water Needs Assessment
Checklist
c.

Has your school’s water quality been tested? When was it last
tested?

d.

Are testing results readily available to students, parents, and
the community?

e.

Is the available drinking water optimally fluoridated?

Response
options
Yes

Notes

No

Step 3: Conduct an assessment of the school water access environment.
a.

What kind of building information does your school or
district regularly collect? Does your facilities, maintenance,
or environmental health division collect or maintain records
of water access points or water quality testing results in your
school district or individual school building?
• Are the following water access points available to
students at school? (Please indicate the number and
where they are located in the Notes column, for
example, in the cafeteria, gymnasium, hallway.) Refer to
Appendix 2 to learn more about the differences between
each of these water access points.

b.

i.

Water fountains.

ii.

Water coolers.

iii.

Bottle fillers.

iv.

Pitchers or containers of water served at lunch.

v.

Other (please describe).

Are the drinking water access points that are available to
students clean and operating properly?
• Elements to assess include the clarity of the water,
cleanliness (e.g., any visible dirt, gum, or trash),
temperature of the water, and water pressure.

c.

Are cups provided at drinking water access points?

d.

Is there signage or other materials promoting drinking
water in the school? Please include where this information
is included.

Step 4: Perception about drinking water.
Have you assessed students’ and other stakeholders’ (e.g., school
administrators, staff, health and nutrition agency representatives,
and families) perceptions about current drinking water and about
providing drinking water in the school?

Step 5: Identify key water champions.
a.

Are there potential water champions in your school? You can
identify specific champions in the Notes section (e.g., parents,
teachers, school nutrition staff).

b.

Describe the potential role of water champions in the Notes
section.

40

Appendices

Planning Question 1: On the basis of the results from the School Drinking Water Needs Assessment,
what are the strengths and areas for improvement in providing access to and consumption of
drinking water?
Strengths
1. Example: All water access points are clean and
operating properly.

Areas for Improvement
1. Example: Students perceive that the tap water
at school is not safe

2.

2.

3.

3.

4.

4.

5.

5.

Planning Question 2: On the basis of the areas for improvement identified above, what are the
recommended priority actions for improving access to and consumption of drinking water (e.g.,
increase funding for water-related programs, install one new water access point in the cafeteria, form
a drinking water student committee)?
1. Example: Develop and implement a water promotion campaign to address students’ concerns about
water safety.
2. ________________________________________________________________________________
________________________________________________________________________________
3. ________________________________________________________________________________
________________________________________________________________________________
4. ________________________________________________________________________________
________________________________________________________________________________
5. ________________________________________________________________________________
________________________________________________________________________________

Appendices

41

Goals and Objectives Template
Use this template to identify goals and objectives for each of the priority actions that you have identified.
Remember to develop specific, measurable, achievable, realistic, and time-phased (SMART) objectives,
and identify an individual or group of individuals who are responsible for implementing each objective.
The following is an example of a goal and SMART objectives for the example priority action.
Sample Goal 1:
Develop and implement a water promotion campaign to address students’ concerns about water safety.
Sample Objective 1.1: By the beginning of school year 2014, communicate to students, parents,
and teachers the most recent drinking water test results.
Sample Objective 1.2: By the beginning of school year 2014, identify 6–8 students to participate
in a committee to identify 3–5 key messages for a water promotion campaign.
Sample Objective 1.3: By November 2014, develop posters and other materials by using the key
messages identified by the student committee.
You can revisit these goals each year to check on the progress that has been made. If an objective was not
met, consider focusing on it during the next year.
Fully Met/
Person
Partially Responsible
Met/
for the
Not Met
Objective

Comments

Goal 1
Objective 1.1
Objective 1.2
Objective 1.3
Goal 2
Objective 2.1
Objective 2.2
Objective 2.3
Goal 3
Objective 3.1
Objective 3.2
Objective 3.3

42

Appendices

Appendix 2: Diagram of Water Testing In Schools
This diagram outlines the water testing process for schools.

Is your school a
public water system?a

Yes

No

Has your school’s
water quality been
tested?

Yes

Obtain the most
current lead results.

EPA action level for
lead is 20 parts per
billion (ppb).b

Appendices

School is not required
to undergo water
quality testing.

No

Conductin monitoring
according to the
federal and state
regulations under
the Safe Drinking
Water Act.

If concerned about
water quality,
schools can undergo
voluntary testing.

Contact municipal
water system to
obtain latest water
quality results.

If within normal limits
consider sampling
of high priority
water outlets.b

a

A school meets the definition of a public water system if it provides water for human
consumption to at least 25 individuals a day AND has its own water source (e.g., a
well) OR treats the water OR sells the tap water.

b

Students, parents, or any school administrative officials can approach their facilities
division about conducting water quality testing.

43

Appendix 3: Examples of Water Dispensers for Schools
Water Dispenser

Type

Pricea

Considerations

Portable Water
Dispenser

$

• Potential weight concern for staff refilling
container in the sink.
• Requires room for storage.
• Account for expenses to provide cups.
• Requires access to commercial dishwasher or
other way to sanitize.

Water
Dispenser

$

•
•
•
•

Water Cooler

$/month

Bottle Filler

$$$$

• Station needs to be placed near existing water
source.
• Filtered water.
• Ideal for school cafeterias that are undergoing
construction because it will make installation
easier and be cost effective.
• Sleek-looking and may alleviate students’
perception that public water sources are unsafe.
• Some models display how many bottles are
saved from waste.
• Account for expenses to provide cups if
students do not have refillable water bottles.

Water
Fountain with
Bottle Filler

$$$-$$$$

• Must be placed near existing water source.
• Filtered water.
• Ideal for school cafeterias undergoing
construction because it will make installation
easier.
• Sleek-looking and may alleviate students’
perception that public water sources are unsafe.
• Some models display how many bottles are
saved from waste.

Will require staff to refill container.
Potential storage concern.
Need committed nutrition services staff.
Account for expenses to provide cups.

• Monthly fee for leasing machine.
• Option for filtered water, which may alleviate
students’ perceptions about public water
sources.
• Station needs to be placed near existing water
source and electric outlet for cold water.
• May need to disable the hot water spout.
• Easy to install.
• Account for expenses to provide cups.

Price Key (per unit): $ = $1–$99; $$ = $100–$499; $$$ = $500–$999; $$$$ = $1,000–$5,000.

a

Source: Adapted with permission from
http://waterinschools.org/pdfs/CFPA_WaterDispenserOptions.pdf.

44

Appendices

Appendix 4: Strategies to Overcome Potential Challenges
Stakeholders may express concerns about increasing access to drinking water in schools. Below
are examples of some common concerns and suggestions to prevent and address these concerns.
Students’ consumption of milk will decrease during school meals.

Although there has not been a lot of research on this particular issue, unpublished research
demonstrates that milk consumption is not significantly decreased when drinking water is made
available to students in the cafeteria. Water is not a replacement for milk at meals, but rather an
additional beverage that is available to students.
Providing cups at water access points will increase littering in the school.

Providing cups at water access points has been shown to increase the amount of water that students
consume.21 However, there is a concern students will not properly dispose of the cups after they
drink from them. One way to prevent littering is to ensure that trash or recycling receptacles are
available near all water access points. In addition, policies and practices encouraging students to
bring their own reusable water bottles to schools can help to reduce the need for disposable cups.
Concern that tap water is not safe.

Most tap water in the United States is assured by the United States Environmental Protection
Agency standards and regulations to be clean and safe for drinking.28 However, in some cases,
tap water may not be safe to drink because of unsafe plumbing systems or contaminated
water sources. It is important to have drinking water tested so that water quality problems are
addressed when they exist. If water quality problems cannot be fixed, then schools should use
alternate methods of providing drinking water to students, including installing point-of-use
filtration systems that are certified to remove contaminants, or purchasing drinking water for
students and staff. It is a good idea to regularly communicate drinking water testing results and
actions to students, parents, and the community. Schools may consider starting a campaign to
actively promote water quality or work with local organizations on a community-wide tap water
promotion campaign. (See pages 29–30 for ideas about water promotion campaigns.)
Students do not like the taste of the local tap water.

Even though most tap water is safe to drink, the taste of the water varies depending on the
source. Filtering water and chilling the water are two strategies that may improve the taste.
More classroom disruptions will occur because of water spills.

Although very little research has been done on this particular issue, schools can require that all
water bottles must be capped when in the classroom, or kept on the floor to prevent water from
spilling on desks.
Misuse of reusable water bottles (e.g., putting other beverages besides water in
the water bottle).

Schools concerned about the contents of the reusable water bottle can require students to use
clear (i.e., see-through) reusable bottles.

Appendices

45

Appendix 5: Water Access Key Stakeholder Sample Interview Questions
Basic Information
Date of Interview:

Type of Stakeholder:

Coder Initials:

Title of Stakeholder:

Identification Number:

Type of Organization:
Topic #1: Accessibility of Drinking Water in Schools

What type of access do students have to drinking water in school?

Probe: Examples could include water fountains, bathrooms sinks, bottled water from vending machines, water coolers,
hydrations systems, water brought from home, pitchers of water served at lunch, and water as a part of the meal tray.

Do you think students have adequate access to drinking water in public schools?

Topic #2: Attitudes and Perceptions About Current Drinking Water in Schools
What are potential barriers to drinking water in schools?

Probe: Examples could include inadequate number of water access points, inconvenient location of water access points,
water safety concerns, poor maintenance of drinking water outlets, broken or dirty water fountains, poor water taste,
warm and unappealing water color.

Topic #3: Attitudes, Barriers, and Facilitators for Providing Drinking Water in Schools
In your opinion, how should water be offered in schools?

Probe: Examples could include water fountains, bottled water from vending machines, water coolers, hydrations systems with cups vs. refillable water bottles, water brought from home, pitchers of water served at lunch, and water as a
part of the meal tray.

When should students have access to water in schools?

Probe: Examples could include during mealtimes (breakfast, lunch, and for nutrition), after recess, right before school,
after school, after sports or PE, and during classes.

What factors would make providing water in schools hard to do? (Ask the following probes if not covered in
response to this question.)

Probe (if needed): Do you know of any federal or state regulations that prohibit serving water at breakfast or lunch or
for nutrition. If so, what is your understanding of these regulations? (Probe about USDA reimbursement for certain
types of beverages offered in the cafeteria.)
Probe (if needed): Are there individual school or district challenges to providing water to students in schools? If so,
what are these challenges? (e.g., providing students with containers for water [disposable cups vs. bottles], long lines
to water dispensing areas, time for obtaining water, costs, labor union contracts, vandals tampering with hydration
stations, maintenance personnel to assist with upkeep, increased restroom access or breaks because of increased consumption, water bottle size limitations).
Probe (if needed): Are there any regulations related to water safety and quality?

What factors would make providing water in school easy to do?

46

Appendices

Topic #4: Water-Related Interventions
Do you know of other schools that are providing water to students? If so, how do these schools provide water to
students?
Probe: Examples could include filtered water stations, pitchers of water, as a part of the meal tray, and
vending machines with bottled water for purchase.

When do these schools provide water to students? Does the availability vary depending on the water source?
Probe: Examples could include accessible all day, meal times, after school, and summer.

Do you know the costs associated with providing water to students? (Costs can include those to students,
schools, etc.)
How, if at all, does the school advertise, market, or promote drinking water to students?

Topic #5: Suggestions for Other Key Informants
If you were designing an intervention a program to increase availability and consumption of water in schools,
from whom in the community would you want to get input and buy-in?
Probe: Examples include PTA leaders, teachers, school leaders, city officials, media, businesses, community
organizations, students, parents, policymakers, and advocacy groups.

I am interested in interviewing other individuals like you. Whom would you suggest?

Appendices

47

Acknowledgments
The Centers for Disease Control and Prevention, Division of Population Health and Division of
Nutrition, Physical Activity and Obesity thank the following individuals and organizations for
their contributions to the development of this document:
*Javier Arce-Nazario, PhD
Universidad de Puerto Rico, Cayey
Cayey, Puerto Rico

Tia Henderson, PhD, MST
Upstream Public Health
Portland, Oregon

*Cheryl Berman
Unbundled
Wilmette, Illinois

*Kate Hohman, MPH
YMCA of the USA
Washington, DC

*Ellen Braff-Guajardo, JD, Med
California Food Policy Advocates
Oakland, California

Karen Keyser, BS
South Dakota Department of Education
Pierre, South Dakota

Jill Camber Davidson, RD, CD
Action for Healthy Kids
Chicago, Illinois

*Tiffany Lommel, MS, RD, LD
Certified School Nutrition Director
Gainseville, Georgia

*Kirk Chase, BS
Georgia Department of Natural Resources
Atlanta, Georgia

Deb Loy, BSN, BSE, RN, PHN
Minnesota Department of Education
Roseville, Minnesota

*Angie Cradock, ScD
Harvard School of Public Health
Boston, Massachusetts

Whitney Meagher, MSW
National Association of State Boards of Education
Alexandria, Virginia

*Brenda Davy, PhD, RD
Virginia Tech
Blacksburg, Virginia

*Debra Nigri, MA, RD
United States Department of Agriculture,
Food and Nutrition Service
Alexandria, Virginia

*Brian Elbel, MPH, PhD
New York University School of Medicine
New York, New York
*Laurel Firestone, JD
Community Water Center
Visalia, California
*Steven Gortmaker, PhD
Harvard School of Public Health
Boston, Massachusetts
*Kordula Green, PhD
National Association for Family Child Care
Pine Lake, Georgia
*Karla Hampton, JD
Enigami Consulting Services, LLC
San Pablo, California
*Kenneth Hecht, LLB
Nutrition Policy Institute,
University of California, Berkeley and
Center for Weight and Health,
University of California, Berkeley
Berkeley, California

*Anisha Patel, MD, MSPH
University of California, San Francisco
San Francisco, California
*Crystal Rhodes
Kids ‘R’ Kids, International, Inc.
Duluth, Georgia
*Lorrene Ritchie, PhD, RD
University of California, Berkeley
Berkeley, California
Francine St Denis, PhD
Environmental Protection Agency
Washington, DC
Katherine Wilbur, MEd, MCHES
The Alliance for a Healthier Generation
Damariscotta, Maine
*Cara Wilking, JD
Public Health Advocacy Institute
Boston, Massachusetts

*These individuals participated in an expert panel
in 2012 to guide the development of this tool kit.
48

Appendices

References

50

References

1. National Center for Education Statistics. Digest of Education Statistics, 2011. Alexandria, VA:
National Center for Education Statistics, US Dept of Education; 2012.

2. Kaushik A, Mullee MA, Bryant TN, Hill CM. A study of the association between children’s access

to drinking water in primary schools and their fluid intake: can water be ‘cool’ in school? Child Care
Health Dev. 2007;33:409-415.

3. Muckelbauer R, Libuda L, Clausen K, Toschke AM, Reinehr T, Kersting M. Promotion and

provision of drinking water in schools for overweight prevention: randomized, controlled cluster
trial. Pediatrics. 2009;123:e661-e667.

4. Wang Y C, Ludwig DS, Sonneville K, Gortmaker SL. Impact of change in sweetened caloric

beverage consumption on energy intake among children and adolescents. Arch Pediatr Adolesc Med.
2009; 163(4):336-343.

5. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68(8):439-458.
6. Kempton MJ, Ettinger U, Foster R, et al. Dehydration affects brain structure and function in healthy
adolescents. Hum Brain Mapp. 2011;32:71-79.

7. Edmonds CJ, Jeffes B. Does having a drink help you think? 6-7-year-old children show

improvements in cognitive performance from baseline to test after having a drink of water. Appetite.
2009;53:469-472.

8. Edmonds CJ, Burford D. Should children drink more water? The effects of drinking water on
cognition in children. Appetite. 2009;52:776-779.

9. Community Services Task Force. Preventing Dental Caries: Community Water Fluoridation.
http://www.thecommunityguide.org/oral/fluoridation.html. Accessed May 1, 2014.

10. Benton D, Burgess N. The effect of the consumption of water on the memory and attention of
children. Appetite. 2009;53:143-146.

11. National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods
Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010, 7 CFR § 210.10(a)(1).
http://www.gpo.gov/fdsys/pkg/FR-2013-06-28/pdf/2013-15249.pdf. Accessed May 1, 2014.

12. National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods
Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010, 7 CFR § 220.8(a)(1).
http://www.gpo.gov/fdsys/pkg/FR-2013-06-28/pdf/2013-15249.pdf. Accessed May 1, 2014.

13. US Dept of Agriculture. SP 28-2011 Revised Child Nutrition Reauthorization 2010: Water
Availability During National School Lunch Program Meal Service-Revised.
http://www.fns.usda.gov/sites/default/files/SP28-2011_osr.pdf. Accessed May 1, 2014.

14. Institute of Medicine. Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier
Youth. Washington, DC: National Academies Press; 2007.

15. Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and
physical activity. MMWR Morb Mortal Wkly Rep. 2011;60(5).

16. Alliance for a Healthier Generation Healthy Schools Program. https://schools.healthiergeneration.org.
Accessed May 1, 2014.

References

51

17. US Dept of Agriculture. Healthier US School Challenge.

http://teamnutrition.usda.gov/healthierUS/index.html. Accessed May 1, 2014.

18. American Academy of Pediatrics. Committee on Nutrition and the Council on Sports Medicine

and Fitness. Sports drinks and energy drinks for children and adolescents: are they appropriate?
Pediatrics. 2011;127:1182-1189.

19. Child Nutrition and WIC Reauthorization Act of 2004. S 204, 108th Cong. Public Law 108-205 (2004).
20. Chriqui JF, Resnick EA, Schneider L, et al. School District Wellness Policies: Evaluating Progress

and Potential for Improving Children’s Health Five Years after the Federal Mandate. School Years
2006–07 through 2010-11. Volume 3. Chicago, IL: Bridging the GapProgram, Health Policy Center,
Institute for Health Research and Policy, University of Illinois at Chicago; 2013.
www.bridgingthegapresearch.org. Accessed May 1, 2014.

21. Jones SE, Axelrad R, Wattigney WA. Healthy and safe school environment, part II, physical school
environment: results from the School Health Policies and Programs Study 2006. J Sch Health.
2007;77: 544-556.

22. Patel AI, Bogart LM, Elliot MN, et al. Increasing the availability and consumption of drinking water
in middle schools: A pilot study. Prev Chronic Dis. 2011; 8(3):1-9.

23. Patel AI, Bogart LM, Uyeda KE, Rabin A, Schuster MA. Perceptions about availability and

adequacy of drinking water in a large California school district. Prev Chronic Dis. 2010;7(2):A39.

24. Patel AI, Hampton KE. Encouraging consumption of water in school and child care settings: access,
challenges, and strategies for improvement. Am J Public Health. 2011;101(8):1370-1379.

25. Chandran K. Improving water consumption in schools: challenges, promising practices, and next
steps. California Food Policy Advocates.
http://waterinschools.org/pdfs/WaterInSchools_FullReport_2009.pdf. Accessed May 1, 2014.

26. Cradock AL, Wilking CL, Olliges SA, Gortmaker SL. Getting back on tap: the policy context

and cost of ensuring access to low-cost drinking water in Massachusetts schools. Am J Prev Med.
2012;43(3S2):S95-S101.

27. ChangeLab Solutions. Model Wellness Policy Language for Water Access in Schools.

http://changelabsolutions.org/publications/wellness-policy-water. Accessed May 1, 2014.

28. The United States Environmental Protection Agency. Water: Safe Drinking Water Act.
http://water.epa.gov/lawsregs/rulesregs/sdwa. Accessed May 1, 2014.

52

References

CS245650