Promotion of Drinking Water Among Latino Immigrant Youth

Objective: To design an innovative intervention to increase drinking water behaviors among Latino immigrant youth. Methods: We conducted two rounds of focus groups, totaling 10 sessions (n=61), with Latino immigrant youth, aged 6-18 years, living in Langley Park, Maryland. Participants were stratified into focus groups by age group (elementary, middle, and high school) and language preference (Spanish and English). A professional, bilingual-speaking moderator used a semistructured discussion guide to examine: (1) what youth preferred to drink in different settings and why, (2) their reactions to promotional messages, (3) slogans that would entice them to drink more water in school and at home, and (4) concept testing. The design and analyses were grounded on the social environmental framework to understand how various environments shape drink preferences. The sessions were audio-recorded, transcribed verbatim and translated into English. Two independent coders analyzed the data using an inductive approach to categorize texts according to recurring themes, concepts, and terms. Data were analyzed separately for each age group and language preference. After inter-rater agreement was achieved, final codes and sub-codes were defined in a coding dictionary. All transcribed discussions were entered into the software Atlas.ti and coded using the developed coding dictionary. Results: Beverage behaviors and preferences depended on (a) availability of water and other drinks, (b) perceived health benefits, (c) level of thirst, and (d) perceptions of taste and safety. There were no major differences in recurrent themes across age groups. Availability: Youth described that they preferred to drink bottled water at home, since this was what their parents made available to them. At school, however, most youth preferred chocolate milk, which is what was most available to them at lunch time. Youth described that they would not drink fountain water because it did not taste good, and that other forms of water were not available in the cafeteria. Older youth reported that water was often unavailable in vending machines at school. Perceived health benefits: Youth preferred to drink water to be attractive and to have energy. Concepts emerged around topics related to water makes you run, and athletes that drink water. Reactions to promotional messages that use celebrities were positive, but they did remark that some Latino celebrities endorse soda. Level of thirst: When really thirsty, youth preferred to drink water and only water to quench their thirst. They also recounted preferring water when it is hot outside. Promotional materials with these concepts received positive reactions. Taste and safety of tap water: Tap water was considered unsafe and distasteful both at home and at school. Having both English and Spanish represented in branding and slogans was considered important. Promotional materials were considered appealing if they were visually interesting, included a celebrity or an athlete, and were informative about water. Conclusions: A bilingual school- and home-based water promotion intervention that highlights (a) the health benefits of drinking water, (b) the power of water to quench true thirst, and (c) the safety, taste and benefits of drinking tap water is a promising strategy to target some of the barriers around drinking water behaviors among Latino immigrant youth