Factors influencing water intake at school among youth in King County, Washington: a qualitative study based on the social ecological model

Thesis (Master's)--University of Washington, 2015-12Introduction: Sufficient water intake is essential for health, cognitive function, and school performance among youth. Approximately three in four children do not drink enough water during the school day leading to inadequate hydration status. Although research on youth water intake in school indicates that beverage choice may be influenced by school infrastructure, water quality, and policy, there is a lack of comprehensive multilevel research about the influences on youth water consumption at school. Methods: This secondary qualitative study was based on the social ecological framework. Focus groups were conducted with youth aged 14-19 years at 10 high schools in King County, WA. Schools were selected based on percent free and reduced priced meal eligibility. Focus group transcripts were coded using Atlas.ti and analyzed using phenomenological qualitative methodologies to determine common themes. Results: Perceived barriers to drinking water include overall quality of water from fountains, access to water fountains, and cost of water bottles. Facilitators of drinking water included water bottle filling stations on campus, water coolers in classrooms or cafeterias, and bringing water from home. Availability of other beverages around school, in coffee shops, convenience stores, and supermarkets also influenced beverage consumption, especially when schools had an open campus lunch policy. Conclusion: This study highlights perceptions about the adequacy of school drinking water, and suggests that availability of and access to high quality and affordable drinking water may be inadequate. Because school and community infrastructure and policies influence beverage choice among adolescents, collaborative, multilevel policies and interventions are needed to promote water intake, access, quality, and affordability in schools