Introduction Improving children’s tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. Methods The “Hydrate Philly” intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling “hydration stations”, conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n=28 centers) of the intervention’s impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6–12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. Discussion Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study.
What is already known about this topic?Interventions in schools to install bottle-filling water fountains, called hydration stations, have yielded substantial increases in students' water consumption but mixed results for changing sugar-sweetened beverage intake.What is added by this report?Recreation centers in Philadelphia with summer camp programs were randomly assigned to have a hydration station installed with the goal of increasing water intake and decreasing sugar-sweetened beverage consumption. Centers' water use levels at fountains doubled, but no changes were observed in counts of sugar-sweetened beverage youth brought to camp.What are the implications for public health practice?Hydration stations may be a cost-effective strategy to increase water consumption in community recreation centers, but additional targeted strategies are needed to reduce sugar-sweetened beverage consumption. Abstract IntroductionPrevious interventions to increase water access and consumption have focused on school settings, have shown mixed results on sugar-sweetened beverage (SSB) consumption, and have rarely addressed tap water safety. Our randomized controlled trial examined how improving access and appeal of water in recreation centers in low-income neighborhoods affected counts of SSBs carried by youth attending summer camp. MethodsRecreation centers (N = 28) matched on their characteristics were randomly assigned to control or intervention groups. Intervention centers received a new water fountain with a bottle filler (hydration station), water testing services, reusable water bottles, and water promotion and education training and materials. Primary outcomes were 1-year changes in center-level average daily gallons of water from fountains and hydration stations (flowmeter readings). Secondary outcomes were counts of SSBs observed, use of bottled water and reusable water bottles, staff SSB consumption, and hydration station maintenance. ResultsResults showed increased water use (b = 8.6, 95% CI, 4.2-13.0) and reusable bottle counts (b = 10.2, 95% CI, 4.2-16.1) in intervention centers compared with control centers. No change occurred in youth carrying SSBs at camp, but center staff's past 30day SSB consumption frequency decreased (b = −34.8, 95% CI, −67.7 to −1.9). Intervention sites had marginally lower odds of maintenance problems (OR = 0.09; 95% CI, 0.004-0.76, P = .06) than control sites. ConclusionAlthough providing hydration stations along with water testing, reusable water bottles, education, and promotion increased water consumption among youth at recreation centers, it had no effect on the number of SSBs observed during camp. Future strategies to increase water consumption should also address reducing SSB intake. childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004;328(7450):1237. 9. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84(2):274-88. 10. Ebbeling CB, Feldman HA, Osganian SK...
Indoor tanning is a risk factor for melanoma among young white women. Health communications can be an effective way of reaching this population and promoting behavior change. The purpose of this study was (i) to investigate the associations between intention to quit indoor tanning and attitudes, normative pressure, and efficacy about quitting, and (ii) to identify beliefs about quitting indoor tanning that can be used to design effective health communication messages to reduce skin cancer risk. A national online survey was conducted with 279 non-Hispanic white women ages 18-25 in the USA who are indoor tanners. The survey, based on the reasoned action approach, assessed intention, attitudes, norms, and efficacy and their corresponding underlying beliefs related to quitting indoor tanning, along with other known covariates. Data were collected in November/December 2015. Intention to quit indoor tanning was significantly associated with attitudes, specifically with the beliefs that it would "reduce damage to skin" (increased intention) and "make me less happy" (decreased intention). While self-efficacy was not related to intention to quit indoor tanning, injunctive normative beliefs were with key referent groups including mothers, friends, and romantic partners. Messages aimed at discouraging indoor tanning among young, non-Hispanic, white women should highlight the salient belief that quitting indoor tanning will reduce skin damage, counter the belief that it will make them less happy, and highlight key people who would approve of them quitting indoor tanning.
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