Improving Student Access to Tap Water for

Improving Student Access to
Tap Water for Better Health
Results, Lessons Learned and Recommendations
From a David Douglas School District Pilot Project
MAY 2012
Dr. Tia Henderson, Upstream Public Health
Stephanie Manfre, David Douglas School District
Oregon’s children need better access to filtered tap water to
promote health where they learn, eat and play. Upstream
Public Health, a non-profit organization, is dedicated to
creating the social and environmental conditions where all
Oregonians can thrive. David Douglas School District, home to
the largest high school in the state, prioritized improving
water access for its students through policy and program
initiatives. In collaboration with David Douglas School District,
with funding from Multnomah County, Upstream Public Health
set out to support the District’s policy efforts by providing
filtered tap water to students. The partnership successfully
piloted a project with multiple elements including water
stations, a poster contest, nutrition education and water
bottles. This document summarizes the lessons learned in
implementing the pilot project in order to help other school
districts learn from the experience.
JUNE 2012
Improving Student Access to Tap Water for Better Health
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Table of Contents
Acknowledgements
iii
EXECUTIVE SUMMARY
iv
Background
Water and Health: Why Access is Important for Children
Water Stations
Policy and School Water Access
Addressing Health Disparities
1
1
2
2
2
Approach
Increasing Student Water Access: School Selection for Water Stations
Water Station Selection
Water Station Locations and Installation
Evaluating Water Station Use
Encouraging Student Water Consumption
Student Media and Promotion Program
Providing Free Water Bottles to Students
Water and Beverage Related Education
School Water Policy
Evaluating Consumption
3
3
4
6
6
7
7
7
7
8
8
Project Challenges and Lessons Learned
Water Station Siting and Installation
Water Filter and Equipment Issues
Water Consumption
10
10
10
11
Conclusions
12
References
12
Appendix 1 - Survey
Appendix 2 - Permission Slip
Appendix 3 - Poster Contest Info
Appendix 4 - Poster Contest Entry Form
i
iv
vi
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Acknowledgements
Project Staff:
Dr. Tia Henderson, Research Manager, Upstream Public Health
Stephanie Manfre, Healthy Active Schools Coordinator, David Douglas School District
Project Supported By:
Teachers
Rachel Wagner, Andrew Locke, Steve Benner, Angela Nurre
Principals and Administrators
John Bier, Mark Gaulke, James Johnston, Charlene Bassine, Mark Haner
Project Advisors
Raquel Bournhonesque, Upstream Public Health
Barbara Kienle, David Douglas School District
David Callaway, David Douglas School District
Frank Bruno, David Douglas School District
Funding
Upstream Public Health, a community-based public health organization, worked with the David
Douglas School District on this project. Upstream received a grant through the Healthy People
Healthy Places Grant, part of Multnomah County’s Health Department’s comprehensive approach
to obesity prevention funded through the Centers for Disease Control and Prevention’s (CDC)
Communities Putting Prevention to Work (CPPW) Program. The David Douglas School District
received a Healthy Active Schools (HAS) grant through the same Multnomah County program.
Donations
CamelBak, Elkay and the Oaks Amusement Skating Park
For questions, contact:
Dr. Tia Henderson, [email protected]
Barbara Kienle, [email protected]
Floyd Light Middle School - Poster
Contest, Runner-Up
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Executive Summary
Policy efforts to address the childhood obesity epidemic are more effective with on-the-ground
support. Upstream Public Health partnered with the David Douglas School District (DDSD) to
increase children’s access to, and consumption of, free filtered tap water during the 2011 and
2012 school years. While the focus of the pilot project activities were centered on three schools,
David Douglas High School, Floyd Light Middle School and Alice Ott Middle School, this project
benefitted eight total schools. The pilot components included 1) upgrading old water fountains
with new water stations (see picture on page two), 2) conducting a water education and
promotion campaign with a student art contest, 3) providing free water bottles in three schools, 4)
gathering water volume monitoring data on water station use (pre and post), and 5) conducting a
pre and post beverage consumption recall survey in the three schools to evaluate student water
and other beverage intake changes. Health teachers at each school also taught nutrition units
during the project’s implementation phase.
The project was successful in increasing student access to, and consumption of, water. While this
pilot project only studied three schools, through collaboration and funding from two grants, the
project installed twelve water stations in eight schools, and dispersed 4,940 BPA-free water
bottles to students. Needless to say, the water stations and bottles were a big hit with students,
teachers, staff and administrators alike. The water volume data results showed that all schools
increased their use of the new water stations
over the project period. While the recall survey
showed an increase in student water
consumption for some groups, it was not
across the board. Latino and White high school
students reported drinking significantly more
water three months after the beginning of the
project. White high school survey participants
reported drinking significantly fewer sugary
drinks at the end of the project. Middle school
survey participants did not report significant
changes in water or sugary drink consumption
after one month of implementing the project
elements.
The project encountered technical and
logistical challenges including: space
restrictions, old asbestos in walls, and problems with water station filters clogging from pipe
sediment. Project collaborators modified initial decisions to upgrade fountains only in cafeterias
and gymnasiums to a decision of being as close as possible to these locations to address space
issues and have electrical access. Asbestos was safely removed following required protocols. The
partners worked with various filter types and the manufacturer of the water station to arrive at a
working set of filter options. There were concerns about students carrying opaque reusable water
bottles, but school principals responded with a suggestion to use clear bottles. The DDSD school
board also addressed concerns about water access and updated its wellness policy’s
administrative rules to promote student water consumption. The policy now permits students
carrying reusable water bottles at school and providing access to free water at all district facilities.
All of the initial technical and logistical challenges were overcome.
This project was supported by a Healthy People Healthy Places grant from Multnomah County to
Upstream Public Health and a Healthy Active School (HAS) grant to the David Douglas School
District. Both grants were from the Centers for Disease Control and Prevention’s (CDC)
Communities Putting Prevention to Work (CPPW) Program.
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Background
In the spring of 2010, the David Douglas School
District (the district) received a Healthy Active
Schools (HAS) program grant from Multnomah
County. The HAS program worked in partnership
with schools, community members and SUN
Community Schools in Multnomah County to
create policy, environmental and system changes
to support healthy eating and physical activity for
students. During an initial assessment of district
schools and facilities related to HAS grant
objectives, district staff brought up water access
and availability frequently as a challenge.
Because of the age of many district buildings, old
pipes contributed to poor tasting water and
many fountains were aged, some beyond repair.
Most principals wanted increased water access as
a priority goal related to the Healthy Active
Schools grant. In the fall of 2010, the district
began developing wellness policy language and
selected a Multnomah County Health
Department’s Healthy Active Schools Action Plan
objective, “policies and practices that increases
and promotes the availability of drinking water
for students,” as part of their policy efforts. The
district HAS coordinator, Stephanie Manfre,
began engaging school communities to assess
water access sites and needs.
During this time, Upstream Public Health, an
Oregon non-profit that advocates for health
policy, was working to promote student tap
water consumption instead of sugary drinks in
schools to reduce student excess calorie intake
as part of environmental efforts to address
obesity. The district and Upstream formed a
partnership (the partners) to increase student
access to better tasting, filtered tap water
through installing water stations. Additionally,
Upstream worked to support the district’s
development of a related to water access to
incorporate into their wellness policy. The goals
of this project were to:
1. Increase student and school water access,
2. Increase student water consumption,
3. Increase district-wide support for adopting
wellness policy language centered on
increasing water access, and
4. Develop a best practices document
regarding water station installation linked
to wellness policies.
Upstream applied for a Healthy People Healthy
Places Grants mini-grant from Multnomah
County to support the district in reaching their
water access goals. The project included
evaluation elements to ensure the different goals
were met, covered later in this report. This
document on lessons learned is intended to be a
tool used for Oregon school districts to extend
water access for other student communities.
Water and Health: Why Access is
Important for Children
In 2010, Section 203 of the federal Healthy
Hunger Free Kids Act required that all schools
participating in the national school lunch
program provide children access to free, potable
water during meal times. This policy is part of a
national trend to turn the tide on the obesity
epidemic affecting children. Childhood obesity
rates have more than tripled in the last thirty
years1,2. Currently one in three children and
adolescents in the U.S. are overweight or obese3.
In the Tri-county region, including Multnomah
County, nearly one out of every four youth in 8th
and 11th grade are overweight or at risk of being
overweight4. Obesity is a serious problem
affecting youth because these individuals are
more likely to develop obesity-related chronic
health issues as adults1,5. Obesity is one of the
leading causes of preventable death in the U.S.6.
Obesity is also a health equity issue. Children
from communities of color may be more at risk of
being obese, as African American, Latino and
Native American adults experience a higher
prevalence of obesity7. Obesity has a public cost
as well as an individual one. The estimated
medical costs related to adult obesity in Oregon
were estimated as $781 million per year in 2004
and are most likely well over $1 billion today8.
Promoting the consumption of healthy foods and
beverages, such as water, is included in
recommended strategies to combat obesity9.
Recent studies indicate that student intake of
sugary drinks such as soda contributes to weight
gain10–13. Adolescents ages 12 to 19 are the
largest consumer of sugary beverages, drinking
an average of 220 kilocalories a day 14 .
Encouraging students to drink water in place of
sugary drinks can reduce the potential for child
weight gain15.
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Consumption of soda is also a leading
contributor to dental decay16–18. Low-income
children, Black/African American, non-Hispanic
and Hispanic children have more than twice the
rates of untreated dental decay compared to
their White, non-Hispanic peers 19 . Dental
problems are one of the leading causes of school
absenteeism in the U.S., more common than
asthma or hayfever20. Water consumption can
also reduce child dental decay when children
choose it over sugary drinks21–23.
Beyond the obesity challenge and dental decay,
all people need water to promote health. Water
supplies every cell in our bodies with oxygen to
thrive. Water clears out colds and other illnesses
through lymph fluid, carries enzymes to digest
food in the stomach and flushes toxins out of the
body. Dehydration affects cognitive ability,
physical performance and motor skills 24,25 .
Dehydration can reduce mental performance and
has most recently been tied to feeling cranky26,27.
Children need filtered water to support their
health for learning in school.
Water Stations
In this project, the
partners chose to
replace outdated
water fountains with
water stations. A
water
station
combines a chilled,
filtered water source
with a water fountain
and up to three water
bottle filler spouts.
Figure 1 shows the
type used in this
project. This design
increases the number
of physical water
access sites youth can
use to quickly obtain
adequate servings of
Figure 1: Water station
water. This design
improves water access
in two ways. In
addition to getting a drink from the bubbler
fountain, youth can also fill a water bottle and
keep water with them throughout the day.
Policy and School Water Access
Federal, state and local laws intersect in relation
to water access requirements in public schools.
Chapter 29 of the Oregon Structural Specialty
Code Section 2903 requires that schools have
one drinking fountain for each floor, regardless
of school population. Oregon schools, especially
larger facilities, may lack adequate water access
for students. Prior to this project, the David
Douglas School District wellness policy did not
contain language related to water access. Under
the federal 2010 Healthy Foods for Healthy Kids
Act, schools are required to provide access to
water during meals times. The 2004 federal Child
and Nutrition and WIC Reauthorization Act
required all school districts participating in
federal meal programs establish a local wellness
policy by the 2006 school year. These wellness
policies address water access in school.
Addressing Health Disparities
The goals of this project were implemented in
order to address health disparities and support
health equity. The David Douglas School District
is in an area of Multnomah County, Oregon (see
Figure 2) where populations carry a
disproportionate burden of poverty and health
issues and communities have historically felt
exclusion from accessing resources. The number
of people in mid Multnomah County who meet
federal poverty guidelines increased by 53
percent from 2000 to 200828. More than 70
percent of students at each school site are
eligible for free and reduced lunches (see Table
2). Nearly one quarter of the student population
in the district are limited English proficient and
more than half are people of color (see Tables 1
and 2). Additionally, 74.1 percent of District
students in 2010-2011 were eligible for free and
Figure 2: Multnomah County, OR
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Table 2. 2011-2012 School demographic
information29,30
Table 1. 2011 - 2012 DDSD demographics29,30
David Douglas District
SCHOOL
Children
FRL
Student
of Color Eligible Enrollment
Total student enrollment
10,642
Total children of color
54.5%
David
Douglas H.S.
53.5%
70.2%
3,219
District Limited English Proficient
23.7%
Alice Ott M.S.
45.3%
73.6%
739
Floyd Light
M.S.
54.4%
78.9%
824
60.2%
86.9%
842
31.4%
44.2%
156
53.7%
80.1%
447
62.8%
82.2%
411
54.2%
79.9%
603
42.9%
69.4%
641
64.3%
88.5%
641
55.6%
77.8%
491
63.7%
91.1%
586
56.5%
84.8%
547
54.8%
89.3%
458
reduced meals and the district has the largest
high school in the state29.
The partners wanted to ensure more vulnerable
students from low-income families or
communities of color could have greater access
to good tasting, filtered tap water and increase
their water intake along with their peers. This
was part of the project goal of increasing student
water consumption. Based on this goal, the
partners selected schools with high populations
of children from diverse backgrounds. The
impacted student community includes over 4700
students at three schools: David Douglas High
School (DDHS), Alice Ott Middle School (AOMS)
and Floyd Light Middle School (FLMS) (see Table
2). A fourth school, Ron Russell Middle School
(RRMS) was compared to the participating
middle schools for evaluation purposes.
Each water station was located in an accessible
location to ensure that all students, regardless of
race, ethnicity or income, would have access to
filtered water at each school. The third goal of
developing a district policy related to water
access also helped meet a longer-term equity
goal of expanding water access to all schools
across the district.
Approach
Increasing student water access:
School Selection for Water
Stations
The David Douglas School District had
established in previous water testing that school
water was safe to drink and posed no health risks
from contaminants. Although safe, feedback
from students and school staff indicated that
water from most fountains had a metallic taste.
The district and Upstream selected three schools
Ron Russell
M.S.
Arthur
Academy
Cherry Park
Elem
Earl Boyles
Elem
Gilbert
Heights Elem
Gilbert Park
Elem
Lincoln Park
Elem
Menlo Park
Elem
Mill Park Elem
Ventura Park
Elem
West
Powellhurst
Elem
to receive new water stations with the pilot
project’s grant funds using the following criteria:
1) School had reported lack of good
tasting water access.
2) S c h o o l s e r v e d l a r g e r s t u d e n t
populations.
3) School had higher numbers of
students eligible for free and reduced
meals.
4) School had older buildings with
fountains that needed to be updated.
5) School had administrative support for
the other components of the project.
Based on the criteria, the partners decided to
use funds from both grants to install new
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hydration stations with cold, filtered water at
eight schools: Alice Ott Middle School, Floyd
Light Middle School, Ron Russell Middle School,
David Douglas High School, West Powellhurst
Elementary, Menlo Park Elementary, Ventura
Park Elementary, and Cherry Park Elementary.
Overall, through the collaboration and funding
from two grants, twelve Elkay water stations
were installed.
In addition to the water stations, the district’s
HAS grant also supported purchasing water
containers and reusable plastic cups for all ten
elementary school cafeterias, along with the Fir
Ridge Campus, an alternative high school.
Another HAS coordinator at a neighboring
district had made similar purchases for schools
and was able to share lessons learned.
Prompted by the new federal School Lunch
Program (SLP) requirement that all students have
access to water during meal times, and given the
fact that not all district schools had water
fountains located within cafeterias (or if they did,
the fountains were old and students did not have
day-long access), the purchase of water
containers allowed for all students to have access
to fresh water in the cafeteria during the school
day. Each cafeteria was provided with a rolling
cart, refillable water containers that could be
stored in the kitchen or in walk-in refrigerators to
keep water cool, and 100 washable plastic cups.
Water Station Selection
The project team considered three potential
types of water stations for this project (see
Figure 3). Project partners wanted the stations to
be compliant with the American Disabilities Act
to ensure all students could have access.
Affordability was also a factor in deciding on
which station to use. The concept of affordability
included the initial price of the unit, price of
replacement filters, price to hire any out of
district contractors, costs of new infrastructure
changes and the cost of installation in labor and
other parts. The David Douglas School District
has an electrician and a plumber that can
complete installation, but all new sewage drains
have to be permitted through the City of
Portland. This permitting can involve time delays
and require out of district contractors, which
might cost more than in-district staff. The district
wanted to limit additional costs where possible.
Figure 3: Water station options in this project
All fourteen schools in the David Douglas School
District have water fountains in a hallway or
classroom and seven have them in a cafeteria.
The quality and age of the water fountains varies.
There are 43 water fountains in the high school
campus including north and
south buildings, the performing
arts center and the district
offices. Alice Ott Middle School
has six fountains. Floyd Light
Middle School has nine
fountains. Ron Russell has seven
fountains. The water fountains
in all schools range in type from
old-style ceramic bubblers
without filtration or cooling
units to modern steel bubblers
(see Figure 4). Prior to this
project, none had water bottle
fill options and few were filtered
and chilled. The discussion built
on previous district efforts
examining water quality at
different school sites and
making upgrades, such as
Figure 4: Older water
installing water filters or chiller
fountains in David
units in other buildings.
Douglas School District
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The district operations partners wanted to be
able to retrofit or replace existing water
fountains rather than install new plumbing in new
locations on school campuses to use resources
efficiently. Another factor contributing to ongoing maintenance costs is if water station units
or components that could be easily tampered
with, and if so, could be easily replaced for low
cost. Upstream partners wanted a design that
would provide both a water fountain and a water
Criteria
ADA compliant?
bottle filler option so that students could carry
water with them and reduce waiting time in lines.
Each of the three water stations were reviewed
based on these and other criteria presented in
Table 3. The project partners chose the Elkay EZ
H2O unit, as it fit the best with project goals.
Table 3 Water station selection and criteria
Elkay EZ H2O Bottle
Filling Station
Brita Hydration
2000
Multi-Faucet or water fill
w/ Single Sink
✓
✓
Would need to install foam padding
beneath sink and put chiller in
cabinet
Requires
additional
plumbing or a
drain?
no
no
Each separate sink requires its own
drain; this requires permits from the
city; any city permitted process
requires hiring a non-district
contractor (higher costs)
Requires
electricity?
✓
✓
✓
Has filtration unit
w/reasonable
gallon capacity?
✓
(1.1 gal/minute
chilled; change every
3000 gals)
✓
✓
Has chiller unit w/
reasonable
gallon capacity?
✓
✓
2 gallons/minute
Are the parts
likely to be
vandalized?
Similar to existing
fountains
Plastic housing in
wall
Are breakable
parts easy to
replace?
Similar to existing
Spigots – could be a
challenge
Yes, but may be frequent
Water monitor?
Built in (12 oz
counter)
None
Add-on
Accessibility of
filter?
Under unit
Behind wall
Under unit
Approximate
Estimate Costs
Unit ~ $1040,
replacement filters
$100, installation and
materials $500 ~
$1640
Unit $2150, chiller
$945, replacement
filters $80,
installation $500 =~
$3675
$640 infrastructure, initial filter $150,
replacement filters $62, chilling unit
$700 (12 gallons/hour), labor $500=
~ $2052
Final choice
Selected this one
Price higher than we
could pay
Can’t install new drain – this is out
Narrow ¼” drain easy to clog;
plastic spigot lever can break off
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Water Station Locations and
Installation
Before being awarded the grant, the partners
identified a few potential sites near school
cafeterias and gymnasiums that would provide all
day access to children and potentially at meal
times or during physical activity before being
awarded the grant. After
Upstream received a grant, the
district plumber and electrician
completed extensive walkthroughs of various sites at
each of the three schools with
photos to help the partners
better understand the best
potential sites at each school.
The plumber and electrician
provided cost estimates for
replacing or retrofitting existing
water fountains with the new
water stations based on
supplies, materials and labor.
installed additional fountains at the DDHS; the
Alice Ott, Floyd Light and Ron Russell middle
schools, and the Cherry Park, Menlo Park,
Ventura Park, and West Powellhurst elementary
schools. In total, twelve water fountains were
installed in eight schools from the Upstream
Public Health and David Douglas School District
collaboration and two grants. Ron Russell
received a water fountain as a thank you for
participating as a comparison
control school in this project.
Measuring Water
Station Use
Water monitors measured large
increases in water use. The
partners installed HM Digital
water monitors in each water
line in existing water fountains
at FLMS, the DDHS, AOMS and
RRMS to record fountain water
use. The monitors remained
when the old fountains were
replaced with the water
stations. Upstream collected
water
volume
data
approximately every two weeks
for one month before and
several months after the water
stations were installed.
In conducting the walkthroughs and completing the
estimates, the partners
determined some of the
potential sites were unworkable
because they required opening
solid or brick walls, which would
be too costly. The final location
of each water station was based
The water readings were
on 1) proximity to high traffic
challenging to collect as the
areas with day-long access such
monitor sometimes stopped
as the cafeteria or the gym, 2)
working, batteries were taken
access to existing plumbing, Figure 5: Example locations of new
from the units and the water
drainage and electricity, and 3) water stations at FLMS and AOMS
station filters suffered technical
space to accommodate the
problems. Upstream did not
chiller unit without having to open solid walls.
include inaccurate monitor readings before
The grant project budget included funding for
conducting Wilcoxon Rank Sum tests on the data
repairs and a year’s worth of replacement water
at FLSM, AOMS and the HS. The water monitor
filters to help the district cover intermediate
results indicate the school populations at the
upkeep of the water stations.
high school and at FLMS used the new water
stations significantly more than the previous
The district staff installed water fountains at
water fountains (p< 0.01). At AOMS, the average
AOMS and FLMS in April of 2011 and one at
water usage from this fountain doubled after
DDHS in the summer of 2011 (see Figure 5). The
installation, but the difference was not
first DDHS fountain was located near the north
statistically significant, likely due to technical
cafeteria, the first AOMS fountain was in a
challenges with the monitor. The control school
hallway, and the FLMS fountain was near the
monitor readings did not show changes in water
front office that children pass on the way to the
fountain volume flow during the project.
cafeteria. Using the HAS grant, the district
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Student Perceptions
The water stations were a big hit with students,
teachers, staff and administrators alike. As one
high school student said, "there's a huge crowd
of students around every lunch who want to get
the clean, filtered water and not the zinc-y,
metal-y water." This project used multiple
strategies, all of which support student water
consumption. The project provided technical
assistance for policy development, installing
water stations, a water-bottle give-away and an
education campaign that included youth
developing media and water slogans that were
displayed above each new water station.
Student Media and Promotion
Program
During the spring of 2011,
Upstream Public Health
worked with principals,
teachers and staff at
AOMS, FLMS and DDSD
to hold a water poster
contest to generate and
promote youth-oriented
messages about health
and water consumption
(see Figure 6). Upstream
staff presented contest
forms and educational
materials to several
student classes and to
staff to encourage
participation (see
Appendices 1 and 2).
Figure 6: Winning entry from
Upstream staff, the
DDHS: “I got that H2O that
district HAS Coordinator
future flow”, FLMS: “Start with
and teachers judged the
tap”, and collage of entries
entries to select winners
and runners up. Upstream
received donations from
the Oaks Amusement Park Skating Rink and
purchased Jamba Juice gift cards for winners and
runners up. Students at AOMS and FLMS used
other entries to create large collages that they
hung in the cafeteria and hallways. Upstream
posted winning entries on banners above the
new water stations in spring and fall of 2011 (see
Figure 6).
Providing Free Water Bottles to
Students
Upstream ordered water bottles for AOMS and
FLMS from American Promotions. The company
was able to print a one-color designed version of
each winning student artwork on the bottles at
each school (see image Figure 7). Students,
administrators and teachers who worked on the
project received the new water bottles. The
bottles and water
stations were well
received. One viceprincipal remarked
“I was amazed how
many of our
s t u d e n t s
appreciated getting
the bottles and how
nice they were –
thanks again.”
Figure 7: Water bottles with winning art from DDHS and Floyd
Light MS (left, right).
Water and Beverage Related
Education
This project integrated promotion and health
education into environmental and policy change
elements because research indicates that adding
these elements significantly improves youth
water consumption through hydration stations31.
The water poster contest included educational
information and winning entries were also
supportive of water and health messages (see
Appendix 3). The poster contest and display of
winning entries corresponded with nutrition
curriculum in the schools. In the 2010-2011
school year, seventh grade health students
learned about water and health during the spring
of 2011 as part of the nutrition health curriculum.
In the fall of 2011, high school health students
learned about nutrition, obesity and the health
risks of soda consumption. One health teacher is
also the chair of the David Douglas High School
health department and thus had influence on
translating the program on the ground to other
faculty.
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School Water Policy
In August, 2011, the Healthy Active School
Coordinator Stephanie Manfre presented new
policy language based on best practices to the
school board. The school board made changes
to their administrative rules language related to
water and other wellness areas. Elements of the
new language that support water access are
italicized below:
The district recognizes that children
need an ongoing water supply to keep
their bodies functioning optimally and to
avoid dehydration. Therefore, the
district will promote the consumption of
water as an essential nutrient that plays
a role in overall health and will provide
all students and employees with access
to clean and safe drinking water free of
charge at all district facilities. Students
will be permitted to carry water bottles
while at school.
While not a defined policy, kids are generally not
allowed to have opaque water bottles at school.
We showed principals images of a transparent
and slightly tinted water bottle and many found
this acceptable. One principal preferred a
completely clear water bottle to ensure that
inside contents were easily identifiable.
Student Beverage Consumption
Changes
The project was successful in changing some
student’s water and soda consumption based on
survey responses. Upstream gave an adapted
version of beverage consumption questions from
the Oregon Youth Risk Behavior Survey (YRBS) to
a sample of health students at FLMS and DDHS
(see Appendix 1). Middle school students took
the pre surveys in early April and the follow up in
late May; high school students took the pre
survey in early October and the follow up in midDecember of 2011. Upstream added modified
YRBS format questions to better understand the
quantity of water students consumed. Ron
Russell Middle School agreed to administer the
pre and post survey to their students during the
same time period to help the evaluation as a
control school. Upstream provided the school
board with a description of the project, the
survey and a parent permission form to follow
best human subjects practices (see appendix 2).
Upstream performed Pearson chi-square or
Fisher’s exact tests on student survey response
"There's a huge crowd of students around
every lunch who want to get the clean,
filtered water and not the zinc-y, metal-y
water."
- high school student
data to see if there were any differences in
beverage consumption before and after the
intervention. Upstream used three categories of
beverage consumption frequency as outcome
variables: low (1-3 times in past 7 days), medium
(4-6 times in past 7 days), and high (at least once
a day). Middle school student responses did not
show a change in overall student water intake
among participants. Student responses showed
pre-existing differences in water consumption
between the schools. Survey participants at
Floyd Light were 1.9 times more likely to report
consuming water at least once a day compared
to their peers at Ron Russell M.S. both before
and after the project elements were in place.
There were no significant reported changes in
consumption of any beverage in the middle
school survey participants. This may be due to
the pre and post survey being spaced only one
month apart.
When all high school students were grouped
together, there were no significant changes in
student reported water consumption in the three
months between the pre and post surveys.
However, when we examined student reported
behaviors among different populations, Pearson
chi-square analysis found the number of Hispanic
and white high school students drinking at least
8 oz of water a day increased significantly (P<.05)
from pre to post survey. Other students did not
report a significant change in daily water
consumption including Asian/American Asian,
Black/African American, or Native Hawaiian and
Pacific Island adolescents. Strangely, the number
of American Indian/Alaskan Native students
reporting daily water consumption decreased
between the pre and post surveys; however this
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Improving Student Access to Tap Water for Better Health
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those who reported not drinking lowsugar flavored beverages in the past 7
days increased from 53% to 62%. The
number of Hispanic and white high
school students drinking any amount
of soda decreased significantly
(p<0.01).
The findings are most likely related to
the combination of messages students
received through the promotion
contest materials and existing nutrition
curriculum in health classes. Contest
participants used art to show linkages
between health and water
consumption. Many entries focused on
how water is related to obesity
through displacing sugary drink intake.
The increase in the number of high
school Hispanic/Latino and White
students reportedly drinking water
and less of them drinking soda is a
positive indication the project helped
increase water consumption while also
potentially lowering some student’s
intake of calories from soda. The
reduction of calories from soda is
related to weight gain, and the sugar
in soda is associated with diabetes and
dental decay – two pressing health
issues for children in Multnomah
County. Survey responses did not
show significant changes in the
number of African American/Black,
Native Hawaiian and Pacific Islander,
or Asian/American Asian students
changing daily water or soda intake .
Students with water bottles and poster
finding should be interpreted with caution as the
the sample size was very small (less than 20).
Overall, the number of high school students
reporting drinking any soda or at least one soda
a day, any or daily consumption of other
sweetened beverages, and any consumption of
low-sugar flavored drinks significantly decreased
after the project elements were in place (p<.001,
p,<.01, p<.001; p<.02, p<.01 respectively). The
share of high school students who reportedly did
not drink soda in the past 7 days increased from
25% to almost 39% at follow up; those who
reported not drinking sweetened beverages in
the past 7 days increased from 47% to 61%; and
There are other factors beyond this
pilot project that can affect student reported
intake of beverages such as household income
and access to healthy options. While we could
not look at all factors, Upstream used multiple
logistic regression models to examine how
student race, time, and container size were
associated with the frequency of student intake
of four drinks. After controlling for potentially
confounding variables, Hispanic/Latino and
African American students had a lower odds of
drinking water every day (OR 0.86 not sig., 0.49
p<0.01, respectively). Although not significant,
Asian/American Asian, Native Hawaiian and
Pacific Islander and American Indian/Alaskan
Native had a higher odds of drinking water every
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Improving Student Access to Tap Water for Better Health
______________________________________________________________________________
day (OR 1.03 - 1.10). Students drinking soda
every day was not strongly related to time (OR
0.41, P<0.01). Time was associated with the
potential for students to report drinking water
every day (OR 1.27, p,0.12) although it was not
significant. Students drinking soda from a 20oz
container had a greater odds of drinking soda
every day (OR 2.41, p<0.01) than if they did not
use this larger portion size. This is important
because if students could reduce their intake of
by 110-165 calories a day it can help them stay at
a healthy weight or lose pounds (based on a
3,500 calorie diet leading to one pound of
weight a day)32,33. Students drinking caffeinated
drinks or low sugar flavored drinks every day had
a greater odds (OR 3.30, 3.72 p<.01 respectively)
of drinking soda every day than if not consuming
those drinks.
Project Challenges and
Lessons Learned
This project would not have been feasible
without collaboration among school
administration and school district departments.
The district Student Services Director, the
Operations Manager, and the Healthy Active
Schools Program Coordinator thought this
project would help build support for the district
wellness policy development process. During the
water access project, the open communication
among the district plumber, electrician,
Operations Manager, the HAS Coordinator,
school principals, and Upstream staff ensured the
project could address challenges as they came
up. These individuals worked to make decisions
based on feedback from school and district
administrators.
Water Station Siting and
Installation
The partners recommend that schools involve
principals and maintenance staff early on when
developing plumbing, electrical and other cost
estimates prior to applying for grants to fund
water station installation projects such as this
one. An initial challenge the partners faced was
finding sites with all day access that met other
criteria such as existing electricity, plumbing,
drainage, space for a chiller unit and non-solid
walls. The partners chose to upgrade existing
water fountains so no walls would have to be
opened or new plumbing and drainage installed.
This helped keep additional installation costs
down, however, it also limited new station
locations.
We created initial estimates based on input from
maintenance before applying for the grant and
had to revise these significantly based on
perspectives from school principals. Two of the
locations we were considering turned out to be
unfeasible due to infrastructure. We then had to
select new sites and create new cost estimates
two months into the project. If applying for grant
funds, we recommend working through the
station siting criteria and getting agreement from
district facility staff and school principals before
establishing the budget. The partners checked in
with each school principal about potential water
station sites before finalizing location of water
station decisions. These conversations helped
ensure the partners were locating each station in
a spot that fit with school needs and all day
access. This was a successful method and one
others should use in the future.
It is also beneficial if districts and schools work
with in-house specialists as much as feasible for
scoping each location, installation and
replacement of filters or other broken parts.
When the project encountered challenges, being
able to work consistently with the same people
helped each person build their knowledge base
and fostered creative problem solving.
The project was affected by school timelines and
workload of operations staff. Timelines for
installation need to take into account doing
major work on days and at times when children
would not be exposed to noise and dust (i.e. a
hallway outside a cafeteria). During installation,
our plumber had to remove asbestos. While this
is common for old buildings, it is something to
keep in mind in terms of safety and disposal.
Water Filter and Equipment
Issues
The project encountered challenges with water
fountain operation. The filters in the units
clogged up earlier than expected or as
advertised. This resulted in slower water flow and
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Improving Student Access to Tap Water for Better Health
______________________________________________________________________________
longer student lines to use the fountains.
Principals were frustrated with this until the
problem was solved. Through trial and error,
repeated problem-solving discussions and
listening to partner concerns, the grant partners
found viable solutions to each of these
challenges.
We learned that the Elkay units had sensitive
filters that were clogged from common, harmless
sediment in our public water sources. Old
plumbing in buildings and city pipes as well as
particulate from the Bull Run Watershed
contributed to this challenge. We learned that
other school districts installed sediment filters
with each Elkay unit. Sediment filters are installed
outside of the Elkay unit so that water travels
from the main plumbing system, through the
new filter, into the Elkay unit. School district staff
worked with Upstream Public Health to try
several filter options in combination with the
existing internal Elkay filter including a sediment
sieve, a sediment filter, a separate “pre-filter”,
and replacing the original filter with a new Elkay
prototype filter. Two of these filtration options
worked well: 1) the use of an external presediment filter in addition to the internal original
Elkay filter and 2) substitution of the original
Elkay filter with a new prototype from the
manufacturer. The use of a pre-sediment filter
with the internal Elkay filter was considered a
secondary option because of the additional
infrastructure maintenance (it was housed in a
locked wooden box mounted to the wall beneath
each unit), added time, and additional cost to
change an external filter at a different time than
the internal Elkay filter. The external unit used
wooden housing and piping subject to student
vandalism (e.g. being kicked) that could result in
additional repair.
In an act of support, the Elkay manufacturer
donated all existing prototype filters to David
Douglas and Portland Public School Districts. The
manufacturer only had twenty left for limited
testing, and all were distributed to two local
school districts, including David Douglas. The
district plans to use these prototype filters on
units that structurally cannot accommodate the
secondary pre-filter option (e.g. because of a
brick wall exterior or lack of space beneath the
unit). This grant provided funds to supply original
Elkay filters and pre-filters for those models that
will continue to use this secondary method for at
least one year after the grant ends. When the
original Elkay filters run out, the district will
switch to purchasing the new prototype filter.
The new version is approximately the same price
as the original filter.
Another unexpected technical challenge is the
need for a snubber to accompany the water
stations. The snubber keeps the ground fault
interrupter from tripping. Without this part
installed, the solenoid valves in the fountain and
the bottle filler tend to trip the breaker on the
outlet. It is not hard to install on site, but if one
does not know about it at the onset, it can lead
to thinking that there is either a problem with the
unit or the outlet. Elkay sent the snubbers at our
request, we recommend asking for these if they
are not included in the purchase of a unit.
One middle school has wood floors under the
existing water fountain. The principal was
concerned that two water sources at the same
location (instead of the original bubbler) would
increase the likelihood of spills and water
damage. At the middle school with a wood floor
in the cafeteria, operations staff keep a “caution
wet floor” sign up in front of the water fountain
at all times and a towel on the ground to absorb
any spills. Even with the challenges faced by the
installation of the water stations, they proved to
be a tremendous success and very popular with
students and staff alike.
Winning entry from AOMS
Water Consumption
The main challenge related to water
consumption in this project was the need for
clear water bottles. School principals were
concerned about the potential for students to
bring in unsanctioned beverages on campuses.
Schools in this project sell water in clear bottles
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Improving Student Access to Tap Water for Better Health
______________________________________________________________________________
through vending machines. Providing clear water
bottles for regular use was a method to address
principals’ concerns while also giving students
more options for accessing water during the day.
Based on results from the water consumption
survey, installing water stations and providing
students with water bottles can encourage more
students to drink water. The promotion program
was limited to messages linking health, water
and obesity. Other projects building on this work
would benefit from tailoring project elements to
the unique needs, interests and concerns of
specific at-risk youth such as Black/African
American or Asian and Pacific Islander students.
In the HAS grant project, the new water
containers led to a few water spills and
unintended student movement during lunchtime
at the elementary school level. The Healthy
Active Schools Coordinator was able to work
with both Nutrition Services and school staff to
address these challenges. In addition to being
available during lunch, the water containers and
cups were also made available at dinner
provided by SUN after school programs at
several schools. Students created colorful
signage and hung them above the water carts to
promote the water opportunity.
Conclusions
This relatively short project successfully helped
expand access to chilled, filtered tap water at
three schools serving high need students in the
David Douglas School District. These simple
elements - water fountains, water bottles and
policy supporting water access - can help more
students drink water for health. This project was
successful in encouraging more students to drink
water and had the second unexpected benefit of
helping students drink less soda. This secondary
benefit was likely due to the nutrition curriculum
taught in health classes.
The involvement of the operations staff, invested
school and district administrators, participation
of the HAS coordinator, and support from health
and leadership teachers at each school, was
instrumental for ensuring each project element
was in place. This project could not have been
realized without support from district operations
and administrative staff including Stephanie
Manfre and Barbara Kienle’s support at the
administrative level. Frank Bruno and David
Callaway were critical for problem solving and
siting the water stations. Principals John Bier,
James Johnston, and Mark Gaulke helped with
water station siting and operations issues; and
Elkay manufacturing was willing to help us
address the Elkay filtration problem.
The David Douglas School District understands
that many of its students are at risk for obesity
and other chronic diseases and potentially lack
adequate resources for achieving a healthy
lifestyle. Through the participation in the Healthy
Active Schools grant, the district has shown a
commitment to increasing supports and access
to healthy options, including access to filtered,
chilled tap water. In addition to the Healthy
Active Schools partnership, the district has
Multnomah Schools Uniting Neighborhoods
(SUN) Programs at nine of fourteen schools,
including the two selected middle schools, and
David Douglas High School, which provide
before and after school, summer, and evening
programs including academic support, sports
and extra curricular activities, family engagement
and health and social services for students and
their families. Additionally, a Multnomah County
Health Department School Based Health Center
is located at David Douglas High School to
provide health services to its students.
_______________________________
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Appendices
Appendix 1 – Survey
Appendix 2 – Permission Slip
Appendix 3 – Poster Contest Info
Appendix 4 – Poster Contest Entry Form
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