Improving Drinking Water Access in School and Community: Barriers, - - PowerPoint PPT Presentation

Improving Drinking Water Access in School and Community: Barriers, Facilitators and Next Steps

10th Biennial Childhood Obesity Conference Beyond Obesity: Tackling Root Causes

Anaheim, July 15-18, 2019

Angie Cradock, Christina Hecht, Anisha Patel, Roberto Vargas

Moderated by Jake Ferreira

Introductions

Speakers

• Dr. Christina Hecht
• Dr. Angie Cradock
• Mr. Roberto Vargas
• Dr. Anisha Patel

Moderator

Jake Ferreira

Objectives

During this presentation, we will discuss…

• Why drinking water safety and access is relevant to childhood obesity and

chronic disease prevention;

• The importance of providing safe drinking water in schools;
• The concern around negative perceptions about tap water quality;
• Drinking water contamination; and
• The types of contributions stakeholders can leverage to reduce disparities in

safe drinking water access and consumption.

Drinking Water: The Issues

Christina Hecht, PhD Nutrition Policy Institute, University of California

Enabling healthy beverage choices

Posters: LA County DPH; Alaska DHSS

Sugary Drinks

Added sugars: Largest single source Calories: Among the top sources Nutrition: Virtually none Satiety: Little compensation American Heart Association daily sugar recommendations: Children - 6 tsp Women - 6 tsp Men - 9 tsp

= 17 tsp

Sources: Reedy 2010; Mattes 2006; American Heart Association; Coca-Cola label

46 37.6 55.4 40.4 17.5 30.4 8.8 21.5 10 20 30 40 50 60

Wh White Bla lack Asian Hispan anic Contribu bution t to tot

• tal

al beverag age c consumption

• n (

(%) Wat ater SSB SBs

Disparities in beverage consumption

Herrick et al, NCHS Data Brief, no 320, 2018

91 64 69 71 86

10 20 30 40 50 60 70 80 90 100 White Mexican Am. Other Hispanic Black Other

Children en d drinking an g any tap ap wat ater (%)

Source: NHANES

Disparities in tap water intake

Disparities in health

Source: CDC 2017

Incidence of Type 2 Diabetes Among US Children and Adolescents Aged 10 to 19 Years, by Race/Ethnicity, 2011-2012

Why Tap Water?

Water in any form is healthier than SSBs Tap water has benefits over bottled water

▪

Lower cost

▪

More regularly tested

▪

Smaller environmental footprint

▪

More likely to be fluoridated to prevent cavities

Access to safe drinking water where kids learn and play

First step in promoting water intake is to ensure - and assure - that it is safe

Media reports of tap water contamination since 1/2015 National Drinking Water Alliance

Tap Water Contamination Incidents

Lead C Contamin inatio ion in in School

• ls &

& Pa Parks Other Contamination in System Lead C Contamin inatio ion in in Com Community Other Contamination in Schools

Tap water safety “It’s not just Flint, and it’s not just lead”

• Flint water crisis and renewed attention to tap water safety
• How bad is the problem?

Source: GAO. | GAO-12-424

Water 101

How lead can enter water

Potential for lead in drinking water

• Presence of lead parts
• Corrosion control
• Stagnation time
• Action Level
• First draw sample

0 ppb <1 ppb 5 ppb 10 ppb 15 ppb 20 ppb Other

“No safe level for lead” AAP1

FDA for bottled water2

3 states

WHO

3

EPA-LCR AL for water system4 13 statess EPA – 3T’s5 8 states 1 state 1American Academy of Pediatrics (AAP) 2Food and Drug Administration (FDA) 3World Health Organization (WHO) 4Environmental Protection Agency (EPA) 5EPA (Environmental Protection Agency). 3Ts for Reducing Lead in Drinking Water in Schools: 2006.

Other standards for lead in drinking water (sources below) Findings from Early Adopters study

Understanding lead action levels

Lead and children’s health

Sources: CDC; Shannon et al 1992; EPA

About 20% 20% of children’s lead exposure is through drinking water – up to 60% 60% if they fed formula mixed with tap water

Contam amin inan ant Ar Arse seni nic Nit itrat ate Hexaval alent Chromi mium m Source Pesticide, groundwater Fertilizers, human waste Industrial processes He Heal alth Impacts Skin warts/ Discoloration Cancers – skin/bladder / liver/lung IQ/growth/ development Limited ability

• f blood to

transport

• xygen
• Blue baby

syndrome

• ↓ BP
• ↓ HR
• HA
• Abdominal

cramps/ vomiting Nose and breathing problems – nose ulcers, runny nose, asthma, cough, shortness of breath,

• r wheezing

Cancers – lung/ stomach

https://www.atsdr.cdc.gov/substances/index.asp

Health impacts of other drinking water contaminants

Water is required in school and childcare meal programs

“L “Letter o

• f the law”

” technical compli liance “Spirit of the law” water that kid ids c can and will l drink

Federal Child Nutrition Act legislation requires access to potable drinking water at no charge in the place where meals are served in school, and throughout the day in childcare

Concept of effective access to water

• Accessibility
• Appeal
• Flow
• Vessels
• Promotion

Second step in promoting water intake is to develop effective access.

Federal agencies Policymakers State programs

Drive change with policy

Policy opportunity: Child Nutrition Act reauthorization

• WI

WIC

• Assure safe tap water for formula, kids and moms;

add healthy beverage education

• CACFP
• Good regulations: how can we assure they are

implemented & that water is safe?

• NS

NSLP

• Assure water is safe; expand water access beyond the

cafeteria/meal times

Policy opportunity 2020 Dietary Guidelines for Americans

• The DGAs underlie federal nutrition

programs, SNAP-Ed, procurement policies and clinical dietary advice

• New this time: guidance for infants and

toddlers

• Send a comment to USDA!

Water on MyPlate

The National Drinking Water Alliance is leading an ongoing national campaign to urge the United States Department of Agriculture to place an icon for drinking water on the MyPlate graphic. Click the www.DrinkingWaterAlliance.org ‘Take Action’ button to learn more

Enable people to drink water, not sugary drinks

State Approaches to Testing School Drinking Water for Lead in the United States

• Angie Cradock, ScD, MPE
• Harvard T.H. Chan School of Public Health
• Christina Hecht, PhD
• Nutrition Policy Institute, University of

California

Presenter Disclosures

• Angie Cradock, ScD, MPE
• Christina Hecht, PhD
• The authors have no relationships to disclose.

Project Team

Mary Kathryn Poole, MPH Laura Vollmer, MPH, RD Chasmine Flax, MPH Jessica Barrett, MPH Molly Knox, MA This research was supported by a grant to Healthy Eating Research at Duke University from the Robert Wood Johnson Foundation.

Acknowledgments

 Issues & Background  The Study

 Methodology  Key Findings  Conclusions

 Policy/Practice Implications

Presentation overview

State Actions in 2016-17 for Children’s Tap Water Safety Failed Legislation Mandatory Pending Funding Proposed Legislation Voluntary

Issue: States’ “scattershot” legislative response

Legislation since 1/2016 National Drinking Water Alliance

• Before 2016, limited testing at the tap
• Since 2016, state testing, but with varied approaches
• No federal program
• EPA provides guidance on testing

Research questions

• 1. What are key features of the

policies or programs underlying state-wide initiatives to test school drinking water for elevated levels of lead?

• 2. What are school-level water lead

testing results and are there associations with school-level characteristics?

How lead can enter water

Potential for lead in drinking water

• Presence of lead parts
• Corrosion control
• Stagnation time
• Action Level
• First draw sample

State policy: 15 (60%) State program: 10 (40%)

States with school drinking water lead testing programs as of February 2018

MI MD NJ MA NH ME VT NY ND

Program: an effort initiated by a state agency or department pursuant to an existing directive or grant of authority Policy: a mechanism to establish a program via state statute, executive order, or funding appropriation

Methodology: Policy analysis & water lead content

Characterizing state policy & programs

• Structured content analysis
• Compared to EPA recommendations & guidelines for public

health surveillance

Characterizing water sample lead (Pb) content

• First draw
• Percentage of schools

Key findings

There is no uniformity in approaches to create and

• versee programs to test for elevated lead in school

drinking water There is no uniformity in states’ action levels

Mandatory or Voluntary

8 (32%) 17 (68%)

Mandatory Voluntary

State funding available

State school drinking water lead testing program characteristics as of February 2018

State agency leadership

8 (32%) 3 (12%) 6 (24%) 4 (16%) 4 (16%)

Dept of Environment Dept of Education Dept of Health Joint Leadership Other

0 ppb <1 ppb 5 ppb 10 ppb 15 ppb 20 ppb Other

“No safe level for lead” AAP1

FDA for bottled water2 3 states (12%)

WHO3

EPA-LCR AL for water system4 13 states (52%) EPA – 3T’s5 8 states (32%) 1 state (4%)

sec165-110.pdf [accessed September 19, 2018].

eng.pdf;jsessionid=3881FE535AD164B693E889262390B0A1?sequence=1%20Guidelines%20for%20-%20apps.who.int. [Accessed September 19, 2018]

idx?SID=531617f923c3de2cbf5d12ae4663f56d&mc=true&node=sp40.23.141.i&rgn=div6#se40.25.141_180. [Access date September 19, 2018].

Other standards for lead in drinking water (sources below) Findings from Early Adopters study

Variation in allowable or recommended maximum concentration levels

• f lead in drinking water

Key findings

There is no uniformity in states’ protocols to test school drinking water for lead and to share their findings There is no uniformity in states’ recommendations for school responses to testing

Types of taps sampled Frequency of sampling/testing Sampling protocol

Variation in state school drinking water lead testing program data collection strategies as of February 2018

10 (40%) 19 (76%) 19 (76%)

2 4 6 8 10 12 14 16 18 20 Routine Short-term Long-term Treatment measures specified

Treatment measures specified

10 (40%) 5 (20%) 16 (64%) 12 (48%) 17 (68%) 6 (24%) 7 (28%) 4 (16%) 9 (36%) 5 (20%) 6 (24%) 1 (4%)

5 10 15 20 25 30 Results Treatment efforts

Notification of results & treatment efforts

Treatment & remediation strategies and stakeholder communication

Schools in these 24 states (and DC) educate

54%

• f all public school students in the U.S. in grades PK-12

School water quality results

Key findings

There is no uniformity in the formats used to organize and maintain data on water quality

Testing was completed in

10,888

schools1

485,152

first draw tests were completed

FIRST DRAW

• f all tests were above

the state specified action level

57,152 (12%)

44%

• f schools tested had one
• r more water samples

with a lead concentration at or above the state’s action level

• 1. In 12 states; these 12 were those with available data on the lead content found in drinking water in schools

Key findings from twelve state school drinking water testing programs

Key findings

Schools that collected and tested water from a greater number of taps were also more likely to identify a sample with elevated lead concentrations The use of lower action levels by a state program would increase the proportion of schools needing to take steps to address the lead content in the drinking water

Implications

Specified, standardized practices for tap water sampling for lead testing of school tap water together with financial and technical assistance for both testing and remediation could support more states in adopting programs and recommended practices to limit lead exposure in school drinking water

Implications

Up-to-date electronic data management guidance bolstered by improved federal financial and technical support, could standardize practices for data collection, database development and reporting to improve timely identification of elevated lead levels in school tap water and limit lead exposure from school water outlets

Federal agencies Policymakers State programs

Policy relevance

• Study recommendations limited to available information and data
• Data are not representative of all states or schools in states with

programs

• Reporting of precise lead content level not always required by

states

• Uncertainties in sampling process
• Lack of a health-based standard for lead in drinking water

Limitations

Ensuring that all children have easy and appealing access to lead-safe school drinking water should be a health promotion policy priority for relevant federal and state agencies and will support the promotion of drinking water as a healthy beverage of choice.

Angie Cradock acradock@hsph.harvard.edu Christina Hecht ceahecht@ucanr.edu

Learn more about this project, read the full report and the supplemental state reports by visiting: https://www.hsph.harvard.edu/prc/projects/school-research/early- adopters

Thank you!

Questions

Investigating Drinking Water Quality in California Public Schools

Anisha Patel, MD, MSPH Stanford University Christina Hecht, PhD Nutrition Policy Institute

C H I L D H O OD O BESI T Y CON F E RE N C E J ULY 1 7 , 2 0 1 9

Study Objectives

– Examine schools’ reported practices related to drinking water testing – Investigate language regarding drinking water testing or remediation in school district wellness policies – Assess the prevalence of key contaminants in school drinking water

Study Design

Study Design

Characteristics of Study Schools

Characteristic California schools Survey schools (n=240) Study testing (n=64) State testing (n=126) Student enrollment Elementary 525 494 439 538* Middle 758 622 755 739* High 1326 1269 1365 1561* Academic performance index 790 786 761* 798* Free/reduced price eligible, % 58 63 68* 60 English learners, % 21 20 20 18 Latino students, % 53 52 55 49 Respondent type, % Principal Vice principal Facilities Other n/a 47 15 7 31 42 16 11 31 44 17 6 33

Results: Administrator Surveys

Schools’ Report of Water Testing Practices (%)

Practice Yes No Don’t Know

Periodic inspections that test drinking water

• utlets for lead

47 16 37 Periodic inspections that test drinking water

• utlets for contaminants
• ther than lead

27 22 51 Drinking water safe to drink at each outlet 95 1 4

Results: School District Wellness Policies

Schools with Wellness Policy Language about Water Testing and Remediation

64% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Testing drinking water for lead Treatment/remediation of unsafe water % of schools

Results: VA Tech Water Testing Study

Schools that Violate Standards for Lead in Drinking Water

3 19 73 92 2 6 33 81 10 20 30 40 50 60 70 80 90 100

EPA FDA bottled water AAP PHG

1st draw 2nd draw

1ppb 0.2ppb 5ppb

n=64 schools, 192 taps

% of schools 15ppb

Violations for Other Key Drinking Water Contaminants

5 41 64 78 10 20 30 40 50 60 70 80 90 100

Copper Arsenic Nitrate Hexavalent Chromium

EPA PHG

n=64 schools, 192 taps

% of schools EPA 1.3mg/L; PHG 0.3mg/L EPA 10ppb; PHG 0.004ppb EPA/PHG 10mg/L EPA 100ppb CA 50ppb PHG 0.02ppb

Schools with Violations for One or More Contaminant*

8 73 100 10 20 30 40 50 60 70 80 90 100

EPA AAP PHG n=64 schools, 192 taps

% of schools

*Contaminants include lead, copper, arsenic, nitrate, or hexavalent chromium

Results: California State Lead Testing

Schools in CA State Testing Program that Violate Lead Drinking Water Standards

4 12 10 20 30 40 50 60 70 80 90 100

EPA (15 ppb) FDA bottled water (5 ppb) n=126 of 240 study sample schools

% of schools

CA state program does not test below 5ppb; unable to examine AAP and PHG violations

Location of Taps Tested through State Program

Food service area 17% Physical activity space 14% Classroom 8% Hallway/common area 42% Unknown 19%

n=126 schools, 617 taps

67

Gaps in Testing through State Program

– 40% of schools did not test a tap in the food service area – 21% of schools tested a tap that wasn’t accessible to students

• 78% staff/admin area
• 16% nurse’s office
• 6% maintenance area

Conclusion

– Administrators have a low awareness of water testing practices – Wellness policies do not address remediation – Variation in violations depending on standard applied

– CA state testing of busiest taps showed:

• Less than half of schools tested water in food service

areas

• Taps not used by students for consumption used to meet

testing requirements

69

Acknowledgments

– Study schools – Co-investigators

• Marc Edwards and Jeff Parks

at Virginia Tech – Research associates and students

• Emily Altman, Gala Moreno,

Jeff Ezennia, Caitlin Joseph, Isi Umunna – Funding

• RWJF Healthy Eating Research

Program

Assessed for eligibility (n=10,481 public schools) Randomized sample (n=240) Study testing Schools enrolled (n=102) Schools with testing results (n=64) Schools that haven't yet tested (n=38) Schools declined (n=49) Schools ineligible (n=7) Schools not yet responded (n=82) State testing Schools tested through state program (n=126) Schools submitted exemption forms (n=13) Schools haven't tested yet (n=101)

Participating Study Schools that Violate Lead Drinking Water Standards in California State Testing Program

6 18 3 18 73 88 10 20 30 40 50 60 70 80 90 100

EPA (15 ppb) FDA bottled water (5 ppb) AAP (1 ppb) PHG (0.2 ppb)

state program 240 study

n=33 of 240 study sample schools

% of schools n/a n/a

Location of Taps Tested through State Program among schools that also tested through 240 study

n=33 schools, 172 taps

Food service area 20% Physical activity space 15% Classroom 8% Hallway/common area 52% Unknown/other 5%

Types of Taps Tested through State Program

Sink 16% Fountain 55% Water filling station 5% Unknown/other 24%

n=126 schools, 617 taps

Contaminant Arsenic Nitrate Hexavalent Chromium

Source Pesticide, groundwater Fertilizers, human waste Industrial processes Health Impacts Skin warts/ Discoloration Cancers – skin/bladder/ liver/lung IQ/growth/ development Limited ability of blood to transport oxygen

• Blue baby

syndrome

• ↓ BP
• ↓ HR
• HA
• Abdominal

cramps/ vomiting Nose and breathing problems – nose ulcers, runny nose, asthma, cough, shortness of breath,

• r wheezing

Cancers – lung/ stomach

https://www.atsdr.cdc.gov/substances/index.asp

Policy Implications

• Two Big “P” Questions

› Closing the gap between allowable Maximum Contaminant

Level (MCL) and a public health goal

› Who should regulate

• More concrete implications

› Mandatory vs. voluntary testing › Improving implementation of testing programs

Questions

Working Collaboratively against Sugary Drinks & for Water Equity

• Shape Up and SFHIP
• July 2019
• Vanessa Bohm, MPH; Monique LeSarre, PhD; Eric Mar, JD;
• Christina Nip; Anisha Patel, MD, Christina Goette, MPH;
• Marianne Szeto, MPH; Roberto Vargas, MPH

78

Collective Impact for Water Equity

Steps leading to where SF is today

• Education
• Sugary drinks 101
• Water promotion
• Research
• Leveraging existing literature
• CBPR leads to need for Water Access & promotion
• Policy and Environmental change
• Organizational wellness policies
• City policies, including Soda Tax

Current activities:

• Soda tax implementation
• Water access, policy and promotion

SF SPECTRUM OF PREVENTION FOR SSB/ H2O

80

ADVISING ON POLICY AND LEGISLATION

EDUCATION & TECHNICAL ASSISTANCE TO POLICY MAKERS

CHANGING ORGANIZATIONAL PRACTICES

ORGANIZATIONAL WELLNESS POLICIES

FOSTERING COALITIONS AND NETWORKS

SHAPE UP SF COALITION; SFHIP; REGIONAL UTILITIES

EDUCATING PROVIDERS

SUGAR SCIENCE and DPH TRAINING OF TRAINERS

PROMOTING COMMUNITY EDUCATION

LAY HEALTH WORKER EDUCATION; SFUSD WELLNESS

STRENGTHENING INDIVIDUAL KNOWLEDGE AND SKILLS

TABLING AT SUNDAY STREETS, CBO EDUCATION ACTIVITIES

Shape Up SF Coalition

82

Multi-stakeholder efforts

• SF Policymakers
• UCSF
• SF Department of Public Health
• SF Mayor’s Office
• SF Public Utilities Commission
• BANPAC
• SF Unified School District
• Community Based Organizations and more…

83

Holding Their Stake: Public Health

84 84

• Promote education in clinics
• Community education Citywide
• Build community capacity for peer education
• Technical assistance and data for policy (org. and public)
• Staffing coalitions (backbone org.)

MISSI ON TENDER LOIN VISITACION VALLEY EXCELSI OR BAYVI EW

SODA EXPENDITURES

Percent of Total Expenditures, National Rank by Tract (2011)

Percent of Children (Ages 2-11) and Adolescents (Ages 12- 17) Drinking At Least One Sugar-Sweetened Beverage per Day in 2005-07 and 2011-12, by Race/Ethnicity

Consumption of sugary drinks for young children Consumption of sugary drinks for adolescents among all ethnic/racial groups except Whites.

87

Holding Their Stake: Impacted Communities

88

• Co-convened focus groups –

health equity coalitions

• Adopted beverage policies –

Y, BVHPF, Children’s Council, Boys and Girls Club, Cornerstone church, etc.

• Educated community
• Spa water only events
• Lay health worker workshops on SSBs and H2O
• Counter-marketing

Community-based education

• Healthy Beverage

Education Partnerships Community Based Coalitions/ Councils

– Asian/ Pacific Islander Health Parity: NICOS – African American Health Equity: Rafiki – Chicano/ Latino/ Indigena: CARECENSF

Culturally/ Community specific education– critical to changing behavior

90

91

Community Specific Outreach

92

Lay Health Worker Sessions

93

Community Events

94

Social Media and web-based campaigns against SSB

• www.sugarscience.org
• www.TheBiggerPicture.org (Check UCSF CHARM website)
• www.OpenTruthNow.org
• Shape Up SF Coalition
• Dunk the Junk

95

Holding Their Stake: Universities

96

• Leverage science for City strategy and policies
• Research – CBPR and traditional, expert testimony
• Evaluation – including parks study on H2O consumption
• Grad/Undergrad student support
• Authoritative education materials

Community Perspectives: What will Get Us to Drink Less Sugar

What we learned from communities drinking the most sugar, and how we put those lessons into action

• Policy
• Structural change
• Education/ Promotion

Findings: “Protect our children”

• Wanted protection for kids; even those who didn’t like policy
• Desire to limit marketing & access for kids

Cost and affordability

• Keep it cheap, even if it’s unhealthy
• Don’t tax consumers or retailers; tax producers or distributors
• Make healthy drinks cheaper; including water

Finding: More Water Access, Now!

• Increase access to clean drinking water. Most think

bottle-filling stations are more sanitary; dual is better

• Education about water should be near the tap
• Be safe, clean, accessible and protected
• Placed in low-income communities

100

• Convened Hearings on Water Equity, Economic

Impact of SSB consumption

• Proposed City investment in H2O
• Served as Spokespeople

Holding Their Stake: Policy Makers

SF Soda Tax

San Francisco – Prop E got 56% of vote in 2014. Prop V passed in 2016

• $.01 per oz. excise tax on

distributors of drinks with 25 calories or more

• f sweetener
• General Tax
• Advisory board currently

in development Currently $11.2-15 Million per year for investment in chronic disease prevention

Other SF Policy

• 1. UC San Francisco removed all sugary drinks for

service/sale on campuses. (June 2015)

• 2. Zuckerberg San Francisco General Hospital removed

all sugary drinks for service/sale on campuses. (Nov. 2015)

• 3. 3 City and County SSB Policies (June 2015)
• 4. 2 Dignity hospitals

Adopt beverage policy & KP adopt policies (2016)

102

The healthy alternative: H2O

• Partnership for water

equity

– City, UCSF, Community – Tap installation and water promotion/ education – 53 new tap stations in ’15- ’16; dozens more in ’19-’20 – Lay Health Workers promote public water – Nearly $1.5M invested in tap stations by 2020 in SF

Recent Activities

• Regional collaboration on water equity in schools (BANPAC)
• Soda Tax Advisory Board TA & imp.
• Educate new cohort of policymakers on the issue of Water

Equity

– Identified signage and sites for new installations – Developing POPOs and other H2O policy

• Dissemination
• Evaluation of impact on consumption

104

Community-Based Grants School Food, Nutrition Education … Food Access Healthy Retail Oral … Infrastructure Water Access Rec and …

Co Communit ity-B y-Based ased Gran Grants - 4 s - 45% School Food, Nutrition Education & Student Led Action - 15% Food Access - 9.6% Healthy Retail - 1.4%

SDDTAC Funding Allocation Recommendations

SDDTAC Guiding Principles for Community-Based Grants

Funded projects should:

• Be community-led and informed
• Be culturally relevant
• Be peer-led
• Provide training and employment for target community members
• Foster collaboration and partnerships
• Foster leadership development
• Be accessible (free/low cost services)
• Demonstrate an intersection of strategies and program areas

107

108

Roberto Ariel Vargas, MPH Center for Community Engagement Community Engagement and Health Policy Program of CTSI Roberto.Vargas@ucsf.edu Special thanks to co-directors: Kevin Grumbach, MD Laura Schmidt, PhD

Questions

Perceptions of Drinking Water and Strategies to Promote Water Intake through Parks

Childhood Obesity Conference July 17, 2019

Anisha Patel MD, MSPH, MSHS

San Francisco Beverage Initatives

▪

Installation of water bottle filling stations in parks and public spaces

▪

Ethnic community coalition-led drinking water promotion

▪

Soda tax

Parks: Novel Setting for Health Promotion

▪

Numerous individuals visit U.S. parks

–

68% of Americans visited parks in the last month

–

3 in 4 live within walking distance of a park

▪

San Francisco has over 200 parks

• Novel setting for health promotion

Overall Study Objective

• To understand how installation of water stations in parks

and soda taxes impacts beverage intake as compared to soda taxes alone

Drink Tap Evaluation Logic Model

Quasi-experimental Design

Evaluation Methods

Drink Tap Evaluation Timeline

Park Neighborhood and City Demographics

Resident characteristics SF Study Parks % (sd) SF City (%) Oakland Study Parks % (sd) Oakland City % Below poverty level 13.4 (8.5) 11.7 17.8(11.8) 18.7 Race/ethnicity African American Latino API White 6.9 (9.8) 16 (14.9) 28.8 (17.5) 42.6 (22.9) 5.3 15.3 34.6 40.8 14.1 (19.2) 17.5 (8.8) 26.3 (27.5) 31.8 (19.9) 24.3 27.0 16.5 27.3

Park Survey Respondent Characteristics

Characteristic (%)

Age in years, mean (SE) 40.7 (0.60) Female 57.2 Race/ethnicity Latino African American Asian/Pacific Islander Other 20.3 19.2 20.8 38.7 English primary language spoken at home 68.6 U.S. Born 61.2 Years in US, mean (SE) 17 (0.91) ≥ 1 child less than 18 yrs in household 54.6 Brings child/children to park ≥ once/wk 76.8 Response rate 73

Water and SSB Intake by Race/Ethnicity

22 16.4 22.5 19.9 14.7 6.6 12.4 6.1

• 6

4 14 24 34 44 54 64 African-American Asian/Pacific Islander Hispanic/Latino Other Ounces of beverage consumed per day

• unces of water per day
• unces of SSB per day

n=558 survey respondents

Type of Water Consumed by Race/Ethnicity

5.6 5.9 6.1 9.1 6 6.4 6.5 6.1 10.4 6.3 9.9 6.7 5 10 15 20 25 African-American Asian/Pacific Islander Hispanic/Latino Other Ounces of water consumed unfiltered tap filtered tap bottled n=558 survey respondents

Perceptions of Tap Water at Home and in Parks

*Agree with one of the following: water tastes horrible, smells bad, is not clear, is too hot/cold, or unsafe to drink

62 43 48 35 93 82 89 83 10 20 30 40 50 60 70 80 90 100 African-American* Asian/Pacific Islander* Hispanic/Latino* Other*

Negative Perceptions of Tap Water (%)

Home Park

n=558 Survey Respondents

* = P<0.05

Safest Type of Water to Drink

10.6 9.8 18.3 15.8 41.6 48.4 39.2 50.9 35.4 25.4 31.7 12.2 10 20 30 40 50 60 African-American* Asian/Pacific Islander* Hispanic/Latino* Other* Safest Water to Drink (%) Tap Filtered Tap Bottled

n=558 Survey Respondents

* = P<0.05

Preferred Strategies for Promoting Water Intake in Parks

Conclusion

• Racial/ethnic disparities in beverage intake and perceptions
• f drinking water
• Among African American and Latino populations
• ↑ SSB intake; ↓ tap water intake
• Tap water perceived more negatively
• Combination of improvements in drinking water conditions,

reductions in SSB access, and water promotion needed to encourage water intake

Next Steps

▪

Examination of the Drink Tap program’s impact on beverage intake in progress

▪

Efforts to promote use of stations

▪

SF Supervisor Fewer introducing an ordinance to require water stations in newly constructed parks

▪

SF Sugary Drinks Distributor Tax Advisory Committee supporting water access/promotion efforts

127

Acknowledgments

• Co-investigators/partners
• Roberto Vargas, Laura

Schmidt (UCSF)

• CBOs and agencies
• Research associates
• Funders
• W.K. Kellogg Foundation,

SF Foundation, Mount Zion Health Fund, SDRC Pilot and Feasibility Award

Community Context

▪

SF Health Improvement Partnership (SFHIP) is a collaboration

• f community agencies and UCSF

▪

Conducted focus groups with low-income communities about strategies to reduce SSB intake

▪

Common themes:

–

Distrust of tap water

–

Lack of access to affordable clean water

–

Reusable water bottle filling stations primarily located in tourist locations or higher-income areas

Questions

Thank you!

For more info, please visit:

drinkingwateralliance.org