Increasing water availability during afterschool snack: evidence, strategies, and partnerships from a group randomized trial

Am J Prev Med. 2012 Sep;43(3 Suppl 2):S136-42. doi: 10.1016/j.amepre.2012.05.013.


Background: Providing drinking water to U.S. children during school meals is a recommended health promotion strategy and part of national nutrition policy. Urban school systems have struggled with providing drinking water to children, and little is known about how to ensure that water is served, particularly in afterschool settings.

Purpose: To assess the effectiveness of an intervention designed to promote water as the beverage of choice in afterschool programs.

Design: The Out of School Nutrition and Physical Activity Initiative (OSNAP) used a community-based collaboration and low-cost strategies to provide water after school. A group RCT was used to evaluate the intervention. Data were collected in 2010-2011 and analyzed in 2011.

Setting/participants: Twenty afterschool programs in Boston were randomized to intervention or control (delayed intervention).

Intervention: Intervention sites participated in learning collaboratives focused on policy and environmental changes to increase healthy eating, drinking, and physical activity opportunities during afterschool time (materials available at Collaboration between Boston Public Schools Food and Nutrition Services, afterschool staff, and researchers established water-delivery systems to ensure children were served water during snack time.

Main outcome measures: Average ounces of water served to children per day was recorded by direct observation at each program at baseline and 6-month follow-up over 5 consecutive school days. Secondary measures directly observed included ounces of other beverages served, other snack components, and water-delivery system.

Results: Participation in the intervention was associated with an increased average volume of water served (+3.6 ounces/day; p=0.01) during snack. On average, the intervention led to a daily decrease of 60.9 kcals from beverages served during snack (p=0.03).

Conclusions: This study indicates the OSNAP intervention, including strategies to overcome structural barriers and collaboration with key actors, can increase offerings of water during afterschool snack. OSNAP appears to be an effective strategy to provide water in afterschool settings that can be helpful in implementing new U.S. Department of Agriculture guidelines regarding water availability during lunch and afterschool snack.

Trial registration: NCT01396473.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Boston
  • Child
  • Child Welfare
  • Confidence Intervals
  • Cooperative Behavior*
  • Drinking / physiology*
  • Female
  • Health Policy
  • Health Promotion
  • Humans
  • Male
  • Nutritional Status*
  • Program Development
  • Program Evaluation
  • School Health Services / statistics & numerical data*
  • Snacks*
  • Social Marketing
  • Statistics as Topic
  • Water Supply / statistics & numerical data*

Associated data