Water First School Water Promotion and Access Intervention: A Cost Analysis Study

Andrea Pedroza-Tobias; Angie L Cradock; Lauren Blacker; Lorrene D Ritchie; Laura A Schmidt; Charles E McCulloch; Joshua A Salomon; Claire D Brindis; Michael D Cabana; Anisha I Patel

doi:10.1016/j.jand.2024.10.022

Water First School Water Promotion and Access Intervention: A Cost Analysis Study

J Acad Nutr Diet. 2024 Nov 6:S2212-2672(24)00924-9. doi: 10.1016/j.jand.2024.10.022. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California. Electronic address: andreapt@stanford.edu.
² Harvard TH Chan School of Public Health, Boston, Massachusetts.
³ Rush Medical College, Chicago, Illinois.
⁴ Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California.
⁵ Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California.
⁶ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
⁷ Department of Health Policy, Stanford University School of Medicine, Stanford, California.
⁸ Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Department of Pediatrics, University of California San Francisco, San Francisco, California.
⁹ Division of General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.
¹⁰ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.

PMID: 39515643
DOI: 10.1016/j.jand.2024.10.022

Abstract

Background: Adequate water intake is associated with improved cognitive and physical performance, prevention of dental caries, and overweight and obesity. However, access to free drinking water in schools remains inadequate. Water First, a school-based intervention promoting water consumption, was shown effective in preventing overweight, yet its costs have not been quantified.

Objective: To evaluate the costs of Water First from the school's perspective over 1 academic year.

Design: Secondary analysis of a cluster-randomized clinical trial assessing the cost of Water First.

Participants and setting: Six public schools in the San Francisco Bay Area during the 2018-2019 academic year, with an average of 578 ± 69 students per school and 110 ± 2 fourth-grade students in intervention schools, and 508 ± 190 students per school and 101 ± 5 fourth-grade students in control schools.

Intervention: Schools were randomized to receive water dispensers and stations in cafeterias and high-traffic areas and a schoolwide water promotion campaign (school-level intervention). Fourth-grade students and teachers received reusable water bottles, lessons, and materials for school and home (class-level intervention).

Main outcome measures: Activities, resources, and the value needed to implement the school-level and classroom-level intervention were systematically captured over 1 academic year, including labor, materials, and utilities costs.

Statistical analysis: The intervention costs per school and per student were estimated by summing the component-specific costs. Results are presented for both school-level and classroom-level interventions in 2023 US dollars.

Results: The Water First intervention costs $20 per student for the school-level and $131 per student for the classroom-level intervention over 1 academic year. Accounting for the useful life of the installed water stations and dispensers beyond 1 year, the annualized cost of the school-level intervention was $11 per student.

Conclusions: These cost estimates provide useful insights for schools and stakeholders to plan and implement effective school-based interventions that promote access to drinking water.

Keywords: Cost analysis; Overweight; School-based intervention; Sugar-sweetened beverages; Water intake.