A new study in the American Journal of Preventive Medicine reports findings from a randomized controlled trial—the gold standard study design in health research—showing that promoting drinking water in elementary schools can help prevent overweight and reduce sugar-sweetened beverage intake among children, with particularly strong benefits for some groups. The study examined for whom the Water First intervention works best, providing insights to strengthen school-based nutrition strategies. Water First combined environmental changes—such as improving access to free drinking water—with education encouraging water as a healthy alternative to sugar-sweetened beverages.
Researchers followed 1,250 fourth-grade students over 15 months and found that the program’s benefits were largely consistent across sociodemographic, family, and health-related characteristics. Notably, the intervention was especially effective for children who consumed more sugar-sweetened beverages at baseline: for each additional daily sugar-sweetened beverage consumed, students in Water First schools reduced their intake by 5% more than students in control schools. The program also had a stronger effect on increasing water consumption among children with lower acculturation—those who spoke only Spanish at home—suggesting water promotion may be particularly impactful for students facing greater structural or cultural barriers to healthy beverage choices.
Overall, the findings reinforce Water First as a valuable program to promote healthier beverage habits and prevent childhood overweight across diverse school populations.
The study was authored by Viviane Richard from Stanford University and the University of Geneva, Keejeong Ryu from Stanford University, Yadira Peralta from Stanford University and the Center for Research and Teaching in Economics, Mexico, Andrea Pedroza-Tobias and Valeria Ordonez from Stanford University, Laura A. Schmidt and Charles E. McCulloch from the University of California, San Francisco, Lorrene D. Ritchie from the Nutrition Policy Institute, UC Agriculture and Natural Resources, with senior authorship by Anisha I. Patel from Stanford University.
This study was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Numbers R01HL129288 and K24HL169841. Viviane Richard was also supported by grants from the University of Geneva and the Boninchi Foundation.