Thirsty? Choose Water! A regional perspective to promoting water consumption in secondary school students.

OBJECTIVE: Adolescents are high consumers of sugar-sweetened beverages (SSB), which contribute to overweight and obesity - a significant public health issue. Evidence suggests that replacing SSB with water and school-based interventions can reduce consumption. This study examines the acceptability of a previously trialled intervention (Thirsty? Choose Water!) in regional and remote secondary schools. DESIGN: An open-label randomised controlled trial using a two-by-two factorial design tested the outcomes of a behavioural and/or environmental intervention on SSB and water consumption. SETTING: Regional and remote secondary schools (public, catholic and independent) within the boundaries of two regional Local Health Districts within New South Wales. PARTICIPANTS: Twenty-four schools participated in the study. The target group was year 7 students (n 1640) - 72 % of eligible students completed baseline data. The study followed students into year 8 (n 1188) - 52 % of eligible students completed post-intervention data. Forty teachers undertook training to deliver the intervention. RESULTS: Interventions showed high levels of acceptability. Students demonstrated changes in knowledge, attitudes and consumption behaviours. Multivariable ordinal logression analysis demonstrated that all interventions increased the odds of students increasing their water consumption (though not statistically significant). Conversely, the combined (OR: 0·75; 95 % CI: 0·59, 0·97) or environmental intervention (OR: 0·68; 95 % CI: 0·51, 0·90) had greater odds of reducing SSB consumption and was statistically significant. CONCLUSIONS: This study builds on recent Australian evidence regarding the impact of school-based interventions on water and SSB consumption. In this study, despite a minor intervention change, and the impacts of fires, floods and COVID-19 on study implementation, the interventions were highly regarded by the school communities with positive outcomes.

The outcomes of Thirsty? Choose Water! Determining the effects of a behavioural and an environmental intervention on water and sugar sweetened beverage consumption in adolescents: A randomised controlled trial.

ISSUE ADDRESSED: Childhood obesity is a serious public health challenge. Consumption of sugar-sweetened beverages (SSBs) is one contributing factor, with adolescents being the highest consumers. METHODS: This study used a randomised controlled trial and two-by-two factorial design to determine the effectiveness of a school-based behavioural intervention (including education/promotional messages) and/or environmental intervention (chilled water station), on encouraging adolescents to choose water instead of SSBs. Sixty-one secondary schools (n = 8992 eligible students year 7 student) were recruited and randomly allocated to one of four study groups, the behavioural intervention, the environmental intervention, both interventions or neither. RESULTS: The primary outcome was increased water consumption; secondary outcomes included changes in students' knowledge and attitudes about water and SSBs and changes in SSB consumption. For students who received at least one intervention there was an increased odds (though not statistically significant) of higher water consumption compared to those that received no intervention. There was a decrease in SSB consumption for students who received both interventions combined (OR: 0.67; 95% confidence interval: 0.55-0.082; P < .01). CONCLUSIONS: The combined intervention had a greater effect on decreasing SSBs consumption. This is noteworthy given SSBs are a key contributor to overweight and obesity. SO WHAT?: To our knowledge this is the first Australian study examining combined school-based interventions to specifically promote the consumption of water and decrease the consumption of SSBs in adolescents. The study findings add to the evidence regarding the benefits of delivering multicomponent school-based interventions which add value to existing interventions that address the complex public health issue of overweight and obesity.

Thirsty? Choose Water! Encouraging Secondary School Students to choose water over sugary drinks. A descriptive analysis of intervention components.

BACKGROUND: Childhood obesity is a significant public health issue. Sugar-sweetened beverage (SSB) consumption contributes to this and adolescents are high consumers. This paper provides a descriptive overview of a school-based intervention to address this. METHODS: 61 secondary schools in New South Wales were randomised to receive a behavioural intervention (BI), a chilled water station (CWS), both interventions or neither (control). The BI was delivered through classroom lessons, school-based promotion and vaccination clinic. The CWS intervention included the installation of one CWS per school. Intervention effectiveness over time was assessed via student surveys at baseline, post-intervention and follow-up (individual-level outcomes), feedback from teachers and vaccination nurses, a school information survey, and remotely monitored CWS water usage (school-level outcomes). RESULTS: Teachers reported the BI was useful in teaching students about drinking water and negative consequences of SSBs. Nurses considered the post-vaccination waiting period a good opportunity to deliver health promotion messages. Students in this group showed statistically significant changes in knowledge about SSBs, dehydration effects and changes in daily SSB consumption (T1 23.18%; T3 18.20%). Positive feedback regarding CWSs was received with an increase in water consumption reported for students in this group (T1 86.15% to T3 89.66%) and a statistically significant increase in students carrying a water bottle to school and filling it observed. CONCLUSIONS: Both interventions were readily implemented with high levels of acceptability and impact on students' knowledge and SSB consumption. The study demonstrates how to promote water consumption in schools utilising two different interventions. SO WHAT?: Evidence regarding how to decrease SSB consumption amongst secondary school students has been strengthened.

Thirsty? Choose Water! Behavioural interventions and water stations in secondary schools a two-by-two factorial randomised controlled trial.

BACKGROUND: Childhood overweight and obesity is a significant public health issue. A key contributing factor is sugar sweetened beverages (SSBs) consumption. Evidence suggests that secondary school students are frequent consumers of SSBs, with high daily consumption. The promotion of water consumption and provision of chilled water stations can reduce SSBs consumption. The Thirsty Choose Water! study will evaluate the effectiveness of two interventions, a behavioural intervention, Thirsty? Choose Water! behavioural intervention (TCW-BI), that target students through the domains of the health promoting high schools framework, and the second intervention is the installation and promotion of chilled water stations. METHODS/DESIGN: This community trial will recruit 60 secondary schools from across three Local Health Districts (LHDs) within New South Wales (NSW). A two-by-two factorial study design will be used to determine the effect of the Thirsty? Choose Water! behavioural intervention (TCW-BI), and the installation of chilled water stations. The recruited secondary schools will be randomised and non-blinded to one of four study arms receiving either the TCW-BI or chilled water stations, both interventions, or neither (control group). Baseline measures will be collected including student self-report surveys which will gather data regarding knowledge, attitudes and consumption of water and SSBs, a school profile and an environmental scan. Student surveys will be repeated post the intervention and at follow-up. Regular water meter readings will determine the water flow from the chilled water stations across the study period. DISCUSSION: There is an increasing body of evidence which suggests that decreasing consumption of SSBs can impact positively on childhood overweight and obesity. However, in the Australian context there are limited studies on how this may occur in the secondary school setting. This study will add to this evidence base and establish the effectiveness of TCW-BI and chilled water stations, either alone or combination on increasing water consumption in adolescents. Information about barriers and facilitators to implementation will be documented. Packages to support the implementation of the TCW-BI as a state-wide initiative will be developed. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register ACTRN12618000526279 April 2018.