domingo, 7 de junio de 2015

Drinking Water in California Child Care Sites Before and After 2011–2012 Beverage Policy

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Drinking Water in California Child Care Sites Before and After 2011–2012 Beverage Policy

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Drinking Water in California Child Care Sites Before and After 2011–2012 Beverage Policy

Lorrene D. Ritchie, PhD, RD; Sallie Yoshida, DrPH, RD; Sushma Sharma, PhD; Anisha Patel, MD, MSPH; Elyse Homel Vitale, MPH; Ken Hecht, JD

Suggested citation for this article: Ritchie LD, Yoshida S, Sharma S, Patel A, Vitale EH, Hecht K. Drinking Water in California Child Care Sites Before and After 2011–2012 Beverage Policy. Prev Chronic Dis 2015;12:140548. DOI:


Drinking water is promoted to improve beverage nutrition and reduce the prevalence of obesity. The aims of this study were to identify how water was provided to young children in child care and to determine the extent to which water access changed after a federal and state child care beverage policy was instituted in 2011 and 2012 in California.
Two independent cross-sectional samples of licensed child care providers completed a self-administered survey in 2008 (n = 429) and 2012 (n = 435). Logistic regression was used to analyze data for differences between 2008 and 2012 survey responses, after adjustment for correlations among the measurements in each of 6 child care categories sampled.
A significantly larger percentage of sites in 2012 than in 2008 always served water at the table with meals or snacks (47.0% vs 28.0%, P = .001). A significantly larger percentage of child care sites in 2012 than in 2008 made water easily and visibly available for children to self-serve both indoors (77.9% vs 69.0%, P = .02) and outside (78.0% vs 69.0%, P = .03). Sites that participated in the federal Child and Adult Care Food Program had greater access to water indoors and outside than sites not in the program. In 2012 most (76.1%) child care providers reported no barriers to serving water to children. Factors most frequently cited to facilitate serving water were information for families (39.0% of sites), beverage policy (37.0%), and lessons for children (37.9%).
Water provision in California child care improved significantly between samples of sites studied in 2008 and 2012, but room for improvement remains after policy implementation. Additional training for child care providers and parents should be considered.


We thank the Robert Wood Johnson Foundation for funding this research (Healthy Eating research grant no. 69298) and Mary Story and Karen Kaphingst for their support. Thanks also to Ellen Braff-Guajardo, Kumar Chandran, and the late Sarah Samuels for study conception and design, to Paula James and Ed Mattson for survey critique, to Sally Smyth, Shelly Mandel, Sheila Stern, Lauren Goldstein, Temika Green, Shauna Pirotin, Jessica Jew, Claudia Olague, and Nayeli Cerpas for assistance with conducting the study and to Suzanna Martinez and Sheila Stern for manuscript review. Finally we are indebted to the many busy child care staff for participating.

Author Information

Corresponding Author: Lorrene D. Ritchie, PhD, RD, Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin St, Ste 10123, Oakland, CA 94607. Telephone: 510-987-0523. Email:
Author Affiliations: Sallie Yoshida, Sarah Samuels Center for Public Health Research and Evaluation, Oakland, California; Sushma Sharma, Atkins Center for Weight and Health, University of California, Berkeley, California; Anisha Patel, School of Medicine, University of California, San Francisco, California; Elyse Homel Vitale, California Food Policy Advocates, Oakland, California; Ken Hecht, Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California. Dr Sharma is now affiliated with Dallas-Fort Worth Hospital Council Foundation, Irving, Texas.


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