HCS 457 Week 5 Strategies for Health Promotion Example

Make Water the Easy Choice: A Health Promotion Strategy to Put Cold, Free Drinking Water Within Reach in a District's Middle Schools

[Student Name]

University of Phoenix

HCS/457: Public and Community Health

Week 5 Assignment

[Instructor Name]

[Date]

The school district, its survey figures and its program targets are composites written for a model paper; research findings come from the sources listed.

In a district of 38,000 students, the most recent student health survey found that 31% of middle schoolers drank a sugar-sweetened beverage, such as soda, sports drinks or sweetened tea, at least once a day, and only about half said they drank water at school on a typical day. When asked why, students gave practical answers. "The fountains are warm and some don't work," one seventh grader wrote. Another said she could not refill her bottle anywhere. This paper proposes a health promotion strategy for the district's six middle schools that makes water the easy choice and explains the evidence, theory, objectives and evaluation behind it.

Why the Environment Comes First

Frieden (2010) arranged public health interventions in a pyramid by their reach. Socioeconomic change forms the wide base; above it come changes to the setting that make healthy choices the default, then protective interventions that last, then clinical care, with counseling and education at the narrow top. The lower the level, the wider the reach and the less each person has to do on their own. A lesson on the sugar in soda sits at the top of the pyramid. Putting cold, free water within reach of every student sits on the second level: it changes the context so that the healthy choice is also the convenient one.

What the Evidence Shows

Schwartz et al. (2016) studied the installation of water jets, electrically cooled dispensers with large clear jugs, in New York City public elementary and middle schools, comparing students in schools that received them with students in schools that had not yet, before and after installation. Across more than a million students, water jets were associated with a reduction in standardized body mass index of 0.025 for boys and 0.022 for girls, and with a 0.9 percentage point lower likelihood of being overweight for boys and 0.6 points for girls. Schools with water jets also saw fewer milk purchases, which the authors explored as one possible pathway. The effects are small for any one child, but a low-cost change that shifts a whole school population slightly in the right direction is exactly the kind of result a population strategy aims for.

Patel and Hampton (2011) reviewed water access in schools and child care and described common barriers: too few fountains, fountains that are dirty, broken or warm, students not allowed to carry water bottles, and concerns about water quality, especially lead in older buildings. They recommended improving the availability and appeal of water, allowing bottles and testing water quality. The district's own walk-through last spring found 42 working fountains across six buildings serving 5,900 students, many in bathrooms or far from cafeterias.

The Socioecological Model

The socioecological model explains health behavior as shaped by nested layers: individual, interpersonal, organizational, community and policy. The strategy works on several layers at once. For individual students, cold water in reach and a reusable bottle make drinking water easier. Interpersonally, a campaign designed by students uses peers as messengers. Organizationally, schools change where water is available and what vending machines sell. At the policy level, the district updates its wellness policy to allow water bottles in class and to require water at lunch.

SMART Objectives

By the end of the first school year, every middle school cafeteria will have at least one chilled water dispenser and each building at least three bottle-filling stations, with all outlets tested for lead before use. Twelve months in, the share of middle school students who report drinking water at school on a typical day will rise from about 50% to 70%. By the end of the first year, sales of sugar-sweetened beverages from school vending machines will fall to zero as machines are restocked with water and unsweetened options. By the end of the second year, the share of students drinking a sugar-sweetened beverage daily will fall from 31% to 25%.

Program Design

The district's facilities department will install six cafeteria dispensers and 18 bottle-filling stations, funded by a county health department grant and the district's capital budget, at an estimated $95,000. Before installation, every drinking outlet will be tested for lead, and any fixture above the district's action level will be replaced or filtered. Each student will receive a reusable bottle, and teachers will be asked to let students keep bottles at their desks, a change the wellness policy will make official. Custodial staff will clean stations daily and change filters on a schedule posted beside each one, so students can see that the water is looked after. Student councils at each school will design the campaign, choosing slogans and posting counters that display how many bottles each station has filled. The district's food service will restock vending machines. The county health department will provide evaluation support and communication materials in the languages families speak.

Evaluation

Process measures include outlets installed and tested, bottles distributed, gallons dispensed from station counters and vending sales by product. Outcome measures include the annual student survey questions on water and sugary drinks and, over several years, the district's fitness assessment data on body mass index, interpreted cautiously given the small effects expected.

Partners and Roles

The county health department funds equipment and leads evaluation. The district's facilities staff install, test and maintain outlets. Food service manages vending changes and cafeteria dispensers. Student councils run the campaign, and the parent-teacher associations help distribute bottles and explain the program to families. A small steering group with one member from each partner meets each quarter to review station counters and survey results.

Equity and Sustainability

Students in the district's lower-income neighborhoods reported the highest daily sugary drink use and the fewest working fountains, so installation begins in their buildings. To last, the program needs a maintenance budget for filters and repairs and a named staff member at each school responsible for the stations, both written into the wellness policy.

Conclusion

Making water cold, free and close at hand is a modest, evidence-based way to shift a school population toward healthier drinks. Built on the health impact pyramid and socioecological model, held to measurable objectives and grounded in careful attention to water safety and equity, it is a health promotion strategy that changes the setting rather than asking students to change on their own.

References

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590-595. https://doi.org/10.2105/AJPH.2009.185652

Patel, A. I., & Hampton, K. E. (2011). Encouraging consumption of water in school and child care settings: Access, challenges, and strategies for improvement. American Journal of Public Health, 101(8), 1370-1379. https://doi.org/10.2105/AJPH.2011.300142

Schwartz, A. E., Leardo, M., Aneja, S., & Elbel, B. (2016). Effect of a school-based water intervention on child body mass index and obesity. JAMA Pediatrics, 170(3), 220-226. https://doi.org/10.1001/jamapediatrics.2015.3778