public spaces crop.png

Water First

Drinking sugar-sweetened beverages, such as sodas and other drinks with added sugar, is a major contributor to obesity, high cholesterol, diabetes, cavities, and other chronic conditions. Children spend substantial time in schools where they consume up to 50% of daily calories, including those from sugary drinks.

En español

While schools have restricted access to sugary drinks on their campuses, there has been limited focus on making sure that students have access to healthy beverage alternatives like safe drinking water. If students drink more water, it may not only help them maintain a healthy weight, but may also help to prevent cavities and improve their ability to learn.


The goal of the Water First randomized controlled study is to understand if providing clean and fresh water in schools and promoting its intake helps students to have healthier nutrition and weight.

Eligible Schools

  • Elementary schools in the San Francisco Bay Area

  • Schools that have at least 50% students who are eligible for free and reduced price meals

  • Limited access to appealing drinking water such as water dispensers or stations; no access to cups or other drinking vessels

Water First Program

  • Three lead-free water bottle filling stations will be installed at the school

  • Compostable or recyclable cups are provided in the cafeteria

  • Each 4th grade student receives a BPA-free water bottle for home and school

  • Children's singer Andy Z will perform a song about drinking water

  • Participating classrooms receive lessons about why drinking water is important for health

  • Special activities for 4th grade classes

  • Some schools get the program now whereas others receive a modified version of the program at a later date

Water First Evaluation

School-level evaluation includes the following activities:

  • Observations of what students drink at school, including from drinking fountains and water stations

  • Audits of drinking water sources and other beverages available at school

  • Surveys with administrators and food service personnel about school nutrition and physical activity policies

  • School administrators and personnel receive gift cards for their participation

Fourth grade students participate in the following evaluation activities:

  • Complete two 24-hour food and beverage diaries

  • Have height and weight measurements taken three times throughout the study

  • Complete short surveys about beverage intake, screen time and physical activity three times throughout the study

  • Students receive movie gift cards for their participation

Policy Implications

The information gathered during the study may help schools, public health officials and policymakers better understand how improvements in water access and water promotion affect student health.

Study Status

Recruiting schools

View Full Protocol


National Institutes of Health


Water First.png