Evidence map›Paper›PMID 42288871›Full record

Trial reportBMC public health2026

Fidelity evaluation of the Water First intervention for promoting tap water consumption in school-age children.

Anjali Gupta, Keejeong Ryu, Yadira Peralta, Valeria Ordonez, Charles E McCulloch, Laura A Schmidt, Lorrene D Ritchie, Anisha I Patel

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03181971 (The Impact of the School Water Access on Child Food and Beverage Intake and Obesity), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03181971 nacompletednot on this map

The Impact of the School Water Access on Child Food and Beverage Intake and Obesity

TypeinterventionalSponsorStanford UniversityRan2016 to 2022Enrolled1,861ConditionsObesityArmsWater First
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Anjali GuptaStanford University School of Medicine, Stanford, CA, USA.
Keejeong RyuQuantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA.
Yadira PeraltaCenter for Research and Teaching in Economics, Department of Applied Economics, Aguascalientes, Mexico.
Valeria OrdonezDepartment of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Charles E McCullochDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Laura A SchmidtPhilip R. Lee Institute for Health Policy Studies and Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA.
Lorrene D RitchieNutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, USA.
Anisha I PatelDepartment of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. anipatel@stanford.edu.

Funding

The Impact of School Water Access on Child Food and Beverage Intake and ObesityR01HL129288 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI PATEL, ANISHA INDRAVADAN · 2016 to 2020
$3.0M
National Heart, Lung, and Blood Institute of the National Institutes of Health R01HL129288NHLBI NIH HHS R01 HL129288
6 · The paper itself

Abstract

backgroundA cluster-randomized controlled trial examining the impact of the Water First water promotion and access program in 18 elementary schools found that the intervention increased water consumption and prevented overweight. This study describes a secondary analysis of implementation fidelity and its association with change in students' beverage intake and body mass index (BMI) z-score in the intervention arm.

methodsResearchers observed Water First fidelity (visible water promotional material, quality of study-provided water sources and drinking vessels in classrooms, school cafeterias, high-traffic areas) 2 times/week during the intervention period, with data collected via yes/no questions. Responses indicating high fidelity were assigned a value of 1 and low fidelity were assigned 0; these were averaged to generate a summary score for each location (0 to 1). Home-engagement activity completion (%) was calculated per student based on returned class assignments. Anthropometrics and past-week frequency of beverage intake (instrument adapted from the validated Beverage and Snack Questionnaire) were assessed at baseline, 7-months, and 15-months. Mixed-effects linear regression models examined associations of fidelity with the primary (water intake) and secondary (sugar-sweetened beverage [SSB], milk, 100% fruit juice intake, BMI z-score) outcomes. The primary predictor was the fidelity score (0.1-unit increase) by time interaction. Beverage frequencies were log-transformed, and regression coefficients were exponentiated to derive the percent change in outcomes.

resultsFidelity was highest in the cafeteria (mean: 0.87, SD: 0.06) compared to high-traffic water station areas (0.66, SD: 0.15) and classrooms (0.73, SD: 0.13). Mean home-engagement activity completion rate was 0.41 (SD: 0.33). There were no associations of fidelity with water intake. Each 0.1 unit increase in classroom fidelity was associated with a decreased intake of 100% fruit juice (0.95; Cl: 0.91-0.99). Higher high-traffic area fidelity was associated with decreased intake of SSB (0.94; Cl: 0.91-0.98) and plain milk (0.92; Cl: 0.89-0.96). Higher cafeteria fidelity was associated with 0.027 decrease in BMI z-score (Cl: -0.046, -0.008). No significant associations were observed for home-engagement activity completion.

conclusionsThe intervention was largely implemented with high fidelity, with scores ranging from 0.66 to 0.87. Higher cafeteria fidelity was associated with reductions in BMI z-score, while home-engagement activity completion was not associated with changes in beverage outcomes or BMI z-score.

trial registrationThe trial was preregistered (2017-06-09) at clinicaltrials.gov (NCT03181971).

Indexed as

DrinkingDrinking WaterHealth PromotionBeveragesBody Mass IndexChildFemaleHumansMaleOverweightProgram EvaluationSchoolsDrinking WaterBeveragesIntervention fidelityObesityPublic healthWater

Identifiers

PMID42288871
PMCPMC13491641

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.