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CHOICES Research to Be Presented at APHA 2018

At the 2018 American Public Health Association’s (APHA) Annual Meeting and Expo in San Diego, CA, Jennifer Reiner will present CHOICES research. Presentation details are below.

Date: Sunday, November 11, 2018Logo for APHA 2018
Time: 4:30pm-5:30pm
Session: 2098.0 FN Section Poster Session 5
Program: Food and Nutrition

Board 1: Strategies to promote water consumption in schools: Impacts on population health, health equity, and cost-effectiveness

Introduction: School-based strategies promoting water consumption hold promise for reducing youth sugary drink intake and obesity prevalence, improving hydration, and narrowing health disparities. However, their relative cost-effectiveness and population impact are unknown. Our objectives were to estimate the costs and health impacts of four school-based water promotion strategies overall and by race/ethnicity and socioeconomic status.

Methods: The Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost-effectiveness of nationwide installation of chilled water dispensers on school lunch lines as well as the cost, number of children reached, and impact on water consumption of three separate additional strategies elsewhere in the cafeteria: installing cup dispensers and cups near existing water fountains, distributing bottle-less water coolers, and using portable water dispensers.

Results: Installing chilled dispensers on lunch lines was estimated to reach 56.0 million children (95% uncertainty interval (UI): 55.5 million, 56.5 million) over 10 years, prevent 180,000 cases of childhood obesity in 2025 (95% UI: 102,000, 258,000) and save $0.31 in healthcare costs per dollar invested (95% UI: $0.15, $0.55). Although installing cup dispensers next to existing water fountains was the least costly intervention, it also reached fewer children and had less impact. Preliminary results indicate all these strategies also reduce disparities in obesity prevalence and water consumption.

Discussion: Interventions to promote drinking water in schools should be considered as effective, relatively inexpensive strategies for addressing childhood obesity, improving water intake, and reducing health disparities.

Learning Areas

  • Public health or related public policy Social and behavioral sciences

Learning Objectives

  • Explain how cost-effectiveness analysis can be used to understand the potential public health impact of different school-based water interventions. Compare the costs, population reach, and impact on drinking water consumption of four evidence-based school water promotion strategies. Describe the estimated impact of a hypothetical nationwide implementation of a school water strategy on disparities in childhood obesity.


  • Water & Health
  • School-Based Health

Jennifer Reiner, MPH


Erica L. Kenney, ScD
Harvard T.H. Chan School of Public Health
Angie L. Cradock, ScD, MPE
Harvard T.H. Chan School of Public Health
Michael Long, ScD
George Washington University
Jessica L. Barrett, MPH
Harvard T.H. Chan School of Public Health
Catherine M. Giles, MPH
Harvard T.H. Chan School of Public Health
Zachary J. Ward, MPH
Harvard T.H. Chan School of Public Health
Jennifer Reiner, MPH
Harvard T.H. Chan School of Public Health
Steven L. Gortmaker, PhD
Harvard T.H. Chan School of Public Health