RESEARCH Research and Professional Briefs Factors Associated with Low Drinking Water Intake among Adolescents: The Florida Youth Physical Activity and Nutrition Survey, 2007 SOHYUN PARK, PhD, MS; BETTYLOU SHERRY, PhD, RD; TERRENCE O’TOOLE, PhD; YOUJIE HUANG, MD, DrPH ABSTRACT There is limited information on which characteristics are associated with water intake among adolescents. This cross-sectional study examined the association between demographic, dietary, and behavioral factors and low wa- ter intake as the outcome measure. Analyses were based on the 2007 Florida Youth Physical Activity and Nutri- tion Survey using a representative sample of 4,292 stu- dents in grades six through eight in 86 Florida public middle schools. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for factors associated with low water intake (3 glasses water per day). About 64% of students had low water intake. Factors significantly associated with low water intake were Hispanic ethnicity and non- Hispanic other (vs non-Hispanic white; ORs 0.79 and 0.76, respectively), drinking no 100% juice, drinking it 1 time/day, and drinking it 1 to 2 times/day (vs drinking it 3 times/day; ORs 1.83, 1.91, and 1.32, respectively), drinking no milk and drinking 2 glasses of milk/day (vs drinking 2 glasses/day; ORs 1.42 and 1.41, respec- tively), drinking 1 soda/day (vs drinking none; OR 1.40), drinking fruit-flavored drinks/sports drinks 1 time/day and drinking it 1 time/day (vs drinking none; ORs 1.49 and 1.41, respectively), eating at a fast-food restaurant 3 days/week (vs none; OR 1.38, respectively), not par- ticipating on team sports or participating on 1 to 2 team sports in previous 12 months (vs participating on 3 teams; ORs 1.77 and 1.24, respectively), and consuming snack/soda while watching television/movies “sometimes” and “most/every time” (vs never; ORs 1.65 and 2.20, re- spectively). The strongest factor associated with low wa- ter intake was frequent consumption of snacks/sodas while watching television/movies. Although study find- ings should be corroborated in other states and in a nationally representative sample, they may be useful in targeting adolescents for increased water consumption. J Am Diet Assoc. 2011;111:1211-1217. T he prevalence of childhood obesity has increased sub- stantially in the United States (1,2) and is a major public health concern because of morbidities associ- ated with it (3-5). High consumption of sugar drinks has been associated with obesity among youth (6-10). Sugar drinks are the largest source of added sugar (11) and account for 7.1% of total energy in the average US diet (12). Given that the average energy intake among US youth has increased during the past few decades, partic- ularly from sugar drinks (13,14), the substitution of drinking water for sugar drinks might help them to main- tain a healthier weight (10,15). Adequate water consumption is important in prevent- ing dehydration, which has been associated with adverse health outcomes, including certain cancers (16,17), coro- nary heart disease (16), kidney stones (16), and severe bronchopulmonary disorders (18). Although total water intake requirements can be met by consuming beverages and foods, drinking water is a zero-energy, thirst-quench- ing option (16) that obviously will not promote obesity. The adequate intake (AI) level for water in any form (foods, beverages, and drinking water) was established by the Institute of Medicine as a guide for preventing ad- verse effects of dehydration rather than for decreasing risks for chronic diseases (16). Specific AI levels vary by sex and age. The AI levels for total water are 2.4 L/day, including 1.8 L (8 c) in the form of water or other beverages for boys 9 to 13 years of age and 3.3 L/day, including 2.6 L (11 c) as beverages for boys 14 to 18 years of age. The AI levels for total water are 2.1 L/day, including 1.6 L (7 c) in the form of water or other beverages for girls 9 to 13 years of age and 2.3 L/day, including 1.8 L (8 c) as beverages for girls 14 to 18 years of age. People who are physically active or living in hot climates require even more water (16). However, based on the 2005-2006 National Health and Nutrition Examina- tion Survey (NHANES), the average total water intake S. Park is an epidemiologist and B. Sherry is a lead epi- demiologist, Division of Nutrition, Physical Activity, and Obesity, and T. O’Toole is a public health analyst, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Pre- vention, Atlanta, GA. Y. Huang is the state chronic dis- ease epidemiologist, Bureau of Epidemiology, Florida Department of Health, Tallahassee. Address correspondence to: Sohyun Park, PhD, MS, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Pre- vention, 4770 Buford Hwy, NE, Atlanta, GA 30341. E-mail: spark3@cdc.gov Manuscript accepted: February 7, 2011. Published by Elsevier Inc. on behalf of the American Dietetic Association. 0002-8223/$0.00 doi: 10.1016/j.jada.2011.05.006 Journal of the AMERICAN DIETETIC ASSOCIATION 1211