Twenty-six schools were approached for the study. Two declined because of concerns that the study evaluation would be disruptive to instructional time, 11 already had a nonfountain water source in their cafeteria, and 1 never responded. In each study arm (ie, dispenser schools, cooler schools, control schools), 240 students were randomly sampled to complete evaluation surveys. In dispenser schools, 33 students refused or did not complete baseline surveys, and 4 students refused or did not complete follow-up surveys. In cooler schools, 45 students refused or did not complete baseline surveys and 2 students refused or did not complete follow-up surveys. In control schools, 37 students refused or did not complete baseline surveys and 4 students did not complete follow-up surveys. We analyzed data from 4 schools in each study arm; data from 203 students were analyzed in the dispenser schools, data from 193 students were analyzed in the cooler schools, and data from 199 students were analyzed in the control schools.

Figure 1. Consolidated standards of reporting trial diagram of study participants from middle schools, San Francisco Bay Area, 2013. 

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Figure 2. Measurements of water taken from free water sources in cafeterias at lunch in San Francisco Bay Area Middle Schools, 2013. The mean ounces of water per student taken from intervention water sources at lunch during the intervention period was not significantly different in schools with water dispensers than in schools with bottleless water coolers (P = .19). Water taken from traditional fountains in control schools was not measured.

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