Crystal Smit

General Discussion 6 139 The Impact of the Intervention This dissertation demonstrated that the Share H 2 O intervention can improve children’s healthy drinking behaviors. However, it is important to note that these changes in beverage consumption were small—about a quarter of a serving per day. Nevertheless, previous research has shown that even small changes in daily intake can have an impact on children’s weight. In fact, consuming just one serving of SSB per day appears to lead to an additional weight gain of 6.75 kg in one year (Apovian, 2004). From this perspective, reducing children’s SSB consumption with a quarter of a serving per day over a longer period of time could be a step in the right direction in preventing childhood overweight and obesity. To determine the impact of these small changes in beverage consumption, it would be interesting for future research to perform a cost-effectiveness analysis. In such analyses, the implementation costs of the intervention are compared with the outcomes measured in natural units, in this case per healthcare cost reduction (Gray, Clarke, Wolstenholme, & Wordsworth, 2011; Weinstein & Stason, 1977). Although the changes in consumption behavior caused by the Share H 2 O social network intervention appeared to be small, they were found to be greater than other interventions promoting water consumption. A recent meta-analysis conducted among 24 interventions that showed an improvement in children’s healthy drinking behavior concluded the following: “Two studies, an RCT by Smit et al. that used a peer influence intervention strategy and a large non-RCT by Muckelbauer et al. that installed water fountains at schools had a larger effect compared with the effect of most other studies included in our review” (Franse et al., 2020, p. 9). The findings of this meta-analysis imply that promoting change in the social and/or physical environment are effective intervention strategies for encouraging water consumption among children. Future research should investigate the effect of a combined approach, implementing both the Share H 2 O intervention and installing