Family Food Environments and Their Association with Primary and Secondary Students' Food Consumption in Beijing, China: A Cross-Sectional Study.

Family is the most fundamental and proximal context for children, and children's eating behavior occurs mostly in the home or together with family members. With this study, we aimed to evaluate the distribution of family food environment dimensions and their relationship with healthy and unhealthy food consumption in primary and secondary students in order to provide evidence in the Chinese context and explore environmental solutions for improved child nutrition. Multi-stage stratified cluster sampling was used to conduct a cross-sectional survey among students in Beijing, China, from September 2020 to June 2021. Family food environment (FFE) was measured by the validated Family Food Environment Questionnaire for Chinese School-age Children, which was self-administered by the children's caregivers. The students were asked to answer questions about food consumption frequencies in the past 7 days. Binary logistic regression models were used to investigate the relationships between food consumption frequency and FFE, and odds ratios ( ORs ) with 95% confidence intervals ( CI ) were computed for independent variables. Among the study population, 9686 students in grades 3-12 and their caregivers completed the survey. The mean score of FFE was 65.7 (±8.4) out of a total possible score of 100, with 76.6% of students categorized as relatively healthier according to their FFE score (≥ 60). Compared with the reference group, students in primary schools and those cared for principally by parents were more likely to be in a healthy FFE category ( p < 0.05). Daily consumption of fruits and vegetables was reported by 62.6% and 71.6% of students, respectively, and weekly sugared soft drink consumption was reported by 70.9% of the students. Students with a healthier FFE score (≥60) were more likely to consume fruits ( OR = 1.578, 95% CI : 1.428~1.744) and vegetables ( OR = 1.402, 95% CI : 1.263~1.556) but less likely to consume sugared soft drinks ( OR = 0.592, 95% CI : 0.526~0.667). Family food availability ( β = 0.137), caregivers' nutritional literacy ( β = 0.093), meal practices ( β = 0.079) and food rules ( β = 0.050) were positively correlated with food consumption behavior ( p < 0.05). The students with healthier FFE scores ( OR = 1.130, 95% CI : 1.014~1.258) and whose caregiver was obese ( OR = 2.278, 95% CI : 1.973~2.631) were more likely to be overweight. The family food environment plays an important role in shaping food consumption in children. Provision of healthy foods instead of unhealthy foods, positive meal practices and food rules, and nutrition education for parents can promote healthy eating in children.