Abstract: Background: Increasing attention has been paid to the school food environment as a strategy to reduce childhood obesity. The purpose of this study was to examine associations between the school food environment, students’ dietary intake, and obesity in British Columbia (BC), Canada. Methods In 2007/08, principal responses about the school environment (N = 174) were linked to grades 7-12 students (N = 11,385) from corresponding schools, who participated in the BC Adolescent Health Survey. Hierarchical mixed-effect regression analyses examined the association between the school food environment and student’s intake of sugar-sweetened beverages (SSBs), food consumption, and body mass index. Analyses controlled for school setting, neighborhood education level and student’s age and sex. Results School availability of SSBs was positively associated with moderate (Odds Ratio (OR) = 1.15, 95% Confidence Interval (CI) = 1.02-1.30) and high (OR = 1.43, 95% CI = 1.13-1.80) SSB intake as were less healthful school nutrition guidelines for moderate SSB consumers only (OR = 0.65, 95% CI = 0.48-0.88). Availability of SSBs at school and its consumption were positively associated with student obesity (OR = 1.50, 95% CI = 1.12-2.01 and OR = 1.66, 95% CI = 1.19-2.34, respectively) but not with overweight. In contrast, consumption of less healthful food was positively associated with overweight (OR = 1.03, 95% CI = 1.01-1.06). Conclusions The results of this study provide further evidence to support the important role of schools in shaping adolescents’ dietary habits. Availability and consumption of SSBs, but not less healthful foods, at school were associated with higher adolescent obesity highlighting that other environments also contribute to adolescent obesity. ; Applied Science, Faculty of ; Medicine, Faculty of ; Nursing, School of ; Pediatrics, Department of ; Non UBC ; Population and Public Health (SPPH), School of ; Reviewed ; Faculty
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