Abstract A26: Relative influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens
Authors: Clarke Megan A. , Tabak Rachel G. , Schwarz Cynthia D. , Haire-Joshu Debra L. , Joshu Corinne E. 
Published: October 2015

Abstract
Background: Nearly one third of adolescent girls are overweight or obese, and this risk is significantly heightened for postpartum, high-risk teenagers. Interventions among this difficult to reach population are critical for the prevention of obesity and related health effects, including several types of epithelial cancers. Targeting the home and school environment, where teens spend most of their time, may be particularly effective at reducing behaviors associated with obesity. Previously, in a study of high-risk postpartum teens, we found a greater influence of the perceived home food environment (vs. school) on total calories consumed from food and beverage groups. Here we aim to build upon these findings, looking at consumption of specific food and beverage items and the relative influence of school and home food environments, and whether relationships vary by baseline body mass index (BMI).
Methods: This is a cross-sectional, baseline analysis of 875 girls enrolled in the Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE) study, a weight loss intervention designed to prevent obesity among postpartum, high-risk adolescents across 26 states. A total of 8 items were used to assess perceived healthful school and home food environments, respectively, on a 5-point Likert Scale. Ratings were averaged and dichotomized to generate an overall environment score. To assess the relative influence of home and school environment, we created the following categories: 0,“negative school & home”; 1, “positive school only” 2, ”positive home only” 3, ”positive school & home”. Frequency of specific food and beverage items were collapsed into binary categories to reflect infrequent (0-3 days/week) and frequent (4-7 days/week) consumption. Height and weight were obtained by trained staff and used to calculate BMI-for-age (dichotomized as normal [&lt;85th %tile] and overweight/obese [≥85th %tile]). Relationships between environment and dietary behaviors were assessed using chi-square tests. To assess the relative influence of home and school environments, we used logistic regression with generalized estimating equations (GEE) to account for clustering within state. Regression models were adjusted for race, age, and postpartum status (results reported as GEE OR, 95% CI). All models were stratified by baseline BMI.
Results: Among 875 postpartum teens, a positive home environment was significantly associated with decreased consumption of chips and increased consumption of fruit and vegetables (p &lt;0.05). A positive school environment was associated with increased fruit consumption (p &lt;0.05). In terms of beverage items, only a positive home environment was significantly associated with increased consumption of water and milk and a decreased consumption of regular soda (chi-sq p &lt;0.05). Results from the regression analyses indicated significant relationships between a positive home, and both positive home & school environments and healthy food items (i.e., fruit: 2.9, 1.6 – 5.6 and 2.9, 1.6 – 5.4, respectively) and decreased consumption of unhealthy food items (i.e., chips: 0.5, 0.3 – 0.8 and 0.8, 0.5 – 1.1, respectively). Similar findings were observed for beverage items (i.e., water: 2.6, 1.7 – 4.0 and 1.8, 1.2-2.6, respectively) and (i.e., regular soda: 0.5, 0.3 – 0.7 and 0.7, 0.5 – 1.0, respectively). In general, patterns did not differ significantly by baseline BMI.
Conclusions: In this understudied population of postpartum teens, the home environment was associated with healthy dietary behaviors. Results indicated that having a positive home environment was enough to influence behavior and for many items, the added benefit of a positive school environment was relatively low. Improving the home environment may be particularly important among this population of teen moms who are at increased risk for obesity and who are in a position to pass down their food behaviors to their children.
Citation Format: Megan A. Clarke, Rachel G. Tabak, Cynthia D. Schwarz, Debra L. Haire-Joshu, Corinne E. Joshu. Relative influence of home and school environments on specific dietary behaviors among postpartum, high-risk teens. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A26.