Beverage intake among Jamaican School Children: An analysis across child and school environment levels.

Sugar-sweetened beverages, a subset of ultra-processed foods, are consumed frequently by children in Jamaica. Given the abundance of time children spend in school and the evidence for school-related determinants of dietary intake, school food environments can be key influencers of children's beverage consumption and drive their dietary behaviors and preferences. 907 primary school students (ages 7-11) in Jamaica were surveyed on their demographic information, nutrition-related preferences, knowledge, and consumptions patterns of sweetened and unsweetened beverages in 2018. School environment audits, documenting internal and external factors from the 30 schools which children attended, were completed at the same time. A two-part model was applied that considered children's probability of consuming each beverage type and the amount they consumed. Models accounted for both child-level characteristics and school food environment measures. Descriptive statistics revealed a large proportion of non-consumers of water (20.9%) and unsweetened beverages (19.8%). Collectively, child-level factors contributed to the modeling of all beverage types and external school environment measures were highly significant to the sweetened beverage model fit. External school measures were jointly associated with sweetened beverage consumption volume while unsweetened beverage intake is more likely impacted by classroom rules, school wide policies, and the internal school environment. Results support the inclusion of beverage regulations, both the promotion of unsweetened and the de-incentivization of sweetened drinks, in Jamaica's recently approved national school nutrition policy.