Food environments in schools and in the immediate vicinity are associated with unhealthy food consumption among Brazilian adolescents

- School cafeterias selling unhealthy foods are associated with consumption of these items among Brazilian adolescents.
- Availability of healthy foods is associated with lower consumption of unhealthy foods among Brazilian adolescents.
- Lower consumption of unhealthy foods is associated with consumption of meals from the BSFP among Brazilian adolescents.
- Provision of healthy options has had limited impact on unhealthy food consumption among Brazilian adolescents.
- School food environments are an important target for improving dietary behaviour.

BackgroundEvidence of the influence of the school food environment on adolescent diet is still little explored in low- and middle-income countries. We aimed to evaluate the association between food environment in schools and the immediate vicinity and the regular consumption of unhealthy food among adolescents.MethodsWe used cross-sectional data collected by the Brazilian National Survey of School Health (PeNSE) from a representative sample of adolescents attending 9th grade public and private schools in Brazil, in 2012. We estimated students' regular consumption (> 5 days/week) of unhealthy food (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and school availability, in the cafeteria or an alternative outlet, of the same food plus some healthy options (fruit and natural fruit juice). We performed multilevel logistic regression models.ResultsHaving a cafeteria inside school selling soft drinks (private schools OR = 1.23; 95% CI = 1.14-1.33; public schools OR = 1.13; 95% CI = 1.06-1.20) and deep fried salty snacks (private schools OR = 1.41 95% CI = 1.26-1.57; public schools OR = 1.16 95% CI = 1.08-1.24) was associated with a higher consumption of these unhealthy foods of among students. In private schools, cafeteria selling fruit and natural fruit juice was associated with lower student consumption of bagged salty snacks (OR = 0.86; 95% CI 0.77-0.96) and soft drinks (OR = 0.85; 95% CI = 0.76-0.94). In addition, eating meals from the Brazilian School Food Program in public schools was associated with a lower consumption of unhealthy foods.ConclusionsFoods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil.