Journal
PREVENTIVE MEDICINE
Volume 146, Issue -, Pages -Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ypmed.2021.106456
Keywords
School food environment; Product availability; Adolescent; Healthy diet; Longitudinal data
Funding
- Network of Applied Research and Knowledge at Getulio Vargas Foundation
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) [001]
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Evidence suggests that the school food environment in Brazil's private schools has low availability of high nutritional value products. However, improving menu quality can lead to increased consumption of healthier products and decreased consumption of unhealthy ones.
Evidence of the association between the school food environment and children?s and adolescents? diet is mostly cross-sectional, usually based on self-reported behavior, and often conducted in high-income countries. Also, relatively little is known about how variations in menu quality associate with the subsequent expenditure on food and beverages of the same-(vs. cross-) nutritional value. Based on a three-year longitudinal dataset comprised of 4,268,457 purchases made by 20,333 children and adolescents from 54 private schools in Brazil, we unobtrusively assess how changes in (un)healthy product availability associate with students? subsequent purchase behavior. Our results reveal that, on average, only 11.6% of the products offered in the school cafeterias were of high nutritional value (HNV). Critically, expenditure on HNV products increased following both the addition of one HNV product (13 = 0.18; 95% CI = 0.128, 0.240) and, to a lesser extent, the subtraction of one low nutritional value (LNV) product from the menu (13 =-0.03; 95% CI =-0.042,-0.016). Cross-nutritional value effects were stronger for beverages. The inclusion of one HNV beverage was associated not only with a subsequent increase in expenditure on HNV beverages (13 = 0.19; 95% CI = 0.115, 0.264), but also with a decrease in expenditure on LNV beverages (13 =-0.18; 95% CI =-0.352,-0.010). Although only a small percentage of foods and beverages consumed in private school cafeterias in Brazil are of high nutritional value, improvements to menu quality have the potential to increase the consumption of healthier products and decrease the consumption of unhealthy ones.
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