Factors underlying compliance with a healthy snacking initiative in the school environment: accounts of school principals in Montevideo (Uruguay)

Objective: To evaluate the implementation of the Uruguayan healthy snacking initiative in primary and secondary schools in the capital, and to explore the factors underlying compliance from the perspective of school principals. Design: A mixed-method approach was used, which included semi-structured interviews with school principals and a survey of the foods and beverages sold and advertised in the schools. Setting: Primary and secondary schools in Montevideo (the capital city of Uruguay). Participants: School principals. Results: The great majority of the schools did not comply with the initiative. Exhibition of non-recommended products was the main cause for noncompliance, followed by advertising of non-recommended products through promotional activities of food and beverage companies. Although school principals were aware of the healthy snack initiative and showed a positive attitude towards it, the majority lacked knowledge about its specific content. Factors underlying compliance with the healthy snacking initiative were related to its characteristics, characteristics of the schools, and external factors such as family habits and advertising. Conclusions: Results showed that the rationale underlying the selling of products at schools favours the availability of ultra-processed products and constitutes the main barrier for the promotion of healthy dietary habits among children and adolescents. Strategies aimed at facilitating the identification of unhealthy foods and beverages and provision of incentives to canteen managers to modify their offer are recommended.