title: Food environments in schools and in the immediate vicinity are associated with unhealthy food consumption among Brazilian adolescents.
abstract: Evidence 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.
  
  
  
  We 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 (>5days/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.
  
  
  
  Having 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.
  
  
  
  Foods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil.
authors.affiliation: Faculdade de Medicina da Universidade Federal de Uberlândia, Av. Pará 1720, Bloco 2 U, Sala 20, Campus Umuarama, Uberlândia, MG 38.405-320, Brazil. Electronic address: catarina.azeredo@ufu.br.
authors.forename: Catarina Machado
authors.initials: CM
authors.lastname: Azeredo
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Medicina Preventiva, Av. Dr. Arnaldo 455, 2° Andar., São Paulo, São Paulo 01246-903, Brazil. Electronic address: lerezende@usp.br.
authors.forename: Leandro Fórnias Machado
authors.initials: LF
authors.lastname: de Rezende
authors.affiliation: Instituto de Nutrição da Universidade Estadual do Rio de Janeiro, Rua São Francisco Xavier, 524, Rio de Janeiro, RJ 20550-013, Brazil. Electronic address: danicanella@gmail.com.
authors.forename: Daniela Silva
authors.initials: DS
authors.lastname: Canella
authors.affiliation: Escola de Enfermagem da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte, MG 01246904, Brazil. Electronic address: rafael.claro@gmail.com.
authors.forename: Rafael Moreira
authors.initials: RM
authors.lastname: Claro
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Medicina Preventiva, Av. Dr. Arnaldo 455, 2° Andar., São Paulo, São Paulo 01246-903, Brazil. Electronic address: mftperes@usp.br.
authors.forename: Maria Fernanda Tourinho
authors.initials: MF
authors.lastname: Peres
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Medicina Preventiva, Av. Dr. Arnaldo 455, 2° Andar., São Paulo, São Paulo 01246-903, Brazil. Electronic address: olinda@usp.br.
authors.forename: Olinda do Carmo
authors.initials: Odo C
authors.lastname: Luiz
authors.affiliation: Faculdade de Saúde Pública da Universidade de São Paulo, Av. Dr. Arnaldo 715, 2° Andar., São Paulo, São Paulo 01246-904, Brazil. Electronic address: ifjunior@usp.br.
authors.forename: Ivan
authors.initials: I
authors.lastname: França-Junior
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: Sanjay.Kinra@lshtm.ac.uk.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kinra
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: Sophie.Hawkesworth@lshtm.ac.uk.
authors.forename: Sophie
authors.initials: S
authors.lastname: Hawkesworth
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Departamento de Medicina Preventiva, Av. Dr. Arnaldo 455, 2° Andar., São Paulo, São Paulo 01246-903, Brazil. Electronic address: rlevy@usp.br.
authors.forename: Renata Bertazzi
authors.initials: RB
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D001938:Brazil; D002253:Carbonated Beverages / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy; D004435:Eating; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012574:Schools; D062410:Snacks; D013334:Students / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Adolescent; Diet; Environmental health; Multilevel modelling; School food environment