1 Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 2 Faculdade de Medicina da Universidade Federal de Uberlândia, Brazil; 3 Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 4 Faculdade de Saúde Pública da Universidade de São Paulo, Sao Paulo, Brazil.
Purpose: Evidence of the influence of the school food environment on adolescents’ diet is still mixed and little explored in low- and middle-income countries. We aimed to evaluate the association between school food environment and the regular intake of unhealthy food markers among adolescents. Methods: We used 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 intake (>5 days/week) of unhealthy food markers (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and the school availability, in the cafeteria or an alternative outlet, of the same markers plus some healthy options (fruit, and natural fruit juice). We performed multilevel logistic regression models. Results: Cafeteria selling unhealthy foods inside school, irrespective of school type, were associated with a higher frequency of intake of unhealthy food items among students. In private schools, cafeteria selling fruits and natural fruit juice were associated with lower student consumption of soft drinks and bagged salty snacks. In addition, eating meals from the Brazilian School Food Program in public schools was related to a lower frequency of consumption of unhealthy foods. Conclusions: School food environments that provide unhealthy food options are associated with students’ regular intake of unhealthy food among Brazilian adolescents.