Food environment near schools in the largest Brazilian metropolis: analyses and contributions based on census data

Leite, Maria Alvim; Barata, Mayra Figueiredo; Levy, Renata Bertazzi

doi:10.1590/0102-311XEN030223

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ARTICLE • Cad. Saúde Pública 39 (9) • 2023 • https://doi.org/10.1590/0102-311XEN030223 copy

Food environment near schools in the largest Brazilian metropolis: analyses and contributions based on census data

Ambiente alimentar próximo às escolas na maior metrópole brasileira: análises e contribuições com base em dados censitários

Entorno alimentario cerca de las escuelas en la mayor metrópoli brasileña: análisis y contribuciones a partir de datos censales

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

Keywords:
Schools; Food Supply; Access to Healthy Foods; Built Environment; Geographic Mapping

MOST COMMON SCHOOL CATEGORIES IN BRAZIL		COVERAGE OF BASIC EDUCATION STUDENTS *	ADMINISTRATION MODE	STUDENT COSTS
Public	Municipal	48.4%	Management and funds from the municipality	Free
Public	State	32.1%	Management and funds from the state	Free
Private		18.6%	Private management	Monthly fee

Characteristics	Total	Municipal (17.78%)	State (37.04%)	Private (45.18%)
Characteristics	%	%	%	%
Schools
Size (students)
Up to 200	21.1	0.0	3.2	44.0
200-500	20.5	2.5	15.5	31.7
500-1,000	27.8	31.9	39.1	16.9
Over 1,000	30.6	65.6	42.2	7.4
Education offered
Just elementary school	55.8	98.6	41.1	51.1
Elementary school and high school or just high school	44.9	1.4	58.9	48.9
Neighborhood of the school
M-HDI (quartiles)
1	25.3	41.6	36.3	9.7
2	25.3	30.1	25.6	23.1
3	25.3	19.3	22.8	29.8
4	24.2	9.0	15.3	37.4
Population (average)	18,160	17,856	18,099	18,330

Establishments/Schools	Radius of 100m	Radius of 200m	Radius of 300m	Radius of 400m	Radius of 500m	p-trend
Establishments/Schools	Adjusted mean *	Adjusted mean *	Adjusted mean *	Adjusted mean *	Adjusted mean *	p-trend
Street vendors
Municipal	13.3	12.8	12.6	12.9	12.5	0.15
State	13.2	12.6	12.6	12.8	12.6	0.28
Private	15.2	16.0	15.3	15.0	14.4	0.16
Bars
Municipal	9.2	8.2	8.0	8.0	7.7	0.05
State	7.0	8.3	8.4	8.6	8.4	0.14
Private	10.4	10.8	10.3	9.9	9.6	0.08
Candy store
Municipal	6.1	6.1	5.9	5.7	5.5	0.01
State	4.7	5.3	5.3	5.3	5.4	0.09
Private	7.8	7.4	6.8	6.5	6.2	< 0.01
Bakeries
Municipal	6.1	5.9	5.4	5.7	5.5	0.11
State	5.7	5.7	5.9	5.9	5.9	0.06
Private	7.5	8.2	7.7	7.2	6.9	0.19
Snack bars
Municipal	28.1	29.2	28.5	28.9	28.5	0.75
State	25.9	31.0	31.3	32.1	31.9	0.10
Private	44.5	45.8	42.6	40.2	38.2	0.02
Mini markets
Municipal	15.1	15.0	13.4	13.7	13.3	0.04
State	12.7	14.3	14.6	14.6	14.4	0.18
Private	16.5	18.3	17.3	16.6	16.1	0.43
Super and hypermarkets
Municipal	1.0	1.4	1.5	1.7	1.7	0.03
State	1.5	1.5	1.7	1.8	1.8	0.01
Private	2.9	3.1	2.7	2.5	2.4	0.04
Fruit and vegetable stores
Municipal	4.6	4.6	5.4	6.0	5.8	0.03
State	4.4	5.4	5.7	5.8	6.1	0.03
Private	9.2	8.3	7.4	7.3	7.0	0.01
Butcher shops and fish markets
Municipal	5.5	3.9	4.0	4.4	4.0	0.28
State	3.0	3.5	3.5	3.7	3.9	0.01
Private	5.9	6.2	5.5	5.2	5.1	0.04

Establishments/Schools	Mean (95%CI)	Crude model		Adjusted model *		Prevalence (95%CI)	Crude model		Adjusted model *
Establishments/Schools	Mean (95%CI)	β	p	β	p		PR	p	PR	p
Street vendors
Municipal	2.9 (2.7; 3.2)	Reference		Reference		85.1 (81.8; 87.8)	Reference		Reference
State	2.7 (2.5; 2.8)	-0.26	0.08	-0.01	0.97	79.3 (76.9; 81.6)	0.67	0.01	0.88	0.45
Private	2.7 (2.6; 2.9)	-0.18	0.20	0.54	0.01	80.2 (78.1; 82.2)	0.71	0.01	1.44	0.07
Bars
Municipal	1.8 (1.6; 2.0)	Reference		Reference		65.6 (61.5; 69.4)	Reference		Reference
State	1.7 (1.6; 1.9)	-0.06	0.59	0.09	0.49	65.2 (62.4; 67.9)	0.98	0.88	1.27	0.06
Private	1.9 (1.7; 2.0)	0.03	0.76	0.48	< 0.01	66.2 (63.7; 68.7)	1.03	0.78	1.97	< 0.001
Candy store
Municipal	1.1 (0.9; 1.2)	Reference		Reference		50.8 (46.6; 55.0)	Reference		Reference
State	1.1 (1.0; 1.2)	0.01	0.88	-0.09	0.43	51.1 (48.2; 54.0)	1.01	0.90	1.11	0.38
Private	1.4 (1.3; 1.5)	0.32	0.00	0.27	0.05	56.3 (53.7; 58.9)	1.25	0.03	1.66	< 0.01
Bakeries
Municipal	1.3 (1.1; 1.4)	Reference		Reference		56.9 (52.8; 61.0)	Reference		Reference
State	1.2 (1.1; 1.3)	-0.08	0.35	0.07	0.51	56.6 (53.7; 59.4)	0.99	0.89	1.15	0.26
Private	1.5 (1.4; 1.5)	0.19	0.02	0.52	< 0.001	63.9 (61.4; 66.4)	1.34	0.00	1.96	< 0.001
Snack bars
Municipal	5.2 (4.6; 5.7)	Reference		Reference		86.9 (83.8; 89.4)	Reference		Reference
State	6.1 (5.5; 6.6)	0.92	0.08	0.51	0.41	83.0 (80.8; 85.1)	0.74	0.04	1.07	0.69
Private	8.9 (8.2; 9.5)	3.70	0.00	3.08	< 0.001	89.9 (88.2; 91.4)	1.35	0.05	2.57	< 0.001
Mini markets
Municipal	3.5 (3.2; 3.8)	Reference		Reference		79.6 (76.1; 82.8)	Reference		Reference
State	3.2 (3.0; 3.4)	-0.33	0.08	0.10	0.65	78.6 (76.1; 80.8)	0.94	0.60	1.18	0.29
Private	2.8 (2.6; 3.0)	-0,72	0,00	0,79	< 0.01	75,7 (73,4; 77,8)	0,80	0,06	1,56	0.02
Super and hypermarkets
Municipal	0.3 (0.3; 0.4)	Reference		Reference		21.8 (18.6; 25.4)	Reference		Reference
State	0.3 (0.3; 0.4)	-0.01	0.83	0.02	0.75	21.7 (19.4; 24.2)	0.99	0.97	1.12	0.45
Private	0.6 (0.5; 0.6)	0.22	0.00	0.26	< 0.001	34.0 (31.5; 36.5)	1.85	0.00	2.12	< 0.001
Fruit and vegetable stores
Municipal	1.4 (1.2; 1.5)	Reference		Reference		58.0 (53.9; 62.1)	Reference		Reference
State	1.2 (1.1; 1.3)	-0.17	0.07	0.11	0.30	52.7 (49.8; 55.6)	0.81	0.04	1.04	0.77
Private	1.3 (1.2; 1.4)	-0.09	0.32	0.53	< 0.001	55.8 (53.2; 58.4)	0.91	0.38	1.64	< 0.01
Butcher shops and fish markets
Municipal	0.9 (0.8; 1.1)	Reference		Reference		40.7 (36.7; 44.9)	Reference		Reference
State	0.8 (0.7; 0.8)	-0.16	0.04	-0.05	0.56	37.8 (35.1; 40.6)	0.88	0.25	1.08	0.53
Private	1.0 (0.9; 1.1)	0.06	0.42	0.40	< 0.01	47.0 (44.4; 49.6)	1.29	0.01	2.14	< 0.001

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[1] Correspondence
M. A. Leite Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Arnaldo 455, São Paulo, SP 01246-903, Brasil. maria.alvim.leite@gmail.com