Medidas regulatórias do ambiente alimentar escolar: análise comparativa entre cantinas de escolas particulares localizadas em áreas com ou seu regulamentação

Abstract

Introduction: The school food environment is a determining factor in food consumption among children and adolescents. In Brazil, high exposure to ultra-processed foods has been observed in schools, especially in private schools, contributing to the increased consumption of these foods. In this context, public policies and regulations can play an important role in promoting healthy eating, and understanding their existence and implementation is essential to assessing their impact on school eating practices. Objective: To analyze the association between the existence and quality of regulatory measures and the presence of EAN initiatives, advertising, and food marketing in private school cafeterias located in 26 Brazilian state capitals and the Federal District. Methods: This is an ecological study representing 2,241 cafeterias in private elementary and high schools located in 26 Brazilian state capitals and the Federal District. The data are part of the study "Food Marketing in Brazilian Schools (CAEB)," conducted between 2022 and 2024, with in-person data collection conducted by trained interviewers. Variables related to the school's administrative aspects (type of administration, number of employees and clients, and presence of a nutritionist) were examined, as well as the availability and variety of foods sold, the presence of advertising strategies to promote the items sold, food and nutrition education (EAN) initiatives, and the distribution of foods sold in the cafeterias. Foods were classified according to the NOVA classification, classified as natural, minimally processed, or processed and organic foods based on these foods (AIMPP), and ultraprocessed and organic foods based on these foods (AUPP). The study stages were evaluated according to the strategic axes of Decree No. 11,821/2023: EAN (whether actions are carried out to encourage healthy eating); food marketing (healthiness index, number of AIMPP and AUPP sold, whether the average variety of AUPP is greater than that of AIMPP, and whether the sale of foods is prohibited); marketing communication (presence of advertising strategies to sell AIMPP and AUPP). Finally, a systematic search was conducted at each cafeteria location to assess the presence of municipal and state regulatory measures in effect up to the month prior to the collection. The quality of regulations was assessed based on the criteria of food and nutrition education, food marketing, marketing communications, and points of excellence. Each cafeteria was considered exceptional in terms of quality and the presence of potential municipal and/or state regulations. Crude and adjusted generalized linear models (GLM) and binary logistic regression were used to analyze the associations between regulations and the stages of the school food environment. Results: 2,241 cafeterias were identified. Half of the cafeterias were located in locations with no regulations, and only 17.76% were located in locations with high-quality municipal and/or state regulations. It should be noted that 26.95% of the cafeterias developed activities outside of the school to promote healthy eating practices, and approximately one-third used at least one advertising strategy for the sale of AIMPP and AUPP foods. The average healthiness index was 56.88, and in most cafeterias, the average variety of AUPP sold was greater than that of AIMPP (65.79%). According to the adjusted regression models, when compared to those in locations without regulation, cafeterias located in municipalities and/or states with at least one regulation with a score <8 and ≥8 were evaluated as follows: 1.75 and 1.73 times more likely, respectively, to carry out EAN actions; 1.51 and 2.49 times more likely to prohibit the sale of some type of food; 31% and 36% less likely, respectively, to sell a greater variety of AUPP than AIMPP; and 1.30 and 1.59 times more likely, respectively, to adopt at least one AIMP advertising strategy. Furthermore, the healthiness index was higher and the number of AUPPs sold was lower in cafeterias located in areas with regulations, especially when the regulations were of better quality. A greater number of AIMPPs sold was distributed only among cafeterias located in municipalities and/or states with better regulations. Conclusion: The results reveal that the presence, and especially the quality, of regulations related to a healthier school food environment.