Association of neighbourhood food availability with the consumption of processed and ultra-processed food products by children in a city of Brazil: a multilevel analysis.

OBJECTIVE: To investigate the association between neighbourhood food availability and the consumption of ready-to-consume products (RCP), either processed or ultra-processed, and unprocessed/minimally processed foods (UF-MPF) by children. DESIGN: Cross-sectional. 24 h Dietary recalls were collected from children from January 2010 to June 2011. Neighbourhood food availability data were collected from 672 food stores located within 500 m of participants' homes, using an adapted and validated instrument. Neighbourhood-level socio-economic status (SES) was obtained by calculating the mean years of household head's education level in each census tract covered by 500 m buffers. Foods that were consumed by children and/or available in the food stores were classified based on their degree of industrial processing. Multilevel random-effect models examined the association between neighbourhood food availability and children's diets. SETTING: Santos, Brazil. SUBJECTS: Children (n 513) under 10 years old (292 aged <6 years, 221 aged ≥6 years). RESULTS: The availability of RCP in food stores was associated with increased RCP consumption (P<0·001) and decreased UF-MPF consumption (P<0·001). The consumption of UF-MPF was positively associated with neighbourhood-level SES (P<0·01), but not with the availability of UF-MPF in the neighbourhood. CONCLUSIONS: Results suggest that food policies and interventions that aim to reduce RCP consumption in Santos and similar settings should focus on reducing the availability in food stores. The results also suggest that interventions should not only increase the availability of UF-MPF in lower-SES neighbourhoods, but should strive to make UF-MPF accessible within these environments.

How Latina mothers navigate a 'food swamp' to feed their children: a photovoice approach.

OBJECTIVE: To understand how mothers who recently migrated from Central America to the USA feed their children in a neighbourhood saturated with unhealthful food choices ('food swamp') and to formulate a mother-driven plan of action to facilitate their acquisition of foods. Design/Setting/Subjects We purposively sampled mothers with children (<10 years old) who were recent immigrants/refugees from Central America and lived in a 'food swamp' neighbourhood. We used the photovoice approach to elicit textual data from thirty in-depth interviews, a participatory workshop, and visual data from photographs. Analyses were guided by the Social Ecological Framework and Social Cognitive Theory to identify barriers, facilitators and strategies that support parents in feeding their children. RESULTS: Mothers valued foods that they considered to be 'traditional' and 'healthful'. They navigated their food retail environment looking for these foods (of good quality and well-priced). Food values were reinforced by pre-migration food customs and culture, health professionals' advice and, in some cases, by the desire to avoid conflict with their children. The neighbourhood food environment could directly influence children's food preferences and often created conflict between what the child wanted to eat and the foods that mothers valued. Mothers in this 'food swamp' wanted to be engaged in addressing the selection of foods offered in schools and in neighbourhood food venues to reflect their own food values. CONCLUSIONS: These mothers' feeding choices were influenced directly by their food values, and indirectly by the neighbourhood and school food environments via their children's preferences.

Prática de atividade física e perfil nutricional de mães com filhos de até 10 anos de idade residentes na área urbana do município de Santos-SP / Physical activity and nutritional status of mothers with children under 10 years old residents of an urban area in Santos, Brazil

In this study, we aimed to describe the physical activity level and nutritional status of mothers with children under 10 years old living in different socioeconomic areas in the municipality of Santos, Sao Paulo state, Brazil. To this end, we used a cross-sectional design and collected data on physical activity level, means of transportation, anthropometric measures, and socioeconomic status through home-based interviews in a sample of 538 mothers. The physical activity level of individuals was assessed by a short version of the International Physical Activity Question¬naire (IPAQ). We used the Chi-square ande Kruskal-Wallis tests to assess the difference in physical activity level among various socioeconomic areas of the city and evaluate the association between this outcome and the nutritional status of women. We found a high prevalence of women with little activity (43.7%) and a high frequency of women who do not practice leisure-time physical activity (79.2%). When practice occurs, the most common exercises are walking (10.4%) and working out (9.1%). We also found a high prevalence of excess body fat (74.3%) and overweight (52%) among this population. A higher prevalence of leisure-time physical activity was found among participants from high-income areas. Thus, we recommend that new strategies to promote physical activity should take into account socioeconomic inequalities and cultural differences that can affect the physical activity level of the population.

Describir la práctica de actividad física y el perfil nutricional de la población de madres con hijos de hasta 10 años de edad, residentes en diferentes regiones socioeconómicas del municipio de Santos. El estudio tuvo un diseño transversal y los datos se recogieron por medio de encuestas domiciliarias con una muestra de 538 madres. Se preguntó sobre nivel de actividad física, medios de transporte utilizados, medidas antropométricas y datos socioeconómicos. El nivel de actividad física se evaluó por medio del instrumento International Physical Activity Questionnaire (IPAQ ? versión breve). Se evaluó la diferencia en el nivel de actividad física entre las regiones de la ciudad y se asoció dicha variable con el estado nutricional de las mujeres, por medio de los tests de Kruskal-Wallis y Chi-cuadrado. Se encontró una alta prevalencia de mujeres poco activas (43,7%) y una alta frecuencia de mujeres que no practican actividad física en su tiempo libre (79,2%). Las actividades de tiempo libre más frecuentes fueron caminatas (10,4%) y musculación (9,1%). También se encontró una alta prevalencia en el exceso de grasa corporal (74,3%) y sobrepeso (52%) en esta población. Se encontraron diferencias en el perfil de actividad física de la población, dependiendo, éstas, de la región de residencia. Se pudo verificar una mayor prevalencia de actividad física en el tiempo libre entre los residentes de las regiones de mayor nivel socioeconómico. Por lo tanto, se recomienda que las nuevas estrategias de incentivo a la actividad física tengan en cuenta las desigualdades socioeconómicas y culturales que influyen en el nivel de actividad física.

Descrever a prática de atividade física e o perfil nutricional da população de mães com filhos de até 10 anos de idade, residentes nas diferentes regiões socioeconômicas do município de Santos-SP. O estudo teve delineamento transversal e os dados foram coletados por meio de entrevistas domiciliares com uma amostra de 538 mães. Foram investigadas questões sobre o nível de atividade física, os meios de transporte utilizados, as medidas antropométricas e os dados socioeconômicos. O nível de atividade física foi avaliado por meio do instrumento International Physical Activity Questionnaire (IPAQ - versão curta). Foi avaliada a diferença no nível de atividade física entre as regiões da cidade e a associação dessa variável com o estado nutricional das mulheres, por meio dos testes de Kruskal-Wallis e Qui-quadrado. Foi observada alta prevalência de mulheres pouco ativas (43,7%) e alta frequência de inatividade física no lazer (79,2%). As atividades de lazer mais praticadas foram caminhada (10,4%) e musculação (9,1%). Encontrou-se também uma alta prevalência de excesso de gordura corporal (74,3%) e excesso de peso (52%) nesta população. Diferenças no perfil de atividade física da população apareceram de acordo com a região de moradia. Foi possível verificar maior prevalência de atividade física no domínio do lazer entre os residentes das regiões de maior nível socioeconômico. Recomenda-se que novas estratégias de incentivo à atividade física considerem as disparidades socioeconômicas e culturais que influenciam o nível de atividade física.

Validation of an adapted version of the nutrition environment measurement tool for stores (NEMS-S) in an urban area of Brazil.

OBJECTIVE: To validate an adapted instrument that assesses the nutritional environment of food stores in Brazilian urban areas. METHODS: The instrument measured aspects of food environment such as availability, prices, and quality. The Harvard Healthy Eating Pyramid and the degree of processing were used to define healthy foods. The sample included 44 food stores in 3 census tracts in the city of Santos. Inter-rater reliability and stability coefficient were obtained with measurements performed by different individuals at different times. Internal consistency and construct validity were assessed by Cronbach α and the known-groups comparison method, respectively. RESULTS: Inter-rater reliability was high. The mean intra-class correlation coefficient was 0.98 and the mean kappa was 0.77. Cronbach α values ranged from .68 to .93. CONCLUSIONS AND IMPLICATIONS: The instrument can be useful in the development of interventions to promote healthy eating through actions focused on healthy food availability in Brazilian communities.

Availability of processed foods in the perimeter of public schools in urban areas.

OBJECTIVES: To assess the availability of food in relation to their degree of industrial processing and the types of food stores in the perimeters of elementary schools. METHODS: This is a cross-sectional study. 82 food stores located within a 500 m radius buffer of three public schools located in three distinct regions with different socioeconomic levels in the municipality of Santos, state of São Paulo, Brazil, were assessed. All streets within a 500-meter radius of the schools were covered, geographic coordinates were recorded and information about the stores and food items available were collected by direct observation and interview with store managers. Available food items were classified in relation to their degree of industrial processing as ultra-processed foods and minimally processed foods. Kernel's density maps were used to assess the degree of agglomeration of stores near the schools. RESULTS: The stores that offered mostly ultra-processed foods were significantly closer to schools than those who offered mostly minimally processed foods. There was a significant difference between the availability of processed food in different types of stores and between the three regions assessed. CONCLUSIONS: The data found by this work evidence that children who attend the three public schools assessed are exposed to an environment that encourages the consumption of ultra-processed foods through easier access of these products in the studied stores.

Oferta de alimentos processados no entorno de escolas públicas em área urbana / Availability of processed foods in the perimeter of public schools in urban areas

OBJETIVO: Avaliar a disponibilidade de alimentos comercializados em relação ao seu grau de processamento industrial e os tipos de comércios existentes nos perímetros de escolas de ensino fundamental. MÉTODOS: O estudo teve delineamento transversal, e foram avaliados 82 comércios localizados a um raio de 500 metros de três escolas públicas situadas em regiões distintas do município de Santos, que apresentam diferentes níveis socioeconômicos. Foram percorridas todas as ruas existentes nos perímetros das escolas, considerando-se um raio de 500 metros para delimitação da área, tendo sido registradas as coordenadas geográficas e coletadas informações sobre os pontos de venda e sobre os alimentos comercializados, por meio de observação e entrevista com os responsáveis pelo estabelecimento. Os alimentos encontrados foram classificados, em relação ao seu grau de processamento industrial, em: alimentos ultraprocessados e alimentos minimamente processados. Para a avaliação do grau de aglomeração dos estabelecimentos nos perímetros das escolas, foram utilizados mapas de densidade de Kernel. RESULTADOS: Os pontos de vendas que ofertavam, em sua maioria, alimentos ultraprocessados estavam significativamente mais próximos das escolas do que aqueles que ofertavam maioria de alimentos com menor grau de processamento. Observou-se diferença estatisticamente significativa entre a oferta desses alimentos nas diferentes categorias de comércios e entre as três regiões avaliadas. CONCLUSÕES: Os dados existentes neste trabalho evidenciam que as crianças que frequentam as três escolas públicas avaliadas estão expostas a um ambiente que incentiva o consumo de alimentos ultraprocessados por meio de um acesso facilitado nos comércios investigados.

OBJECTIVE: To assess the availability of food in relation to their degree of industrial processing and the types of food stores in the perimeters of elementary schools. METHOD: This is a cross-sectional study. 82 food stores located within a 500 m radius buffer of three public schools located in three distinct regions with different socioeconomic levels in the municipality of Santos, state of São Paulo, Brazil, were assessed. All streets within a 500-meter radius of the schools were covered, geographic coordinates were recorded and information about the stores and food items available were collected by direct observation and interview with store managers. Available food items were classified in relation to their degree of industrial processing as ultra-processed foods and minimally processed foods. Kernel's density maps were used to assess the degree of agglomeration of stores near the schools. RESULTS: The stores that offered mostly ultra-processed foods were significantly closer to schools than those who offered mostly minimally processed foods. There was a significant difference between the availability of processed food in different types of stores and between the three regions assessed. CONCLUSIONS: The data found by this work evidences that children who attend the three public schools assessed are exposed to an environment that encourages the consumption of ultra-processed foods through easier access of these products in the studied stores.

Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil.

OBJECTIVE: The present study aimed to investigate the individual and family determinants of being overweight among children younger than 10 years of age. DESIGN: Cross-sectional survey. Direct data on children's age, food intake, physical activity, type of transportation used and anthropometric measurements, as well as the education level of the mothers, were collected by trained interviewers. SETTING: Population-based study in the city of Santos, Brazil. SUBJECTS: A total of 531 children under 10 years of age (302 aged <6 years, 229 aged ≥6 years), living in the city of Santos. RESULTS: The overall prevalence of overweight and obesity (BMI-for-age Z-score >1) was 35·4 % for children under 6 years and 38·9 % for children aged 6-10 years. The socio-economic status of the family was associated with being overweight for both age groups. Logistic regression analysis showed that the lower the socio-economic status, the higher the likelihood of being overweight, among both younger children (OR = 7·73; P = 0·02) and older children (OR = 1·98; P = 0·04). The use of active transportation was associated with a lower likelihood of being overweight, but only among younger children (OR = 1·70; P = 0·05). CONCLUSIONS: Socio-economic status seems to be an important individual-level determinant of overweight in children. Public policies should consider promoting the use of active transportation, as the results showed it to have a positive effect on reducing overweight issues. The high prevalence of overweight in younger children suggests that this age group should be a priority in health-promoting interventions.