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Urban school neighborhoods dominated by unhealthy food retailers and advertisements in Greater Tunis : a geospatial study in the midst of the nutrition transition.
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Edité par CCSD ; Cambridge University Press (CUP) -
International audience. Objective: Food environments are a major determinant of children’s nutritional status. Scarce evidence on food environments exists in low and middle-income countries (LMICs). This study aims to fill this gap by documenting the obesogenicity of food environments around schools in Greater Tunis, Tunisia – an LMIC of the Middle East and North Africa region with an ongoing nutrition transition and increasing rates of childhood obesity. Design: In this cross-sectional study, we assessed built food environments around 50 primary schools. Ground-truthing was performed to collect geographic coordinates and pictures of food retailers and food advertisement-sets within an 800-meter road-network buffer of each school. Retailers and advertisement-sets were categorized as healthy or unhealthy according to a NOVA-based classification. Associations between school characteristics and retailers or advertisement-sets were explored using multinomial regression models. Setting: Greater Tunis, Tunisia. Participants: Random sample of 50 (35 private and 15 public) primary schools. Results: Overall, 3,621 food retailers and 2,098 advertisement-sets were mapped. About two thirds of retailers and advertisement-sets were labeled as unhealthy. Most retailers were traditional corner stores (22%) and only 6% were fruit and vegetable markets. The prevailing food group promoted was carbonated and sugar-sweetened beverages (22%). The proportion of unhealthy retailers was significantly higher in the richest vs. poorest areas. Conclusions: School neighborhood food environments included predominantly unhealthy retailers and advertisements. Mapping of LMIC food environments is crucial to document the impact of the nutrition transition on children’s nutritional status. This will inform policies and interventions to curb the emergent childhood obesity epidemic.
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