Fernandes Meenakshi, Folson Gloria, Aurino Elisabetta, Gelli Aulo
Partnership for Child Development Imperial College London, Department of Infectious Diseases, London UK.
University of Ghana Noguchi Memorial Institute for Medical Research (NMIMR), Department of Nutrition, Accra, Ghana.
Food Secur. 2017;9:1073-1090. doi: 10.1007/s12571-017-0712-0. Epub 2017 Oct 1.
Food environments can play an important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP). Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse.
食物环境在塑造营养和健康结果方面发挥着重要作用。学校食物环境就是这样一种有可能影响青少年的环境。然而，与高收入国家不同的是，关于中低收入国家学校食物环境对儿童和青少年的作用，存在关键的证据空白。这项混合方法研究通过调查加纳学校食物环境对儿童和青少年饮食行为的作用，有助于填补这一空白。它借鉴了家庭和学校问卷的数据，以及作为加纳学校供餐计划（GSFP）影响评估基线的一部分收集的焦点小组讨论数据。在个体、家庭和社区层面采用了带有随机截距的多层次回归模型。焦点小组讨论的摘录提供了对定量结果的更深入理解。接受GSFP提供的免费学校餐食或住得离学校较远的儿童和青少年回家吃午饭的可能性较小。超过一半的抽样学校报告称有独立摊贩出售食品，最常见的是餐食，其次是糖果、水果和含糖饮料。带钱去学校买食物的预测因素包括未收到免费学校餐食、处于青春期、离家通勤距离更远、家庭资产得分以及城市地区。关注学校食物环境的政策努力可能有助于儿童和青少年养成健康的饮食行为，并在整个生命历程中产生积极影响。
