(P24-061-24) Sugar-Sweetened Beverage Consumption Is Associated With School Neighborhood Food Environment and Unhealthy Food Consumption in Urban Schoolchildren in Lebanon and Tunisia

Objectives: To examine factors at individual, household, school, and school neighborhood levels that are associated with sugar-sweetened beverage (SSB) consumption among children in urban Lebanon and Tunisia – two contexts undergoing a nutrition transition with high child obesity rates.

Methods: Two-stage cluster-randomized, cross-sectional school surveys recruited representative samples of children in grades 4-6 in 2022 in Greater Beirut, Lebanon (n=2,125), and in 2020 in Greater Tunis, Tunisia (n=2,465). Data on eating habits and dietary intake of children on the previous school day (including intake of SSB) and on household socio-demographics and school characteristics were collected through questionnaires administered to children, parents and school directors. Density of food outlets in school neighborhoods (defined by an 800m road network buffer around schools) was assessed using geospatial methods. Crude and adjusted multi-level logistic regression models assessed factors associated with SSB consumption.

Results: In both settings, around 36% of children consumed SSB on the previous day. SSB consumption was associated with consuming sweets [Adjusted OR (95%CI): 1.6 (1.2-2.1) in Beirut and 3.1 (2.1-4.4) in Tunis] and salted snacks [1.3 (1.1-1.6) in Beirut and 1.7 (1.2-2.5) in Tunis], and attending schools with high neighborhood density of unhealthy food retailers [3.9 (2.0-7.3) in Beirut and 1.8 (1.1-3.1) in Tunis]. In Tunis, SSB consumption was also associated with consuming fast-food ≥1 time/week, eating in front of a screen ≥2 days/week, buying food from stores in/around schools and attending private schools. In Beirut, it was associated with male sex, low nutrition knowledge, and attending schools without a health or nutrition educator.

Conclusions: In these urban middle-income nutrition transition settings, density of unhealthy food outlets in school neighborhoods, along with ultra-processed food consumption behaviors were consistently associated with SSB intake in schoolchildren, whereas other factors spanning the socio-ecological model were differentially associated with SSB intake across contexts. These results provide insights for contextually adapted interventions to improve schoolchildren’s diets.

Funding Sources: International Development Research Centre – Canada