Artigos

Introduction
One of the main drivers of unhealthy diets is the obesogenic nature of food environments. These environments are characterized by features that favor the consumption of unhealthy foods over healthier options. In particular, they include the high availability, accessibility, and affordability of ultra processed foods (UPF), as well as marketing strategies that promote their consumption 1.
Since the 1960s, food has been understood as a communication system, in which advertising plays a central role. Through persuasive techniques, advertising assigns meanings to food that consumers may perceive consciously or unconsciously2, thereby influencing attitudes, preferences, and consumption patterns3. A substantial body of evidence has shown that exposure to unhealthy food advertising, especially to UPF, is associated with poorer dietary choices 3,4 . However, most of this evidence comes from studies focusing on television, digital media, and promotional materials, while research conducted within food stores remains limited 1,5.
In-store advertising includes messages displayed on packaging and signage, shelf label, and promotional strategies such as discounts and product sampling. An audit of 104 supermarkets in Australia found a higher frequency of price promotions for unhealthy foods compared with healthier options6. In the United States, fruit and vegetable (FV) advertising have been reported more frequently in supermarkets than in specialized stores 7.
Although international findings provide important insights, examining the Brazilian context is essential to understand how these dynamics operate locally and to inform public health strategies. In Brazil, a study conducted in small supermarkets in São Paulo found that advertising appeals related to novelty, fun, and puffery (claims emphasizing superiority over competing products) were predominantly associated with snacks, pre-prepared foods, dairy products and biscuits8. Another audit, carried out in 2013 in food stores selling FV near public health promotion services, showed that 40.2% of stores displayed some form of food advertising, with similar proportions displaying only FV advertising (19.6%) or only UPF advertising (17.4%) 9.
The advertising within food stores is particularly relevant because it influences consumers at the point of purchase, making it a key component of the food environment 10,11. This influence may be even more pronounced in socially disadvantaged areas, where marketing strategies can exacerbate existing inequalities by promoting less nutritious foods among populations with limited access to healthier options, which can be more serious during times of economic crisis.
Between 2014 and 2020, Brazil experienced a period of economic instability marked by rising food prices, increasing unemployment, and growth in informal labor 12. Economic conditions shape both consumers purchasing behavior and the consumer food environment. As households become more price-sensitive, retailers may increasingly rely on point-of sale advertising and price promotions to attract consumers and maintain sales1,7. Consequently, consumers may purchase smaller quantities, seek promotions across multiple retail outlets, and become more frequently exposed to in-store advertising.
Despite evidence that food environments change over time 1,3,5, longitudinal studies assessing how in-store food advertising evolves remain scarce. This is particularly true for studies examining not only the presence of food advertising but also the content and appeals used in promotional messages. Analyses of the food retail environment in a Brazilian metropolis revealed stability in the number of stores over a five years but shifts according to store type and the socioeconomic vulnerability of the area13. However, little is known about how advertising strategies within these stores change over time and across different levels of vulnerability 1.
Therefore, this study aimed to evaluate changes in food advertising in FV retail stores located around health promotion services in a Brazilian metropolis over the five-year period (2013–2018), representing the first study in the country to evaluate these changes. So, the findings will may be support public health actions, such as educational interventions with retailers and regulatory initiatives aimed at improving the local food environment.

Methods
Setting and study design
This ecological longitudinal study was conducted in food stores selling FV located in the neighborhoods of eighteen units of the Health Academy Programme (Programa Academia da Saúde, PAS, as in Portuguese) units in Belo Horizonte, Minas Gerais, Brazil. The city is the sixth largest in Brazil and the eighth largest in Latin America, with an estimated population of 2 315 560 14.
PAS has been part of the Primary Health Care (PHC) in Belo Horizonte since 2006 and was expanded nationwide since 2011. PAS units provide health promotion activities, including supervised physical activity and other health promotion initiatives.15,16. In this study, PAS units were used as the research setting because they represent key public health environments for the prevention and control of non-communicable diseases (NCDs), particularly in socially vulnerable areas 15.
Study sample and data collection
Sampling was conducted at the baseline. Of the 50 PAS units installed in the municipality in 2013, 42 were eligible. Six units located in areas of low health vulnerability were excluded due to their small number in the municipality, and two units were excluded because they had participated in a previous intervention study. Eighteen (42.8%) units distributed across the nine administrative regions of the municipality were randomly selected. This sample represented the total number of PAS units with a confidence level of 95% and an error of 1.4%. More information about methods and sampling procedures can be found in a previous publication 17 (Figure 1).
All food stores selling FV located within a 1-mile (1,600m) buffer around each selected PAS unit were eligible. We restricted the sample to stores selling FV because the consumption of these foods is associated with better health outcomes 18. The 1-mile buffer was adopted because it encompasses approximately 95% of adult destinations within walkable distance 19,20.
At baseline, food stores were identified using an official list provided by the municipal administration containing the name and address of all registered food retailers. Stores located within the PAS buffer areas were audited²¹. One store was excluded because the surrounding area was considered unsafe for field data collection²².
Data collection occurred between April-May and August-September 2013. Upon arrival, auditors contacted the manager or person in charge, explained the study objectives, and requested authorization to conduct the audit. If a store listed in the public database was not located during fieldwork, verification was performed by telephone or via Google Street View. Unregistered stores identified during the audit were included to update the database 21.
Five years after the initial audit, a new audit was carried out between September and November 2018. The 2018 assessment was based on the list of stores identified in 2013. New stores established in the buffer area during this audition were also included 13. During the five years between data collections, Brazil experienced a significant economic and political crisis, which may have influenced changes in the retail sector.
The research team consisted of dieticians or undergraduate nutrition students. Fieldwork was conducted in pairs under researcher supervision. All interviewers underwent standardized training using a detailed field manual. Training included: a theoretical session addressing study objectives, their responsibilities, and the importance of standardizing data collection; a detailed review of the data collection instrument; a supervised pilot audit conducted in a store outside the sample, followed by debriefing with the field supervisor.

Variables
Food Advertising
In both study periods, food advertising was assessed using a validated instrument adapted from the Nutrition Environment Measures Survey in Stores (NEMS-S) for use in Brazil. The instrument characterizes the consumer food environment. Mean and intra-class correlation coefficient were 0.98 and 0.77, and Cronbach ? values ranged from 0.68 to 0.93 23. According to this instrument, food advertising in food stores is defined by checking the presence of signs with nutritional information, signs or other displays that encourage the purchase or consumption of food, and discounts 23.
Advertising for FV and UPF was assessed. UPF included sweetened beverages, cookies, crackers, and packaged snacks. Food advertising was classified by product type as: FV advertising only (excluding tubers, roots, and frozen foods); UPF advertising only (regular soft drinks, fruit-flavored drinks, and juice/nectars with added sugar, cream-filled chocolate biscuits, and corn chips snacks); and both FV and UPF advertising.
Advertising appeals were also assessed and classified into three categories: (1) price; (2) health, nutrition, and wellness; (3) other claims (e.g., sensory attributes , product launch, or free gifts) [Board]. Standardized examples of each appeal category were provided in the instrument guide to ensure consistency in data collection 24. Price appeals included discounts, special offers, and promotions encouraging bulk purchases (e.g., “buy 3, pay for 2,” family-size packaging, or bonus quantities). Health, nutrition, and wellness appeals referred to messages attributing positive health effects (e.g., “reduces cholesterol”), emphasizing nutritional composition (e.g., “source of fibre,” “low-fat,” “no added sugar”), associating the product with physical performance, or linking it to well-being and quality of life. Other claims included advertisements emphasizing sensory characteristics (e.g., taste, texture, aroma), promoting newly launched products, or offering gifts unrelated to the purchased item. Advertisements could contain more than one appeal; therefore, each appeal was recorded independently when present.

[Insert Board]

Type of food stores
Food stores selling FV were classified into large-chain supermarkets and grocery stores, specialized FV markets/stores, local grocery stores, and delis and convenience stores. This classification was based on categories adapted from the validated instrument previously mentioned, according to the characteristics to each type of establishment as defined by CNAE (National Economic and Social Registry)23. Bakeries and convenience stores were grouped with local markets because they represented a small proportion of establishments selling FV and shared similar characteristics in this context 16. For analysis, stores were recategorized as (i) Large-chain supermarkets; (ii) Specialized FV markets; and (iii) Local grocery stores, convenience stores, and bakeries.

Health vulnerability
Area vulnerability was assessed using the Health Vulnerability Index (HVI). This index was developed by the Municipal Health Secretary of Belo Horizonte to guide resource allocation and intervention planning, including the implementation of PAS units. The HVI combines socioeconomic and sanitation indicators derived from census data and classifies areas into four levels: low, medium, high, and very high risk. Higher HVI values indicate greater territorial vulnerability 25. For analytical purposes, high and very high categories were combined due to their similarities.

Data analysis
Food advertising characteristics in food stores located around PAS units were described for 2013 (n= 260) and 2018 (n=255) using absolute numbers, relative frequencies and, 95% confidence intervals. Analyses were stratified by HVI and store type. Changes in prevalence were calculated as the difference between the information observed in 2018 and 2013 (change = 2018 measure – 2013 measure). Negative values indicated a decrease over time, whereas positive values indicated an increase over time. The Chi-square test or Fisher test was used to assess differences over time. Bonferroni correction was applied when variables contained more than two categories. Analyses were performed using Stata version 14. Statistical significance was set at p < 0.05.
No individual-level human data were collected. However, store managers authorized the audit and signed a written informed consent form. The study protocol was approved by the University Ethics Committee (blind for review) and the City Hall (blind for review). The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure methodological rigor and transparency in reporting.

Results
In 2013, 260 food stores were audited; in 2018, 255 were audited. Overall, the proportion of stores displaying food advertising rose from 41.1% to 65.5%. Stores featuring only FV advertising increased from 16.1% to 40.0% (p<0.001), while those with only UPF advertising declined from 16.9% to 10.2% (p<0.001). The simultaneous presence of FV and UPF advertising also increased, from 8.1% to 15.3% (p<0.001) (Table 1).

[Insert Table 1]

Regarding the type of appeal used, FV advertising with price-related appeals increased significantly (80.8% to 94.0%; p=0.004), whereas FV advertising with health-related appeals declined (39.7% to 9.3%; p<0.001). For UPF advertising, the only statistically significant change was a reduction in health-related appeals (8.9 to 0.4%; p<0.001) (Table 2).

[Insert Table 2]

When stratified by story type (Table 3), specialized FV stores showed a significant decreased in the proportion of stores without advertising (-24.4% points; p<0.001), alongside a significant increase in stores displaying both FV and UPF advertisements (+35.9% points; p<0.001). Large-chain supermarkets followed a similar pattern, with a reduction in stores without advertising (32.7% in 2013 to 8.3% in 2018; p<0.001), and an increase in combined FV and UPF advertising (22.4% to 58.3%; p<0.001).
When stratified by area-level vulnerability, no statistically significant changes were observed in low-HVI areas, however, the direction of the change was similar to that found in other types of establishments. In contrast, medium and high-HVI areas showed significant increases in the proportion of stores displaying only FV advertising (medium HVI: 18.4% to 45.3% (p<0.001); high HVI: 11.7 to 45.6% (p<0.001)], and in those displaying both UPF and FV advertising [medium HVI: 8.8% to 16.2% (p<0.001); high HVI: 1.7% to 10.9% (p<0.001)] (Table 3).

[Insert Table 3]

With respect to appeals by store type (Table 4), specialized FV markets experienced a significant increase in FV price appeals (78.6% to 94.2%; p=0.005), and a significant decline in health-related appeals (45.2% to 11.6%; p<0.001). Health-related UPF appeals, present in 8.5% of these stores in 2013, were no longer observed in 2018 (p=0.001). In large-chain supermarkets, health-related FV appeals decreased significantly (-26.2% points; p=0.017), while UPF price appeals increased (52.6% to 89.6%; p<0.001). In local grocery stores, convenience stores, and bakeries, the only statistically significant change was the disappearance of UPF health-related appeal (14.6% to 0.0%; p=0.010) (Table 4).

[Insert Table 4]

Finally, when stratified by HVI, FV price appeals increased significantly in medium-HVI areas (79.4% to 93.5%; p=0.027) and high-HVI areas (62.5% to 100%; p=0.009). FV health-related appeals declined in medium-HVI areas (50.0 to 9.1%; p<0.001). For UPF advertising, significant reductions in health-related appeals were observed in both medium-HVI areas (11.6 to 0.9%; p=0.002) and high-HVI areas (9.8% to 0.0%; p=0.045) (Table 4).

Discussion
The present study describes changes over the five-year period in the characteristics of food advertising within stores that sell FV in areas surrounding health promotion services in Brazil. The results showed an overall increase in food advertising at the establishments analyzed. Regardless of store type and the HVI of the area, we observed an increase in the proportion of stores with only FV advertising and with simultaneous FV and UPF advertising. Additionally, there was an increase in FV advertising related to price and a decrease in food advertising with health-related appeals. In our study, the increase in FV price-related advertising was particularly evident in medium- and high-vulnerability areas, while health-related appeals for UPF declined across most store types. These specific shifts provide the empirical basis for the interpretations discussed below.
The overall increase in food advertising within retail stores, from 41.1% to 65.5% over the five-year period, indicates a more promotional consumer food environment, in which shoppers are increasingly exposed to marketing strategies at the point of purchase. This finding is consistent with evidence showing that food marketing is becoming increasingly pervasive across multiple settings3. However, in-store advertising represents only one component of consumers' overall exposure to food marketing. When combined with marketing through television, digital media, and food packaging, the cumulative influence of these multiple sources may further reinforce food-related messages and amplify their potential effects on food choices3. Beyond documenting this increase, the present study advances the literature by examining how the content and persuasive appeals of in-store advertising changed over time according to food type, store type, and area-level health vulnerability.
The increase in FV advertising and the decline in health-related appeals for UPF observed in our data may be interpreted in light of broader societal shifts. In recent years, the public has become more concerned about personal health, community well-being, and environmental sustainability 26. Increased awareness of these issues, driven by greater access to information, is prompting retailers to adapt their marketing strategies to align with market trends 27. Our findings are consistent with this trend, although we did not directly assess consumer perceptions.
The observed reduction in health-related appeals in UPF advertising aligns with the recommendations of the Dietary Guidelines for the Brazilian Population (DGBP) 28. In our sample, health-related appeals for UPF declined by 8.5% points. The DGBP was pioneered the classification of foods based on processing to guide the population towards a healthier diet. It recognizes the influence of the environment on food choices and advises against UPF consumption due to its atherogenic properties, negative impact on food culture and environmental consequences 28. In addition, the guidelines identify food advertising as a barrier to health and recommend promoting critical thinking about nutrition information in marketing, which primarily aims to sell rather than inform. The dissemination of these recommendations since 2014 may have contributed to the observed decrease in UPF advertising. Although causality cannot be established, the temporal overlap between DGBP dissemination and the reduction in health-related appeals for UPF suggests a possible influence on public debate and, indirectly, on market practices. These findings reinforce the importance of using the DGBP as a reference for public policies aimed at fostering healthier food environments in line with its principles.
This study identified an increase in advertising related to FV prices within real-world retail settings, particularly in socially vulnerable areas. Price is a key factor influencing consumer behavior 29, and the DGBP also identifies the price of healthy foods as a barrier to health. An intervention in an English supermarket demonstrated that price promotions on healthier products led to increased sales30. An experimental study that offered a 50% discount on FV significantly boosted FV purchases among customers who received the discount compared to those who did not 31.
Our findings indicate that changes in advertising varied according to store type and area-level vulnerability. This differentiation by store type adds to the literature, which has largely focused on overall retail patterns rather than longitudinal changes stratified by store category. In specialized FV stores, there was an increase in the presence of only FV advertising and in FV advertising related to price. The decline in health-related advertising messages for FV and UPF was observed across all store types, except for FV in local stores. A review of studies on improving healthy food consumption and purchasing suggests that promoting health education in retail environments is a promising strategy5. Such interventions are often combined with sales strategies such as food demonstrations, shelf positioning, and promotional offers 5. Thus, changes in advertising characteristics could potentially benefit consumers; however, this remains a hypothesis that warrants further investigation in studies designed to assess purchasing behavior and dietary outcomes.
In large-chain supermarkets, total advertising decreased, while simultaneous FV and UPF advertising increased. Supermarkets are the primary retailers of UPF in Brazil 32. However, they also account for a significant portion of unprocessed food purchases (43.4% of purchased food is unprocessed) 33. Therefore, attention to the food environment in these stores is crucial.
We also observed an increase in price-related advertising for UPF in supermarkets. Specifically, UPF price appeals increased from 52.6% to 89.6% in large-chain supermarkets, contrasting with the more modest changes observed in other store types. This pattern suggests that promotional strategies may differ according to retail structure. Large retailers may benefit from bulk purchase agreements, potentially enabling lower prices and greater use of price-based advertising strategies. In contrast, FV procurement costs and seasonal price fluctuations may limit consistent price promotions for these foods34, especially for retailers with smaller volumes. Smaller stores, which typically purchase lower volumes, may face constraints in offering discounts. These factors may help explain the distinct advertising patterns observed, although retailer decision-making processes were not directly examined in this study.
Although no statistically significant differences were found regarding the advertising characteristics of local stores, we observed a trend similar to that seen in other types of stores of increased advertising for fresh vegetables and a reduction in advertising for UPF. These results should be interpreted with caution, given that local stores often have a more limited selection of fresh or minimally processed foods9,21. Consequently, the absence of statistically significant changes does not necessarily indicate a distinct advertising pattern but may instead reflect the characteristics and scale of this retail segment.
The analysis of advertising according to area-level vulnerability revealed differences over a five year of follow-up, except in low vulnerability areas. A possible explanation for the stability observed in these areas is that customers may already prioritize healthy foods, sustaining demand patterns, independently of advertising 34. However, this interpretation should be viewed cautiously, as consumer preferences were not directly measured. A qualitative study in New York investigating food retailer’s strategies found that traders in high-income areas believed their customers had established eating habits and could afford higher-priced foods29. As a result, traditional retail advertising strategies, such as sales and promotions, may have minimal impact on this group.
In medium-HVI and high-HVI areas, there was an increase in FV-only advertising and simultaneous UPF and FV advertising, alongside a decrease in UPF-only advertising. The World Health Organization recommends that strategies to prevent and control non-communicable diseases should encourage the purchase of healthy foods through price promotions and information dissemination while restricting UPF marketing 35. This simultaneous increase in FV advertising and decrease in UPF advertising may create conditions that favor the purchase of healthy foods, especially in more economically vulnerable areas 30,31. Nevertheless, the study did not assess actual purchasing or consumption patterns, so these results should be interpreted with caution. Even so, the greater visibility and accessibility of FV in socially vulnerable regions should be seen as an opportunity to reinforce public policies that promote healthier diets. Aligning this market movement with international guidelines could help reduce inequalities in access to adequate nutrition among populations at greater social and economic risk.
The simultaneous increase in FV advertising and the decrease or cessation of UPF advertising is especially important in places that offer a variety of fresh or minimally processed foods. According to the DGBP, shopping in these stores is essential to maintaining healthy diets28. However, if UPF advertising is prominent in these locations, it may compete with healthy options. These findings support discussions on the potential role of restricting UPF advertising and encouraging FV promotion within stores that predominantly sell fresh or minimally processed foods as part of broader strategies to support healthy food policies 30.
The price appeal message of FV advertising increased in food stores located in medium- and high-HVI areas, reaching 100% of stores in the most vulnerable regions. As previously mentioned, Brazil experienced a severe political and economic crisis starting in 2017, accompanied by high food price inflation 12. This reduction in purchasing power may have exerted pressure on retailers, to adopt strategies aimed at maintaining sales. Advertising may represent one such strategy, given its relatively low implementation cost and potential to attract consumers in a competitive context. In our findings, the most pronounced increase in FV price advertising occurred in high-HVI areas, reaching 100% of stores. This temporal coincidence suggests that economic constraints may have interacted with local vulnerability to shape advertising strategies. However, the specific motivations underlying retailer decisions were not assessed. In this context, promotions and advertisements related to price gain prominence, as food cost became a decisive factor in household purchasing decisions11. Therefore, given that economic crises can affect advertising strategies in the food retail sector, it is crucial to implement public policies that protect consumers and encourage healthier choices, particularly in contexts of greater social vulnerability.
Regarding UPF advertising, there was a decline in health-related advertising in medium- and high-HVI areas, aligning with Brazil’s official dietary guidelines 28. Evidence suggests that unhealthy foods are more frequently sold in stores located in socioeconomically disadvantaged regions 36. Even though regulation advertising remains limited, many countries have taken initial steps to support consumer’s choices through nutritional labeling regulation. For example, in 2021, Brazil implemented new front-of-pack warnings labels. Given that our study documented the persistence of price-based UPF advertising in certain store types, alongside the reduction of health-related claims, regulatory debates remain pertinent, However, evidence indicates that additional measures are necessary to regulate advertising and restrict the sale of products that are high in calories, sodium, sugar, or saturated fat, as seen in Chile 37. In Brazil, UPF advertising regulations are primarily limited to foods for infants and young children. A 2010 resolution aimed at regulating the promotion of food high in sugar, saturated fat, trans fat, and sodium foods was suspended due to food industry appeals 38.
From a public health perspective, our findings reinforce the importance of prioritizing FV promotion within retail environments. In contrast, the persistence of UPF advertising, particularly when associated with price incentives, highlights the need for regulatory debate on strategies that may mislead consumers regarding product healthfulness. England has adopted a comprehensive approach that combines restrictions on TV and online advertising with bans on location- and price-based promotions 39. These regulations limit the placement and promotion of certain foods and drinks that are high in fat, salt, or sugar 39.
Several intervention studies conducted across different countries suggest that supply chain regulation can be both innovative and supportive of public health without being prohibitively costly40. However, overcoming political inertia at various government levels and addressing food industry interference in health and nutrition policies are critical challenges. Governments must establish clear mechanisms for addressing opposition from private interests, while civil society must actively participate in advocating for regulatory measures 41.
This study has some limitations. First, it analyzed only the consumer food environment within retailers that sell FV. Therefore, the findings cannot be generalized to other types of food outlets, such as fast food establishments and restaurants, which should be examined in future research. Second, the study used Euclidean distance to define the food environment. Although this method has been considered appropriate for estimating store availability and community food access19, it does not account for street networks or physical barriers that may influence actual accessibility. Third, as the evaluated stores were located within buffers around PAS units, the external validity of the findings is limited and results may not represent other urban areas. Fourth, the data refer to changes observed between 2013 and2018, with the most recent data collected eight years ago. The current retail context may have changed since then, particularly considering the substantial disruptions to the food sector during the COVID-19 pandemic (2020-2022). Further studies are needed to assess whether additional changes have occurred.
This is the first study in Brazil to evaluate changes in food advertising within retail stores over time. Additionally, it examined areas surrounding health promotion services, which are part of Brazilian primary care and have the potential to improve health. Investing in research on the promotion of healthy foods in these areas, where many people gather, may be an important strategy for creating healthy environments. The decline in UPF advertising and the increase in FV advertising observed in stores that sell FV may represent a favorable shift in the food retail environment. However, these changes varied according to area vulnerability and store type, underscoring the complexity of retail dynamics. In this context, the urgent need for food advertising regulation as a food environment strategy becomes even clearer. However, Brazil still lacks effective regulatory mechanisms in this area, which limits protection for the population against the advertising of unhealthy products. Strengthening food advertising regulation may represent a relevant and feasible strategy to improve food environments, particularly in socially vulnerable contexts.

Data availability statement
The data sources adopted in the research are indicated in the article’s body.

REFERENCES
1. Pérez-Ferrer C, Auchincloss AH, de Menezes MC, et al. The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases. Public Health Nutr 2019; 22: 3447–3464.
2. Roland Barthes. Toward a Psychosociology of Contemporary Food Consumption. In: Food and Culture. New York: Routledge, 2013, pp. 23–30.
3. World Health Organization. Food marketing exposure and power and their associations with Food-related attitudes, beliefs, and behaviours: a narrative review. Geneva: World Health Organization, https://www.who.int/publications/i/item/9789240041783 (2022, accessed 5 March 2024).
4. Halford JCG, Gillespie J, Brown V, et al. Effect of television advertisements for foods on food consumption in children. Appetite 2004; 42: 221–225.
5. Karpyn A, McCallops K, Wolgast H, et al. Improving Consumption and Purchases of Healthier Foods in Retail Environments: A Systematic Review. Int J Environ Res Public Health 2020; 17: 7524.
6. Charlton EL, Kähkönen LA, Sacks G, et al. Supermarkets and unhealthy food marketing: An international comparison of the content of supermarket catalogues/circulars. Prev Med 2015; 81: 168–173.
7. Powell LM, Kumanyika SK, Isgor Z, et al. Price promotions for food and beverage products in a nationwide sample of food stores. Prev Med 2016; 86: 106–113.
8. Batista CHK, Leite FHM, Borges CA. Associação entre padrão de publicidade e alimento ultraprocessado em pequenos mercados. Ciênc saúde coletiva 2022; 27: 2667–2678.
9. Horta PM, Souza J de PM, Freitas PP, et al. Food availability and advertising within food outlets around primary healthcare services in Brazil. Journal of Nutritional Science 2020; 9: e49.
10. Ni Mhurchu C, Vandevijvere S, Waterlander W, et al. Monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in community and consumer retail food environments globally. Obes Rev 2013; 14 Suppl 1: 108–119.
11. Fernqvist F, Spendrup S, Tellström R. Understanding food choice: A systematic review of reviews. Heliyon 2024; 10: e32492.
12. World Bank. Brazil Poverty and Equity Assessment: Looking Ahead of Two Crises., https://openknowledge.worldbank.org/entities/publication/5c9a5af4-1960-5986-ab4f-bfd51436be6d (2022, accessed 21 October 2025).
13. de Freitas PP, Lopes MS, Costa BV de L, et al. A longitudinal analysis of the fluctuation of food stores in Belo Horizonte, Minas Gerais, Brazil. BMC Public Health 2023; 23: 2454.
14. Brasil. Belo Horizonte (MG) | Cidades e Estados | IBGE. IBGE, https://www.ibge.gov.br/cidades-e-estados/mg/belo-horizonte.html (accessed 15 November 2024).
15. Brasil. Portaria de consolidação no 5, de 28 de Setembro de 2017, https://www.gov.br/aids/pt-br/central-de-conteudo/copy_of_portarias/2021/portaria-de-consolidacao-no-5-de-28-de-setembro-de-2017 (2017, accessed 15 November 2024).
16. Costa BV de L, Mendonça R de D, Santos LC dos, et al. Academia da Cidade: um serviço de promoção da saúde na rede assistencial do Sistema Único de Saúde. Ciênc saúde coletiva 2013; 18: 95–102.
17. Menezes MCD, Costa BVDL, Ferreira NL, et al. Methodological course of a community controlled trial in health care services: translational epidemiological research on Nutrition. DEMETRA 2017; 12: 1203–1222.
18. Murray CJL, Aravkin AY, Zheng P, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1223–1249.
19. Charreire H, Casey R, Salze P, et al. Measuring the food environment using geographical information systems: a methodological review. Public Health Nutr 2010; 13: 1773–1785.
20. Smith L, Sánchez GF, Veronese N, et al. Fruit and Vegetable Intake and Non-Communicable Diseases among Adults Aged ?50 Years in Low- and Middle-Income Countries. J Nutr Health Aging 2022; 26: 1003–1009.
21. Costa BV de L, Freitas PP de, Menezes MC de, et al. Ambiente alimentar: validação de método de mensuração e caracterização em território com o Programa Academia da Saúde. Cad Saúde Pública 2018; 34: e00168817.
22. Freitas PP de, Lopes MS, Menezes MC de, et al. Consumer food environments change over a 5-year period. Public Health Nutrition 2024; 27: e187.
23. Duran AC, Lock K, Latorre MDRDO, et al. Evaluating the use of in-store measures in retail food stores and restaurants in Brazil. Rev Saúde Pública; 49. Epub ahead of print 2015. DOI: 10.1590/S0034-8910.2015049005420.
24. Duran AC, Diez Roux AV, do Rosario DO Latorre M, et al. Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in Sao Paulo, Brazil. Health Place 2013; 23: 39–47.
25. Secretaria Municipal de Saúde de Belo Horizonte. Índice de Vulnerabilidade à Saúde, https://prefeitura.pbh.gov.br/sites/default/files/estrutura-de-governo/saude/2018/publicacaoes-da-vigilancia-em-saude/indice_vulnerabilidade2012.pdf (2012, accessed 22 June 2020).
26. Barone B. Sustentabilidade e alimentação sustentável: percepção e o comportamento de consumidores Brasileiros. Universidade Estadual de Campinas (UNICAMP), https://repositorio.unicamp.br/acervo/detalhe/1238855 (2018, accessed 20 March 2025).
27. International Food Information Council. 2022 Food & Health Survey: Diets, Food Prices, Stress and the Power of Gen Z. International Food Information Council, https://ific.org/media-information/press-releases/2022-food-health-survey/ (2022, accessed 18 May 2022).
28. Brasil. Guia alimentar para a população brasileira. 2nd edn. Brasília, DF: Ministério da Saúde, https://www.gov.br/saude/pt-br/assuntos/saude-brasil/publicacoes-para-promocao-a-saude/guia_alimentar_populacao_brasileira_2ed.pdf (2014).
29. Figueira TR, Lopes ACS, Modena CM. Barreiras e fatores promotores do consumo de frutas e hortaliças entre usuários do Programa Academia da Saúde. Rev Nutr 2016; 29: 85–95.
30. Piernas C, Harmer G, Jebb SA. Testing availability, positioning, promotions, and signage of healthier food options and purchasing behaviour within major UK supermarkets: Evaluation of 6 nonrandomised controlled intervention studies. PLoS Med 2022; 19: e1003952.
31. Bernales-Korins M, Ang IYH, Khan S, et al. Psychosocial Influences on Fruit and Vegetable Intake following a NYC Supermarket Discount. Obesity (Silver Spring) 2017; 25: 1321–1328.
32. Machado PP, Claro RM, Martins APB, et al. Is food store type associated with the consumption of ultra-processed food and drink products in Brazil? Public Health Nutr 2018; 21: 201–209.
33. Câmara Interministerial de Segurança Alimentar e Nutricional. Estudo Técnico – mapeamento dos desertos alimentares no Brasil, https://aplicacoes.mds.gov.br/sagirmps/noticias/arquivos/files/Estudo_tecnico_mapeamento_desertos_alimentares.pdf (2018, accessed 17 February 2022).
34. Martinez O, Rodriguez N, Mercurio A, et al. Supermarket retailers’ perspectives on healthy food retail strategies: in-depth interviews. BMC Public Health 2018; 18: 1019.
35. World Health Organization. ‘Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases, https://movendi.ngo/wp-content/uploads/2020/08/WHO_Appendix_BestBuys.pdf (2017, accessed 17 February 2022).
36. Houghtaling B, Serrano EL, Kraak VI, et al. A systematic review of factors that influence food store owner and manager decision making and ability or willingness to use choice architecture and marketing mix strategies to encourage healthy consumer purchases in the United States, 2005–2017. Int J Behav Nutr Phys Act 2019; 16: 5.
37. Taillie LS, Bercholz M, Popkin B, et al. Changes in food purchases after Chile’s polices on food labeling, marketing, and sales in schools: a before and after study. Lancet Planet Health 2021; 5: e526–e533.
38. Pereira TN, Gomes FDS, Carvalho CMPD, et al. Medidas regulatórias de proteção da alimentação adequada e saudável no Brasil: uma análise de 20 anos. Cad Saúde Pública 2021; 37: e00153120.
39. England F, England PH. The Food (Promotion and Placement) (England) Regulations, https://www.legislation.gov.uk/ukdsi/2021/9780348226195 (2021, accessed 17 February 2022).
40. Southey F. Supermarkets call for extension on new HFSS laws: ‘This tight timeframe will add considerable cost and burden’. FoodNavigator.com, https://www.foodnavigator.com/Article/2021/11/23/Supermarkets-call-for-extension-on-new-HFSS-laws-This-tight-timeframe-will-add-considerable-cost-and-burden/ (2021, accessed 17 February 2022).
41. Sainsbury E, Colagiuri S, Magnusson R. An audit of food and beverage advertising on the Sydney metropolitan train network: regulation and policy implications. BMC Public Health 2017; 17: 490.
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