Artigos

Introduction
It is known that barriers and facilitators for healthy eating may vary according to the types of commercial food establishments1. In natura trading, establishments are associated with more significant purchases and consumption of healthy food.2-5 As establishments with mixed food trade, they are often associated with the purchase and greater consumption of ultra-processed food.6-8
In this context, to guarantee access to healthy foods, several Brazilian Nutrition and Food Programs are focused on the food environment, such as Food and Nutrition Public Establishments (FNPE) (Equipamento Público de Segurança Alimentar e Nutricional, as in Portuguese), which are physical structures and public spaces supporting the supply, distribution, and marketing of in natura food9. It is worth highlighting that several studies point to improvements in dietary patterns achieved through food environment intervention policies at the national level. 10,11
Access to food is constructed based on five dimensions of the adequacy of commercial food establishments to individual needs, namely: availability; physical accessibility (accessibility), financial accessibility (affordability); acceptability (acceptability), and convenience (accommodation).12-13 Of these, availability is among the most frequently studied.13 On the other hand, understanding the convenience dimension is a significant gap in the current literature.12-14 Convenience is related to the adaptation of commercial food establishments to the needs of individuals, including factors such as opening hours, accepted payment methods, presence of parking, and others. 11-13
Significantly, the opening hours of the food trade in low and middle-income countries are considered limited (barrier) compared to high-income countries.15 Still, multiple configurations can be observed in commercial establishments of in natura foods that, many times, present themselves as open-air markets, markets (open and closed), physical stores, and even street vendors, who operate in inconstant and discrepant hours16, interfering in the way individuals interact with the food environment.17 Investigating the opening hours of commercial food establishments is essential to indicate whether the establishments are indeed accessible to individuals.17 It is assumed that different personal limitations (e.g. fixed commitments) may limit access to commercial food establishments in a way in which there are no options left.17-19
Because of the reduced number of studies that investigate characteristics related to the accommodation of commercial food establishments, the objective of this study was to evaluate the opening hours of commercial establishments of in natura and mixed foods in areas with and without Food and Nutrition Public Establishments (FNPE) (Equipamento Público de Segurança Alimentar e Nutricional, as in Portuguese), an essential public policy for access to healthy foods.

Methodology
A cross-sectional study was carried out in the city of Belo Horizonte, Brazil. The city has a territory of approximately 330,000 km², with 2.5 million inhabitants, according to data from the most recent demographic census.20
The study involved a representative sample of FNPE in the city and commercial establishments selling food for home consumption, existing in areas with and without FNPE.
The FNPE are actions of the Federal Government, in partnership with medium and large cities, implemented in the whole Brazilian territory.9 They constitute different structures or spaces, similar to initiatives implemented in other countries in Latin America22, Europe23-27 and also in the United States, such as farmers markets; farm stands20,23,28; mobile markets3,29; or food banks (food pantries and food banks)30.
The FNPE of Belo Horizonte were identified by the official list of the municipal public agency that manages the city, specifically, by the administration responsible for structuring and administering the local SAN systems. The eligibility criteria were to be in operation in May 2019 and sell food for consumption at home. In all, 116 FNPE eligible for the study were identified, namely: public grocery stores, street markets, organic markets, establishments for direct purchase from family farming producers, and municipal markets.
The FNPE were selected through simple random sampling, by consecutive raffles, stratified according to the city administrative limits and the socioeconomic vulnerability of the census sector where the equipment was located. The socioeconomic vulnerability was identified by the Health Vulnerability Index (Índice de Vulnerabilidade a Saúde, as in Portuguese), a synthetic indicator used to guide the implementation of public policies in Belo Horizonte and constructed from socioeconomic indicators from the 2010 Demographic Census from the Brazilian Institute of Geography and Statistics (IBGE, as in Portuguese)31. A higher concentration of FNPE was identified in areas of low vulnerability, being necessary to select two equipment in the central region of the city, guaranteeing the proportionality of the sample. Thus, ten FNPE were selected. The sample was representative of the FNPE, with 95% confidence and an error of less than 3%. The details of the sampling process are described in a previous study21.
Areas with FNPE were defined by circular buffers with a radius of 500 meters, traced around the FNPE. Areas without FNPE were selected from census sectors located outside the areas of influence of the FNPE, defined by circular buffers with a radius of 1000 meters around the FNPE. In areas without FNPE, circular buffers with a radius of 500 meters were also drawn using the center of the census tracts as a reference9.
The areas delimited for investigation were mapped and covered by researchers to identify commercial food establishments. All establishments contained in areas with and without FNPE were invited to participate in the study. A total of 235 commercial food establishments for consumption at home were identified within the analysis areas and in 88 (37.4%) establishments the data could not be collected.
Commercial establishments were classified according to the nature of the food commonly sold and purchased in their region30. Dividing into: “commercial establishments of in natura food”, represented by specialized fresh food public and private retailers, organic fairs, open-air fairs, establishments for direct purchase from family farming producers; and “mixed commercial establishments'' comprising small markets, grocery stores, and warehouses, supermarkets and hypermarkets, bakeries and convenience stores.
Data were collected in pairs, by trained researchers and accompanied by a field supervisor and the research coordinator. The instruments used in data collection were: “Instrument for the Evaluation of Establishments selling Food for Home Consumption (ESAO-S)” and “Audit Instrument for Outdoor Markets”, tested and validated for Brazil 31. The information was collected on the working days and hours of commercial food establishments and FNPE. In municipal markets, each store was considered individually due to their marketing liberty and different working standards between stores. The other FNPE were treated as single study units.
The working hours of the establishments were recorded for weekdays (i.e. Monday to Friday), Saturdays, and Sundays, and were divided into four statuses: closed; open half day; open during business hours (i.e. until 6 pm); and open at extended hours (i.e. after 18 hours)32. The average number of working hours per week (i.e. Monday to Friday), and Saturdays and Sundays were also recorded.
At first, the distribution of establishments (absolute and relative), according to its type, was estimated for the total set of establishments and areas with and without FNPE. Then, the average number of working hours (and its standard deviation - SD) was estimated for commercial establishments of in natura food and mixed commercial establishments, by weekday and weekend, allowing the comparison between the types of establishments (Student's t-test). Then a similar procedure was used to compare these same types of establishments regarding the distribution of the four operating statuses (Closed, Open half day, Open business hours, and Open extended hours), again for weekdays and weekends (Chi-Square). Finally, a new comparison was made considering the working hours of in natura and mixed food establishments, on weekdays and weekends, but now also considering the establishment location (with or without FNPE) (t-test from Student). Statistical analyzes were performed using the Stata software, version 14.2. A significance level of 5% was adopted.
All individuals who participated in the study received information about the research and signed the Informed Consent Form. The study was approved by the Research Ethics Committee (CAAE 84707818.3.0000.5149).

Results
Information was collected on the functioning of 147 commercial food establishments for at-home consumption (including FNPE (n=17)). Most audited establishments were of the mixed type (60.1%), and the total prevalence of in natura and mixed food establishments did not vary between areas with and without FNPE (p>0.05) (Table 1). Table 1 also details the prevalence of different commercial food establishments, including in the in natura and mixed categories; when compared between the areas, no substantial differences were observed either (p>0.05).
Insert Table 1
Regarding working hours, mixed commercial establishments were open, on average, longer hours than in natura commercial establishments (p<0.001). This was observed for average weekly hours (70.1 hours vs. 56.2 hours per week), Saturdays (13.7 hours vs. 11.3 hours), and Sundays (10.6 hours vs. 6.2 hours). (Table 2)
Insert Table 2
Table 3 shows the daily operating status of in natura commercial establishments and mixed commercial establishments. On weekdays (Monday to Friday), extended hours were the most frequent for both types of establishments. However, while this modality can be observed in 67.8% of in natura food establishments, in mixed commercial establishments it reached 90.9% (p<0.001).
On Saturdays, a similar situation was observed, mixed commercial establishments became more available during extended hours, when compared to in natura food commercial establishments (84.1% vs. 55.9%; p<0.001). On Sundays, most commercial establishments selling fresh foods were only open part-time (74.6%) or closed (18.6%); although the number of mixed commercial establishments opened during extended hours has reduced considerably concerning weekdays and Saturdays, they, once again, accounted for most of the establishments open during these hours (40.9% vs. 3.4%; p<0.001) (Table 3).
Insert Table 3
Finally, table 4 shows the comparison of the average working hours for mixed and in natura food establishments, compared according to areas with and without FNPE. The average number of weekly hours of operation of in natura food commercial establishments was lower in areas with FNPE than in areas without FNPE (61.0 hours vs. 51.2 hours; p<0.05); on Saturdays and Sundays, the differences were not significant. The average hours of operation of mixed commercial establishments did not vary between areas with and without FNPE (Table 4).
Insert Table 4

Discussion
Mixed food commercial establishments were on average open longer hours than in natura commercial establishments. On weekdays and Saturdays, the number of mixed commercial establishments open at extended hours (after 6 pm) was remarkably higher than the number of commercial in natura food establishments open. On Sundays, most commercial establishments selling fresh food were only open part-time or closed; mixed commercial establishments again accounted for most part the establishments opening during extended hours. Comparing the working hours of establishments between areas, the average weekly opening time of in natura food commercial establishments was lower in areas with FNPE, whereas the average working hours of mixed commercial establishments did not vary.
These results indicate that commercial food establishments for at-home consumption tend to be open longer during the week and are more likely to be closed on weekends, evidencing realities similar to those observed in developed countries.34,35
In natura food establishments had shorter working hours than mixed establishments and, therefore, may not meet the purchasing needs of consumers16,18,19. In developed countries, similar realities are pointed out, and it is common to observe that mixed commercial establishments (e.g. convenience stores, supermarkets, grocery stores) have longer working hours than commercial establishments of in natura food (e.g. greengroceries, farmers markets)19,34,36,37 working longer during extended hours and on weekends35. Considering extended hours, the prevalence of mixed establishments compared to in natura food establishments was 1.3 times higher during the week, 1.5 times higher on Saturdays, and 12 times higher on Sundays. It is urgent to reconsider policy strategies and actions to make managers and traders of in natura food establishments aware of the importance of extending the working hours of their establishments.
In low and middle-income countries such as Brazil, evidence is scarce; a study in India displays a scenario similar to that of developed countries and the present research, showing that commercial establishments selling in natura food had irregular working hours, while mixed commercial establishments had ample working hours, which favored the purchase of food for a more significant number of consumers16.
It is known that longer working hours are more convenient to meet the demand of consumers with fixed activity commitments, such as students and workers18,19. Generally, consumers choose commercial food establishments whose opening hours accommodate their demands17.
Consumers tend to assume routine behavior when buying food and eventually use one or a few kinds of commercial food establishments repeatedly17. Often, this recurrent use of the same type of establishment is due to the scarcity of options, due to the working hours of the establishment, and the time remaining after the completion of fixed appointments17. Thus, the preference of consumers to buy food in mixed commercial establishments (e.g. supermarkets and convenience stores) is evident due to the broad working hours, among other variables such as proximity, price, and convenience38,39.
These extended working hours of mixed commercial establishments can directly impact the food consumption of their customers, considering the types of food available in these places, which can influence purchasing decisions17,40. Mixed establishments have not only a more significant availability of ultra-processed food but also a grander amount of advertising and publicity of these foods1, offered at lower prices8. It is known, for example, that price and convenience in supermarkets encourage the purchase of ultra-processed food8 and their wide working hours play an important role in accessing these establishments and, consequently, in increasing the consumption of these products36.
On the other hand, the regular consumption of fruits and vegetables is associated with the presence of commercial establishments selling in natura food2-5, and the choice of these establishments as a place of purchase is selected by longer working hours, especially at night and on weekends16,35. A strategy for expanding access to healthy foods is the more significant availability of commercial establishments selling in natura foods with extended opening hours, close to public transportation centers41. Public transport is used by many people, who, when starting or ending their fixed activity commitments, can benefit from easy access to commercial establishments selling in natura food41.
After comparing the areas, it was found that commercial establishments selling fresh foods in areas without FNPE operated longer than those located in areas with FNPE. This reduced operation of commercial establishments selling fresh food in areas with FNPE is related to the presence of street markets, organic markets, and the direct purchase program from producers, given that they operate intermittently, usually only once a week, due to infrastructure issues (e.g. displacement of producers to the place of sale, need to close streets)40,41. Research points to this limitation in open-air markets and places where producers buy directly, signaling reduced or irregular opening hours14,17,37,42,43. It should also be noted that opening hours are precisely one of the main barriers pointed out by consumers for making purchases in these places35,36,42,44.
There was no difference between the prevalence of in natura and mixed food establishments according to the areas with and without FNPE. We observed a higher prevalence of FNPE in areas of lower social vulnerability, which is corroborated by the literature 42. Therefore, the importance of more investment in areas of high social vulnerability stands out, considering that these are usually regions with a higher prevalence of mixed establishments and sale of ultra-processed foods associated with higher rates of health problems, such as obesity and câncer 43.
Farther, after comparing the areas, it was found that commercial establishments selling fresh foods in areas without FNPE operated longer than those located in areas with FNPE. Researchs points a limitation in open-air markets and places where producers buy directly, signaling reduced or irregular opening hours16,19,39,44,45. It should also be noted that opening hours are precisely one of the main barriers pointed out by consumers for making purchases in these places37,38,44,46. On the other hand, it should also be noted that the operation of mixed establishments did not vary according to their location in areas with and without FNPE, this space occupied by mixed commercial establishments in the food chain ends up distancing even more consumers from producers38. In this context, FNPE plays a fundamental role, as they reduce commercial circuits, bringing producers closer to consumers.
It is unattainable to directly compare the findings related to the FNPE with the Brazilian literature, since, as far as we know, this is the first study to evaluate the dimension of accommodation related to a public policy of food and nutrition security that intervenes in the food environment. A study conducted in the United States evaluated the opening hours of an important policy for access to healthy foods, shows deficiencies in the five dimensions of access, especially concerning accommodation, that is, reduced and irregular opening hours were observed30.
Some methodological limitations need to be considered. Firstly, the categorical measurement of opening hours and the comparison of the average hours of operation prevent capturing more subtle differences, which could be significant for consumer access to establishments due to personal availability issues34. With that in mind, the comparison between extended hours (closes after 6 pm) and weekends was highlighted, due to the possibility of accommodating the needs of a larger portion of the population18. Furthermore, as only 20 areas were studied, the possibility of small differences cannot be ruled out, as the power of the study would be insufficient to detect them. However, based on current knowledge, it is uncertain whether small environmental differences can produce greater differences in the manner individuals buy or consume food34. The randomness of the sample supports the interpretations of the findings, while its reduced size concerning the number of commercial establishments present in the city, may suggest that the relationship with the presence of FNPE is simply an unintentional by-product of the sampling. However, it is worth considering that the FNPE sample was representative of the equipments installed in the city during the study period, therefore, it is expected to capture its impacts effectively.
In any case, studies like this one, which investigate the impacts of the implementation of FNS policies in low- and middle-income countries, are of paramount importance, as they can elucidate important issues in the context of investigations of the food environment and the different dimensions of access to healthy food, especially accommodation, which is little explored16.



Conclusion
Opening hours were much wider in mixed establishments than in in natura food establishments. During extended hours, the number of mixed establishments available was significantly higher than that of in natura food establishments. In areas with FNPE, in natura food establishments had shorter opening hours than in areas without FNPE but the operation of mixed establishments did not vary according to their location. The number of in natura food establishments available during extended opening hours is not ideal and the quantify of mixed commercial establishments during this time may compromisse the adoption of healthy food.

Declarations of interest: none

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