Adolescents’ exposure to unhealthy foods and beverages in and around schools in urban Comoros: a cross-sectional mixed-methods study

Abstract Background In Comoros, undernutrition among adolescents persists while overweight and obesity are increasing, particularly in urban settings. Although schools are recognized as key platforms for promoting healthy eating behaviors, school food environment (SFE) remain poorly documented in this island context. Objective To describe adolescents’ exposure to food and beverages during school days in urban and peri-urban Comoros. Methods A cross-sectional mixed-methods survey was conducted in a random sample of 32 secondary schools in two urban and peri-urban districts of Grande Comore. SFE was assessed through quantitative questionnaires administered to school directors (n = 32) and direct observations of foods sold by school caterers (n = 13) and food vendors operating around school gates (n = 15). Semi-structured qualitative interviews with school caterers (n = 9) and external food vendors (n = 16) explored challenges in providing healthier food options and willingness to change current practices. Results No school implemented a school meal program and only one offered food price reductions for students. Fourteen schools had a cafeteria managed by a caterer and 15 schools had at least one food vendor operating around the school gate. The diversity of food sold in and around schools were mainly energy-dense, nutrient-poor items such as cakes and fried foods. Barriers to healthier food provision included students’ low purchasing power and food safety concerns. External vendors additionally highlighted students’ preference for unhealthy ready-to-use snacks and the need to remain competitive by selling products aligned with demand. Despite these challenges, both school caterers and external food vendors expressed willingness to offer healthier foods, conditional on financial, social and regulatory support. Conclusions Adolescents in Comoros are predominantly exposed to unhealthy foods during school days. Improving the SFE would require context-specific interventionsto reduce economic constraints on vendors, engage students and school communities, and establish supportive national and school-level regulations.