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The transformation of the first-food systems and the widespread availability and marketing of breastmilk substitutes undermine efforts to promote adequate breastfeeding practices. The objective of the present research was to explore mothers' perspectives on infant formula use in Montevideo, the capital of Uruguay. A generic qualitative design was used to explore mothers' perspectives on the factors that act as enablers or barriers for infant formula use. Semi-structured interviews with thirty-four mothers of 0-23 months old children, aged between 25- and 40-years old, were conducted. The interview transcripts were analyzed using content analysis based on inductive-deductive coding considering the framework of the Capability, Opportunity, Motivation, and Behavior (COM-B) model. The discourse of the interviewees enabled the identification of a wide range of barriers and enablers for the use of infant formula, which were related to the three components of the model: capabilities, opportunity, and motivation. The health system emerged as the key determinant of infant formula use. Most of the participants who used infant formula referred to medical indication when explaining the reasons underlying their infant feeding decisions. The working status of the mother and emotional aspects of the child feeding experience were also identified as key enablers of infant formula use, whereas knowledge about health benefits and breastfeeding techniques, support from families and health-professionals, and motivation to breastfeed were key barriers. Taken together, these results suggest that strategies to reduce the use of infant formula in Uruguay should mainly focus on providing opportunities to breastfeed by improving the quality of the support and guidance provided to families in the health system and facilitating greater balance between breastfeeding and work., Competing Interests: Declaration of competing interest The authors declare no conflicting interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Digital marketing has seen a rapid rise in the last decade as a consequence of the increased popularity of social media. However, few studies so far have analyzed the prevalence and persuasive power of digital marketing of ultra-processed products. The present study aimed at: (i) analyzing the content of Instagram posts of ultra-processed products through the lens of the heuristic-systematic model, and (ii) evaluating the influence of the content of the posts on user interactions. A search for Instagram accounts of ultra-processed products was performed using a master list of products commercialized in the two most popular online supermarkets in Uruguay. For each of the identified Instagram accounts, all the content posted in a 6-month period was recorded (August 15th, 2020 to February 15th, 2021). The posts were analyzed using content analysis based on inductive coding, and gradient boosting models (GBMs) were used to address the second study objective. A total of 2178 Instagram posts promoting specific ultra-processed products or brands were identified. The posts included a diverse set of cues to trigger both systematic and heuristic processing. References to the pleasure derived from product consumption as well as health-related cues were most prevalent. The GBM showed that references to contests and raffles and invitations to interact encouraged users to engage with the posts through posting comments. Taken together, results stress the need to implement comprehensive regulatory approaches to reduce exposure to and the power of digital marketing of ultra-processed products given the harmful health-related consequences associated with excessive consumption of such products., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Adolescents are particularly vulnerable to digital food marketing. However, research on adolescents' recall, awareness, and opinions of this type of marketing is still scarce. Accordingly, the present study aimed to conduct an in-depth examination of adolescents' experiences with digital food marketing. A convenience sample of 209 adolescents was recruited at two private educational institutions and a public health facility in Montevideo, the capital city of Uruguay. Semi-structured group interviews were conducted, recorded in audio and transcribed. The transcripts were analyzed using content analysis based on a deductive-inductive approach. Results showed that participants were highly exposed to digital food marketing, as they all remembered having seen advertisements, with those of fast-food restaurants and food-ordering apps being the most frequently mentioned. According to the adolescents' accounts, images, colors, music, oversized portions, product novelty, price promotions and celebrities were the most memorable aspects of food advertisements. Participants recognized the effect of advertisements on product awareness and wanting, and, to a lesser extent, on actual purchase and consumption behavior. Factors that were thought to mediate the impact of digital marketing on food choice were also identified. In the final part of the interviews, participants proposed strategies to reduce the effect of digital marketing on their food choices, which included both regulatory approaches to reduce exposure to digital marketing of unhealthy foods and behavior change communication. Together, the current findings provide insights for the development of multifaceted strategies to reduce the effects of digital food marketing on the eating habits of adolescents., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Although several efforts to promote breastfeeding have been implemented worldwide, the prevalence of exclusive breastfeeding in the first 6 months of life remains low. One of the factors responsible for this trend is the widespread sales and marketing of breast-milk substitutes. In this context, the present work aimed at exploring mothers and health professionals' social representations of breastfeeding and infant formula. The study was conducted in Montevideo (Uruguay), as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast-milk substitutes according to the OMS/UNICEF NetCode toolkit. A total of 330 mothers of children under 24 months old and 154 health professionals were recruited at 33 health care facilities. Participants were asked to complete two word association tasks, one with breastfeeding and the other with infant formula. Inductive coding was used to classify the responses into categories and dimensions. The structure of the social representations was explored considering the frequency of mention and the average rank of appearance of the categories. Results showed that mothers' social representations mainly positioned breastfeeding as a feeding practice, whereas infant formulas were mainly perceived as a complement to breast-milk that provides support. In the case of health professionals, the social representations of breastfeeding and infant formulas were in line with scientific evidence and health recommendations. These results suggest that efforts to promote breastfeeding should focus on raising public awareness of the risks associated with breast-milk substitutes and on overcoming the systemic barriers to breastfeeding, particularly among working mothers., (Copyright © 2020 Elsevier Ltd. All rights reserved.)