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[This corrects the article DOI: 10.1371/journal.pgph.0000763.].

Individuals with non-communicable diseases (NCDs) are potentially at increased vulnerability during the Covid-19 pandemic and require additional help to reduce risk. Self-management is one effective strategy and this study investigated the effect of sociodemographic and health factors on the self-management of some non-communicable diseases, namely hypertension, type 2 diabetes mellitus and dyslipidemia, among Chilean adults during the Covid-19 pandemic. A cross-sectional telephone survey was carried out on 910 participants with NCDs, from Santiago, Chile. An adapted and validated version of the “Partners in Health” scale was used to measure self-management. Exploratory Factor analysis yielded five dimensions of this scale: Disease Knowledge, Healthcare Team Relationship, General Self-Management and Daily Routines, Drug Access and Intake, and Monitoring and Decision-Making. The average of these dimensions was calculated to create a new variable Self-Management Mean, which was used as a dependent variable together with the five separate dimensions. Independent variables included age, gender, years of schooling, number of diseases, the percentage of Multidimensional Poverty Index in the commune of residence, and self-rated health status. Beta regressions and ANOVA for the Beta regression residuals were utilized for analyses. Beta regression model explained 8.1% of the variance in Self-Management Mean. Age, years of schooling, number of diseases and self-rated health status were statistically associated with Self-Management Mean and dimensions related to daily routines and health decision making, such as Disease Knowledge, General Self-Management and Daily Routines, and Monitoring and Decision-Making. Gender and the percentage of Multidimensional Poverty Index in the commune of residence were insignificant. Strategies for self-management of NCDs during a crisis should consider age, years of schooling, number of diseases, and self-rated health status in their design.

Objective To analyze the association between the prevalence of overweight and obesity in children younger than six years of age cared for in the primary healthcare setting with socioeconomic level and environment of Chilean districts. Methods We conducted an ecological study to analyze the correlation between the prevalence of overweight and obesity and indicators of socioeconomic status (poverty by income and multidimensional poverty) and district environment and surroundings (green areas and crime reporting rate for crimes of significant social connotation). Furthermore, we performed four simple linear regression models with the correlated variables. Results At the district level, we found that the percentage of people living in poverty as defined by income, and the rate for reporting of crimes, are significantly correlated with the prevalence of overweight and obesity. The crime reporting rate correlated negatively with prevalence, and no correlation was found with communal green areas. Those districts with greater income poverty and a lower crime reporting rate have a higher prevalence of overweight and obesity in children under six years of age. Conclusions The characteristics of the district environment in which children are raised could augment the risk for overweight and obesity, mainly due to socioeconomic level. The crime reporting rate, on the contrary, shows an inverse relationship with these nutritional conditions.

Abstract In 2011, Chile added 12 mandatory extra weeks of maternity leave (ML). In January 2015, a pay-for-performance (P4P) strategy was included in the primary healthcare system, incorporating exclusive breastfeeding (EBF) promotion actions. The COVID-19 pandemic led to healthcare access difficulties and augmented household workloads. Our aim was to evaluate the effect of a 24-week ML, the P4P strategy, and COVID-19 on EBF prevalence, at 3 and 6 months in Chile. Aggregated EBF prevalence data from public healthcare users nationwide (80% of the Chilean population) was collected by month. Interrupted time series analyses were used to quantify changes in EBF trends from 2009 to 2020. The heterogeneity of EBF changes was assessed by urban/setting and across geographic settings. We found no effect of ML on EBF; the P4P strategy increased EBF at 3 months by 3.1% and 5.7% at 6 months. COVID-19 reduced EBF at 3 months by − 4.5%. Geographical heterogeneity in the impact of the two policies and COVID-19 on EBF was identified. The null effect of ML on EBF in the public healthcare system could be explained by low access from public healthcare users to ML (20% had access to ML) and by an insufficient ML duration (five and a half months). The negative impact of COVID-19 on EBF should alert policy makers about the crisis's effect on health promotion activities.

Summary: Background: Childhood obesity is a rising global health problem. The rapid urbanization experienced in Latin America might impact childhood obesity through different pathways involving urban built and social features of cities. We aimed to evaluate the association between built and social environment features of cities and childhood obesity across countries and cities in Latin America. Methods: Cross-sectional analysis of data from 20,040 children aged 1–5 years living in 159 large cities in six Latin American countries. We used individual-level anthropometric data for excess weight (overweight or obesity) from health surveys that could be linked to city-level data. City and sub-city level exposures included the social environment (living conditions, service provision and educational attainment) and the built environment (fragmentation, isolation, presence of mass transit, population density, intersection density and percent greenness). Multi-level logistic models were used to explore associations between city features and excess weight, adjusting for age, sex, and head of household education. Findings: The overall prevalence of excess weight among preschool children was 8% but varied substantially between and within countries, ranging from 4% to 25%. Our analysis showed that 97% of the variability was between individuals within sub-city units and around 3% of the variance in z-scores of weight for height was explained by the city and sub-city levels. At the city-level, a higher distance between urban patches (isolation, per 1 SD increase) was associated with lower odds of excess weight (OR 0.90, 95% CI 0.82–0.99). Higher sub-city education was also associated with lower odds of excess weight, but better sub-city living conditions were associated with higher odds of excess weight. Interpretation: Built and social environment features are related to excess weight in preschool children. Our evidence from a wide range of large Latin American cities suggests that urban health interventions may be suitable alternatives towards attaining the goal of reducing excess weight early in the life course. Funding: The SALURBAL project (Salud Urbana en América Latina, Urban Health in Latin America) is funded by Wellcome [205177/Z/16/Z].

Abstract Background Obesity is a global health problem, and its connection with social and environmental factors is well-established. Social factors, such as urban segregation, may impact obesity through various mechanisms, including food and physical activity environments, as well as social norms and networks. This multilevel study aims to examine the effect of socio-economic residential segregation of Latin American cities on the obesity of individuals within those cities. Methods We analyzed data from national surveys for a total of 59,340 individuals of 18–70 years of age, conducted in 156 cities across Brazil, Chile, Colombia, and Mexico between 2007 and 2013. We adjusted two-level linear mixed models for body mass index (BMI) stratified by sex and country, controlling for age, educational level and poverty. Separate models were built for dissimilarity and isolation segregation indices. Results The relationships between segregation indices and BMI were mostly not statistically significant, and in some cases, they were opposite to what was expected. The only significant relationships were observed in Colombian men, using the dissimilarity index (-7.5 [95% CI: -14.4, -0.5]) and in Colombian women, using the isolation index (-7.9 [95% CI: -14.1, -1.7]). Conclusions While individual-level factors cannot fully explain differences among people in the same city, segregation indices may help. However, we found that in some cases, the relationship between BMI and segregation indices is opposite to what is expected based on prior literature. This should be considered in examining the phenomenon. Further research on obesogenic environments in segregated neighborhoods could provide valuable evidence.

BackgroundFood environments are crucial for promoting healthy and sustainable eating and preventing obesity. However, existing food environment frameworks assume an already installed causality and do not explain how associations in food environments are established or articulated, especially from an integrative and transdisciplinary approach. This research attempts to bridge these gaps through the use of Actor-Network Theory, which traces the relationship network between human (and nonhuman) actors in order to describe how these interact and what agencies (direct or remote) are involved. ObjectiveThis study aims to explain the practices and interactions of actors in food environments in order to approach the problem of unhealthy eating with a transdisciplinary approach. MethodsThis is a nonexperimental, cross-sectional study. Due to the complexity of the study phenomena, a mixed methods approach with 4 consecutive phases will be developed in Chile. Phase 1 involves a systematic literature review of food environment evidence since 2015, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol; phase 2 involves the application of a shortened version of the Nutrition Environment Measure Scale—Perceptions adapted to Chile (NEMS-P-Ch) in 2 neighborhoods with different socioeconomic levels; in phase 3, six focus groups in each neighborhood will be conducted to address social determinants such as gender, employment status, and migration; and in phase 4, participant observation and in-depth interviews will be used to analyze the direct and empirical exploration of the actors in their daily interaction with food environments. The triangulation and complementarity of the data will allow us to create a practical model about the practices and interactions of actors in their food environments, which reflects the complexity and transdisciplinary nature of the study. ResultsWe have advanced in phases 1-3 of the study. In phase 1, a total of 109 manuscripts are being revised for data extraction. In phase 2, we applied the NEMS-P-Ch to 785 people, 49.4% (388/785) of whom belong to a low socioeconomic neighborhood. Participants from phase 2 are being contacted to participate in the focus groups (phase 3). By the end of July, we have conducted 6 focus groups with 5-11 participants. ConclusionsThis study will provide a comprehensive understanding of how individuals interact with their food environments, offering deep insights into the factors influencing their food-related decisions. In addition, the study aims to develop a model that more accurately reflects reality by examining not only the food environments themselves but also the interactions among various stakeholders within these environments and their daily practices. The findings of this study will offer evidence-based insights to inform public policies tailored to the specific territories and communities under investigation or those with similar characteristics. International Registered Report Identifier (IRRID)DERR1-10.2196/62765

Las Guías Alimentarias Basadas en Alimentos (GABA) son un instrumento nacional de educación nutricional destinadas a la población general. En el contexto de alta prevalencia de enfermedades crónicas no transmisibles, relacionadas con dietas inadecuadas, buscan contribuir a alcanzar mejores estándares de alimentación. En el contexto americano, de alta prevalencia de sobrepeso y obesidad, las GABA forman parte de un conjunto de políticas gubernamentales para combatir estos problemas. El objetivo de este ensayo fue realizar un análisis comparativo de las GABA en nueve países americanos: Canadá, Chile, Estados Unidos, México, Paraguay, Colombia, Brasil, Uruguay y Argentina. Para la comparación se seleccionaron siete dimensiones generales: política, metodología, participación, mensajes, aspectos socioculturales, aspectos ambientales, y de implementación y evaluación, a partir de las recomendaciones para la elaboración de las GABA de organismos internacionales (FAO-OMS). Los resultados revelaron brechas en las guías de los países estudiados, destacando Brasil como uno de los países que pone mayor atención a la participación y a la incorporación de factores socioculturales en la producción de su documento. Mientras que Chile elude elementos como el género, el acceso y disponibilidad, la diversidad cultural, la sostenibilidad y los entornos alimentarios. Con guías alimentarias que abordan escasamente la propuesta FAO-OMS, es de esperar que en una futura actualización se consideren las dimensiones propuestas en un formato de desarrollo basado en la participación ciudadana, intersectorial y de expertos/as, fortaleciendo los aspectos socioculturales y ambientales.