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BackgroundPromoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. ObjectiveThis study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. MethodsNUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. ResultsOf the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. ConclusionsWhile NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial RegistrationClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896

Innovative and continuously changing methods of digital marketing are routinely used to reach young women and their families with advertisements that normalise infant artificial feeding and undermine breastfeeding. Legislation and provisions regulating digital and social media marketing are limited across countries. The aim of this scoping review was to systematically identify and summarise worldwide legislation implemented to regulate breast-milk substitutes (BMS) marketing on digital and social media, as well as identifying areas of opportunity to strengthen and improve it. Documents published from January 2012 to April 2022 were examined using search strategies including multiple databases and citation tracking. A total of 127 sources were evaluated, and only 28 documents from 24 countries meeting the inclusion criteria were retained. Most of the reviewed documents explicitly stated that digital marketing was prohibited (n=23), as opposed to being regulated only, with prior approval from the relevant authorities in each country. Regarding monitoring, from the countries included in this scoping review, only 14 of 24 (58.3%) stipulate a monitoring process for compliance with legal measures and have designated an actor responsible for monitoring. In addition, 22 of 24 (91.6%) countries included have defined sanctions, but only 17 (70%) countries specify the entity responsible for enforcement. The results highlight the urgent call for the explicit regulation of BMS marketing in digital and social media worldwide, as well as the public documentation of such legal measures. Likewise, it is important that there are effective, transparent and free of commercial influence national monitoring systems used to ensure compliance with legal measures.

La doble carga de la desnutrición y el exceso de peso (o mala nutrición) es uno de los indicadores que mejor ilustra las inequidades en salud que existen en zonas indígenas de México. Por otro lado, existe escasa evidencia del estado de nutrición en población Tarahumara. Objetivo: Estimar indicadores del estado de nutrición y su asociación con factores sociodemográficos en población indígena Tarahumara menor de 5 años. Métodos: Estudio transversal en 21 localidades indígenas de la Sierra Tarahumara en Chihuahua, México, que analizó información sociodemográfica, de salud y antropométrica en población infantil de 6 a 59 meses de edad (n=323). Se estimaron índices antropométricos y su asociación con variables de interés mediante regresión logística múltiple. Un valor de p ≤0,05 fue considerado como estadísticamente significativo. Todos los análisis se realizaron en el paquete estadístico Stata v14.2. Resultados: Se encontraron altas prevalencias de talla baja (44,4%), emaciación (5,3%), bajo peso (11,9%) y sobrepeso (15,2%). El sexo masculino se asoció significativamente con talla baja (Razón de Momios (RM)=2,5; 1,45-4,34), mientras que, ninguna escolaridad de la madre (RM=0,39; 0,15-0,99) y ser beneficiario de un programa local de nutrición por más de 2 años se asoció con sobrepeso (RM=2,97; 1,26 -6,97). Conclusión: Se encontraron indicadores de mala nutrición en la muestra estudiada; éstos hallazgos podrían sugerir la existencia de inequidad y rezago en salud y nutrición de población infantil indígena Tarahumara. Se requieren más estudios que puedan orientar programas y acciones de salud y nutrición para atender a esta población de forma prioritaria.

Abstract Background Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals. Methods Mixed methods were conducted between May and July 2017, including surveys (n = 543) and semi-structured interviews (n = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15–49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico. Results Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%; p

Objetivo: Evaluar los procesos de una intervención de actividad física durante el embarazo y postparto. Métodos: En el contexto de un programa social que combate la pobreza extrema, las beneficiarias (n=927) recibieron una intervención que consistió en la promoción de la práctica de actividad física, a través de consejería, talleres y materiales educativos. En 2008-9, 2010 y 2012 se visitaron unidades de salud urbanas y rurales, seleccionadas aleatoriamente, de cuatro entidades federativas de México. Se recolectó información de procesos a través de prestadores de servicios de salud, observación en consulta y aplicación de encuestas de salida a beneficiarias. Se estudiaron cuatro indicadores de implementación de la intervención: fidelidad a actividades planeadas; dosis entregada a la población; alcance de la población objetivo; y recepción de la intervención por embarazadas y en el posparto de las participantes. Resultados: Se visitaron unidades de salud en la etapa inicial (n=91), intermedia (n=47) y final (n=82) del estudio. La dosis liberada presentó un nivel del 81-86% de implementación. La fidelidad presentó

Abstract Although actions have been taken to improve breastfeeding in Mexico, trends over the last decade and their associated factors have not been analysed. We estimated trends in breastfeeding practices at the national, rural/urban, and regional level indigenous ethnicity and socio‐economic level, and their associated factors using the National Demographic Dynamics Survey (2006, 2009, 2014 and 2018). We assessed breastfeeding indicators of women with children

Objective. To describe the coverage and targeting of Social Food Assistance Programs (SFAP) in Mexico. Materials and methods. Data were obtained from 9 137 households of the Halfway National Health and Nutrition Survey 2016 (Ensanut MC 2016) who receive SFAP. The distribution of the SFAP by place of residence, index of socioeconomic status and SFAP relevance were analyzed. Results. 44% of households receive some SFAP, with a higher concentration in indigenous households (70%), a very low socioeconomic level (70%), and moderate and severe food insecurity. The SFAP with the greatest coverage were Prospera (21%), Liconsa (9%), School Breakfasts Program (17%) and the Support Program for Older Adults; of these the best-focused program was Prospera. Conclusions. It is necessary to review the resources of the programs and direct them to the population with greater deficiencies and greater nutritional vulnerability.

Objetivo. Explorar percepciones de proveedores de salud y beneficiarias del Programa Oportunidades sobre la práctica de actividad física durante el embarazo y posparto, e identificar características de la consejería sobre el tema en el primer nivel de atención en salud. Material y métodos. Estudio de métodos mixtos que forma parte de una intervención en nutrición del Programa Oportunidades. La información cualitativa se colectó por entrevista (50 mujeres; 34 proveedores de salud) y se obtuvo información cuantitativa a partir de un cuestionario (n=88 mujeres; n=64 proveedores; n=111 observaciones de consulta). Resultados. Se documentaron barreras a) individuales: falta de tiempo y de apoyo social; b) socioculturales: prejuicios de pares y familiares, y falta de instructores, y c) ambientales: falta de espacios físicos seguros y apropiados. 38% de las mujeres reporta haber recibido consejería sobre el tema versus 63.4% de proveedores que reportan haberla dado (p=0.002). Conclusiones. Urgen capacitación a proveedores y promoción de la actividad física que eliminen los prejuicios asociados al tema durante el embarazo y posparto.

Objective. This study aims to explore adolescents’ intentions related to the early formation of a family. Materials and methods. We administered a survey to students in eight schools in Morelos and Mexico City, in 2010. We analyzed intentions of marrying or having a child and fitted an exploratory path model to assess predictors of the intentions of having a child before the age of 20 (n=2974). Results. Around 77% of adolescents expect to have their first child at 20 years or later; 21% show ambivalence or incongruence regarding this, whereas 2% expect to have a child before the age of 20. Parents’ expectations for their child’s education influence the importance that adolescents give to education. The latter promotes the idea of postponing childbearing until 20 years or later (β=0.13). Conclusions. In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

OBJETIVO: El estudio de patrones dietarios ha demostrado su utilidad en la investigación para entender la relación entre dieta y salud. En este trabajo se buscó identificar patrones de dieta en adolescentes mexicanas a través de dos métodos estadísticos. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio transversal con 477 mujeres de 12-19 años (Encuesta Nacional de Nutrición 1999). Se caracterizaron patrones dietarios por medio de análisis de factores y de conglomerados. RESULTADOS: Se identificaron tres patrones dietarios por conglomerados "urbano"[U], 9.7%, "rural" [R], 47.9% y "occidental" [O], 42.3%. Por aporte energético, los principales grupos de alimentos en el patrón [U] fueron el maíz (20%) e industrializados (17%). En el patrón [R] predominaron el maíz (48%), los alimentos de trigo y leguminosas (~6% c/u). En [O] el trigo (19%) y las carnes rojas (11%). Asimismo, se identificaron cuatro patrones dietarios por el método de factores. En el factor uno predominaron los productos de trigo, postres, botanas y carnes. El factor dos se caracterizó por consumo alto de lácteos bajos en grasas y cereal de caja. El factor tres se caracterizó por consumo alto de refrescos e industrializados. En el factor cuatro predominaron el café, los dulces y las leguminosas. CONCLUSIONES: Se identificaron patrones dietarios en adolescentes mexicanas y los resultados de los dos métodos utilizados fueron comparables.OBJECTIVE: To identify dietary patterns in Mexican female adolescents by two statistic methods. MATERIAL AND METHODS: Cross-sectional study of 477 women 12 to 19 years of age -National Nutrition Survey, 1999. Dietary patterns were obtained by factor and cluster analyses. RESULTS: Three dietary patterns were identified by cluster analysis: "Urban-poor" [U] (9.7%), "Rural" [R] (47.9%), and "Western" [W] (42.3%). Pattern [U] was characterized by a sizeable intake of maize products (20%) and industrialized foods (17%). Maize products and legumes predominated in the [R] pattern (48% and 6% of total energy, respectively). In the [W] pattern, wheat products and meat contributed 19% and 10.6% of energy, respectively. Moreover, four dietary patterns were identified through factor analysis. Factor 1 had a positive loading factor on wheat products, desserts, and meat. Factor 2 was characterized by a high consumption of low-fat dairy and low-fiber breakfast cereals. Factor 3 had a high loading for sweetened beverages and industrialized foods. Factor 4 had a moderate loading on maize products and legumes. CONCLUSION: We identified dietary patterns in Mexican adolescent girls by two methods, obtaining comparable results between methods.