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While television has been the most widely used medium for food and beverage marketing, companies are shifting in favor of digital media. The ubiquitous digital marketing of breast-milk substitutes (BMS) and foods and beverages high in saturated fat, salt, and/or free sugars (FBHFSS) has been considered a powerful environmental determinant of inadequate dietary practices during infancy, childhood, and adolescence. The scoping review’s aim was to systematically identify and map the types of methodologies available to monitor the digital marketing of foods and beverages targeting infants, children, and adolescents (ICA) worldwide. Research evidence published from 2011 to October 2021 was examined using search strategies including multiple databases and citation tracking. A total of 420 sources were evaluated, and 28 studies from 81 countries meeting the inclusion criteria were retained. Most of the studies (n = 24) documenting methodologies to monitor inappropriate digital marketing were published since 2015 and were primarily aimed at identifying the promotional techniques and nutritional content of FBHFSS targeting adolescents (n = 13). It is paramount to develop a feasible and scalable monitoring system to develop effective policies to protect parents and ICA from BMS and FBHSFF digital marketing.

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

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 p = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05; p p = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46; p = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists. Conclusions Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.

Aim We aimed to examine the advertising and marketing of breast milk substitutes (BMS) through the internet, social media and television in Mexico. Methods We recorded the programming of four main TV channels at peak times to identify BMS advertisements. In addition, we identified the main BMS products and companies present on the internet, as well as related home pages and social networks (Facebook, Twitter and YouTube). After that, we examined current BMS' marketing practices using the International Code of Marketing of Breast-milk Substitutes ('the Code') as a framework for ethical marketing. Qualitative and statistical analyses are presented. Results BMS manufacturers have a presence on television, social media and the internet. Violations of the Code, as well as promotional practices unforeseen by the Code, were identified in all the studied media. These include text and images idealising the use of BMS, as well as mechanisms for boosting sales and making contact with consumers. Conclusions The Mexican population is exposed to BMS advertisements that breach the Code on the internet, on social networks and on television. Emerging challenges related to the use of electronic means to market BMS may call for new strategies for monitoring and enforcing the Code through local regulations.

Background The Integrated Strategy for Attention to Nutrition (EsIAN in Spanish) is a national strategy within Mexico's conditional cash transfer program (initially Progresa, then Oportunidades, then Prospera, CCT-POP) designed to strengthen the health and nutrition component, address the nutrition transition, and improve the health and nutritional status of its beneficiaries, through 3 main components: 1) procurement of functioning equipment to primary health care (PHC) units; 2) providing free micronutrient supplements to beneficiary women and children; 3) implementing a behavior change communication (BCC) strategy and a training system for PHC providers (PHCPs). Objective We aim to describe the iterative process and evidence-based approach used to design and roll-out the EsIAN at scale, by focusing on the BCC component. Methods The BCC strategy was developed by following an iterative process through the following phases: situational analysis, formative research and design of the BCC strategy (using the socioecological framework and the social marketing approach), large-scale feasibility study, redesign, and national scale-up. Results The review and formative research revealed several barriers and issues that limited program coverage, utilization, and acceptance. These included misconceptions about pregnancy and infant feeding, nonalignment of practices with international recommendations, and lack of knowledge on nutrition and related topics, among others. These results were used to identify priority behaviors and elaborate key messages for mothers/caregivers and providers to develop the BCC strategy. The feasibility study resulted in significant improvements in PHCPs' knowledge, counseling (breastfeeding, and supplement use and consumption), and caregivers' complementary feeding behaviors, and highlighted several design and delivery aspects that needed strengthening. Based on these findings, the BCC strategy was adapted prior to a national scale-up. Conclusions The theory-based iterative approach resulted in the identification of specific actions to target, and approaches to do so, as part of the design and roll-out of the BCC strategy at scale.

This study estimated the prevalence of violations of the International Code of Marketing of Breast-milk Substitutes (BMS) and subsequent resolutions of the World Health Assembly (Code) at health facilities, points of sale (POS), and on BMS labelling and media in Mexico. We carried out a cross-sectional survey among 693 mothers with children aged less than 24 months and 48 health providers at public and private health facilities in two states of Mexico. Observational assessment at 20 POS and the health facilities was conducted as well as an analysis of labels on BMS products for sale. Women attending public and private health facilities reported receiving free BMS samples in the previous 6 months (11.1%), and about 80% reported seeing BMS promotion in the mass media. Health providers reported contact with BMS manufacturer representatives in the previous 6 months (15.5%), and only 41.6% of the health providers had knowledge of the Code. BMS promotions were identified at nearly all POS. Analysis of 190 BMS labels showed that 30% included pictures/text idealizing the use of BMS, and all labels incorporated health and nutrition claims. Violations of the Code are prevalent within the health services, POS, and labelling of BMS products. The high percentage of health providers with no knowledge of the Code calls for action at national level to better disseminate and comply with the Code. A transparent, free from commercial influence, and continual monitoring system for Code compliance is needed, including a follow-up component on sanctions for contraventions of the Code.

This study aims to explore adolescents' intentions related to the early formation of a family.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).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).In order to prevent early pregnancies, interventions and programs should encourage the construction of personal and professional goals.

To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico.A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation).The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002).There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

The aim of this study was to assess the vitamin D status in preschool and school-age children in Mexico.25-hydroxyvitamin D (25-OH-D) serum concentrations were measured using a direct enzyme-linked immunosorbent assay commercial kit in a nationally representative sample of 1025 Mexican children ages 2 y to 12 y who participated in the 2006 Mexican National Health and Nutrition Survey.Mean serum 25-OH-D concentration was 94.6 ± 47 nmol/L. Concentrations were lower in preschool children (2-5 y; 78.3 ± 37 nmol/L) than in school-aged children (6-12 y; 105.8 ± 51 nmol/L; P 0.001). Children living in urban areas had lower levels (89.8 ± 36 nmol/L) than children from rural areas (108.1 ± 75 nmol/L; P 0.05). Twenty-four percent of preschool children had vitamin D deficiency (25-OH-D 50 nmol/L) compared with 10% of school-aged children (P 0.05). Thirty percent of preschool children had vitamin D insufficiency (25-OH-D 50-74.9 nmol/L) compared with 18% of school-aged children (P 0.05). In urban areas, 18% of children had vitamin D deficiency and 25% had insufficiency compared with 10% and 16% of children in rural areas, respectively (P 0.05). Prevalence of severe vitamin D deficiency (25-OH-D 20 nmol/L) was extremely low (0.3%).Vitamin D deficiency and insufficiency are important public health problems in Mexican children.

Our objective was to identify and describe the major dietary patterns in the Mexican adult population and their association with being overweight or obese. Dietary intake was evaluated by a FFQ that was completed by 15,890 Mexican adults who participated in the National Health and Nutrition Survey 2006. Dietary patterns were generated by cluster analysis based on the percent contribution to total energy intake from 30 food groups. We identified 3 major dietary patterns: refined foods and sweets (RS), traditional (T), and diverse (D). The T pattern was characterized by low dietary diversity, with maize and maize foods accounting for ~47% of energy intake. This pattern had the lowest contribution of most food groups, with the exception of beans (~4.0%). The RS pattern had the highest contribution of alcohol (9.4%), soft drinks (9.4%), white bread (7.7%), fast food, sweets, and snacks. The D pattern had the lowest contribution of maize (15.5%) and the highest contribution of whole-fat dairy (8.0%), rice and pasta, meat, poultry, eggs, saturated fat, fruits, and vegetables. After adjusting for age, gender, physical activity, socioeconomic status, area, and region, the RS and D dietary patterns were associated with 14 and 17% increased risk of being overweight (P < 0.01) and 20% increased risk of being obese, respectively, compared with the T dietary pattern (P < 0.001). These findings support an association of dietary patterns with being overweight or obese in a nationally representative sample of Mexican adults.

Obesity is considered a public health problem worldwide. Evidence from epidemiologic studies has shown that early undernutrition may be a determinant of obesity later in life. Longitudinal studies are scarce in the setting of low- and middle-income countries. In Pelotas, southern Brazil, a birth cohort has been followed since 1982. Between 2004 and 2005, 4297 members of this cohort were interviewed. The aim of this study is to describe the association between maternal anthropometry and offspring BMI and waist:height ratio (WHtR) at 23 y of age in individuals from the 1982 Pelotas birth cohort. Independent variables included maternal prepregnancy BMI and maternal height, obtained in 1982. The BMI and WHtR of the offspring at 23 y of age were the outcomes. The analysis was stratified by sex and restricted to those cohort members belonging to the lower income group. Multivariable linear regression was adjusted for potential confounding or mediating factors according to a hierarchical framework. For each unit of maternal prepregnancy BMI, the offspring BMI increased 0.65 and 0.63 kg/m(2) in men and women, respectively (P < 0.001). Maternal prepregnancy BMI was directly associated with offspring WHtR in both sexes (P < 0.001). On the other hand, maternal height was not associated with offspring BMI or WHtR. In conclusion, our study suggests that maternal anthropometry is associated with the offspring BMI and WHtR at 23 y of age.

To identify dietary patterns in Mexican female adolescents by two statistic 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.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.We identified dietary patterns in Mexican adolescent girls by two methods, obtaining comparable results between methods.