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We evaluated the association between availability of specific physical activity (PA) spaces and PA practices among adolescents within Mexican high schools (HS).Data were collected through an online survey applied to principals or person in charge of 4023 Mexican HS during the 2015-2016 school year. Adequate PA was defined as moderate to vigorous intensity PA for ≥60 minutes/day, ≥5 days/week, whereas PA-specific spaces were considered those that were available and specifically designed/used for PA. HS demographic factors were explored as covariates. Associations were estimated using a logistic regression model.From total participating HS, 83.10% had at least 1 PA-specific space and 31.07% had adequate PA practices. A higher number of PA-specific spaces was associated with greater adequate PA practices (33% to 61%). Possibilities for adequate PA increased when: physical education (PE) classes were led by a designated PE teacher (OR 2.39; 95%CI: 2.03-2.83); the number of enrolled students was higher (OR 1.78; 95%CI, 1.43-2.22 and OR 2.23; 95% CI, 1.71-2.89, second and third tertile, respectively); HS financing sources were autonomous or private (OR 1.76; 95% CI, 1.19-2.60); and HS were located in northern Mexico (OR 1.27; 95%CI, 1.02-1.57).PA-specific spaces, designated PE teachers, and financing sources are important factors in achieving adequate PA within Mexican high schools.

A massive incorporation of ultra-processed products into young children’s diets worldwide and in Mexico has been documented. The aim of this study is to understand the role of sociocultural factors in principal caregivers’ decisions to give a type of ultra-processed food to children under age five, called ‘comida chatarra’ (‘junk food’ in English), usually includes sugar-sweetened beverages, sweet and salty snacks, and sweet breakfast cereals. We conducted a descriptive, observational qualitative study. The research was conducted in urban and rural communities in two Mexican states. Twenty-four principal caregivers were equally distributed between the two states and types of communities. They were interviewed in person. Phenomenology underpinned this study. Results highlight the preponderant role of culture in food choices and feeding practices with junk food. Local culture influences child-feeding with ultra-processed products through social norms, knowledge, or socially constructed attitudes. These social norms, built in the context of abundant ultra-processed products and omnipresent marketing, ‘justify’ children’s consumption of junk food. They acquire these products from the principal caregivers, family members, and neighbors, among others, who reward and pamper them. These actors also define what amount (small amounts) and when (after meals as snacks) children are given these products. Cultural factors must be considered in the development of effective public policies and programs that aim to change the culture around ultra-processed products among children and avoid their consumption.

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

Green space or natural vegetation may reduce obesity risk by increasing opportunities for physical activity or reducing stress and exposure to other pollutants. Obesity prevalence in Mexico is ranked among the highest in the world. However, research on the association between green space and obesity in Mexico is lacking. We used data from the National Nutrition Survey in Mexico (2018–2019), a nationally representative sample of Mexican adults. The analytical sample included participants between 20–59 years of age (n = 12,631). We assessed exposure to green space using a 30 m resolution Landsat satellite Normalized Difference Vegetation Index (NDVI) from 2018. Linear regression models examined associations between NDVI and body mass index (BMI), adjusting for confounders. The mean age of the study sample was 38 (SD 0.19) years. Participants living in areas with the highest green space exposure had the lowest education level (53.51%) and socioeconomic status (28.38%) and were located in central (33.01%), south (30.37%), and rural areas (21.05%). Higher residential exposure to green space was associated with a mean decrease in BMI of −1.1 kg/m2 (95% CI: −1.59, −0.68). This is one of the first studies in Latin America to suggest a protective association between green space and obesity among Mexican adults.

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.

Background The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers’ routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.

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.

Factors that have a bearing on adolescent pregnancies have been widely documented worldwide. However, rarely has the adolescents’ own perception on the ideal timing to transit into adulthood-related events, such as family formation, been considered. Neither has it been widely investigated if these aspirations are linked to the risk of early pregnancies. Using data from a cross-sectional study with a sample of adolescents in Mexico City and Morelos, Mexico, we explored expectations regarding the ideal timing for family formation (marriage and childbearing) and their link to sexual behavior. We surveyed 3,332 adolescents in eight middle schools and high schools. Four types of aspirations were identified: (a) early plan: desire to marry at age 21 and have children at 22; (b) middle plan: desire to marry and have children at ages 25 and 26 respectively; (c) late plan: desire for a stable partner at age 29 and children at 31; and (d) non-traditional plan: adolescents that do not want to marry and/or have children. Those adolescents that aspire to postpone family formation particularly until 29 years of age (late plan) are more likely to report condom use at first intercourse and to have fewer sexual relations during all their life. Adolescents’ expectations about their life in the future affect their present sexual and reproductive decisions. Identifying their aspirations should enhance the design of more viable and successful policy strategies to prevent adolescent pregnancies.

Resumen: Objetivo: Describir la cobertura y focalizacion de los Programas de Ayuda Alimentaria (PAA) en Mexico. Material y metodos: Se obtuvo informacion de 9137 hogares de la Encuesta Nacional de Salud y Nutricion Medio Camino (Ensanut MC) 2016 sobre los PAA que reciben. Se analizo la distribucion de los PAA por lugar de residencia, indice de nivel socioeconomico y pertinencia los PAA. Resultados: El 44% de los hogares recibe algun PAA, con mayor concentracion en hogares indigenas (70%), de muy bajo nivel socioeconomico (70%) y en inseguridad alimentaria moderada y severa. Los PAA con mayor cobertura fueron Prospera (21%), Liconsa (9%), Programa de Desayunos Escolares (17%) y el Programa de Adultos Mayores; de estos, el programa mejor focalizado fue Prospera. Conclusiones: Es necesario revisar los recursos de los programas y dirigirlos a la poblacion con mayores carencias y mayor vulnerabilidad nutricional.

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.

Made available in DSpace on 2014-08-20T13:57:55Z (GMT). No. of bitstreams: 1 Dissertacao_Ana_Lilia_Lozada_Tequeanes.pdf: 390842 bytes, checksum: e91fb92ead95ecd8272b2a0c2648359c (MD5) Previous issue date: 2008-07-02 O presente estudo investigou a relação entre a nutrição de mães e do seus filhos nascidos em Pelotas no ano de 1982 e que foram acompanhados até os 23 anos de idade. Entre os achados mais importantes do estudo, encontrou-se que os filhos de mães muito magras e baixinhas não apresentaram maior chance de ocorrência de obesidade na idade adulta. Por outro lado, mães que apresentavam sobrepeso ou obesidade antes da gestação tiveram filhos com maior peso em relação à altura e também maior quantidade de gordura na região da cintura aos 23 anos. Atualmente a obesidade apresenta-se como um dos principais problemas de saúde da população em geral, sendo também observado na população mais pobre. De acordo com os resultados deve-se buscar esclarecer às mulheres em idade reprodutiva que o seu estado de nutrição no momento de engravidar é também importante para a saúde e nutrição dos seus filhos ao longo da vida. Sendo assim, as mulheres devem ser orientadas a atingir um peso adequado para a sua altura antes de experimentar a primeira gravidez.

Objective. To identify dietary patterns in Mexican female adolescents by two statistic methods. Material and Meth ods. 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: “Urbanpoor” [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.

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.

Objetivo. Analizar las intenciones de adolescentes de formar una familia a edad temprana. Material y métodos. Estudio transversal con cuestionarios a estudiantes de ocho secundarias y preparatorias en Morelos y Ciudad de México, en 2010. Se exploraron intenciones de casarse y tener un hijo y se ajustó de manera exploratoria un modelo de rutas para identificar predictores en el plan de tener un hijo antes o después de los 20 años (n=2 974). Resultados. El 77% espera tener su primer hijo a los 20 años/después; 21% se muestra indeciso y 2% antes de los 20 años. Las expectativas de los padres influyen en la importancia que el adolescente le otorga a alcanzar un alto nivel de estudios, mismo que promueve las intenciones de tener hijos hasta los 20 años o después (β=0.13). Conclusiones. En la prevención de embarazos tempranos es imprescindible apoyar a los adolescentes para que se fijen metas de desarrollo personal.