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Gance-Cleveland B, Frenn M, Browne N, Greenberg CS, Snethen JA, Hodges EA, Fial AV, Small L, Irving SY. A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework. Worldviews Evid Based Nurs 2024; 21:445-453. [PMID: 38584314 DOI: 10.1111/wvn.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.
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Affiliation(s)
- Bonnie Gance-Cleveland
- University of Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | | | | | - Julia A Snethen
- University of Wisconsin-Milwaukee, School of Nursing, Milwaukee, Wisconsin, USA
| | - Eric A Hodges
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Alissa V Fial
- Marquette University, Raynor Memorial Libraries, Milwaukee, Wisconsin, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Sharon Y Irving
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
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Tello B, Ocaña J, García-Zambrano P, Enríque-Moreira B, Dueñas-Espín I. Determinants of overweight and obesity among children between 5 to 11 years in Ecuador: A secondary analysis from the National Health Survey 2018. PLoS One 2024; 19:e0296538. [PMID: 38578761 PMCID: PMC10997090 DOI: 10.1371/journal.pone.0296538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/10/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND During the 1990s, global eating habits changed, affecting poorer and middle-income nations, as well as richer countries. This shift, known as the "obesity transition," led to more people becoming overweight or obese worldwide. In Ecuador, this change is happening, and now, one in three children is affected by overweight or obesity (OW/OB). This study explores the links between social, economic, and demographic factors and childhood obesity in Ecuador, seeking to provide insights for shaping future health policies in response to this intricate shift. METHODS A cross-sectional study using 2018 National Health and Nutrition Survey data from Ecuador. Weighted percentages were computed, and odds ratios for OW/OB unadjusted and adjusted for each category of explanatory variables were estimated using multilevel multivariate logistic regression models. RESULTS Among 10,807 Ecuadorian school children aged 5 to 11, the prevalence of OW/OB was 36.0%. Males exhibited 1.26 times higher odds than females (95% CI: 1.20 to 1.33), and each additional year of age increased the odds by 1.10 times (95% CI: 1.09 to 1.10). Economic quintiles indicated increased odds (1.17 to 1.39) from the 2nd to 5th quintile (the richest) compared with the first quintile (the poorest). Larger household size slightly reduced odds of OW/OB (adjusted odds ratio [aOR] = 0.93, 95% CI: 0.91 to 0.95), while regular physical activity decreased odds ([aOR] = 0.79, 95% CI: 0.75 to 0.82). The consumption of school-provided meals showed a non-significant reduction (aOR: 0.93, 95% CI: 0.82 to 1.06). Children from families recognizing and using processed food labels had a higher likelihood of being overweight or obese (aOR = 1.14, 95% CI: 1.02 to 1.26). CONCLUSION Age, male gender, and higher economic quintile increase OW/OB in Ecuadorian school children. Larger households and physical activity slightly decrease risks. Ecuador needs policies for healthy schools and homes, focusing on health, protection, and good eating habits.
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Affiliation(s)
- Betzabé Tello
- Center for Research in Health in Latin America CISeAL, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - José Ocaña
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Paúl García-Zambrano
- Postgrado de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Betsabé Enríque-Moreira
- Postgrado de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Iván Dueñas-Espín
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
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Bueno AK, Vilar-Compte M, Cruz-Villalba V, Rovelo-Velázquez N, Rhodes EC, Pérez-Escamilla R. Implementation of the Baby-Friendly Hospital Initiative in Mexico: a systematic literature review using the RE-AIM framework. Front Public Health 2023; 11:1251981. [PMID: 38145069 PMCID: PMC10740192 DOI: 10.3389/fpubh.2023.1251981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/30/2023] [Indexed: 12/26/2023] Open
Abstract
The Baby-Friendly Hospital Initiative (BFHI) is a global strategy to encourage health facilities to promote, support, and protect breastfeeding by implementing a package of policies and practices known as the Ten Steps to Successful Breastfeeding. Prior studies have found that implementing the Ten Steps has a positive impact on breastfeeding outcomes. Yet, little is known about the implementation of the Ten Steps in Mexico. The objective of this study was to conduct a systematic review to evaluate the reach, efficacy/effectiveness, adoption, implementation, and maintenance of the Ten Steps in Mexico, using the RE-AIM framework. The systematic literature review included studies published in English or Spanish without date restrictions. Two of the authors coded each of the articles through a harmonized data extraction tool, and group meetings were used to discuss any discrepancies. The reviewed data were managed in the Rayyan platform. The risk of study bias was assessed through the Johanna Briggs Institute critical appraisal checklists. Of the 1,123 articles initially identified, 6 met the review inclusion criteria. None of the articles evaluated the reach and maintenance of the Ten Steps. The articles identified major gaps in the implementation of the Ten Steps. Most of the articles had important limitations in terms of their quality. In Mexico, it is necessary to rethink the BFHI and employ multiple strategies to improve implementation of the Ten Steps, including developing transparent BFHI monitoring mechanisms that produce data on implementation and that are publicly available, as well as investing in implementation research and evaluation to generate strong evidence to support the adoption and efficient maintenance of the Ten Steps in health facilities in Mexico. When properly implemented, BFHI becomes central to promote, protect, and support breastfeeding. Therefore, it is essential for Mexico to position BFHI as a top priority of the country's public policy agenda. Systematic Review Registration identifier: CRD42021248118.
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Affiliation(s)
- Angela K. Bueno
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
| | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Valeria Cruz-Villalba
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Natalia Rovelo-Velázquez
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth C. Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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4
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Bleiweiss-Sande R, Skelton K, Zaltz D, Bacardí-Gascón M, Jiménez-Cruz A, Benjamin-Neelon SE. Interventions to prevent obesity in Latinx children birth to 6 years globally: a systematic review. Public Health Nutr 2023; 26:2498-2513. [PMID: 37622420 PMCID: PMC10641617 DOI: 10.1017/s1368980023001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/03/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To conduct a systematic review of obesity prevention interventions in Latinx children ages birth to 6 years published in any language from 2010-2020. DESIGN We used PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online (SciELO) and Google Scholar databases to conduct a search on May 1 2020, January 1 2021 and November 1 2022. We included randomised controlled trials, quasi-experimental studies and non-randomised interventions with a control or comparison group that reported measures of adiposity. SETTING Interventions taking place in the United States, Latin America or the Caribbean. PARTICIPANTS Latinx children ages birth to 6 years. RESULTS Of 8601 unique records identified, forty manuscripts about thirty-nine unique studies describing thirty distinct interventions in the United States and nine interventions in Latin America and the Caribbean met our inclusion criteria. Interventions were primarily based in early care and education centres (n 13) or combined home settings, for example home and community (n 7). Randomised interventions taking place in community or home settings were more likely to report significant reductions in adiposity or weight-related outcomes compared to other settings. Using the Cochrane risk of bias tools for randomised and non-randomised studies, we judged thirty-eight randomised trials and nine non-randomised interventions to have a high or unclear risk of bias. CONCLUSIONS The results highlight a need for more rigorous designs and more effective intervention strategies in Latinx children at risk for having overweight and obesity. Registered with the PROSPERO database for systematic reviews under registration number CRD42020161339.
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Affiliation(s)
- Rachel Bleiweiss-Sande
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD21205, USA
| | - Kara Skelton
- Department of Health Sciences, Towson University, Towson, MD, USA
| | - Daniel Zaltz
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD21205, USA
| | | | - Arturo Jiménez-Cruz
- Universidad Autónoma de Baja California, Department of Medicine and Psychology, Tijuana, Mexico
| | - Sara E Benjamin-Neelon
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pérez-Escamilla R. Ultra-processed foods and the nutritional transition among infants and young children: a radiography from Brazil. CAD SAUDE PUBLICA 2023; 39:e00118123. [PMID: 37878866 PMCID: PMC10599230 DOI: 10.1590/0102-311xen118123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/27/2023] Open
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Baker JL, Bjerregaard LG. Advancing precision public health for obesity in children. Rev Endocr Metab Disord 2023; 24:1003-1010. [PMID: 37055611 PMCID: PMC10101815 DOI: 10.1007/s11154-023-09802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/15/2023]
Abstract
Worldwide, far too many children and adolescents are living with the disease of obesity. Despite decades of public health initiatives, rates are still rising in many countries. This raises the question of whether precision public health may be a more successful approach to preventing obesity in youth. In this review, the objective was to review the literature on precision public health in the context of childhood obesity prevention and to discuss how precision public health may advance the field of childhood obesity prevention. As precision public health is a concept that is still evolving and not fully identifiable in the literature, a lack of published studies precluded a formal review. Therefore, the approach of using a broad interpretation of precision public health was used and recent advances in childhood obesity research in the areas of surveillance and risk factor identification as well as intervention, evaluation and implementation using selected studies were summarized. Encouragingly, big data from a multitude of designed and organic sources are being used in new and innovative ways to provide more granular surveillance and risk factor identification in obesity in children. Challenges were identified in terms of data access, completeness, and integration, ensuring inclusion of all members of society, ethics, and translation to policy. As precision public health advances, it may yield novel insights that can contribute to strong policies acting in concert that ultimately lead to the prevention of obesity in children.
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Affiliation(s)
- Jennifer L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Frederiksberg, Denmark.
| | - Lise G Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Bispebjerg and Frederiksberg, Frederiksberg, Denmark
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7
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Machado JG, Buccini G, Recine E. An Analysis of Key Actor Networks for Scale-Up Strategies for Childhood Obesity Prevention and the Care of Children with Obesity in Brazil. Curr Dev Nutr 2023; 7:101961. [PMID: 37396061 PMCID: PMC10310469 DOI: 10.1016/j.cdnut.2023.101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Effective scale-up of multisectoral strategies aimed to prevent and treat childhood obesity has been a challenge in Brazil, the largest country in Latin America. Implementation Science methods, such as Net-Map, can identify key actors and opinion leaders (OLs) to advance the implementation and promote sustainability. Objectives This study aimed to analyze power relations between key actors and OLs who influence the scale-up of Brazilian strategies for childhood obesity at the federal and state/municipal (local) levels. Methods A mixed method study, applying the Net-Map method, collected data through virtual workshops with federal and local level stakeholders. The Net-Map included key actors mapping, power mapping, and identification of OLs. Four domains of power were analyzed: command, funding, technical assistance, and dissemination. Network cohesion and centrality measures were calculated. A qualitative analysis was conducted to qualify power relations according to ∗ gears for a successful scale-up (i.e., coordination, goals, and monitoring; advocacy; political will; legislation and policy; funding and resources; training; program delivery; communication; and research and technical cooperation). Results A total of 121 federal key actors and 63 local key actors were identified across networks, of which 62 and 28 were identified as OLs, respectively. Whereas the command domain of power had the highest number of key actors, the funding domain had the least. The health sector executive branch emerged as an OL across all domains of power. Conclusions Barriers that threatened successful scale-up include the lack of coordination between domains of power, missing leadership within key actors, and lack of mechanisms to manage conflict of interest. Governance strategies to enhance multisectoral coordination and communication are needed to effectively scale-up and sustain childhood obesity strategies in Brazil.
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Affiliation(s)
- Juliana Gonçalves Machado
- Human Nutrition Graduate Program, School of Health Science, University of Brasília (UnB), Federal District, Brazil
| | - Gabriela Buccini
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Elisabetta Recine
- Human Nutrition Graduate Program, School of Health Science, University of Brasília (UnB), Federal District, Brazil
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Thomas-Venugopal R, Hem-Lee-Forsyth S, Gomez A, Edwards N, James D. Review: Evaluating existing policies to address overweight and obesity in the Anglophone Caribbean: A narrative review of Barbados, Grenada, St. Lucia, and Trinidad & Tobago. OBESITY PILLARS (ONLINE) 2023; 6:100060. [PMID: 37990655 PMCID: PMC10662106 DOI: 10.1016/j.obpill.2023.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 11/23/2023]
Abstract
Overweight and obesity continues to be a burden to the health and well-being of Caribbean residents. The rise of childhood obesity and non-communicable diseases within the Caribbean is a major public health challenge for policymakers, educators and health professionals. These alarming rates of obesity also pose a threat to the sustainability of existing health systems particularly in small island developing states like the Caribbean. Therefore, it is crucial to evaluate existing policies and create policy solutions to address these problems and reduce the potential impact later on. This systematic review explored existing policies among countries within the Anglophone Caribbean to identify trends within the region. The literature search focused on the following themes: (i) national policies (ii) school nutrition policies and programs (iii) physical activity among youth, and (iv) food import bill and food security. An analysis was conducted on literature from national, regional and international institutions including but not limited to the World Health Organization, Ministries of Health and the Healthy Caribbean Coalition. Countries throughout the region has acknowledged the challenges with overweight and obesity in the region. Collectively decisions have been made to address food insecurity and promote healthy lifestyle behaviours through policy changes. There's still a need for Caribbean countries to work together to create effective policy solutions in collaboration with community service organizations and other stakeholders. As small island developing states grappling with the same issues, pooling resources to create effective regional policies can help to address this public health crisis.
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Kunihiro S, da Silva Vernasque JR, da Silva C, dos Santos MF, Cremasco CP, Gabriel Filho LRA. Intersectoral Actions for the Promotion and Prevention of Obesity, Diabetes and Hypertension in Brazilian Cities: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13059. [PMID: 36293640 PMCID: PMC9602621 DOI: 10.3390/ijerph192013059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
This study showed the effectiveness of biomedical interventions in obesity, diabetes and hypertension (NCDs), but innovative and intersectoral elements in the fight against obesity, type 2 diabetes and hypertension were rare. BACKGROUND Is it possible to find effective and innovative actions to promote health and prevent NCDs in Brazilian municipalities? Can they be replicated? OBJECTIVE Our objectives were to identify innovative and effective intersectoral actions for promoting and preventing NCDs in Brazilian municipalities. METHODS This is a systematic review in an exploratory theoretical essay with a qualitative and quantitative approach. It is descriptive and analytical in terms of reporting findings and results. Inclusion and exclusion criteria favored health promotion work. Bias risk assessments was performed using the Cochrane GRADE and bias risk, with meta-analyses using RevMan and Iramuteq. RESULTS Meta-analysis of biometric markers resulted in -4.46 [95% IC; -5.42, -3.49], p = 0.00001, indicating a reduction in NCD risk rates. The textual meta-analysis revealed P(r) ≈ 83% (Reinert), meaning low connectivity between the 'halos'. CONCLUSIONS There is evidence of the effectiveness in interventions, but innovative and intersectoral elements to combat and prevent NCDs were barely seen. While evidence of intervention effectiveness was observed, innovative and intersectoral elements to combat and prevent NCDs were barely noticed.
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Affiliation(s)
- Stephen Kunihiro
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
| | - Juliana Ribeiro da Silva Vernasque
- Faculty of Medical and Biological Sciences, São Paulo State University (Unesp), Botucatu 18618-687, Brazil
- Marília Medical School, FAMEMA, Marília 17519-030, Brazil
| | - Celso da Silva
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
- Maurício de Nassau College—Dean’s Office, Maurício de Nassau University Center (UNINASSAU), Recife 52011-220, Brazil
- The Regional Council of Administration—CRA/SP, São Paulo 01427-001, Brazil
| | | | - Camila Pires Cremasco
- School of Sciences and Engineering, São Paulo State University (UNESP), Tupã 17602-673, Brazil
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10
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Is nutrition labeling associated with decreased obesity? A quantitative approach to nutritional health policy in Ecuador. J Public Health Policy 2022; 43:593-612. [PMID: 36195650 DOI: 10.1057/s41271-022-00368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/21/2022]
Abstract
Few studies assess consumer response to nutrition labeling, especially in less-developed countries. We analyzed the link between nutrition labeling and obesity in Ecuador using a representative cross-sectional sample of 29,770 individuals from the National Health and Nutrition Survey (ENSANUT) in 2018. Nutrition labeling reduced the probability of obesity in adolescent (12-18 years old) and adult (18-59 years old) people by 4% (CI: - 5.7, - 2.2) and 8.4% (CI: - 12.7, - 4.0), respectively. The magnitude of average treatment effect of using nutrition label on obesity ranged from 0.90 (CI: - 1.299, - 0.500) to 1 (CI: - 1.355, - 0.645) BMI points for adolescent, and from 1.16 (CI: - 1.554, - 0.766) to 1.80 (CI: - 2.791, - 0.811) BMI points for adult. The effect of nutrition labeling is greater among the less obese. We recommend that health policy makers and clinicians continue to promote nutrition labeling especially where obesity is not chronic, where nutrition labeling is most successful.
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Hernández‐Cordero S, Pérez‐Escamilla R, Zambrano P, Michaud‐Létourneau I, Lara‐Mejía V, Franco‐Lares B. Countries' experiences scaling up national breastfeeding, protection, promotion and support programmes: Comparative case studies analysis. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13358. [PMID: 35438250 PMCID: PMC9113475 DOI: 10.1111/mcn.13358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 12/28/2022]
Abstract
Scaling up effective interventions, policies and programmes can improve breastfeeding (BF) outcomes. Furthermore, considerable interest exists in learning from relatively recent successful efforts that can inform further scaling up, with appropriate adaptations, across countries. The purpose of this four-country case studies analysis was to examine why and how improvements in BF practices occurred across four contrasting countries; Burkina Faso, the Philippines, Mexico and the United States of America. Literature reviews and key informant interviews were conducted to document BF trends over time, in addition to why and how BF protection, promotion and support policies and programmes were implemented at a national level. A qualitative thematic analysis was conducted. The 'Breastfeeding Gear Model' and RE-AIM (Reach; Effectiveness; Adoption; Implementation; and Maintenance) frameworks were used to understand and map the factors facilitating or hindering the scale up of the national programmes and corresponding improvements in BF practices. Each of the studied countries had different processes and timing to implement and scale up programmes to promote, protect and support breastfeeding. However, in all four countries, evidence-based advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment for BF. Furthermore, in all countries, lack of adequate maternity protection and the aggressive marketing of the breast-milk substitutes industry remains a strong source of negative feedback loops that are undermining investments in BF programmes. Country-specific best practices included innovative legislative measures (Philippines), monitoring and evaluation systems (United States of America), engagement of civil society (Mexico) and behavior change communication BF promotion (Burkina Faso) initiatives. There is an urgent need to improve maternity protection and to strongly enforce the WHO Code of Marketing of Breast-Milk Substitutes.
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Affiliation(s)
- Sonia Hernández‐Cordero
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE)Universidad IberoamericanaMéxico CityMexico
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Paul Zambrano
- Alive & Thrive Southeast Asia/FHI 360ManilaPhilippines
| | - Isabelle Michaud‐Létourneau
- Department of Social and Preventive Medicine, School of Public HealthUniversité de MontréalMontrealQuebecCanada
| | - Vania Lara‐Mejía
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE)Universidad IberoamericanaMéxico CityMexico
| | - Bianca Franco‐Lares
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE)Universidad IberoamericanaMéxico CityMexico
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12
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Lopes AF, Machado TC, Nascimento VG, Bertoli CJ, Leone C. Cesarean Delivery and Risk of Excess Weight Among Brazilian Preschool Children. Matern Child Health J 2022; 26:1305-1311. [PMID: 34982336 DOI: 10.1007/s10995-021-03295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the relationship between cesarean Delivery (CD) and overweight in preschool children, considering the presence of birth aspects and demographic characteristics that have been associated with the risk of excess weight. METHODS This retrospective cross-sectional analysis used representative data of children from 2 to 6 years of age at municipal daycare centers in Taubaté, São Paulo, Brazil. The sample included 752 preschoolers. Weight and height were collected in daycare centers, and the nutritional status classification was performed using z scores of Body Mass Index (zBMI). Data analysis was performed in the bivariate and multivariate manner, the latter with the inclusion of another possible risk factor. Adjustments were made for daycare centers time, sex, birth length and weight and maternal schooling. RESULTS The mean age of preschool children was 4.7 years, and 53.8% were boys. The prevalence of overweight children was 21.7%. The median zBMI of the children born by CD was higher than that of vaginal Delivery (p = 0.0194). The prevalence of overweight showed association with CD (p = 0.0196; PR = 1.397 with 95% CI of 1065-1831). Logistic binary multivariate regression analysis confirmed the association, even in the presence of other possible risk factors (CR: 1.580, 95% CI: 1.072-2.330). CONCLUSION FOR PRACTICE Birth by CD is one of the factors that are associated with the early development of overweight in preschoolers.
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Affiliation(s)
- Amanda Forster Lopes
- Health and Biotechnology Institute, Federal University of Amazonas, Manaus, Brazil.
| | - Thais Costa Machado
- Department of Health, Life Cycles and Society of the Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Viviane Gabriela Nascimento
- Department of Health, Life Cycles and Society of the Faculty of Public Health, University of São Paulo, São Paul, Brazil.,Paulista University, São Paul, Brazil
| | | | - Claudio Leone
- Department of Health, Life Cycles and Society-FSP-USP, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP 01246-904, Brazil
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13
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da Silva JM, Matos JDP, Rodrigues MB, Mais LA, Claro RM, Horta PM. Advertising patterns of a fast-food chain on social media in Brazil. Public Health Nutr 2021; 25:1-8. [PMID: 34937603 PMCID: PMC9991549 DOI: 10.1017/s1368980021004973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the advertising patterns on the posts of a fast-food chain in Brazil on three social media platforms in 2019. DESIGN An exploratory cross-sectional study. SETTING Advertising strategies on the posts of a major fast-food chain on their official Facebook, Instagram and YouTube accounts. The strategies were investigated according to the INFORMAS protocol for food promotion monitoring. Principal component analysis (PCA) was employed to identify advertising patterns in each platform. PARTICIPANTS 305 advertisements. RESULTS Four advertising patterns were identified in the PCA of Facebook and Instagram. In both platforms, the components for kids and product exaltation were similar. On Facebook, a pattern corresponding to economic appeal was identified as price and discount, while on Instagram, this pattern also included a practical approach. On Facebook, the fourth component was named celebrity, while on Instagram it was celebrity/innovation since on this second social media the component also included the 'new brand development' variable. On YouTube, three advertising patterns were identified in PCA. Similar to the other platforms, the first and the second patterns were called for kids and price and discount, and the third component referred to both celebrity and commemorative dates. CONCLUSIONS The advertising patterns of the fast-food chain on three social media platforms were commonly directed to children and addressed price, discounts and the celebrities' universe. The findings of this study corroborate other data in the literature regarding unhealthy food advertising on social media. This study discusses the urgency of regulating food advertising content on this medium.
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Affiliation(s)
- Jéssica Moreira da Silva
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena 190, Belo Horizonte30130-100, Brazil
| | - Juliana de Paula Matos
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena 190, Belo Horizonte30130-100, Brazil
| | - Michele Bittencourt Rodrigues
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena 190, Belo Horizonte30130-100, Brazil
| | - Laís Amaral Mais
- Instituto Brasileiro de Defesa do Consumidor (IDEC), São Paulo, Brazil
| | - Rafael Moreira Claro
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena 190, Belo Horizonte30130-100, Brazil
| | - Paula Martins Horta
- Departamento de Nutrição, Universidade Federal de Minas Gerais (UFMG), Avenida Professor Alfredo Balena 190, Belo Horizonte30130-100, Brazil
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14
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Flattum C, Friend S, Horning M, Lindberg R, Beaudette J, Fulkerson JA. Family-focused obesity prevention program implementation in urban versus rural communities: a case study. BMC Public Health 2021; 21:1915. [PMID: 34674674 PMCID: PMC8532281 DOI: 10.1186/s12889-021-11967-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. Methods This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. Results Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. Discussion When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.
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Affiliation(s)
- Colleen Flattum
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
| | - Sarah Friend
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Horning
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
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15
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Salvo D, Parra DC, Jáuregui A, Reséndiz E, Garcia-Olvera A, Velazquez D, Aguilar-Farias N, Colón-Ramos U, Hino AA, Kohl HWB, Pratt M, Ramirez Varela A, Ramirez-Zea M, Rivera JA. Capacity for childhood obesity research in Latin American and US Latino populations: State of the field, challenges, opportunities, and future directions. Obes Rev 2021; 22 Suppl 3:e13244. [PMID: 33825321 PMCID: PMC8365746 DOI: 10.1111/obr.13244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/25/2022]
Abstract
Childhood obesity is a major problem in Latin America and among US Latinos. Effective public health policies require contextually relevant evidence to guide them, which demands sustained research capacity. The objectives of this study are to determine research productivity in Latin America and in the United States focused on Latino populations and examine domains of research capacity (research infrastructure, training programs, mentoring, funding, and networks). We conducted a scoping review of indexed childhood obesity-related articles published June 2015-December 2019. We collected data on perceptions of capacity for childhood obesity research among Latin American investigators through an online survey. We identified 612 childhood obesity-related articles (505 from Latin America, 124 from the United States, and 17 US-Latin America collaborations). Brazil, Mexico, Chile, Colombia, and the United States are the top publishing countries. There are similar numbers of obesity, nutrition, and physical activity articles, but physical activity research capacity lagged in other domains (research training, funding, and networking opportunities). Complementary research areas, including sedentary behavior, systems science, and policy studies, are uncommon in Latin America but more prevalent in the United States, whereas sleep research is nascent across settings. Realizing the promise of an effective cross-border collaborative childhood obesity prevention agenda will require committed investment in all domains of research capacity and across all relevant topics.
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Affiliation(s)
- Deborah Salvo
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Diana C Parra
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alejandra Jáuregui
- Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Eugen Reséndiz
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Armando Garcia-Olvera
- Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Daniel Velazquez
- Department of Physical Activity and Healthy Lifestyles, Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Nicolas Aguilar-Farias
- Department of Physical Education, Sports and Recreation, UFRO Activate Research Group, University of the Frontier, Temuco, Chile
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Adriano A Hino
- Health Technology Graduate Program, Pontifical Catholic University of Parana, Curitiba, Brazil
| | - Harold W Bill Kohl
- School of Public Health in Austin, University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Michael Pratt
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California, San Diego, California, USA
| | | | - Manuel Ramirez-Zea
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Juan A Rivera
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
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16
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Garcia LMT, Hunter RF, de la Haye K, Economos CD, King AC. An action-oriented framework for systems-based solutions aimed at childhood obesity prevention in US Latinx and Latin American populations. Obes Rev 2021; 22 Suppl 3:e13241. [PMID: 33825301 PMCID: PMC8217154 DOI: 10.1111/obr.13241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Abstract
Childhood obesity in US Latinx and Latin American populations is a persistent, complex public health issue and, as such, requires solutions grounded on systems science theory and methods. In this paper, we introduce an action-oriented framework to design, implement, evaluate, and sustain whole-of-community systems changes for childhood obesity prevention in US Latinx and Latin American populations. Our framework covers six action steps: (1) foster multisectoral team; (2) map the system, its context, and drivers; (3) envision system-wide changes; (4) effect system-wide changes; (5) monitor, learn, and adapt; and (6) scale and sustain. We also propose 10 principles that put human and environmental rights and systems thinking at the center of these systems-based solutions. For each action step, we provide a list of concrete activities, methods, approaches, and examples that can be used to guide and inform the work needed to achieve the expected outputs. Finally, we discuss how a wider adoption of systems science for childhood obesity prevention among US Latinx and Latin American populations can be encouraged and sustained.
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Affiliation(s)
| | - Ruth F Hunter
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Kayla de la Haye
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, Massachusetts, USA
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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17
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Berrigan D, Arteaga SS, Colón‐Ramos U, Rosas LG, Monge‐Rojas R, O'Connor TM, Pérez‐Escamilla R, Roberts EFS, Sanchez B, Téllez‐Rojo MM, Vorkoper S. Measurement challenges for childhood obesity research within and between Latin America and the United States. Obes Rev 2021; 22 Suppl 3:e13242. [PMID: 33942975 PMCID: PMC8365689 DOI: 10.1111/obr.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/27/2022]
Abstract
Childhood obesity is a major public health challenge across Latin America and the United States. Addressing childhood obesity depends on valid, reliable, and culturally sensitive measurements. Such progress within and between countries of the Americas could be enhanced through better measurement across different age groups, different countries, and in sending and receiving communities. Additionally, better and more comparable measurements could accelerate cross-border collaboration and learning. Here, we present (1) frameworks that influenced our perspectives on childhood obesity and measurement needs across the Americas; (2) a summary of resources and guidance available concerning measurement and adaptation of measures for childhood obesity research; and (3) three major areas that present challenges and opportunities for measurement advances related to childhood obesity, including parental behavior, acculturation, and the potential to incorporate ethnographic methods to identify critical factors related to economics and globalization. Progress to reduce childhood obesity across the Americas could be accelerated by further transnational collaboration aimed at improving measurement for better surveillance, intervention development and evaluation, implementation research, and evaluation of natural experiments. Additionally, there is a need to improve training related to measurement and for improving access to valid and reliable measures in Spanish and other languages common in the Americas.
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Affiliation(s)
- David Berrigan
- National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - S. Sonia Arteaga
- Environmental Influences on Child Health Outcomes ProgramOffice of the Director, National Institutes of HealthBethesdaMarylandUSA
| | - Uriyoán Colón‐Ramos
- Department of Global Health, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Lisa G. Rosas
- Department of Epidemiology and Population HealthStanford UniversityStanfordCaliforniaUSA
| | - Rafael Monge‐Rojas
- Nutrition and Health Unit, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA)Ministry of HealthTres RíosCosta Rica
| | - Teresia M. O'Connor
- USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHoustonTexasUSA
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | | | - Brisa Sanchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | | | - Susan Vorkoper
- Fogarty International CenterNational Institutes of HealthBethesdaMarylandUSA
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18
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Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice. Obes Rev 2021; 22 Suppl 3:e13247. [PMID: 33951275 PMCID: PMC8365637 DOI: 10.1111/obr.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Camila Corvalan
- Institute of Nutrition, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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19
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King AC, Perez‐Escamilla R, Vorkoper S, Anand N, Rivera J. Childhood obesity prevention across borders: The promise of U.S.-Latin American research collaboration. Obes Rev 2021; 22 Suppl 3:e13238. [PMID: 33949095 PMCID: PMC8365639 DOI: 10.1111/obr.13238] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Abby C. King
- Departments of Epidemiology and Population Health and Medicine (Stanford Prevention Research Center)Stanford University School of MedicineStanfordCAUSA
| | | | - Susan Vorkoper
- Fogarty International CenterNational Institutes of HealthBethesdaMDUSA
| | - Nalini Anand
- Fogarty International CenterNational Institutes of HealthBethesdaMDUSA
| | - Juan Rivera
- Centro de Investigación en Nutrición y SaludInstituto Nacional de Salud PúblicaCuernavacaMexico
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