Differences in Body Weight According to Skin Color and Sex in Mexican Adults.

OBJECTIVES: 1) To analyze the differences in body weight according to skin color in Mexican adults. 2) Identify mediator variables that could explain possible differences in body weight according to skin color. METHODS: A nationally representative survey of Mexican adults was analyzed (n = 12,021). People with obesity were identified (body mass index, BMI > 30) based on self-reported weight and height. Skin color was measured by self-report using a chromatic scale. The mediator variables were socioeconomic level, height, neighborhood public services, public safety, and discrimination based on skin color. RESULTS: Compared to white-skinned women, brown-skinned women had higher BMI and a higher probability of being obese. These differences in weight by skin color are related to the lower level of education and more discrimination experiences of brown-skinned women. In men, there were no differences in weight according to skin color. CONCLUSIONS: In Mexican women (but not in men), darker skin color was associated with a higher probability of being obese, and the examined social factors partially explained this disparity.

Energy Expenditure in Free-Living Physical Activities and Sedentary Behaviors in Mexican Schoolchildren.

Purpose: Metabolic equivalents for youth (METy) are derived using the estimated basal metabolic rate (BMR). However, is unknown whether this METy can be different when measured resting energy expenditure (REE) is used. The purposes of this article are to: (a) To determine whether there is equivalence between METy values calculated using measured REE (METy-mea) and METy using predicted BMR (METy-est). (b) To determine whether METy values of different activities are dependent on age, sex, and body composition. Methods: A cross-sectional study with a sample of 122 Mexican children (5-11 years old) was conducted. With indirect calorimetry, energy expenditure was measured at rest and during 16 sedentary- to vigorous-intensity physical activities. METy were obtained in two forms: METy-mea and METy-est. Equivalence testing was used to compare METy-mea and METy-est. To examine the individual-level agreement, Bland-Altman plots were graphed, and intra-class correlation coefficients (ICC) were calculated. Linear regression models were estimated having METy as the outcome. Results: For 15 activities, there was equivalence between METy-mea and METy-est (t > 2.05, p < 0.050). However, at the individual-level, for 7 activities the agreement between METy-eREE and METy-mREE was inadequate (ICC<0.75). In the Bland-Altman plots was evident that in 8 activities METy-est was biased compared to METy-mea, METy-est had more correlations with body mass index and body fat. Conclusions: In conclusion, at group-level, for most activities METy-mea and METy-est were equivalent. However, at the individual level, METy-est of many activities is not a valid estimate of METy-mea. METy-est of many physical activities were dependent on adiposity, which could be an artifact introduced when BMR is predicted.

External validation of a prediction model for estimating fat mass in children and adolescents in 19 countries: individual participant data meta-analysis.

OBJECTIVE: To evaluate the performance of a UK based prediction model for estimating fat-free mass (and indirectly fat mass) in children and adolescents in non-UK settings. DESIGN: Individual participant data meta-analysis. SETTING: 19 countries. PARTICIPANTS: 5693 children and adolescents (49.7% boys) aged 4 to 15 years with complete data on the predictors included in the UK based model (weight, height, age, sex, and ethnicity) and on the independently assessed outcome measure (fat-free mass determined by deuterium dilution assessment). MAIN OUTCOME MEASURES: The outcome of the UK based prediction model was natural log transformed fat-free mass (lnFFM). Predictive performance statistics of R2, calibration slope, calibration-in-the-large, and root mean square error were assessed in each of the 19 countries and then pooled through random effects meta-analysis. Calibration plots were also derived for each country, including flexible calibration curves. RESULTS: The model showed good predictive ability in non-UK populations of children and adolescents, providing R2 values of >75% in all countries and >90% in 11 of the 19 countries, and with good calibration (ie, agreement) of observed and predicted values. Root mean square error values (on fat-free mass scale) were <4 kg in 17 of the 19 settings. Pooled values (95% confidence intervals) of R2, calibration slope, and calibration-in-the-large were 88.7% (85.9% to 91.4%), 0.98 (0.97 to 1.00), and 0.01 (-0.02 to 0.04), respectively. Heterogeneity was evident in the R2 and calibration-in-the-large values across settings, but not in the calibration slope. Model performance did not vary markedly between boys and girls, age, ethnicity, and national income groups. To further improve the accuracy of the predictions, the model equation was recalibrated for the intercept in each setting so that country specific equations are available for future use. CONCLUSION: The UK based prediction model, which is based on readily available measures, provides predictions of childhood fat-free mass, and hence fat mass, in a range of non-UK settings that explain a large proportion of the variability in observed fat-free mass, and exhibit good calibration performance, especially after recalibration of the intercept for each population. The model demonstrates good generalisability in both low-middle income and high income populations of healthy children and adolescents aged 4-15 years.

Main Retailers In Which Mexican Households Acquire Their Food Supply.

OBJECTIVE: To describe the frequency of food and beverages purchased made by Mexican households at different types of grocery retailers. DESIGN: A national cross-sectional survey. SETTING: Mexico. PARTICIPANTS: A representative sample of Mexican households (n = 70,311). MAIN OUTCOME MEASURE(S): Household food and beverages purchases. ANALYSIS: The association between amounts of food and beverages supply bought in different food retailers (as outcome) and households' sociodemographic characteristics (as covariates) was assessed using logistic and linear regression models. RESULTS: Mexican households acquired their food and beverages primarily from abarrotes stores, followed by supermarkets and mercados and tianguis. Abarrotes stores and supermarkets were sources of unprocessed and processed foods. Specialized stores, mercados, and tianguis were primary sources of unprocessed foods. Households with low socioeconomic status and those in the central or southern regions acquired more foods from abarrotes stores, mercados and tianguis, and specialized stores. Households with high socioeconomic status and living in the northern region acquired more foods from supermarkets and convenience stores. CONCLUSIONS AND IMPLICATIONS: Abarrotes stores are the primary source of food and beverages for Mexican households; however, some interventions are needed to increase their supply of unprocessed foods. Public health interventions aiming at increasing access to unprocessed foods could be done through traditional retailers.

Development and Interrater Reliability of a Street Food Stand Assessment Tool.

OBJECTIVE: To design and test the interrater reliability of a Street Food Stand Assessment Tool (SFSAT). DESIGN: Variables were adapted from validated assessment tools, field observations, and the Mexican Dietary Guidelines. Two researchers tested the SFSAT by observing street food stands (SFS) in 3 middle- to high-income neighborhoods. SETTING: Mexico City. PARTICIPANTS: Fifty-two SFS. VARIABLES MEASURED: The SFSAT contains 14 items for SFS characteristics and 44 items for food and beverages. ANALYSIS: Percent agreement and kappa interrater reliability scores were calculated for each variable. RESULTS: Almost perfect kappa interrater reliability scores (0.81-1.00) were reported for 62.7% of SFS characteristic items. Interrater reliability scores for food and beverage availability and variety ranged from 0.00-1.00, whereas the percent agreement for these items ranged from 59.6%-100.0%. CONCLUSIONS AND IMPLICATIONS: The SFSAT is a reliable assessment tool to measure the availability and variety of street foods and beverages in Mexico City. Future research can update and adapt the SFSAT to the street food environment of other cities-in Mexico and abroad.

Association Between Overt and Subtle Experiences of Discrimination and Violence and Mental Health in Homosexual and Bisexual Men in Mexico.

The aim of this study was to determine whether the experiences of direct or subtle forms of discrimination and violence are associated with mental health in Mexican gay, homosexual, and bisexual (GHB) men. A cross-sectional survey was conducted online; the sample consisted of 4,827 GHB men. Ten forms of overt and subtle sexual orientation-based discrimination and violence (SO-DV) were assessed. Linear and logistic regression models were used to evaluate the association between SO-DV experiences and mental health outcomes. Physical violence was reported less frequently than the other forms of SO-DV. As the number of settings in which SO-DV were experienced increased, a stronger association with negative mental health outcomes was observed. Experiences of subtle SO-DV were associated with increased distress, lower vitality, and increased risk of suicidal ideation. Disapproval of gender nonconformity was associated with negative mental health outcomes independently of violence based on sexual orientation. Subtle forms of SO-DV are more common than direct and overt forms. Both types of SO-DV could negatively affect mental health. Studies investigating these negative experiences are required to gain an understanding of the health inequalities faced by non-heterosexual populations.

[Social inequalities in the progression of COVID-19 in the Mexican population]. / Inequidades sociales en la progresión de la COVID-19 en población mexicana.

OBJECTIVE: To determine if there are disparities associated with socioeconomic stratification, ethnicity, medical services, and geographic region in the progression of coronavirus disease (COVID-19) in Mexican adults infected with SARS-CoV-2. METHOD: We analyzed data registered by the General Direction of Epidemiology of the Ministry of Health of the Federal Government of Mexico regarding the confirmed cases of SARS-CoV-2 infection. The analysis was limited to data from adults 20 years and older recorded up to July 10, 2020 (n=234 870). Indicators of severity of COVID-19 were hospitalization, development of pneumonia, requirement for intubation or admission to the intensive care unit, and death. Differences were estimated according to the level of municipal marginalization, belonging to an indigenous group, geographic region, and service sector. Prevalence ratios (PR) were estimated using multilevel regression models. RESULTS: People who lived in municipalities with greater marginalization were at greater risk of presenting the four indicators of severe forms of COVID-19 (PR=1.05 or 1.06). Indigenous people were at greater risk of pneumonia (PR=1.22), hospitalization (PR=1.14) and death (PR=1.23). Among the cases treated in the private health sector, the risk of death was lower (PR=0.40), but the use of intubation or admission to the intensive care unit was higher (PR=4.45). CONCLUSIONS: The trends observed indicate that the effects of COVID-19 are not only related to the biological characteristics of SARS-CoV-2, but also to the resources (or lack thereof) to deal with it, which are distributed by social processes.

Inequidades sociales en la progresión de la COVID-19 en población mexicana

Objetivo. Determinar si existen disparidades asociadas a la estratificación socioeconómica, la etnicidad, los servicios médicos y la región geográfica en la progresión de la enfermedad por coronavirus (COVID-19) en adultos mexicanos infectados por SARS-CoV-2. Método. Se analizaron los datos registrados por la Dirección General de Epidemiología de la Secretaría de Salud del Gobierno Federal de México respecto de los casos confirmados de infección por SARS-CoV-2. El análisis se limitó a los datos de adultos de 20 años o más registrados hasta el 10 de julio del 2020 (n=234 870). Los indicadores de severidad de la COVID-19 fueron hospitalización, desarrollo de neumonía, requerimiento de intubación o ingreso a la unidad de cuidados intensivos, y muerte. Se estimaron diferencias de acuerdo con el nivel de marginación municipal, la pertenencia a un grupo indígena, la región geográfica y el sector de los servicios. A partir de modelos de regresión multinivel se estimaron razones de prevalencias (RP). Resultados. Las personas que residían en municipios con mayor marginación tuvieron mayor riesgo de presentar los cuatro indicadores de formas severas de COVID-19 (RP=1,05 o 1,06). Las personas indígenas tuvieron mayor riesgo de neumonía (RP=1,22), hospitalización (RP=1,14) y muerte (RP=1,23). Entre los casos atendidos en servicios privados fue menor el riesgo de muerte (RP=0,40), pero mayor el uso de intubación o ingreso a la unidad de cuidados intensivos (RP=4,45). Conclusiones. Las tendencias observadas indican que los efectos de la COVID-19 no solo se deben a las características biológicas del SARS-CoV-2, sino también a los recursos (o falta de ellos) para enfrentarlo, los cuales están distribuidos por procesos sociales.

Objective. To determine if there are disparities associated with socioeconomic stratification, ethnicity, medical services, and geographic region in the progression of coronavirus disease (COVID-19) in Mexican adults infected with SARS-CoV-2. Method. We analyzed data registered by the General Direction of Epidemiology of the Ministry of Health of the Federal Government of Mexico regarding the confirmed cases of SARS-CoV-2 infection. The analysis was limited to data from adults 20 years and older recorded up to July 10, 2020 (n=234 870). Indicators of severity of COVID-19 were hospitalization, development of pneumonia, requirement for intubation or admission to the intensive care unit, and death. Differences were estimated according to the level of municipal marginalization, belonging to an indigenous group, geographic region, and service sector. Prevalence ratios (PR) were estimated using multilevel regression models. Results. People who lived in municipalities with greater marginalization were at greater risk of presenting the four indicators of severe forms of COVID-19 (PR=1.05 or 1.06). Indigenous people were at greater risk of pneumonia (PR=1.22), hospitalization (PR=1.14) and death (PR=1.23). Among the cases treated in the private health sector, the risk of death was lower (PR=0.40), but the use of intubation or admission to the intensive care unit was higher (PR=4.45). Conclusions. The trends observed indicate that the effects of COVID-19 are not only related to the biological characteristics of SARS-CoV-2, but also to the resources (or lack thereof) to deal with it, which are distributed by social processes.

Factores sociodemográficos asociados con los modos de transporte en escolares y adolescentes mexicanos / Commuting to school among Mexican schoolchildren and adolescents

Resumen Introducción: Los modos activos de transporte (caminar o andar en bicicleta) tienen efectos benéficos para la salud, por lo cual deben identificarse factores que los promuevan. El objetivo de este estudio fue analizar la relación de los modos de transporte utilizados por la población pediátrica mexicana para acudir a la escuela con las características sociodemográficas, socioeconómicas y de inseguridad pública a nivel estatal. Métodos: Se estimó la frecuencia de los modos de transporte utilizados por los escolares y adolescentes para trasladarse a la escuela (con la base de la Encuesta Intercensal 2015). En un análisis ecológico (i.e., entidades federativas como unidades de observación) se obtuvieron correlaciones con estadísticas a nivel estatal con inseguridad alimentaria, nivel de urbanización y mortalidad por muertes violentas. Resultados: El modo de transporte más frecuente fue caminar (66.2%), seguido por el automóvil (16.2%) y el transporte público (15.3%). El transporte activo fue más frecuente en individuos del sexo masculino, escolares, personas de nivel socioeconómico bajo, zonas rurales, la región sur y aquellos cuyo traslado requería menos de 15 minutos. El transporte pasivo fue más frecuente en individuos del sexo femenino, adolescentes, personas de nivel socioeconómico alto y en zonas urbanas. En los estados más urbanizados fue menos frecuente el transporte activo y más prevalente el trasporte motorizado. La inseguridad pública se relacionó negativamente con el uso de bicicleta. Conclusiones: Se requiere mantener o incrementar el uso de modos de transporte activos en la población pediátrica mexicana mediante políticas públicas que mejoren el entorno y garanticen ambientes seguros.

Abstract Background: Active commuting (walking or cycling) is associated with benefits to health; thus, it is required to identify factors that promote it. The objective of this study was to analyze the relationship between the transport modes used by Mexican pediatric population to commute to school with sociodemographic and socioeconomic individual characteristics and public insecurity at the state level. Methods: The frequency of transport modes used by schoolchildren and adolescents to commute to school (walking, cycling, private car and public transport) were estimated using the database of the Encuesta Intercensal 2015. In an ecological analysis (i.e., states as observation units) correlations with food insecurity, urbanization level, and violent deaths statistics at state-level were obtained. Results: The most frequent transportation mode was walking (66.2%), followed by car (16.2%) and public transportation (15.3%). Active commuting (walking or cycling) was more frequent in males, schoolchildren, low socioeconomic status, living in rural or southern areas and those who spent <15 min to commute. Passive commute was more frequent among females, adolescents, high socioeconomic status, and living in urban areas. In the more urbanized states, active transportation was less frequent, but motorized transportation was more prevalent. Public insecurity was negatively related to cycling. Conclusions: Maintaining or increasing active commuting among Mexican pediatric population is necessary through public policies aimed to improve physical and social environment.

Commuting to school among Mexican schoolchildren and adolescents.

Background: Active commuting (walking or cycling) is associated with benefits to health; thus, it is required to identify factors that promote it. The objective of this study was to analyze the relationship between the transport modes used by Mexican pediatric population to commute to school with sociodemographic and socioeconomic individual characteristics and public insecurity at the state level. Methods: The frequency of transport modes used by schoolchildren and adolescents to commute to school (walking, cycling, private car and public transport) were estimated using the database of the Encuesta Intercensal 2015. In an ecological analysis (i.e., states as observation units) correlations with food insecurity, urbanization level, and violent deaths statistics at state-level were obtained. Results: The most frequent transportation mode was walking (66.2%), followed by car (16.2%) and public transportation (15.3%). Active commuting (walking or cycling) was more frequent in males, schoolchildren, low socioeconomic status, living in rural or southern areas and those who spent <15 min to commute. Passive commute was more frequent among females, adolescents, high socioeconomic status, and living in urban areas. In the more urbanized states, active transportation was less frequent, but motorized transportation was more prevalent. Public insecurity was negatively related to cycling. Conclusions: Maintaining or increasing active commuting among Mexican pediatric population is necessary through public policies aimed to improve physical and social environment.

Introducción: Los modos activos de transporte (caminar o andar en bicicleta) tienen efectos benéficos para la salud, por lo cual deben identificarse factores que los promuevan. El objetivo de este estudio fue analizar la relación de los modos de transporte utilizados por la población pediátrica mexicana para acudir a la escuela con las características sociodemográficas, socioeconómicas y de inseguridad pública a nivel estatal. Métodos: Se estimó la frecuencia de los modos de transporte utilizados por los escolares y adolescentes para trasladarse a la escuela (con la base de la Encuesta Intercensal 2015). En un análisis ecológico (i.e., entidades federativas como unidades de observación) se obtuvieron correlaciones con estadísticas a nivel estatal con inseguridad alimentaria, nivel de urbanización y mortalidad por muertes violentas. Resultados: El modo de transporte más frecuente fue caminar (66.2%), seguido por el automóvil (16.2%) y el transporte público (15.3%). El transporte activo fue más frecuente en individuos del sexo masculino, escolares, personas de nivel socioeconómico bajo, zonas rurales, la región sur y aquellos cuyo traslado requería menos de 15 minutos. El transporte pasivo fue más frecuente en individuos del sexo femenino, adolescentes, personas de nivel socioeconómico alto y en zonas urbanas. En los estados más urbanizados fue menos frecuente el transporte activo y más prevalente el trasporte motorizado. La inseguridad pública se relacionó negativamente con el uso de bicicleta. Conclusiones: Se requiere mantener o incrementar el uso de modos de transporte activos en la población pediátrica mexicana mediante políticas públicas que mejoren el entorno y garanticen ambientes seguros.

[Contribution of NOVA food groups to energy and nutrient supply in Mexican households]. / Contribución de los grupos de alimentos NOVA a la disponibilidad de energía y nutrientes en los hogares mexicanos.

OBJECTIVE: To analyze the contribution of natural, processed and ultra-processed foods to energy and nutrient supply in Mexican households. MATERIALS AND METHODS: The database of the National Household Expenditure Survey 2013 was analyzed (n=58 001), which is a cross-sectional survey. Food supply (g/adult equivalent/day) and energy, macro- and micro-nutrient supplies were estimated. Foods were classified following the NOVA system. Households sociodemographic characteristics were analyzed as covariates. RESULTS: Natural foods (NF) contributed with more energy (55.0%) followed by ultra-processed foods (UPF, 21.2%). NF were the main source of most nutrients. Processed culinary ingredients (PCI) and processed foods (PF) had high content of energy, total fats, and saturated fats, but low content of certain micronu- trients. Sodium was mainly available in PF (34.6%) and UPF (31.4%). Sugar-sweetened beverages, fast foods, and biscuits and cookies were the main UPF in terms of energy supply. CONCLUSIONS: In Mexican households, the PCI, PF and UPF had low nutritional quality.

OBJETIVO: Analizar la contribución de los alimentos naturales, procesados y ultraprocesados a la disponibilidad de energía y nutrientes en los hogares mexicanos. MATERIAL Y MÉTODOS: Se analizó la base de datos de la Encuesta Nacional de Gasto de los Hogares 2013 (n = 58 001), la cual es una encuesta transversal. Se estimó la disponibilidad de alimentos (g/adulto equivalente/día), energía y nutrientes. Los alimentos fueron clasificados siguiendo el sistema NOVA. RESULTADOS: Los alimentos naturales (AN) y los ultraprocesados (AUP) contribuyeron con más energía. Los AN fueron la principal fuente de la mayoría de los nutrimentos. Los ingredientes culinarios procesados (ICP) y los alimentos procesados (AP) tenían alto contenido de energía, grasas totales y grasas saturadas pero bajo contenido de ciertos micronutrientes. El sodio estaba disponible principalmente en AP y AUP. Las bebidas azucaradas, comidas rápidas, galletas y panes fueron los principales AUP. CONCLUSIONES: En México, los ICP, AP y AUP tienen baja calidad nutricional.

Contribution of Nova food groups to energy and nutrient supply in Mexican households / Contribución de los grupos de alimentos Nova a la disponibilidad de energía y nutrientes en los hogares mexicanos

Abstract: Objective: To analyze the contribution of natural, processed and ultra-processed foods to energy and nutrient supply in Mexican households. Materials and methods: The database of the National Household Expenditure Survey 2013 was analyzed (n=58 001), which is a cross-sectional survey. Food supply (g/adult equivalent/day) and energy, macro- and micro-nutrient supplies were estimated. Foods were classified following the Nova system. Households sociodemographic characteristics were analyzed as covariates. Results: Natural foods (NF) contributed with more energy (55.0%) followed by ultra-processed foods (UPF, 21.2%). NF were the main source of most nutrients. Processed culinary ingredients (PCI) and processed foods (PF) had high content of energy, total fats, and saturated fats, but low content of certain micronutrients. Sodium was mainly available in PF (34.6%) and UPF (31.4%). Sugar-sweetened beverages, fast foods, and biscuits and cookies were the main UPF in terms of energy supply. Conclusions; In Mexican households, the PCI, PF and UPF had low nutritional quality.

Resumen: Objetivo: Analizar la contribución de los alimentos naturales, procesados y ultraprocesados a la disponibilidad de energía y nutrientes en los hogares mexicanos. Material y métodos: Se analizó la base de datos de la Encuesta Nacional de Gasto de los Hogares 2013 (n= 58 001), la cual es una encuesta transversal. Se estimó la disponibilidad de alimentos (g/adulto equivalente/día), energía y nutrientes. Los alimentos fueron clasificados siguiendo el sistema Nova. Resultados: Los alimentos naturales (AN) y los ultraprocesados (AUP) contribuyeron con más energía. Los AN fueron la principal fuente de la mayoría de los nutrimentos. Los ingredientes culinarios procesados (ICP) y los alimentos procesados (AP) tenían alto contenido de energía, grasas totales y grasas saturadas pero bajo contenido de ciertos micronutrientes. El sodio estaba disponible principalmente en AP y AUP. Las bebidas azucaradas, comidas rápidas, galletas y panes fueron los principales AUP. Conclusión: En México, los ICP, AP y AUP tienen baja calidad nutricional.

Violence as Mediating Variable in Mental Health Disparities Associated to Sexual Orientation Among Mexican Youths.

In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males.

Evaluating the effectiveness of physician counseling to promote physical activity in Mexico: an effectiveness-implementation hybrid study.

Integrating physical activity (PA) counseling in routine clinical practice remains a challenge. The purpose of this study was to evaluate the implementation and effectiveness of a pragmatic strategy aimed to improve physician PA counseling and patient PA. An effectiveness-implementation type-2 hybrid design was used to evaluate a 3-h training (i.e., implementation strategy-IS) to increase physician use of the 5-As (assess, advise, agree, assist, arrange) for PA counseling (i.e., clinical intervention-CI) and to determine if the CI improved patient PA. Patients of trained and untrained physicians reported on PA and quality of life pre-post intervention. Medical charts (N = 1700) were examined to assess the proportion of trained physicians that used the 5-As. The RE-AIM framework informed our evaluation. 305/322 of eligible physicians participated in the IS (M age = 40 years, 52% women) and 683/730 of eligible patients in the CI (M age = 49 years, 77% women). The IS was adopted by all state regions and cost ~ $20 Mexican pesos (US$1) per provider trained. Physician adoption of any of the 5-As improved from pre- to post-training (43 vs. 52%, p < .01), with significant increases in the use of assessment (43 vs. 52%), advising (25 vs. 39%), and assisting with barrier resolution (7 vs. 15%), but not in collaborative goal setting (13 vs. 17%) or arranging for follow-up (1 vs. 1%). Patient PA and quality of life did not improve. The IS intervention was delivered with high fidelity at a low cost, but appears to be insufficient to lead to broad adoption of the CI.

Characterization of the School Neighborhood Food Environment in Three Mexican Cities.

Food resources in school neighborhoods can negatively influence diet; however, this environment is understudied. This study characterized the school neighborhood food environment in Guadalajara (n=11), Puerto Vallarta (n=7), and Mexico City (n=14). Convenience stores, table-service restaurants, and taco stands were highly available in all three cities. Grocery stores were highly available in Mexico City school neighborhoods, yet less frequently observed in Guadalajara and Puerto Vallarta. Socioeconomic differences in food cart and grocery store availability were observed in Guadalajara and Puerto Vallarta. Policy and intervention strategies are needed to address the saturation of food resources in Mexico school neighborhoods.

A Multisite Study of Environmental Correlates of Active Commuting to School in Mexican Children.

BACKGROUND: Mexican children often use active commuting to school (ACS). In order to maintain high levels of ACS it is important to understand correlates of ACS in this population. However, most evidence comes from high-income countries (HICs). We examined multilevel correlates of ACS in children attending public schools in 3 Mexican cities. METHODS: Information on 1191 children (grades 3 to 5) attending 26 schools was retrieved from questionnaires, neighborhood audits, and geographic information systems data. Multilevel logistic modeling was used to explore individual and environmental correlates of ACS at 400-m and 800-m buffers surrounding schools. RESULTS: Individual positive correlates for ACS included age (6-8 years vs 9-11 years, odds ratio [OR] = 1.5; 6-8 years vs ≥12 years: OR = 2.1) and ≥ 6 adults at home (OR = 2.0). At the 400-m buffer, more ACS was associated with lower walkability (OR = 0.87), presence of posted speed limits (< 6% vs > 12%: OR = 0.36) and crossing aids (< 6% vs 6-20%: OR = 0.25; > 20%: OR = 0.26), as well as higher sidewalk availability (< 70% vs > 90%: OR = 4.5). Similar relationships with speed limits and crossing aids were observed at the 800m buffer. CONCLUSIONS: Findings contrast with those reported in HICs, underscoring the importance of considering the local context when developing strategies to promote ACS. Future studies are needed to replicate these relationships and investigate the longitudinal impact of improving active transportation infrastructure and policies.

[Socioeconomic inequality and health in Mexico]. / Desigualdad socioeconómica y salud en México.

OBJECTIVE: To establish the relationship between socioeconomic inequality and health problems amongst Mexican population reviewing studies with national or regional representation. METHODS: A literature search was performed at national and international databases using the following keywords: health, disease, mental disorders, nutrition, food, social class, social status, unemployment, employment, occupation, income, wage, poverty and socioeconomic status. Reports of national or regional surveys conducted from the nineties were included. RESULTS: Mostly, diseases events were more common among people from low socioeconomic status: anencephaly, viral infections, anemia, transit accidents by run over, metabolic syndrome, hypertension, affective disorder, anxiety and substances abuse; some malignancies, difficulties to perform activities of daily living, and poor perceived health status. On the opposite, as it goes down in the social scale, are less frequent some protective factors (e.g. fruits or vegetables intake and physical activity) and there is less access to medical aid and preventive interventions (e.g. condom use or diagnosis and treatment for HIV infection, hypertension or obesity). CONCLUSIONS: Socioeconomic status affects all living conditions; therefore, its effects are not confined to certain diseases, but a general precarious state of health. The conceptual and public policy implications related with social inequalities in health are discussed.

Objetivo: establecer la relación entre la desigualdad socioeconómica y los problemas de salud en la población mexicana a partir de la revisión de estudios con representatividad nacional o regional. Métodos: la revisión bibliohemerográfica se realizó consultando bases de datos nacionales e internacionales, mediante el uso de las siguientes palabras clave: salud, enfermedad, trastornos mentales, nutrición, alimentación, clase social, estrato social, desempleo, empleo, ocupación, ingreso, salario, pobreza, nivel socioeconómico y estatus socioeconómico. Se incluyeron los reportes de encuestas nacionales y regionales realizados a partir de la década de los noventa. Resultados: la mayoría de los eventos de enfermedad fueron más comunes entre las personas de baja posición socioeconómica. Asimismo, conforme se desciende de la escala social, son menos frecuentes los factores protectores y es menor el acceso a la atención médica y a las medidas preventivas. Conclusiones: la posición socioeconómica afecta la totalidad de las condiciones de vida de las personas, por lo que sus efectos no se reducen únicamente a ciertas enfermedades, sino que condiciona un estado de salud precario. Las implicaciones conceptuales y en política pública de las desigualdades en salud son ampliamente discutidas.

[Disparities in mental health associated with sexual orientation among Mexican adolescents]. / Disparidades en salud mental asociadas a la orientación sexual en adolescentes mexicanos.

The aim of this study was to document disparities in mental health related to discrimination based on sexual orientation in Mexican adolescents. A representative national sample of secondary school students was analyzed. Criteria for homosexual orientation were having had a same-sex boyfriend or girlfriend and having had same-sex sexual relations. The events were: depression, low self-esteem, suicidal ideation, attempted suicide, smoking, alcohol abuse, and drug use. Teenagers with same-sex relationships or sexual relations had an increased risk of depressive symptoms, suicidal ideation, attempted suicide, and alcohol abuse. These differences were particularly related to having experienced violence in the family and in school. Despite institutional and legal progress in acknowledging the rights of the lesbian, bisexual, and gay population, health inequities persist due to discrimination based on sexual orientation.

Disparidades en salud mental asociadas a la orientación sexual en adolescentes mexicanos / Disparities in mental health associated with sexual orientation among Mexican adolescents / Desigualdades em saúde mental associada com a orientação sexual em adolescentes mexicanos

El objetivo de este estudio fue documentar las disparidades en salud mental relacionadas con la discriminación por orientación sexual en adolescentes de México. Se estudió una muestra nacional representativa de estudiantes de bachillerato. Se usaron dos indicadores de orientación homosexual: haber tenido un novio del mismo sexo y haber tenido relaciones sexuales con alguien del mismo sexo. Los eventos fueron: depresión, autoestima, ideación suicida e intento de suicidio y consumo de cigarros, alcohol y otras drogas. Los adolescentes que habían tenido noviazgos o relaciones sexuales con personas de su mismo sexo tuvieron un riesgo incrementando de síntomas depresivos, ideación e intento de suicidio y consumo problemático de alcohol. Estas diferencias sobre todo se relacionaron con la experiencia de violencia en la familia y la escuela. A pesar de los avances institucionales y legales para el reconocimiento de los derechos de la población lésbica, bisexual y homosexual, persisten inequidades en salud relacionadas con la discriminación por orientación sexual.

The aim of this study was to document disparities in mental health related to discrimination based on sexual orientation in Mexican adolescents. A representative national sample of secondary school students was analyzed. Criteria for homosexual orientation were having had a same-sex boyfriend or girlfriend and having had same-sex sexual relations. The events were: depression, low self-esteem, suicidal ideation, attempted suicide, smoking, alcohol abuse, and drug use. Teenagers with same-sex relationships or sexual relations had an increased risk of depressive symptoms, suicidal ideation, attempted suicide, and alcohol abuse. These differences were particularly related to having experienced violence in the family and in school. Despite institutional and legal progress in acknowledging the rights of the lesbian, bisexual, and gay population, health inequities persist due to discrimination based on sexual orientation.

O objetivo deste estudo foi avaliar disparidades em saúde mental relacionadas com a discriminação baseada na orientação sexual em adolescentes do México. Estudou-se uma amostra nacional e representativa dos alunos do ensino médio. Foram utilizados dois indicadores de orientação homossexual: ter um namorado do mesmo sexo e tendo relações sexuais com alguém do mesmo sexo. Os eventos foram: depressão, autoestima, ideação suicida, e tentativa de suicídio e consumo de cigarros, álcool e outras drogas. Adolescentes que tinham compromissos ou relações sexuais com pessoas do mesmo sexo tiveram risco aumentado de sintomas depressivos, ideação suicida, tentativa de suicídio e consumo problemático de álcool. Essas diferenças foram relacionadas com a experiência da violência na família e na escola. Apesar dos desenvolvimentos institucionais e legais para o reconhecimento dos direitos da população lésbica, bissexual e homossexual, persistem desigualdades na saúde relacionadas com a discriminação por orientação sexual.

Factores sociodemográficos asociados a la satisfacción con los servicios públicos de salud entre personas con VIH/SIDA / Sociodemographic correlates of satisfaction with public health services among people living with HIV / Fatores sociodemográficos associados à satisfação com os serviços públicos de saúde entre pessoas com VIH/SIDA

Objetivo: evaluar la satisfacción de personas con VIH con la atención que reciben en los servicios de salud. Material y métodos: se evaluó la satisfacción del usuario y las características sociodemográficas de personas con VIH/SIDA atendidas en dos instituciones públicas de la ciudad de México (n = 557). Para conocer si existían diferencias se estimaron modelos de regresión logística. Resultados: los hombres homosexuales tuvieron mayor probabilidad de insatisfacción con la relación médico-paciente y con el funcionamiento del servicio. Las personas con seguridad social tuvieron mayor probabilidad de insatisfacción con el funcionamiento del servicio y con la atención de las diferentes áreas de la clínica. Los hombres, las personas solteras y quienes tenían mayor escolaridad presentaron mayor insatisfacción con los aspectos administrativos. Conclusiones: se identificaron aspectos de los servicios públicos que pueden ser mejorados, lo cual podría modificar la opinión que las personas con VIH tuvieron sobre ellos.

Objectives: To evaluate the satisfaction of people with HIV/AIDS with the care received from public health services. Material and methods: The user satisfaction and socio-demographic characteristics of people with HIV/AIDS who were treated at two public institutions in Mexico City (n = 557) were assessed. To know whether there were any differences, logistic regression models were estimated. Results: Homosexual males were more likely to be dissatisfied with physician-patient relationship and with services operation. People with social security had higher probability of dissatisfaction with service operation and with the attention received from different areas. Dissatisfaction with administrative aspects was more frequent among men, single people and those who had higher education higher. Conclusions: There were aspects of public services that can be improved, which could result in the improvement of the opinion that people with HIV had of them.

Objetivo: avaliar a satisfação de pessoas com o VIH, atendidos em serviços de saúde. Material e métodos: avaliou-se a satisfação do utente e as características sociodemográficas do pessoal com o VIH/SIDA atendidas em duas instituições públicas da cidade de México (n = 557). Para conhecer se existiam diferenças foram estimados modelos de regressão logística. Resultados: os homes homossexuais tiveram maior probabilidade de insatisfação na relação médico-paciente e com o funcionamento do serviço. As pessoas com previdência social tiveram maior probabilidade de insatisfação com o funcionamento do serviço e a atenção das diferentes áreas da clínica. Os homes, as pessoas solteiras e quem teve maior escolaridade apresentou maior insatisfação com os aspetos administrativos. Conclusões: identificaram-se aspectos dos serviços públicos que podem se melhorar, o qual poderia modificar a opinião das pessoas com VIH.