International trade and the neoliberal diet in Central America and the Dominican Republic: Bringing social inequality to the center of analysis.

Scholarship on international trade and health analyzes the effects of trade and investment policies on population exposure to non-nutritious foods. These policies are linked to the nutrition transition, or the dietary shift towards meat and processed foods associated with rising overweight and obesity rates in low- and middle-income countries. We argue for expanding the trade and health literature's focus on population exposure through the concept of the neoliberal diet, which centers subnational social inequality as both an outcome of neoliberal agri-food trade policies and a determinant of dietary change. We develop this perspective through a regional analysis of non-nutritious food availability following the implementation of the Dominican Republic-Central America Free Trade Agreement (CAFTA-DR), together with an extended case study, from the late 1990s to the present, of household expenditure and food price changes in the Dominican Republic, the region's largest food importer. Our analysis demonstrates that low-income consumers face increasing household food expenditures in a context of overall food price inflation, in addition to relatively higher price increases for healthy versus ultraprocessed foods. Neoliberal policies not only contribute to restructuring the availability and pricing of healthy food for low-income consumers, but they also exacerbate social inequality in the food system through corporate-controlled supply chains and farmer displacement. Our findings support policy proposals for socially distributive forms of healthy food production to stem the negative effects of the nutrition transition.

Factors associated with physical inactivity and sedentary behavior among women living in the urban area of Santos City, Brazil / Fatores Associados à Inatividade Física e Sedentarismo de Mulheres Moradoras da Zona Urbana do Município de Santos, Brasil

We aimed to assess the association between individual, socioeconomic, and environmental variables and sedentary behavior and physical inactivity (PI) among urban Brazilian women of varying economic status in Santos. Through a cross-sectional design in a home-based study, we interviewed 538 women with children under 10 years. We assessed PI through two different indices: the International Physical Activity Questionnaire (IPAQ) and the physical activity time/week as recommended by the World Health Organization (WHO). Sedentary behavior was assessed by sitting-time (>360min/week). Using adjusted logistic regression, walking and driving remained significantly correlated to IPAQ's score (OR 0.24 95% CI 0.11; 0.50; OR 1.87 95% IC 1.25; 2.81) and to WHO's guideline (OR 0.20 95% CI 0.08; 0.48; OR 1.77 95% CI 1.16; 2.70). Sedentary behavior was associated with having housekeeper in the household (OR 2.14 95% IC 1.31; 3.50) and perceiving as a barrier for physical activity not having money (OR 0.29 95% CI 0.12; 0.65). Physical inactivity and sedentary behavior were associated with individual, psychosocial and environmental perceptions factors among women with children. Therefore, environmental and policy interventions with multilevel approach may be considered in urban areas to promote health and to prevent obesity among maternal-infant group.

Este estudo teve como objetivo investigar os fatores associados à inatividade atividade e comportamento sedentário em relação às variáveis individuais, socioeconômicas e ambientais de mulheres residentes em uma zona urbana de diferentes níveis socioeconômicos. Estudo transversal, com coleta dados através de entrevistas domiciliares em 538 mulheres com filhos de até 10 anos. Inatividade física foi avaliada por três diferentes indicadores: classificações do Questionário Internacional de Atividade Física (IPAQ), tempo por semana de atividade física recomendado pela Organização Mundial da Saúde (OMS) (mínimo150 minutos/semana) e o tempo gasto sentado em um dia de semana maior que 360 minutos/semana como indicador de comportamento sedentário. Modelos de regressão logística foram ajustados a fim de encontrar os fatores associados a cada indicador. Caminhada como uma atividade de lazer e usar carro como meio de transporte permaneceram associados ao escore de inatividade física do IPAQ (OR 0,24 95% IC 0,11; 0,50; OR 1,87 95% IC 1,25; 2,81) e das recomendações da OMS (OR 0,20 95% IC 0,08; 0,48; OR 1,77 95% IC 1,16; 2,70). O comportamento sedentário foi associado à presença de empregada doméstica na residência (OR 2.14 IC 95% 1.31; 3.50) e perceber como barreira para a atividade física não ter dinheiro (OR 0.29 IC 95% 0.12; 0.65). A inatividade física das mulheres investigadas esteve associada a fatores individuais, psicossociais e de percepção do ambiente. Assim, o delineamento de intervenções, programas e políticas públicas em áreas urbanas deve considerar a interação de todos os fatores numa abordagem compreensiva e sistêmica para a promoção da saúde e prevenção da obesidade no grupo materno infantil.