Legislation on marketing of breast-milk substitutes in digital and social media: a scoping review.

Innovative and continuously changing methods of digital marketing are routinely used to reach young women and their families with advertisements that normalise infant artificial feeding and undermine breastfeeding. Legislation and provisions regulating digital and social media marketing are limited across countries. The aim of this scoping review was to systematically identify and summarise worldwide legislation implemented to regulate breast-milk substitutes (BMS) marketing on digital and social media, as well as identifying areas of opportunity to strengthen and improve it. Documents published from January 2012 to April 2022 were examined using search strategies including multiple databases and citation tracking. A total of 127 sources were evaluated, and only 28 documents from 24 countries meeting the inclusion criteria were retained. Most of the reviewed documents explicitly stated that digital marketing was prohibited (n=23), as opposed to being regulated only, with prior approval from the relevant authorities in each country. Regarding monitoring, from the countries included in this scoping review, only 14 of 24 (58.3%) stipulate a monitoring process for compliance with legal measures and have designated an actor responsible for monitoring. In addition, 22 of 24 (91.6%) countries included have defined sanctions, but only 17 (70%) countries specify the entity responsible for enforcement. The results highlight the urgent call for the explicit regulation of BMS marketing in digital and social media worldwide, as well as the public documentation of such legal measures. Likewise, it is important that there are effective, transparent and free of commercial influence national monitoring systems used to ensure compliance with legal measures.

Methodologies for Monitoring the Digital Marketing of Foods and Beverages Aimed at Infants, Children, and Adolescents (ICA): A Scoping Review.

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

Physical Activity in Mexican High Schools.

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

Countries' experiences scaling up national breastfeeding, protection, promotion and support programmes: Comparative case studies analysis.

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.