Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study.

BACKGROUND: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. OBJECTIVE: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. METHODS: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children's age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants' experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. RESULTS: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was "good," "useful," and "helpful" for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. CONCLUSIONS: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. TRIAL REGISTRATION: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896.

Anaemia in adolescent women: A priority for the nutrition agenda in Mexico. A comparison of data from the ENSANUT 2012 and 2018-2019 surveys.

The risk of anaemia in adolescence increases due to accelerated growth. This study aims to: (1) estimate the prevalence of anaemia in 2012 and 2018-2019 (Encuesta Nacional de Salud y Nutricion - ENSANUT [n = 5841 in 2012 and n = 2380 in 2018-2019]) in non-pregnant, Mexican adolescent women aged 12-19 years, and the changes in prevalence over this period according to sociodemographic, health and nutrition characteristics; (2) estimate the associations between anaemia and sociodemographic, health and nutrition characteristics in each year and overall, in non-pregnant Mexican adolescent women. Anaemia was defined as capillary haemoglobin <12 g/dL. The distribution of characteristics and their changes between 2012 and 2018-2019 were described. The covariate-adjusted prevalence of anaemia in 2012 and 2018-2019 and the changes over that period were estimated from a multiple log-binomial regression model and the factors associated with anaemia were assessed in each survey year and in both years combined. The prevalence of anaemia was 7.7% in 2012 and 13.1% in 2018-2019 (69% increase, Prevalence Ratio: PR = 1.69; 95%CI: 1.35, 2.13). The covariate-adjusted prevalence of anaemia increased from 6.9% to 10.5% in the overall population (PR = 1.53, 95%CI: 1.19, 1.96), and increased considerably in the age group 12-14 years (PR = 1.94, 95%CI: 1.36, 2.75), and in the northern region (PR = 3.68, 95%CI: 2.55, 5.32). Those receiving iron supplements or school breakfasts did not register a significant increase. A higher household wellbeing status and older age were associated with a lower prevalence of anaemia. Anaemia in non-pregnant adolescent women continues to be a public health problem. To improve the development and health of adolescent women in Mexico and to pave the way to a healthy pregnancy for the next generation, the causes of anaemia should be identified.

Parental Feeding Styles and Their Association With Complementary Feeding Practices and Growth in Mexican Children.

Background: Complementary feeding practices and corresponding parental feeding styles influence nutritional status in later stages of childhood. Findings on the association of these variables with infant growth remain inconsistent; in Mexico, a research gap exists in this area. Research Aims: (1) To characterize parental feeding styles and complementary feeding practices, and (2) to evaluate the association of parental feeding styles with complementary feeding practices and infant growth at 6 and 9 months of age. Methods: Data were collected from a prospective Mexican birth cohort. Parental feeding styles, complementary feeding practices, and anthropometric data from 263 to 234 mother-child pairs (infants of 6 and 9 months of age, respectively) were analyzed. Logistic and linear regression models were used to determine the associations between variables. Results: The predominant parental feeding style was the "responsive style" (90%). Only 43.7 and 8.1% of 6- and 9-month-old infants, had adequate complementary feeding practices, respectively. At 6 months, mothers who were responsive to satiety signals had 11% lesser possibilities (OR = 0.89, 95% CI [0.80, 0.98]) of their infant having inadequate complementary feeding practices than their counterparts and "pressuring to finish" and "pressuring to eat cereal" sub-constructs were associated with lower weight for length and body mass index Z-scores (p = 0.02). Conclusions: A high proportion of infants (>40%) did not meet international recommendations. The "pressuring" parental feeding style sub-constructs were associated with growth indicators in 6-month old infants. This emphasizes the importance of promoting parental responsiveness to infant appetite and satiety signals to achieving adequate complementary feeding practices.

[Food groups consumption and its associationwith sociodemographic characteristics in Mexicanpopulation. Ensanut 2018-19]. / Consumo de grupos de alimentos y su asociación con características sociodemográficas en población mexicana. Ensanut 2018-19.

OBJECTIVE: To describe the consumption of recommended and non-recommended food groups for daily consumption, and their association with sociodemographic characteristics in Mexican population. MATERIALS AND METHODS: Infor-mation from the 2018-19 National Health and Nutrition Survey from Mexico, using a 7-day food consumption fre-quency questionnaire, in children and adults. We estimated consumption of seven food groups in quartiles by age group. We analyzed the association of locality of residence, region and tertil of well-being index (WBI). RESULTS: Living in urban locality, north region, or medium or high WBI were associated with higher possibility of being in higher quartiles of egg and dairy, legumes, processed meat and snacks, candies and desserts consumption. CONCLUSIONS: In the southern Mexico more fruits are consumed, but less legumes, eggs and dairy products, while in urban locations more snacks, sweets and desserts are consumed.

OBJETIVO: Describir el consumo de grupos de alimentos recomendables y no recomendables para consumo cotidiano y su asociación con características sociodemográficas en población mexicana. MATERIAL Y MÉTODOS: tomada de la Encuesta Nacional de Salud y Nutrición 2018-19, utilizando un cuestionario de frecuencia de consumo de ali-mentos. Se estimaron cuartiles de consumo de siete grupos de alimentos por grupo poblacional. Se analizó la asociación del consumo con tipo de localidad, región y terciles de condición de bienestar (ICB). RESULTADOS: Pertenecer a localidades urbanas, región norte e ICB medio y alto se asoció con mayor posibilidad de estar en los cuartiles más altos de consumo de huevo y lácteos y carnes procesadas, mientras que la región sur se asoció con mayor consumo de leguminosas y bebidas endulzadas. CONCLUSIONES: En el sur de México se consume más frutas, pero menos leguminosas, huevo y lácteos, mientras que en localidades urbanas se consume más carnes procesa-das, botanas, dulces y postres.

Consumo de grupos de alimentos y su asociación con características sociodemográficas en población mexicana. Ensanut 2018-19 / Food groups consumption and its association with sociodemographic characteristics in Mexican population. Ensanut 2018-19

Resumen: Objetivo: Describir el consumo de grupos de alimentos recomendables y no recomendables para consumo cotidiano y su asociación con características sociodemográficas en población mexicana. Material y métodos: Información tomada de la Encuesta Nacional de Salud y Nutrición 2018-19, utilizando un cuestionario de frecuencia de consumo de alimentos. Se estimaron cuartiles de consumo de siete grupos de alimentos por grupo poblacional. Se analizó la asociación del consumo con tipo de localidad, región y terciles de condición de bienestar (ICB). Resultados: Pertenecer a localidades urbanas, región norte e ICB medio y alto se asoció con mayor posibilidad de estar en los cuartiles más altos de consumo de huevo y lácteos y carnes procesadas, mientras que la región sur se asoció con mayor consumo de leguminosas y bebidas endulzadas. Conclusión: En el sur de México se consume más frutas, pero menos leguminosas, huevo y lácteos, mientras que en localidades urbanas se consume más carnes procesadas, botanas, dulces y postres.

Abstract: Objective: To describe the consumption of recommended and non-recommended food groups for daily consumption, and their association with sociodemographic characteristics in Mexican population. Materials and methods: Information from the 2018-19 National Health and Nutrition Survey from Mexico, using a 7-day food consumption frequency questionnaire, in children and adults. We estimated consumption of seven food groups in quartiles by age group. We analyzed the association of locality of residence, region and tertil of well-being index (WBI). Results: Living in urban locality, north region, or medium or high WBI were associated with higher possibility of being in higher quartiles of egg and dairy, legumes, processed meat and snacks, candies and desserts consumption. Conclusions: In the southern Mexico more fruits are consumed, but less legumes, eggs and dairy products, while in urban locations more snacks, sweets and desserts are consumed.