Agreement between a web collaborative dataset and an administrative dataset to assess the retail food environment in Mexico.

BACKGROUND: Latin American countries are often limited in the availability of food outlet data. There is a need to use online search engines that allow the identification of food outlets and assess their agreement with field observations. We aimed to assess the agreement in the density of food outlets provided by a web collaborative data (Google) against the density obtained from an administrative registry. We also determined whether the agreement differed by type of food outlet and by area-level socioeconomic deprivation. METHODS: In this cross-sectional study, we analyzed 1,693 census tracts from the municipalities of Hermosillo, Leon, Oaxaca de Juarez, and Tlalpan. The Google service was used to develop a tool for the automatic acquisition of food outlet data. To assess agreement, we compared food outlet densities obtained with Google against those registered in the National Statistical Directory of Economic Units (DENUE). Continuous densities were assessed using Bland-Altman plots and concordance correlation coefficient (CCC), while agreement across tertiles of density was estimated using weighted kappa. RESULTS: The CCC indicated a strong correlation between Google and DENUE in the overall sample (0.75); by food outlet, most of the correlations were from negligible (0.08) to moderate (0.58). The CCC showed a weaker correlation as deprivation increased. Weighted kappa indicated substantial agreement between Google and DENUE across all census tracts (0.64). By type of food outlet, the weighted kappa showed substantial agreement for restaurants (0.69) and specialty food stores (0.68); the agreement was moderate for convenience stores/small food retail stores (0.49) and fair for candy/ice cream stores (0.30). Weighted kappa indicated substantial agreement in low-deprivation areas (0.63); in very high-deprivation areas, the agreement was moderate (0.42). CONCLUSIONS: Google could be useful in assessing fixed food outlet densities as a categorical indicator, especially for some establishments, like specialty food stores and restaurants. The data could also be informative of the availability of fixed food outlets, particularly in less deprived areas.

Association Between Household Deprivation and Living in Informal Settlements and Incidence of Diarrhea in Children Under 5 in Eleven Latin American Cities.

Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84-1.28) and 3.19 times (95% CI 1.80-5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.

Speed limits and their effect on air pollution in Mexico City: A quasi-experimental study.

Speed limits are an evidence-based intervention to prevent traffic collisions and deaths, yet their impact on air pollution in cities is understudied. The objective of this study was to investigate the association between lower speed limits and air pollution. We leverage the introduction of a new road safety policy in Mexico City in December 2015 which lowered speed limits, increased fines, and installed speed radars to enforce compliance. We tested whether the policy had an impact on particulate matter (PM2.5) and nitrogen dioxide (NO2) at the city level, and whether air-quality monitoring stations' proximity to speed radars moderated this effect due to more acceleration and deceleration around radars. NO2 and PM2.5 concentrations from January 2014 to December 2018 were obtained from the National System of Air Quality Information. Air-quality monitoring stations were classified as in close-proximity or far-from-speed radars. Interrupted time series analyses were conducted for each outcome separately, using linear mixed models and adjusting for seasonality and time-varying confounders: registered vehicles, temperature, wind-speed and relative humidity. The results suggest improvement in both contaminants after the speed limits policy. For NO2, the pre-policy trend was flat, while the post-policy trend showed a decline in concentrations of 0.04 ppb/week. For PM2.5, concentrations were increasing pre-policy by 0.08 µg/m3 per week, then this trend flattened in the post-policy period to a weekly, non-significant, increase of 0.03 µg/m3 (p = 0.08). Air-quality monitors' proximity to speed radars did not moderate the effect of the policy on either of the pollutants. In conclusion, the speed limits policy implemented in Mexico City in 2015 was associated with improvements in air pollution.

Socioeconomic Position, Pre-Obesity and Obesity in Latin American Cities: A Systematic Review.

Currently the socioeconomic gradient of obesity it is not well understood in the urban population in Latin American. This study reviewed the literature assessing associations between pre-obesity, obesity, and socioeconomic position (SEP) in adults living in urban areas in Latin American countries. PubMed and SciELO databases were used. Data extraction was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We extracted data on the association between SEP (e.g., education, income), pre-obesity (body mass index [BMI] ≥ 25 and < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2). Relative differences between low and high SEP groups were assessed and defined a priori as significant at p < 0.05. Thirty-one studies met our inclusion criteria and most were conducted in Brazil and Mexico (22 and 3 studies, respectively). One study presented nonsignificant associations. Forty-seven percent of associations between education or income and pre-obesity were negative. Regarding obesity, 80 percent were negative and 20 percent positive. Most negative associations were found in women while in men they varied depending on the indicator used. Pre-obesity and obesity by SEP did not follow the same pattern, revealing a reversal of the obesity social gradient by SEP, especially for women in Latin America, highlighting the need for articulated policies that target structural and agentic interventions.

Perspective: Mexico's Experience in Building a Toolkit for Obesity and Noncommunicable Diseases Prevention.

Noncommunicable diseases (NCDs) are a leading cause of death and disability worldwide, with a higher risk of death in low- and middle-income countries. Diet and excess weight are risk factors for NCDs. In Mexico, the prevalence of overweight and obesity increased dramatically in the last 30 y and is among the highest in the world. To address this public health problem, governments and public health professionals have several policy instruments available. In this study, we present the policy instruments currently approved in Mexico, which include fiscal, informational, and authoritative tools that aim to improve the food environment and promote healthy behaviors (taxes, school food guidelines, front-of-pack labeling, marketing regulations, and dietary guidelines). These types of interventions are important in regions like Latin America, where social inequities and poor access to information are common, and individual healthy choices are often limited. These interventions target the environments in which individuals live, study, work, and seek entertainment, while limiting access to unhealthy choices and offering information to promote healthy alternatives. The Mexican experience in design, implementation, and evaluation of policies to improve the food environment can be useful for other low- and middle-income countries facing similar challenges.

Association of service facilities and amenities with adolescent birth rates in Mexican cities.

BACKGROUND: The association of the built environment and the structural availability of services/amenities with adolescent birth rates (ABR) has been overlooked in Latin America. We investigated the association of the availability, and changes in the availability, of services/amenities with ABR in 92 Mexican cities. METHODS: We estimated ABR using data on live birth registration linked to municipality of residence at the time of birth from 2008-2017. The number of services/amenities were obtained from the National Statistical Directory of Economic Units in 2010, 2015, and 2020 and grouped as follows: education, health care, pharmacies, recreation, and on- and off-premises alcohol outlets. Data were linearly interpolated to obtain yearly estimates. We estimated densities per square km by municipality. We fitted negative binomial hybrid models, including a random intercept for municipality and city, and adjusted for other social environment variables. RESULTS: After adjustment a 1-unit increase in the density of recreation facilities, pharmacies, and off-premises alcohol outlets within municipalities was associated with a 5%, 4% and 12% decrease in ABR, respectively. Municipalities with higher density of education, recreational and health care facilities had a lower ABR; in contrast, municipalities with a higher density of on-premises alcohol experienced a higher ABR. CONCLUSION: Our findings highlight the importance of economic drivers and the need to invest in infrastructure, such as pharmacies, medical facilities, schools, and recreation areas and limit the availability of alcohol outlets to increase the impact of current adolescent pregnancy prevention programs.

Trends in food and beverage purchases in informal, mixed, and formal food outlets in Mexico: ENIGH 1994-2020.

Background: The retail food environment in Mexico is characterized by the co-existence of both, formal and informal food outlets. Yet, the contribution of these outlets to food purchases over time has not been documented. Understanding the longitudinal trends where Mexican households purchase their foods is critical for the development of future food retail policies. Methods: We used data from Mexico's National Income and Expenditure Survey from 1994 to 2020. We categorized food outlets as formal (supermarkets, chain convenience stores, restaurants), informal (street markets, street vendors, acquaintances), and mixed (fiscally regulated or not. i.e., small neighborhood stores, specialty stores, public markets). We calculated the proportion of food and beverage purchases by food outlet for each survey for the overall sample and stratified by education level and urbanicity. Results: In 1994, the highest proportion of food purchases was from mixed outlets, represented by specialty and small neighborhood stores (53.7%), and public markets (15.9%), followed by informal outlets (street vendors and street markets) with 12.3%, and formal outlets from which supermarkets accounted for 9.6%. Over time, specialty and small neighborhood stores increased 4.7 percentage points (p.p.), while public markets decreased 7.5 p.p. Street vendors and street markets decreased 1.6 p.p., and increased 0.5 p.p. for supermarkets. Convenience stores contributed 0.5% at baseline and increased to 1.3% by 2020. Purchases at specialty stores mostly increased in higher socioeconomic levels (13.2 p.p.) and metropolitan cities (8.7 p.p.) while public markets decreased the most in rural households and lower socioeconomic levels (6.0 p.p. & 5.3 p.p.). Supermarkets and chain convenience stores increased the most in rural localities and small cities. Conclusion: In conclusion, we observed an increase in food purchases from the formal sector, nonetheless, the mixed sector remains the predominant food source in Mexico, especially small-neighborhood stores. This is concerning, since these outlets are mostly supplied by food industries. Further, the decrease in purchases from public markets could imply a reduction in the consumption of fresh produce. In order to develop retail food environment policies in Mexico, the historical and predominant role of the mixed sector in food purchases needs to be acknowledged.

City features related to obesity in preschool children: a cross-sectional analysis of 159 cities in six Latin American countries.

Background: Childhood obesity is a rising global health problem. The rapid urbanization experienced in Latin America might impact childhood obesity through different pathways involving urban built and social features of cities. We aimed to evaluate the association between built and social environment features of cities and childhood obesity across countries and cities in Latin America. Methods: Cross-sectional analysis of data from 20,040 children aged 1-5 years living in 159 large cities in six Latin American countries. We used individual-level anthropometric data for excess weight (overweight or obesity) from health surveys that could be linked to city-level data. City and sub-city level exposures included the social environment (living conditions, service provision and educational attainment) and the built environment (fragmentation, isolation, presence of mass transit, population density, intersection density and percent greenness). Multi-level logistic models were used to explore associations between city features and excess weight, adjusting for age, sex, and head of household education. Findings: The overall prevalence of excess weight among preschool children was 8% but varied substantially between and within countries, ranging from 4% to 25%. Our analysis showed that 97% of the variability was between individuals within sub-city units and around 3% of the variance in z-scores of weight for height was explained by the city and sub-city levels. At the city-level, a higher distance between urban patches (isolation, per 1 SD increase) was associated with lower odds of excess weight (OR 0.90, 95% CI 0.82-0.99). Higher sub-city education was also associated with lower odds of excess weight, but better sub-city living conditions were associated with higher odds of excess weight. Interpretation: Built and social environment features are related to excess weight in preschool children. Our evidence from a wide range of large Latin American cities suggests that urban health interventions may be suitable alternatives towards attaining the goal of reducing excess weight early in the life course. Funding: The SALURBAL project (Salud Urbana en América Latina, Urban Health in Latin America) is funded by Wellcome [205177/Z/16/Z].

Longitudinal association between density of retail food stores and body mass index in Mexican school children and adolescents.

BACKGROUND: Obesity is rapidly increasing in Mexican children and adolescents, while food environments are rapidly changing. We evaluated the association between changes in retail food stores and change in body mass index (BMI) in Mexican children and adolescents. METHODS: Data on 7507 participants aged 5-19 years old came from the Mexican Family Life Survey 2002-2012. Density of food stores at the municipal-level (number of food stores/area in km2) came from the Economic Censuses of 1999, 2004 and 2009. We categorized food stores as small food retail (small neighborhood stores, tiendas de abarrotes in Mexico), specialty foods, fruit/vegetables, convenience foods, and supermarkets. Associations between change in food stores and change in BMI were estimated using five longitudinal linear fixed-effects regression models (one per type of food store) adjusted for age, parental education, municipal-level socioeconomic deprivation and population density. Density of each food store type was operationalized as quartiles. Analyses were stratified by urbanization. RESULTS: There was an inverse dose-response association between increases in fruit/vegetable store density and BMI (ß = -0.455 kg/m2, ß = -0.733 kg/m2, and ß = -0.838 kg/m2 in the second, third, and fourth quartile). In non-urban areas, children living in municipalities with the highest density of small food retail stores experienced a reduction in BMI (ß = -0.840 kg/m2). In urban areas, there was an inverse association between specialty food stores with BMI (ß = -0.789 kg/m2 in third quartile, and ß = -1.204 kg/m2 in fourth quartile). We observed dynamic associations with age; results suggested stronger associations in adolescents. CONCLUSIONS: The availability of fruit/vegetable stores may influence a reduction in children and adolescents BMI. These results indicate that policy approaches could be tailored by type of food store - with some consideration for level of urbanization and children's age.

Evaluation of road safety policies and their enforcement in Mexico City, 2015-2019: an interrupted time-series study.

BACKGROUND: Mexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths. METHODS: Collisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis. RESULTS: The 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI -0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different. CONCLUSION: Policies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.

Food and beverage purchases at formal and informal outlets in Mexico.

OBJECTIVE: To examine food and beverage purchasing patterns across formal and informal outlets among Mexican households' and explore differences by urbanicity and income. DESIGN: Cross-sectional study of a nationally representative sample of households. We calculated the proportion of total food and beverage expenditure in each household by food outlet type overall and by urbanicity and income. We defined informal outlets as those which are not registered or regulated by tax and fiscal laws. Since some of the outlets within community food environments do not fall in clear categories, we defined a continuum from formal to informal outlets, adding mixed outlets as a category. SETTING: Mexico. PARTICIPANTS: Mexican households (n 74 203) from the 2018 National Income and Expenditure Survey. RESULTS: Of the total food and beverage purchases, outlets within the formal food sector (i.e. supermarkets and convenience stores) accounted for 15 % of the purchases, 13 % of purchases occurred in outlets within the informal food sector (i.e. street markets, street vendors and acquaintances) and 70 % in fiscally mixed outlets (i.e. small neighbourhood stores, specialty stores and public markets). Across levels of urbanicity and income, most food and beverage purchases occurred in mixed outlets. Also, purchases in informal and mixed outlets decreased as levels of urbanicity and income increased. In contrast to informal outlets, purchases in formal outlets were most likely from richer households and living in larger sized cities. CONCLUSIONS: Understanding where Mexican households shop for food is relevant to create tailored interventions according to food outlet type, accounting for regulatory and governance structures.

One-year impact of a multicomponent, street-level design intervention in Mexico City on pedestrian crashes: a quasi-experimental study.

BACKGROUND: Mexico City implemented the Pasos Seguros programme to prevent pedestrian injuries and deaths at dangerous road intersections, which included street-level design changes, such as visible pedestrian crossings, sidewalk widening, refuge islands, lane reductions, pedestrian signals and adjustment of traffic light timing at these intersections. Few studies in low and middle-income countries (LMICs) have evaluated the effect of such interventions on pedestrian safety. AIM: Assess the effectiveness of the Pasos Seguros programme at reducing total, injury and fatal pedestrian-motor vehicle crashes. METHODS: Two-group quasi-experimental design. Monthly pedestrian crashes were obtained from the road incident database from Mexico City's Citizen Contact Center. The programme's effectiveness was evaluated by comparing 12 months preintervention to 12 months postintervention implementation using a negative binomial regression with random intercept with a difference-in-difference estimation. A qualitative comparative analysis was used to find the configuration of intersection characteristics and programme components associated with a decrease in pedestrian crashes. RESULTS: Total pedestrian crashes were reduced by 21% (RR 0.79; 95% CI 0.62 to 0.99) after implementation of Pasos Seguros programme. This reduction was observed for pedestrian injury crashes (RR 0.79; 95% CI 0.62 to 1.00) and for fatal crashes (RR 0.61; 95% CI 0.13 to 2.92) although not statistically significant for the latter. A decrease in pedestrian crashes was found at the most complex intersections where more of the programme components was implemented. CONCLUSION: The Pasos Seguros programme successfully decreased total and injury pedestrian crashes. Similar interventions may improve walking safety in other LMIC cities.

Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities?

While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m2) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.

Evaluation of the national sobriety checkpoints program in Mexico: a difference-in-difference approach with variation in timing of program adoption.

BACKGROUND: Up to a third of global road traffic deaths, and one in five in Mexico, are attributable to alcohol. In 2013, Mexico launched a national sobriety checkpoints program designed to reduce drink-driving in municipalities with high rates of alcohol-related collisions. Our study measured the association between the sobriety checkpoints program and road traffic mortality rates in 106 urban municipalities. METHODS: We leveraged data from the Salud Urbana en America Latina (SALURBAL), which compiles health and environmental data from cities with over 100,000 residents. Death data from 2005 to 2019 (i.e., outcome) were from official vital statistics. Among 106 Mexican municipalities defined as priority areas for intervention, 54 adopted the program (i.e., treatment) in 2013, 16 municipalities did so in 2014, 16 in 2015, 10 in 2016, 7 in 2017, and 2 in 2019. We used a difference-in-difference approach with inverse probability weighting adapted to a context where program adoption is staggered over time. RESULTS: There was a 12.3% reduction in road traffic fatalities per 10,000 passenger vehicles in the post-treatment period compared to the pre-treatment period (95% Confidence Interval, - 17.8; - 6,5). There was a clear trend of decline in mortality in municipalities that adopted the program (vs. comparison) particularly after year 2 of the program. CONCLUSIONS: In this study of 106 municipalities in Mexico, we found a 12.3% reduction in traffic fatalities associated with the adoption of sobriety checkpoints. There was a clear trend indicating that this association increased over time, which is consistent with sustained changes in drink-driving behavior. These findings provide support and insight for efforts to implement and evaluate the impact of sobriety checkpoint policies across Latin America.

Socioeconomic deprivation and changes in the retail food environment of Mexico from 2010 to 2020.

We aimed to analyze the change in the retail food environment of Mexican municipalities from 2010 to 2020, and to assess if these trends were modified by socioeconomic deprivation. We used data from the National Statistical Directory of Economic Units. Changes in the food store count were estimated using fixed-effects Poisson regression models, including coefficients for time, socioeconomic deprivation, and their interaction. We found a rapid growth in convenience stores, seed-grain stores, and supermarkets while small food retail stores declined. Urban areas had a higher count of all types of food stores; however, the steepest increases in food stores were observed in non-urban areas. The increase in convenience stores, supermarkets, specialty food stores, fruit-vegetable stores, and seed-grain stores was greater in the most deprived areas, compared to the least deprived areas. There has been a substantial expansion and rapid change in Mexico's food environment, mainly driven by increases in convenience stores and supermarkets in more deprived and less urbanized areas.

Perceived Availability of Healthy and Unhealthy Foods in the Community, Work, and Higher Education Settings across Five Countries: Findings from the International Food Policy Study 2018.

BACKGROUND: Food environments play a key role in dietary behavior and vary due to different contexts, regulations, and policies. OBJECTIVES: This study aimed to characterize the perceived availability of healthy and unhealthy foods in 3 different settings in 5 countries. METHODS: We analyzed data from the 2018 International Food Policy Study, a cross-sectional survey of adults (18-100 y, n = 22,824) from Australia, Canada, Mexico, the United Kingdom (UK), and the USA. Perceived availability of unhealthy (junk food and sugary drinks) and healthy foods (fruit or vegetables, healthy snacks, and water) in the community, workplace, and university settings were measured (i.e. not available, available for purchase, or available for free). Differences in perceived availability across countries were tested using adjusted multinomial logistic regression models. RESULTS: Across countries, unhealthy foods were perceived as highly available in all settings; in university and work settings unhealthy foods were perceived as more available than healthy foods. Australia and Canada had the highest perceived availability of unhealthy foods (range 87.5-90.6% between categories), and the UK had the highest perceived availability of fruits and vegetables for purchase (89.3%) in the community. In university and work settings, Mexico had the highest perceived availability for purchase of unhealthy foods (range 69.9-84.9%). The USA and the UK had the highest perceived availability of fruits and vegetables for purchase (65.3-66.3%) or for free (21.2-22.8%) in the university. In the workplace, the UK had high perceived availability of fruits and vegetables for purchase (40.2%) or for free (18.5%), and the USA had the highest perceived availability of junk food for free (17.3%). CONCLUSIONS: Across countries, unhealthy foods were perceived as highly available in all settings. Variability between countries may reflect differences in policies and regulations. Results underscore the need for the continuation and improvement of policy efforts to generate healthier food environments.

Greenhouse Gas Emissions Associated With the Mexican Diet: Identifying Social Groups With the Largest Carbon Footprint.

Background: Most studies of the climate footprint of diets have been conducted in countries in the global north, but the majority of the world population lives in global south countries. We estimated total dietary greenhouse gas emissions (GHGE) in Mexico, examined the contribution of major food and beverage groups, and assessed variation across social groups. Methods: We linked individual-level dietary data from the Mexican National Health and Nutrition Survey 2018 to the SHARP Indicators Database, containing GHGE estimates for 182 primary food and beverages. Results: Mean dietary GHGE was 3.9 kg of carbon dioxide equivalent per person per day. Dietary GHGE is highest among those in young adulthood and middle age versus adolescents and older adults, and among males, those with higher educational attainment, higher socioeconomic status, that do not speak an indigenous language, and that live in urban areas. Conclusion: The Mexican diet has a much lower carbon footprint than diets in other Latin American countries for which such estimates are available. In contrast to patterns observed in Argentina and Brazil, dietary GHGE was lowest in those in lower socioeconomic and educational strata and in rural areas. A better understanding of the differences in diet sustainability between and within countries will be needed for developing global and local strategies that meet the environmental sustainability goals.

Exacerbación de las inequidades educativas en tiempos de Covid-19.

No disponible.

Changes in the Retail Food Environment in Mexican Cities and Their Association with Blood Pressure Outcomes.

Shifting food environments in Latin America have potentially contributed to an increase in the consumption of ultra-processed foods and sugar-sweetened beverages, along with decreases in healthy foods, such as fruits and vegetables. Yet, little is known about the impact that such changes in the food environment have on blood pressure in low- and middle-income countries, including Mexico. We utilized individual-level systolic and diastolic blood pressure (SBP and DBP) measures from the 2016 Mexican Health and Nutrition Survey (ENSANUT, n = 2798 adults). Using an inventory of food stores based on the economic census for 2010 and 2016, we calculated the change in the density of fruit and vegetable stores, convenience stores, and supermarkets. Multilevel regression was used to estimate the association between the 2010-2016 food environment neighborhood-level changes with individual-level blood pressure measured in 2016. Declines in neighborhood-level density of fruit and vegetable stores were associated with higher individual SBP (2.67 mmHg, 95% CI: 0.1, 5.2) in unadjusted models, and marginally associated after controlling for individual-level and area-level covariates. Increases in the density of supermarkets were associated with higher blood pressure outcomes among adults with undiagnosed hypertension. Structural interventions targeting the retail food environment could potentially contribute to better nutrition-related health outcomes in Latin American cities.