Self-efficacy and Social Settings Matter for Fostering Healthy Eating in Mexican Schoolchildren.

OBJECTIVE: To identify differences in schoolchildren's self-efficacy for eating behaviors across social settings and self-efficacy sources favoring healthy and unhealthy eating. DESIGN: A cross-sectional, mixed-methods study using self-efficacy and demographic surveys, focus groups, and school environment semistructured observations. SETTING: Morelos, Mexico, Cuernavaca City school district, public elementary schools in the National School Lunch Program. PARTICIPANTS AND RECRUITMENT: We studied 274 fifth- and sixth-grade children from 8 elementary schools during the 2016-2017 school year. VARIABLES MEASURED: Children's self-efficacy for healthy and unhealthy eating across 3 settings (school cafeteria, recess, and home). Children's perceptions about sources of self-efficacy, which favor their healthy or unhealthy eating (performance accomplishments, behavior modeling, verbal persuasion, and emotional or physiological states). Sociodemographic information was obtained from parents. ANALYSIS: We performed a variance components analysis with school and students within schools as random effects with paired t tests (quantitative data) and content analysis on the basis of the Social Cognitive Theory (qualitative data). RESULTS: Schoolchildren's self-efficacy for healthy eating differed across social settings, being greater in the school cafeteria than at recess or home, except for drinking water. On average, self-efficacy for unhealthy eating was lower in the cafeteria than in other studied settings. Performance achievements and behavior modeling were key sources of self-efficacy for healthy and unhealthy eating. CONCLUSION AND IMPLICATIONS: Sources of self-efficacy and social settings matter to understanding schoolchildren's healthy and unhealthy eating. Future interventions might consider developing collective efficacy among the school community and boosting children's participation in home meal planning. Further research could explore locus of control and other intrapersonal dimensions influencing self-efficacy.

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.

Perceptions of childcare staff for preventing overweight in Mexican preschool children: A SWOT analysis.

OBJECTIVE: To identify strengths, weaknesses, opportunities, and threats (SWOT) perceived by childcare staff for preventing childhood overweight. MATERIAL AND METHODS: Qualitative study using an interpretative phenomenological approach; 18 in-depth, semi-structured interviews and 12 focus groups with 89 key informants working in six Mexican public childcare centers (CCC) were conducted. Through content and SWOT analyses, experts further ranked fifty-nine recurrent perceptions regarding healthy feeding and physical activity (PA), using the Delphi method. RESULTS: Strengths: Acknowledgement of the CCC's responsibility in fostering healthy feeding, availability of organizational regulations, and access to PA infrastructure/indoor activities. Weaknesses: Disregard of preschool overweight as a health problem, nu- tritional misperceptions, and perceived risk of child injuries while conducting PA. Opportunities: Willingness to reduce children's access to junk foods, and parental active play with children during weekends. Threats: Limited family nutritional education, and restricted parental time/economic constraints/access to safe public spaces for PA. CONCLUSIONS: The identified SWOT must be considered when developing obesityprevention interventions targeted at CCC.

Perceptions of childcare staff for preventing overweight in Mexican preschool children: A SWOT analysis / Percepciones del personal de guarderías sobre la prevención del sobrepeso en preescolares mexicanos: análisis FODA

Abstract: Objective: To identify strengths, weaknesses, opportunities, and threats (SWOT) perceived by childcare staff for preventing childhood overweight. Materials and methods: Qualitative study using an interpretative phenomenological approach; 18 in-depth, semi-structured interviews and 12 focus groups with 89 key informants working in six Mexican public childcare centers (CCC) were conducted. Through content and SWOT analyses, experts further ranked fifty-nine recurrent perceptions regarding healthy feeding and physical activity (PA), using the Delphi method. Results: Strengths: Acknowledgement of the CCC's responsibility in fostering healthy feeding, availability of organizational regulations, and access to PA infrastructure/indoor activities. Weaknesses: Disregard of preschool overweight as a health problem, nutritional misperceptions, and perceived risk of child injuries while conducting PA. Opportunities: Willingness to reduce children's access to junk foods, and parental active play with children during weekends. Threats: Limited family nutritional education, and restricted parental time/economic constraints/access to safe public spaces for PA. Conclusion: The identified SWOT must be considered when developing obesity-prevention interventions targeted at CCC.

Resumen: Objetivo: Identificar fortalezas, debilidades, oportunidades y amenazas (FODA) percibidas por personal de guarderías, para prevenir sobrepeso en preescolares. Material y métodos: Estudio cualitativo con enfoque fenomenológico interpretativo en seis guarderías públicas de la Ciudad de México. Se realizaron 18 entrevistas semiestructuradas a profundidad y 12 grupos focales con 89 directivos y trabajadores. Mediante análisis de contenido y FODA se identificaron 59 percepciones sobre alimentación y actividad física (AF), jerarquizadas por expertos mediante el método Delphi. Resultados: Fortalezas: Reconocimiento del potencial de guarderías en promover alimentación saludable, disponibilidad de reglamentos y acceso a infraestructura/práctica de AF en interiores. Debilidades: No se considera el sobrepeso infantil como un problema de salud, baja alfabetización nutricional y percepción de riesgo de lesiones al practicar AF. Oportunidades: Voluntad de limitar acceso a alimentos chatarra y estimular a padres e hijos a realizar juegos activos en fines de semana. Amenazas: Limitada orientación alimentaria y restricciones temporales/económicas/de acceso a espacios seguros para AF. Conclusión: Las FODA identificadas deben considerarse en las intervenciones para prevenir el sobrepeso en guarderías.

Understanding and acceptability by Hispanic consumers of four front-of-pack food labels.

BACKGROUND: Front-of-pack food labels (FOPL) can help consumers make healthy and informed food choices. FOPL are used in the food market but evaluations of their understanding and acceptability are scanty. This study aimed to explore the subjective understanding and acceptability of four FOPL among Hispanic consumers. METHODS: A qualitative study was conducted in six States of Mexico, in 18 urban elementary schools. A purposive sample of 135 parents of fifth-grade children was selected. Four FOPL were assessed: Logos, Rating Stars, Guideline Daily Allowances (GDA's), and Multiple Traffic Lights (MTL). Trained interviewers performed 18 focus groups with the participants, using an interview guide. Participants were asked about their subjective understanding and acceptability of the FOPL, displaying 16 generic breakfast cereal boxes designed for this study (four for each FOPL), varying in their nutritional value. Afterwards, participants were asked to choose among the four cereal boxes the one to best communicate the product healthiness and their reasons for choice, proposals for improving the FOPL, and desirable characteristics for new FOPL. Finally, a socio-demographic questionnaire was applied. Thematic analysis of the transcriptions of the focus groups was performed, using Altlas.tiV5 software. RESULTS: Logos were perceived as easy to understand, highly acceptable, and useful for decision-making; institutional endorsement of Logos was related to greater confidence in the label. The GDA's were hard to understand considering the nutritional knowledge and time needed for interpretation. The Rating Stars were related to the quality in businesses rather than foods. The MTL were viewed as indicating the high/low content of specific nutrients, but the meaning of the amber color was not fully understood. Participants highlighted the need for a simple FOPL that allows easily identification of healthy products while considering food purchasing time limitations and interpretation of food portions. CONCLUSIONS: Logos with an institutional endorsement was the best understood and accepted FOPL, and the GDA's and Rating Stars were the least. Our findings provide valuable insights about Hispanic consumers´ perceptions regarding FOPL and to guide public health policy. Further studies are needed in populations with chronic diseases and diverse social contexts.

Use and understanding of the nutrition information panel of pre-packaged foods in a sample of Mexican consumers.

OBJECTIVE: To assess the use and understanding of the Nutritional information Panel (NIP) of pre-packaged foods by Mexican consumers. MATERIALS AND METHODS: A questionnaire and an understanding test for NIP were applied to adult consumers in supermarkets of six cities in the Northern, Central, and Southern regions of Mexico. Data were analyzed by frequencies and Poisson regression models. RESULTS: Interviewed 731 consumers; 71.5% were women, mean age 33 ± 9.7 (range: 18-60), 70% completed high-school or a higher degree. In total, 17% of consumers use the NIP for making purchase decisions; 49% did not understand the NIP. Only 1.2% of consumers answered correctly the five questions of the NIP understanding test. CONCLUSIONS: The use and understanding of the NIP are low despite a high proportion self-reported reading and understanding. The lack of previous knowledge of the technical language prevents use and interpretation of NIP nutritional information for purchasing decisions.

Use and understanding of the nutrition information panel of pre-packaged foods in a sample of Mexican consumers / Uso y comprensión del etiquetado nutrimental posterior de los alimentos pre-empaquetados en una muestra de consumidores mexicanos

OBJECTIVE: To assess the use and understanding of the Nutritional information Panel (NIP) of pre-packaged foods by Mexican consumers. MATERIALS AND METHODS: A questionnaire and an understanding test for NIP were applied to adult consumers in supermarkets of six cities in the Northern, Central, and Southern regions of Mexico. Data were analyzed by frequencies and Poisson regression models. RESULTS: Interviewed 731 consumers; 71.5% were women, mean age 33 ± 9.7 (range: 18-60), 70% completed high-school or a higher degree. In total, 17% of consumers use the NIP for making purchase decisions; 49% did not understand the NIP. Only 1.2% of consumers answered correctly the five questions of the NIP understanding test. CONCLUSIONS: The use and understanding of the NIP are low despite a high proportion self-reported reading and understanding. The lack of previous knowledge of the technical language prevents use and interpretation of NIP nutritional information for purchasing decisions.

OBJETIVO: Evaluar el uso y comprensión del etiquetado nutricional posterior (NIP, por sus siglas en inglés) de alimentos preempacados por consumidores mexicanos. MATERIAL Y MÉTODOS: Se aplicaron un cuestionario y una prueba de comprensión del NIP a consumidores adultos en supermercados de seis ciudades de las regiones Norte, Centro y Sur de México. RESULTADOS: Se entrevistaron 731 consumidores; 71.5% eran mujeres, la media de edad 33 ± 9.7 años (intervalo 18-60); 70% terminaron preparatoria o un nivel más alto. El 17% usa la etiqueta nutrimental para elegir sus alimentos; 49% no comprendía la NIP. Sólo 1.2% de los consumidores respondió correctamente las cinco preguntas de la prueba de comprensión del NIP. CONCLUSIONES: El uso y comprensión del NIP fue bajo, a pesar de la gran proporción que autorreportó leerlo y comprenderlo. La falta de conocimiento previo del lenguaje técnico dificulta el uso e interpretación de la información nutricional de NIP para las decisiones de compras de alimentos.

Opportunities to Strengthen Childhood Obesity Prevention in Two Mexican Health Care Settings.

BACKGROUND: The purpose of this study was to examine Mexican caregivers' perceptions of the role of primary care in childhood obesity management, understand the barriers and facilitators of behavior change, and identify opportunities to strengthen obesity prevention and treatment in clinical settings. METHODS: We conducted 52 in-depth interviews with parents and caregivers of overweight and obese children age 2-5 years in 4 Ministry of Health (public, low SES) and 4 Social Security Institute (insured, higher SES) primary care clinics in Mexico City and did systematic thematic analysis. RESULTS: In both health systems, caregivers acknowledged childhood overweight but not its adverse health consequences. Although the majority of parents had not received nutrition or physical activity recommendations from health providers, many were open to clinician guidance. Despite knowledge of healthful nutrition and physical activity, parents identified several barriers to change including child feeding occurring in the context of competing priorities (work schedules, spouses' food preferences), and cultural norms (heavy as healthy, food as nurturance) that take precedence over adherence to dietary guidelines. Physical activity, while viewed favorably, is not a structured part of most preschooler's routines as reported by parents. CONCLUSIONS: The likelihood of success for clinic-based obesity prevention among Mexican preschoolers will be higher by addressing contextual barriers such as cultural norms regarding children's weight and support of family members for behavior change. Similarities in caregivers' perceptions across 2 health systems highlight the possibility of developing comprehensive interventions for the population as a whole.

Obesity determinants in Mexican preschool children: parental perceptions and practices related to feeding and physical activity.

BACKGROUND AND AIMS: Obesity represents a major public health problem worldwide. In Mexico, overweight and obesity have increased dramatically, affecting 26% of school-aged children. The aim of this study was to explore perceptions and practices of key obesity determinants among parents of preschool children attending child care centers. METHODS: We conducted five focus groups with 38 parents from six Mexico City child care centers. Inquiry topics were 1) childhood obesity causes and consequences; 2) child feeding practices at the child care center and home; 3) healthful and unhealthful foods for young children; 4) significance of physical activity in childhood; and 5) physical activity-promoting factors and barriers. We analyzed these data using content analysis. RESULTS: We identified a number of barriers to healthful eating, including parental time constraints, permissive feeding styles, unhealthful food preparation practices, lack of knowledge about nutrition, food advertisement, and high availability of unhealthful foods in public places. Facilitators to healthful eating included recognition of childhood overweight prevention and consequences, and healthy food choices. Main barriers to childhood physical activity included influence of young family members to play video games, parental time constraints, street safety, low access to sports facilities, and insufficient communication with child care centers. CONCLUSIONS: Understanding parental views and perceptions of the main factors influencing preschoolers' weight-related behavior can inform home-based or environmental interventions that support healthful eating and regular physical activity.