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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.

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INTRODUCTION: Raising tobacco taxes is considered the most effective strategy to avoid smoking initiation and discourage its use, especially among vulnerable groups. However, few low- and middle-income countries have adopted high tobacco taxes. Raising taxes is, therefore, an opportunity to strengthen and accelerate tobacco control. The objective of this study is to analyze the barriers and facilitators to the tobacco tax increase in Mexico. AIMS AND METHODS: Based on the Governance Analytical Framework, data were generated through 17 in-depth interviews with key intersectoral actors for fiscal policy. The interviews were transcribed and coded according to Hufty's theory of governance. RESULTS: Robust scientific evidence, intersectoral coordination, and the presence of "champions" boosted progress in tobacco control (facilitators). The main barriers were the incomplete implementation of the World Health Organization-Framework Convention on Tobacco Control (WHO-FCTC) and MPOWER package and lack of commitment ("political will") by government decision makers and legislators, misinformation about the effects of tobacco taxes, and strong tobacco industry interference. CONCLUSIONS: Robust evidence is necessary but not sufficient to advance the implementation of the MPOWER (WHO-FCTC) actions. To achieve tobacco tax increases and public policies that protect people from unhealthy products in general, the implementation of policies or legal frameworks against industry interference in the development of public policies is imperative. IMPLICATIONS: By analyzing the barriers and facilitators to increasing the tobacco tax in Mexico, this study identifies two key messages: (1) The need to sensitize legislators and the general population to the problem of smoking not only through epidemiological data but also through testimonies that highlight the life experiences and adversities faced by people who smoke. (2) The need for a regulatory framework to prevent industry interference in public affairs and conflicts of interest. The same framework could be very useful for public health policies to control the consumption of ultra-processed food products or alcohol.

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A massive incorporation of ultra-processed products into young children's diets worldwide and in Mexico has been documented. The aim of this study is to understand the role of sociocultural factors in principal caregivers' decisions to give a type of ultra-processed food to children under age five, called 'comida chatarra' ('junk food' in English), usually includes sugar-sweetened beverages, sweet and salty snacks, and sweet breakfast cereals. We conducted a descriptive, observational qualitative study. The research was conducted in urban and rural communities in two Mexican states. Twenty-four principal caregivers were equally distributed between the two states and types of communities. They were interviewed in person. Phenomenology underpinned this study. Results highlight the preponderant role of culture in food choices and feeding practices with junk food. Local culture influences child-feeding with ultra-processed products through social norms, knowledge, or socially constructed attitudes. These social norms, built in the context of abundant ultra-processed products and omnipresent marketing, 'justify' children's consumption of junk food. They acquire these products from the principal caregivers, family members, and neighbors, among others, who reward and pamper them. These actors also define what amount (small amounts) and when (after meals as snacks) children are given these products. Cultural factors must be considered in the development of effective public policies and programs that aim to change the culture around ultra-processed products among children and avoid their consumption.

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This study explored the psychosocial determinants of consumption of soda and other taxed sugar-sweetened beverages (SSBs) in Mexican construction workers (CWs) and whether consumption changed as a result of the 2014 SSB tax. We conducted a qualitative case study involving in-depth interviews and focus groups (FGs) with 30 Mexican CWs; supplemented with descriptions of the food and beverages consumed during lunch breaks. We used NVivo 10 to classify information according to the analysis categories, primarily informed by the Reasoned Action Approach (RAA). CWs reported not having changed their consumption of soda and other taxed SSBs as a result of the SSB tax, despite the price increase and "knowing" the potential negative consequences of soda drinking. The most important determinants of soda consumption are a deep-seated social norm of soda drinking and use of soda drinking as part of their professional identity; their likeness for soda; a wide availability of soda in their environments; and a low perceived behavioral control (because they thought themselves as addicted to it). Participants indicated that the best way for them not to consume soda would be if it were not available. These findings lend support for the tight regulation of the availability of SSBs. To have a meaningful impact on these consumers, the SSB tax may need to be much higher. Policy-level interventions should be coupled with interventions at the individual and community levels that aim at denormalizing soda consumption, create new meanings in relation to water consumption, and develop behavioral control to decrease soda consumption.

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At the end of December 2019, SARS-COV-2 virus was identified as responsible for the COVID-19 pandemic. The rapid spread of transmission exposed structural failures of modern societies and of the health systems in preventing and containing a health threat. Scientific discussion has focused on the search for a vaccine, but less on understanding the social response to the current global threat and fear of outbreaks. In this essay, we reflect, based on the social sciences, on the importance of linking three concepts: vulnerability-perception-risk. This is necessary to develop preventive strategies appropriate to population circumstances, especially with the most vulnerable population, in favor of health equity.

A finales de diciembre 2019 se identificó el virus SARS-COV-2 como responsable de la pandemia de Covid-19. La rápida expansión de la transmisión puso al descubierto fallas estructurales de las sociedades modernas y de los sistemas de salud para prevenir y contener una amenaza sanitaria. La discusión científica se ha concentrado en la búsqueda de una vacuna, pero menos en comprender la respuesta social ante la amenaza globalizada actual y el temor a los rebrotes. En este ensayo reflexionamos, desde las ciencias sociales, sobre la importancia de vincular tres conceptos: vulnerabilidad-percepción-riesgo. Esto es necesario para desarrollar estrategias preventivas adecuadas a las circunstancias poblacionales, especialmente con la población más vulnerable, a favor de la equidad en salud.

No final de dezembro de 2019, o vírus SARS-COV-2 foi identificado como responsável pela pandemia de Covid-19. A rápida propagação da transmissão expôs falhas estruturais das sociedades modernas e dos sistemas de saúde na prevenção e contenção de uma ameaça sanitária. A discussão científica tem se concentrado na busca por uma vacina, mas menos na compreensão da resposta social à atual ameaça global e ao medo de novos surtos. Neste ensaio refletimos, a partir das ciências sociais, sobre a importância de associar três conceitos: vulnerabilidade-percepção-risco. Isso é necessário para desenvolver estratégias preventivas adequadas às circunstâncias da população, principalmente junto à população mais vulnerável, em prol da equidade na saúde.

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Resumen: Objetivo: Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos: Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados: Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones: Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

Abstract: Objective: To think about the emotional support that Mutual Aid Groups (MAG) offer up to indigenous people with diabetes and their importance in adherence to treatment. Materials and methods: Qualitative study: 25 semi-structured interviews; 3 focus groups (17 participants); and non-participant observation. Content analysis was carried out with the support of the Atlas-ti program. Results: We identified emotional expressions related to the disease. The opinion about MAGs and group work was positive. The MAG is a catharsis space, but it does not work as a support to face the restrictions of the treatment and the emotional impact in case of major complications. Conclusions: With proper training of the health personnel in charge of the groups, MAGs can become emotional support spaces for indigenous people and contribute to their well-being.

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BACKGROUND: A product package can be a powerful marketing tool to persuade and attract consumers at the point-of-sale. Evidence shows that most advertised products have low nutritional quality. Currently, Mexico has incorporated advertising regulations on food and beverage packaging. OBJECTIVES: To analyze the advertising strategies used to target children on packaging and to assess the nutritional quality of sugar-sweetened beverages available in the Mexican market. METHODS: Photographs of 2380 beverages available in retail stores in Mexico City from January to March 2017 were analyzed. Beverages were classified as displaying child-directed strategies or nondirected strategies. Nutrition quality was evaluated using the Pan American Health Organization nutrient profile model. RESULTS: The use of characters was the most frequent strategy among beverages with child-directed strategies (82.0%). The evaluation of nutrition quality found that 88.0% (P < .001) of sugar-sweetened beverages with child-directed strategies were excessive in free sugars and 56.9% (P < .001) contained other sweeteners. Beverages with more than two advertising strategies have the highest proportion of excessive free sugars (93.4%, 95% CI 82.8-98.6). CONCLUSIONS: The use of characters and other visual strategies were frequently used in the packaging of sugar-sweetened beverages with child-directed strategies. In addition, these beverages are excessive in free sugars and contain a large number of products with other sweeteners.

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RESUMEN A finales de diciembre 2019 se identificó el virus SARS-COV-2 como responsable de la pandemia de Covid-19. La rápida expansión de la transmisión puso al descubierto fallas estructurales de las sociedades modernas y de los sistemas de salud para prevenir y contener una amenaza sanitaria. La discusión científica se ha concentrado en la búsqueda de una vacuna, pero menos en comprender la respuesta social ante la amenaza globalizada actual y el temor a los rebrotes. En este ensayo reflexionamos, desde las ciencias sociales, sobre la importancia de vincular tres conceptos: vulnerabilidad-percepción-riesgo. Esto es necesario para desarrollar estrategias preventivas adecuadas a las circunstancias poblacionales, especialmente con la población más vulnerable, a favor de la equidad en salud.

RESUMO No final de dezembro de 2019, o vírus SARS-COV-2 foi identificado como responsável pela pandemia de Covid-19. A rápida propagação da transmissão expôs falhas estruturais das sociedades modernas e dos sistemas de saúde na prevenção e contenção de uma ameaça sanitária. A discussão científica tem se concentrado na busca por uma vacina, mas menos na compreensão da resposta social à atual ameaça global e ao medo de novos surtos. Neste ensaio refletimos, a partir das ciências sociais, sobre a importância de associar três conceitos: vulnerabilidade-percepção-risco. Isso é necessário para desenvolver estratégias preventivas adequadas às circunstâncias da população, principalmente junto à população mais vulnerável, em prol da equidade na saúde.

ABSTRACT At the end of December 2019, SARS-COV-2 virus was identified as responsible for the COVID-19 pandemic. The rapid spread of transmission exposed structural failures of modern societies and of the health systems in preventing and containing a health threat. Scientific discussion has focused on the search for a vaccine, but less on understanding the social response to the current global threat and fear of outbreaks. In this essay, we reflect, based on the social sciences, on the importance of linking three concepts: vulnerability-perception-risk. This is necessary to develop preventive strategies appropriate to population circumstances, especially with the most vulnerable population, in favor of health equity.

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(1) Background: Nutrient-poor, energy-dense food and beverage (F&B) advertisements influence children's food preferences, consumption, and purchase requests, contributing to overweight and obesity. Objective: To characterize the nutritional quality of F&B advertised by product placement (PP) in Mexican television programs with the highest audience ratings for children. (2) Methods: A total of 48 h of television programs between December 2016 and January 2017 during the hours with the highest ratings for children were analyzed. Nutritional quality was assessed through the Mexican Ministry of Health (MMH-NPM), the World Health Organization Regional Office for Europe (WHO-Europe), and the Pan American Health Organization nutrient profile models (PAHO-NPM). (3) Results: A total of 119 F&B were broadcast, of which more than 60% were unhealthy according to the three nutritional models. Reality shows and movies presented the most PP advertising. The food category most frequently advertised was sugar-sweetened beverages (41.2%). F&B advertised in children's programs had a higher content of energy, total fat, and saturated fat (p < 0.01). (4) Conclusion: The MMH-NPM was the most permissive and the PAHO-NPM was the strictest for evaluating nutritional quality. Mexico must strengthen the regulation of advertising to protect children from its negative effects on health.

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Objetivo. Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos. Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados. Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones. Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

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BACKGROUND: The impact of the Conditional Cash Transfer Program in Mexico was significant but smaller than expected. Several bottlenecks related to program design and implementation have been identified that may have limited its impact; population and other contextual factors may be equally important to analyze. OBJECTIVES: We aimed to explore how sociocultural context contributes to poor nutrition in Mexico and how it shaped the acceptability, fidelity, and penetration of the fortified food and of education sessions provided by the program. METHODS: We carried out qualitative research studies in the central and southern states in urban, rural, and indigenous settings between 2001 and 2014 with different informants and by using interviews, focus group discussions, and nonparticipatory observation. We explored 4 dimensions of the sociocultural context: objective dimension (e.g., food availability and family organization), social norms and symbolic meaning related to child feeding, literacy and communication with the biomedical culture, and knowledge related to child care generally and child feeding. We generated information about the experience of the beneficiaries with fortified food and education sessions. RESULTS: Several sociocultural factors, including patriarchal family organization, high availability of nonnutritious food, social norms promoting the consumption of food in liquid form for young children, sharing of food among family members, traditional knowledge, and communication barriers with the biomedical culture, participated in shaping the poor nutrition situation, the inadequate utilization of fortified foods, and the inappropriateness of the education sessions. CONCLUSIONS: Our studies revealed the importance of local context and culture to understand the acceptance, utilization, and impact of a nutrition program and shed light on infant and child feeding practices. This knowledge is critical to strengthen program designs and ensure adequacy with the diversity of cultural and social contexts in which programs are implemented.

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BACKGROUND: Despite positive nutrition impacts, the prevalence of malnutrition among beneficiaries of Mexico's conditional cash transfer (CCT) program remains high. Greater nutrition impact may have been constrained by the type of nutritional supplements provided. OBJECTIVE: The objective of this study was to inform a potential modification to the supplements distributed to pregnant and lactating women and children. METHODS: Impact was assessed using 2 cluster-randomized trials (pregnant women, children) run simultaneously. Communities (n = 54) were randomly assigned to the fortified foods provided by the program (Nutrivida women, Nutrisano children) or alternatives: tablets (women), syrup (children), or micronutrient powders for women (MNP-W) and children (MNP-C). Each supplement for women/children contained the same micronutrients based on the formulations of Nutrivida and Nutrisano, respectively. Pregnant women (aged >18 y) were recruited before 25 weeks of gestation and followed to 3 mo postpartum. Children aged 6-12 mo were recruited and followed to age 24 mo. Primary outcomes were anemia for women and length growth for children. Statistical analyses appropriate for cluster-randomized designs were used, and structural equation modeling to estimate dose-response effects. Supplement costs per beneficiary (daily dose for 18 mo) were estimated for production and distribution. RESULTS: There was no significant difference in change of anemia prevalence between supplement groups in women, or in length growth between groups in children. One daily dose of any supplement was associated with 0.8 cm greater length growth. From baseline to age 24 mo, the prevalence of anemia in the Nutrisano, syrup, and MNP-C groups decreased by 36.7, 40.8, and 37.9 percentage points, respectively (within-group, P < 0.05; between groups, P > 0.05). Costs per beneficiary ranged from $12.1 (MNP-C) to $94.8 (Nutrivida). CONCLUSIONS: The CCT program could distribute alternative supplements at lower cost per beneficiary without compromising potential for impact. Acceptance among beneficiaries should also be considered in choice of alternatives. This trial was registered at www.clinicaltrials.gov as NCT00531674.

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BACKGROUND: The Integrated Strategy for Attention to Nutrition (EsIAN in Spanish) is a national strategy within Mexico's conditional cash transfer program (initially Progresa, then Oportunidades, then Prospera, CCT-POP) designed to strengthen the health and nutrition component, address the nutrition transition, and improve the health and nutritional status of its beneficiaries, through 3 main components: 1) procurement of functioning equipment to primary health care (PHC) units; 2) providing free micronutrient supplements to beneficiary women and children; 3) implementing a behavior change communication (BCC) strategy and a training system for PHC providers (PHCPs). OBJECTIVE: We aim to describe the iterative process and evidence-based approach used to design and roll-out the EsIAN at scale, by focusing on the BCC component. METHODS: The BCC strategy was developed by following an iterative process through the following phases: situational analysis, formative research and design of the BCC strategy (using the socioecological framework and the social marketing approach), large-scale feasibility study, redesign, and national scale-up. RESULTS: The review and formative research revealed several barriers and issues that limited program coverage, utilization, and acceptance. These included misconceptions about pregnancy and infant feeding, nonalignment of practices with international recommendations, and lack of knowledge on nutrition and related topics, among others. These results were used to identify priority behaviors and elaborate key messages for mothers/caregivers and providers to develop the BCC strategy. The feasibility study resulted in significant improvements in PHCPs' knowledge, counseling (breastfeeding, and supplement use and consumption), and caregivers' complementary feeding behaviors, and highlighted several design and delivery aspects that needed strengthening. Based on these findings, the BCC strategy was adapted prior to a national scale-up. CONCLUSIONS: The theory-based iterative approach resulted in the identification of specific actions to target, and approaches to do so, as part of the design and roll-out of the BCC strategy at scale.

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OBJECTIVE: To understand non-adherence to medically recommended diets among Mayans with diabetes. DESIGN: Using partially sequential mixed methods, questionnaires, semi-structured brief and in-depth interviews were applied. Questionnaire data were analysed with Pearson's χ2 and Student's t tests and qualitative interviews with grounded theory microanalysis. SETTING: Rural, predominantly Mayan communities in Chiapas, Quintana Roo and Yucatan, Mexico, 2008-2012. PARTICIPANTS: Purposive sample of Mayans with type 2 diabetes; using public health care; 168 women and twenty-seven men; age 21-50+ years. RESULTS: Participants understood diabetes as caused by negative emotions, divine punishment, revenge via spells, chemicals in food and high sugar/fat consumption. Eliminating corn, pork, sugary beverages and inexpensive industrialized foods was perceived as difficult or impossible. More Mayans reporting not understanding physician instructions (30 v. 18 %) reported difficulty reducing red meat consumption (P = 0·051). Non-adherence was influenced by lack of patient-provider shared knowledge and medical recommendations misaligned with local culture. Men whose wives prepared their meals, women who liked vegetables and young adults whose mothers prepared their meals reported greater adherence to dietary recommendations. Partial adherents said it made life tolerable and those making no physician-recommended dietary changes considered them too restrictive (they meant 'starving to death'). Over half (57 %) of participants reported non-adherence; the two principal reasons were dislike of recommended foods (52·5 %) and high cost (26·2 %). CONCLUSIONS: Adherence to dietary regimens in diabetes treatment is largely related to social and cultural issues. Taking cultural diversity, food preferences, local food availability and poverty into consideration is essential when developing health-promotion activities related to diabetes.

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Obesity is a serious problem among children in Mexico. In 2010, the government implemented a national food and physical activity policy in elementary schools, to prevent obesity. The goal of this study is to assess the implementation of this policy, using the logic model from a descriptive survey with national representativeness at the elementary school level and based on a stratified cluster design. We used a systematic random sampling of schools (n = 122), stratified into public and private. We administered questionnaires to 116 principals, 165 members of the Food and Physical Activity Committees, 132 food school food vendors, 119 teachers, 348 parents. This study evidences a significant deviation in implementation from what had been planned. Our lessons learned are the importance to: base the design/implementation of the policy on a theoretical framework, make programs appealing to stakeholders, select concrete and measurable objective or goals, and support stakeholders during the implementation process.

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Excess weight in schoolchildren is a serious health problem in Mexico. In 2010, the government established General Guidelines for Dispensing or Distribution of Foods and Beverages at School Food Establishments (SFEs) in Elementary Schools with the objective of stopping the epidemic of overweight and obesity. This study aimed to evaluate compliance with the Guidelines during two academic years. With a sample of 39 schools already randomly selected, we carried out a follow-up study. The research team recorded foods and beverages available at schools in two academic years, and compared their nutritional characteristics to those established in the Guidelines. At the schools in both stages of the study, we found broad availability of energy-dense foods not allowed in the SFEs. Vegetables, fruits, and plain water accounted for less than 7 per cent of the foods and drinks. We observed no changes between stages in the compliance the Guidelines.

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INTRODUCTION: Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior. OBJECTIVE: Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico. METHODS: We performed a secondary analysis using the theory of planned behavior with cross-sectional data, which included semi-structured individual interviews with fathers (n 10), 8 focus groups with mothers (n 50), and 8 focus groups with women community leaders (n 44) with a total of 104 participants. Our data also included a quantitative survey among pregnant women and mothers (n 321). RESULTS: Women reported supplementing breast milk with water and teas soon after birth, as well as introducing small bites of solid food a few months after birth. Social norms appeared to support breastfeeding, but not exclusive breastfeeding or breastfeeding for periods longer than about a year. This may be partially explained by: a) behavioral beliefs that for the first 6 months breast milk alone is insufficient for the baby, and that water in addition to breast milk is necessary to hydrate an infant and b) normative beliefs related to the appropriateness of breastfeeding in public and as the child gets older. CONCLUSIONS: Future strategies should focus on positively influencing social norms to support recommended practices, and emphasize the specific reasons behind the recommendations. Future efforts should take a multi-pronged approach using a variety of influences, not only directed at healthcare providers but close family members, including fathers.

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OBJECTIVE: This study aimed to describe the ways social support works in the daily life of patients with type 2 diabetes living in conditions of social and economic marginality, in order to understand how that support relates to treatment compliance. METHODS: Sequential mixed methods research was used. The sample of patients was obtained from primary health care units and selected considering regional representativeness, and levels of morbidity and mortality for type 2 diabetes. RESULTS: Results point to the nuclear family as the main source of support. Regardless of the area of residence, four main dimensions of support were identified: economic support, help with treatment compliance, emotional support, and material aid. CONCLUSIONS: We conclude that the support network assists the patient in different ways and helps cope with the disease, but in conditions of social and economic marginality, does not guarantee the quality of attention nor enable the self-management of treatment.

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OBJECTIVE: To identify barriers and opportunities for the regulation of food and beverage advertising to children. MATERIALS AND METHODS: A qualitative study. Fourteen key informants from the congress, private sector, officials from the ministry of health and academics involved in the issue of regulation of advertising were interviewed. RESULTS: Barriers identified: conception of obesity as an individual problem, minimization of the negative effects on health, definition of the vulnerability of children bounded to their cognitive development. Facilitators support from various sectors of society regulation, extensive scientific discussion on the subject, successful experience and its lessons on tabacco industry. CONCLUSION: Mexico has key elements for achieving effective regulation on advertising.

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OBJECTIVE: This paper describes the methods and key findings of formative research conducted to design a school-based program for obesity prevention. MATERIALS AND METHODS: Formative research was based on the ecological model and the principles of social marketing. A mixed method approach was used. Qualitative (direct observation, indepth interviews, focus group discussions and photo-voice) and quantitative (closed ended surveys, checklists, anthropometry) methods were employed. RESULTS: Formative research key findings, including barriers by levels of the ecological model, were used for designing a program including environmental strategies to discourage the consumption of energy dense foods and sugar beverages. CONCLUSION: Formative research was fundamental to developing a context specific obesity prevention program in schools that seeks environment modification and behavior change.

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