RESUMO
This article examines the policy change process that resulted in the current sugar-sweetened beverages taxes in Mexico and Chile, using the Kaleidoscope Model for Policy Change, a framework developed for nutrition and food policy change analysis. We used a qualitative study design, including 24 key informant (KI) interviews (16 researchers, 5 civil society representatives and 3 food/beverage industry representatives), encompassing global and in-country perspectives. The analysis shows concurrence with the Kaleidoscope Model, highlighting commonalities in the policy change process. These included the importance of focusing events and coalitions for agenda-setting. Both top-down executive leadership and bottom-up pressure from civil society coalitions were important for the policy adoption as were flexible framing of the tax, and taking advantage of windows of opportunity. In both countries, the tax resulted from national, revenue-seeking fiscal reforms and in sub-optimal tax rates, as a result of the industry influence. KIs also discussed emerging evaluation results, highlighting differences in interpretation concerning the magnitude of change from the tax, and shared potential modifications to the current policies. This analysis contributes to a greater understanding of the policy change process focused on obesity prevention, using an innovative theoretical framework developed specifically for food and nutrition policy.
Assuntos
Bebidas Adoçadas com Açúcar , Bebidas , Chile , Humanos , México , Política Nutricional , Obesidade/prevenção & controle , ImpostosRESUMO
Objective: To adapt and apply the Nutrition Environment Measures Survey for Restaurants (NEMS-R) to Hispanic Caribbean (HC) restaurants and examine associations between restaurant characteristics and nutrition environment measures. Methods: We adapted the NEMS-R for HC cuisines (Cuban, Puerto Rican, Dominican) and cardiovascular health-promoting factors, and applied the instrument (NEMS-HCR) to a random sample of HC restaurants in New York City (NYC) (N=89). Multivariable linear regression was used to assess independent associations between NEMS-HCR score and restaurant characteristics (cuisine, size, type [counter-style vs sit-down] and price). Results: None of the menus in the restaurants studied listed any main dishes as "healthy" or "light." More than half (52%) offered mostly (>75%) nonfried main dishes, and 76% offered at least one vegetarian option. The most common facilitator to healthy eating was offering reduced portion sizes (21%) and the most common barrier was having salt shakers on tables (40%). NEMS-HCR scores (100-point scale) ranged from 24.1-55.2 (mean=39.7). In multivariable analyses, scores were significantly related to cuisine (with Puerto Rican cuisine scoring lower than Cuban and Dominican cuisines), and size (with small [<22 seats] restaurants scoring lower than larger restaurants). We found a significant quadratic association with midpoint price, suggesting that scores increased with increasing price in the lowest price range, did not vary in the middle range, and decreased with increasing price in the highest range. Conclusions: Our application of the NEMS-R to HC restaurants in NYC revealed areas for potential future interventions to improve food offerings and environmental cues to encourage healthful choices.
Assuntos
Alimentos , Valor Nutritivo , Restaurantes/estatística & dados numéricos , Comércio/estatística & dados numéricos , Cuba/etnologia , Dieta Saudável , República Dominicana/etnologia , Alimentos/economia , Humanos , Cidade de Nova Iorque , Porto Rico/etnologiaRESUMO
To understand the process by which immigrants adopt dietary practices, this study offers a binational comparison of factors that predispose, enable, and reinforce healthful eating in the sending and receiving countries. Data are from two qualitative studies that examined barriers and facilitators to healthful eating in El Salvador (four focus groups, n = 28 adults) and in the US (30 in-depth interviews n = 15 mothers recently migrated from Central America). There was a strong emphasis on hygiene and vitamin-content of foods among participants in El Salvador. In both settings, participants perceived that their respective community food environments (schools, food stores) exposed their families to highly processed, unhealthful foods. In both settings, they described similar struggles to encourage their families to eat foods healthfully (traditional, home-made foods). These results underscore the importance of acknowledging the changing food environment in sending countries where people may already be exposed to processed foods.
Assuntos
Dieta Saudável/etnologia , Emigrantes e Imigrantes , Preferências Alimentares/etnologia , Hispânico ou Latino , Adolescente , América Central/etnologia , District of Columbia , Características da Família , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pesquisa QualitativaRESUMO
The study was conducted to understand fried-food (FF) consumption among Hispanic Caribbean (HC) communities in New York City. Data were collected through qualitative interviews with 23 adults self-identified as Cuban, Dominican, or Puerto Rican. Most informants considered FFs an important part of their traditional diet. Potential explanations included taste, cost, convenience, and the emotive values attached to FF. FF consumption was contextualized in local foodscapes. Results include strategies to diminish FF consumption and differences across HC groups and migratory generations. The relevance for future nutrition interventions addressing health disparities in this community is discussed.
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Culinária , Análise de Alimentos , Preferências Alimentares , Adulto , Cuba , República Dominicana , Feminino , Hispânico ou Latino , Humanos , Masculino , Cidade de Nova Iorque , Porto Rico , Paladar , Adulto JovemRESUMO
OBJECTIVE: Dietary guidelines are important education and policy tools to address local nutrition concerns. The current paper presents a comparative analysis of nutrition messages from three Spanish-speaking Caribbean countries (Cuba, Puerto Rico and Dominican Republic) to explore how these dietary guidelines address common public health nutrition concerns, contextualized in different changing food environments and food culture similarities. DESIGN: Qualitative, comparative analysis of current dietary guideline documents and key recommendations. RESULTS: Key recommendations were categorized into sixteen themes (two diet-based, ten food-based and four 'other'). Only the Cuban dietary guidelines included diet-based key recommendations. Of the ten food-based key recommendations, only four themes overlapped across the three dietary guidelines (the encouragement of fruits and vegetables, addressing protein sources and fat). Other overlaps were found between dietary guideline pairs, except between Cuba and Puerto Rico. Further analysis revealed differences in levels of specificity and acknowledgement of local dietary patterns and issues, as well as the need to revise the guidelines to account for current scientific advances. CONCLUSIONS: The present study underscored the importance of context in the framing of dietary advice and the influence of national socio-economic and political situations on nutrition policy and education efforts. The results contribute to inform efforts to improve nutrition communication in the region and among migrant communities.
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Dieta/etnologia , Etnicidade , Comportamento Alimentar/etnologia , Política Nutricional , Adolescente , Adulto , Criança , Pré-Escolar , Comparação Transcultural , Cuba , República Dominicana , Educação em Saúde , Humanos , Lactente , Porto Rico , Pesquisa Qualitativa , Fatores SocioeconômicosRESUMO
Antecedentes: la definición de la seguridad alimentaria y nutricional (SAN) incluye la importancia de la calidad nutricional de los alimentos además de la suficiencia. Sin embargo, aún existe un énfasis en el aspecto de la suficiencia, incluso en contextos con crecientes problemas relacionados con sobrealimentación. Objetivos: describir estrategias locales para el manejo de la alimentación en la escasez de recursos; documentar perspectivas sobre la SAN en comunidades vulnerables; evaluar enlaces conceptuales entre la SAN y la alimentación saludable en estas comunidades, y comparar las definiciones locales acerca de la SAN con la política nacional sobre la SAN. Materiales y métodos: investigación cualitativa utilizando grupos focales, entrevistas informales y observaciones no estructuradas, seguida por codificación y análisis. Resultados y conclusiones: los participantes definieron la SAN como ''asegurar'' los alimentos (disponibilidad e inocuidad, incluyendo modo de producción y procesamiento de alimentos). Hubo desacuerdo entre los participantes sobre la conexión entre la SAN y la alimentación saludable. Se encontraron áreas de concordancia y desacuerdo entre la percepción local sobre la SAN y la política nacional. Es necesario entender cómo las concepciones locales evolucionan dado cambios en los alimentos disponibles localmente y la capacidad adquisitiva de poblaciones vulnerables.
Background: the definition of food and nutrition security (FNS) includes the importance of the nutritional quality of foods other than sufficiency. However, there is still an emphasis on sufficiency, even in settings with increasing problems relating to overeating. Objectives: (1) describe local coping strategies in times of resource scarcity; (2) document perspectives related to FNS in vulnerable communities; (3) evaluate the conceptual links between FNS and healthy eating in these communities and (4) compare local FNS definitions to the national discourse found in the FNS national policy. Materials and methods: qualitative research using focus groups, informal interviews and unstructured observations, followed by analytic coding. Results and conclusions: participants defined FNS as ''securing'' the food (availability and food safety, including concerns over food production and processing methods). There was disagreement among the participants regarding the connection between FNS and healthy eating. Areas of agreement and disagreement between the local discourse on national politics and SAN were found. More information is needed on how local conceptions evolve in the light of changes in the types of food available and accessible locally for vulnerable populations.
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Humanos , América Central , Segurança Alimentar , Dieta , El Salvador , Dieta Saudável , Pobreza , Pesquisa QualitativaRESUMO
OBJECTIVE: To develop a household-level diet quality indicator (HDQI) using the Salvadorian dietary guidelines to assess the dietary quality of households in vulnerable communities in El Salvador. DESIGN: The Salvadorian dietary guidelines were reviewed and eighteen HDQI components were identified (nine foods and nine nutrients). The components were evaluated using a proportional scoring system from 0 to 1, penalizing over- and under-consumption, where appropriate. The HDQI was validated in consultations with experts in El Salvador and by statistical analyses of the study sample data. Dietary variety and energy, nutrient and food intakes were compared among households above and below the median HDQI score using Student's t test. SETTING: Vulnerable, border communities in El Salvador. SUBJECTS: Households (n 140) provided food consumption information using an FFQ and sociodemographic data. RESULTS: The mean HDQI score was 63·5, ranging from 43·6 to 90·0. The indicator showed a positive, significant association with the dietary variety components. The statistical associations of the indicator with the energy and nutrient components were as expected. CONCLUSIONS: Based on the indicator's demonstrated face validity and the results of the expert consultations, the indicator is suggested as a good measure of diet quality for households in El Salvador.
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Dieta/normas , Transição Epidemiológica , Estado Nutricional , Características de Residência , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , El Salvador/epidemiologia , Ingestão de Energia/fisiologia , Feminino , Abastecimento de Alimentos/normas , Humanos , Modelos Lineares , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Avaliação Nutricional , População Rural , Estações do Ano , Fatores Socioeconômicos , Inquéritos e Questionários , Populações Vulneráveis/psicologiaRESUMO
OBJECTIVE: This study aimed to examine the dietary intake of Salvadoran households according to perceived access to healthy meals (PAHD), and to identify household characteristics associated with diet quality and PAHD. METHODS: Secondary data analysis with a sample of 139 Salvadoran households from resource-poor communities in El Salvador. Chi-square tests and ANOVA were used to assess differences in dietary intake across households classified according to PAHD. RESULTS: High-PAHD households had higher women's education, household food security levels, overall diet quality, and variety, and higher intakes of animal products, fats, cholesterol, vitamin C, and sodium (P < .05). Diet quality was not associated with the household characteristics studied. CONCLUSIONS AND IMPLICATIONS: Overall diet quality was associated with higher levels of PAHD, but some differences in intakes were not as expected, such as higher intakes in foods and nutrients associated with low-quality diets, among high PAHD households.