Hacia el diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México

OBJETIVO

Describir el proceso de diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México. Material y métodos. Se conformó un equipo de trabajo entre especialistas en salud y la Secretaría de Educación Pública. Se establecieron las bases científicas de Vida Saludable, se seleccionaron y evaluaron materiales para Vida Saludable, y se revisaron contenidos vigentes de salud incluidos en otras asignaturas.

RESULTADOS

Alimentación, actividad física e higiene y limpieza fueron definidos como los tres ejes temáticos para Vida Saludable. Se aprobaron 3 de 228 insumos para usarse en Vida Saludable y 71.7% de los con-tenidos vigentes en educación básica sobre salud requieren ediciones.

CONCLUSIONES

Vida Saludable es un parteaguas hacia la alfabetización en materia de salud en educación básica en México, que se alinea con la agenda global para preservar la salud humana y planetaria.

Escudos sociales y balas mágicas para el control de la epidemia por Covid-19 en México

La pandemia por Covid-19 llegó a México en febrero de 2020. Las autoridades sanitarias promovieron medidas de prevención no farmacológicas para contrarrestar el avance de la epidemia y a finales del año se anunció la aplicación de las primeras vacunas. A nivel global y local, las vacunas marcaron un hito al erigirse como “balas mágicas”, sin em­bargo, enfrentaron diversas dificultades como la producción masiva, la logística de distribución, la efectividad, su aplicación escalonada que priorizó a grupos vulnerables, el rechazo y la baja percepción de riesgo por parte de algunos grupos de la población; por tanto, el énfasis sobre las medidas preventivas o “escudos sociales” se diluyó con el avance de la estrategia de vacunación. Este ensayo resalta la importancia de man­tener “los escudos sociales” como medidas fundamentales y complementarias a la aplicación de vacunas, puesto que, por sí solas, las “balas mágicas” presentan retos que podrían comprometer su eficacia.    

Design of an Online Initiative to Promote Water Consumption in Mexican Adolescents

Objectives

To describe the development of an initiative for water consumption in Mexican adolescents of public secondary schools.

Methods

Based on a diagnosis in adolescents 11 to 16 years from public secondary schools we developed an initiative following the Intervention Mapping protocol: (1) Logic model of the problem, (2) Logic model of change, (3) Program design, (4) Program production, (5) Program implementation plan, and (6) Evaluation plan. We established behavioral outcomes for the next levels: Intrapersonal (adolescents), Interpersonal (mothers and fathers), Organizational (principals and teachers) and Social (authorities of the respective Ministries of Education and Health). At Intrapersonal and Interpersonal levels, we based on the Health Belief Model and the Social Cognitive Theory. For Organizational and Social levels, we considered the Stage Theory of Organizational Change.

Results

We developed a comprehensive initiative with a gender perspective entitled EPCA (for its acronym in Spanish of Schools Promoting Water Consumption). It includes an online course for adolescents, which shows the benefits of water and the health risks of sugary drinks, it guides adolescents to identify their water requirement and gives them tips to achieve it. The course presents funny challenges and healthy advices in audiovisual materials. For principals, teachers, mothers, and fathers there are digital resources available on the Facebook page of the EPCA initiative, which aim to help adults guide adolescents to take the course online, in addition, the resources motivate them to consume water. For the implementation of the EPCA initiative we developed a manual and planned online workshops with authorities of the Ministries of Education and Health, principals, and parents. We developed a process and impact evaluation plan, in which we considered to make a randomized controlled trial.

Conclusions

The EPCA initiative is a multilevel online intervention that was developed in accordance with a systematic protocol grounded in theory and scientific evidence, which will be implemented in a pilot manner in a random sample of Mexican adolescents to evaluate their impact on water consumption.

Funding Sources

This study was financed by the United Nations Children's Fund, UNICEF-Mexico.

Consumo de agua, bebidas azucaradas y uso de bebederos en secundarias del Programa Nacional de Bebederos Escolares de la Ciudad de México

Objetivo. Describir prácticas de consumo de bebidas y uso de bebederos escolares en estudiantes de secundarias del Programa Nacional de Bebederos Escolares (PNBE). Material y métodos. Estudio transversal descriptivo, con enfoque mixto en secundarias públicas (turnos matutino y vespertino). Se indagó el consumo de agua y bebidas azucaradas, utilización de bebederos escolares y barreras-facilitadores para el consumo de agua. Resultados. Se entrevistaron 617 estudiantes (11 a 16 años); 51.5% fueron hombres. El consumo promedio de agua (568.9 ml; IC95%: 470.7-667.1) y bebidas azucaradas (143.4 ml; IC95%:124.0-162.7) fue similar entre hombres y mujeres. En el turno matutino las mujeres presentaron una menor probabilidad de hacer uso de los bebederos en comparación con los hombres (p=0.032). Hombres y mujeres desconfían del agua de los bebederos. Conclusiones. Se requieren acciones integrales para favorecer el consumo de agua y el uso de los bebederos en las secundarias del PNBE.

Perceptions on the General Guidelines for the Sale of Food and Beverages at an Elementary School in Mexico City

Objectives

To document the perceptions of an elementary school director in Mexico City concerning the implementation of guidelines for vendors of food and beverages in schools (the Guidelines).

Methods

We interviewed the director of an elementary school in order to document his perceptions of the Guidelines, his experience –including the day-to-day difficulties encountered– while implementing them, the actors involved in this process and the food and beverages sold at his school. Data analysis was performed through Atlas-ti ® software.

Results

The level of information reported by the director on the origins of the Guidelines was adequate. Among the causes he referenced for their introduction was the growing prevalence of obesity and diabetes, which he indicated warranted the regulation of food and beverage sales in schools. With regard to the foods and beverages permitted for sale, the information reported was only partial; he recognized that restricted foods were in fact being sold. Information on the Guidelines had been transmitted to him orally by the school district supervisor, and he was provided no list of permitted and prohibited foods and beverages. There were no documents or teaching materials available in the school which could be used for disseminating this information and for training the members of the school committee in charge of supervising the implementation of the Guidelines. To ensure compliance with the Guidelines, the director advised that a specific committee composed of parents and the school district supervisor was monitoring the quality, hygiene and nutritional value of the food. The director believed that prohibiting sugary drinks in schools had produced a substantial and positive change: students had reduced their consumption of soda with favorable health results. In addition, he affirmed that, owing to the implementation of the Guidelines, the students had access to nutritious and quality food.

Conclusions

Although the school director is a key actor for ensuring Guideline compliance, he lacks the necessary information for implementing the Guidelines correctly given a lack of teaching material and adequate training.

Funding Sources

National Institute of Public Health.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Feeding Guidance Methodology Aimed to Personnel Responsible of Food Management in a Mexican Nursery Program (P04-020-19)

Objectives

To enhance the knowledge of the personnel about correct feeding of girls and boys under six years old, that attend to a Mexican social program nurseries.

Methods

A methodology for feeding guidance (MFG) was pilot-tested and applied for personnel responsible of preschool children feeding from nurseries belonging to five different states from the country: Mexico City, Chihuahua, Jalisco, Morelos and Yucatán. MGF consisted in provide and replicate five thematic sessions with the same pedagogic structure which includes a video projection and conduction of individual as well as group activities aimed to information reinforcement and reflection. Sessions were given at three levels according to the personnel function in the nursery: 1) directors, supervisors and administrative personnel; 2) supervisors and responsible 3) responsible assistants and cooks. In order to evaluate the MGF efficacy knowledge questionnaires were applied before (pre-test) and after (post-test) the sessions.

Results

A total of 15 workshops with 328 participants were organized, a considerable increase was found in the mean and percentage of tests approved when comparing pre-test with posttest on every level of all the workshops, being the kitchen's personnel whom showed the greater rise in their knowledge. (25% more approved).

Conclusions

MGF is an adequate strategy for providing guidance to the personnel involved in the feeding of beneficiaries of Mexican nurseries social program.

Funding Sources

National System for the Integral Development of the Family.

Does the Mexican sugar-sweetened beverage tax have a signaling effect? ENSANUT 2016

OBJECTIVE

To evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs.

METHODS

Cross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20-59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs.

RESULTS

Compared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs.

CONCLUSIONS

Implementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills.

[Perception of body weight and of the probability of developing obesity in Mexican adults]

OBJECTIVE

To document the perception of body weight, the variables that are associated with a correct perception of it and with the perception about the probability of developing obesity at short-term in Mexican adult population.

MATERIALS AND METHODS

We used data from the Perception of obsesity, eating behavior and physical activity questionnaire (POCAA, by its Spanish acronym), as well as household and anthropometric measurements obtained at Ensanut MC during May and October of 2016.

RESULTS

More than 90% of the population tend to underestimate their weight; 32% of the population said that they would be very likely to develop obesity at short-term; more than 90% considered that suffering from obesity is very serious. Having a correct perception of body weight and being overweight or obese by BMI, were positively related to the perception of developing obesity at short-term.

CONCLUSIONS

It is very relevant that individuals, regardless of the state of their weight, have an accurate perception of their body and the consequences to their health.

Conocimiento y nivel de comprensión de la campaña Chécate, Mídete, Muévete en adultos mexicanos

 Objetivo. Evaluar el conocimiento, nivel de comprensión y características asociadas con la población adulta mexicana en relación con la campaña Chécate, Mídete, Muévete. Material y métodos. A partir de la Encuesta Nacional de Salud y Nutrición de Medio Camino 2016, se obtuvo información sobre el conocimiento y comprensión del logotipo y men­sajes que apoyan la campaña Chécate, Mídete, Muévete. Para identificar las características asociadas, se probaron modelos de regresión logística y lineal para presentar los contrastes de efectos por variable. Resultados. El 11% de los adultos conoce la campaña; 31% tuvo una alta comprensión y 1% no la comprendió en absoluto. Sexo, escolaridad, servicio de salud y sobrepeso u obesidad se asocian con el conocimiento de la campaña; para la comprensión, las características asociadas fueron edad, escolaridad y nivel socioeconómico. Conclu­sión. Estos resultados contribuyen a retroalimentar uno de los esfuerzos por controlar la epidemia de sobrepeso, obesidad y diabetes en México

Implementación de un modelo de capacitación multimedial para brindar orientación alimentaria a los beneficiarios de un programa de ayuda social en México

Introducción:

Se implementó un modelo de capacitación en orientación alimentaria para la población beneficiaria y el personal operativo del Programa de Abasto Rural (PAR) de Diconsa, el cual es una iniciativa social de ayuda alimentaria que abastece productos básicos y complementarios, además de brindar capacitación en localidades de alta marginación en México.

Objetivo:

Documentar la utilización de la Metodología de Capacitación Multimedial (MCM) en el desarrollo de un esquema de capacitación sobre orientación alimentaria y su implementación en la población beneficiaria del PAR, a través de la propia estructura operativa del PAR.

Metodología:

El modelo se fundamenta en la MCM, integrada por cuatro elementos didácticos e indivisibles que conforman el paquete pedagógico multimedial (PPM), compuesto a su vez por tres videos y rotafolios, material impreso, prácticas y las relaciones interpersonales. Los ejes temáticos fueron: alimentación correcta para una vida saludable, alimentación materno-infantil, elecciones saludables y gasto familiar. El modelo fue replicado en cascada en los tres niveles operativos del PAR (responsables de capacitación, supervisores operativos y beneficiarios del PAR), con un componente de multiplicación horizontal, e implementado como piloto en cuatro estados de México.

Resultados:

Se observó un cambio positivo sobre los conocimientos en alimentación correcta en todos los niveles de capacitación, principalmente en los beneficiarios del PAR. La evaluación del proceso mostró conocimientos previos de los responsables de capacitación en los temas, buen desempeño como facilitadores, y habilidades de presentación y manejo del grupo de los supervisores operativos. A partir de las evaluaciones y del acompañamiento en la prueba piloto, fueron modificados las actividades, las estrategias y los materiales educativos del PPM.

Conclusiones:

La capacitación multimedial y la educación nutricional promueven procesos de cambio y desarrollo comunitario, posibles a través de la toma de conciencia y la puesta en práctica de acciones que favorecen la salud.

[Effect of an intervention based on child-care centers to reduce risk behaviors for obesity in preschool children]

BACKGROUND

Preschool age is a critical stage for health promotion and prevention of obesity, which is an emerging public health problem in children. The aim of this study was to design and evaluate the effect of a multifaceted intervention based on child-care centers to reduce risk behaviors for obesity among preschool children.

METHODS

A 12-month cluster-randomized community trial was conducted in 16 Mexican Institute of Social Security child-care centers in Mexico City. Children between 2 and 4 years of age enrolled in the selected child-care centers participated in the study. Intervention comprised 12 weekly curriculum sessions for the children, and six family workshops. Changes in children's dietary and physical activity, food availability at home, and maternal feeding styles were determined after 6 and 12 months. Changes within groups among stages, and between groups by stage were analyzed through χ² test.

RESULTS

The intervention showed decrease of home availability for some non-recommended foods and increase in physical activity in the intervention group compared to the usual care group.

CONCLUSIONS

Improvement in physical activity can be effective in the long term; innovative strategies aimed to modify family dietary risk behaviors are required.

Development of an educational intervention to promote healthy eating and physical activity in Mexican school-age children

Mexico has the highest and most alarming rates of childhood obesity worldwide. A study conducted in the State of Mexico revealed that one of every three children presents overweight or obesity. The objective of this paper is to provide a step-by-step description of the design and implementation of an educational intervention to promote healthy eating and physical activity called "Healthy Recess". The educational intervention was designed using the six stages of the Health Communication Process. This methodological model allowed identifying the needs of school-age children on information and participation in activities. In order to improve the strategy, adjustments were made to the print and audiovisual materials as well as to assessment tools. Typography was modified as well as the color of the images in student's workbook and facilitator's; special effects of the videos were increased; the narration of the radio spots was improved and common words and phrases were included. The Health Communication Process is an effective tool for program planners to design interventions aimed at managing prevalent health problems such as overweight and obesity in school-age children.