Abstract

Efforts are needed to improve U.S. children's poor diet quality. Our purpose was to examine whether a policy that restricts the availability of snack foods in the schools is associated with greater fruit and vegetable consumption in a nationally representative sample of 5th grade children. Children in schools with restricted snack availability had significantly higher frequency of fruit and vegetable consumption than children in schools without restricted snack availability. Our findings suggest that a restrictive snack policy should be part of a multi-faceted approach to improve children's diet quality.

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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.

Interest in household food insecurity (FI) within scientific and policy groups has motivated efforts to develop methods for measuring it. Questionnaires asking about FI experiences have been shown to be valid in the contexts in which they were created. The issue has arisen as to whether such questionnaires need be developed from the ground up or if a generic questionnaire can be adapted to a particular context. This study aimed to gain an in-depth understanding of household FI in urban Costa Rica, develop and validate a questionnaire for its measurement, and inform the choice between the 2 methods of development. The study was conducting using qualitative and quantitative methods provided in the Food and Nutrition Technical Assistance (FANTA) guidelines. In-depth interviews were conducted with 49 low-middle-income urban women using a semistructured interview guide. A 14-item FI questionnaire was developed based on results from these interviews. A field study was conducted in 213 households. The results show that the developed questionnaire provides valid measurement of household FI in urban Costa Rica and is simple and quick to apply in the household setting. FANTA developed a guide during the period that this research was completed that provides a generic questionnaire that can be adapted for use in various countries, rather than building the questionnaire from the ground up. This study provides evidence that careful attention to the procedures in this guide will likely yield a questionnaire suitable for assessing household FI in middle-income countries.