Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study

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Abstract

Background

Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children’s school snacks.

Methods

Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n = 645 children from N = 99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks.

Results

On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR = 1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR = 3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased.

Conclusions

Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6330-8) contains supplementary material, which is available to authorized users.

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Most cited references 13

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A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight.

Kathryn Backholer, Alison Beauchamp, Kylie Ball … (2014)

We developed a theoretical framework to organize obesity prevention interventions by their likely impact on the socioeconomic gradient of weight. The degree to which an intervention involves individual agency versus structural change influences socioeconomic inequalities in weight. Agentic interventions, such as standalone social marketing, increase socioeconomic inequalities. Structural interventions, such as food procurement policies and restrictions on unhealthy foods in schools, show equal or greater benefit for lower socioeconomic groups. Many obesity prevention interventions belong to the agento-structural types of interventions, and account for the environment in which health behaviors occur, but they require a level of individual agency for behavioral change, including workplace design to encourage exercise and fiscal regulation of unhealthy foods or beverages. Obesity prevention interventions differ in their effectiveness across socioeconomic groups. Limiting further increases in socioeconomic inequalities in obesity requires implementation of structural interventions. Further empirical evaluation, especially of agento-structural type interventions, remains crucial.

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How Infants and Young Children Learn About Food: A Systematic Review

Manon Mura Paroche, Samantha Caton, Carolus M J L Vereijken … (2017)

Early childhood is a critical time for establishing food preferences and dietary habits. In order for appropriate advice to be available to parents and healthcare professionals it is essential for researchers to understand the ways in which children learn about foods. This review summarizes the literature relating to the role played by known developmental learning processes in the establishment of early eating behavior, food preferences and general knowledge about food, and identifies gaps in our knowledge that remain to be explored. A systematic literature search identified 48 papers exploring how young children learn about food from the start of complementary feeding to 36 months of age. The majority of the papers focus on evaluative components of children's learning about food, such as their food preferences, liking and acceptance. A smaller number of papers focus on other aspects of what and how children learn about food, such as a food's origins or appropriate eating contexts. The review identified papers relating to four developmental learning processes: (1) Familiarization to a food through repeated exposure to its taste, texture or appearance. This was found to be an effective technique for learning about foods, especially for children at the younger end of our age range. (2) Observational learning of food choice. Imitation of others' eating behavior was also found to play an important role in the first years of life. (3) Associative learning through flavor-nutrient and flavor-flavor learning (FFL). Although the subject of much investigation, conditioning techniques were not found to play a major role in shaping the food preferences of infants in the post-weaning and toddler periods. (4) Categorization of foods. The direct effects of the ability to categorize foods have been little studied in this age group. However, the literature suggests that what infants are willing to consume depends on their ability to recognize items on their plate as familiar exemplars of that food type.

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Banning all sugar-sweetened beverages in middle schools: reduction of in-school access and purchasing but not overall consumption.

Daniel R. Taber (2012)

To determine whether state policies that regulate beverages in schools are associated with reduced in-school access and purchase of sugar-sweetened beverages (SSBs) and reduced consumption of SSBs (in and out of school) among adolescents. Cross-sectional. Public schools in 40 states. Students sampled in fifth and eighth grades (spring 2004 and 2007, respectively). State policies that ban all SSBs and state policies that ban only soda for 2006-2007. In-school SSB access, in-school SSB purchasing behavior, and overall SSB consumption (in and out of school) in eighth grade. The proportions of eighth-grade students who reported in-school SSB access and purchasing were similar in states that banned only soda (66.6% and 28.9%, respectively) compared with states with no beverage policy (66.6% and 26.0%, respectively). In states that banned all SSBs, fewer students reported in-school SSB access (prevalence difference, -14.9; 95% CI, -23.6 to -6.1) or purchasing (-7.3; -11.0 to -3.5), adjusted for race/ethnicity, poverty status, locale, state obesity prevalence, and state clustering. Results were similar among students who reported access or purchasing SSBs in fifth grade compared with those who did not. Overall SSB consumption was not associated with state policy; in each policy category, approximately 85% of students reported consuming SSBs at least once in the past 7 days. Supplementary analyses indicated that overall consumption had only a modest association with in-school SSB access. State policies that ban all SSBs in middle schools appear to reduce in-school access and purchasing of SSBs but do not reduce overall consumption.

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Author and article information

Contributors

Carolina Pérez-Ferrer: carolina.perez@insp.mx

Tonatiuh Barrientos-Gutierrez: tbarrientos@insp.mx

Juan A. Rivera-Dommarco: jrivera@correo.insp.mx

Francisco Javier Prado-Galbarro: frjavipg@gmail.com

Alejandra Jiménez-Aguilar: aljimenez@insp.mx

Carmen Morales-Ruán: cmruan@insp.mx

Teresa Shamah-Levy:

ORCID: http://orcid.org/0000-0002-1357-720X

+52-777-1012916 , tshamah@insp.mx

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 27 December 2018

Publication date PMC-release: 27 December 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 1411

Affiliations

[1 ]ISNI 0000 0004 1773 4764, GRID grid.415771.1, Centro de Investigación en Salud Poblacional, , Instituto Nacional de Salud Pública, ; Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico

[2 ]ISNI 0000 0004 1773 4764, GRID grid.415771.1, Centro de Investigación en Evaluación y Encuestas, , Instituto Nacional de Salud Pública, ; Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico

[3 ]ISNI 0000 0004 1773 4764, GRID grid.415771.1, Dirección General, , Instituto Nacional de Salud Pública, ; Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico

Author information

Teresa Shamah-Levy http://orcid.org/0000-0002-1357-720X

Article

Publisher ID: 6330

DOI: 10.1186/s12889-018-6330-8

PMC ID: 6307217

PubMed ID: 30591040

SO-VID: e4146fae-1afb-43fd-8990-7ea2d6bc52fe

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 April 2018

Date accepted : 17 December 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100007500, Bloomberg Family Foundation;

Award ID: CINYS/1305

Award Recipient : Juan A. Rivera-Dommarco

Custom metadata

ScienceOpen disciplines: Public health

Keywords: schools,obesity,nutrient-based standards,policy,mexico

Data availability:

ScienceOpen disciplines: Public health

Keywords: schools, obesity, nutrient-based standards, policy, mexico

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Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study

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Abstract

Background

Methods

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Conclusions

Electronic supplementary material

Related collections

Chinese Journal of School Health

Most cited references 13

A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight.

How Infants and Young Children Learn About Food: A Systematic Review

Banning all sugar-sweetened beverages in middle schools: reduction of in-school access and purchasing but not overall consumption.

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Cited by 8

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