Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America.

Objective: To understand the sexual and reproductive health (SRH) experiences of migrant women and girls of reproductive age (15-49 years) from the Northern Triangle of Central America (El Salvador, Guatemala and Honduras) during their journey to the United States. Methods: A descriptive, qualitative research design included 39 in-depth interviews with migrant women and unaccompanied migrant girls from El Salvador, Guatemala and Honduras from January to June 2022. Participants were recruited using purposive sampling. Interviews were transcribed, coded and analyzed using thematic analysis. Results: Migrant women and girls lack information and resources to manage their SRH during migration. The SRH of those traveling with smugglers is compromised due to their limited access to menstrual pads, water and sanitation services; the risks of transactional sex and sexual violence; the high risk of sexually transmitted infections; the inability to report sexual violence; the lack of access to SRH and prenatal services; and limited knowledge about their sexual and reproductive rights. Conclusions: There is a significant need for improved interventions during the predeparture phase of migration to inform migrant women and girls about the SRH risks they may encounter and to provide information and resources to support their SRH throughout their journey. Special attention should be directed towards trying to reach girls and women who will travel with smugglers.

Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America

[ABSTRACT]. Objective. To understand the sexual and reproductive health (SRH) experiences of migrant women and girls of reproductive age (15–49 years) from the Northern Triangle of Central America (El Salvador, Guatemala and Honduras) during their journey to the United States. Methods. A descriptive, qualitative research design included 39 in-depth interviews with migrant women and unac- companied migrant girls from El Salvador, Guatemala and Honduras from January to June 2022. Participants were recruited using purposive sampling. Interviews were transcribed, coded and analyzed using thematic analysis. Results. Migrant women and girls lack information and resources to manage their SRH during migration. The SRH of those traveling with smugglers is compromised due to their limited access to menstrual pads, water and sanitation services; the risks of transactional sex and sexual violence; the high risk of sexually transmitted infections; the inability to report sexual violence; the lack of access to SRH and prenatal services; and limited knowledge about their sexual and reproductive rights. Conclusions. There is a significant need for improved interventions during the predeparture phase of migra- tion to inform migrant women and girls about the SRH risks they may encounter and to provide information and resources to support their SRH throughout their journey. Special attention should be directed towards trying to reach girls and women who will travel with smugglers.

[RESUMEN]. Objetivo. Conocer las experiencias relacionadas con la salud sexual y reproductiva (SSR) de mujeres y niñas migrantes en edad reproductiva (15-49 años) del Triángulo Norte de América Central (El Salvador, Guatemala y Honduras) durante su viaje hacia Estados Unidos. Métodos. Se llevó a cabo una investigación descriptiva y cualitativa que incluyó 39 entrevistas en profundidad a mujeres y niñas no acompañadas migrantes de El Salvador, Guatemala y Honduras, entre enero y junio de 2022. El reclutamiento de las participantes se llevó a cabo mediante un muestreo intencional. Las entrevistas fueron transcritas, codificadas y analizadas mediante análisis temático. Resultados. Las mujeres y niñas migrantes carecen de información y recursos para cuidar su SSR durante la migración. La SSR de las personas que viajan con traficantes de personas se ve afectada por un acceso limitado a toallas menstruales, agua y servicios sanitarios; los riesgos del sexo transaccional y la violencia sexual; el alto riesgo de infecciones de transmisión sexual; la imposibilidad de denunciar la violencia sexual; la falta de acceso a servicios de SSR y prenatales; y el conocimiento limitado sobre sus derechos sexuales y reproductivos. Conclusiones. Existe una necesidad significativa de mejorar las intervenciones durante la fase previa a la migración para informar a las mujeres y niñas migrantes sobre los riesgos relacionados con la SSR que pueden encontrar y proporcionar información y recursos para apoyar su SSR a lo largo de su viaje. Debe prestarse especial atención a intentar llegar a las niñas y mujeres que viajarán con traficantes de personas.

[RESUMO]. Objetivo. Conhecer as experiências de saúde sexual e reprodutiva (SSR) de mulheres e meninas migrantes na idade reprodutiva (15-49 anos) do Triângulo Norte da América Central (El Salvador, Guatemala e Hondu- ras) durante sua viagem aos Estados Unidos. Método. Foi realizada uma pesquisa descritiva e qualitativa que incluiu 39 entrevistas em profundidade com mulheres e meninas não acompanhadas migrantes de El Salvador, Guatemala e Honduras, entre janeiro e junho de 2022. As entrevistas foram transcritas, codificadas e analisadas mediante análise temática. Resultados. As mulheres e meninas migrantes carecem de informações e recursos para cuidar seu SSR durante a migração. La SSR das pessoas que viajam com traficantes de pessoas é afetada pelo acesso lim- itado a absorventes menstruais, água e serviços sanitários; os riscos de sexo transacional e violência sexual; o alto risco de infecções de transmissão sexual; a impossibilidade de denunciar a violência sexual; a falta de acesso a serviços de SSR e pré-natais; e o conhecimento limitado sobre seus direitos sexuais e reprodutivos. Conclusões. Há uma necessidade significativa de melhorar as intervenções durante a fase anterior à migração para informar as mulheres e meninas migrantes sobre os riscos de SSR que podem encontrar e for- necer informações e recursos para apoiar seu SSR ao longo de sua viagem. Deve ser dada atenção especial para tentar chegar as meninas e mulheres que viajarão com traficantes de pessoas.

Sexual and reproductive health of migrant women and girls from the Northern Triangle of Central America / Salud sexual y reproductiva de las mujeres y niñas migrantes del Triángulo Norte de América Central / Saúde sexual e reprodutiva de mulheres e meninas migrantes do Triângulo Norte da América Central

ABSTRACT Objective. To understand the sexual and reproductive health (SRH) experiences of migrant women and girls of reproductive age (15-49 years) from the Northern Triangle of Central America (El Salvador, Guatemala and Honduras) during their journey to the United States. Methods. A descriptive, qualitative research design included 39 in-depth interviews with migrant women and unaccompanied migrant girls from El Salvador, Guatemala and Honduras from January to June 2022. Participants were recruited using purposive sampling. Interviews were transcribed, coded and analyzed using thematic analysis. Results. Migrant women and girls lack information and resources to manage their SRH during migration. The SRH of those traveling with smugglers is compromised due to their limited access to menstrual pads, water and sanitation services; the risks of transactional sex and sexual violence; the high risk of sexually transmitted infections; the inability to report sexual violence; the lack of access to SRH and prenatal services; and limited knowledge about their sexual and reproductive rights. Conclusions. There is a significant need for improved interventions during the predeparture phase of migration to inform migrant women and girls about the SRH risks they may encounter and to provide information and resources to support their SRH throughout their journey. Special attention should be directed towards trying to reach girls and women who will travel with smugglers.

RESUMEN Objetivo. Conocer las experiencias relacionadas con la salud sexual y reproductiva (SSR) de mujeres y niñas migrantes en edad reproductiva (15-49 años) del Triángulo Norte de América Central (El Salvador, Guatemala y Honduras) durante su viaje hacia Estados Unidos. Métodos. Se llevó a cabo una investigación descriptiva y cualitativa que incluyó 39 entrevistas en profundidad a mujeres y niñas no acompañadas migrantes de El Salvador, Guatemala y Honduras, entre enero y junio de 2022. El reclutamiento de las participantes se llevó a cabo mediante un muestreo intencional. Las entrevistas fueron transcritas, codificadas y analizadas mediante análisis temático. Resultados. Las mujeres y niñas migrantes carecen de información y recursos para cuidar su SSR durante la migración. La SSR de las personas que viajan con traficantes de personas se ve afectada por un acceso limitado a toallas menstruales, agua y servicios sanitarios; los riesgos del sexo transaccional y la violencia sexual; el alto riesgo de infecciones de transmisión sexual; la imposibilidad de denunciar la violencia sexual; la falta de acceso a servicios de SSR y prenatales; y el conocimiento limitado sobre sus derechos sexuales y reproductivos. Conclusiones. Existe una necesidad significativa de mejorar las intervenciones durante la fase previa a la migración para informar a las mujeres y niñas migrantes sobre los riesgos relacionados con la SSR que pueden encontrar y proporcionar información y recursos para apoyar su SSR a lo largo de su viaje. Debe prestarse especial atención a intentar llegar a las niñas y mujeres que viajarán con traficantes de personas.

RESUMO Objetivo. Conhecer as experiências de saúde sexual e reprodutiva (SSR) de mulheres e meninas migrantes na idade reprodutiva (15-49 anos) do Triângulo Norte da América Central (El Salvador, Guatemala e Honduras) durante sua viagem aos Estados Unidos. Método. Foi realizada uma pesquisa descritiva e qualitativa que incluiu 39 entrevistas em profundidade com mulheres e meninas não acompanhadas migrantes de El Salvador, Guatemala e Honduras, entre janeiro e junho de 2022. As entrevistas foram transcritas, codificadas e analisadas mediante análise temática. Resultados. As mulheres e meninas migrantes carecem de informações e recursos para cuidar seu SSR durante a migração. La SSR das pessoas que viajam com traficantes de pessoas é afetada pelo acesso limitado a absorventes menstruais, água e serviços sanitários; os riscos de sexo transacional e violência sexual; o alto risco de infecções de transmissão sexual; a impossibilidade de denunciar a violência sexual; a falta de acesso a serviços de SSR e pré-natais; e o conhecimento limitado sobre seus direitos sexuais e reprodutivos. Conclusões. Há uma necessidade significativa de melhorar as intervenções durante a fase anterior à migração para informar as mulheres e meninas migrantes sobre os riscos de SSR que podem encontrar e fornecer informações e recursos para apoiar seu SSR ao longo de sua viagem. Deve ser dada atenção especial para tentar chegar as meninas e mulheres que viajarão com traficantes de pessoas.

Interpersonal violence victimisation, HIV-related behaviours and STIs among adult, urban Indigenous and non-Indigenous gay, bisexual and other men who have sex with men in Guatemala.

Gay, bisexual and other men who have sex with men are disproportionately affected by HIV in Guatemala; interpersonal violence may increase behaviours that augment the risk of HIV in this group. Although 44% of Guatemalans identify as Indigenous, little information exists on the experiences of Indigenous sexual minority individuals. In this study, we sought to compare different forms of violence and HIV-related behaviours by Indigenous identity among gay, bisexual and other men who have sex with men; and determine if associations between violence and HIV-related behaviours differed by Indigenous identity. We used cross-sectional survey data from 716 Spanish-speaking, adult men recruited from urban centres to examine the prevalence of and relationship between different forms of interpersonal violence and HIV-related behaviours using logistic regression analyses, including the moderating effect of Indigenous identity. In general, fewer Indigenous participants reported interpersonal violence victimisation and HIV-related behaviours compared to their non-Indigenous counterparts. In weighted multivariable analyses, non-Indigenous participants who reported physical and/or sexual violence were over five times as likely to report transactional sex (OR = 5.17, 95% CI 2.11-12.68, p < 0.001), but the relationship was not significant for Indigenous participants. Findings suggest that Indigenous sexual minority men have unique contexts and that additional strengths-based research is needed to ensure that actions and efforts to promote violence and HIV prevention meet their needs.

Women's circles as a culturally safe psychosocial intervention in Guatemalan indigenous communities: a community-led pilot randomised trial.

BACKGROUND: Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women's Circles) in a population with significant need but no access to mental health services. METHODS: A parallel group pilot randomised study was undertaken in five rural Mam and three periurban K'iche' communities. Participants included 84 women (12 per community, in seven of the communities) randomly allocated to intervention and 71 to control groups; all were pregnant and/or within 2 years postpartum. The intervention consisted of 10 sessions co-designed with and facilitated by 16 circle leaders. Main outcome measures were: maternal psychosocial distress (HSCL-25), wellbeing (MHC-SF), self-efficacy and engagement in early infant stimulation activities. In-depth interviews also assessed acceptability and feasibility. RESULTS: The intervention proved feasible and well accepted by circle leaders and participating women. 1-month post-intervention, wellbeing scores (p-value 0.008) and self-care self-efficacy (0.049) scores were higher among intervention compared to control women. Those women who attended more sessions had higher wellbeing (0.007), self-care and infant-care self-efficacy (0.014 and 0.043, respectively), and early infant stimulation (0.019) scores. CONCLUSIONS: The pilot demonstrated acceptability, feasibility and potential efficacy to justify a future definitive randomised controlled trial. Co-designed women's groups provide a safe space where indigenous women can collectively improve their functioning and wellbeing. TRIAL REGISTRATION: ISRCTN13964819 . Registered 26 June 2018, retrospectively registered.

Healthy casetas: A potential strategy to improve the food environment in low-income schools to reduce obesity in children in Guatemala City.

Developing countries have undergone transitions driven by globalization and development, accelerating increases in prevalence of overweight and obesity among children. Schools have been identified as effective settings for interventions that target children's dietary behaviors. In Guatemala, public schools commonly have food kiosks (Casetas) that sell products to children. From July through October 2013, observations during recess, in-depth interviews with school principals (n = 4) and caseta vendors (n = 4), and focus groups with children (n = 48) were conducted. This article explores products available to children at casetas. Factors that affect what casetas offer include regulations and enforcement, vendor investment and earnings, vendor resources, product demand, pricing, and children's preferences. These factors influence the products that are available and children's tendency to purchase them. Potential strategies for improvement include healthy food preparation, price manipulation and promotions, raffles and games to encourage healthier choices, and policy to push toward development of healthier products.

Guatemalan school food environment: impact on schoolchildren's risk of both undernutrition and overweight/obesity.

Guatemala suffers the double burden of malnutrition with high rates of stunting alongside increasing childhood overweight/obesity. This study examines the school food environment (SFE) at low-income Guatemalan elementary schools and discusses its potential impact on undernutrition and overweight/obesity. From July through October 2013, direct observations, in-depth interviews with school principals (n = 4) and food kiosk vendors (n = 4, 2 interviews each) and also focus groups (FGs) with children (n = 48, 8 FGs) were conducted. The SFE comprises food from school food kiosks (casetas); food from home or purchased in the street; and food provided by the school (refacción). School casetas, street vendors and children's parents largely provide sandwiches, calorie-rich snacks and sugar-sweetened beverages. Refacción typically serves energy dense atol, a traditional beverage. The current school food program (refacción), the overall SFE and the roles/opinions of vendors and principals reveal persistent anxiety concerning undernutrition and insufficient concern for overweight/obesity. Predominant concern for elementary schoolchildren remains focused on undernutrition. However, by the time children reach elementary school (ages 6-12+), food environments should encourage dietary behaviors to prevent childhood overweight/obesity.

Effectiveness of an mHealth intervention to improve the cardiometabolic profile of people with prehypertension in low-resource urban settings in Latin America: a randomised controlled trial.

BACKGROUND: Poor diet and physical inactivity strongly affect the growing epidemic of cardiovascular disease worldwide. Mobile phone-based health interventions (mHealth) have been shown to help promote weight loss and increase physical activity and are an attractive approach for health-care systems with limited resources. We aimed to assess whether mHealth with advice for lifestyle improvements would reduce blood pressure, promote weight loss, and improve diet quality and physical activity in individuals with prehypertension living in low-resource urban settings in Latin America. METHODS: In this parallel-group, randomised controlled trial, we recruited individuals (aged 30-60 years) with systolic blood pressure between 120 and 139 mm Hg, diastolic blood pressure between 80 and 89 mm Hg, or both from health-care centres, workplaces, and community centres in low-resource urban settings in Argentina, Guatemala, and Peru. Participants were randomly assigned to receive either monthly motivational counselling calls and weekly personalised text messages to their mobile phones about diet quality and physical activity for 12 months, or usual care. Randomisation was stratified by country, and we applied minimisation by sex and age groups. Study personnel collecting and analysing data were masked to group assignment. The primary outcomes were mean between-group differences in the changes in systolic and diastolic blood pressure from baseline to 12 months in an intention-to-treat analysis of all participants who completed assessments at 12 months. Secondary outcome measures were changes in bodyweight, waist circumference, and self-reported target behaviours from baseline to 12 months. The trial is registered with ClinicalTrials.gov, number NCT01295216. FINDINGS: Between March 1, 2012, and Nov 30, 2012, we randomly assigned 637 participants to receive intervention (n=316) or usual care (n=321). 266 (84%) participants in the intervention group and 287 (89%) in the control group were assessed at 12 months. The intervention did not affect change in systolic blood pressure (mean net change -0·37 mm Hg [95% CI -2·15 to 1·40]; p=0·43) or diastolic blood pressure (0·01 mm Hg [-1·29 to 1·32]; p=0·99) compared with usual care. However, we noted a significant net reduction in bodyweight (-0·66 kg [-1·24 to -0·07]; p=0·04) and intake of high-fat and high-sugar foods (-0·75 [-1·30 to -0·20]; p=0·008) in the intervention group compared with the control group. In a prespecified subanalysis, we found that participants in the intervention group who received more than 75% of the calls (nine or more, from a maximum of 12) had a greater reduction of bodyweight (-4·85 [-8·21 to -1·48]) and waist circumference (-3·31 [-5·95 to -0·67]) than participants in the control group. Additionally, participants in the intervention group had an increase in the intake of fruits and vegetables and a decrease in diets high in sodium, fat, and simple sugars relative to participants in the control group. However, we found no changes in systolic blood pressure, diasatolic blood pressure, or physical activity in the group of participants who received more than 75% of the calls compared with the group who received less than 50% of the calls. INTERPRETATION: Our mHealth-based intervention did not result in a change in blood pressure that differed from usual care, but was associated with a small reduction in bodyweight and an improvement in some dietary habits. We noted a dose-response effect, which signals potential opportunities for larger effects from similar interventions in low-resource settings. More research is needed on mHealth, particularly among people who are poor and disproportionally affected by the cardiovascular disease epidemic and who need effective and affordable interventions to help bridge the equity gap in the management of cardiometabolic risk factors. FUNDING: National Heart, Lung, and Blood Institute (US National Institutes of Health) and the Medtronic Foundation.

[Acceptability of a mobile health based intervention to modify lifestyles in prehypertensive patients in Argentina, Guatemala and Peru: a pilot study]. / Aceptabilidad de una intervención basada en Salud Móvil para modificar estilos de vida en prehipertensos de Argentina, Guatemala y Perú: un estudio piloto.

OBJECTIVES: To evaluate the acceptability and feasibility of an intervention based on mobile health, for the adoption of healthy lifestyles in prehypertensive people living in low-income urban areas in Argentina, Guatemala and Peru. MATERIALS AND METHODS: Prehypertensive people aged 30-60 years were recruited for a pilot study. The intervention included two counseling calls made by a nutritionist followed by a weekly customized text message. An internet-based platform offered support for the implementation of the intervention. Using semi-structured interviews, we evaluated the reach and acceptability of the intervention in the participants and ease of use for the nutritionists. RESULTS: It was possible to contact 43 of the 45 participants (95%). The average number of calls to contact a subject was two, with a range of 1-9 calls. Two participants could not be reached on their cell phone; five did not receive complete exposure to the intervention. Based on semi-structured interviews, the results showed good acceptability for the intervention by the participants. Nutritionists perceived the platform as friendly and easy to use. Barriers to deliver this intervention were related to difficulties in obtaining an adequate cellular signal. CONCLUSIONS: Given the high penetration of mobile phones in developing countries, it is concluded that it is feasible and acceptable to offer a mobile health based intervention oriented towards lifestyle modification in people with prehypertension or high risk of chronic disease intervention.

Aceptabilidad de una intervención basada en salud móvil para modificar estilos de vida en prehipertensos en Argentina, Guatemala y Perú: un estudio piloto / Acceptability of a mobile health based intervention to modify lifestyles in prehypertensive patients in Argentina, Guatemala, and Peru: a pilot study

Objetivos. Evaluar la aceptabilidad y factibilidad de una intervención basada en salud móvil, para la adopción de estilos de vida saludables en personas prehipertensas que viven en zonas urbanas de bajos recursos en Argentina, Guatemala y Perú. Materiales y métodos. Se reclutaron prehipertensos entre 30 a 60 años para un estudio piloto. La intervención incluyó dos llamadas de consejería realizadas por una nutricionista, seguidas de un mensaje de texto customizado semanal. Una plataforma basada en Internet ofreció el soporte para la implementación de la intervención. Utilizando entrevistas semiestructuradas se evaluó el alcance y la aceptabilidad de esta intervención en los participantes, y la facilidad de uso en las nutricionistas. Resultados. Se logró contactar a 43 de los 45 participantes (95%). El número promedio de llamadas para contactar a un sujeto fue de dos, con un rango de 1-9 llamadas. Dos participantes pudieron ser contactados en su teléfono celular y cinco no recibieron una exposición completa a la intervención. Basados en las entrevistas semiestructuradas, los resultados mostraron una buena aceptabilidad a la intervención en los participantes. Las nutricionistas percibieron a la plataforma como amigable y de fácil manejo. Las barreras para ofrecer esta intervención se relacionaron con dificultades para obtener una señal de telefonía celular adecuada. Conclusiones. Dada la alta penetración de la telefonía celular en países en desarrollo, se concluye que una intervención basada en salud móvil es factible y aceptable para ofrecer una intervención orientada a la modificación del estilo de vida en prehipertensos o personas de alto riesgo de enfermedades crónicas.

Objectives. To evaluate the acceptability and feasibility of an intervention based on mobile health, for the adoption of healthy lifestyles in prehypertensive people living in low-income urban areas in Argentina, Guatemala and Peru. Materials and methods. Prehypertensive people aged 30-60 years were recruited for a pilot study. The intervention included two counseling calls made by a nutritionist followed by a weekly customized text message. An internet-based platform offered support for the implementation of the intervention. Using semi-structured interviews, we evaluated the reach and acceptability of the intervention in the participants and ease of use for the nutritionists. Results. It was possible to contact 43 of the 45 participants (95%). The average number of calls to contact a subject was two, with a range of 1-9 calls. Two participants could not be reached on their cell phone; five did not receive complete exposure to the intervention. Based on semi-structured interviews, the results showed good acceptability for the intervention by the participants. Nutritionists perceived the platform as friendly and easy to use. Barriers to deliver this intervention were related to difficulties in obtaining an adequate cellular signal. Conclusions. Given the high penetration of mobile phones in developing countries, it is concluded that it is feasible and acceptable to offer a mobile health based intervention oriented towards lifestyle modification in people with prehypertension or high risk of chronic disease intervention.

Snack food advertising in stores around public schools in Guatemala.

Obesity in school-age children is emerging as a public heath concern. Food marketing influences preferences and increases children's requests for food. This study sought to describe the type of snack foods advertised to children in stores in and around public schools and assess if there is an association between child-oriented snack food advertising and proximity to schools. All food stores located inside and within a 200 square meter radius from two preschools and two primary schools were surveyed. We assessed store type, number and type of snack food advertisements including those child-oriented inside and outside stores. We surveyed 55 stores and found 321 snack food advertisements. Most were on sweetened beverages (37%) and soft drinks (30%). Ninety-two (29%) were child-oriented. Atoles (100.0%), cereals (94.1%), and ice cream and frozen desserts (71.4%) had the greatest proportion of child-oriented advertising. We found more child-oriented advertisements in stores that were closer (<170 m) to schools compared to those farther away. In conclusion, the food industry is flooding the market, taking advantage of the lack of strict regulation in Guatemala. Child-oriented advertisements are available in almost all stores within a short walking distance from schools, exposing children to an obesogenic environment.

A qualitative study of children's snack food packaging perceptions and preferences.

BACKGROUND: Food marketing is pervasive in high- and low/middle-income countries and is recognized as a significant risk factor for childhood obesity. Although food packaging is one of the most important marketing tools to persuade consumers at the point-of-sale, scant research has examined how it influences children's perceptions. This study was conducted in Guatemala and aimed to understand which snack foods are the most frequently purchased by children and how aspects of food packaging influence their product perceptions. METHODS: Six activity-based focus groups were conducted in two elementary public schools with thirty-seven children (Grades 1 through 6, age range 7-12 years old). During each focus group, children participated in three activities: 1) list their most frequently purchased food products; 2) select the picture of their favorite product, the packaging they liked best, and the product they thought was the healthiest from eight choices; and 3) draw the package of a new snack. RESULTS: Children reported purchasing salty snacks most frequently. Most children chose their favorite product based on taste perceptions, which can be influenced by food packaging. Visual elements influenced children's selection of favorite packaging (i.e., characters, colors) and healthiest product (i.e., images), and persuaded some children to incorrectly think certain foods contained healthy ingredients. When children generated their own drawings of a new product, the most frequently included packaging elements in the drawings were product name, price, product image and characters, suggesting those aspects of the food packaging were most significant to them. CONCLUSIONS: Policies regulating package content and design are required to discourage consumption of unhealthy snacks. This might be another public health strategy that can aid to halt the obesity epidemic.

Formative research to develop a community-based intervention for chronic disease prevention in Guatemalan school-age children.

BACKGROUND: Noncommunicable diseases (NCD) are the most common causes of morbidity and mortality worldwide, even in low- and middle-income countries (LMIC). Recent trends in health promotion emphasize community-based interventions as an important strategy for improving health outcomes. The aim of this study was to conduct formative research regarding the perceptions of NCD risk factors, their influencing factors, and community resources available to aid the development and implementation of a community-based intervention with school-age children. METHODS: Focus group discussions (n = 18), home visits (n = 30), and individual semi-structured interviews (n = 26) were conducted in three urban communities in Guatemala with school-age children (10-12 years of age), teachers, parents, and local community members (i.e., school principals, school food kiosk vendors, religious leaders, authority representatives). All focus groups and interviews were transcribed verbatim for thematic analysis. RESULTS: Children, parents, and teachers have general knowledge about modifiable risk factors. Adults worried more about tobacco use, as compared to unhealthy diet and physical inactivity in children. Participants identified features at the intrapersonal (e.g., negative emotional state), interpersonal (e.g., peers as role models), and organizational and community levels (e.g., high levels of crime) that influence these risk factors in children. School committees, religious leaders, and government programs and activities were among the positive community resources identified. CONCLUSIONS: These findings should help researchers in Guatemala and similar LMIC to develop community-based interventions for NCD prevention in school-age children that are effective, feasible, and culturally acceptable.

Child-oriented marketing techniques in snack food packages in Guatemala.

BACKGROUND: Childhood overweight in Guatemala is now becoming a public health concern. Child-oriented marketing contributes to increase children's food preference, purchase and consumption. This study sought to assess the availability of child-oriented snack foods sold in school kiosks and convenience stores near public schools in Guatemala, to identify the marketing techniques used in child-oriented snack food packages and to classify the snacks as "healthy" or "less-healthy". METHODS: We purchased all child-oriented snacks found in stores inside and within 200 square meters from four schools in an urban community. Snacks were classified as child-oriented if the package had any promotional characters, premium offers, children's television/movie tie-ins, sports references, or the word "child". We used a checklist to assess child-oriented references and price. Snacks were classified as "healthy" or "less-healthy" according to the UK standards for the Nutritional Profiling Model. RESULTS: We analyzed 106 packages found in 55 stores. The most commonly used technique was promotional characters (92.5%) of which 32.7% were brand-specific characters. Premium offers were found in 34% of packages and were mostly collectibles (50%). Most marketing techniques were located on the front and covered nearly 25% of the package surface. Median (interquartile range) price was US$ 0.19 (0.25). Nutrition labels were found in 91 (86%) packages and 41% had a nutrition related health claim. Most snacks (97.1%) were classified as "less-healthy". CONCLUSION: In Guatemala, the food industry targets children through several marketing techniques promoting inexpensive and unhealthy snacks in the school environment. Evidence-based policies restricting the use of promotional characters in unhealthy snack food packages need to be explored as a contributing strategy to control the obesity epidemic.