A Qualitative Exploration of Spanish-Speaking Latina Women's Experiences Participating in WIC Before and During the COVID-19 Pandemic.

BACKGROUND: More than one-third of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants identify as Latino, but participation has been declining and individuals who speak predominantly Spanish face additional barriers to participation. During the COVID-19 pandemic, there were changes in WIC eligibility and benefits that may have been differentially accessible to Spanish-speaking Latina participants due to factors such as language barriers and lack of awareness of changes. Understanding Spanish-speaking Latinas' experiences with the WIC program generally and during the pandemic can inform efforts to equitably implement future emergency food response policies and improve the WIC program and Latina participant enrollment more broadly. OBJECTIVE: This study aimed to understand the perceptions and experiences of Spanish-speaking Latina WIC participants with the WIC program generally and with COVID-19 pandemic-related policy changes made to the WIC program. DESIGN: Qualitative in-depth interviews were conducted virtually in Spanish in August 2022 using a semi-structured guide. PARTICIPANTS/SETTING: Study participants were 18 Spanish-speaking Latina adult WIC participants living in North Carolina recruited using convenience sampling. ANALYSIS: All interviews were recorded, transcribed, and coded in Spanish. Thematic analysis with inductive coding was used to derive key themes. RESULTS: Perceptions about the WIC program in this sample were mixed. Participants felt positively about the healthfulness of foods included in the WIC food packages but expressed concern about the monthly benefit amounts being too low and the cultural appropriateness of food options. Pandemic policy changes, such as remote appointments and the Cash Value Benefit increase were perceived positively; however, barriers to using benefits during this time included limited communication from WIC agencies, food shortages, and concerns about not being granted US citizenship or permanent resident status due to use of WIC (ie, public charge rule). Social networks played an important role in learning about and enrolling in WIC and navigating food shortages during the pandemic. CONCLUSIONS: Concerns about the cultural appropriateness of foods provided, communication challenges, and the public charge rule emphasized the need for resources dedicated in the WIC program to improving Spanish-speaking Latina women's experiences with WIC.

Toddler milk: a scoping review of research on consumption, perceptions, and marketing practices.

Toddler milk is an ultra-processed beverage consisting primarily of powdered milk, caloric sweeteners, and vegetable oil. Pediatric health authorities do not support the use of toddler milk, and emerging evidence suggests that toddler-milk marketing practices may mislead consumers. However, studies have not synthesized the extent of toddler-milk marketing practices or how these practices affect parents' decisions about whether to serve toddler milk. We aimed to summarize the literature about toddler milk to identify what is known about: (1) parents' toddler-milk purchasing and feeding behaviors, (2) toddler-milk marketing, and (3) how marketing practices influence parents' beliefs and perceptions about toddler milk. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we systematically searched 8 databases (PubMed, APA PsycINFO, Scopus, Cochrane Central, Embase, CINAHL, Communication & Mass Media Complete, and Business Source Premier). We identified 45 articles about toddler milk. Studies were conducted in 25 countries across 6 continents. Five types of findings emerged: (1) consumption and feeding behaviors, (2) demographic correlates of toddler-milk purchasing and consumption, (3) misperceptions and beliefs, (4) increased sales, and (5) increased marketing and responses to marketing. The included articles suggested that toddler-milk sales are growing rapidly worldwide. Findings also revealed that toddler-milk packages (eg, labels, branding) resemble infant formula packages and that toddler-milk marketing practices may indirectly advertise infant formula. Purchasing, serving, and consumption of toddler milk were higher in Black and Hispanic populations than in non-Hispanic White populations, and parents with higher educational attainment and income were more likely to offer toddler milk to their children. Findings suggest a need for policies to prevent cross-marketing of toddler milk and infant formula, reduce provision of toddler milk to infants and toddlers, and prevent caregivers from being misled about toddler-milk healthfulness.

Natural Claims on Sugary Fruit Drinks: A Randomized Experiment With U.S. Parents.

INTRODUCTION: Natural claims on food are largely unregulated in the U.S. This study examined the effects of natural claims on a fruit-flavored drink with added sugar (i.e., fruit drink). METHODS: In 2019, U.S. parents of children aged 2-12 years (N=1,078) recruited from an online survey panel were randomized to one of three arms: natural claim on a fruit drink, 100% all-natural claim, or a no-claim control. Parents reported their intentions and perceptions regarding fruit drinks using 1-5 response scales. Analysis occurred in 2022-2023. RESULTS: Both natural claims led parents to have higher intentions to purchase a fruit drink for their child than the control (average differential effect=0.20-0.24, both p<0.05). The natural claim (but not the 100% all-natural claim) also led parents to think that the fruit drink was healthier for their children (average differential effect=0.22, p=0.024). Claims made parents less likely to think that the drink contained added sugar (average differential effect= -0.08 to -0.12, both p<0.05) and led to lower estimated amounts of added sugar in teaspoons (average differential effect= -1.77 to -2.09, both p<0.05). Mediation analyses revealed that the claims led to higher intentions to purchase the fruit drink by increasing perceived healthfulness of the fruit drink and by leading parents to believe that there was no added sugar in the fruit drink. CONCLUSIONS: Natural claims could increase interest in and perceived healthfulness of fruit drinks. Misperceptions about the nutritional content caused by claims appear to be driving greater purchase intentions. These findings suggest a need for stronger regulation around natural claims to prevent consumer misunderstanding.

Toddler Milk Perceptions and Responses to Front-of-Package Claims and Product Warnings: A Qualitative Study of Caregivers of Toddlers.

BACKGROUND: Toddler milk products are ultraprocessed milk-based beverages promoted for children aged 9 through 36 months. They often contain added sugars, which may contribute to unhealthy dietary habits. Aggressive promotion of toddler milk, particularly to the Latinx population, has likely led to rapid rises in sales. OBJECTIVE: The study aims were to qualitatively explore caregivers' experiences with, beliefs about, and attitudes toward toddler milk; to explore caregivers' reactions to health claims and product warnings on toddler milk packaging; and explore whether perceptions of toddler milk differ by Latinx ethnicity. DESIGN: Focus group discussions and in-depth interviews were conducted. PARTICIPANTS: Fifteen online in-depth interviews and 4 online focus groups with US caregivers of children aged 9 through 36 months who reported serving toddler milk to their children were conducted in 2021. STATISTICAL ANALYSES PERFORMED: Audio files were transcribed, coded, and analyzed in NVivo. A thematic analysis with a hybrid analytical approach of deductive and inductive coding was conducted. RESULTS: Caregivers struggled to discern toddler milk from infant formula and perceived formula as a larger term that included toddler milk. Participants described offering toddler milk to their children for its convenience, nutritional profile, and perceived benefits tied to health claims present on the labels. Participants reported that health claims on toddler milk packaging attracted their attention; most participants did not express skepticism about the veracity of the claims. An "added sugar" warning increased understanding of the presence of added sugar in a toddler milk product. Latinx and non-Latinx participants largely reported similar perceptions, beliefs, and patterns of provision of toddler milk. CONCLUSIONS: Health claims may lead caregivers to perceive toddler milk as a nutritionally adequate product. Research is needed to investigate caregiver-directed interventions for informing caregivers about the distinction between infant formula and toddler milk.

How pictorial warnings change parents' purchases of sugar-sweetened beverage for their children: mechanisms of impact.

BACKGROUND: Pictorial health warnings on sugar-sweetened beverages (SSBs) are a promising policy for preventing diet-related disease in children. A recent study found that pictorial warnings reduced parents' purchases of SSBs for their children by 17%. However, the psychological mechanisms through which warnings affect parental behavior remain unknown. We aimed to identify the mechanisms that explain how pictorial warnings affect parents' SSB purchasing behavior for their children using secondary data from a randomized trial. METHODS: In 2020-2021, parents of children ages 2 to 12 years (n = 325) completed a shopping task in a convenience store laboratory in North Carolina, USA. Participants were randomly assigned to a pictorial warnings arm (SSBs displayed pictorial health warnings about type 2 diabetes and heart damage) or a control arm (SSBs displayed a barcode label). Parents then bought a beverage for their child and took a survey measuring 11 potential psychological mediators, selected based on health behavior theories and a model explaining the impact of tobacco warnings. We conducted simple mediation analyses to identify which of the 11 mechanisms mediated the impact of exposure to pictorial warnings on purchasing any SSBs for their children. RESULTS: Two of the 11 constructs were statistically significant mediators. First, the impact of pictorial warnings on the likelihood of purchasing any SSB was mediated by parents' perceptions that SSBs were healthier for their child (mediated effect= -0.17; 95% CI = - 0.33, - 0.05). Second, parents' intentions to serve SSBs to their children also mediated the effect of warnings on likelihood of purchasing any SSB (mediated effect= -0.07, 95% CI=-0.21, - 0.003). CONCLUSIONS: Pictorial warnings reduced parents' purchases of SSBs for their children by making parents think SSBs are less healthful for their children and reducing their intentions to serve SSBs to their children. Communication approaches that target healthfulness perceptions and intentions to serve SSBs may motivate parents to buy fewer SSBs for their children.

The Impact of Toddler Milk Claims on Beliefs and Misperceptions: A Randomized Experiment with Parents of Young Children.

BACKGROUND: Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been marketed increasingly in the United States with structure/function claims on product packaging that are potentially misleading. OBJECTIVE: This study examined how structure/function claims impact parents' beliefs and perceptions about a toddler milk product. DESIGN: This was a 3-arm between-subjects randomized experiment. PARTICIPANTS: A diverse sample of 2,190 US parents of children aged 1 to 5 years were chosen to take an online survey. INTERVENTION: Participants were randomly assigned to view a toddler milk package with either an unrelated claim ("new and improved," ie, control condition), a "brain development" claim (ie, "brain" claim), or an "immunity-related" claim (ie, "immunity" claim). MAIN OUTCOME MEASURES: Outcomes included perceptions, intentions, and beliefs about the toddler milk product. STATISTICAL ANALYSES PERFORMED: Linear regression for continuous outcomes and logistic regression for dichotomous outcomes. RESULTS: Parents who were exposed to the "brain" claim or the "immunity" claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow's milk compared with those who saw the control claim (89% for brain claim, 87% for immunity claim, and 79% for control; P < .001 for both comparisons). Parents exposed to either the brain or immunity claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared with parents exposed to the control (all, P < .001). CONCLUSIONS: These findings suggest that structure/function claims on toddler milk packaging may mislead parents and increase the appeal of toddler milk. Our findings support calls for public health policies to regulate marketing on toddler milk packaging.

Motivations, barriers, and communication recommendations for promoting face coverings during the COVID-19 pandemic: Survey findings from a diverse sample.

State and local health departments have been tasked with promoting the use of face coverings to decrease the spread of COVID-19 in their respective communities. However, little is known about motivations and barriers to wearing face coverings in the context of COVID-19 prevention, particularly among communities of color who are at an increased risk of serious illness from the disease. The purpose of this study was to identify common motivations and barriers to face covering use, as well as explore perceptions of messages encouraging the use of face coverings among a racially and ethnically diverse sample. A survey was distributed electronically to North Carolina (NC) residents through NC Department of Health and Human Services listservs in July 2020. Participants self-categorized as Latino/a (33.5%), Black (39.1%), or white or another race (27.5%). The most commonly endorsed motivations for wearing face coverings were to avoid spreading COVID-19 (77%), as well as to protect people who are vulnerable (76%) and one's community (72%). Being uncomfortable (40%) was the most commonly endorsed barrier. Messages that included a clear request (ex. please wear a face covering) and a direct benefit (ex. keep community safe) were more commonly endorsed than those that did not. Commonly endorsed motivations, behaviors, and messages differed by race and ethnicity. Increased attention to message content, message structure, and access to information and resources may aid local officials in increasing consistent use of face coverings.

Designing warnings for sugary drinks: A randomized experiment with Latino parents and non-Latino parents.

Sugary drink warnings are a promising policy for reducing sugary drink consumption, but it remains unknown how to design warnings to maximize their impact overall and among diverse population groups, including parents of Latino ethnicity and parents with low English use. In 2019, we randomized US parents of children ages 2-12 (n = 1078, 48% Latino ethnicity, 13% low English use) to one topic (one of four warnings, or a neutral control), which they viewed on three designs (text-only, icon, and graphic) to assess reactions to the various warnings on sugary drinks. All warning topics were perceived as more effective than the control (average differential effect [ADE] ranged from 1.77 to 1.84 [5-point Likert scale], all p < .001). All warning topics also led to greater thinking about harms of sugary drinks (all p < .001) and lower purchase intentions (all p < .01). Compared to text-only warnings, icon (ADE = 0.18) and graphic warnings (ADE = 0.30) elicited higher perceived message effectiveness, as well as greater thinking about the harms of sugary drinks, lower perceived healthfulness, and lower purchase intentions (all p < .001). The impact of icon warnings (vs. text warnings) was stronger for parents with low English use, compared to those with high English use (p = .024). Similarly, the impact of icon (vs. text warnings) was stronger for Latino parents than non-Latino parents (p = .034). This experimental study indicates that many warning topics hold promise for behavior change and that including images with warnings could increase warning efficacy, particularly among Latino parents and parents with low English use. Clinical Trial Registration: NCT04382599.

Toddler milk perceptions and purchases: the role of Latino ethnicity.

OBJECTIVES: Toddler milk (i.e. a nutrient-fortified milk-based drink marketed for children 12-36 months old) is increasingly being marketed in the USA despite not being recommended for young children. There is evidence of targeted toddler milk marketing to Latinos in the USA. This study aimed to explore toddler milk perceptions and behaviours among Latino and non-Latino parents. DESIGN: An online survey assessed toddler milk perceptions, behaviours and interpretations of nutrition-related claims. Multivariable logistic and linear regression explored socio-demographic correlates of parent reported past purchases and perceived healthfulness. SETTING: Online. PARTICIPANTS: National convenience sample of 1078 US parents of children aged 2-12 years (48 % Latino). RESULTS: About half of parents (51 %) had previously purchased toddler milk and few (11 %) perceived toddler milk as unhealthy. Latino parents were more likely to have purchased toddler milk than non-Latino parents (P < 0·001), but there were no differences in perceived product healthfulness (P = 0·47). Compared to parents born in the USA, parents living in the USA 10 years or less were more likely to have purchased toddler milk (P < 0·001) and perceive toddler milk as healthier (P = 0·002). Open-ended interpretations of claims were primarily positive, suggesting 'health halo' effects. CONCLUSIONS: Common misperceptions about toddler milk healthfulness suggest stronger labelling regulations are needed. Greater reported purchases by Latino parents and recent immigrants warrant further investigation.

Parental Perceptions and Exposure to Advertising of Toddler Milk: A Pilot Study with Latino Parents.

Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12-36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents' experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential "health halo" effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.

Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups.

Widespread use of face coverings is a key public health strategy to prevent the spread of COVID-19. However, few studies have examined why Americans use or do not use face coverings, and little is known about the most effective messaging strategies. This study explored perceptions of face coverings, including motivations and barriers for use, and examined reactions to messaging promoting the use of face coverings. Six virtual focus groups were conducted with 34 North Carolina residents in July 2020. Participants reported high compliance with face covering recommendations but often did not wear them around family, friends, and colleagues. The most prevalent motivation for the use of face coverings was to protect or respect other people, including high-risk populations and individuals. Other motivators were self-protection, responsibility, desire for control, requirements, and expert advice. Barriers included physical and social discomfort, confusion or misinformation, low perceived susceptibility to COVID-19, and perceptions of identity and autonomy. Even among individuals who frequently wear face coverings, there are opportunities to improve compliance. Messaging should highlight how face coverings protect the wearer and others around them, normalize the use of face coverings in social settings, and emphasize requirements. Positive messages that focus on unity, personal experiences and the rationale for face coverings are recommended.

Can the risk in public-private partnerships be classified? / O risco de parcerias público-privadas em saúde pública pode ser classificado?

In the coming years, public-private partnerships (PPPs) should play an increasingly relevant role as an important alternative for financing projects and infrastructure in public services. However, especially in public health, PPPs are not always a good alternative, since they may introduce distortions in the agenda that sets health needs, favoring companies' interests. Public agencies can benefit from collaboration with the private sector in areas where there is a lack of specialization, such as the development of research and technologies. Even in these cases, each institution's role needs to be defined in order to avoid conflicts of interest. This can be challenging when dealing with the formulation of public and regulatory policies, on the impacts of certain policies, especially in developing countries. To engage with the private sector without compromising the integrity of government actions requires a broad discussion by public health stakeholders, for clear reasons of conflicting visions and scopes between corporations and public health. Combined with this is the need for multi-sector approaches, with a high load of financial investments in the various dimensions of policies to control the most prevalent diseases, especially chronic non-communicable diseases (NCD). This article classifies PPPs in categories in order to minimize the potential risks of conflicts of interest than can impact public health. These categories are defined as possible, possible with caveats, and impossible for involvement with certain institutions.

Resumo: Durante os próximos anos, Parcerias Público-Privadas (PPP) deverão desempenhar um papel cada vez mais relevante, despontando como uma importante alternativa de financiamento de projetos e de infraestrutura no cenário de serviços públicos. No entanto, especialmente para a Saúde Pública, as PPP nem sempre são uma boa alternativa, uma vez que pode haver distorção da agenda que define as necessidades da saúde, favorecendo os interesses das empresas. Os órgãos públicos podem se beneficiar da colaboração com o setor privado em áreas em que há falta de especialização, tais como desenvolvimento de pesquisas e tecnologias. Mesmo nesses casos, os papéis de cada instituição devem ser bem definidos, para que não haja conflito de interesses. Isso pode ser um desafio quando se trata da formulação de políticas públicas e regulatórias, sobre os impactos que determinadas políticas possam exercer, especialmente sobre nações em desenvolvimento. Envolver-se com o setor privado, sem comprometer a integridade das ações governamentais, exige ampla discussão por parte dos atores da saúde pública, por motivos claros de conflito das visões e escopos entre corporações e saúde pública. Alia-se a isso a necessidade de abordagens multissetoriais, alta carga de investimentos financeiros das várias dimensões das políticas de controle de doenças mais prevalentes, sobretudo as doenças crônicas não transmissíveis (DCNT). Este artigo classifica as PPP em categorias, a fim de minimizar os riscos potenciais de conflito de interesses que podem ter impacto na saúde pública. Essas categorias são definidas como possíveis, possíveis com ressalvas e impossíveis de se envolver com determinadas instituições.

Resumen: Durante los próximos años, las colaboraciones público-privadas (PPP) por sus siglas en portugués) deberán desempeñar un papel cada vez más relevante, despuntando como una importante alternativa de financiación de proyectos y de infraestructura en el escenario de servicios públicos. No obstante, especialmente para la Salud Pública, las PPP no siempre son una buena alternativa, ya que puede haber distorsiones de la agenda que define las necesidades de la salud, favoreciendo los intereses de las empresas. Los órganos públicos pueden beneficiarse de la colaboración con el sector privado en áreas donde hace falta especialización, tales como: desarrollo de investigaciones y tecnologías. Incluso en esos casos, los papeles de cada institución deben ser bien definidos para que no exista un conflicto de intereses. Eso puede ser un desafío cuando se trata de la formulación de políticas públicas y regulatorias, sobre los impactos que determinadas políticas puedan ejercer, especialmente sobre naciones en desarrollo. Involucrarse con o el sector privado, sin comprometer la integridad de las acciones gubernamentales, exige una amplia discusión por parte de los actores de la salud pública, por motivos claros de conflicto de las visiones y objetivos entre corporaciones y salud pública. Se une a esto la necesidad de enfoques multisectoriales, alta carga de inversión financiera de las diferentes dimensiones de las políticas de control de enfermedades más prevalentes, sobre todo las enfermedades crónicas no transmisibles (DCNT). Este artículo clasifica las PPP en categorías, a fin de minimizar los riesgos potenciales de conflicto de intereses que pueden tener un impacto en la salud pública. Estas categorías se definen como posibles, posibles con salvaguardias e imposibles de implicación con determinadas instituciones.

Institutions and the implementation of tobacco control in Brazil. / As instituições e a implementação do controle do tabaco no Brasil.

This research examines the institutional features of Brazil's National Commission for the Implementation of the Framework Convention on Tobacco Control (CONICQ) and how these institutional features have facilitated and hindered its ability to foster intersectoral tobacco control. In particular, we evaluate the key institutional features of CONICQ starting from when it was one of the key drivers of change and improvements in early tobacco control policies, which helped to make Brazil a world leader in this area. We also examine how the committee has evolved, as tobacco control has improved and particularly elucidate some of the major challenges that it faces to bring together often disparate government sectors to generate public health policies.

Resumo: Esta pesquisa examina as características institucionais da Comissão Nacional para a Implementação da Convenção-Quadro sobre Controle do Tabaco (CONICQ) e como essas características institucionais facilitaram e impediram sua capacidade de promover o controle intersetorial do tabagismo. Os autores avaliam particularmente as características da CONICQ enquanto um dos principais fatores de mudanças e melhorias nas primeiras políticas de controle do tabaco, e que ajudaram a transformar o Brasil em líder mundial nessa área. O artigo também analisa como a Comissão evoluiu junto com a melhora do controle do tabaco, além de discutir alguns dos maiores desafios para reunir diversos setores do governo na elaboração de políticas de saúde pública.

Resumen: Esta investigación examina las características institucionales de la Comisión Nacional para la Implementación del Convenio Marco para el Control del Tabaco (CONICQ) y cómo estas características institucionales han facilitado y dificultado su capacidad de fomentar el control intersectorial del tabaco en Brasil. En particular, evaluamos las características clave institucionales de la CONICQ, cuando era uno de los agentes clave de cambios y mejoras en las primeras políticas de control de tabaco, que ayudaron a hacer de Brasil un líder mundial en esta área. También examinamos cómo el comité ha evolucionado al mejorar el control del tabaco y, particularmente, elucidar algunos de los mayores desafíos a los que se enfrenta para aunar sectores gubernamentales a menudo dispares, con el fin de generar políticas de públicas de salud.

O risco de parcerias público-privadas em saúde pública pode ser classificado? / ¿Puede ser clasificado el riesgo de las colaboraciones público-privadas en salud pública? / Can the risk in public-private partnerships be classified?

Resumo: Durante os próximos anos, Parcerias Público-Privadas (PPP) deverão desempenhar um papel cada vez mais relevante, despontando como uma importante alternativa de financiamento de projetos e de infraestrutura no cenário de serviços públicos. No entanto, especialmente para a Saúde Pública, as PPP nem sempre são uma boa alternativa, uma vez que pode haver distorção da agenda que define as necessidades da saúde, favorecendo os interesses das empresas. Os órgãos públicos podem se beneficiar da colaboração com o setor privado em áreas em que há falta de especialização, tais como desenvolvimento de pesquisas e tecnologias. Mesmo nesses casos, os papéis de cada instituição devem ser bem definidos, para que não haja conflito de interesses. Isso pode ser um desafio quando se trata da formulação de políticas públicas e regulatórias, sobre os impactos que determinadas políticas possam exercer, especialmente sobre nações em desenvolvimento. Envolver-se com o setor privado, sem comprometer a integridade das ações governamentais, exige ampla discussão por parte dos atores da saúde pública, por motivos claros de conflito das visões e escopos entre corporações e saúde pública. Alia-se a isso a necessidade de abordagens multissetoriais, alta carga de investimentos financeiros das várias dimensões das políticas de controle de doenças mais prevalentes, sobretudo as doenças crônicas não transmissíveis (DCNT). Este artigo classifica as PPP em categorias, a fim de minimizar os riscos potenciais de conflito de interesses que podem ter impacto na saúde pública. Essas categorias são definidas como possíveis, possíveis com ressalvas e impossíveis de se envolver com determinadas instituições.

Resumen: Durante los próximos años, las colaboraciones público-privadas (PPP) por sus siglas en portugués) deberán desempeñar un papel cada vez más relevante, despuntando como una importante alternativa de financiación de proyectos y de infraestructura en el escenario de servicios públicos. No obstante, especialmente para la Salud Pública, las PPP no siempre son una buena alternativa, ya que puede haber distorsiones de la agenda que define las necesidades de la salud, favoreciendo los intereses de las empresas. Los órganos públicos pueden beneficiarse de la colaboración con el sector privado en áreas donde hace falta especialización, tales como: desarrollo de investigaciones y tecnologías. Incluso en esos casos, los papeles de cada institución deben ser bien definidos para que no exista un conflicto de intereses. Eso puede ser un desafío cuando se trata de la formulación de políticas públicas y regulatorias, sobre los impactos que determinadas políticas puedan ejercer, especialmente sobre naciones en desarrollo. Involucrarse con o el sector privado, sin comprometer la integridad de las acciones gubernamentales, exige una amplia discusión por parte de los actores de la salud pública, por motivos claros de conflicto de las visiones y objetivos entre corporaciones y salud pública. Se une a esto la necesidad de enfoques multisectoriales, alta carga de inversión financiera de las diferentes dimensiones de las políticas de control de enfermedades más prevalentes, sobre todo las enfermedades crónicas no transmisibles (DCNT). Este artículo clasifica las PPP en categorías, a fin de minimizar los riesgos potenciales de conflicto de intereses que pueden tener un impacto en la salud pública. Estas categorías se definen como posibles, posibles con salvaguardias e imposibles de implicación con determinadas instituciones.

Abstract: In the coming years, public-private partnerships (PPPs) should play an increasingly relevant role as an important alternative for financing projects and infrastructure in public services. However, especially in public health, PPPs are not always a good alternative, since they may introduce distortions in the agenda that sets health needs, favoring companies' interests. Public agencies can benefit from collaboration with the private sector in areas where there is a lack of specialization, such as the development of research and technologies. Even in these cases, each institution's role needs to be defined in order to avoid conflicts of interest. This can be challenging when dealing with the formulation of public and regulatory policies, on the impacts of certain policies, especially in developing countries. To engage with the private sector without compromising the integrity of government actions requires a broad discussion by public health stakeholders, for clear reasons of conflicting visions and scopes between corporations and public health. Combined with this is the need for multi-sector approaches, with a high load of financial investments in the various dimensions of policies to control the most prevalent diseases, especially chronic non-communicable diseases (NCD). This article classifies PPPs in categories in order to minimize the potential risks of conflicts of interest than can impact public health. These categories are defined as possible, possible with caveats, and impossible for involvement with certain institutions.

As instituições e a implementação do controle do tabaco no Brasil / Instituciones y la implementación del control del tabaco en Brasil / Institutions and the implementation of tobacco control in Brazil

Resumo: Esta pesquisa examina as características institucionais da Comissão Nacional para a Implementação da Convenção-Quadro sobre Controle do Tabaco (CONICQ) e como essas características institucionais facilitaram e impediram sua capacidade de promover o controle intersetorial do tabagismo. Os autores avaliam particularmente as características da CONICQ enquanto um dos principais fatores de mudanças e melhorias nas primeiras políticas de controle do tabaco, e que ajudaram a transformar o Brasil em líder mundial nessa área. O artigo também analisa como a Comissão evoluiu junto com a melhora do controle do tabaco, além de discutir alguns dos maiores desafios para reunir diversos setores do governo na elaboração de políticas de saúde pública.

Resumen: Esta investigación examina las características institucionales de la Comisión Nacional para la Implementación del Convenio Marco para el Control del Tabaco (CONICQ) y cómo estas características institucionales han facilitado y dificultado su capacidad de fomentar el control intersectorial del tabaco en Brasil. En particular, evaluamos las características clave institucionales de la CONICQ, cuando era uno de los agentes clave de cambios y mejoras en las primeras políticas de control de tabaco, que ayudaron a hacer de Brasil un líder mundial en esta área. También examinamos cómo el comité ha evolucionado al mejorar el control del tabaco y, particularmente, elucidar algunos de los mayores desafíos a los que se enfrenta para aunar sectores gubernamentales a menudo dispares, con el fin de generar políticas de públicas de salud.

Abstract: This research examines the institutional features of Brazil's National Commission for the Implementation of the Framework Convention on Tobacco Control (CONICQ) and how these institutional features have facilitated and hindered its ability to foster intersectoral tobacco control. In particular, we evaluate the key institutional features of CONICQ starting from when it was one of the key drivers of change and improvements in early tobacco control policies, which helped to make Brazil a world leader in this area. We also examine how the committee has evolved, as tobacco control has improved and particularly elucidate some of the major challenges that it faces to bring together often disparate government sectors to generate public health policies.