An Assessment of Government Capacity Building to Restrict the Marketing of Unhealthy Food and Non-Alcoholic Beverage Products to Children in the Region of the Americas.

The Pan American Health Organization (PAHO) Strategic Plan 2020-2025 committed to reduce children's consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO's Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives (n = 35) to complete a 28-item web-based survey (January to July 2020). Capacity-building needs were assessed using an adapted version of the World Health Organization's government capacity-building framework with three modules: public health infrastructure, policies and information systems. Notable achievements for the PAHO's Plan of Action were identified. State representatives reported strong infrastructure and information systems; however, policy improvements are needed to increase comprehensive national responses. These include using a constitutional health and human rights approach within the policies, policies that document conflict of interest from non-state actors, and strengthening regulatory oversight for digital media platforms. These findings provide baseline data and we suggest priorities for further action to strengthen national governments' capacity-building and to accelerate the development, implementation, and monitoring systems to restrict the marketing of HFSS food and non-alcoholic beverages to children in the region of the Americas.

Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research.

There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally. This study conducted a two-step scoping review to map and describe the effect of restaurant menu labeling policies on menu reformulation. First, we identified national, state, and municipal menu labeling policies in countries from global databases. Second, we searched four databases (i.e., PubMed, CINHAL/EBSCO, Web of Science, and Google Scholar) for peer-reviewed studies and gray-literature sources in English and Spanish (2000-2020). Step 1 identified three voluntary and eight mandatory menu labeling policies primarily for energy disclosures for 11 upper-middle and high-income countries, but none for low- or middle-income countries. Step 2 identified 15 of 577 studies that met the inclusion criteria. The analysis showed reductions in energy for newly introduced menu items only in the United States. We suggesr actions for governments, civil society organizations, and the restaurant businesses to develop, implement, and evaluate comprehensive menu labeling policies to determine whether these may reduce obesity and NCD risks worldwide.

SHAPING THE EVOLUTION OF THE INFORMATION FLOW: THE CENTRALIZING MECHANISMS IN THE EVOLUTION OF THE NORTH AMERICAN TOBACCO QUITLINE CONSORTIUM.

The research reported here is an analysis of the evolution of the relationships that comprise a single public health network, focusing especially on the position of the network administrative organization (Provan and Kenis, 2008) in the flow of knowledge among a large number of organizations providing similar services. Our study examines the North American Quitline Consortium (NAQC), a multi-sector network that spans the US and Canada and whose members provide telephone-based tobacco cessation services to anyone interested in quitting smoking. Data were collected using web-based surveys at three different points of time. Implications are discussed for network organizing, for both theory and practice, focusing especially on the importance of the network administrative organization in shaping the evolution of the whole network information flow.

Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing.

OBJECTIVES: We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). METHODS: We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. RESULTS: State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. CONCLUSIONS: If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free.

Coevolution of Information Sharing and Implementation of Evidence-Based Practices Among North American Tobacco Cessation Quitlines.

OBJECTIVES: We examined the coevolution of information sharing and implementation of evidence-based practices among US and Canadian tobacco cessation quitlines within the North American Quitline Consortium (NAQC). METHODS: Web-based surveys were used to collect data from key respondents representing each of 74 participating funders of NAQC quitlines during the summer and fall of 2009, 2010, and 2011. We used stochastic actor-based models to estimate changes in information sharing and practice implementation in the NAQC network. RESULTS: Funders were more likely to share information within their own country and with funders that contracted with the same service provider. Funders contracting with larger service providers shared less information but implemented significantly more practices. Funders connected to larger numbers of tobacco control researchers more often received information from other funders. Intensity of ties to the NAQC network administrative organization did not influence funders' decisions to share information or implement practices. CONCLUSIONS: Our findings show the importance of monitoring the NAQC network over time. We recommend increased cross-border information sharing and sharing of information between funders contracting with different and smaller service providers.