Carolina Pérez‐Ferrer

Instituto Nacional de Salud Pública

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Tonatiuh Barrientos‐Gutiérrez

Instituto Nacional de Salud Pública

Nancy López‐Olmedo

Instituto Nacional de Salud Pública

Dalia Stern

Instituto Nacional de Salud Pública

Usama Bilal

Drexel University

J. Jaime Miranda

Universidad Peruana Cayetano Heredia

JÁ

Juan Á. Rivera

Centers for Disease Control and Prevention

Olga L. Sarmiento

Universidad de Los Andes

Mariana Carvalho de Menezes

Universidade Federal de Minas Gerais

M. Arantxa Colchero

Instituto Nacional de Salud Pública

Ariela Braverman‐Bronstein

Instituto Nacional de Salud Pública

Cooperative Institutions

Instituto Nacional de Salud Pública

Drexel University

Universidad de Los Andes

Universidad Nacional Autónoma de México

ORCID

University of Michigan–Ann Arbor

University of Chile

Pontificia Universidad Católica de Chile

National Institute of Public Health

Johns Hopkins University

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City features related to obesity in preschool children: a cross-sectional analysis of 159 cities in six Latin American countries

The Lancet Regional Health - Americas (2023)

Jessica Hanae Zafra‐Tanaka Ariela Braverman‐Bronstein Cecilia Anza-Ramírez Ana Ortigoza Mariana Lazo

Childhood obesity is a rising global health problem. The rapid urbanization experienced in Latin America might impact childhood obesity through different pathways involving urban built and social features of cities. We aimed to evaluate the association between built and social environment features of cities and childhood obesity across countries and cities in Latin America.Cross-sectional analysis of data from 20,040 children aged 1-5 years living in 159 large cities in six Latin American countries. We used individual-level anthropometric data for excess weight (overweight or obesity) from health surveys that could be linked to city-level data. City and sub-city level exposures included the social environment (living conditions, service provision and educational attainment) and the built environment (fragmentation, isolation, presence of mass transit, population density, intersection density and percent greenness). Multi-level logistic models were used to explore associations between city features and excess weight, adjusting for age, sex, and head of household education.The overall prevalence of excess weight among preschool children was 8% but varied substantially between and within countries, ranging from 4% to 25%. Our analysis showed that 97% of the variability was between individuals within sub-city units and around 3% of the variance in z-scores of weight for height was explained by the city and sub-city levels. At the city-level, a higher distance between urban patches (isolation, per 1 SD increase) was associated with lower odds of excess weight (OR 0.90, 95% CI 0.82-0.99). Higher sub-city education was also associated with lower odds of excess weight, but better sub-city living conditions were associated with higher odds of excess weight.Built and social environment features are related to excess weight in preschool children. Our evidence from a wide range of large Latin American cities suggests that urban health interventions may be suitable alternatives towards attaining the goal of reducing excess weight early in the life course.The SALURBAL project (Salud Urbana en América Latina, Urban Health in Latin America) is funded by Wellcome [205177/Z/16/Z].

Cross-sectional study

10.1016/j.lana.2023.100458

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Citations (7)

Association Between Household Deprivation and Living in Informal Settlements and Incidence of Diarrhea in Children Under 5 in Eleven Latin American Cities

Journal of Urban Health (2024)

Victoria Alpaugh Ana Ortigoza Ariela Braverman‐Bronstein Carolina Pérez‐Ferrer Nicolle Wagner-Gutíerrez

Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84-1.28) and 3.19 times (95% CI 1.80-5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.

Association (psychology)

Informal Settlements

Human settlement

10.1007/s11524-024-00854-y

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Citations (1)

Social and built environment interventions to prevent alcohol, tobacco, and legal cannabis use: a scoping review

Andrés Sánchez‐Pájaro Tonatiuh Barrientos‐Gutiérrez Carolina Pérez‐Ferrer

Eligibility criteria: We will use the following inclusion criteria: 1) Document must mention by name or describe at least one intervention, strategy, program or policy to prevent alcohol, tobacco and legal cannabis use. 2) Document must contain enough information for the researchers to determine if the intervention, strategy, program or policy was aimed at modifying the social and/or built environment. 3) Intervention, strategy, program or policy must have been aimed at modifying the social and/or built environment, using the following definitions: Social environment: “…the immediate physical surroundings, social relationships, and cultural milieus within which defined groups of people function and interact…Social environments can be experienced at multiple scales, often simultaneously, including households, kin networks, neighborhoods, towns and cities, and regions…”; Built environment: “the surroundings or conditions designed and built through human intervention, where a person lives or operates”. 4) Document must mention that intervention/strategy/program/policy has been implemented within the last 30 years (1992-2022), whatever the setting, time frame, or subpopulation. 5) Document must be within the body of scientific literature (peer-reviewed articles, research journal commentaries, editorials, or perspective pieces), be a published book or book chapter, a government, multinational organization or non-profit organization report, or a dissertation/thesis. 6) Document must not be a conference abstract, public letter, speech transcript, budget report, independent website post or blog, or news article. 7) Document must be in English or Spanish. 8) Document must be open-source, publicly available online, or accessible through the INSP’s library services.

10.37766/inplasy2023.5.0101

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The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases

Public Health Nutrition (2019)

Carolina Pérez‐Ferrer Amy H. Auchincloss Mariana Carvalho de Menezes Maria F. Kroker‐Lobos Letícia de Oliveira Cardoso

Abstract Objective: Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition. Design: Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings. Setting: Studies conducted in LA countries. Participants: The search yielded 2695 articles of which eighty-four met inclusion criteria. Results: Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision ( n 27), marketing ( n 16) and labelling ( n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods. Conclusions: Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.

Food marketing

Food Choice

10.1017/s1368980019002891

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Citations (94)

Perspective: Mexico’s Experience in Building a Toolkit for Obesity and Noncommunicable Diseases Prevention

Advances in Nutrition (2024)

Juan Á. Rivera M. Arantxa Colchero Carolina Pérez‐Ferrer Sı́món Barquera

Non-communicable diseases (NCD) are a leading cause of death and disability worldwide, with higher risk of death in low- and middle-income countries. Diet and excess weight are risk factors for NCDs. In Mexico, the prevalence of overweight and obesity increased dramatically in the last 30 years and is among the highest in the world. To address this public health problem, governments and public health professionals have several policy instruments available. In this study, we present the policy instruments currently approved in Mexico, which include fiscal, informational, and authoritative tools that aim to improve the food environment and promote healthy behaviours (taxes, school food guidelines, front of pack labelling, marketing regulations and dietary guidelines). These types of interventions are important in regions like Latin America, where social inequities and poor access to information are common, and individual healthy choices often limited. These interventions target the environments in which individuals live, study, work, and seek entertainment, while limiting access to unhealthy choices and offering information to promote healthy alternatives. The Mexican experience in design, implementation, and evaluation of policies to improve the food environment can be useful for other low and middle income countries facing similar challenges. There are a number of cost-effective policy tools that help improve the food environment and prevent non communicable diseases. In countries with vast inequalities and with food systems incentivized to produce unhealthy options, a mix of policy tools is needed to effectively modify food environments, promote healthier food choices, and prevent and control the increasing trends in obesity and non-communicable diseases. In addition, more complex, global initiatives are required to achieve the transformation of the food system.

10.1016/j.advnut.2024.100180

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Citations (4)

6065-416. ANÁLISIS DE LA IMPLEMENTACIÓN DE LA RUTA ASISTENCIAL DE INSUFICIENCIA CARDIACA EN ATENCIÓN PRIMARIA

Revista Española de Cardiología (2024)

María Ferré Vallverdú Cristina Gastón Martínez Laura Molina Payà B Prat Carolina Pérez‐Ferrer

10.1016/s0300-8932(25)01111-x

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Citations (0)

[Tuberculosis and human immunodeficiency virus infection. A prospective study of 215 patients].

PubMed (1993)

Navarro J Guix B Bernacer A Nieto Rafael Borrás

Immune status

Source

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Relationship between body mass index and residential segregation in large cities of Latin America

BMC Public Health (2024)

Tamara Doberti Herrera Lorena Rodríguez Sandra Flores‐Alvarado Carolina Pérez‐Ferrer Diana Higuera

Obesity is a global health problem, and its connection with social and environmental factors is well-established. Social factors, such as urban segregation, may impact obesity through various mechanisms, including food and physical activity environments, as well as social norms and networks. This multilevel study aims to examine the effect of socio-economic residential segregation of Latin American cities on the obesity of individuals within those cities.

Biostatistics

10.1186/s12889-024-19074-9

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Citations (1)

Understanding the obesity dynamics by socioeconomic status in Colombian and Mexican cities using a system dynamics model

Heliyon (2024)

José D. Meisel Valentina Esguerra Carolina Pérez‐Ferrer Ivana Stankov Felipe Montes

Dynamics

10.1016/j.heliyon.2024.e39921

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Learning from international policies on trans fatty acids to reduce cardiovascular disease in low- and middle-income countries, using Mexico as a case study

Health Policy and Planning (2009)

Carolina Pérez‐Ferrer Karen Lock Juan Á. Rivera

Trans fatty acids (TFA) are a major risk factor for cardiovascular disease (CVD), and are consumed in large quantities in low- and middle-income countries as they are used to produce low cost, commonly eaten processed food products. International organizations agree that evidence linking TFA and CVD is strong enough to warrant public health action. This study investigates barriers and opportunities that exist for TFA policy development in low- and middle-income countries, through a literature review of international TFA policy and stakeholder analysis. Previous national policy responses have mostly been in developed countries. Voluntary reduction of TFA by the food industry, following food labelling and/or consumer lobbying, has been the approach in several countries but with varying levels of success, and resulting in major differences in formulation of products between countries. Canada and New York have now moved from voluntary to mandatory approaches. Only three countries have regulated the TFA content of food. Common factors for successful TFA reduction include increased consumer and political awareness of the health impacts of TFA and the need for champion consumer organizations. A stakeholder analysis, using the Mexican policy context as a case study, explored contextual issues influencing implementation of TFA regulation in low- or middle-income countries. Although the public health context seemed to be appropriate to promote TFA policy, the issue is not on the political agenda because it lacks legitimacy and support as a health or regulatory issue. The food industry and government resist the need for regulation, and there is no organized health or consumer lobby to counter this. This is likely to be the case in other middle- and low-income countries.

Champion

10.1093/heapol/czp040

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Citations (35)