title: Stakeholder perspectives on national policy for regulating the school food environment in Mexico.
abstract: In Mexico, the school environment has been promoting sale of unhealthy foods. There is little empirical evidence on multi-stakeholder perspectives around national school food policy to regulate this. We studied stakeholders' perspectives on the proposed regulation for school sale of unhealthy foods. Comments about the regulation were available from an open consultation process held in June 2010 before the approval and implementation of the regulation. To examine perspectives, we coded 597 comments for beliefs, expectations and demands in NVivo. We created matrices by actors: academics, parents, citizens, health professionals and food industry. For academics, citizens and health professionals, the primary issue regarding the regulation was obesity, while for parents it was health of children. Academics, citizens, health professionals and parents believed that government was responsible for health of citizens, expected that this regulation would improve eating habits and health (i.e. less obesity and chronic diseases), and demanded that unhealthy foods be removed from schools. Parents demanded immediate action for school food policy that would protect their children. Citizens and health professionals demanded nutrition education and healthy food environment. Food industry opposed the regulation because it would not solve obesity or improve diet and physical activity behaviours. Instead, industry would lose income and jobs. Food industry demanded policy aimed at families that included nutrition education and physical activity. There was substantial consensus in narratives and perspectives for most actor types, with the primary narrative being the food environment followed by shared responsibility. Food industry rejected both these narratives, espousing instead the narrative of personal responsibility. Consensus among most actor groups supports the potential success of implementation of the regulation in Mexican schools. With regard to addressing childhood obesity, sound government policy is needed to balance different perspectives and desired outcomes among societal actors, particularly in Mexico between food industry and other actors.
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México.
authors.forename: Eva C
authors.initials: EC
authors.lastname: Monterrosa
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México.
authors.forename: Fabricio
authors.initials: F
authors.lastname: Campirano
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México.
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Tolentino Mayo
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México.
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández Cordero
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México.
authors.forename: Martha
authors.initials: M
authors.lastname: Kaufer-Horwitz
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, 800 Sumter St. Room 216, Columbia, SC 29208, USA, Centro de Investigación y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, México and Obesity and Eating Disorders Clinic, Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Tlalpan 14000, D.F., México jrivera@insp.mx.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Rivera
mesh_terms: D001294:Attitude to Health; D002648:Child; D000067576:Child Health; D002675:Child, Preschool; D019649:Food Industry; D006801:Humans; D008800:Mexico; D018673:Nutrition Policy; D010290:Parents / Q000523:psychology; D063766:Pediatric Obesity / Q000517:prevention & control; D012572:School Health Services / Q000458:organization & administration*
keywords: Mexico; Stakeholder perspectives; childhood obesity; national policy; school food environment