Background: In 2020-2021, both Mexico and the United States implemented similar, newly formatted nutrition facts labels (NFLs). Mexico simultaneously implemented front-of-package warning labels (FoPWLs), which emphasize high amounts of less healthy nutrients described in NFLs (e.g., calories, sugar, salt, trans fat, and saturated fat) to enhance consumer understanding of nutrition information. Objectives: To evaluate these policies by comparing pre-and postpolicy trends in self-reported responses to NFLs. Methods: Annual surveys from the adult International Food Policy Study (2018-2023) were analyzed for Mexico (n = 24,832) and the United States (n = 25,464). Outcomes included reported ease of finding nutrition information in grocery stores and awareness, use, and understanding of NFLs (all measured on 1-5 Likert scales). A difference-in-differences method using adjusted and weighted linear regression models compared cross-country differences in trends for these outcomes over the transition (2019-2020), early (2019-2021), mid (2019-2022), and late (2019-2023) postimplementation periods relative to prepolicy trends (2018-2019). Results: Trends over the transition period (compared with prepolicy) were stable within and across countries. For all outcomes, trends up to the early implementation period (compared with prepolicy) were more positive in Mexico than in the United States (i.e., ease of finding nutrition information B = 0.195, P = 0.003; awareness B = 0.220, P < 0.001; understanding B = 0.332, P < 0.001; and use B = 0.211, P = 0.006), driven by both increases in Mexico (i.e., ease of finding B = 0.126, P = 0.008; awareness B = 0.132, P = 0.001; understanding B = 0.198, P < 0.001; and use B = 0.087, P = not significant [ns]) and decreases in the United States (i.e., ease of finding information B = ns; awareness B =--0.088, P =--0.049; understanding B =--0.134, P = 0.002; and use B =--0.124, P = 0.025). When evaluating mid and late postimplementation periods, contrasts favored Mexico over the United States for all outcomes, except NFL use, which did not differ within or across countries. Conclusions: Newly formatted NFLs in the United States did not increase awareness, understanding, or use of NFLs, particularly when compared with Mexico's new NFLs that were accompanied by FoPWLs. Further research should determine the labeling effects on eating behaviors.

BACKGROUND:Lack of knowledge about sugary drinks may contribute to the high prevalence of consumption. OBJECTIVES:This study aimed to assess knowledge of 1) sugar content, and 2) health effects of sugary drinks and associations with intake. DESIGN:Annual cross-sectional data from the International Food Policy Study were analyzed. Using pooled data from 2018 to 2021, Study 1 assessed knowledge of sugar content of sugary drinks within ±4 grams (1 teaspoon) of the actual value for 1 of 7 beverage types. Using data from 2019 and 2020 only, Study 2 assessed knowledge of health effects (obesity, diabetes, and tooth decay) with true/false measures. Sugary drink frequency of intake was assessed using a Beverage Frequency Questionnaire. PARTICIPANTS/SETTINGS:A total of 61,002 and 37,965 adults (aged 18 and over) from Australia, Canada, Mexico, the United Kingdom, and the United States were included in Studies 1 and 2, respectively. MAIN OUTCOME MEASURES:The main outcome measures were self-reported knowledge and intake of sugary drinks. STATISTICAL ANALYSIS PERFORMED:Negative binomial regressions examined the association between knowledge and sugary drink frequency of intake. Logistic regression models examined differences in knowledge of health effects between countries. RESULTS:Few participants correctly estimated the sugar content of beverages, except for water. Underestimation was most frequent for chocolate milk (34.9%) and 100% juice (29.7%), and overestimation most frequent for energy and diet soft drinks (51.3% and 50.5%, respectively). Most participants agreed sugary drink consumption can cause obesity (93.3%), diabetes (92.3%), and tooth decay (94.5%), with highest overall agreement in Mexico and Australia. In relatively few countries, knowledge of the sugar content of sports drinks, 100% juices, and diet soft drinks, as well as knowledge of health effects of sugary drinks, were associated with intake. No associations were found for chocolate milk, iced tea, and energy drinks. CONCLUSION:Findings indicate high awareness of the health effects of sugary drinks, but lower knowledge of their sugar content. The inconsistent findings between knowledge and intake indicate that measures only targeting knowledge may have limited impact.

Food pleasure and worry may operate differently across cultural contexts; however, no studies have examined food pleasure or worry and eating-related outcomes among Mexican Americans. This study explored whether: (1) food pleasure/worry were associated with individual-level cultural attributes; (2) food pleasure/worry were associated with eating-related outcomes; and (3) relationships between food pleasure/worry and eating-related outcomes were moderated by cultural attributes. Data were collected with 3,329 Mexican American adults recruited through online panels to complete an online survey between November and December 2022. Participants had unique IP addresses, were aged 18-100, lived in the U.S., were able to read in English or Spanish, and had Mexican heritage. The survey assessed food pleasure, food worry, six cultural attributes (e.g., language use), and five eating-related outcomes believed to be associated with eating pleasure (e.g., sugary drink consumption) or nutrition monitoring (e.g., use of Nutrition Facts labels). Most participants rated food pleasure as important (83.6%) and had no food worry (83.1%). Rating food pleasure as important (vs. not) was associated with more Latino-oriented cultural attributes, higher sugary drink intake, consuming food prepared outside the home, and greater importance of sugary drinks at social gatherings. Having food worry (vs. not) was associated with being foreign-born, lower sugary drink intake, lower importance of sugary drinks at social gatherings, and greater likelihood of using Nutrition Facts labels. There was no strong evidence of moderation by cultural attributes. Food pleasure was associated with more obesogenic behaviors, and food worry was associated with more nutrition monitoring behaviors. More nuanced measurement of these food attitudes is needed to elucidate how food pleasure and worry influence eating behaviors, as well as whether nutrition interventions should target these food attitudes to promote healthy eating among Mexican American adults.

Objetivo. Documentar la conformación de la Red Mexicana de Investigación sobre Actividad Física, Sueño y Sedentarismo (REMIASS) y reportar acciones prioritarias en México para frenar y revertir la crisis de inactividad física y comportamientos sedentarios en México. Material y métodos. Se realizó un mapeo y una convocatoria de la comunidad académica y científica en México. Mediante el método Delphi modificado se desarrolló una encuesta en línea para buscar consenso (>80%) para identificar acciones prioritarias analizadas mediante estadísticas descriptivas. Resultados. Las acciones prioritarias recomendadas por REMIASS fueron mejorar los índices de criminalidad y la apropiación del espacio público; incrementar la seguridad de peatones y ciclistas; desarrollar e implementar una Estrategia Nacional de Promoción de la Actividad Física; fortalecer la capacitación en actividad física, comportamiento sedentario y sueño; y promover una educación física de calidad. Conclusiones. Este esfuerzo suma a las acciones para atender la salud humana y planetaria.

Objectives To estimate the proportion of children who meet the restrained sitting guidelines (i.e. <1 h in continuous restrained sedentary). The secondary aim was to determine which factors contribute to the probability a child will meet the restrained sitting guidelines. Design Secondary data analysis of 32 countries participating in the SUNRISE International Study. Methods Parent surveys were used to collect child demographic information and total restrained sitting. Physical activity was assessed with an accelerometer (ActiGraph wGT3X-BT). A generalized linear mixed model was used to determine the probability of a child meeting the restrained sitting guidelines based on sex, age, geographic region, time spent in a vehicle, and hours of total physical activity. Separate models were run by country income level. Results Final analysis included 2647 children (4.3 ± 0.5 years, 50.6% girls, 49.0% rural). Overall, 81.9% of participants met the restrained sitting guidelines. Odds of meeting the guidelines were 35% lower for children in urban areas and 71% lower for spending 60 min or more in a vehicle Every additional hour of physical activity increased the odds of meeting the guidelines by a factor of 1.25. These relationships differed when stratified by country income level. Conclusions While most children meet the guidelines, a focus on children living in urban areas, spending more time in vehicles, and those who engage in less physical activity is warranted.

Objective We assessed changes in bicycle ridership patterns associated with COVID-19-related restrictions and the implementation of large-scale temporary cycleways in Mexico City. We assessed differences in overall, male, and female bicycle ridership before and after the onset of the pandemic and the introduction of temporary cycleways, according to their availability, and examined weekly post-onset ridership trends. Methods Quasi-experimental study using manual bicycle counts collected across street segments with regular, temporary, or no cycleways. Data were collected at three timepoints: October 2019–March 2020 (Time 1, 84 segments, 1541 observations), August–November 2020 (Time 2, 60 different segments, 2135 observations), and November 2021–February 2022 (Time 3, same 60 segments, 2266 observations). Crude, adjusted, and inverse-probability-weighted Poisson models with time-by-cycleway interaction terms estimated changes in ridership over time. Fixed-effects Poisson models assessed weekly trends from Time 2 to Time 3. Results Relative to stable trends on streets without cycleways, those with cycleways experienced greater ridership increases at Time 2 (AIRR: 1.47, 95% CI: 1.35–1.61) and Time 3 (AIRR: 1.74, 95% CI: 1.60–1.89), with stronger associations among female riders (AIRR Range: 1.51–1.95). From Time 2 to Time 3, male ridership declined on streets with no or regular cycleways (0.1%–0.3% weekly decrease), but remained stable on temporary ones. Female ridership increased weekly on streets with temporary cycleways (0.6%) and without cycleways (0.2%), and remained stable on regular cycleways. Conclusion Temporary cycleways were associated with sustained or increasing ridership, particularly among women, suggesting their potential to support more equitable and longer-term transitions toward cycling in large Latin American cities.

Objective. To explore barriers and facilitators to physical activity, sedentary behavior, and sleep among low-income older adults (OA) and people with limited mobility (PLM) in urban and rural Mexico. Materials and methods. A cross-sectional study with twelve focus groups. Results. OA and PLM shared barriers and facilitators. Participants perceived more barriers than facilitators to physical activity, largely due to poor infrastructure, medical indications, physical fatigue, and safety concerns. Environmental factors such as noise, hot weather, insects, and screen use were shared barriers for sleep. However, social support encouraged physical activity, active breaks limited sedentary behavior, and relaxation techniques, and consistent bedtime routines enhanced sleep. For OA, personal motivation and green spaces were also physical activity facilitators. For PLM, family overprotection contributed to increased sedentary behaviors. Conclusions. This study highlights the need for inclusive public health initiatives that address structural and social barriers, fostering more active and healthier lifestyles for these populations.

Introduction Sugar-sweetened beverages (SSBs) are a major source of added dietary sugars in Mexico and the US and contribute to chronic disease risk. In 2020, Mexico implemented mandatory front-of-package warning labels (FoPWLs), and the US implemented updated Nutrition Facts labels that increased the salience of calories and added sugars. We compared changes in SSB intake in Mexico and the US. Methods Using 6 annual cross-sectional surveys (2018-2023) from the International Food Policy Study, we analyzed Mexican (n = 24,574) and US (n = 25,019) adults. Past-week SSB intake was summarized across 5 SSB categories. Outcomes were any SSB consumption, SSB consumption frequency, and, among SSB consumers, total volume, calories, and added sugars from SSBs. Difference-in-differences models with country-by-period interactions (2018-2019 vs 2020-2023) adjusted for sociodemographic and behavioral covariates; sex-stratified analyses were also conducted. Results From 2018-2019 to 2020-2023, any SSB consumption and SSB consumption frequency increased in the US (adjusted odds ratio, 1.26; 95% CI, 1.17-1.36; adjusted incidence rate ratio, 1.16; 95% CI, 1.10-1.22, respectively). In Mexico, any SSB consumption also increased (adjusted odds ratio, 1.11; 95% CI, 1.00-1.22), but increases were smaller than in the US for any consumption (adjusted odds ratio, 0.88; 95% CI, 0.77-0.99) and frequency (adjusted incidence rate ratio, 0.89; 95% CI, 0.84-0.95). Among SSB consumers, changes in volume, calories, and added sugars did not differ between countries overall. In sex-stratified models, Mexican women had a greater relative reduction in SSB volume than US women (adjusted regression coefficient, -304 mL/week; 95% CI, -593 to-16). Conclusion Compared with contemporaneous changes in the US, Mexico's FoPWL implementation was associated with more favorable trends in whether and how often adults consumed SSBs, but not in overall changes in volume, calories, or added sugars among SSB consumers.

Objective. To document the establishment of the Mexican Research Network on Physical Activity, Sleep, and Sedentary Behaviour (REMIASS) and to report priority actions in Mexico to address and reverse the crisis of physical inactivity and sedentary behaviours. Materials and methods. A mapping and a call for participation were carried out among the academic and scientific community in Mexico. Using the modified Delphi method, an online survey was developed to seek consensus (>80%) in order to identify priority actions, which were analysed through descriptive statistics. Results. The priority actions recommended by REMIASS were improving crime rates and the appropriation of public space; increasing pedestrian and cyclist safety; developing and implementing a National Strategy for the Promotion of Physical Activity; strengthening training on physical activity, sedentary behaviour, and sleep; and promoting quality physical education. Conclusions.This effort contributes to actions aimed at addressing both human and planetary health.

PurposeEvaluate trends and correlates of self-reported awareness of and responses to front-of-package warning labels (FoPWLs) on packaged Mexican foods among Mexican Americans (MAs) in the United States (US).DesignInternational Food Policy Study annual cross-sectional surveys (2021, 2022, 2023).SettingOnline survey.SampleMA adults in the US (n = 9662).MeasuresSelf-reported past-month frequency of buying food at Mexican-oriented stores (recoded: often/very often vs less often), awareness of Mexican FoPWLs (recoded: often/very often vs less often), and self-reported reductions in purchasing less healthy foods (yes vs no for eight foods) due to FoPWLs.AnalysisAdjusted logistic models regressed binary outcomes (above) on sociodemographics and survey year.ResultsMost participants bought food in Mexican-oriented stores (87.2%). Of those who noticed Mexican FoPWLs (67.6%), many reported that FoPWLs influenced them to reduce purchasing less healthy foods (range = 31.1% [snacks like chips] to 43.9% [cola]). In adjusted models, noticing FoPWLs often/very often (vs less often) increased over time (AOR2022 vs 2021 = 1.30; AOR2023 vs 2021 = 1.21), as did self-reported reductions in purchasing sweetened fruit drinks (AOR2022 vs 2021 = 1.27), and desserts (AOR2022 vs 2021 = 1.32). People with limited vs adequate health literacy reported higher awareness of FoPWLs (AOR = 1.21).ConclusionMAs' awareness and reported effects of Mexican FoPWLs were high and stable or increased over time, with greater awareness among those with limited health literacy.

Background: Postmenopausal women with a sedentary lifestyle and lower physical activity have a worse metabolic profile. Additionally, there is no consensus on the cut-off points to classify sedentary behavior (SED) and movement. Objective: To analyze the association between SED and cardiovascular risk indicators and the association between reclassifying SED as light physical activity (LPA) and body and truncal fat, glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and leptin. Methods: This cross-sectional study assessed SED and LPA via accelerometry in 89 postmenopausal women. We classified SED and LPA using Vanhelst and Freedson’s cutoff points. We evaluated body composition, truncal fat, glucose, insulin, HOMA-IR, and leptin levels. Associations were analyzed through linear and logistic regression models, adjusting for confounders. Results: In this study of postmenopausal women with overweight or obesity, higher SED time (0.40 counts per minute [CPM]) was positively associated with adiposity and metabolic markers. Each 10% increase in SED time was associated with a 0.8% higher total body fat (ß = 0.8; 95% Confidende Interval (CI): 0.1, 1.5) and a 1.3 kg higher truncal fat mass (ß = 1.3; 95% CI: 0.4, 2.3), while women in the highest SED tertile showed higher insulin and leptin levels. Conversely, higher LPA was inversely associated with trunk fat (ß = 1.0; 95% CI: −1.8, −0.2) and leptin (ß = 3.0 µg/ML; 95% CI: −5.5,−0.5); 95% CI: −1.8, −0.2), particularly using a > 40 CPM threshold. Conclusions: SED is a risk factor for metabolic disorders and increased body fat among postmenopausal women, whereas LPA may be protective, even at low intensities.

Objective. To analyze changes in the use and objective understanding of the Mexican front-of-package warning labeling system (SEFAM) between 2021 and 2024. Materials and methods. A semi-structured questionnaire was administered to adults aged 20 years and older within a subsample of the Encuesta Nacional de Salud y Nutrici & oacute;n. Questions focused on the use of the labelling system and the correct identification of the meaning of the excess warning label. Crude and adjusted logistic regression models were used for the analysis, controlling for respondents' sociodemographic characteristics. Results. Between 2021 and 2024, there was a 15.5 percentage points increase in the identification of the "Excess Calories" warning label on sugar-sweetened beverages, and a 12 percentage point increase in the objective understanding of SEFAM. Conclusion. Five years after its implementation, an increase has been observed in the use and understanding of SEFAM among Mexican adults, which could contribute to strengthening informed decision-making at points of sale.

Study Objectives To examine (1) multidimensional sleep profiles in preschoolers (3-6 years) across geocultural regions and (2) differences in sleep characteristics and family practices between Majority World regions (Pacific Islands, Sub-Saharan Africa, Eastern Europe, Northeast Asia, Southeast Asia, South Asia, the Middle East and North Africa, and Latin America) and the Minority World (the Western world).Methods Participants were 3507 preschoolers from 37 countries. Nighttime sleep characteristics and nap duration (accelerometer: n = 1950) and family practices (parental questionnaire) were measured. Mixed models were used to estimate the marginal means of sleep characteristics by region and examine the differences.Results Geocultural region explained up to 30% of variance in sleep characteristics. A pattern of short nighttime sleep duration, low sleep efficiency, and long nap duration was observed in Eastern Europe, Northeast Asia, and Southeast Asia. The second pattern, with later sleep midpoints and greater night-to-night sleep variability, was observed in South Asia, the Middle East and North Africa, and Latin America. Compared to the Minority World, less optimal sleep characteristics were observed in several Majority World regions, with medium-to-large effect sizes (divided by d divided by=0.48-2.35). Several Majority World regions reported more frequent parental smartphone use during bedtime routines (Northeast Asia, Southeast Asia: 0.77-0.99 units) and were more likely to have electronic devices in children's bedroom (Eastern Europe, Latin America, South Asia: OR = 5.97-16.57) and co-sleeping arrangement (Asia, Latin America: OR = 7.05-49.86), compared to the Minority World.Conclusions Preschoolers' sleep profiles and related family practices vary across geocultural regions, which should be considered in sleep health promotion initiatives and policies.

Objetivo. Examinar la prevalencia y tendencia de la actividad física, comportamiento sedentario y sueño en adolescentes mexicanos, así como su asociación con factores sociodemográficos. Material y métodos. Estudio transversal con datos de adolescentes de 15-19 años de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 a 2022-2024. Se usaron modelos lineales generalizados para comparar minutos diarios, prevalencias por encuesta y regresión logística con el fin de analizar asociaciones con factores sociodemográficos. Resultados. Las mujeres, los menores de 18 años y quienes no trabajan, así como aquellos con mayor bienestar y que viven en zonas urbanas, reportaron menos minutos por día de actividad física moderada a vigorosa. El tiempo sentado por día aumentó de 2012 a 2022-2024 en casi todos los grupos. El incumplimiento de las recomendaciones aumentó en los tres comportamientos en el mismo periodo. Las mujeres, los adolescentes menores de 17 años, quienes no trabajan, con alto índice de bienestar y escolaridad, que viven en zonas urbanas y en el norte del país tuvieron mayor posibilidad de no cumplir con una o tres de las recomendaciones. Conclusiones. Existen desigualdades en el cumplimiento de los tres comportamientos (actividad física, sedentarismo y sueño) en los adolescentes mexicanos, especialmente en mujeres, residentes en áreas urbanas, con mayor escolaridad y mayor nivel de bienestar, así como en residentes del norte del país.

BACKGROUND:Women face greater challenges meeting physical activity guidelines than men especially during pregnancy and postpartum. We examined physical activity associated factors and trends among Mexican men and women from 2006 to 2023, disaggregated by demographic characteristics, including women's physiological status (nonpregnant, pregnant, and postpartum). We also assessed whether the 2030 World Health Organization goal of a 15% reduction in physical inactivity is achievable based on 2012-2023 trends. METHODS:Adult data (20-65 y; n = 101,047) were compiled from the 2006, 2012, 2018, and 2022/2023 National Health and Nutrition Surveys. Physical activity was assessed using the International Physical Activity Questionnaire short form. Sociodemographic characteristics and physiological status were self-reported. Multivariate logistic and generalized linear regression models computed estimates. RESULTS:From 2006 to 2022/2023, the percentage meeting physical activity guidelines declined among women (86.5% to 79.5%, -0.41% points/y) and men (87.1% to 83.0%, -0.24% points/y). The steepest overall declines (-0.52 to -0.90% points/y) occurred among women who were pregnant, postpartum, aged 50-59 years, indigenous, or living in 4 of the 8 country regions. Pregnant women experienced the largest decline from 2006 to 2012 but showed slight rebounds in 2018 and 2022/2023. Assuming 2012-2022/2023 trends persist, the 2030 global target will not be met, with widening sex gaps expected. Pregnant women, and men and women aged 60 or older, or living in the Peninsula region seemed to be on track to meet the target. CONCLUSIONS:Current trends in Mexico suggest widening sex gaps in physical activity and predict the country is offtrack to meet the 2030 target.

OBJECTIVE:To examine the associations between parent perceived environmental factors, nighttime sleep duration and 24-h sleep duration among an international sample of preschool-aged children. METHODS:Secondary analyses of cross-sectional data from preschoolers across 23 countries (19 LMICs), collected during the third pilot phase (January 2021-August 2024) of the SUNRISE Study. Parents completed a questionnaire which asked about their child's sleep patterns and environmental factors that impacted their child's sleep in the previous 3 days. RESULTS:Data from 2,219 children were analyzed. A significant difference was observed between nighttime sleep (F = 14.27, p = <0.0001) and nap duration (F = 9.10, p = 0.0004) across country income level. Environmental factors such as heat (-12.87, 95% CI: -11.54, -0.61) and cold (-17.70, 95% CI: -34.53, -0.85) were negatively associated with nighttime sleep duration. CONCLUSIONS:Public health researchers and professionals should prioritize context-specific strategies to minimize the impact of weather conditions on sleep to promote healthy levels of sleep among preschoolers from diverse settings.

Background The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear. Objective To identify how to improve surveillance of movement behaviours, from the perspective of experts. Methods This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important. Results We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research. Conclusions This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.

BACKGROUND:The time spent physically active outside of school (e.g., extracurricular physical activity) is an important contributor to children's total daily physical activity for health and well-being. Little is known about the opportunities available to children to engage in extracurricular physical activity from low- to middle-income countries. This study aims to answer the question: What are the main perceived barriers and facilitators of extracurricular physical activity among school-age children in Mexico? METHODS:A multi-method cross-sectional study was performed. Six focus groups with children (aged 9-12 years), six focus groups with parents, 10 one-on-one interviews with parents, 12 interviews with teachers, and six interviews with head teachers were conducted across Campeche, Morelos, and Mexico State, Mexico. A questionnaire was applied to explore children's physical activity frequency and preferences for time inside and outside of school. Qualitative data analyses were performed with inductive thematic analysis supported with NVivo software. Quantitative data were analysed with descriptive statistics using IBM SPSS 26. RESULTS:Three main themes summarise the study's findings: (1) how children spend their time outside of school, (2) the places that children access, and (3) the social environment for physical activity outside of the school. The data suggest that children in Mexico dedicate their spare time to screen, work, do housework, or perform unstructured physical activity mostly at home instead of playing sports or actively outdoors. Family support, enjoyment of physical activity, access to programs and facilities, time, living in a housing complex with open common areas, and mild weather were important facilitators identified. 69.4% of children engage in extracurricular physical activity, none of which was provided by schools. More children commute by walking than riding a bike to and from school. Children living inland spent three times more time at home compared to those in seafront areas. CONCLUSIONS:Children rely on their families to partake in extracurricular structured physical activity. Policies targeting children's health and well-being should include school-based extracurricular physical activity programs.

Diet-related non-communicable diseases (NCDs) are major global health concerns. Front-of-package warning labels (WLs) and nutrition facts labels (NFLs) aim to promote healthier food choices, yet their use among individuals with NCDs and across populations remains underexplored. This study uniquely compares two labeling systems (WL and NFL) and examines the association between NCD diagnosis and label use among Mexican, Mexican American, and non-Mexican American adults. Cross-sectional data from the 2021–2022 International Food Policy Study were analyzed. Self-reported WL and NFL use and NCD diagnoses (diabetes, hypertension, heart disease, high cholesterol, cancer) were examined using multivariate logistic regression models adjusting for sociodemographic and health-related confounders. Among 23,951 adults, NFL use was highest among non-Mexican Americans (80.1

Background: Investigators from low-, middle-, and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ). The GAC-PAQ is designed to assess physical activity (PA) across all key domains (i.e., school, chores, work/volunteering, transport, free time, outdoor time). It aimed to address multiple gaps in global PA surveillance (e.g., omission of important PA domains, insufficient cultural adaptation, underrepresentation of rural areas in questionnaire validation studies). The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts, 8-to 17-year-olds, and one of their parents/ guardians, and to discuss changes made to the questionnaire based on participants' feedback. Methods: Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed-and open-ended questions about the content validity of the GAC-PAQ. The proportion of experts who agreed or strongly agreed with the items was calculated. Child-parent/guardian dyads from 15 countries (n = 250; 10-40 per country) participated in a structured cognitive interview to assess the clarity of the questions and response options, and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire. Participating countries are: Aotearoa New Zealand, Brazil, Canada, China, Colombia, Czech Republic, India, Malawi, Mexico, Nepal, Nigeria, Spain, Sweden, Thailand, and the United Arab Emirates. Interviews were conducted in 13 different languages and structured by PA domain. Generic images were included to help participants in answering questions about PA intensity. Results: Expert agreement with the items for each domain exceeded 75%, and their qualitative feedback was used to revise the questionnaire before cognitive interviews. In general, participants found the questionnaire to be comprehensive. Adolescents (12-17 years) found it easier than children (8-11 years) to answer the questions. Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes, active trips, and organized activities. Many parents/guardians were unsure about the frequency, duration, and intensity of their children's or adolescents' PA at school and/or recommended using more culturally relevant and appropriate images. Some participants misunderstood the concept of activities that "make you stronger" (intended to assess resistance activities) and/or struggled to differentiate between work, volunteering, and chores. Conclusion: Participants' feedback was used to develop a revised, simplified, and culturally adapted GAC-PAQ, which will be pilot-tested in all 15 countries in an App that will include country-specific images and narration in local languages. Further research is needed to assess the reliability and validity of the revised GAC-PAQ.