Unhealthy food and beverage products marketed through diverse media platforms contribute to poor diet quality, obesity, and chronic diseases in the United States (US). Limited empirical research is available on the effectiveness of integrated marketing communications (IMC) and branded media campaigns used to positively influence Americans' diet-related cognitive, behavioral and health outcomes. The purpose of this research was to assess and inform the Partnership for a Healthier America's Fruits and Veggies (FNV) Campaign to increase fruit and vegetable purchases and intake among targeted teen and mom populations. This PhD research evaluated the use, outcomes, and perspectives on branded food marketing campaigns to inform the FNV Campaign through four studies. Study 1 used a mixed-methods research approach that included a scoping review; comprehensive review of peer-reviewed articles, gray literature and media sources; and key-informant interviews (n=11) to identify 13 national branded marketing campaigns that used health-branding strategies to encourage healthy dietary purchases and consumption in the US between 1990-2016. Study 2 explored views of diverse stakeholders (n=22) regarding the FNV Campaign using semi-structured interviews that were thematically analyzed using a conceptual framework with eight constructs (i.e., campaign design, reach, adoption, effectiveness, impact, expansion, scaling up and sustainability). Study 3 assessed FNV Campaign awareness, cognitions and behaviors for buying and eating fruits and vegetables through a survey of targeted teen and millennial mom audiences (n=1,604) in Hampton Roads, Virginia and Fresno, California where the FNV Campaign pilot was launched. Study 4 encompassed a mixed-methods evaluation using data from the second and third studies that assessed and explored congruence between FNV brand awareness and recall of IMC strategies among survey respondents with stakeholders' perspectives regarding IMC strategy contexts and potential. This body of research expands knowledge about the effectiveness of diet-related IMC and media campaigns and provides a foundation for future FNV Campaign evaluations. Taken together, findings across the four studies identified significant opportunities for large-scale IMC campaigns to improve evaluation designs and outcome reporting. These results can inform evidence-based strategies and policies to improve the design of the FNV Campaign and other IMC initiatives to improve dietary patterns and population health. / Doctor of Philosophy / Marketing promotions for unhealthy foods and beverages are widespread in the United States (US) and influence Americans' diet choices that lead to weight gain, obesity, and chronic diseases. There is little understanding of how marketing and media campaigns can be used to positively influence Americans' to consume high quality diets and improve their health outcomes. The purpose of this research was to assess and inform the Partnership for a Healthier America's Fruits and Veggies (FNV) Campaign to increase fruit and vegetable purchases and intake among target populations. This PhD research evaluated the use, outcomes, and perspectives on branded food marketing campaigns to inform the FNV Campaign through four studies. Study 1 used a mixed-methods research approach that included a scoping review of the academic and non-academic literature, and key-informant interviews to identify 13 national branded marketing campaigns that used branding strategies to encourage healthy diets in the US between 1990-2016. Study 2 used interviews to explore the views of 22 stakeholders experienced with the FNV Campaign or fruit and vegetable promotion. Interviews were thematically analyzed using a framework with eight constructs (i.e., campaign design, reach, adoption, effectiveness, impact, expansion, scaling up and sustainability) to understand diverse stakeholder perspectives. Study 3 assessed FNV Campaign awareness, cognitions and behaviors for buying and eating fruits and vegetables through a survey of targeted teen and millennial mom audiences (n = 1,604) in Hampton Roads, Virginia and Fresno, California where the was initially launched. Study 4 used data from the second and third studies that assessed similarities and differences between FNV brand awareness and recall of marketing strategies among survey respondents with stakeholders' perspectives regarding marketing strategy contexts and potential. This body of research expands knowledge about the effectiveness of diet-related marketing and media campaigns and provides a foundation for future FNV Campaign evaluations. Taken together, findings across the four studies identified opportunities for large-scale marketing campaigns to improve evaluation designs and outcome reporting. These results can inform future strategies and policies to improve the design of the FNV and other IMC campaigns to improve population diets and health.

Urbanisation and the associated nutrition transition have been linked with the recent rise in osteoporotic fragility fracture incidence in many countries. Predictions indicate that hip fracture incidence will increase 6-fold in Africa and Asia by 2050, partially attributed to demographic transition and population ageing. Differences in areal bone mineral density (aBMD) between rural and urban locations indicate that urban regions of high-income countries (HIC) have lower aBMD and a higher incidence of hip fracture. The few studies conducted in low and middle-income countries (LMIC) provide inconsistent results; in contrast to HIC, most have found higher aBMD in urban populations. To investigate the impact of migrating to an urban environment, detailed studies of bone phenotype and factors affecting bone health have been conducted in two groups of pre-menopausal Gambian women: urban migrant (n=58) and rural (n=81). Both groups spent their formative years in the same rural setting of Kiang West, urban women were known to have migrated to coastal districts, concentrated in Brikama and Kanifing, when aged ≥16 years. Bone phenotype (bone mineral content (BMC); bone area (BA); aBMD, and size-adjusted BMC (adjusted for height, weight and BA) of the whole-body, lumbar spine and hip) was measured by dual energy x-ray absorptiometry (DXA), with further characterisation by peripheral quantitative computed tomography (pQCT). Data were also collected on anthropometry, body composition, food and nutrient intakes, physical activity, socio-demographic characteristics, vitamin D status, and 24hr urinary mineral outputs (Na, K, P, and Ca). Mean age and height of rural and urban migrant groups were not significantly different (p > 0.05). Urban migrant women were significantly heavier (p < 0.01). Significant differences in BMC and aBMD were found between groups at all skeletal sites, with urban women having higher BMC and aBMD; BA was not significantly different. The greatest difference in BMC was found at the lumbar spine (8.5% ± SE 3.0, p < 0.01), a meaningful difference, equivalent to 0.76 of rural SD. T- Scores were also calculated using a young adult (white, female) reference population, mean T- scores were -1.03 and -0.22, for rural and urban groups respectively. After adjusting for size, differences in whole-body and hip BMC were mostly attenuated (p > 0.05), but difference in spine BMC remained significant (6.2% ± SE 2.1, p < 0.01). These results indicate that rural-to-urban migration is associated with higher BMC; BA and height were similar, and difference in body weight could not fully account for higher BMC at the lumbar spine. Calcium intakes were low in both groups, urban migrant 294mg/d (IQR: 235 to 385) and rural 305mg/d (IQR: 222 to 420). Urban women had significantly lower intakes of potassium, magnesium and dietary fibre (p < 0.01), related to lower consumption of fruit, green leafy vegetables and groundnuts. 25-hydroxy vitamin D status was good in both groups, urban migrant 64.0 ± 14.2nmol/L and rural 68.3 ± 15.7nmol/L (M ± SD, p > 0.05). Implications for bone health of the nutrition and demographic transition, principally future fracture risk and other non-communicable diseases require further research in LMICs. ORIGINAL CONTRIBUTION TO KNOWLEDGE To my knowledge, this is the first study investigating the impact of rural-to-urban migration on bone health to be conducted in sub Saharan Africa. It is the first study of bone health and determinants of bone health in an urban population in The Gambia.

Viena iš sveiko gyvenimo būdo formavimo veiksnių yra sveikatos raštingumas. Socialinis ugdymas ir pagalba, tame tarpe psichologinė-pedagoginė, šeimoms, auginančioms vaikus, yra viena svarbiausių socialinės apsaugos krypčių. Tokios veiklos svarba yra neabejotina, siekiant užtikrinti visapusišką vaikų gyvenimą dabar ir ateityje: tinkamą buitį, socialinį-psichologinį saugumą, auklėjimą ir kt. Darbo tikslas: atskleisti visuomenės požiūrį į šeimos pedagogo vaidmenį vaiko sveikatos raštingumo ugdyme. Uždaviniai: 1. Nustatyti visuomenės požiūrį į šeimos pedagogo poreikį. 2. Atskleisti visuomenės nuomonę apie šeimos pedagogo specializacijų poreikį. 3. Įvertinti visuomenės požiūrį į šeimos pedagogo vaidmenį sveikatos raštingumo ugdyme. Tyrimo metodika. Duomenų surinkimui pasirinktas metodas – anketinė šeimų, auginančių vaikus apklausa. Respondentų (šeimų, auginančių vaikus) atrankai naudotas prieinamų atvejų būdas. Siekiant išsiaiškinti šeimos pedagogų poreikį bei jų vaidmenį sveikatos raštingumo ugdyme buvo apklausta 126 šeimų atstovai. Iš jų 80,2 proc. sudarė moterys ir 19,8 proc. – vyrai, 54,8 proc. miesto ir 45,2 proc. rajono tipo gyvenviečių ir kaimo gyventojai. Respondentų amžiaus vidurkis 38,9 metai (standartinė paklaida (SD) - 0,7 metai). Jauniausias asmuo buvo 24, vyriausias – 65 metų amžiaus. Tyrime dalyvavę respondentai augino nuo 1 iki 5 vaikų. Pirmojo vaiko amžiaus vidurkis buvo 10,8 (SD = 0,5 metai), penktojo – 20,8 (SD = 0,8 metai). Rezultatai. Respondentų nuomonė... [toliau žr. visą tekstą] / One of the main conditions for the promotion of healthy lifestyle is health literacy. Social education and assistance including psychological-pedagogical aid for families with children becomes one of the most significant approaches to social security. The importance of a certain activity is undeniable, especially in order to ensure children’s everyday life now and in future: proper household, social-psichological safety, education, etc. Aim of the study. The aim of research is to reveal the public attitude towards the influence of the family pedagogue in the development of health literacy. Tasks: 1. To determine the public attitude towards the demand of the family pedagogue. 2. To reveal the public attitude towards the demand of specializations of the family pedagogue. 3. To estimate the public attitude towards the influence of the family pedagogue in the development of health literacy. Methods. Questionnaire poll, which was filled in by families having children. This method allows selecting large amount of data. A survey covering the opinion of 126 families’ was carried out, in order to ascertain the influence of the family pedagogue in the health literacy education. 80,2 % of the respondents were women and 19,8 % – men. 54,8 % respondents were from urban and 45,2 % from rural areas. The average age of the respondents was 38,9 (Standard deviation (SD) - 0,7). The number of children in the respondents’ families ranged from 1 to 5 children. Results. The attitude of... [to full text]

abstract: Health is among the most basic needs of the people and driving force of social and economic development. The health nutrition & wellness industry is gradually becoming a global sunrise industry . However, the industry is faced many problems and challenges including weaknesses in the industry structure, fragmentations of supply chain, low efficiency in resources allocation, and lacking in quality on personnel training. To achieve core competitiveness and value creation, it is important that the health nutrition & wellness industry must meet the needs of Chinese market and its customers with a customer centric perspective to design a firm’s organization strucrture and management processes. This thesis is based on an analysis of the competitive landscape faced by the nutrition & wellness industry as exemplified by By-Health.Ltd. The investigation begins with an analysis and synthsis of the common industry practices on sales & distribution channels for their underlying similarities and differences in product strategies, branding strategies, and agency models on incentive design and profit sharing mechanisms. Through an empirical survey, this thesis also investigate customer’s demand for nutritious and healthy products. The results through factor analysis reveal that such demands are driven by individual factor, product factor, enterprise factor and environmental factor. The study concludes with a proposed framework to link customer value through three innovative designs in sales and distribution: community marketing model, sharing marketing model and Internet factory marketing model. / Dissertation/Thesis / Doctoral Dissertation Business Administration 2018

<p>Dietary supplement (DS) use is highly prevalent in the U.S. and can contribute substantial amounts of micronutrients to the one-half of U.S. adults and nearly one-third of U.S. children who use them. Despite their pervasive use, the best practices for assessing the prevalence of use of and measuring nutrient intakes from supplemental sources remain largely unknown, and currently no metric designed to assess total micronutrient exposures from foods, beverages, and DS exists. Comprehensive and robust methods for assessing the prevalence of use of and nutrient intakes from DS are critical for population-level research and surveillance. </p> <p>Therefore, the overarching aims of the research presented in this dissertation were to 1) identify the most comprehensive method for assessing the prevalence of use of and estimating nutrient intakes from DS, 2) characterize DS use and examine trends in overall and micronutrient-containing DS use among the U.S. population using multiple modes of DS assessment, 3) develop the first micronutrient-based diet quality index designed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population (i.e., the Total Nutrient Index (TNI)) and 4) to determine if the TNI is a useful measure for assessing total micronutrient exposures among the U.S. adult population.</p> <p>National Health and Nutrition Examination Survey (NHANES) 2011-2014 data among U.S. adults were employed to evaluate four combinations of methods constructed from two data collection instruments (i.e., the 24-hour dietary recall (24HR) and the NHANES in-home inventory with a frequency-based DS prescription medicine questionnaire (DSMQ)) for measuring the prevalence of use of and amounts of selected nutrients from DS. The results from the analysis indicated that a higher prevalence of DS use is reported when using frequency-based methods, like the DSMQ, but higher nutrient amounts are reported on the 24HR. Thus, combining the DSMQ with at least one 24HR (i.e., DSMQ or ≥1 24HR) provides the most comprehensive approach for measuring DS use and estimating nutrient intakes from supplemental sources among U.S. adults.</p> <p>Differences in the estimated prevalence of use of DS on the DSMQ or ≥1 24HR as compared with the DSMQ only were also noted among a nationally representative sample of the U.S. population from the 2007-2018 NHANES. When characterizing DS use and examining trends in overall and micronutrient-containing DS use among the U.S. population using multiple modes of DS assessment, increases in both overall and micronutrient-containing DS use were observed over time, but the prevalence of use was lower on the DSMQ than the DSMQ or ≥1 24HR among the total population and across all population subgroups. Therefore, the findings from this study were congruent with our previous analysis and contributed to a growing body of literature that utilizes multiple methods of DS assessment to improve the comprehensiveness of DS exposure assessment. </p> <p>The insights garnered from identifying the most comprehensive method for approximating micronutrient intakes from supplemental sources were implemented in the development and initial application of the first micronutrient-based diet quality index designed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population, named the TNI. The TNI assesses U.S. adults’ total nutrient intakes relative to the Recommended Dietary Allowance or Adequate Intake for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. In the initial application of the TNI, based on dietary data from the 2011-2014 NHANES, the mean TNI score of U.S. adults was 75.4 out of 100, whereas the mean score when ignoring contributions from DS was only 69.0 (t-test; p<0.001). Therefore, the results from this analysis suggested that the TNI extends existing measures of diet quality by including nutrient intakes from all sources.</p> <p>However, another analysis designed to examine the construct and criterion validity of the TNI was completed using data from a nationally representative sample of U.S. adults who participated in the 2011-2014 NHANES, as well as exemplary menus reflective of high-quality diets. The results showed that the TNI yielded high scores on exemplary menus (84.8-93.3 out of 100), was moderately correlated with the Healthy Eating Index-2015 (r=0.48) and was able to differentiate between groups with known differences in nutrient intake for DS users vs. non-DS users, non-smokers vs. smokers, and those who were food-secure vs. food insecure (all <em>p</em><0.001). Moreover, correlations of TNI component scores with nutritional biomarkers for vitamins A, C, D, and E were significantly higher when compared with those obtained via the diet alone.</p> <p>Taken together, the research findings from the studies presented in this dissertation contribute evidence supporting the use of multiple modes of DS assessment to improve the comprehensiveness of DS exposure assessment, as well as the importance of capturing micronutrient exposures from all sources. These results also highlight the broad applicability of the TNI framework as a tool for comprehensively representing the totality of nutrient exposures, inclusive of DS. Our outcomes point towards a need for additional investigation into the random and systematic error that pervades DS assessment, the development of tools that can be used to describe micronutrient exposures more completely and how those relate to nutritional status, as well as further applications of the TNI. </p>

<p dir="ltr">Undernutrition affects millions of children in low- and middle- income countries, causing poor growth, poor development, and increased risk of mortality. Many nutrition-sensitive interventions for rural areas increase household access to nutritious foods through increasing home production, a strategy that has small positive effects on child diets. However, there is growing evidence that local markets are also important for dietary quality. Despite the importance of rural markets, the rural food environment and food purchasing practices among rural households are not well-characterized in the literature. It is possible that promoting improved household food purchase practices is an effective method for improving child nutrition in rural areas. Tanzania experiences a high prevalence of undernutrition among children under the age of 5 years, particularly among rural populations. This dissertation utilizes data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS), a cluster randomized controlled trial that was conducted in rural Mara, Tanzania. The EFFECTS trial promoted improved diets through both home production and through food purchases through a social and behavior change strategy. We measured changes in dietary diversity (a proxy for diet quality), children’s nutrient intake adequacy, and diversity of foods purchased and produced. This dissertation presents evidence that food purchase diversity is positively associated with dimensions of the rural food environment, including high market food diversity (+0.37 food groups, p=0.01), living within 30 minutes of a market (+0.36 food groups, p=0.001) and household purchasing power (+0.14 food groups per additional million Tanzanian shillings spent by the household, p<0.001). In turn, purchase diversity is positively associated with dietary diversity (b=0.22, p<0.001), and intake adequacy of folate, vitamin B12, and calcium (all p<0.05) among children 9-23 months. Promoting food purchase diversity was effectively integrated into the EFFECTS interventions, resulting in purchasing +0.54 food groups at endline compared to changes in the control (p<0.01), which mediated 25% of the total improvement in child dietary diversity. In contrast, production diversity was associated with increased intake adequacy of vitamin A only (p<0.05), households produced +0.44 food groups at endline compared to control (p<0.05), and this mediated 15% of the total improvement in child dietary diversity. These findings suggest that promoting diverse food purchases, alongside diverse home production, is an effective way to improve children’s diets in similar settings.</p>

L’objet de cette recherche correspond aux aliments santé à orientation fonctionnelle (ASOF), définis comme des produits courants qui, au-delà de leur valeur nutritive de base, ciblent un effet positif sur une fonction spécifique de l’organisme, via des composants additionnels. Les travaux en matière de consommation nutrition-santé (CNS) démontrent la prédominance de l’approche cognitiviste, érigeant le raisonnement analytique et l’attitude en tant que régulateurs principaux du processus décisionnel du consommateur. Toutefois, une exploration conceptuelle préliminaire (revue documentaire pluridisciplinaire et étude qualitative multi-méthodes) suggère que le postulat de rationalité des consommateurs, s’il n’est pas sans fondement, peut paraître restrictif et ne rend pas totalement compte du caractère multidimensionnel de la consommation des ASOF (fonctionnelle, hédonique et symbolique). A ce titre, la recherche s’inscrit dans une perspective expérientielle, en positionnant la valeur perçue de la consommation en tant que clé d’analyse. Afin de mettre à jour les mécanismes à l’oeuvre dans la perception d’une valeur de la CNS, une validation empirique de la mesure du concept est établie, dans l’objectif d’en proposer un cadre explicatif intégrateur éclairant la dynamique qui anime la perception de la valeur, ses déterminants, ses modérateurs et ses conséquences (intention de réachat). L’application du cadre d’analyse expérientiel à la CNS montre qu’il semble tout à fait approprié pour appréhender la facette affective de la consommation. Le processus met ainsi en jeu une interaction consommateur-produit, soumise à la force modératrice de traits de personnalité durables. / Functional foods are conventional products that contain additional bioactive compound targeting physiological benefits beyond basic nutritional value. Previous research regarding the health nutrition consumption widely focused on the cognitive features of reasoned decisional process to explain consumer acceptance. Bearing on experiential perspective, the purpose of the present study is to provide an in-depth analysis of functional food consumption by exploring the multidimensional approach of consumer perceived value (utilitarian, hedonistic and symbolic). A primary literature review allowed determining the factors which might affect consumption experience (typology of value components, variables related to consumer, product characteristics and personality traits). An exploratory qualitative survey which mixed interviews with diary and questionnaire was carried out in order to verify research proposals. Finally, following an empirical validation of a perceived value scale, an integrative conceptual model was elaborated and tested through a quantitative survey. This explanatory frame highlighted the underlying relationships between the perceived value of functional food consumption, its predictors, its moderators and its effects (repurchasing intention). Results showed that experiential framework gives a relevant insight into the affective pattern of functional food consumption that emerges from an interaction between the consumer and the product.

Introdução: Dentre as carências nutricionais de maior relevância destacam-se, neste estudo, anemia e deficiência de vitamina A, que constituem as principais preocupações das políticas públicas, na área de alimentação e nutrição. Apesar de medidas de prevenção e controle já terem sido implantadas no Brasil há algum tempo, suas prevalências continuam elevadas, com profundas repercussões na saúde infantil. Assim, embora reconhecidos como problemas de saúde pública e bastante explorados, politicamente, ainda há espectros de interesse epidemiológico a serem investigados. Objetivo: Analisar os determinantes da anemia e da deficiência de vitamina A (DVA), bem como a presença concomitante dessas duas carências nutricionais em crianças brasileiras. Métodos: Reanálise dos dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS) de 2006, abrangente inquérito das condições de saúde de mulheres e crianças brasileiras cuja 3ª edição incorporou a avaliação dos níveis de hemoglobina e vitamina A. Essa reanálise baseou-se numa amostra probabilística complexa com representação nacional, o que permitiu descrever a situação de anemia e DVA nas macrorregiões brasileiras e suas áreas urbanas e rurais. O presente estudo incluiu a análise de 3.417 crianças de 6 a 59 meses. Anemia foi definida como hemoglobina (Hb) <11g/dL, determinada pelo método da cianometa-hemoglobina. DVA foi definida como retinol sérico <0,7mol/L, avaliado por cromatografia líquida de alta eficiência. Para expansão da amostra utilizaram-se critérios adotados pela PNDS. As variáveis respostas foram presença de anemia, de DVA e carência concomitante de DVA e anemia, enquanto as explanatórias, analisadas considerando-se três dimensões, foram vinculação aos processos estruturais da sociedade (variáveis socioeconômicas e ambientais); ao ambiente imediato da criança (variáveis maternas, de segurança e consumo alimentar); e individual (características biológicas da criança). A força de associação entre as variáveis respostas e as explanatórias foi avaliada pelo odds ratio (OR), tanto na análise univariada (OR bruta) quanto na múltipla (OR ajustada), com nível de significância de 5%. Resultados: Determinantes da anemia: A prevalência de anemia no País foi de 20,5%. Na análise múltipla, permaneceram associadas à anemia residir no Nordeste [OR: 3,45; IC: 2,21-5,40] Sudeste [OR: 2,55; IC: 1,60-4,06] e Sul [OR: 2,22; IC: 1,39-3,55]; na zona urbana [OR: 2,01; IC: 1,35-3,00]; e ter insegurança alimentar grave [OR: 1,78; IC: 1,00-3,16], destacando-se como proteção ter mãe com 5 a 8 anos de estudo [OR: 0,62; IC: 0,41-0,92] e consumir carne pelo menos uma vez na semana [OR: 0,45; IC: 0,22-0,93]. Determinantes da DVA: A prevalência de DVA no País foi de 17,5%. Após ajuste para as variáveis de confusão, permaneceram associadas ao DVA residir no Nordeste [OR: 1,77; IC: 1,16-2,77] e Sudeste [OR: 1,74; IC: 1,16-2,72]; na zona urbana [OR: 1,29; IC: 0,91-1,87]; e ter mãe com idade 36 anos [OR: 3,14; IC: 1,48-7,09], considerando-se proteção consumir carne pelo menos uma vez na semana [OR: 0,19; IC: 0,09-0,40]. Determinantes da DVA e da anemia: A prevalência concomitante de DVA e anemia foi de 3,9%, sem associação entre elas (p>0,05). As variáveis estatisticamente associadas (p<0,05) com DVA e anemia na análise múltipla foram residir no Sudeste [OR: 4,28; IC: 1,96-11,68] e Nordeste [OR: 2,92; IC: 1,31-7,96]; na zona urbana [OR: 3,66; IC: 1,46-12,30]; e ter insegurança alimentar grave [OR: 3,64; IC: 1,41-8,84]; revelando-se proteção ter idade 2 anos de idade [OR: 0,51; IC: 0,26-0,99]; e consumir carne pelo menos uma vez na semana [OR: 0,04; IC: 0,00-0,23]. Conclusões: Os resultados mostram redução importante na prevalência de anemia e DVA infantil no Brasil, embora, de acordo com o critério de importância epidemiológica da Organização Mundial da Saúde (OMS), continuem como problema moderado de saúde pública. Apesar das fortes evidências de que a DVA contribui para o desenvolvimento da anemia, constatou-se baixa prevalência concomitante dessas duas carências nutricionais entre as crianças brasileiras, e sem associação entre elas. Entretanto, anemia e DVA apresentam determinantes comuns (residir em macrorregiões menos e mais desenvolvidas e em área urbana), que reiteram o caráter trans-social dessas carências estudadas. O fato de terem como determinante a insegurança alimentar e como proteção consumir carne pelo menos uma vez por semana reforça a determinação social dessas deficiências nutricionais, embora a insegurança alimentar não tenha se associado à DVA. Os resultados evidenciaram como principais determinantes da anemia e da DVA aqueles relacionados aos processos estruturais da sociedade e do ambiente imediato da criança e não os individuais. Constatou-se, também, que as estratégias governamentais têm contribuído para a prevenção e controle dessas carências nutricionais no País, porém, sinaliza-se a necessidade de expansão da estratégia governamental no sentido de prevenção e controle da DVA, até então restrita a áreas de risco (região Nordeste e áreas pobres da região Sudeste). / Introduction: Among the most relevant nutritional deficiencies, anemia and vitamin A deficiency stand out, constituting the main concerns of public policy in food and nutrition area. Even though prevention and control measures have already been implemented in Brazil some time ago, their prevalence remains high, with profound effects on child health. Thus, in spite of recognized as problems of public health and plenty explored, politically, there are still spectra of epidemiological interest to be investigated. Objective: To analyze the determinants of anemia, vitamin A deficiency (VAD), as well as these two concomitant nutritional deficiencies in Brazilian children. Methods: Reanalysis of data from the National Survey on Demography and Health of Women and Children (PNDS) of 2006, comprehensive survey of health of women and children in Brazil, whose 3rd edition incorporated the evaluation of hemoglobin and vitamin A levels. This reanalysis was based on a complex random sampling with national representation, which allowed describing the situation of VAD and anemia in Brazilian regions and their urban and rural areas. This study included analysis of 3.417 children aged from 6 to 59 months. Anemia was defined as hemoglobin (Hb) <11g/dL, determined by cyanometahemoglobin method. VAD was set as serum retinol <0.7 mol/L, evaluated by high performance liquid chromatography. To expand the sample, the criteria adopted by PNDS were used. The variable responses were presence of anemia, VAD and concomitant deficiency of VAD and anemia, while the explanatory, analyzed considering three dimensions, were link to the structural processes of society (socioeconomic and environmental variables), to the immediate environment of the child (maternal variables, of safety and food consumption); and individual (biological characteristics of the child). The strength of association between the response and the explanatory variables was evaluated by odds ratio (OR), both in univariate (crude OR) and in multiple analysis (adjusted OR), with a significance level of 5%. Results: Determinants of anemia: The prevalence of anemia in the Country was 20.5%. In multiple analysis, remained associated with anemia living in the Northeast [OR: 3,45, CI; 2,21-5,40], Southeast [OR: 2,55; CI: 1,60-4,06] and South [OR:2,22;IC:1,39-3,55]; in urban area [OR: 2,01; CI: 1,35-3,00], and having severe food insecurity [OR: 1,78; CI :1,00-3,16], highlighting as protection having a mother with 5 to 8 years of study [OR: 0,62; CI: 0,41-0,92] and consuming meat at least once a week [OR: 0,45; CI: 0,22-0,93]. Determinants of VAD: The prevalence of VAD in the Country was 17.5%. After adjustment for confounding variables, remained associated with DVA living in the Northeast [OR: 1,77; CI: 1,16-2,77] and Southeast [OR: 1,74; CI: 1,16-2,72]; in urban area [OR: 1,29; CI: 0,91-1,87]; and having a mother aged 36 years [OR: 3,14; CI :1,48-7,09], considering protection to consume meat at least once a week [OR: 0,19; CI: 0,09-0,40]. Determinants of anemia and VAD: The concomitant prevalence of VAD and anemia was 3.9%, with no association between them (p>0,05). Variables statistically associated (p <0.05) with VAD and anemia in multiple analysis were living in the Southeast [OR: 4,28; CI: 1,96-11,68] and Northeast [OR: 2,92; IC: 1,31-7,96]; in urban area [OR: 3,66; CI: 1,46-12,30], and having severe food insecurity [OR: 3,64; CI: 1,41-8,84]; revealing protection being 2 years old [OR: 0,51; CI: 0,26-0,99] and consuming meat at least once a week [OR: 0,04; CI: 0,00-0,23]. Conclusions: The results show a significant reduction in the prevalence of child anemia and VAD in Brazil, although according to the criterion of epidemiological importance of the World Health Organization (WHO), they continue as a moderate public health problem. Despite strong evidences that VAD contributes to the development of anemia, it was verified a low prevalence of these two concomitant nutritional deficiencies among Brazilian children, and no association between them. However, anemia and VAD present common determinants (living in macro-regions less and more developed and in urban areas), reaffirming the transocial character of these nutritional deficiencies. The fact they have as a determinant food insecurity and as protection consuming meat at least once a week reinforce the social determination of these nutritional deficiencies, although food insecurity was not associated with VAD. The results showed as major determinants of anemia and VAD, those related to structural processes of society and the immediate environment of the child and not the individuals. It was also verified that government strategies have contributed to the prevention and control of these nutritional deficiencies in the Country, but it is signalized the need for expansion of the government\'s strategy for prevention and control of VAD, so far restricted to high-risk areas (Northeast and poor areas of the Southeast).

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6566. Adviser: Steven H. Kelder. Includes bibliographical references.

The evolution of fiscal spending in nutrition, health and education of children and adolescents between 2000–2005, has not been following the same pattern of growth as that of GDP in the same period of time in Peru. These important components of public policy in childhood and adolescence have not been properly attended with the larger resources collected by the State, specially in the nutrition area given that fiscal real expenditure in that area fell in spite of the rapid growth of GDP during the period of our study. With the figures found in the SIAF, the structure of publicexpenditure in the indicated components has been constructed, according to the expenditure budgetary functions, allowing us to establish a base that allows us to make proposals on improvements in public policy in the formation of the human capital since childhood. / La evolución del gasto público en nutrición, salud y educación de niños, niñas y adolescentes en el período 2000–2005 no ha seguido una tendencia similar al crecimiento del PBI para el mismo período en el Perú. Estos importantes rubros de la política pública en infancia y adolescencia no han sido fuertemente atendidos con los mayores recursos recaudados por el Estado, en particular el de nutrición que tuvo cada vez menos recursos del gasto público en proporción al crecimiento que experimentó el PBI en dicho período de estudio. Con las cifras encontradas en el SIAF se ha construido la estructura del gasto público en los rubros antes señalados,según las funciones presupuestales de gasto, lo que ha establecido una base que permite proponer mejoras en la política pública de formación de capital humano desde la infancia.