Compliance, Barriers, and Improvement Areas of Two Food Programs in Mexican Middle Schools: Stakeholders' Perceptions.

Abstract

Background: The Mexican government has implemented two nationwide initiatives to improve the food environment in schools: the 2010 General Guidelines for Dispensing and Distributing Foods and Beverages in Public School Stores (Guidelines), and the 2015 National School Drinking Fountain Program (PNBE). Nevertheless, a 2018 assessment of 10 middle schools in Mexico City revealed high consumption of sugar-sweetened beverages and limited use of drinking fountains.

Methods: A qualitative study was carried out in 2018-2019 to explore the perceptions of 13 stakeholders (school principals, food store personnel, one drinking fountain coordinator, and government representatives) regarding the barriers and opportunities associated with the Guidelines and PNBE initiatives. Content analysis was performed using ATLAS.ti v8.0.

Results: Both initiatives yielded positive outcomes such as higher water consumption in specific neighborhoods, greater use of refillable bottles, and improved oversight efforts by school authorities. However, their full implementation has been hindered by systemic and behavioral barriers, including student preference for ultra-processed foods, minimal parental involvement, inadequate fountain maintenance, and weak policy enforcement. Study participants recommended updating the food and beverage regulations, launching additional educational campaigns, and fostering intersectoral collaboration.

Implications for school health policy, practice, and equity: Advancing healthier and more equitable school food environments demands urgent action to remove contextual and structural barriers, foster stakeholder engagement, and introduce more robust enforcement mechanisms.

Conclusions: Strengthening policy enforcement, fostering participatory decision-making, and addressing systemic barriers are essential.