TABLE A1.

Research questions and methodological needs to advance the understanding of the role of different components of the food environment and childhood obesity in Latin America and among Latino children living in the United States

Food environment component	Research questions and methodological needs
Food retail	• How do we examine the impact of different food retailers while controlling for the selectivity of shopping at specific retailers and considering the endogeneity of the food environment (e.g., retailers' choice to locate in a particular area)? • What is the impact of different strategies to improve healthier food purchases inside food retailers? For example, “nudges” to alter choice architecture, such as product placement, banning ultra‐processed foods from checkout, changes on promotional strategies of ultra‐processed foods, and others. • Need for more innovative methods such as eye‐tracking technology, consumer panels, and experiments using virtual and actual “grocery store” labs. • Implications for cross‐borders research: Would strategies like healthy food financing, which have been implemented in the United States, work in Latin America? Conversely, are retailer‐based strategies, such as Mexico's ban on junk food to minors, feasible in the United States?
Food promotion	• What is the impact of personalized marketing, particularly in digital media, and integrated marketing strategies? • What is the broader impact of child‐directed food marketing on children's rights (e.g., privacy and healthy development)? • How well are existing statutory marketing policies being enforced and monitored? • What are the cross‐border implications of marketing policies implemented in one country on other countries without regulations? • How has industry responded to policies? What strategies does industry use to avoid or push back against new policies?
Provision of foods in schools	• How well are school food policies being implemented? What are the factors (country‐level, state‐level, district‐level, and school‐level) that drive implementation? • What are the impacts of school food policies on shaping the food system, including the local economy and family farmers' livelihood? • How and to what extent can food procurement for national school feeding policies be used to shape the food supply? • In countries without existing school policies, what is the food environment within schools and how is it changing, including availability and quality of foods and beverages, clean drinking water, and presence of food marketing? • What are the differential impacts of free universal and targeted school feeding programs on children's diet, consumption of the foods offered as part of school meals, and stigma and consequently children's mental health? • What is the impact of policies, including banning sales and marketing of sugar‐sweetened beverages (SSBs) and ultra‐processed foods, setting school food nutritional standards, requiring procurement from local farms, and requiring that high percentages of school foods be minimally processed, on children's outcomes, including dietary intake (both at school and total dietary intake), education (including attendance, graduation, and other metrics), and health? • What are the impacts of bans on sales of competing foods inside schools in the uptake of free school lunches?
Food labeling	• How do front‐of‐package labeling regulations interact with other food‐related policies, such as restrictions on child‐directed marketing, restrictions on nutrition claims, or policies influencing price, with regard to influencing both industry response and consumer behavior? • What is the role of schools in transmitting understanding and use of front‐of‐package labels? • With regard to real‐world evaluation studies, to what extent are changes in intake of nutrients of concern and ultra‐processed foods driven by industry changes (e.g., product reformulation) or shifts in consumer behavior, or both? • What are potential unanticipated consequences of front‐of‐package labeling regulations? For example, do “high in sugar” labels lead to reductions in sugar but increases in noncaloric sweetener? • To what extent can lessons learned in Latin America, where front‐of‐package labeling regulations have spread rapidly, be applied to Latino parents and children in the United States, particularly regarding their impact on diet and health? • While most countries in Latin America have implemented a warnings‐style label on nutrients of concern (e.g., salt, sugar, and saturated fat), primarily to reduce purchases and intake of ultra‐processed foods, what is the impact of voluntary positive labels on minimally processed foods? • What is the ideal nutritional profile to underpin a front‐of‐package labeling system? Relatedly, what is the optimal coverage of products in a food supply carrying the label to inform consumers and improve the healthfulness of purchases? • Do front‐of‐package labeling policies improve disparities in childhood diet and health, including by income level, education, and (in the United States) race–ethnicity?
Food prices	• What is the impact of taxes on overall dietary intake, not only taxed items, or their direct substitutes, but on total diets? • How sustainable are taxes? Do consumers eventually return to pretax levels of purchasing, and how much time does that take? • Do tax policies reduce or exacerbate health inequalities? What are the potential unintended consequences of SSBs and ultra‐processed food taxes, and what policies or strategies can be used to mitigate these? • What is the impact of taxes on US Latinos and how does this compare to the impact of taxes in Latin American countries? • What are the impact of other pricing strategies, like adjustments to subsidies to increase purchases and intake of healthy foods, such as fruits and vegetables?