Availability of limited service food outlets surrounding schools in British Columbia.
Black, Jennifer L. ; Day, Meghan
Improving the eating habits of children and adolescents is a
priority area for health promotion, particularly given evidence of
increasing rates of obesity and nutrition-related health conditions such
as type 2 diabetes among Canadian youth. (1-3) Given that youth spend a
substantial proportion of their time in or en route to school, there is
growing interest in understanding how the food environment inside and
surrounding school shapes dietary outcomes. (4-6) In British Columbia
(BC), several provincial initiatives (including Action Schools! BC, Sip
Smart! BC, Farm to School, and the School Fruit and Vegetable Snack
Program) aim to improve access to nutritious foods and to reduce
exposures to foods of low nutritional quality. (7) Additionally, revised
provincial guidelines restrict the sale of foods and beverages with poor
nutritional quality across all settings where foods are sold inside
schools, including cafeterias, vending machines, fundraising efforts and
school events. (8,9) The effectiveness of recent school-based healthy
eating initiatives may be moderated however if students have pervasive
exposure to retailers (and related advertising) selling snack foods,
sugar-sweetened beverages and fast food in the immediate vicinity
surrounding schools. (10)
Recent policy recommendations in BC, Quebec and outside of Canada
have called for the development of new guidelines to restrict food and
beverages sold in areas surrounding schools; (10,11) and regulations
restricting the number of new fast food restaurants have been
implemented in some communities in the United States. (12,13) While
there is a growing body of evidence suggesting that more frequent visits
to fast food outlets are associated with higher energy intake, reduced
dietary quality and increased obesity risk, (14,15) there remain large
gaps in knowledge regarding the distribution of food outlets surrounding
schools and the net impact on students' food purchases and dietary
choices.
In the United States, one third of schools are within walking
distance of a fast food outlet or convenience store, (16) with higher
exposure reported in commercially dense urban areas, near secondary
schools compared to elementary schools, and in neighbourhoods
characterized by lower socio-economic status. (16-20) Similarly, in a
national sample of Canadian schools, approximately 31% of schools were
found to be located within 1 km of a fast food restaurant. (21) In
Montreal, schools in the lowest-income neighbourhoods have 10 times more
food stores within 750 m compared to schools in the highest-income
areas, (22) but a dearth of Canadian studies have carefully
characterized the food environment surrounding schools in provinces
outside of Quebec. To that end, this study aims to describe the
availability of limited service food outlets within walking distance of
BC schools to provide insight regarding the nature of the food
environment surrounding schools in this province.
METHODS
The study sample included 1,392 BC public schools offering standard
educational programs listed in the BC Ministry of Education's
school database as of February 2011 with a physical address that could
be geocoded. (23) Twenty-three percent of these schools are located in
areas that are considered rural by Canada Post. (24) Schools serving any
of grades 8-12 were defined as secondary schools (n=380). Grade 8 is
commonly designated as the first year of secondary school in BC and
students in grade 8 and higher are likely to have more autonomy over
food choices, including permission to leave school campus during lunch
periods. In BC, secondary schools have significantly higher numbers of
enrolled students compared to elementary schools and may therefore
provide a larger customer base for nearby food retailers.
Additional school-level attributes were derived from the 2006
Canadian Census, including median family income and population density
per square kilometre. These school-level attributes were derived by the
BC Ministry of Education Analysis and Reporting Group based on weighted
average attribute values from Census dissemination area values where
students reside, weighted by the proportion of students per school in
2006/7 residing in each dissemination area. (25) School-level income and
population density variables were coded into tertiles to compare schools
representing students from neighbourhoods with diverse levels of
relative median family income (lowest <$59,879, medium
$59,880-$72,474, highest [greater than or equal to]$72,495) and
population density (lowest <934, medium 935-2,777, highest [greater
than or equal to]2,778 residents per square km).
Food retailer data and geographic coordinates were obtained from
the 2010 Canadian Business Data files, a proprietary database of
Canadian business information including company names, industry codes
and geographic coordinates. (26) Four categories of limited service food
outlets, described below, were defined in consultation with the BC
Ministry of Health. Categories aimed to be comparable with previous
estimates in the literature and where possible were delineated by North
American Industry Classification System (NAICS) descriptions. (27,28)
1) Beverage and snack food stores were identified with NAICS
description "snack & nonalcoholic beverage bars" and
included chain and independent vendors selling coffee, ice cream, donuts
and snacks.
2) Fast Food Outlets were defined as restaurants without waiter
service where customers select and purchase food before consumption,
with three or more outlets in BC.
3) Delis included food stores coded with NAICS description
"limited-service restaurants" and included delicatessens and
independent take-out shops with one or two locations.
4) Convenience stores were classified with NAICS description
"convenience stores".
Data analyses
School and food store locations were mapped with geographic
information systems (GIS) using ArcMap GIS software (ESRI, Redlands,
CA). The number of food outlets within 800 m buffer distances
surrounding each school were estimated, comparable with recent studies,
(17,20,29) to characterize food outlet availability within a 10-12
minute walking distance. The closest distance from schools to food
outlets along street routes was calculated as an additional measure of
proximity, using ArcMap's Network Analyst tool, with street routes
identified using CanMap[R] RouteLogistics, v2010.3 (DMTI Spatial Inc.,
Markham, ON).
Descriptive statistics were calculated for the combined sample and
stratified by school type, school size (categorized as enrollment less
than versus greater than or equal to the sample median) and by tertiles
of median family income and population density. Logistic regression
models then examined the associations between school-level factors with
food outlet availability within 800 m of schools. Sensitivity analyses
further tested these associations using negative binomial models with
the number of outlets within 800 m as the outcome variables (data not
shown), and yielded findings similar to those from binary logistic
regression models. Analyses were conducted using Stata version 11
(College Station, TX).
RESULTS
Table 1 describes the availability of limited service food outlets
surrounding BC schools, showing that 54% of schools had at least one
limited service food outlet within 800 m (median=1, mean=3).
Availability varied widely ranging from 0 to 83 outlets (SD=5.47), and
8% of schools had 10 or more outlets within walking distance. Beverage
and snack food stores and fast food outlets were the most commonly
available outlet categories, while only 16% and 22% of schools had a
deli or convenience store within 800 m, respectively.
The median closest distance to any outlet was just over 1 km (1016
m). Approximately 15% of schools had at least one food outlet available
within 400 m (by road), which represents a walking time of approximately
5 minutes. However, 26% of schools were over 2 km from the nearest
snack/beverage, fast food, deli or convenience store.
Tables 2 and 3 describe the unadjusted and multivariate relations
between school type, school size, median income and population density
with food outlet availability. A slightly higher proportion of secondary
schools (58%) had a limited service outlet within 800 m compared to
elementary schools (53%), and schools with larger student enrollments
(64%) were significantly more likely to be located near food outlets
compared to smaller schools (44%, p<0.001). After adjusting for
school-level income and population density, schools with larger student
enrollments were still significantly more likely than smaller schools to
be within walking distance of a snack and beverage outlet (OR=1.36,
p<0.05), a chain fast food outlet (OR=1.43, p<0.01) and a
convenience store (OR=1.41, p<0.05). Although secondary schools were
more likely than elementary schools to be located near food outlets,
differences were not statistically significant after controlling for
school size.
Compared to schools with students from neighbourhoods with the
highest median family incomes, schools characterized by the lowest or
medium income levels were significantly more likely to be located near
all categories of limited service food outlets. Schools comprised of
students from neighbourhoods with higher population densities were also
significantly more likely to have snack/beverage, fast food, deli and
convenience stores nearby.
DISCUSSION
This study provides valuable insight about the availability,
proximity and variety of limited service food outlets near public
schools across BC and reveals wide disparities in food environment
exposures across the province. Over half of the schools in this sample
(54%) had at least one limited service food outlet within a 10-12 minute
walk and 10% of schools were within walking distance of nine or more
outlets. On the other hand, a substantial proportion of schools (46%)
had no limited services outlets within 800 m, and 17% of schools were
over 3 km away from the nearest outlet.
While it is difficult to make direct comparisons with previous
studies due to varied classifications of food outlets and definitions of
access and proximity, current findings suggest that overall, BC public
schools have similar if not higher rates of exposure to limited service
food outlets compared to estimates from outside BC. For example, in
Quebec, 37% of public schools are within a 15-minute walk to a fast food
outlet, similar to estimates from a Canadian national school sample.
(16,21,30) Estimates from the United States similarly report that
approximately one third of secondary schools have a fast food restaurant
within an 805 m walking distance, (16) a seemingly lower proportion
compared to current estimates from BC.
Older students in secondary school have increased mobility and
autonomy over food choices during the school day compared to younger
students and likely serve as an important customer base for local food
retailers who offer inexpensive and convenient food options. One third
of Canadian teens (age 14-18 years) report having consumed food prepared
by a fast food restaurant the day before completing national health
surveys, and are more frequent consumers of fast food compared to
younger children. (31) Moreover, the transition to secondary school is
associated with decreased consumption of fruits, vegetables and milk,
and increased intake of low nutritional quality foods such as soft
drinks and fast food. (32) Previous studies have suggested that
secondary schools have increased exposure to fast food outlets compared
to schools serving younger students, (16,17,20) which may contribute to
changes in dietary practices among older adolescents. In BC, secondary
schools were also slightly more likely to have food outlets nearby
compared to elementary schools; however, differences were not
statistically significant in multivariate models. School size emerged as
a more salient predictor of food outlet availability than school type,
with food outlets more likely to be located near schools with a larger
student body.
This study is in line with previous national estimates from Canada
and the United States that report higher availability of limited service
food outlets near schools in large urban centres compared to rural
areas, in neighbourhoods with higher commercial and population densities
and in neighbourhoods characterized by lower socio-economic status.
(18,19,22) However in BC, in addition to limited service outlets,
lower-income neighbourhoods and those with higher population densities
in urban neighbourhoods are also likely to have increased access to a
host of food options, including supermarkets and fresh food vendors.
(33) Therefore, students attending schools in lower-income
neighbourhoods may have access to a variety of both nutritious and
"obesogenic" beverages and snacks near school. It remains to
be seen how the complex set of competing food options inside and
surrounding BC schools contribute to students' food-related
attitudes and behaviours.
This study has several strengths and limitations that should be
considered. An important strength was the use of a comprehensive sample
of public schools characterized in the BC Ministry of Education's
school database. This database provided key information about the
enrollment size, programs and grades offered by each school, allowing
for the comparison of schools serving secondary school students versus
students in younger grades. However, this sample excluded private
schools, alternate programs, distributed learning programs and youth
custody educational centres and findings should not be generalized to
such settings. This study was strengthened by applying school-level
census variables derived by the BC Ministry of Education based on the
weighted characteristics of students' neighbourhoods of residence.
However, the median family income and population density of
neighbourhoods where students live may differ from the characteristics
of neighbourhoods where schools are located. Additional analyses were
therefore conducted and found that these school-level measures were
highly correlated with Census attributes of the forward sortation areas
(FSA) where schools were located. An FSA represents the geographic
region delineated by the first three digits of a Canadian postal code
(e.g., V6T). (24) Sensitivity analyses that replicated the multivariate
regression models reported in Table 3 using FSA-level Census variables
yielded conclusions comparable to models presented in this paper.
All food store data were obtained from the Canadian Business Data
files, a database of commercial businesses and food vendors. (26) To our
knowledge, this is the highest-quality proprietary data source of
commercial food outlets available in BC, and is comparable to datasets
used previously in the literature that have demonstrated acceptable
levels of agreement compared to direct observations made through
systematic social observation. (34) The definitions and categorization
of food outlets were informed by several recent studies in the US and
Canada and were completed with input from local stakeholders from the BC
Ministry of Health. However, it was not possible to systematically
ground truth the geospatial accuracy of outlets or the types and costs
of food sold in these stores. This study also did not quantify snack and
take-out foods available at grocery stores, full-service restaurants,
drug stores, or inside public buildings such as recreation centres where
students may also purchase foods and beverages. (35) Hence, current
estimates likely underestimate true exposures to inexpensive food with
minimal nutrition quality surrounding schools.
Still, this analysis captured a substantial proportion of vendors
where BC students purchase snacks, beverages, fast food and convenience
food, and provides a baseline profile needed to inform provincial and
municipal efforts to create and support healthy communities. (11)
Overall, these findings are in line with previous studies that highlight
differences in food environment exposures among schools in varied
geographic contexts. In BC, the predicted probability of having a
limited service food outlet within walking distance was 87% for a large
secondary school with students from the lowest-income and
highest-density neighbourhoods, but only 17% for a small elementary
school characterized by students from the highest-income, lowest-density
areas. Despite these differences, it remains to be seen whether varied
exposures surrounding schools translate into divergent dietary outcomes
for BC's youth. Additional research is needed to evaluate the
impacts of proposed municipal policies and bylaws that restrict access
to limited service food outlets in close proximity to schools and to
fill gaps in current understanding regarding the role of the food
environment in shaping dietary behaviours and health outcomes.
Received: January 6, 2012
Accepted: May 21, 2012
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Jennifer L. Black, PhD, RD, [1] Meghan Day, MA, RD [2]
Author Affiliations
[1.] Food, Nutrition and Health, University of British Columbia,
Vancouver, BC
[2.] Population and Public Health, BC Ministry of Health,
Vancouver, BC
Correspondence: Jennifer L. Black, Food, Nutrition and Health,
University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4,
Tel: 604-822-6869, Fax: 604-822-5143, E-mail: j.black@ubc.ca
Acknowledgements/Funding Sources: Funding for this project came
from the British Columbia Ministry of Health. Sincere thanks to Natalie
Work and the BC Ministries of Citizens' Services and Education for
providing school-level data and geographic coordinates. Stuart Fleming
also provided valuable GIS assistance.
Conflict of Interest: None to declare.
Table 1. Descriptive Profile of the Limited Service Food Outlets
Surrounding BC Schools
Snack/ Fast Food
Beverage Stores Outlets
All Schools (n=1392)
Mean [+ or -] SD (number 1.27 [+ or -] 2.64 1.27 [+ or -] 2.37
of outlets within 800 m)
Median (number of outlets 00001
within 800 m)
Range (min-max number of 0-44 0-29
outlets within 800 m)
% with at least one outlet 43.68% 40.30%
within 800 m
Median distance to closest 1271 1392
outlet (metres)
Delis Convenience
Stores
All Schools (n=1392)
Mean [+ or -] SD (number 0.24 [+ or -] 0.64 0.27 [+ or -] 0.57
of outlets within 800 m)
Median (number of outlets
within 800 m)
Range (min-max number of 0-5 0-5
outlets within 800 m)
% with at least one outlet 16.09% 21.98%
within 800 m
Median distance to closest 3281 2387
outlet (metres)
All Snack, Fast
Food, Deli and
Convenience Stores
All Schools (n=1392)
Mean [+ or -] SD (number 3.05 [+ or -] 5.47
of outlets within 800 m)
Median (number of outlets
within 800 m)
Range (min-max number of 0-83
outlets within 800 m)
% with at least one outlet 54.17%
within 800 m
Median distance to closest 1016
outlet (metres)
Table 2. Limited Service Food Outlet Availability and Proximity by
School-level Characteristics
Percent of Median Number
Schools of Outlets
(n=1392) Within 800 m
School Type
Elementary Schools 27% 1
Secondary Schools 73% 1
School Size([double dagger])
Lower Enrollment 50% 0
Higher Enrollment 50% 2
School-level Median Family
Income ([section])
Lowest Income Tertile 33% 1
Medium Income Tertile 33% 1
Highest Income Tertile 33% 0
School-level Population Density
([parallel])
Lowest Density Tertile 33% 0
Medium Density Tertile 33% 1
Highest Density Tertile 33% 3
% of Schools Median Distance
With At Least One to Closest
Outlet Within 800 Outlet (Metre)
m([dagger])
School Type
Elementary Schools 52.57 1086
Secondary Schools 58.42 898
p=0.051
School Size([double dagger])
Lower Enrollment 43.95 1412
Higher Enrollment 64.33 861
p=0.000
School-level Median Family
Income ([section])
Lowest Income Tertile 57.11 873
Medium Income Tertile 59.17 947
Highest Income Tertile 46.94 1226
p=0.000
School-level Population Density
([parallel])
Lowest Density Tertile 32.68 2468
Medium Density Tertile 55.12 992
Highest Density Tertile 75.16 745
([dagger]) p-values from chi square tests of significance.
([double dagger]) School size defined as below or above sample median
(< or [greater than or equal to] 293 students enrolled per school).
([section]) Median family income (lowest <$59,879, medium
$59,880-$72,474, highest [greater than or equal to] $72,495).
([parallel]) Population density (lowest <934, medium 935-2,777,
highest [greater than or equal to] 2,778 residents per square km).
Table 3. Logistic Regression Models Predicting Odds (95% CI) of
Limited Service Food Outlets Within 800 Metres of Schools
Snack/Beverage Fast Food Outlets
Stores
School Size
Lower Enrollment 1.00 1.00
Higher Enrollment 1.36 * (1.05,1.78) 1.43 ** (1.09,1.89)
School Type
Elementary School 1.00 1.00
Secondary School 1.19 (0.90,1.56) 1.24 (0.93,1.64)
Median Family Income
Lowest Income 2.63 *** (1.95,3.54) 2.94 *** (2.16,4.00)
Medium Income 1.88 *** (1.42,2.49) 2.26 *** (1.70,3.02)
Highest Income 1.00 1.00
Residential Density
Lowest Density 1.00 1.00
Medium Density 2.80 *** (2.07,3.80) 2.92 *** (2.12,4.00)
Highest Density 5.47 *** (3.98,7.50) 6.56 *** (4.73,9.11)
Delis Convenience
Stores
School Size
Lower Enrollment 1.00 1.00
Higher Enrollment 1.01 (0.71,1.44) 1.41 * (1.03,1.92)
School Type
Elementary School 1.00 1.00
Secondary School 1.09 (0.76,1.58) 1.09 (0.80,1.51)
Median Family Income
Lowest Income 2.99 *** (2.01,4.42) 2.55 *** (1.85,3.60)
Medium Income 1.61 * (1.09,2.39) 1.55 * (1.11,2.17)
Highest Income 1.00 1.00
Residential Density
Lowest Density 1.00 1.00
Medium Density 2.38 *** (1.47,3.93) 2.36 *** (1.60,3.51)
Highest Density 7.07 *** (4.50,11.12) 4.80 *** (3.26,7.06)
Any Snack, Fast
Food, Deli or
Convenience Store
School Size
Lower Enrollment 1.00
Higher Enrollment 1.60 *** (1.22,2.08)
School Type
Elementary School 1.00
Secondary School 1.24 (0.93,1.64)
Median Family Income
Lowest Income 2.60 *** (1.92,3.51)
Medium Income 1.94 *** (1.46,2.58)
Highest Income 1.00
Residential Density
Lowest Density 1.00
Medium Density 2.82 *** (2.10,3.78)
Highest Density 6.37 *** (4.62,8.77)
Odds Ratios (95% confidence intervals in brackets).
* p<0.05, ** p<0.01, *** p<0.001
