摘要：Objectives. To examine the association of school sociodemographic characteristics with tobacco outlet and fast-food restaurant availability near schools in a national study. Methods. Business lists and data from the National Center for Education Statistics were used to calculate the numbers of tobacco outlets and fast-food restaurants within 800 meters of public schools in 97 US counties. Results. More than 50% of schools with a majority of Hispanic students had both a fast-food restaurant and tobacco outlet nearby, compared with 21% of schools with a majority of White students. In adjusted models, each 10% increase in the number of low-income and Hispanic students enrolled in a school led to a 3% to 5% increase in the odds of the school having both a fast-food restaurant and a tobacco outlet nearby. Conclusions. Low-income and Hispanic students are disproportionately exposed to both tobacco outlets and fast-food restaurants near their schools. Easy access to tobacco products and fast food may influence youth smoking initiation and contribute to poor dietary intake. Obesity and tobacco use are risk factors for cardiovascular disease and many forms of cancer, and disparities in both of these risk factors exist by socioeconomic status and race/ethnicity 1 (for example, obesity rates are higher among non-Hispanic Black and Hispanic youths than among non-Hispanic White youths 2 ). Fast-food consumption has been associated with increased total energy, fat, sodium, and sugar-sweetened beverage intake among both children and adolescents, 3 which may contribute to future obesity and overweight. 4 In the case of all racial/ethnic groups, smoking initiation rates are highest among lower income youths, 5 and tobacco use rates have been shown to be higher among Hispanic than White middle schoolers. 6 Nearly 90% of adult smokers initiate smoking before the age of 18 years, 7 and thus early interventions targeting vulnerable populations are critical. Furthermore, smoking and poor dietary intake appear to covary, 8 consolidate early, 9 and track together over time. 8–10 Young people are exposed to retail outlets in school neighborhoods when they walk, drive to and from school, or leave campus during lunch. Evidence suggests that the availability of fast-food restaurants (FFRs) near schools is associated with higher body mass index 11 and that the availability of nearby retail tobacco outlets (TOs) is associated with experimental smoking among young people. 12 Students permitted to leave school during lunch are more likely than students on closed campuses to consume fast food, 13 and exposure to point-of-sale tobacco marketing has been associated with youth smoking initiation, prevalence, and susceptibility as well as pro-smoking attitudes. 14 Increased availability of FFRs and TOs near schools is a problem for youths not only because of easier access to unhealthy products but also because of increased exposure to point-of-sale marketing of those products. Both fast-food and tobacco companies target low-income, minority, and youth populations with promotions and advertising. 15,16 FFRs in lower income neighborhoods are more likely than those in higher income neighborhoods to offer free prizes with purchases and kids’ meals. 17 Similarly, stores selling tobacco products in lower income and racial/ethnic minority neighborhoods have more tobacco marketing, 18 lower cigarette prices, 19 and higher availability of products with youth appeal (e.g., menthol cigarettes, cigarillos). 18 To our knowledge, no research to date has concomitantly examined both the availability of FFRs and TOs near schools and the extent to which their availability differs according to race/ethnicity and student socioeconomic status. To address this gap, we examined the availability of FFRs and TOs near public schools in a national sample of US counties in association with student race, ethnicity, and socioeconomic status. We hypothesized that schools with higher proportions of Black students, Hispanic students, and students receiving free or reduced-price lunches would have more FFRs nearby, would have more TOs nearby, and would be more likely to have both an FFR and a TO nearby than would schools that were less diverse and had fewer students eligible for free or reduced-price lunches. Because older students may have greater autonomy and purchasing power, we also hypothesized that high schools and middle schools would have more FFRs and TOs nearby than would primary schools and would be more likely to have both nearby.
