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CX3 Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention
APHA- Denver, CO, November 9, 2010
Presented by:
Alyssa Ghirardelli, MPH, RD
Additional contributors: Valerie Quinn, MEd., Sharon Sugerman, MS, RD
Access to fast food around schools:
Exposures in California’s low-income
neighborhoods
This material was produced by the California Department of Public Health, Network for a Healthy California, with funding from the USDA Supplemental Nutrition
Assistance Program (formerly the Food Stamp Program).
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed
during the past 12 months:
Alyssa Ghirardelli, MPH, RD
No relationships to disclose
Fast Food in Close Proximity to Schools : Evidence
• Davis, et al. Proximity of Fast Food Restaurants to schools and Adolescent Obesity. Am J Public Health, 2009.– Links fast-food within a ½ mile of schools to higher
BMI and poor dietary behaviors• Simon, et al. Proximity of fast food restaurants to schools:
Do neighborhood income and type of school matter? Preventive Med, 2008.
• Austin, et al. Clustering of fast-food restaurants around schools a novel application of spatial statistics to the study of food environments. Am J Public Health, 2005.
• Kwate, et al. Separate and unequal: the influence of neighborhood and school characteristics on spatial proximity between fast food and schools. Prev Med. 2010
Overweight and Obesity California Teens Aged 12-17
(BMI ≥ 85th %ile 1998-2004 p<.001), (BMI ≥ 85th %ile 2002-2004 p<.01) (BMI ≥ 95th %ile 1998-2004 p<.001), (BMI ≥ 85th %ile 2004-2008 p<.001)
California Teen Eating, Exercise, and Nutrition Survey (CalTEENS) Trends
810.6 8.8
12.4 12.68.7
13
13.714.6
16.2 14.4
13.1
0
5
10
15
20
25
30
35
1998 2000 2002 2004 2006 2008
Pe
rce
nt
of
Te
en
s
Overweight
Obese
21.3
24.3 23.4
28.6
26.7
21.8
CalTEENS Comparison to National and other Statewide Data
Obese (BMI ≥ 95th percentile)1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
CalTEENS 8% 11% 9% 12% 13% 9%
CHIS 12% 12% 14% 13%
YRBSS
national
11% 11% 12% 13% 13% 12%
NHANES 15% 17% 17% 18% 18%
Sex-and age-specific BMI ≥ 95th percentile based on the CDC growth charts
Sources:
-University of California Los Angeles Center for Health Policy Research. California Health Interview Survey, Adolescent Survey AskCHIS internet data query system In. Los Angeles,
CA. http://www.chis.ucla.edu/main/, Accessed 9/28/10.
-Youth Risk Behavior Surveillance - United States, 2009. http://apps.nccd.cdc.gov/youthonline/App/Default.aspx, Accessed on 9/28/10.
-Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 Through 2007-2008 by Cynthia Ogden, Ph.D., and Margaret Carroll, M.S.P.H., Division of Health and Nutrition Examination Surveys
Fast Food and Soda Consumption Among Youth
Ages 12-17• 23% reported eating fast food at least once
on a previous day (CalTEENS 2006)
• 46% of youth report eating fast food 2 or more times per week (CHIS 2007)
• 13% report 4 or more times each week (CHIS 2007)
• Nearly 9% reported eating fast food 2 or more times on a previous day (CHIS 2005)
• 26% drank 2 or more SSB’s per day, down from 31% on previous survey (CHIS 2005, 2007)
• 60-62% drank one or more SSB per day (CalTEENS 2006, CHIS 2005)
“ Back in the days when we first got a company airplane, we used to spot good locations for McDonald’s stores by flying over a community and looking for schools. Now we use a helicopter, and it’s ideal.”
Ray Kroc, McDonald’s Corporation founderReference: Ray Kroc, Grinding It Out: The Making of McDonald’s, (Chicago,
IL: Contemporary Books,1977), 176. – Found in: Corporate Accountability
International’s, Clowning with Kids Health, The Case for Ronald McDonald’s
Retirement. www.retireronald.org. Accessed 9/30/10.
England Allows Ban FF
Around Schools
400 Meter Exclusion Zone
(aprox. = 1300 feet, ¼ mile,
or 2 blocks)
Study found that secondary schools have
on average 23 junk food outlets in their
neighborhoods, with some surrounded by
46
• Documents the physical environment and encourages local action to change conditions to support individual behaviors
• Involves assessing communities in relation to a variety of obesity prevention benchmarks known as community indicators and assets
• Uses data to activate consumers and partners to improve food availability in low-income neighborhoods
• 3 = nutrition, physical activity and obesity prevention
CX3: Communities of Excellence
in Nutrition, Physical Activity and Obesity Prevention
CX3 Data: Mapping• Access to Supermarkets
– Markets with >20 employees
– ½ mile service area
– Transit to supermarkets
• Density of Fast Food– Fast food chain/not chain
– Pizza
– Deli
• Small Markets & C-Stores around schools
• Farmers Markets
CX3 :Use of On-line Network GIS Map Viewer
http://www.cnngis.orghttp://www.cnngis.org
CX3 Data: Field Surveys• Grocery stores and small markets
– Different types of stores
– Availability and quality of fruits and vegetables, other healthy foods
– Fruit and vegetable prices
– Marketing of healthy/unhealthy foods
• Fast food around schools– Availability of healthy options
– Menu labeling
– Marketing
• Outdoor marketing around schools
• Alternative Food Sources –Community Supported Agriculture–Produce Stands–Community Gardens
• Emergency Food Sources
• Local Health Department Infrastructure
• Media Coverage
CX3 Data: Assessment/Tracking
CX3 Sites23 Network funded Local
Health Departments
All types: Urban dense,
suburban, rural, remote
More w/ other funding,
including CA Regional
Obesity Prevention Projects
• 3-7 low-income neighborhoods• Each neighborhood comprised of • 1-5 census tracts• > 50% of population in census tract at or below
185% Federal Poverty Level (FPL)• Other selection factors
• School in Neighborhood• Established partnerships• Race/Ethnic make-up• Rural and Urban (for some sites)• Obesity rates (used by one site)
CX3 Neighborhood Selection
CX3 Fast Food Outlets • Fast Food Chain, Non-Chain, Pizza,
Sandwich/Deli• Quick service restaurants characterized by:
– food ready to eat quickly after ordering– minimal service – where the customer pays for food prior to its
consumption• Number of outlets within 1000 ft and ½ mile to
schools in neighborhood• Proportion of schools with fast food outlets
within 1000 ft and ½ mile• Highest number of outlets for a school with fast
food within 1000 ft and ½ mile (ie. worst case scenario)
Fast food around schools & parks
½ mile buffer
CX3 GIS Findings- Fast FoodAround Schools- From GIS Mapping
• 1000 ft (approx. 2 blocks)– 49% had no fast food
– 30% had 1-2 fast food
• ½ Mile– only 11% had none
– 22% 10+
– Mean of 6 fast food
CX3 Fast Food Surveys - Dataset• 14 Local Health Departments (LHD)• Surveys of Fast Food from 2008 & 2009
– Collected by either LHD staff, community members or youth with quality control methods
• 31 Neighborhoods– Most neighborhoods defined by 1-2 census
tracts • 44 Schools Reporting Fast Food in ½ mile
– Sample of 34% Elementary, 21% Middle, 43% High, 2% Continuation
• 233 Fast Food Outlets– 27% within 1000 ft (2 blocks) of school– 23% visible from school
Number of Fast Food w/in ½ mile of Schools
36%
27%
23%
14%
0%
5%
10%
15%
20%
25%
30%
35%
40%
schools with 1-2 schools with 3-5 schools with 6-9 schools with 10+
Pe
rce
nt
of
Sc
ho
ols
• Mean of 5 fast food
• Worst case scenario:
22 fast food in ½ mile
Percent of Fast Food by School Type
27
18
51
4
0
10
20
30
40
50
60
Elementary Middle High Continuation
Per
cen
t o
f O
utl
ets
%
%
%
%
FF Outlet Types
36%
43%
6% 4% 6% 5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Fast F
ood Chai
n
Fast F
ood (Not C
hain)
Pizza
Chain
Pizza
Other
Sandwic
hes/D
eli Chai
n
Other
Per
cen
t o
f O
utl
ets
• Fast Food Chains: burgers, fried chicken/fish, taco/Mexican/Latino, fast Chinese, ≥ 6 locations
• Fast Food Non-Chain: same styles as Fast Food Chain, but < 6 locations
• Other: deli-non chain, café, hot dog stands, more than one style, etc.
Number and Type of Ads on Doors and
Windows
8.63.9 2.6 .4
37.1
25.420.7
11.25.6
84.5
0
10
20
30
40
50
60
70
80
90
None Minimal A Few Many A Lot
Per
cen
t o
f O
utl
ets
Healthy Ads
Unhealthy Ads
(1-2) (2-5) (3-9) (6+)
33% had large unhealthy ads
27% had ads on roof or walls
28% had ads elsewhere
Due to aggregation of variables with ranges, categories are not mutually exclusive and are used as an indicator
Child-oriented
Marketing
31% Fast Food had Toys
in Kids Meals
84%
1%
15%
Fast Food Chain
Fast Food Non-Chain
Sandwiches/Deli Chain
15% FF had ads that were “kid
oriented”
Among FF with toys in kids meals
Nutrition Information & Labeling
27%
0% 0%
31%
26%
0%
7%
46%
14%
2%
7%
15%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Fast Food Chain Fast Food (NotChain)
Pizza Chain Sandwiches/DeliChain
Pe
rce
nt
of
Ou
tle
t T
yp
e
Poster
Brochure
Sign Nutrition InfoAvailable Upon Request
No outlets with
calories on the
menu board
Brochure or pamphlet of menu items near ordering counter
(within 6 feet) minimum:Total calories
CarbohydratesSaturated fat
Sodium
Brochures/posters, often NOT near the
point of purchase to inform decision
making process
Implications
• More evidence documenting presence of fast food around schools
• Important for developing meaningful, targeted nutrition education
• Critical for understanding what kids are up against outside the school walls
• Can inform partnerships and policies
• Shows need for initiatives to reduce fast food and marketing of fast food around schools
Next Steps for CX3
• Under Development: A school score that examines environment within ½ mile boundary of school and includes– Retail food stores– Fast food– Outdoor marketing (1000 ft)– Mobile vending (500 ft)– Walkability and safety
• Food exposure scale that includes all opportunities for eating– Adding to current elements: donut shops, coffee
shops, ice cream, specialty, etc. – Examine relationships with body composition of
youth (FITNESSGRAM), income and school level
Thank you! Alyssa Ghirardelli, MPH, RDResearch ScientistNetwork for a Healthy CaliforniaCA Dept. of Public HealthPublic Health [email protected]
