APHA 2010 CX3 Neigh School Env Presentation.ppt by zhaonedx

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									                                                Access to fast food around schools:
                                                Exposures in California’s low-income
                                                neighborhoods
                                                  APHA- Denver, CO, November 9, 2010
                                                  Presented by:
                                                  Alyssa Ghirardelli, MPH, RD
                                                  CX3
                                                  Communities of Excellence in Nutrition,
                                                  Physical Activity, and Obesity Prevention


           Additional contributors: Valerie Quinn, MEd., Sharon Sugerman, MS, RD


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
             Alyssa Ghirardelli, MPH, RD

(1)  The following personal financial relationships with
 commercial interests relevant to this presentation existed
               during the past 12 months:

          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
California Teen Eating, Exercise, and
Nutrition Survey (CalTEENS) Trends
                                 Overweight and Obesity
                               California Teens Aged 12-17
                    35                                                                    Overweight

                                                           28.6                           Obese
                    30
                                                                      26.7
                    25
                                     24.3      23.4
 Percent of Teens




                                                                                  21.8
                         21.3
                    20                                      16.2       14.4
                                     13.7
                                                 14.6
                    15    13                                                       13.1


                    10

                                                            12.4       12.6
                     5               10.6
                           8                     8.8                               8.7

                     0
                          1998       2000       2002        2004       2006        2008

                         (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)
    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              11%               11%               12%                13%               13%                12%
national
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 founder

  Reference: 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
CX3: Communities of Excellence
in Nutrition, Physical Activity and Obesity Prevention
 • 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 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.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
CX3 Data: Assessment/Tracking
• Alternative Food Sources
   – Community Supported Agriculture
   – Produce Stands
   – Community Gardens
• Emergency Food Sources
• Local Health Department
  Infrastructure
• Media Coverage
CX3        Sites
23 Network funded Local
Health Departments
All types: Urban dense,
suburban, rural, remote
More w/ other funding,
including CA Regional
Obesity Prevention Projects
CX3 Neighborhood Selection
• 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 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 Food
Around 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

                      40%                                     • Mean of 5 fast food
                                 36%
                      35%                                     • Worst case scenario:
                      30%
                                                    27%
                                                                  22 fast food in ½ mile
                      25%                                               23%
 Percent of Schools




                      20%


                      15%                                                                  14%

                      10%


                      5%


                      0%

                            schools with 1-2   schools with 3-5    schools with 6-9   schools with 10+
        Percent of Fast Food by School Type

                     60

                                                51 %
                     50
Percent of Outlets




                     40



                     30      27 %

                     20
                                        18 %


                     10
                                                            4%
                     0

                          Elementary   Middle   High   Continuation
                                                                           • Fast Food Chains: burgers, fried
                     FF Outlet Types                                         chicken/fish, taco/Mexican/Latino,
                                                                             fast Chinese, ≥ 6 locations
                         50%                                               • Fast Food Non-Chain: same
                         45%                         43%                     styles as Fast Food Chain, but < 6
                         40%       36%                                       locations
Percent of Outlets




                                                                           • Other: deli-non chain, café, hot dog
                         35%

                         30%

                         25%
                                                                             stands, more than one style, etc.
                         20%

                         15%

                         10%                                          6%                             6%        5%
                                                                                      4%
                          5%

                          0%
                                                      )




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                                                                                  Sa
Number and Type of Ads
on Doors and Windows
                     90   84.5
                     80

                     70
                                        Healthy Ads
                     60
Percent of Outlets




                                        Unhealthy Ads
                     50

                     40          37.1

                     30                                 25.4
                                                                                20.7
                     20
                                                                                                       11.2
                                                8.6
                     10                                                3.9                                                     5.6
                                                                                              2.6                      .4
                     0
                           None                 Minimal                  A Few                   Many                   A Lot
                                                  (1-2)                  (2-5)                   (3-9)                  (6+)

                                 Due to aggregation of variables with ranges, categories are not mutually exclusive and are used as an indicator
    Child-oriented                   15% FF had ads that were
      Marketing                           “kid oriented”


    31% Fast Food had
    Toys in Kids Meals

     15%

  1%


Among FF with toys in kids meals

                             Fast Food Chain
                             Fast Food Non-Chain
                 84%
                             Sandwiches/Deli Chain
                                 Nutrition Information & Labeling

                         50%
                               No outlets with                                          46%
                         45%
                               calories on the
                         40%
                                menu board
                         35%
                                                                                  31%
Percent of Outlet Type




                         30%
                               27% 26%
                                                      Poster
                         25%                          Brochure
                         20%
                                                      Sign Nutrition Info
                                                      Available Upon Request                  15%
                         15%
                                         14%

                         10%
                                                                        7% 7%
                         5%
                                                            2%
                                                 0%    0%          0%
                         0%

                               Fast Food Chain   Fast Food (Not     Pizza Chain   Sandwiches/Deli
                                                     Chain)                           Chain
Brochure or pamphlet of menu
 items near ordering counter
   (within 6 feet) minimum:
         Total calories
        Carbohydrates
         Saturated 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, RD
   Research Scientist
   Network for a Healthy California
   CA Dept. of Public Health
   Public Health Institute
   Alyssa.Ghirardelli@cdph.ca.gov
   916-449-5342

								
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