Available online at www.sciencedirect.com
Preventive Medicine 47 (2008) 284 – 288
www.elsevier.com/locate/ypmed
Proximity of fast food restaurants to schools: Do neighborhood
income and type of school matter?
Paul A. Simon a,b,⁎, David Kwan a , Aida Angelescu a , Margaret Shih a , Jonathan E. Fielding a,b
a
Los Angeles County Department of Public Health, USA
b
UCLA School of Public Health, USA
Available online 10 March 2008
Abstract
Objectives. To investigate the proximity of fast food restaurants to public schools and examine proximity by neighborhood income and school
level (elementary, middle, or high school).
Methods. Geocoded school and restaurant databases from 2005 and 2003, respectively, were used to determine the percentage of schools with
one or more fast food restaurants within 400 m and 800 m of all public schools in Los Angeles County, California. Single-factor analysis of
variance (ANOVA) models were run to examine fast food restaurant proximity to schools by median household income of the surrounding census
tract and by school level. Two-factor ANOVA models were run to assess the additional influence of neighborhood level of commercialization.
Results. Overall, 23.3% and 64.8% of schools had one or more fast food restaurants located within 400 m and 800 m, respectively. Fast food
restaurant proximity was greater for high schools than for middle and elementary schools, and was inversely related to neighborhood income for
schools in the highest commercial areas. No association with income was observed in less commercial areas.
Conclusions. Fast food restaurants are located in close proximity to many schools in this large metropolitan area, especially high schools and
schools located in low income highly commercial neighborhoods. Further research is needed to assess the relationship between fast food proximity
and student dietary practices and obesity risk.
© 2008 Elsevier Inc. All rights reserved.
Keywords: Schools; Fast food; Childhood obesity; Diet; Prevention
Introduction
Over the past three decades, the epidemic of overweight
among children in the United States has been accompanied
by major changes in childhood patterns of food and beverage
consumption (St-Onge et al., 2003). Prominent among these
changes has been a significant increase in the consumption of
foods from restaurants and fast food establishments (Nielsen
et al., 2002a,b; Guthrie et al., 2002; Nielsen et al., 2002a,b).
Among adolescents aged 12 to 18 years, the percentage of
total energy intake from restaurant and fast foods consumption increased by nearly 300% from 1977 to 1996 (Nielsen et
al., 2002a,b). Growth in fast food sales has been particularly
rapid, outpacing growth in sales at table service restaurants
⁎ Corresponding author. Division of Chronic Disease and Injury Prevention,
Los Angeles County Department of Public Health, 3530 Wilshire Boulevard,
Suite 800, Los Angeles, CA, 90010, USA. Fax: +1 213 351 2713.
E-mail address: [email protected] (P.A. Simon).
0091-7435/$ - see front matter © 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.ypmed.2008.02.021
by 45% between 1982 and 1997 (Jekanowski, 1999).
Approximately 3 in 10 U.S. children now consume food
from one or more fast food establishments on a typical day
(Bowman et al., 2004).
Consumption of fast food is associated with increased caloric and total fat intake, more added sugar intake, less dietary
fiber, fewer fruits and vegetables, and other indices of poor
dietary quality in children and adolescents (Bowman et al., 2004;
French et al., 2001; Schmidt et al., 2005). In addition,
overweight adolescents have been found to be less likely than
their lean counterparts to compensate for the energy intake from
fast food by adjusting their energy intake from other sources
(Ebbeling et al., 2004). Fast food consumption has also been
associated with increased weight gain and insulin resistance
among young adults in a recent longitudinal study, suggesting
that frequent consumption may be an independent risk factor for
obesity and type 2 diabetes (Pereira et al., 2005).
Strategies to address the childhood obesity epidemic include
efforts to improve the food environment. An important focus of
P.A. Simon et al. / Preventive Medicine 47 (2008) 284–288
these efforts has been on improving school environments by establishing more rigorous nutrition standards for school meals and
regulating what is sold in vending machines (Institute of Medicine,
2007). However, the food environment immediately surrounding
school campuses may also be important, especially at high schools
where students have more freedom to leave school grounds and
purchase food.
A recent study in Chicago found a statistically significant
clustering of fast food restaurants within short walking distances
of schools (Austin et al., 2005). Other studies have found higher
concentrations of fast food restaurants in low income neighborhoods and, in one study (Block et al., 2004), in predominantly
black neighborhoods (Block et al., 2004; Cummins et al., 2005;
Reidpath et al., 2002; Pearce et al., 2007). However, these other
studies did not examine fast food locations in relation to schools.
The objectives of the present study were to assess the proximity
of fast food restaurants to public schools in a large metropolitan area
and to address two primary questions: 1) Is there an association
between fast food proximity to schools and neighborhood income?
2) If so, is this association effected by the level of commercialization of the area? The importance of these questions rests in the
fact that the childhood obesity epidemic has disproportionately
impacted those living in low income neighborhoods (Lee et al.,
2006). Many of these neighborhoods are located in urban centers
that are highly commercialized and densely packed with fast food
restaurants (Block et al., 2004; Kipke et. al., 2007). Given the
greater independence and mobility of adolescents compared with
younger children, our study also sought to examine the relationship
between fast food restaurant proximity and school level (elementary, middle, or high school).
Methods
Data sources
We used 2005 data from the California Department of Education (CDE) to
identify all public schools in Los Angeles County, the most populous county in
the United States. All fast food restaurants in the county among 18 fast food
chains (listed in Table 1) were ascertained using 2003 databases from the food
inspection/safety programs at the Los Angeles County, Pasadena City, and Long
Beach City health departments. These databases are believed to be nearly 100%
complete because all retail food establishments are required by state law to have a
permit and to receive periodic inspections. Though we did not formally validate
completeness, we compared the total number of fast food outlets in our food
inspection database with the total number in a commercial database (Dun &
Bradstreet) for 17 of the 18 chains included in our study (one chain was not
captured in the commercial database). We found 30% more outlets in the food
inspection database (n = 2648) than in the commercial database (n = 1848).
Only restaurants with 10 or more outlets in Los Angeles County and with
primarily counter and/or drive-through service were included in the analysis.
Fast food restaurants located at major sports venues were excluded.
Data on census tract-level median household income were obtained from the
U.S. Census 2000. To examine the influence of neighborhood-level commercial
activity on fast food restaurant proximity to schools, 2004 data on neighborhood
commercialization were obtained from the Parcel Database maintained by the
Los Angeles County Assessor.
Measures and data analysis
A total of 1684 public schools and 2712 restaurants were included in the
analysis. We included schools classified by the CDE as elementary schools
285
Table 1
Fast food restaurant chains included in the analysis, Los Angeles County, 2005
Restaurant name
No. of locations
Arby's
Burger King
Carls's Jr.
Del Taco
Domino's Pizza
El Pollo Loco
In-N-Out Burger
Jack In The Box
KFC
Little Caesar's Pizza
McDonald's
Papa John's Pizza
Pizza Hut
Subway
Taco Bell
Wendy's
Wienerschnitzel
Yoshinoya
Total
13
193
175
89
199
154
52
215
176
84
369
63
187
384
217
28
50
64
2712
(n = 1208), junior high/middle schools (n = 259), or high schools (n = 217).
Schools were also classified by the median household income of the census tract
in which the school was located. Schools were divided equally into four neighborhood income quartiles (i.e., quartile 1 included schools in the b25th percentile
for census-tract median household income, quartile 2 included schools in the
25th–49th percentile, etc.).
Public schools and fast food restaurants were geocoded against Los Angeles
County-specific street and parcel data using street addresses provided in the
respective school directory and food safety databases. The 2005 CDE Public
Schools Database included school addresses which were geocoded at the streetlevel using Thomas Brothers Transportation Lines (TRNL) reference data. From
the geocoded schools, we created layers representing buffered areas around each
school, at 400 m and 800 m in radius separately, with the circle buffers centered
on the street match point. These distances were chosen based on research
estimating that an average person can walk 400 m in 5 min and have been used
in other studies (Austin et al., 2005; Western Australian Planning Commission,
2000; Pikora et al., 2002). We therefore considered both 400 m and 800 m to be
reasonable thresholds for “close proximity”.
The mean number of fast food restaurants, and the percentage of schools with
one or more fast food restaurants, within 400 m and 800 m of each school were
calculated and examined by school type and neighborhood income quartile.
Differences in percentages were assessed for statistical significance with the Chisquare test. Single-factor analysis of variance (ANOVA) models were run to
examine whether the mean number of fast food restaurants within 400 and 800 m
of schools varied significantly by school type and neighborhood income.
To account for differences in population density across neighborhood income
strata in assessing the relationship between mean number of fast food restaurants
and neighborhood income, a single-factor analysis of covariance (ANCOVA)
model was run using population density as the covariate.
To examine whether the level of commercialization in the neighborhood of
the school affected the relationship between mean number of fast food restaurants
and school type or neighborhood income, the level of commercialization surrounding the school was included as a second factor in two-factor ANOVA
models. The hypothesis considered here is that relationships between fast food
proximity to schools and neighborhood income or school type would be most
apparent in highly commercial areas. The percent commercial area of the census tract within which the school was located was used as a proxy for level of
commercialization and was calculated by dividing the total area of commercial
use parcels by the total area of the census tract. Schools were then categorized as
being located in an area of high, moderate, or low level of commercialization
based on tertiles of percent commercial area.
Geographic analysis was performed using ArcGIS 9.1 software (ESRI;
Redlands, CA), and subsequent statistical analyses were performed using SAS
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P.A. Simon et al. / Preventive Medicine 47 (2008) 284–288
Table 2
Mean number of restaurants and percent of schools with at least 1 restaurant in close proximity to schools, by school type and neighborhood income quartile, Los
Angeles County, 2005
No. of Mean number of
Range
Percent of schools with Mean number of
Range
Percent of schools with
schools fast Food restaurants (min, max) 1 or more fast food
fast food restaurants (min, max) 1 or more fast food
within 400 m
restaurants within 400 m within 800 m
restaurants within 800 m
Overall
School type
High school
Middle/junior high
Elementary
1684
0.42
(0, 8)
23.3
2.17
(0, 16)
64.8
217
259
1208
0.65 a
0.42⁎
0.38⁎⁎
(0. 8)
(0, 5)
(0, 7)
30.9⁎⁎
24.3
21.7
2.71
2.10⁎
2.09⁎⁎
(0, 16)
(0, 12)
(0, 15)
71.4
64.5
63.7
0.72⁎⁎⁎
0.45⁎⁎⁎
0.31⁎⁎⁎
0.21 b
(0, 8)
(0, 5)
(0, 5)
(0, 6)
37.7⁎⁎⁎
24.4
18.9
12.1
2.90⁎⁎⁎
2.44⁎⁎⁎
2.07⁎⁎⁎
1.26
(0,
(0,
(0,
(0,
76.8⁎⁎⁎
69.7
65.6
47.3
Neighborhood income quartile
Q1 ($0–$32,832)
422
Q2 ($32,833–$44,416) 422
Q3 ($44,417–$58,318) 419
Q4 ($58,319+)
421
15)
16)
10)
10)
⁎p b 0.05, ⁎⁎p b 0.005, ⁎⁎⁎p b 0.001.
a
School type: high school vs. middle or elementary school.
b
Neighborhood income: 4th income quartile vs. other quartiles.
9.1.3 (SAS Institute; Cary, NC). Post-hoc pairwise comparisons were performed using the Tukey–Kramer adjustment for multiple comparisons, and a
significance level of α = 0.05 was used throughout.
Results
Overall, 23.3% and 64.8% of public schools had one or more
fast food restaurants located within 400 m and 800 m, respectively (Table 2). The percentage with one or more fast food
restaurants within 400 m was highest for high schools (30.9%),
intermediate among middle schools (24.3%), and lowest among
elementary schools (21.7%). A similar trend was seen with the
800 m buffer.
Fast food restaurant proximity to schools was inversely
related to neighborhood income (Table 2). Schools in the lowest
income quartile were over three times more likely to have at
least one fast food restaurant within 400 m than were schools
in the highest income quartile (37.7% vs. 12.1%). This inverse
relationship was also observed with the 800 m buffer. In the
ANCOVA model, the inverse relationship between fast food
restaurant proximity to schools and neighborhood income persisted after controlling for population density (p b 0.001 for both
the 400 and 800 m buffers).
Both school type and level of commercialization were significant effects in the two-factor ANOVA model. When the
400 m buffer was used, the estimated mean number of fast food
restaurants in close proximity to high schools was significantly
higher than the estimated mean for middle schools (p = 0.042)
and elementary schools (p = 0.001). The estimated mean for
middle schools did not differ from the estimated mean for
elementary schools (p = 0.81). The estimated mean number of
fast food restaurants was significantly higher in areas of high
commercialization compared to areas of low commercialization
(p b 0.001, Table 3).
Testing for interaction in the two-factor ANOVA model
using the 400 m buffer revealed a significant interaction between neighborhood income and level of commercialization
(p b 0.001, Fig. 1). The effect of median household income was
found to be significant only within the highest level of commercialization, with the estimated mean number of fast food
restaurants in close proximity to schools being more than five
times as high in areas of low income compared to areas of
high income (1.1 vs. 0.2, respectively, p b 0.001). No significant interaction was found between school type and level of
commercialization. The results were similar when the 800 m
buffer was used.
Discussion
We found that a large percentage of public schools in Los
Angeles County have fast food establishments located within an
easy walking distance. In addition, schools located in low income,
highly commercial neighborhoods were more likely to have fast
food restaurants in close proximity than more affluent neighborhoods with a comparable level of commercialization. This finding
is consistent with those of other studies that have documented
disproportionately high concentrations of fast food outlets in low
income communities (Block et al., 2004; Cummins et al., 2005;
Reidpath et al., 2002; Pearce et al., 2007).
Table 3
Estimated mean number of fast food restaurants within 400 m and 800 m of
schools, by school type and level of commercialization, Los Angeles County,
2005
School Type
High school (ref)
Middle school
Elementary school
Estimated mean no. of
fast food restaurants
within 400 m radius
Estimated mean no. of
fast food restaurants
within 800 m radius
0.65
0.45⁎
0.41⁎⁎
2.71
2.20⁎
2.19⁎⁎
Level of commercialization
Low (ref)
0.22
Medium
0.45⁎⁎⁎
High
0.83⁎⁎⁎
⁎p b 0.05, ⁎⁎p b 0.005, ⁎⁎⁎p b 0.001.
1.21
2.19⁎⁎⁎
3.70⁎⁎⁎
P.A. Simon et al. / Preventive Medicine 47 (2008) 284–288
287
Fig. 1. Estimated mean number of fast food restaurants within 400 m of schools by income quartile and commercialization level, Los Angeles County, 2005.
We also found a greater proximity of fast food restaurants to
high schools than middle or elementary schools, a finding that has
at least several possible explanations. Given the large market
segment represented by teens, it is plausible that fast food chains
may preferentially site outlets near high schools because of the
flexibility these students have to visit these sites before, during,
and after the school day. However, the finding may also reflect
preferential sighting of high schools on major thoroughfares
and, therefore, in closer proximity to fast food establishments
compared with middle and elementary schools that may more
often be sited in largely residential areas. Regardless of the
underlying mechanism, the issue of fast food proximity is likely
of particular importance for high schools, where students are
often free to leave campus during lunchtime and have greater
independence before and after school.
An important limitation of our study is that we focused solely
on fast food establishments and did not assess other aspects of the
food environment. One recent study found that comprehensive
assessments of local food environments are important because
concentrations of unhealthy food outlets can sometimes be accompanied by the presence of healthier food options in the same
community (Pearce et al., 2007). However, other studies have
found that the high density of fast food establishments found
in low income communities are often associated with more
general evidence of unhealthy food environments, including a
paucity of supermarkets, limited access to fresh produce, and an
abundance of convenience stores offering few healthy food options (Baker et al., 2006; Kipke et al., 2007, Morland et al., 2002).
We also did not address in our study the availability of
commercial fast food products sold on school campuses. Though
we could not quantify the percentage of schools that offer these
products on site, such practices have been phased out over the
past several years across Los Angeles County as a result of new
school district-level policies and, more recently, state legislation
mandating more rigorous nutrition standards for foods and beverages sold at schools.
Our study did not assess the degree to which fast food
proximity to schools influenced dietary patterns among students,
including the fact that fast food establishments offer a range of
menu items, some of which are less obesigenic than others. We
also did not assess the relationship between fast food proximity
and childhood obesity rates. Although fast food consumption has
been associated with excess weight gain (Pereira et al., 2005;
Duffey et al., 2007; Thompson et al., 2004), limited information is
available on the influences of fast food proximity and accessibility on dietary practices and weight status. Several studies have
evaluated geographic associations between fast food density and
obesity rates with mixed results (Maddock, 2004; Jeffrey et al.,
2006). However, these ecologic studies are limited because they
do not account for the many other factors that contribute to obesity
at both the community and individual levels. Further research
is needed to better define the relationships between fast food
proximity and weight status as well as dietary practices.
An additional limitation is that we could not identify in the
restaurant database fast food establishments that were not part of
a recognizable chain. Therefore, we do not know the degree to
which the geographic distribution of all fast food restaurants
may have differed from those included in our analysis. In addition, we assessed the proximity of fast food restaurants to
schools using a straight line radius approach rather than incorporating road or path network distances, resulting in potential
overestimation of fast food proximity.
These limitations notwithstanding, our findings raise a concern that the significant efforts made in recent years to improve
nutrition environments within schools, including policies mandating more rigorous nutrition standards for school meals and
restrictions on foods and beverages sold in vending machines,
may potentially be diminished if attention is not given to fast
288
P.A. Simon et al. / Preventive Medicine 47 (2008) 284–288
food outlets directly surrounding schools, especially in low
income communities. These efforts are particularly important
given the disproportionately high rates of childhood obesity in
low income communities (Lee et al., 2006). In addition, the
findings underscore the need for further research to assess
the relationship between fast food proximity to schools and
student dietary practices and obesity risk.
While strategies to curb the childhood obesity epidemic must
include more effective education of children and their parents
on nutrition and portion control, these efforts will likely fall far
short without concurrent environmental change efforts that tip
the balance in favor of healthier food purchases. Municipalities
have much control over how land is used and developed in
their jurisdictions (Ashe et al., 2003). Increasingly, public health
authorities are working with city planners to promote zoning and
other land use policies that incorporate health as a consideration.
Much of this work most recently has focused on physical activity
promotion through, for example, the design of more walkable
neighborhoods and allocation of space for parks, jogging trails,
and bicycle paths (Powell, 2005).
Efforts are needed to expand this focus to food environments.
Potential areas of intervention include regulating the density of
fast food establishments and creating economic and other incentives for markets that offer affordable fresh produce and for
restaurants that offer healthier fare and smaller portions. The
results of this study suggest that consideration in these efforts
should be given to the types of food establishments located near
schools, especially in low income communities with high commercial densities.
Conclusions
Fast food restaurants are located in close proximity to many
schools in this large metropolitan area, especially high schools and
schools located in low income highly commercial neighborhoods.
Further research is needed to assess the relationship between fast
food proximity and student dietary practices and obesity risk.
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