APRIL 2019 DIVISION OF HEALTH PROMOTION JACKSON COUNTY HEALTH DEPARTMENT REPORT PROXIMITY of FAST FOOD RESTAURANTS to SCHOOLS in Eastern Jackson County (EJC) BACKGROUND Obesity by the Numbers JACKSON COUNTY Low Income Children at RESIDENTS WHO Obesity in the United States has be- Higher Risk ARE OBESE come an epidemic. It is a leading Childhood obesity disproportionately factor of chronic disease and health affects children in low income fami- issues and, according to the National lies. While the rate of childhood obe- Center for Health Statistics, the prev- sity increased by 10% from 2003 to alence of adults with obesity in the 2007, it increased somewhere between U.S. is 39.8%.1 Jackson County is not 23-33% for children in low-education, immune to overweight and obesity low-income, and higher-unemploy- rates either. According to the Missouri ment households in that same time County Level Study, 30.58% of Jack- period. A recent study on school dis- son County residents are obese.2 Obe- MISSOURI tricts in Massachusetts found that for sity not only impacts adults; the rate ADOLESCENTS every 1 percent increase in low-income of youth with obesity is 18.5% nation- (10-17 year olds) status, school districts saw a 1.17% in- ally.1 Adolescents in Missouri (10 - 17 WHO ARE OBESE crease in overweight/obesity rates.6 year olds) are obese at a rate of 12.7%. Studies have shown that low-income When considering high school stu- communities often face more barriers dents alone (9th – 12th grade), obe- to improving their overweight/obesity sity rates increase to 16.6%. Interest- status than their higher income neigh- ingly, obesity rates for youth aged 10 bors. For example, low-income com- – 17 year olds have slightly decreased munities may lack full-service grocery over the last year, but the rate in high stores, exercise facilities, and recre- school students has nearly doubled ational programs and parks, but have MISSOURI HIGH since 1999 and increased by nearly 3% an increased access to fast food outlets SCHOOLERS from 2015 – 2017.3 and convenience stores. (9th-12th grade) Childhood Obesity and WHO ARE OBESE Health Children with obesity are at an in- creased risk for a number of health issues including: high blood pressure and high cholesterol, increased risk of impaired glucose tolerance, insulin resistance, type 2 diabetes, breathing problems (such as asthma and sleep apnea) joint problems and fatty liver disease, gallstones, and heartburn.4 sity. If an individual is overweight or Children with obesity also face so- obese as an adolescent, there is a 70% cial and emotional stress as they are chance they will remain overweight or often targets of bullying, experience obese as an adult.6 Adults who have social isolation, and feel an overbur- experienced lifelong obesity also tend den of stress.5 Additionally, childhood to have more serious health problems obesity sets the trajectory for lifelong than those who become obese later in health conditions including adult obe- life. 2 91% of parents report- ed purchasing Fast Food and “Dining Out” lunch or dinner students who attend schools within on the Rise for their child in one half mile of fast food restaurants While there is often an excess of avail- the past week at are more likely to be overweight or ability of fast food within low income one of the four obese.14 communities, all Americans are im- largest chains. pacted by the inundation of fast food. In major metro cities throughout the of children ages 2 – 19 The proportion of meals Americans 1/3 country, including New York City, eat fast food on any given day. eat away from their homes has signifi- Chicago, and Los Angeles, studies cantly increased. The technological have consistently shown fast food advances of the food industry have clustering near schools. Nearly 80% allowed restaurants to mass produce of schools in Chicago have at least their meals, leading to the expansion one fast food restaurant within 800 m of the fast-food industry.7 The number overall sugar, more fat, more saturat- (or about ½ mile).15 This is especial- of fast food outlets in the United States ed fat, and more sodium, while con- ly true for high schools. For instance, has increased from about 30,000 lo- suming less fiber, less fruits and veg- researchers in Los Angeles County 11,12 cations in 1970 to more than 233,000 etables, and less milk. have found a greater proximity of locations in 2004. Additionally, fast fast food restaurants to high schools food outlets have been classified as the Regular consumption of fast food can than middle or elementary schools.16 most rapidly expanding sector of US lead to weight gain and insulin re- And across the United States, 67% of food distribution.8 sistance. In a 15 year study of young high schools in major cities are within adults in the U.S., those who ate fast 800 meters of a fast food outlet.17 The In 2016, 91% of parents reported pur- food two or more times a week gained proximity of fast food locations near chasing lunch or dinner for their child approximately 10 more pounds and high schools could be for various rea- in the past week at one of the four had double the increase of insulin re- sons including the tendency for both largest chains (McDonald’s, Burger sistance over the 15 year period than to locate near major thoroughfares, King, Wendy’s, and Subway). This was those who consumed fast food less or major commercial zones serving 13 an increase from 2010, where 79% of than once per week. Weight gain larger populations. Conversely, mid- parents reported purchasing a meal and insulin resistance increase the dle and elementary schools are often from one of these chains once in the risk of developing obesity and type 2 located in residential neighborhoods past week.9 Results from the 2012 diabetes. serving a smaller number of students NHANES survey showed that children and further from commercial zones and adolescents received an average Fast Food Outlets and Prox- and thoroughfares. of 12.4% of their daily calories from imity to Schools fast food. Adolescents ages 12 – 19 ate As fast food consumption contrib- The location of fast food near high twice as many calories from fast food utes to obesity in children, it is worth schools is important because the rate than children ages 2 – 11. Combined, considering the relationship between of teenage obesity has steadily in- one third of children ages 2 – 19 eat fast food outlets and schools. A 2014 creased in recent years. Among ad- fast food on any given day.10 On days study in Arkansas found that fast olescents aged 12 - 18 years old, the where they do eat fast food, children food restaurants within one mile of a percentage of total energy intake from consume about 126 more calories and school do impact school-level weight restaurant and fast foods consump- adolescents consume about 310 more outcomes and that an addition of a tion increased by nearly 300% from calories than days where they do not fast-food restaurant within one mile 1977 to 1996.18 This may be due to eat fast food. They also consume more radius increases school obesity rates various reasons including that high sugar sweetened beverages, more by 1.23%.7 Another study found that school students have more choice in 3 SOCIAL DETERMINANTS METHODS OF HEALTH AFFECTED the foods they eat because of their A total of 106 public schools and 451 ECONOMIC disposable incomes, their ability to fast food restaurants were included in STABILITY drive or walk themselves to food op- this analysis. Information on fast food tions, their flexible schedules, and restaurants was gathered using Goo- open campus policies that allow them gle. Restaurants labeled as fast food to leave school for lunch.19 In a 2011 or fast casual and convenience loca- EDUCATION study, researchers surveyed adoles- tions were labeled as fast food restau- cents at fast food restaurants on what rants (McDonald’s, Burger King, influenced them to eat there; 57% re- Wendy, Subway, etc.).21 Full service sponded that ease mattered ‘some’ or grocery stores and department stores HEALTH AND ‘a lot’ and 48% responded that loca- with grocery sections were labeled as HEALTH CARE tion was the most important factor. healthy food vendors. Information In that same study, researchers found on public schools was gathered using that adolescents who purchased fast Missouri Spatial Data Information. Data on census tract-level median NEIGHBORHOOD food without a caregiver present tend- AND BUILT ed to order meals with higher calorie household income was obtained from ENVIRONMENT content.20 the U.S. Census. Schools were cate- gorized by elementary school (n= 71), In recognizing the rate of obesity in middle school (n= 19), and high school SOCIAL AND Jackson County, and acknowledging (n=16). Schools were also classified COMMUNITY the fact that fast food consumption by the median household income of CONTEXT contributes to childhood obesity, the the census tract in which the school aim of this study was to examine the was located and then divided into proximity of fast food restaurants four quartiles. Schools and fast food to Eastern Jackson County schools. restaurants were geocoded using lon- Specifically, this study addressed two gitudinal and latitudinal coordinates. questions: 1) Is there a difference in From the geocoded schools, layers proximity of fast food restaurants were created representing buffered ar- among elementary, middle, and high eas around each school at ½ mile and schools? 2) Is there an association 1 mile radius.