title: Disparities in the food environment surrounding US middle and high schools.
abstract: BACKGROUND
  Disparities in the type and density of food retail outlets have been hypothesized as a possible cause of differential obesity rates across racial/ethnic and income groups. Several local studies have documented differences in business environments by sociodemographic neighbourhood characteristics, but no data specific for youth have been published. This study analyses the food environment surrounding all public middle and high schools in the USA.
  
  
  METHODS
  Buffers were calculated with a radius of 400 and 800 m from the main entrance of public secondary schools in the USA (n=31,622), and business establishments within those buffers were identified using InfoUSA proprietary business listings. Indicators of any convenience store, limited-service restaurant, snack store or off-licences/liquor store and counts of businesses were regressed on the proportion of students eligible for free school meals, Title I eligibility of the school, racial/ethnic composition, location and student/teacher ratio.
  
  
  RESULTS
  Hispanic youth are particularly likely to attend schools that are surrounded by convenience stores, restaurants, snack stores or off-licences. This effect is independent and in addition to poverty (i.e. students eligible for free school meals or schools that are Title I eligible) or location (urban core, suburban, town, rural). The association between other racial groups and nearby businesses is weaker, with the exception of off-licences, where a higher proportion of minority groups increases the probability of off-licences in close proximity to the school. Middle schools have fewer surrounding businesses than high schools, and larger schools have fewer surrounding businesses than smaller schools.
  
  
  CONCLUSIONS
  Easy availability of snacks, sodas and fast food in the immediate vicinity of a school could easily negate school food policies, especially among students who can leave campus. Surrounding food outlets could also lower the effectiveness of health education in the classroom by setting a highly visible example that counters educational messages. There are several clear differences across sociodemographic groups with, arguably, the most pernicious being the location of off-licences. These disparities may represent an important type of environmental injustice for minorities and lower-income youth, with potential adverse consequences for dietary behaviours.
authors.affiliation: RAND, Santa Monica, CA 90401, USA. roland_sturm@rand.org
authors.forename: Roland
authors.initials: R
authors.lastname: Sturm
mesh_terms: D000293:Adolescent; D002648:Child; D005522:Food Services; D006801:Humans; D009765:Obesity; D012111:Residence Characteristics; D012147:Restaurants; D012574:Schools; D012923:Social Class; D012931:Social Environment; D014481:United States