title: Clustering of unhealthy food around German schools and its influence on dietary behavior in school children: a pilot study.
abstract: BACKGROUND
  The availability of fast foods, sweets, and other snacks in the living environment of children is assumed to contribute to an obesogenic environment. In particular, it is hypothesized that food retailers are spatially clustered around schools and that a higher availability of unhealthy foods leads to its higher consumption in children. Studies that support these relationships have primarily been conducted in the U.S. or Australia, but rarely in European communities. We used data of FFQ and 24-HDR of the IDEFICS study, as well as geographical data from one German study region to investigate (1) the clustering of food outlets around schools and (2) the influence of junk food availability on the food intake in school children.
  
  
  METHODS
  We geocoded food outlets offering junk food (e.g. supermarkets, kiosks, and fast food restaurants). Spatial cluster analysis of food retailers around child-serving institutions was conducted using an inhomogeneous K-function to calculate global 95% confidence envelopes. Furthermore, a food retail index was implemented considering the kernel density of junk food supplies per service area, adjusted for residential density. We linked the food retail index to FFQ and 24-HDR data of 384 6- to 9-year-old school children in the study region and investigated the impact of the index on food intake, using multilevel regression models adjusted for sex, age, BMI, parent's education and income, as well as adjusting for over- and underreporting of food intake.
  
  
  RESULTS
  Comparing the 95% confidence envelopes to the observed K-function, we showed that food stores and fast food restaurants do not significantly cluster around schools. Apart from this result, the food retail index showed no effect on BMI (β=0.01,p=0.11) or food intake variables assessed by FFQ and 24-HDR.
  
  
  CONCLUSIONS
  In the built environment of the German study region, clustering of food retailers does not depend on the location of schools. Additionally, the results suggest that the consumption of junk food in young children is not influenced by spatial availability of unhealthy food. However, investigations should be replicated in other European communities to increase environmental variability.
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Buck
authors.forename: Claudia
authors.initials: C
authors.lastname: Börnhorst
authors.forename: Hermann
authors.initials: H
authors.lastname: Pohlabeln
authors.forename: Inge
authors.initials: I
authors.lastname: Huybrechts
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.forename: Lucia
authors.initials: L
authors.lastname: Reisch
authors.forename: Iris
authors.initials: I
authors.lastname: Pigeot
mesh_terms: D002648:Child; D002652:Child Behavior; D016000:Cluster Analysis; D003132:Commerce; D004032:Diet / Q000592:standards*; D015930:Diet Records; D004034:Diet Surveys; D057140:Fast Foods; D005247:Feeding Behavior; D005260:Female; D005523:Food Supply; D005858:Germany; D006801:Humans; D008297:Male; D009765:Obesity / Q000209:etiology; D012147:Restaurants; D012574:Schools; D011795:Surveys and Questionnaires