Socioeconomic Inequalities in the Retail Food Environment around Schools in a Southern European Context

Abstract

Across Europe, excess body weight rates are particularly high among children and adolescents living in Southern European contexts. In Spain, current food policies appeal to voluntary self-regulation of the food industry and parents’ responsibility. However, there is no research (within Spain) assessing the food environment surrounding schools. We examined the association between neighborhood-level socioeconomic status (NSES) and the spatial access to an unhealthy food environment around schools using both counts and distance measures, across the city of Madrid. We conducted a cross-sectional study citywide (n = 2443 census tracts). In 2017, we identified all schools (n = 1321) and all food retailers offering unhealthy food and beverages surrounding them (n = 6530) using publicly available data. We examined both the counts of retailers (within 400 m) and the distance (in meters) from the schools to the closest retailer. We used multilevel regressions to model the association of neighborhood-level socioeconomic status (NSES) with both measures, adjusting both models for population density. Almost all schools (95%) were surrounded by unhealthy retailers within 400 m (median = 17 retailers; interquartile range = 8–34). After adjusting for population density, NSES remained inversely associated with unhealthy food availability. Schools located in low-NSES areas (two lowest quintiles) showed, on average, 29% (IRR (Incidence Rate Ratio) = 1.29; 95% CI (Confidence Interval) = 1.12, 1.50) and 62% (IRR = 1.62; 95% CI = 1.35, 1.95) more counts of unhealthy retailers compared with schools in middle-NSES areas (ref.). Schools in high-NSES areas were farther from unhealthy food sources than those schools located in middle-NSES areas (β = 0.35; 95% CI = 0.14, 0.47). Regulating the school food environment (within and beyond school boundaries) may be a promising direction to prevent and reduce childhood obesity.

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review

“…At the interpersonal level, availability, accessibility, parental role modelling, parental permissiveness, family cohesion, parental concerns about child's health, parental norms, visibility of food items, methods of preparation, settings for eating, and parental monitoring were the most consistent correlates of dietary intake among youth . Exposure to unhealthy food outlets in the immediate food environment, food advertising, trade and agricultural policies, food prices and school food policies were also shown to be the factors influencing dietary intake.…”

Assessing the Retail Food Environment in Madrid: An Evaluation of Administrative Data against Ground Truthing

“…This variability suggests the need to examine the accuracy of secondary data on a case-by-case basis [15]. To the best of our knowledge, our study is the first offering insight from a large Southern European setting, where there has been recent interest in food environment research [3,53].…”

Environmental Influences on Dietary Intake of Children and Adolescents

“…Moving from the school setting to the surrounding neighborhood environment, Díez and colleagues [37] examined socioeconomic inequalities in the food environment around schools in Spain. They showed that 95% of the schools were surrounded by unhealthy food retailers within a short range, with a median of 17 unhealthy food outlets per school.…”

“…They showed that 95% of the schools were surrounded by unhealthy food retailers within a short range, with a median of 17 unhealthy food outlets per school. A worrying addition to this was that unhealthy food retailers were both closer and higher in number for schools in low-SES neighborhoods [37], indicating that children from a lower SES background are growing up in a less healthy food environment. Dhillon and colleagues [38] painted an equally problematic picture regarding the food environment of college students living on a food-desert campus in the United States.…”

“…Healthy foods, such as fruit, were too expensive and often not available at campus, and it was very difficult to get food from outside the campus area [38]. Based on the studies of Díez [37] and Dhillon [38], we can conclude that both the overwhelming offer of unhealthy foods and the lack of healthy foods around educational facilities are very problematic.…”