Social Inequalities in Food Exposure Around Schools in an Urban Area

Background: The obesity epidemic among children and youth, and the social gradient in this relationship, could be related to differential exposure to food sources in primary environments. Although the positive association between area-level deprivation and fast-food outlets offering high-calorie foods has been well documented, few studies have evaluated food sources around school settings.

Purpose: This study evaluated the relationships among food sources around schools, neighborhood income, and commercial density.

Methods: A GIS was used to derive measures of exposure to fast-food outlets, fruit and vegetable stores, and full-service restaurants near primary and secondary schools in Montreal, Canada, in 2005. Food source availability was analyzed in 2009 in relation to neighborhood income for the area around schools, accounting for commercial density.

Results: For the 1168 schools identified, strong neighborhood income gradients were observed in relation to food sources. Relative to the highest income-quartile schools, the odds of a fast-food outlet being located within 750 m of a low income-quartile school was 30.9 (95% CI=19.6, 48.9). Similar relationships were observed for full-service restaurants (OR=77, 95% CI=35, 169.3) and fruit and vegetable stores (OR=29.6, 95% CI=18.8, 46.7). These associations were reduced, but remained significant in models accounting for commercial density.

Conclusions: Food source exposure around schools is inversely associated with neighborhood income, but commercial density partly accounts for this association. Further research is necessary to document food consumption among youth attending schools in relation to nearby food source opportunities.