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Greater access to healthy food outlets in the home and school environment is associated with better dietary quality in young children

  • Millie Barrett (a1), Sarah Crozier (a2), Daniel Lewis (a3), Keith Godfrey (a1) (a2), Sian Robinson (a1) (a2), Cyrus Cooper (a1) (a2) (a4), Hazel Inskip (a1) (a2), Janis Baird (a2) and Christina Vogel (a2)...



To explore associations between dietary quality and access to different types of food outlets around both home and school in primary school-aged children.


Cross-sectional observational study.


Hampshire, UK.


Children (n 1173) in the Southampton Women’s Survey underwent dietary assessment at age 6 years by FFQ and a standardised diet quality score was calculated. An activity space around each child’s home and school was created using ArcGIS. Cross-sectional observational food outlet data were overlaid to derive four food environment measures: counts of supermarkets, healthy specialty stores (e.g. greengrocers), fast-food outlets and total number of outlets, and a relative measure representing healthy outlets (supermarkets and specialty stores) as a proportion of total retail and fast-food outlets.


In univariate multilevel linear regression analyses, better diet score was associated with exposure to greater number of healthy specialty stores (β=0·025 sd/store: 95 % CI 0·007, 0·044) and greater exposure to healthy outlets relative to all outlets in children’s activity spaces (β=0·068 sd/10 % increase in healthy outlets as a proportion of total outlets, 95 % CI 0·018, 0·117). After adjustment for mothers’ educational qualification and level of home neighbourhood deprivation, the relationship between diet and healthy specialty stores remained robust (P=0·002) while the relationship with the relative measure weakened (P=0·095). Greater exposure to supermarkets and fast-food outlets was associated with better diet only in the adjusted models (P=0·017 and P=0·014, respectively).


The results strengthen the argument for local authorities to increase the number of healthy food outlets to which young children are exposed.

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1. Public Health England (2015) About Obesity. (accessed October 2015).
2. Daniels, SR (2006) The consequences of childhood overweight and obesity. Future Child 16, 4767.
3. World Health Organization (2016) Report of the Commission on Ending Childhood Obesity. Geneva: WHO.
4. Public Health England (2015) National Child Measurement Programme. (accessed June 2015).
5. Conrad, D & Capewell, S (2012) Associations between deprivation and rates of childhood overweight and obesity in England, 2007–2010: an ecological study. BMJ Open 2, e000463.
6. Engler-Stringer, R, Le, H, Gerrard, A et al. (2014) The community and consumer food environment and children’s diet: a systematic review. BMC Public Health 14, 522.
7. Caspi, CE, Sorensen, G, Subramanian, SV et al. (2012) The local food environment and diet: a systematic review. Health Place 18, 11721187.
8. Holsten, JE (2009) Obesity and the community food environment: a systematic review. Public Health Nutr 12, 397405.
9. Cetateanu, A & Jones, A (2014) Understanding the relationship between food environments, deprivation and childhood overweight and obesity: evidence from a cross sectional England-wide study. Health Place 27, 6876.
10. Fraser, LK & Edwards, KL (2010) The association between the geography of fast food outlets and childhood obesity rates in Leeds, UK. Health Place 16, 11241128.
11. Lytle, LA & Sokol, RL (2017) Measures of the food environment: a systematic review of the field, 2007–2015. Health Place 44, 1834.
12. Vandevijvere, S, Dominick, C, Devi, A et al. (2015) The healthy food environment policy index: findings of an expert panel in New Zealand. Bull World Health Organ 93, 294302.
13. Black, C, Moon, G & Baird, J (2014) Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place 27, 229242.
14. Cummins, S & Macintyre, S (2005) Food environments and obesity – neighbourhood or nation? Int J Epidemiol 35, 100104.
15. Brembeck, H, Johansson, B, Bergstrom, K et al. (2013) Exploring children’s foodscapes. Child Geogr 11, 7488.
16. Cetateanu, A & Jones, A (2016) How can GPS technology help us better understand exposure to the food environment? A systematic review. SSM Popul Health 2, 196205.
17. Williams, J, Scarborough, P, Townsend, N et al. (2015) Associations between food outlets around schools and BMI among primary students in England: a cross-classified multi-level analysis. PLoS One 10, e0132930.
18. Charriere, H, Casey, R & Salze, P (2010) Measuring the food environment using geographical information systems: a methodological review. Public Health Nutr 13, 17731785.
19. Clary, C, Ramos, Y, Shareck, M et al. (2015) Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study. Prev Med 71, 8387.
20. Cobb, LK, Appel, LJ, Franco, M et al. (2015) The relationship of the local food environment with obesity: a systematic review of methods, study quality, and results. Obesity (Silver Spring) 23, 13311344.
21. Van Hulst, A, Barnett, TA, Gauvin, L et al. (2012) Associations between children’s diets and features of their residential and school neighbourhood food environments. Can J Public Health 103, 9 Suppl. 3, eS48eS54.
22. Perchoux, C, Chaix, B, Cummins, S et al. (2013) Conceptualization and measurement of environmental exposure in epidemiology: accounting for activity space related to daily mobility. Health Place 21, 8693.
23. Harrison, F, Burgoine, T, Corder, K et al. (2014) How well do modelled routes to school record the environments children are exposed to? A cross-sectional comparison of GIS-modelled and GPS-measured routes to school. Int J Health Geogr 13, 5.
24. Kestens, Y, Lebel, A, Daniel, M et al. (2010) Using experienced activity spaces to measure foodscape exposure. Health Place 16, 10941103.
25. Timperio, AF, Ball, K, Roberts, R et al. (2009) Children’s takeaway and fast-food intakes: associations with the neighbourhood food environment. Public Health Nutr 12, 19601964.
26. An, RP & Sturm, R (2012) School and residential neighborhood food environment and diet among California youth. Am J Prev Med 42, 129135.
27. Kirkpatrick, S, Reedy, J, Butler, E et al. (2014) Dietary assessment in food environment research: a systematic review. Am J Prev Med 46, 94102.
28. Bornhorst, C, Huybrechts, I & Ahrens, W (2013) Prevalence and determinants of misreporting among European children in proxy-reported 24hr dietary recalls. Br J Nutr 109, 12571265.
29. Jacques, PT & Tucker, KL (2001) Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 73, 12.
30. Hu, F (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.
31. Inskip, H, Godfrey, K, Robinson, S et al. (2006) Cohort profile: the Southampton Women’s Survey. Int J Epidemiol 35, 4248.
32. Okubo, H, Crozier, S, Harvey, N et al. (2015) Diet quality across early childhood and adiposity at 6 years: the Southampton Women’s Survey. Int J Obes (Lond) 39, 14561462.
33. Chaix, B, Merlo, J, Evans, D et al. (2009) Neighbourhoods in eco-epidemiologic research: delimiting personal exposure areas. A response to Riva, Gauvin, Apparicio and Brodeur. Soc Sci Med 69, 13061310.
34. Burgoine, T, Alvanides, S & Lake, A (2013) Creating ‘obesogenic realities’: do our methodological choices make a difference when measuring the food environment? Int J Health Geogr 12, 33.
35. Williams, J, Scarborough, P, Matthews, A et al. (2014) A systematic review of the influence of the retail food environment around schools on obesity-related outcomes. Obes Rev 15, 359374.
36. Barker, M, Baird, J, Lawrence, M et al. (2011) The Southampton Initiative for Health: a complex intervention to improve the diets and increase physical activity levels of women from disadvantaged communities. J Health Psychol 16, 178191.
37. Black, C, Ntani, G, Inskip, H et al. (2014) Measuring the healthfulness of food retail stores: variations by store type and neighbourhood deprivation. Int J Behav Nutr Phys Act 11, 69.
38. Rundle, A, Neckerman, K, Freeman, L et al. (2009) Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect 117, 442447.
39. Thornton, LE & Kavanagh, AM (2012) Association between fast food purchasing and the local food environment. Nutr Diabetes 2, e53.
40. Greenland, S, Pearl, J & Robins, JM (1999) Causal diagrams for epidemiological research. Epidemiology 10, 3748.
41. Jennings, A, Welch, A, Jones, AP et al. (2011) Local food outlets, weight status, and dietary intake: associations in children aged 9–10 years. Am J Prev Med 40, 405410.
42. Vogel, C, Parsons, C, Godfrey, K et al. (2016) Greater access to fast-food outlets is associated with poorer bone health in young children. Osteoporos Int 27, 10111019.
43. Timperio, A, Ball, K, Roberts, R et al. (2008) Children’s fruit and vegetable intake: associations with the neighbourhood food environment. Prev Med 46, 331335.
44. Engler-Stringer, R, Schaefer, J & Ridalls, T (2016) An examination of the roles played by early adolescent children in interactions with their local food environment. Can J Public Health 107, Suppl. 1, 5296.
45. Public Health England (2013) Obesity and the Environment: Regulating the Growth of Fast Food Outlets. PHE Publication no. 2013319. London: PHE.
46. Burgoine, T, Lake, AA, Stamp, E et al. (2009) Changing foodscapes 1980–2000, using the ASH30 Study. Appetite 53, 157165.
47. Bader, MD, Schwartz-Soicher, O, Jack, D et al. (2013) More neighborhood retail associated with lower obesity among New York City public high school students. Health Place 23, 104110.
48. Cummins, S, Macintyre, S, Davidson, S et al. (2005) Measuring neighbourhood social and material context: generation and interpretation of ecological data from routine and non-routine sources. Health Place 11, 249260.
49. Skidmore, P, Welch, A, van Sluijs, E et al. (2010) Impact of neighbourhood food environment on food consumption in children aged 9–10 years in the UK SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study. Public Health Nutr 13, 10221030.
50. Howard Wilsher, S, Harrison, F, Yamoah, F et al. (2016) The relationship between unhealthy food sales, socio-economic deprivation and childhood weight status: results of a cross-sectional study in England. Int J Behav Nutr Phys Act 13, 21.
51. Cade, JE, Burley, VJ, Warm, DL et al. (2004) Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev 17, 522.
52. Thornton, LE, Pearce, JR & Kavanagh, AM (2011) Using Geographic Information Systems (GIS) to assess the role of the built environment in influencing obesity: a glossary. Int J Behav Nutr Phys Act 8, 71.
53. Public Health England, Obesity Knowledge and Intelligence Team (2015) Planning and Environment. (accessed November 2015).
54. Department of Health (2012) Public Health Outcomes Framework 2013 to 2016. London: Department of Health.
55. Camden Borough Council (2016) Camden Local Plan Evidence Report: Fast Food Takeaways and Health. Camden: Camden Borough Council.
56. Gebremariam, MK, Vaque-Crusellas, C, Andersen, LF et al. (2017) Measurement of availability and accessibility of food among youth: a systematic review of methodological studies. Int J Behav Nutr Phys Act 14, 22.
57. Sheats, JL, Winter, SJ, Romero, PP et al. (2017) FEAST: empowering community residents to use technology to assess and advocate for healthy food environments. J Urban Health 94, 180189.


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