Elsevier

Health & Place

Volume 48, November 2017, Pages 102-110
Health & Place

Accessibility of fast food outlets is associated with fast food intake. A study in the Capital Region of Denmark

https://doi.org/10.1016/j.healthplace.2017.10.003Get rights and content

Highlights

  • Fast food access is associated with fast food intake in the capital region of Denmark.

  • The association between fast food outlet density and fast food intake is positive.

  • The association between fast food outlet proximity and fast food intake is negative.

  • The associations are modified by urbanicity and area SES.

Abstract

Literature suggests that people living in areas with a wealth of unhealthy fast food options may show higher levels of fast food intake. Multilevel logistic regression analyses were applied to examine the association between GIS-located fast food outlets (FFOs) and self-reported fast food intake among adults (+ 16 years) in the Capital Region of Denmark (N = 48,305). Accessibility of FFOs was measured both as proximity (distance to nearest FFO) and density (number of FFOs within a 1 km network buffer around home). Odds of fast food intake ≥ 1/week increased significantly with increasing FFO density and decreased significantly with increasing distance to the nearest FFO for distances ≤ 4 km. For long distances (>4 km), odds increased with increasing distance, although this applied only for car owners. Results suggest that Danish health promotion strategies need to consider the contribution of the built environment to unhealthy eating.

Section snippets

Background

Food environments are built environments described by the location of food outlets (FOs), and access to these environments is theorized to influence individual dietary patterns and, ultimately, risk of obesity and chronic diseases (Caspi et al., 2012). The accessibility of food is often defined by geographical measures from home to FOs. Specific measures hypothesized to be important contributors to eating patterns are proximity and density of different types of FOs (Boone-Heinonen et al., 2011b

The Danish Capital Region Health Survey

The present study is based on data from the Danish Capital Region Health Survey, a cross-sectional survey conducted in the 29 municipalities of the Capital Region of Denmark (Christensen et al., 2012, Hammer-Helmich et al., 2011). The survey was conducted from February to May 2010. A random sample of individuals was drawn from the Danish Civil Registration System (CRS). CRS identifies all inhabitants in Denmark by a unique 10-digit personal identification (CPR) number that allows record linkage

Characteristics of population

A total of 6203 participants (16.2%) reported consuming fast food at least once per week (Table 2). Frequent intake of fast food was highest among men, younger age groups, individuals of Danish origin, individuals with shorter education, and among those living in suburban municipalities. Frequent intake of fast food was lowest among the most affluent municipalities.

Accessibility of fast food outlets

Low FFO density and long distances to the nearest FFO were more prevalent in municipalities of higher SES (group 1) (Table 3). No

Discussion

We found an association between FFO access and fast food intake in the Capital Region of Denmark. Regardless of both individual and area characteristics, the likelihood of frequent fast food intake increased with increasing FFO density. Similarly, a resident's odds of frequent fast food intake decreased significantly with increasing distance to the nearest FFO (for distances up to 4 km). For distances greater than 4 km, the opposite association was found, although this applied only for car

Conclusion

This study presents results relevant for environmental influences on fast food intake in a Danish context, which differs in socioeconomic structures and urban form to the US and Australia. It is the first study based on validated FFO data to show that fast food accessibility measures are associated with weekly fast food intake in the Capital Region of Denmark. The association depended on both urbanicity and municipality SES. These results suggest that Danish health promotion strategies need to

Ethics

The research project was approved by the Danish Data Protection Agency according to the Danish Act on Processing of Personal Data. Approval from the Danish Health Research Ethics Committee System was not required according to Danish law, as the research project was purely based on data obtained from questionnaires and national registers. Written informed consent for publication based on the questionnaire data was provided by the participants when returning the questionnaires.

Declaration of conflicting interests

The authors declare that there are no conflicts of interest.

Acknowledgements

The authors thank the team behind the survey at the Research Centre for Prevention and Health. Furthermore, we thank all the participants who took part in the survey.

Funding

This project was funded by the Capital Region of Denmark.

References (65)

  • L.M. Powell et al.

    The availability of fast-food and full-service restaurants in the United States

    Am. J. Prev. Med.

    (2007)
  • L.M. Powell et al.

    Energy intake from restaurants: demographics and socioeconomics, 2003–2008

    Am. J. Prev. Med.

    (2012)
  • A.S. Richardson et al.

    Multiple pathways from the neighborhood food environment to increased body mass index through dietary behaviors: a structural equation-based analysis in the CARDIA study

    Health Place

    (2015)
  • P.E. Rummo et al.

    Beyond supermarkets: food outlet location selection in four U.S. cities over time

    Am. J. Prev. Med.

    (2017)
  • L.E. Thornton et al.

    Fast food restaurant locations according to socioeconomic disadvantage, urban–regional locality, and schools within Victoria, Australia

    SSM - Popul. Heal.

    (2016)
  • G. Turrell et al.

    Socioeconomic disadvantage and the purchase of takeaway food: a multilevel analysis

    Appetite

    (2008)
  • E.L. Wilkins et al.

    Using Geographic Information Systems to measure retail food environments: discussion of methodological considerations and a proposed reporting checklist (Geo-FERN)

    Health Place

    (2017)
  • J. Beaulac et al.

    A systematic review of food deserts, 1966–2007

    Prev. Chronic Dis.

    (2009)
  • C. Black et al.

    Measuring the healthfulness of food retail stores: variations by store type and neighbourhood deprivation

    Int. J. Behav. Nutr. Phys. Act.

    (2014)
  • J. Boone-Heinonen et al.

    Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study

    Arch. Intern. Med.

    (2011)
  • S.A. Bowman et al.

    Fast food consumption of US adults: impact on energy and nutrient intakes and overweight status

    J. Am. Coll. Nutr.

    (2004)
  • T. Burgoine et al.

    Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study

    Am. J. Clin. Nutr.

    (2016)
  • M. Baadsgaard et al.

    Danish registers on personal income and transfer payments

    Scand. J. Public Health

    (2011)
  • H. Charreire et al.

    Measuring the food environment using geographical information systems: a methodological review

    Public Health Nutr.

    (2010)
  • Christensen, A.I., Davidsen, M., Ekholm, O., Pedersen, P.V., Juel, K., 2014a. The health of Danes - The National Health...
  • A.I. Christensen et al.

    Effect of survey mode on response patterns: comparison of face-to-face and self-administered modes in health surveys

    Eur. J. Public Health

    (2014)
  • A.I. Christensen et al.

    The Danish National Health Survey 2010. Study design and respondent characteristics

    Scand. J. Public Health

    (2012)
  • A.I. Christensen et al.

    What is wrong with non‐respondents? Alcohol‐, drug‐and smoking related mortality and morbidity in a 12‐year follow up study of respondents and non‐respondents in the Danish Health and Morbidity Survey

    Addiction

    (2015)
  • L.K. Cobb et al.

    The relationship of the local food environment with obesity: a systematic review of methods, study quality, and results

    Obesity

    (2015)
  • S. Cummins et al.

    Understanding and representing “place”in health research: a relational approach

    Soc. Sci

    (2007)
  • L.K. Fraser et al.

    The geography of fast food outlets: a review

    Int. J. Environ. Res. Public Health

    (2010)
  • R.J. Gamba et al.

    Measuring the food environment and its effects on obesity in the United States: a systematic review of methods and results

    J. Community Health

    (2014)
  • Cited by (25)

    • Investigating the association between the socioeconomic environment of the service area and fast food visitation: A context-based crystal growth approach

      2022, Health and Place
      Citation Excerpt :

      Although findings have been inconsistent in interpreting the impact of the food environment on diet-related health outcomes (Engler-Stringer et al., 2014; Mackenbach et al., 2019), recurring associations are noted. Higher exposure to neighborhood fast food outlets can be associated with higher fast food consumption (Bernsdorf et al., 2017; Cutumisu et al., 2017; Moore et al., 2009; Paquet et al., 2010) and lower intakes of fruits and vegetables (Fraser et al., 2010; Timperio et al., 2008). Some studies have shown that being in closer proximity to fast food outlets or living near a high concentration of fast food outlets can be associated with higher fast food intakes of participants being studied (Bernsdorf et al., 2017; Cobb et al., 2015), and thus increase the risk of obesity (Davis and Carpenter, 2009; Kruger et al., 2014).

    • Perceived Neighborhood-Level Drivers of Food Insecurity Among Aging Women in the United States: A Qualitative Study

      2021, Journal of the Academy of Nutrition and Dietetics
      Citation Excerpt :

      Specifically, limited access to affordable and healthy food options, whether due to unaffordable food/transport prices or a lack of transport options, may lead individuals to purchase overpriced and highly processed foods found at nearby corner stores and gas stations. Notably, although some evidence points to an association between fast-food restaurant availability and fast food consumption,42,43 the participants of this study seldom chose to eat fast food due to perceptions that the food was expensive and not filling, despite acknowledging their widespread availability in comparison to food stores. These data show that individuals with chronic diseases are often highly aware of the food they need to eat to stay healthy, but have their choices constrained by multiple and variable socioeconomic forces beyond their control.

    • Exploring relationships of grocery shopping patterns and healthy food accessibility in residential neighborhoods and activity space

      2020, Applied Geography
      Citation Excerpt :

      The uncertainty in the spatial delineation of contextual units could have affected the associations between food accessibility and health-related behaviors (Black, Moon, & Baird, 2014; Kwan, 2012a, 2012b; Roux, 2007; Wilkins, Morris, Radley, & Griffiths, 2017). Most studies measured food accessibility in residential neighborhood (Feng, Glass, Curriero, Stewart, & Schwartz, 2010; Larson & Story, 2009; Walker, Keane, & Burke, 2010), either by an administrative boundary (e.g. census tract) (Apparicio, Cloutier, & Shearmur, 2007; Bower, Thorpe, Rohde, & Gaskin, 2014; Eckert & Vojnovic, 2017; Grow et al., 2010; Lamichhane et al., 2013; Lee & Lim, 2009; Li, Harmer, Cardinal, Bosworth, & Johnson-Shelton, 2009; Mooney et al., 2018; Moore & Diez Roux, 2006; Morland, Wing, & Roux, 2002; Pearce, Hiscock, Blakely, & Witten, 2008; Powell, Slater, Mirtcheva, Bao, & Chaloupka, 2007; Zenk et al., 2005), or by a home location buffer (Bernsdorf et al., 2017; Frank et al., 2009; Helbich, Schadenberg, Hagenauer, & Poelman, 2017; Jeffery, Baxter, McGuire, & Linde, 2006). A few studies compared healthy food accessibility among multiple delineations of residential neighborhoods (e.g. census tract and block group (Barnes et al., 2016); home location buffers with varying sizes (DuBreck et al., 2018; Burgoine, Alvanides, & Lake, 2013; Thornton, Pearce, Macdonald, Lamb, & Ellaway, 2012)) and found that different definitions of residential neighborhoods could affect the magnitude of food accessibility and its associations with health outcomes.

    • A systematic review employing the GeoFERN framework to examine methods, reporting quality and associations between the retail food environment and obesity

      2019, Health and Place
      Citation Excerpt :

      Stronger associations between the RFE and obesity-related outcomes have been found within more deprived neighbourhoods (Bernsdorf et al., 2017; Fiechtner et al., 2015; Thomsen et al., 2016). Differential associations have also been observed for people of differing income and education (Burgoine et al., 2016; Reitzel et al., 2014), ethnicity (Wong et al., 2017), age (Dwicaksono et al., 2017) and across urban/rural residences (Bernsdorf et al., 2017). Existing systematic reviews either do not account for potential divergent effects across measurement methods or population groups (Williams et al., 2014; Casey et al., 2014), or account only for a limited range of factors using simplistic groupings of studies; for example grouping diverse methods together (Cobb et al., 2015; Feng et al., 2010; Gamba et al., 2015; Caspi et al., 2012).

    View all citing articles on Scopus
    1

    Present address: Center for diabetes, Municipality of Copenhagen, Vesterbrogade 121, 3rd floor, 1620 Copenhagen V, Denmark.

    View full text