Racial, Ethnic, and Socioeconomic Disparities in Exposure to Fast Food in Hillsborough County, Florida

Recent studies have linked the alarming obesity epidemic in the U.S. to the growth of the fast-food restaurant industry, which offers convenient service alongside inexpensive and high-calorie food. As the number of fast-food outlets increases, research demonstrates that their geographic location plays a significant role in creating obesogenic environments, potentially exposing socially disadvantaged groups to unhealthy nutrition choices provided by these outlets. Whereas previous studies have examined the distribution of positive health amenities such as supermarkets and health-food stores, there is a growing need to evaluate the socio-demographic characteristics of neighborhoods that contain negative health entities such as fast-food outlets. Accordingly, this study sought to determine whether access to fast-food restaurants varied by neighborhood racial/ethnic composition and socioeconomic status in Hillsborough County, Florida—an area that is relatively understudied in terms of its food environment and related health implications. Bivariate and multivariate statistical analyses indicated that race and ethnicity play a pervasive role in explaining the prevalence of fast-food outlets in the county. The results reveal a significantly higher density of fast-food outlets near neighborhoods characterized by a larger proportion of racial/ethnic minorities, even after controlling for the effects of socioeconomic factors and locational characteristics. The study underscores the need to consider both the healthy and unhealthy aspects of the food environment in formulating policy solutions for addressing the obesity epidemic. Florida Public Health Review, 2010; 7, 83-92. Background Although the U.S. is one of the wealthiest and most technologically advanced countries in the world, it faces a growing and alarming epidemic obesity. According to the National Health and Nutrition Examination Survey conducted by the Centers for Disease Control and Prevention [CDC] (2009), the number of adults at least 20 years of age classified as “obese” rose from 13.4% in 1960-62 to 34.3% in 2005-06. Additionally, 32.7% of adults are “overweight” and 5.9% are “extremely obese,” totaling a staggering 72.9% of all adults at least 20 years of age that are classified between “overweight” and “extremely obese.” Whereas many factors contribute to this obesity epidemic, behavioral and environmental factors have been documented to play an especially significant role. According to the World Health Organization [WHO] (2006), obesity can be linked to increased consumption of foods “that are high in fat and sugar but low in vitamins” (WHO, 2006). The CDC (2004) reports evidence linking increased food and caloric intake to a rise in obesity amongst Americans. It cites other studies linking this increased caloric-intake to increased “consumption of food away from home; increased consumption of salty snacks, soft drinks, and pizza; and increased portion sizes.” The fast-food industry has been a significant contributor to this increased, often unhealthy, food consumption. This industry has grown rapidly in recent years as the number of fast-food outlets in the U.S. has increased from 30,000 in 1970 to 222,000 in 2001 (Paeratakul et al., 2003). Americans are also eating more fast-food as the percentage of total calories consumed nationwide from fast-food has grown from 3% to 20% in the past 20 years (Block et al., 2004). Fast-food outlets are restaurants that offer affordable, convenient, and unhealthy food that many believe have contributed significantly to this epidemic. Jeffery et al. (2006) surveyed a sample of Minnesota residents by telephone and found that eating fast-food is associated with a high fat diet and a higher BMI. Another study examined the geographic location of these entities in the entire U.S. and found that higher fast-food restaurant density is associated with a higher BMI and a greater risk of being obese (Mehta & Chang, 2008). Ultimately, fast-food outlets and their high-calorie food offerings play a pivotal role in creating these unhealthy environments.