Study finds low-income students and Hispanic students disproportionately exposed to tobacco, fast food near schools

August 1, 2016

A new study finds that low-income students and Hispanic students are disproportionately exposed to both tobacco outlets and fast-food restaurants near their schools. Easy access to tobacco products and fast food may influence youth smoking initiation and contribute to poor dietary intake.

These findings are the subject of a new paper from the UNC Gillings School of Global Public Health, published online July 26 by the American Journal of Public Health.

Dr. Heather D'Angelo

Dr. Heather D’Angelo

The paper’s first author is Heather D’Angelo, PhD, a Gillings School alumna who completed a Cancer Prevention Postdoctoral Fellowship at the National Cancer Institute and now is a research associate with Westat.

Her co-authors, all from the Gillings School, are: Alice Ammerman, DrPH, professor of nutrition, director of UNC’s Center for Health Promotion and Disease Prevention; Penny Gordon-Larsen, PhD, professor of nutrition; Laura Linnan, ScD, professor of health behavior, research program director with the Carolina Collaborative for Research on Work and Health, associate dean for academic and student affairs at the Gillings School; Leslie Lytle, PhD, professor of nutrition and health behavior, chair of the Department of Health Behavior; and Kurt M. Ribisl, PhD, professor of health behavior, program leader for cancer prevention and control at UNC’s Lineberger Comprehensive Cancer Center.

In the first study to examine the availability of both fast-food restaurants and tobacco outlets near public schools in association with students’ race, ethnicity and socioeconomic status, the researchers used local business lists and data from the National Center for Education Statistics to identify outlets and schools. They calculated the numbers of both kinds of outlets located within 800 meters – about a 10-minute walk – of public schools in 97 counties across the United States.

Study results showed that more than 50 percent of schools with a majority of Hispanic students had both a fast-food restaurant and tobacco outlet nearby, compared to 21 percent of schools with a majority of white students.

In adjusted models, each 10 percent increase in the number of low-income students and Hispanic students enrolled in a school led to a three-to-five percent increase in the likelihood of the school having both a fast-food restaurant and a tobacco outlet nearby.

“Schools are places where we would hope to find environments that facilitate healthy choices for our kids,” D’Angelo says. “Our research, however, shows that in many instances kids are faced with a retail environment where tobacco products and less healthy foods are both available and promoted, right outside the school door.”

Poor dietary intake and tobacco use are risk factors for cardiovascular disease and many forms of cancer. Prior research has shown that the availability of fast-food restaurants near schools is associated with higher body mass index in students, while the availability of tobacco outlets is associated with experimental smoking among young people.

Given that smoking initiation rates, in particular, are highest among low-income youth – and that poor dietary intake and smoking early in life may track into adulthood – this disparity is a matter of concern for the field of public health.

The researchers recommend further research, but also suggest that the implementation of licensing or zoning policies restricting the location of fast-food restaurants and tobacco retail outlets in school neighborhoods could reduce youth access to related products and exposure to advertising.

“This is an important study from a very promising new investigator,” says Lytle. “Dr. D’Angelo’s findings support that notion that there are structural factors in neighborhoods, including the presence of fast food restaurants and tobacco outlets, that may disproportionately affect the health of disadvantaged populations. Such knowledge can be helpful in identifying promising policy solutions.”


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or



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