Association between junk food consumption and fast-food outlet access near school among Quebec secondary-school children: findings from the Quebec Health Survey of High School Students (QHSHSS) 2010-11.

<bold>Objective: </bold>We investigated the association between junk food consumption at lunchtime (JCL) and fast-food outlet access near school among secondary-school children in Quebec.<bold>Design: </bold>A geographic information system database was used to characterize the food environment around a sub-sample of 374 public schools in which 26 655 students were enrolled. The outcome variable was JCL during the previous week, dichotomized into low JCL (none or once) v. high JCL (twice or more). Access to fast-food outlets near school was assessed using an existing database of fast-food outlets in Quebec. Covariates included student (age, sex and self-rated perceived health), family (familial status and parental education) and school (urban/rural status and deprivation) variables. Hierarchical logistic regression models were employed for analyses using PROC GLIMMIX of SAS version 9.3.<bold>Setting: </bold>Province of Quebec, Canada.<bold>Subjects: </bold>We used data from the Quebec Health Survey of High School Students (QHSHSS) 2010-11, a survey of secondary-school Quebec students.<bold>Results: </bold>Exposure to two or more fast-food outlets within a radius of 750 m around schools was associated with a higher likelihood of excess JCL (OR=1·50; 95 % CI 1·28, 1·75), controlling for the characteristics of the students, their families and their schools.<bold>Conclusions: </bold>The food environment surrounding schools can constitute a target for interventions to improve food choices among secondary-school children living in the province of Quebec. Transforming environments around schools to promote healthy eating includes modifying zoning regulations that restrict access to fast-food outlets around schools. [ABSTRACT FROM AUTHOR]