Changes in the number of new takeaway food outlets associated with adoption of management zones around schools: A natural experimental evaluation in England

John Rahilly; Ben Amies-Cull; Michael Chang; Steven Cummins; Daniel Derbyshire; Suzan Hassan; Yuru Huang; Matthew Keeble; Bochu Liu; Antonieta Medina-Lara; Oliver Mytton; Nina Rogers; Bea Savory; Annie Schiff; Stephen J Sharp; Richard Smith; Claire Thompson; Martin White; Jean Adams; Thomas Burgoine

doi:10.1016/j.ssmph.2024.101646

Changes in the number of new takeaway food outlets associated with adoption of management zones around schools: A natural experimental evaluation in England

SSM Popul Health. 2024 Mar 19:26:101646. doi: 10.1016/j.ssmph.2024.101646. eCollection 2024 Jun.

Authors

John Rahilly^{1

2}, Ben Amies-Cull³, Michael Chang⁴, Steven Cummins⁵, Daniel Derbyshire⁶, Suzan Hassan⁵, Yuru Huang¹, Matthew Keeble¹, Bochu Liu^{1

7}, Antonieta Medina-Lara⁶, Oliver Mytton², Nina Rogers¹, Bea Savory⁵, Annie Schiff¹, Stephen J Sharp¹, Richard Smith⁶, Claire Thompson⁸, Martin White¹, Jean Adams¹, Thomas Burgoine¹

Affiliations

¹ MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
² Great Ormond Street Institute of Child Health, University College London, UK.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
⁴ Office for Health Improvement and Disparities, Department of Health and Social Care, UK.
⁵ Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Tropical Hygiene and Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
⁶ Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, UK.
⁷ Department of Urban Planning, College of Architecture and Urban Planning, Tongji University, Shanghai, China.
⁸ School of Health and Social Work, University of Hertfordshire, UK.

Abstract

By the end of 2017, 35 local authorities (LAs) across England had adopted takeaway management zones (or "exclusion zones") around schools as a means to curb proliferation of new takeaways. In this nationwide, natural experimental study, we evaluated the impact of management zones on takeaway retail, including unintended displacement of takeaways to areas immediately beyond management zones, and impacts on chain fast-food outlets. We used uncontrolled interrupted time series analyses to estimate changes from up to six years pre- and post-adoption of takeaway management zones around schools. We evaluated three outcomes: mean number of new takeaways within management zones (and by three identified sub-types: full management, town centre exempt and time management zones); mean number on the periphery of management zones (i.e. within an additional 100 m of the edge of zones); and presence of new chain fast-food outlets within management zones. For 26 LAs, we observed an overall decrease in the number of new takeaways opening within management zones. Six years post-intervention, we observed 0.83 (95% CI -0.30, -1.03) fewer new outlets opening per LA than would have been expected in absence of the intervention, equivalent to an 81.0% (95% CI -29.1, -100) reduction in the number of new outlets. Cumulatively, 12 (54%) fewer new takeaways opened than would have been expected over the six-year post-intervention period. When stratified by policy type, effects were most prominent for full management zones and town centre exempt zones. Estimates of intervention effects on numbers of new takeaways on the periphery of management zones, and on the presence of new chain fast-food outlets within management zones, did not meet statistical significance. Our findings suggest that management zone policies were able to demonstrably curb the proliferation of new takeaways. Modelling studies are required to measure the possible population health impacts associated with this change.

Keywords: Exclusion zones; Interrupted time series; Natural experiment; Schools; Takeaway management zones; Takeaways; Urban planning.