MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
Office for Health Improvement and Disparities, Department of Health and Social Care, UK.
Health Place. 2024 May;87:103237. doi: 10.1016/j.healthplace.2024.103237. Epub 2024 Apr 1.
Physical exposure to takeaway food outlets ("takeaways") is associated with poor diet and excess weight, which are leading causes of excess morbidity and mortality. At the end of 2017, 35 local authorities (LAs) in England had adopted takeaway management zones (or "exclusion zones"), which is an urban planning intervention designed to reduce physical exposure to takeaways around schools. In this nationwide, natural experimental study, we used interrupted time series analyses to estimate the impact of this intervention on changes in the total number of takeaway planning applications received by LAs and the percentage rejected, at both first decision and after any appeal, within management zones, per quarter of calendar year. Changes in these proximal process measures would precede downstream retail and health impacts. We observed an overall decrease in the number of applications received by intervention LAs at 12 months post-intervention (6.3 fewer, 95% CI -0.1, -12.5), and an increase in the percentage of applications that were rejected at first (additional 18.8%, 95% CI 3.7, 33.9) and final (additional 19.6%, 95% CI 4.7, 34.6) decision, the latter taking into account any appeal outcomes. This effect size for the number of planning applications was maintained at 24 months, although it was not statistically significant. We also identified three distinct sub-types of management zone regulations (full, town centre exempt, and time management zones). The changes observed in rejections were most prominent for full management zones (where the regulations are applied irrespective of overlap with town centres), where the percentage of applications rejected was increased by an additional 46.1% at 24 months. Our findings suggest that takeaway management zone policies may have the potential to curb the proliferation of new takeaways near schools and subsequently impact on population health.
人们接触外卖餐馆（“外卖”）与不良饮食和体重超标有关，而后者是导致发病率和死亡率过高的主要原因。2017 年底，英格兰有 35 个地方当局（LAs）采用了外卖管理区（或“禁区”），这是一种城市规划干预措施，旨在减少学校周围对外卖的实际接触。在这项全国性的自然实验研究中，我们使用中断时间序列分析来估计该干预措施对地方当局收到的外卖规划申请总数以及每个季度在管理区内首次决定和任何上诉后被拒绝的百分比的影响。这些近端过程措施的变化将先于下游零售和健康影响。我们观察到干预后的 12 个月内，干预地区收到的申请数量总体减少（减少 6.3 个，95%CI-0.1，-12.5），首次决定时被拒绝的申请比例增加（额外增加 18.8%，95%CI3.7，33.9）和最终（额外增加 19.6%，95%CI4.7，34.6），后者考虑了任何上诉结果。规划申请数量的这种效果大小在 24 个月时保持不变，尽管它在统计学上并不显著。我们还确定了三种不同类型的管理区法规（全面、市中心豁免和时间管理区）。在 24 个月时，被拒绝的申请比例增加了额外的 46.1%，这在全管理区最为明显（这些规定无论与市中心的重叠情况如何都适用）。我们的研究结果表明，外卖管理区政策可能有潜力遏制学校附近新外卖店的扩张，并随后对人口健康产生影响。
