a1 Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Strasse 7–11, D-68167 Mannheim, Germany
a2 Institute of Transport Research, German Aerospace Center (DLR), Berlin, Germany
a3 Department of Geography, University of Munich, Munich, Germany
Objective The current discussion regarding ‘place effects on health’ is increasingly focusing on the characteristics of a specific physical environment. Our study investigated whether socially deprived residential areas are more likely than affluent neighbourhoods to provide access to addictive substances and fast food.
Design In this ecological study the total number of tobacco, alcohol and fast-food outlets was recorded and visualized using a geographic information system. Area affluence was measured through the percentage of parents with children of kindergarten or school age with joint annual taxable income <€12 272.
Setting Eighteen social areas in Cologne, Germany.
Subjects All social areas in four districts in Cologne, Germany, with a total of 92 000 inhabitants, were analysed.
Results In the investigation area, 339 tobacco, 353 alcohol and sixty-seven fast-food outlets were identified. As area affluence declined the availability of the following potentially health damaging sources increased: cigarettes (Kendall's tau = 0·433; P = 0·012), alcohol (Kendall's tau = 0·341, P = 0·049) and fast food (Kendall's tau = 0·473; P = 0·009).
Conclusions The availability of addictive substances and fast food can be seen to have a contextual influence on an individual's lifestyle and can, in the form of physical exposure to obesogenic and addictive environments, contribute to a culmination of health risks.
(Received September 07 2011)
(Revised June 01 2012)
(Accepted June 08 2012)
(Online publication July 10 2012)