The moderating role of food cue sensitivity in the behavioral response of children to their neighborhood food environment: a cross-sectional study

Background: Neighborhood food cues have been inconsistently related to residents' health, possibly due to variations in residents' sensitivity to such cues. This study sought to investigate the degree to which children's predisposition to eat upon exposure to food environment and food cues (external eating), could explain differences in strength of associations between their food consumption and the type of food outlets and marketing strategies present in their neighborhood. Methods: Data were obtained from 616 6-12 y.o. children recruited into a population-based cross-sectional study in which food consumption was measured through a 24-h food recall and responsiveness to food cues measured using the external eating scale. The proportion of food retailers within 3 km of residence considered as "healthful" was calculated using a Geographical Information System. Neighborhood exposure to food marketing strategies (displays, discount frequency, variety, and price) for vegetables and soft drinks were derived from a geocoded digital marketing database. Adjusted mixed models with spatial covariance tested interaction effects of food environment indicators and external eating on food consumption. Results: In children with higher external eating scores, healthful food consumption was more positively related to : vegetable displays, and more negatively to the display and variety of soft drinks. No interactions were observed for unhealthful food consumption and no main effects of food environment indicators were found on food consumption. Conclusions: Children differ in their responsiveness to marketing-related visual food cues on the basis of their external eating phenotype. Strategies aiming to increase the promotion of healthful relative to unhealthful food products in stores may be particularly beneficial for children identified as being more responsive to food cues.