Marketing food environment and food consumption in children:

Moderation by food-related psychosocial factors

Catherine Paquet, University of South Australia

Luc de Montigny, de Montigny Consulting

David Buckeridge, McGill University

Alice Labban, Pepperdine University

Uku Vainik, McGill University

Vinita Akula, McGill University

Melissa Iskandar, McGill University

Yu Ma, University of Alberta

Laurette Dubé, McGill University

Food environment and diet/weight outcomes

• Emphasis on local accessibility/availability of food outlets (e.g. fast food restaurants, supermarkets) with limited attention to other drivers of food-related purchasing behaviour.

• Lack of attention to individual differences that may be explaining different levels of responsiveness to local food environment (beyond socio-demographic factors).

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Brain-to-Society (BtS) Approach

Individuals vary in their genetic and neuro-cognitive vulnerability & resilience to

environments

Environments (society) vary in diversity and intensity of exposure conditions they present to individuals.

• Designed to bridge different levels of evidence bearing on individual choices and their environmental conditions

• Use of computational system science modeling to determine relationship between individual & environment

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Brain to Society (BtS) Paradigm to 21st Century Sciences for Health, Well-Being and Sustainable Prosperity: Focus on Healthy Living

Responsiveness to food cues and rewards

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• Sensitivity to reward moderate the effect of food environment (Paquet et al, AJCN, 2010).

• Nutrition quality

• Nutrition sensitivityAvailability

• Variety (assortment)

• Number of outletsAccessibility

• Regular price per serving

• Price discountsAffordability

• Advertising

• Non-price promotion (e.g. display)Appeal

Food environment and marketing indicators(Ma et al 2013)

Ma Y et al. ‘System of Indicators for the Nutritional Quality of Marketing and Food Environment: Product Quality, Availability, Affordability, and Promotion. In: Preedy RV, Hunter L-A, Patel BV, editors. Diet Quality: An Evidence-Based Approach, Volume 2. New York, NY: Springer New York; 2013. p.383-96.

Aim

To investigate psychosocial factors that could help identify children who are more likely to be

influenced by food marketing strategies.

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Methods: Study Background

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• Comparative data collection of ‘brain-to-society’ drivers of childhood obesity.

• Target group: Families with children age 6-12

• Convenience sample from Montreal Metropolitainarea.

• Parent interviewed about child daily habits (eating, sleeping, physical activity) during a 50-minute telephonic interview (n = 616, 23% response rate)

• In-depth follow up paper-based or online survey (n=379)

Behavioural measures(obtained from 24-hour food recall reported by parents)

Category Food items included Scoring

Healthy food consumption

Whole grain foods, fruits, vegetables, and water

Sum of frequency of consumption of each item in last 24 hours

Junk food consumption

Soft drinks, hot dogs, pizza, fries, hamburgers, salty snacks, candies, chocolates, pies, cookies, ice cream.

Sum of frequency of consumption of each item in last 24 hours

Food-related Psychosocial Moderators(self-reported by parents)

Moderators

Reward Sensitivity

Emotional Eating

Sensitivity to food

cues

Parental food

control

Healthy eating norms

Child’s responsiveness to incentives/appetitive stimuli• Behavioural Activation Scale for young children

(Blair, Peters, &Granger, 2004)• 13 items (9-pt) ; Cronbach = 0.87• Collected during follow-up survey

Child’s tendency to eat in response to negative emotions• Dutch Eating Behavior

Questionnaire (DEBQ) –emotional eating scale (adapted for children)

• 13 items (3-pt) ; • Cronbach = 0.87• Collected during phone

interview)

Child’s predisposition to eat upon exposure to food and food cues• DEBQ – external eating scale

(adapted for children)• Mean of 9 items (3-pt);

Cronbach = 0.74• Collected during phone interview

Parents’ beliefs and practices related to what, how much, when, how, and why they should eat.• Eating Norm Inventory (Fisher and Dubé, 2011)• Collected during phone interview• Sum of 11 items (5-pt) ; Cronbach = 0.69

Parents’ tendency to use food to reward or punish behavior• Parental Food Rules Scale

(Puhl & Schwartz 2003) • Collected during follow-up survey• Mean of 6 items (5-pt); Cronbach = 0.69

Food environment and marketing indicators : Data sources

Original data set Aggregation for current study

Year 2008-2013 1 year prior to data collection

Categories 16 2 (soft drinks, vegetables)

Level Weekly 1-year aggregate for each categoryby local area (Forward-SortationArea)

UPC

Store

Derived Variables Sales, Package Size,Variety, Outlets, Regular Price, Price Promotion,Display, Feature

Regular PriceFrequency of PromotionDisplay

Food environment and marketing indicators

• Weighted average of the highest price of each UPC within the category over a three-month moving window

• Overall market shares of each UPC used as weights

Regular Price per serving

• Weighted average number of weeks in which the price of a given UPC was at least two standard deviations below its average price

• Overall market shares of each UPC used as weights

Frequency of Promotion

• Average of the proportion of food products (UPCs) within a target food category that was on display (e.g. end of aisles displays) in a given week in a given store

Display

Values averaged for

the year prior to data

collection and for all stores within the

local area for both food categories

(vegetables and regular soft drinks)

Statistical Analyses

MODEL: Regression models with exponential spatial covariance structure, where the covariance between two observations depends on distance.

Dependent variable

Food environment indicators* (tested in separate models)

Psychosocial moderators*(interactions tested in separate models)

Covariates

Healthful food consumption (modelled as linear regression)

Vegetable displays

Vegetable discount frequency

Vegetable – regular price per serving

Reward sensitivity

Healthy Eating norms

Parental food control

Emotional eating

Sensitivity to food cues

Household

income, child

age and

gender,

language,

population

density within

Census tract.

Unhealthful food consumption (modelled as Poisson regression due to skewness)

Regular Soft Drink displays

Regular Soft Drinkdiscount frequency

Regular Soft Drink –regular price per serving

*standardised prior to analyses

Descriptive Statistics

Telephone survey (n=616)

Follow-upSurvey (n=379)

Age (Mean(SD) 9.1 (1.7) 9.1 (1.7)

Gender (%girls) 50.2% 49.9%

Household income (% < 45 K) 19.5% 18.6%

Language (%English) 44.6% 41.1%

Healthful eating score (Mean (SD), range 0-16) 5.3 (3.4) 5.7 (3.4)

Unhealthful eating score (Mean (SD), range 0-7) 0.2 (0.6) 0.2 (0.5)

Sensitivity to food cues (Mean (SD), range 1-3) 2.1(0.4) 2.1 (0.4)

Emotional eating (Mean (SD), range 1-3) 1.2 (0.3) 1.2 (0.3)

Healthy eating norms (Mean (SD), range 11-55) 43.0 (5.0) 43.0 (4.8)

Reward Sensitivity (Mean (SD), n=320, range 1-9) 6.7 (1.2)

Parental food control (Mean (SD), n=377, range 1-

5)

1.4 (0.5)

Main effects of Moderators*

Healthful food consumption Unhealthful food consumption

Estimate 95%CI P RR* 95%CI P

Sensitivity to food cues(1SD; n=580)

-0.17 (-0.45, 0.11) 0.23 1.06 (0.86, 1.30) 0.60

Emotional eating(1SD; n=580)

-0.04 (-0.32, 0.24) 0.77 1.07 (0.89, 1.29) 0.45

Healthy eating norms (1SD; n=580)

0.35 (0.05, 0.60) 0.02 0.87 (0.72, 1.06) 0.17

Reward sensitivity (1SD; n=311)

0.22 (-0.18, 0.61) 0.28 0.84 (0.64, 1.12) 0.23

Food control (1SD; n=361)

-0.09 (-0.45, 0.27) 0.62 0.99 (0.76, 1.31) 0.97

Models adjusted for child age, gender, household income, language, and population densityRR= Relative Risk

Main effects of Food environment indicators*

Healthful food consumption Unhealthful food consumption

Estimate 95%CI P RR* 95%CI P

Vegetable Display (1SD;(n=256)

-0.14 (-0.87, 0.29) 0.53

Vegetable Discount frequency (1SD; n=256))

0.26 (-0.15, 0.67) 0.22

Vegetable regular price (1SD; n=256)

-0.07 (-0.47, 0.34) 0.75

Regular soft drink Display(1SD; n=463)

1.07 (0.85, 1.35) 0.57

Regular soft drink Discount frequency (1SD; n=463)

1.17 (0.92, 1.47) 0.19

Regular soft drink regular price (1SD; n=463)

0.93 (0.72, 1.19) 0.55

Models adjusted for child age, gender, household income, language, and population densityRR= Relative Risk

Interactions with moderators Healthful Food Consumption

Food environment

Indicator

Sensitivity to food cues (n=256)

Emotional eating (n=256)

Healthy eating norms (n=256)

Reward sensitivity

(n=143)

Food control(n= 157)

Ve

geta

ble

Display0.53

(0.08, 0.98)*0.01

(-0.42, 0.44)-0.12

(-0.59, 0.34)-0.03

(-0.75, 0.68)-0.21

(-0.71, 0.29)

Discount Frequency

-0.59(-1.07, -0.11)*

-0.17 (-0.62, 0.28)

0.29 (-0.18, 0.77)

0.27 (-0.46, 1.01)

0.27 (-0.32, 0.87)

Price-0.12

(-0.69, 0.46)-0.01

(-0.54, 0.51)-0.00

(-0.50, 0.49)0.12

(-0.72, 0.96)-0.06

(-0.91, 0.79)

*< 0.05, **< 0.01

Estimate (95% Confidence Interval) for interaction terms

Interactions with moderators - Unhealthful Food Consumption -

Food environmentIndicator

Sensitivity to food cues (n=463)

Emotionaleating (n=463)

Healthy eating norms (n=463)

Reward sensitivity

(n=245)

Food control

(n= 282)

Re

gula

rso

ft d

rin

k Display0.96

(0.77, 1.19)0.81

(0.65, 1.02)1.07

(0.89, 1.28)1.26

(0.90, 1.77)0.85

(0.58, 1.24)

Discount Frequency

0.98 (0.79, 1.23)

0.78(0.64, 0.96)*

1.05 (0.86, 1.27)

1.24 (0.89, 1.72)

0.87(0.63, 1.22)

Price0.98

(0.79, 1.21)1.26

(0.94, 1.68)0.78

(0.61, 0.99)*0.78

(0.51, 1.18)1.14

(0.84, 1.55)

*< 0.05, **< 0.01

Relative Risk (95% Confidence Interval) for interaction terms

Discussion

• Differences in response to healthful food marketing strategies seem mostly related to sensitivity to food cues.

• The success of affordability strategies (pricing and discounts) for unheathful foods might depend on emotional eating tendencies and parents’ healthy eating norms.

• Follow up studies needed for definitive answer on the moderating influence of reward sensitivity and food control

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Conclusions

• Children differ in their responsiveness to promotion strategies in food stores.

• Design of interventions related to in-store food marketing strategies should consider the type of strategy most likely to be effective for the target population.

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Funding

This study was funded by a Collaborative Team Grant, Canada – India Initiative on Childhood funded by the

Canadian Institutes of Health Research and the Indian Council of Medical Research (#85512). Catherine Paquet is funded by a National Health and Medical Research Council

(NHMRC) Program Grant (#0631947).

Reward Sensitivity

Co

nst

ruct Tendency for individuals to experience

positive affect in response to incentives or appetitive stimuli and to engage in approach behaviours to attain these stimuli

Scal

e Behavioural Activation Scale for young children (Blair, Peters, & Granger, 2004)

Sco

rin

g

Mean of thirteen 9-pt items (alpha = 0.87)

Enter the response that most accurately represents your child’s feelings (1=strong disagreement and 9=strong agreement.If your child sees a chance to get something that he or she wants, he or she moves on it right away

It would excite your child to win a contest

When good things happen to your child, it affects him or her strongly

When your child gets something that he or she wants, he or she feels excited and energized

When your child goes after something, he or she uses a “no-holds barred” approach

When your child is doing well at something, he or she loves to keep at it

When your child sees an opportunity for something he or she likes, he or she gets excited right away

When your child wants something, he or she usually goes all-out to get it

Your child craves excitement and new sensations

Your child goes out of his or her way to get things that he or she wants

Your child is always willing to try something new if he or she thinks it will be fun

Your child often acts on the spur of the moment

Your child will often do things for no reason other than that they might be fun

Emotional Eating

Co

nst

ruct

Tendency to eat in response to negative emotions

Scal

e

Dutch Eating Behavior Questionnaire – emotional subscale (wording and response options adapted for children)

Sco

rin

g

Mean of thirteen 3-pt items(alpha = 0.87)

External food cue sensitivity

23

Co

nst

ruct

Predisposition to eat upon exposure to environment food and food cues

Scal

e

Dutch Eating Behavior Questionnaire – emotional subscale (wording and response options adapted for children)

Sco

rin

g

Mean of nine 3-pt items(alpha = 0.74)

Parental Control Rules

Co

nst

ruct Parents’ tendency to use food to

reward or punish behavior

Scal

e Based on published Parental Food Rules (Puhl & Schwartz 2003)

Sco

rin

g

Mean of six 5-pt items(alpha = 0.69)

Healthy Eating Norms

Co

nst

ruct Parents’ beliefs and practices

related to what, how much, when, how, and why they should eat.

Scal

e Eating Norm Inventory (Fisher and Dubé, 2011)

Sco

rin

g

Sum of eleven 5-pt items(alpha = 0.69)

Correlations between moderators

Foodcontrol

Reward sensitivity

Healthyeating norm

Sensitivityto food

cues

Reward sensitivity

-0.22***

Healthyeating norm

0.03 -0.01

Sensitivity to food cues

-0.04 0.15** -0.05

Emotional eating

-0.06 0.15** -0.03 0.31***

*** < 0.001, ** < 0.01, * < 0.05

Main effects of Moderators*

Healthful food consumption Unhealthful food consumption

Estimate 95%CI P RR* 95%CI P

High Reward sensitivity (highest tertile; n=311)

0.81 (0.00, 1.62) 0.05 0.71 (0.38, 1.36) 0.31

External eating Score(1SD; n=580)

-0.17 (-0.45, 0.11) 0.23 1.06 (0.86, 1.30) 0.60

High Emotional eating(highest tertile; n=580)

-0.54 (-1.10, 0.03) 0.06 1.45 (0.95, 2.20) 0.08

Food control (highest tertile; n=361)

-0.19 (-0.92, 0.55) 0.61 1.20 (0.70, 2.05) 0.51

Low healthy eating norms (lowest tertile; n=580)

-0.58 (-1.15, 0.00) 0.05 1.13 (0.74, 1.74) 0.57

Models adjusted for child age, gender, household income, language, and population densityRR= Relative Risk

Interactions with moderators Unhealthful Food Consumption (categorised measures)

Food environmentIndicator

External eating (n=463)

High Emotionaleating (n=463)

Low healthy eating norms (n=463)

High Reward sensitivity (n=245)

High Food control(n= 282)

Re

gula

rso

ft d

rin

k

Display 1.09 (0.87, 1.37) 0.77 (0.49, 1.21) 0.90 (0.57, 1.43)2.01 (0.97,

4.20)*1.00 (0.52,

1.92)

Discount Frequency

1.08 (0.86, 1.36) 0.90 (0.57, 1.40) 0.89 (0.59, 1.40)1.67 (0.74,

3.75)1.02 (0.54,

1.94)

Price 1.08 (0.86, 1.36) 0.88 (0.53, 1.47) 0.31 (0.83, 2.25)0.39 (0.12,

1.33)1.11 (0.60,

2.05)

*< 0.1**< 0.05***< 0.01

Interactions with moderators Healthful Food Consumption

Food environmentIndicator

External eating (n=256)

High Emotionaleating (n=256)

Low healthy eating norms (n=256)

High Reward sensitivity (n=143)

High Food control(n= 157)

Ve

geta

ble

Display 0.53 (0.08, 0.98)**0.34

(-0.49, 1.19)0.17 (-0.72, 1.06)

0.17 (-1.15, 1.48)

-0.04 (-1.15, 1.07)

Discount Frequency

-0.59 (-1.07, -0.11)**

-0.05 (-0.87, 0.77) -0.23 (-1.10, 0.64)0.97

(-0.31, 2.25)

0.36 (-0.85, 1.58)

Price -0.12 (-0.69, 0.46) -0.15 (-0.96, 0.66) 0.18 (-0.71, 1.07)0.27 (-1.18,

1.72)0.97 (-0.93,

2.86)

*< 0.1**< 0.05***< 0.01