Abstract
BACKGROUND: (Commercial) food cues in outdoor public spaces are environmental drivers of unhealthy diets. This study aimed to explore residents' perceptions of food cues in outdoor public spaces in relation to their perceived food environment, eating behaviour, and their opinion on governmental outdoor food cue regulations. METHODS: A photovoice study, consisting of a photography assignment followed by semi-structured interviews, was conducted among 15 adult residents of the municipality of Wageningen, the Netherlands. Participants had one week to take photographs of outdoor food cues they encountered in their municipality, using a mobile app "myfoodenvironment", that were central to the interview afterwards. RESULTS: Participants mainly noticed unhealthy food cues, which they viewed as constant 'reminders' that unhealthy food was easily accessible and affordable. Their views varied on the extent to which food cues affected their own eating behaviour, but generally believed that food cues affected that of others. Participants identified several factors that amplify outdoor food cues' influence on eating behaviour, including hunger, fatigue and attractiveness of the cues. The findings revealed support for government regulation of food cues, while acknowledging the complexity of this issue and the diverse perspectives on how such regulations should be designed (e.g., where, for whom), with one notable counterargument being concerns about feeling patronized by such policies. CONCLUSIONS: Current findings may inform health professionals and (local) policy makers about the unhealthy food cues encountered by residents in outdoor public spaces, which unconsciously influence their eating behaviour, while also providing insights into designing food cue regulations that attract policy support by balancing public health goals with considerations of consumer autonomy and citizen preferences.