Asia Pacific J Clin Nutr (2002) 11(Suppl): S579–S585 S579

Review Article

Nutrition knowledge and food consumption:

can nutrition knowledge change food behaviour?
Anthony Worsley BSc (Hons), PhD

School of Health Sciences, Deakin University, Melbourne, Australia

The status and explanatory role of nutrition knowledge is uncertain in public health nutrition. Much of the
uncertainty about this area has been generated by conceptual confusion about the nature of knowledge and
behaviours, and, nutrition knowledge and food behaviours in particular. So the paper describes several key
concepts in some detail. The main argument is that ‘nutrition knowledge’ is a necessary but not sufficient factor
for changes in consumers’ food behaviours. Several classes of food behaviours and their causation are discussed.
They are influenced by a number of environmental and intra-individual factors, including motivations. The
interplay between motivational factors and information processing is important for nutrition promoters as is the
distinction between declarative and procedural knowledge. Consideration of the domains of nutrition knowledge
shows that their utility is likely to be related to consumers’ and nutritionists’ particular goals and viewpoints.
A brief survey of the recent literature shows that the evidence for the influence of nutrition knowledge on food
behaviours is mixed. Nevertheless, recent work suggests that nutrition knowledge may play a small but pivotal
role in the adoption of healthier food habits. The implications of this overview for public health nutrition are:
(i) We need to pay greater attention to the development of children’s and adults’ knowledge frameworks
(schema building); (ii) There is a need for a renewed proactive role for the education sector; (iii) We need to take
account of consumers’ personal food goals and their acquisition of procedural knowledge which will enable
them to attain their goals; (iv) Finally, much more research into the ways people learn and use food-related
knowledge is required in the form of experimental interventions and longitudinal studies.

Key words: Behaviour change, food behaviour, nutrition knowledge.

Introduction that skin wrinkling is linked to the type of fats you con-
We live in a knowledge society – knowledge is power – isn’t sume. Declarative knowledge is very important for indi-
it? But the status and role of nutrition knowledge is decid- viduals’ survival, (e.g. it can be important to know that
edly uncertain. Does nutrition knowledge influence food railway lines are not a good place to sleep, or, that ‘real
behaviours? We usually assume that the answer must be in men drink beer’!). Obviously declarative knowledge can
the affirmative. Indeed, most of us implicitly accept the be divided into many domains, some of which include
simple knowledge–attitude–practice model. If people know various types of nutritional knowledge.
what is good for them then they are likely to behave in 2. Procedural knowledge, this is knowledge about how to do
their best interests. Like so many lay views, this model was things. For example, how to choose a red wine for a
abandoned years ago as a complete explanation. However, as meal, how to choose a low salt packet of soup, how to lay
we shall see it may have some currency and may be a good out the cutlery for a dinner party, or how to make spotted
short hand explanation for complex phenomena. Before dick. We require a lot of procedural knowledge even to
coming to answer the key question of this paper we need to perform the most basic tasks, such, as using an ATM or
consider some basic concepts and definitions. programming a video recorder.

Knowledge What is knowledge as distinct from beliefs?

You may believe that iodine deficiency can cause intel-
What kinds of knowledge are there? lectual disability. This is a belief – a perception of a link
Psychologists have distinguished two key types of know- between two concepts – ‘iodine deficiency’ and ‘intellectual
ledge:
1. Declarative knowledge, knowledge of ‘what is’, aware- Correspondence address: Professor Tony Worsley, School of
ness of things and processes. For example, that lemons Health Sciences, Deakin University, Melbourne, Australia.
are a good source of Vitamin C, that the Earth is round, Tel: +61 3 9251 7259; Fax: 61 3 9244 6017
that high intakes of fruit and vegetables can prevent Email: tonyw@deakin.edu.au
hypertension, that milk contains psychotropic peptides,
S580 T Worsley

disability’. You may see a strong or a weak relation between justified) than it does for a meat eater who may be less aware
the two, and you may hold the belief with a particular degree of ‘crucial facts’ about animals (e.g. their sentient nature,
of strength. Scientists ‘make’ new beliefs (facts or factoids; their ability to feel pain). Various balance theories and the
Bryce Courtney in the Power of One reckons fathers make theory of cognitive dissonance, which emerged in the 1930s,
something called ‘dadfacts’ – beliefs that are made up on the show quite clearly that beliefs or ‘messages’ are often
spur of the moment with little evidence but which turn out accepted or rejected according to their consonance with prior
later in life to be surprisingly correct!) beliefs. Many people acquire cognitive consistency only by
We can test the validity of beliefs (or perceptions), in fact manipulating (quite unconsciously) the ‘facts’. Beliefs, then,
all humans do by asking questions, such as: ‘Is that pink are not static but are held in a dynamic manner being
elephant I see at the bottom of the garden real?’ Psycho- subjugated to deeper more ego related beliefs. Marketers are
logists have often examined such questioning and identified well aware of this as a look at current consumer behaviour
the ways that we check out perceptions and beliefs (attribu- texts will show. In contrast, I doubt if I have heard more than
tion theory). But knowledge is more than just a collection of one or two mentions of ‘cognitive consistency’ or the ‘theory
‘true facts’, it is a system of beliefs – what psychologists of cognitive dissonance’ in public health during the past
refer to as schema and meta schema that are skeletal 20 years – yet here we are trying to influence people’s food
frameworks on which beliefs or facts are based. behaviours.

What is knowledge for? What influences our beliefs and knowledge?

Knowledge helps us explain important aspects of the world There are many influences. They include: our experiences,
and gives predictability to events, thus meeting the human and what influences our experiences, the people we mix with
need for cognitive consistency or predictability.1 We all – our social groups, the people we aspire to be like (reference
know when to go home from work; we know how to work groups) and our beliefs about what they want for us (e.g.
during an examination (as fast as possible) while people who most women think men want them to be about two sizes
are unused to our ways do not. smaller than what men want them to be). In addition, our
physical and biological environments certainly influence
Whose knowledge? our beliefs. If you have ever had ‘Montezuma’s Revenge’
Groups of people have different experiences so they have you will have learned a lot about yourself and the world –
different beliefs and knowledge. Nutritionists have their like the value of health insurance!
own meta schema (e.g. energy balance, water soluble vs fat Our prior or established beliefs influence our acceptance
soluble vitamins, antioxidants). Powerful social groups have of new information. For example, if you believe the world is
their own knowledge that they use to explain the world [e.g. flat, when you see the curved horizon from an aeroplane
business parlance, scientists and their jargon (exact termin- you’ll have a bit of struggle and may ‘explain’ your new
ology)] and weak groups of people have their own beliefs perception as ‘something to do with the curved windscreen
and explanations of why things are as they are – what in the cockpit’. That we see the world through rose tinted or
Foucault calls ‘subjugated knowledge’ – imprecise, unoffi- other tinted spectacles has long been understood. The sym-
cial explanations (e.g. ‘He caught pneumonia because he sat bolic interactionists of the early 20th century drew attention
in a draught.’). Different groups of people have their own to the inherent symbolism of perceptions (created by culture
systems of beliefs, (e.g. vegetarians and their quite distinct or prior experiences) and especially of language. Thus to a
views of most things in the world ranging from different food microbiologist a black pudding is a risky food with
views of health and illness to different political opinions and interesting flora, to a Lancastrian it is likely to be a healthy
different dress sense). Note that belief systems help to create and delicious food. Different people often interpret the same
solidarity and exclude non-believers. (e.g. religious vs secular identical object or event in quite different ways according to
views of faith and reason).1 their origins, training and experiences.
Humans then are prime information processors. We sort
How logical is knowledge? it all out but we can’t process everything (we have very
As recorded in scientific textbooks knowledge appears to be limited short-term memories) so we adopt all sorts of
firmly grounded on empirical evidence, but as Thomas Kuhn ‘clumping devices’ or ‘heuristics’. For example, rather than
showed many years ago, some knowledge is ignored while considering all the nutrients listed on a packet of breakfast
other knowledge is highlighted in scientific consciousness.2 cereal we may ‘measure’ the nutritiousness of the cereal by
Two people watching the same football match may come the length in centimetres of the list, the longer the list the
away with quite different views of the game depending on more nutritious the cereal! This may be Illogical but is very
their team allegiances. Events in the world are interpreted handy when the shopping has to be done in a hurry.
and coloured by prior beliefs. Some beliefs (true and false)
are held to be more important by us than others. Thus to What is nutrition knowledge?
vegetarians, say, eating meat is akin to killing animals and Somewhat cynically, but accurately, we can define know-
since animals are part of Creation, as we are, so killing an ledge as that which distinguishes experts from ignoramuses.
animal requires far more justification (if it ever can be In fact this is how we decide which items to include in test
 Nutrition knowledge and food consumption S581

banks. We expect experts to be able to answer items that nutrition is a quantitative science so we know how much of
people unversed in the discipline cannot, with novices a nutrient is ‘too much’ or too little. So when we say ‘too
occupying some middle position.3 Not many so-called nutri- much saturated fat is not healthy’ what do we mean? How
tion knowledge tests have been validated in this way. does this relate to buying cheese? When we say we should
eat a varied diet do we mean at every meal, or everyday or
What nutritionists think it is versus what consumers think weekly? Such questions do raise the possibility that although
it is we may have a lot of facts in nutrition they may not be very
Nutrition knowledge is knowledge of nutrients and nutrition. relevant to every day eating and they may not represent
Immediately one can ask ‘so what’? As Gussow and much knowledge or certainty. They also cast doubt about
Contento4 observed two decades ago, nutritionists have the validity of ‘nutrition knowledge’ tests that seem to be
scientific needs and interests, so do ‘learners’ (consumers) frequently reported in publications and that are often
and so does society. What the various groups understand by unrelated to food choice? It’s all very vague.
nutrition and nutrients requires careful examination. For now When it comes to consumers’ knowledge of nutrition –
let us assume that all there is to understand is what nutrition- this has been described as ‘a mile wide and a centimetre
ists understand. What are the domains of nutrition know- deep’! Few investigators have asked consumers about what
ledge? What are the most important things about nutrition they want to know about nutrition (and food).6 Consumers
that we need to know? I asked a similar question about a seem to view nutrition as including much more than mere
decade ago of nutritionists and shoppers when I asked them nutrients; it includes ways to lose weight, ways to prevent
which nutrition information should be printed on food cancer, the effects of vitamins on skin condition, food safety,
product labels.5 Figure 1 shows the differences between ‘additives’ and their effects, and much more. Why do the
shoppers’ and nutritionists’ answers; the longer the line to differences shown in Fig. 1 exist? Perhaps because lay
the right, the greater was the difference between shoppers’ people are unconstrained by ‘disciplines’ and have a much
and nutritionists’ opinions (the longer the lines to the left, the greater number of interests, motivations and goals than
more nutritionists wanted the information). Do you agree nutritionists – who frequently limit their domain of interest
with these views? to traditional nutrients (thus excluding alcohol, water, non-
How do we conceptualize the domains of nutrition traditional nutrients and physical activity – all of which have
knowledge? Do we look at the functions that nutrients rather widespread effects on body processes). The point is
undertake in the body, such as, energy turnover, or growth that people have knowledge about what they are interested
and repair, or do we think about antioxidants and the various in. Indeed recent studies show that interest and knowledge
defence mechanisms they operate. Or do we classify groups are interrelated.
of nutrients in some other way(s)? What sort of relevance do Which areas of nutrition are worth consumers knowing
such classifications have for the ‘consumer in the shop’? about? Here are some suggestions:
Probably very little, except perhaps to confirm the misbelief 1. The energy content of food.
that fat is bad? Of course it’s not even this simple because 2. The roles of fats.
not only can we group nutrients (according to their functions 3. The sources of vitamins and minerals.
say, or to the disease processes they may be involved in) but 4. The sources of phytochemicals.
5. The links between food production and ecology and
sustainability.
6. What else? It depends on what you consider is important.
Are the things nutritionists are interested in the same as
those various groups of consumers are interested in?

How do you measure nutrition knowledge?

Most of us think that knowledge enables us to distinguish
true from false beliefs, facts from falsehood. So we often
pose questions and count the number of correct answers.
This can be well done (using validated methods)3 or badly
done. However, knowledge is not one-dimensional as tests
scores suggest, it is somewhat structured. We might measure
someone’s knowledge of various areas of nutrition and find
that they know about some areas but less about others. We
could derive profiles of their knowledge. Inside someone’s
mind, however, knowledge (and beliefs) may be more highly
structured or differentiated. Figure 2 shows 10-year-olds’
‘knowledge’ of some of the perceived nutrition properties of
Figure 1. Differences between shoppers’ and nutritionists’ views some foods before and after a nutrition education program.
about information that should be on the food product label. 5 You can see that they associated various properties more
S582 T Worsley

Figure 2. Ten-year-old’s views of foods, nutrients and health. 7 In this figure the closer a food is to a food characteristic the more that food was
perceived to have that characteristic (e.g. cakes and buns were seen to be more fattening than sweet cereal).

with some foods than others. Therefore, measurement of Influences on food behaviours
nutrition knowledge is a little more complex than simple There are many models of human behaviours in relation to
summation of ‘true/false’ scores. ‘dietary’ behaviours, several of which have been reviewed
by Baranowski et al.7 They found that most of these models
Food behaviours yielded similar predictiveness (about 30% of variance) but
What do we mean by food behaviours? The term can cover having any model was better than having no explicit model.
a multiplicity of distinct behaviours from ‘simple’ chewing Some of the key components of these models are described
of food to food shopping, food preparation, etiquette, and briefly to demonstrate that nutrition knowledge is only one
food policy decision-making. It can be general (e.g. doing among many likely influential factors:
the weekly grocery shopping) or quite specific (e.g. choosing 1. The perceived consequences of the behaviour. These can
brand A over brand B according to their saturated fat be favourable or unfavourable, likely or less likely.
contents). Much knowledge is required for these behaviours, Expectancy value models like the health belief model,
only a little of which is related to nutrition. For example, theory of planned behaviour stress this aspect.8
imagine the steps required in making a pavlova, including 2. Attitudes and beliefs about the behaviour and the object
knowing where to buy the best ingredients, how to combine of the behaviour (e.g. perceptions about ‘value for money’)
and cook them. Where exactly in this chain of events does are important.
nutrition knowledge play a part? Behaviours are dynamic 3. Skills like knowing how to shop and how to cook are
processes most of which involve ‘decision points’ (e.g. important.
knowing when it is safe to swallow that bolus of tough 4. Confidence in being able to perform the behaviour is
meat). Simple linear measures of association between stressed as self efficacy in models like Social Learning
knowledge indices and the final behavioural outcomes (as in Theory.
correlation-based statistics) are unlikely to reflect the key 5. The social and physical, internal and external environ-
influence of nutrition knowledge on decision-making. ment. The situations in which foods are purchased and
 Nutrition knowledge and food consumption S583

used are extremely important as they often include both food. In the pool of food behaviour variance it would not be
social constraints (e.g. ‘It is not “cool” to drink with a surprising if nutrition knowledge (however, well defined)
straw.’) and highly attractive or aversive physical stimuli were drowned out. We need more studies which follow the
(e.g. the sight of a chocolate bar, the smell of freshly paths taken in real time (as distinct from timeless multiple
baked bread). regression analyses) by consumers during their behaviours.
6. Motivators are extremely important. These include social Such path analyses are rare.
influences (e.g. doing as your peer group does), environ-
mental rewards (reinforcers), biological needs (e.g. Is nutrition knowledge related to food behaviours? Can it
hunger) psychogenic needs (e.g. need for ego recogni- change food behaviours?
tion) and personal and cultural values – which define Yes, a little! This is not a ‘systematic review’ in the Cochrane
what are ‘good’ and ‘bad’ consequences of behaviours. Collaboration sense. Many studies show no relationship but
Motivators are often subtle, for example, food may there are some that do, albeit mainly at ‘low’ levels of
signify desired states (e.g. eating caviar may signify evidence.
one’s wealth and influence) hence the importance of A major, influential study was performed by Wardle
hermeneutics. People make and use knowledge to meet et al.15 This was a postal survey of 1040 18–75-year-old-
their own goals and purposes – do consumers and nutri- participants selected from General Practitioners’ lists in
tionists share the same goals? A relatively simple con- England. Nutrition knowledge was significantly associated
crete example of a behavioural model is given in Grunert’s with ‘healthy eating’ (e.g., fruit and vegetable intakes)
Food Lifestyle Model (Fig. 3).9 indeed knowledgeable individuals were 25 times more likely
Beyond the mainstream of food choice theory, consumer to consume adequate amounts of fruit and vegetables daily.
behaviourists have invented models that attempt to simulate Through analyses of covariance the authors were able to
the steps taken by humans in food purchasing decision- show that nutrition knowledge was a partial mediator of the
making.10 They also show that many factors impinge on the socio-demographic variation in food intake (especially fruit
behavioural eventual outcome. A currently popular process and vegetable intakes). This work is part of the bigger thrust
model is the transtheoretical theory. This assumes that at University College London to explain the ways in which
people go through a series of stages when changing their social class differences influence health. Social economic,
behaviours.11 It has been successfully applied to fruit and cultural and psychological variables such as ‘powerlessness’
vegetable consumption by Ling and Horwath.12 This is an appear to be important predictors of health and disease
important model if only because it emphasizes that indi- states.16 Similar deconstruction of socio-economic influ-
viduals may be affected by almost unique combinations of ences such as education has been achieved in other related
factors. This has led to tailoring methods of nutrition promo- domains. For example, Davies at the University of Adelaide
tion;13 which are about twice as effective in bringing about showed that education background differences in children’s
dietary behaviour change as other approaches. Recent dental status were explained through different sets of paren-
work on personal food value systems also provides similar, tal beliefs (i.e., subcultures) about the value of dental
indeed greater richness, which is perhaps best provided by hygiene and the prevention of dental caries.17 This suggests
qualitative or experimental studies.14 that ‘education’ encourages a different set of beliefs and
So where does nutrition knowledge fit? Somewhere values (or interests) among its participants. In a similar vein,
among the set of perceptions a person may hold about a food a study by the USDA’s Economic Research Service18 shows
and the behaviours they might perform in relation to that that the more mothers know about food and nutrition the
better the quality of their children’s diets, especially younger
children’s diets.
In another population study Harnack et al. in a national
US sample of adults, showed that fat, fibre, fruit and
vegetable intakes were closer to dietary recommendations
among respondents who had more cancer-prevention know-
ledge, after social economic and nutritional confounders
were taken into consideration.19
The possible role of interest in nutrition in Wardle et al.’s
findings is suggested by a study by Chew and Palmer.20 In a
three wave national survey they showed that differences in
nutrition interest, not education differences, were associated
with differences in nutrition knowledge. They also showed
that TV viewing was associated with greater interest in
nutrition and thus greater nutrition knowledge. We have also
shown that nutrition interest is a key mediator of the link
between personal values and dietary choices.21
Figure 3. The Food Lifestyle Model.10
S584 T Worsley

Kristal et al. found that among 97 middle aged women of education is required. We have anecdotal evidence to
knowledge of fat nutrition and social norms about fat were suggest that the effects may be widespread and far reaching.
positively related to the consumption of low fat diets.22 We need to take education more seriously in order to work
In a study of a random sample of 475 elderly Americans, out what it does. There is a need for new student-centred
Elbon et al. found that high nutrition knowledge was life skills curricula in secondary schools that will prepare
strongly associated with the reading of nutrition information students for adult life, and for the evaluation of the effects of
panels on food products (along with being female, and such curricula.
positive nutrition-related health seeking behaviours, i.e. We need to take account of consumers’ personal food
interest).23 goals and their acquisition of procedural knowledge that will
The possible wide scope of influence of nutrition know- enable them to attain their goals. Which sets of knowledge
ledge is further suggested by two studies. Elbon et al. found are required for people to get the best out of the current food
that elders’ nutrition knowledge of dairy products did not system and to satisfy their aspirations about their bodies,
predict the amount of milk that they drank but instead it their health and their aspirations about society and the
predicted the type of milk consumed.24 In a structural planet? That is, we should attend more to people’s food-
equation modelling study of primary teachers willingness to related goals.
teach nutrition. Finally, Britten found that knowledge was a Knowledge is part of an open system not a closed system.
predictor of their confidence to teach.25 You may teach nutrition knowledge but consumers will
Finally, our systematic review of children’s healthy translate that knowledge and do what they like with it – often
eating literature clearly shows that the nutrition education of years later. For example, our daily physical education inter-
school children can bring about change in their dietary vention study of 1978 (SHAPE28) appears to have resulted in
behaviour, which sometimes last for over 2 years.26 greater participation in vigorous activity and lower than
average smoking rates 20 years later.29 So, it is important in
Why the scarcity of evidence? evaluation to anticipate likely lateral and sleeper effects.
There are several reasons for the scarcity of evidence, among Greater attention to experiential and procedural know-
them are: ledge – it is the ‘how to’ that is difficult, for example, how
1. Poor conceptualization of nutrition knowledge. to reduce energy intake. Perhaps different kinds of nutrition
2. Lack of relevance (e.g. knowledge of cholesterol may be knowledge are required, such as, an understanding of strate-
more relevant to 60 years olds than to 16 years olds – so gies to influence metabolic regulation, energy intake and
why teach it to children?). expenditure.
3. Poor measurement – there is a lack of well validate Finally, we need much more research into the ways
nutrition knowledge instruments, which measure know- people learn and use food-related knowledge in the form of
ledge that is of relevance both to consumers and to systematic reviews, experimental interventions, path model-
nutritionists. ling studies, decision process studies and longitudinal
4. Poor matching of knowledge and outcome variables – studies
Fishbein and Ajzen drew attention to the law of
specificity – dependent and independent variables must References
be measured at the same levels of specificity (e.g. we 1. Epstein S. Integration of the cognitive and the psychodynamic
cannot correlate a person’s knowledge of world mal- unconscious. Am Psychol 1994; 49 (8): 709–724.
nutrition with their use of vitamin supplements).27 Even 2. Kuhn T. The Structure of Scientific Revolutions. Chicago: Univer-
sity of Chicago Press, 1968.
more glaringly, general nutrition knowledge indices are 3. Izard J. Overview of test construction. Paris: IIEP, 1996; 46.
unlikely to predict specific domains of food consump- 4. Gussow JD, Contento I. Nutrition education in a changing world.
tion, such as, vegetable or biscuit consumption. World Rev Nutr Diet 1984; 44: 1–56.
5. Many studies have been small and did not have the statis- 5. Worsley A. Which nutrition information do shoppers want on food
tical power to detect the influence of nutrition knowledge labels? Asia Pacific J Clin Nutr 1996; 5: 70–78.
6. Herda P, Banwell C. The Meaning and Use of Food Among New
on food behaviours. Zealand Women. Auckland: Department of Anthropology, Uni-
versity of Auckland, 1988.
Implications for public health nutrition 7. Baranowski T, Weber-Cullen K, Baranowski J. Psychosocial cor-
We need to pay greater attention to the development of relates of dietary intake: advancing dietary intervention. Annu Rev
children’s and adults’ knowledge frameworks (schema Nutr 1999; 19: 309–317.
8. Feather N. Human values and the prediction of action: an expect-
building) via group and experiential learning. There should ancy value analysis. In: Feather NT, ed. Expectations and Actions:
be more studies of children’s nutrition knowledge and food Expectancy Value Models in Psychology. Hillsdale: Erlbaum,
beliefs and how they develop their dietary patterns. There is 1982; 263–289.
concern among community nutritionists and others that 9. Grunert KG, Brunso K, Bisp S. Food-related life-style: Develop-
many children have poor experiential knowledge of food and ment of a cross-culturally valid instrument for market surveillance.
MAPP Working paper no. 12, Aarhus, Denmark: The Aarhus
have few buying and preparation skills.26 School of Business, 1993.
There is a need for a renewed proactive role for the 10. Bettman JR. An Information Processing Theory of Consumer
education sector. Much more documentation of the effects Choice. Reading: Addison-Wesley, 1979.
 Nutrition knowledge and food consumption S585

11. Prochaska JO, Redding C, Evers K. The Transtheoretical Model of 22. Kristal AR, Bowen DJ, Curry SJ, Shattuck AL et al. Nutrition
Behavior Change. Health Behavior and Health Education. Theory, knowledge, attitudes and perceived norms as correlates of select-
Research and Practice, 2nd edn. San Francisco: Jossey-Bass, 1997: ing low-fat diets. Health Educ Res 1990; 5: 467–477.
60–84. 23. Elbon SM, Johnson MA, Fischer JG. Developing an instrument to
12. Ling A, Horwath C. Perceived benefits and barriers of increased measure the influence of knowledge, behaviors, and attitudes on
fruit and vegetable consumption: validation of a decisional milk consumption patterns in older participants of a community
balance scale. J Nutr Educ 2001; 33: 257–265. wellness group: a pilot study. J Nutr Elderly 1996; 15: 21–37.
13. Brinberg D. Changing food knowledge, food choice, and dietary 24. Elbon SM, Johnson MA, Fischer JG, Searcy CA. Demographic
fiber consumption by using tailored messages. Appetite 2000; 35: factors, nutrition knowledge, and health seeking behaviors influ-
35–43. ence nutrition label reading behaviors among older American
14. Connors M, Bisogni CA, Sobal J, Devine CM. Managing values in adults. J Nutr Elderly 2000; 19: 31–48.
personal food systems. Appetite 2001; 36: 189–200. 25. Britten P. A structural model of training and confidence as predic-
15. Wardle J, Parmenter K, Waller J 2000 Nutrition knowledge and tors of time spent teaching nutrition by elementary school teach-
food intake. Appetite 2002; 34: 269–275. ers. Dissertation Abstracts International Section A. Humanities
16. Marmot M, Wilkinson R. Social Determinants of Health. Oxford: Social Sciences 1996; 57(5): 1956.
Oxford University Press, 1999. 26. Worsley A, Crawford D, Campbell K. Children’s Healthy Eating.
17. Davies M. The role of common sense understanding in social Report to the Victorian Department of Human Services, Mel-
inequities in health. PhD Thesis. Department of Public Health, bourne. 2002.
Adelaide University, Adelaide, 2000. 27. Fishbein M, Ajzen I. Beliefs, Attitudes, Intentions and Behavior.
18. US Department of Agriculture Economic Research Service. New York: Addison-Wesley, 1975.
Mother’s nutrition knowledge is key influence on the quality of 28. Maynard EJ, Coonan WE, Worsley A, Dwyer T, Baghurst PA.
children’s diets. J Am Diet Assoc 2000; 100: 155. The development of the Lifestyle Education Program in Australia.
19. Harnack L, Block G, Subar A, Lane S, Brand R. Association of In: Hetzel BS, Berenson GS, eds. Reduction of Cardiovascular
cancer prevention-related nutrition knowledge, beliefs and atti- Risk Factors in Childhood. Elsevier, Amsterdam. 1987; 123–150.
tudes to cancer prevention dietary behavior. J Am Diet Assoc 29. Hume C. Effects of an intensive physical and health education
1997; 97: 957–965. intervention in elementary school: a 20-year follow-up. BSc
20. Chew F, Palmer S. Interest, the knowledge gap and television pro- Honours Thesis. Department of Sports Sciences, University of
gramming. J Broadcasting Electronic Media 1994; 38: 217–287. South Australia, Adelaide, 2000.
21. Worsley A, Worsley AJ, Coonan W, Peters M. The influence of
the Body Owner’s Program on ten year olds’ food beliefs. J Nutr
Educ 1985; 17(4): 147–153.