Before interventions can be ‘culturally tailored’ to a group, we first need to know the role of foods in a given culture. Culture, broadly defined, influences all aspects of food choices. Each of our cultural experiences consists of beliefs, values, and attitude towards all aspects of our lives including food choices, meal patterns, and physical activity5
. Our place of birth, religion, language, socioeconomic status, age, ethnicity, gender, birth order, and household composition are but a few of the characteristics that shape our culture and our resulting lifestyle habits. Culture is not static and these views can change over time as we experience different events across the life cycle. Our personal identity is reflected in the foods we choose to eat, the way they are prepared, when, where, and with whom we dine.
Culturally acceptable food availability may range from settings such as supermarkets, the school cafeteria, farmer’s markets, street vendors, convenience stores, vending machines, fast-food restaurants, gourmet restaurants, our own gardens, to picking through garbage for leftover scraps. The more widely available a food, the easier it is to add to our diet. Food availability is tightly linked to economic factors. People who have recently immigrated or experienced some other change of circumstance such as becoming unemployed or homeless may not be able to afford unlimited access to some foods. Poorer neighborhoods frequently lack supermarkets with competitive prices for goods, including fresh produce. Thus, when health professionals advocate increased consumption of fruits and vegetables, our target audience may be unable to achieve these goals even if such foods would be culturally acceptable or even preferred.
When some groups immigrate to a new country or area such as the US, they gain access to foods that were considered high status at home, but now they are readily available and less expensive. The impetus is to consume more of them rather than the traditional foods which may be reminders of their pre-immigration status in a negative way. Furthermore, traditional foods may be unavailable, of poorer quality than in the host country, or cost more. Finally, many women post-immigration take on employment outside of the home which limits their time to prepare traditional foods.
Eating habits often change in response to education, relocation, the appearance of new foods in the supermarket or new restaurants in the neighborhood, media information, the development of a chronic disease like CVD, and other influences. This process of adopting beliefs and practices of a dominant or influential culture known as acculturation, is perhaps most visible among people who have recently relocated to a new country.
Certain foods may have culturally or regionally based biases that inhibit or promote consumption or purchase. For example, a particular food may be viewed as “low status” or “high status”, or associated with a particular level of socioeconomic attainment. Symbolically, most cultures value meat as a high status food6
. Meat and fats or oils have been in historically short supply around the world. Baked beans or other dried bean varieties may convey the image of low-cost inexpensive foods and be dismissed as “poor people’s food”. However, consumer attitudes toward black beans and chickpeas are more positive as evidenced by increased sales of these in higher socioeconomic households7
. Recent research has demonstrated the effectiveness of some legume varieties in reducing blood cholesterol levels. Dietary recommendations to reduce CVD risk through consumption of non-meat protein sources that are also high fiber such as legumes, may be more effective if legumes are promoted as ‘trendy’ or ‘high status’ like black beans.
In addition to the many sociocultural roles of foods such as their use in celebration or comfort, religion, or defining us as individuals, some cultures have specific views of foods as inherently unhealthful. Many cultures believe that health depends upon balance of bodily fluids or natural forces. Imbalance of these forces, particularly through diet or lifestyle choices, can result in disease. While biomedicine may scoff at such non-scientific explanations for illness, the relevance of balance in the minds of lay persons remains strong. Two common examples such as ‘hot and cold’ and ‘yin and yang’ are found in many Latino, Middle Eastern, and Asian cultures5
. The foods are believed to strengthen or give these characteristics to people who eat them. To restore the imbalance that causes disease or acute illness, foods of the opposite type are ingested to restore balance. The characteristics of ‘hot and cold’ or ‘yin and yang’ are related not to the temperature at which foods are eaten or to their flavor but instead to properties that may relate to the caloric density of the food. In some instances, recommendations may conflict with the belief system of the client or patient.
Food preparation and types of foods eaten depends upon the ability and facilities to store and cook food, as well as the time needed to prepare foods. If refrigeration is not available or unreliable, foods that spoil easily must be purchased daily. It may be a hardship or impractical for the head of household or person responsible for food preparation to go shopping daily. Methods of preparation are learned and culturally based. For example, while broiling fish may be better for one’s heart than frying breaded chicken in lard, these changes are dependent upon having access to a broiler and knowing how to prepare fish. To a nutritionist, the change may seem simple, but to a woman concerned about her family liking the food she prepares, the change may be a daunting task8