- Research article
- Open Access
Consumer attitudes and misperceptions associated with trends in self-reported cereal foods consumption: cross-sectional study of Western Australian adults, 1995 to 2012
BMC Public Health volume 17, Article number: 597 (2017)
The reasons for low adherence to cereal dietary guidelines are not well understood but may be related to knowledge, attitudes, beliefs and perceived barriers. This study aims to assess trends in cereal foods consumption, intention to change and factors associated with intake among Western Australian (WA) adults 18 to 64 years.
Cross-sectional data from the 1995, 1998, 2001, 2004, 2009, and 2012 Nutrition Monitoring Survey Series involving 7044 adults were pooled. Outcome variables: types and amount of cereals (bread, rice, pasta, and breakfast cereal) eaten the day prior. Attitudes, knowledge, intentions, weight status and sociodemographic characteristics were measured. Descriptive statistics, multiple binary logistic and multinomial logistic regressions assess factors associated with consumption.
Bread (78%) was the most commonly consumed cereal food. The proportion eating bread decreased across survey years (Odds Ratio OR = 0.31; 95% Confidence Interval; 0.24–0.40 in 2012 versus 1995), as did the amount (4.1 slices of bread in 1995 to 2.4 in 2012). The odds of consuming whole-grain cereal foods increased since 2009 (OR = 1.27; 1.02–1.58 versus 1995 p < 0.05). The likelihood of trying to eat less cereal food in the past year was greater in 2012 compared to 1995 (Relative Risk Ratio RRR 10.88; 6.81–17.4). Knowledge of cereal recommendations decreased over time (OR = 0.20; 0.15–0.27 in 2012 versus 1995 p < 0.001). Overweight and obese respondents were more likely than healthy weight respondents to have tried to eat less cereals (RRR 1.65; 1.22–2.24 and 1.88; 1.35–2.63 respectively). ‘I already eat enough’ was the main barrier (75% in 1995 to 84% in 2012 (p < 0.001)).
WA adults are actively reducing the amount of cereal foods they eat and intake is associated with a misperception of adequacy of intake. Nutrition intervention is needed to increase awareness of the health benefits of cereal foods, particularly whole-grains, and to address barriers to incorporating them daily.
Consuming diets high in cereal foods, particularly whole-grains, has been shown to be protective against cardiovascular disease, cancer, Type 2 diabetes, and excess body weight [1,2,3,4]. Countries are encouraged to develop, promote and monitor culturally specific food-based dietary guidelines to promote health and prevent or control non-communicable diseases . Australian Dietary Guidelines (ADG) recommend that adults eat plenty of cereal foods, preferably whole-grain [6,7,8]. The Australian Guide to Healthy Eating, the food selection guide, recommended adults eat at least four standard servings, equivalent to about 500 kJ, of cereal foods per day, particularly whole-grains and/or high cereal fibre varieties . Most adults do not adhere to the cereal ADG and there is emerging evidence from national survey data that intake is declining. Only 7 % of 18,226 women from the Australian Longitudinal Study on Women’s Health met the recommendation . The 2011–2012 Australian Health Survey found in adults aged 19 years and older, the mean intake of cereals foods was less than in the 1995 National Nutrition Survey (164 g (g) compared to 215 g) [10, 11].
Although dietary guidelines of most countries recommend whole-grain foods there is no universally accepted definition  making country comparisons challenging. Cereals, also known as grain foods , include breads, breakfast cereals, grains, and other products. Since 1981, ADGs direct consumers to choose brown or wholegrain varieties over the ‘regular’ or refined versions (for example cereal germ and bran, either as a whole product such as brown rice, or wholemeal products where the whole-grain has been ground into flour such as that in wholemeal pasta), while excluding energy dense refined cereal foods with added sugars, saturated fats or salt [8, 14].
Australian adults consumed on average 83 g of whole-grain foods and 188 g of refined grains in 2011–2012 and need to eat 160% more whole-grains and 30% less refined grains to meet the cereal recommendation .
Previous research shows that people consuming whole-grains tend to have healthier lifestyles overall, and eat more fruit and vegetables [(15, 16], less fat [17, 18], and a more nutrient dense diet . They are also more likely to be physically active [17, 19], non-smokers [15, 17, 19], and have a lower body mass index (BMI) [15, 20]. Those who consume whole-grains are more likely to be older [19, 21], from high socio-economic groups [19, 21], more educated , and live in cities .
Barriers to eating enough cereal foods, particularly whole-grains, include difficulty identifying them, high prices, perceptions of inferior taste compared to refined grains, poor food preparation skills, and lack of awareness of dietary recommendations  and their importance . Monitoring the population’s response to dietary recommendations, including the barriers and promoters to consumption including their beliefs and intentions to change [25, 26] is important to inform the development of policy and interventions to encourage healthful eating.
In Australia however, population surveillance of dietary intake is limited and sporadic with the two most recent national dietary surveys conducted seventeen years apart, in 1995 and 2011–2012. The Western Australian (WA) Department of Health conducts state-wide triennial surveys to monitor changes in self-reported knowledge, attitudes, beliefs and behaviours relating to the ADG. The aim of this paper is to explore trends in consumption of cereal foods intention to change and factors associated with intake among Western Australian adults 18 to 64 years.
The Nutrition Monitoring Survey Series (NMSS) Computer-Assisted Telephone Interviews of adults aged 18 to 64 years were conducted between July and August in 1995, 1998, 2001, 2004, 2009 and 2012. The 1995 sample was stratified by geographic area and the 1998, 2001, and 2004 samples were quota sampled by gender and geographic area. Telephone numbers were randomly selected by a computer generated random digit dialling program. In 2009 and 2012, samples were randomly drawn from the 2008 and 2011 Electronic White Pages for Western Australia, and stratified according to area of residence. Ethics approval was granted by the WA Department of Health and Curtin University Human Research Ethics Committees. Prior consent was sought from survey participants in all survey years.
The type and amount of cereal foods (bread and bread substitutes, rice, pasta, and breakfast cereal) eaten on the day prior to the survey and whether they were whole-grain or regular versions are the key outcomes. For bread, respondents were asked “How many slices of [bread], [bread rolls], [muffins], [flat bread], [crumpets], [scones], [rice cakes], [small crackers], [large crackers], [damper] or [other bread substitute] did you eat yesterday?” then, “What type of bread or bread rolls did you eat yesterday? Was it brown, wholemeal, multigrain, whole-grain, white, white with extra fibre, or another type?” Respondents were also asked about rice and pasta, “How many cups of cooked [rice], [pasta] and [spaghetti] did you eat yesterday?” and “What type of rice, pasta or spaghetti did you eat? Was it brown, wholemeal?” and breakfast cereals, “How many different types of breakfast cereal did you eat yesterday?” then “How many cups of breakfast cereal did you eat?”
Factors potentially associated with cereal consumption (i.e. knowledge, perceptions, barriers, enablers, and stages of change  were measured. Respondents were asked “What do you think is the recommended minimum number of serves of cereal foods that should be eaten each day? One serve of cereal food is equal to one slice of bread, one cup of breakfast cereal, or half a cup of cooked rice or pasta.”, about the level of attention paid to the health aspects of the food they eat, and actions taken control weight over the last year. Stages of dietary change  were measured by: “In the past 12 months, have you tried to change the total amount of cereal foods such as breakfast cereal, pasta, rice, bread, or bread products that you eat?” with eat [more, less, or about the same] responses; and “Do you feel you eat ‘more’, ‘less’, or ‘about the same’ amount of cereal foods in total than you did 12 months ago?”
Motivators, barriers and promoters were sought using two open ended questions, “What influences you to try to change the amount of cereal foods you eat?” and “What are the main things that make it difficult for you to eat more cereal foods?”
BMI was derived from self-reported height and weight, adjusted prior to calculation of BMI to account for potential reporting bias . BMI classifications used were overweight (25–29.9 kg/m2), obese (≥ 30 kg/m2) and healthy weight (< 25 kg/m2) . Sociodemographic information (age, gender, highest education level, household income, employment status, country of birth, area of residence, and living arrangements) were also collected. The 2012 NMSS questionnaire is provided in the Additional file 1 as an example of the current survey instrument.
Sampling methods were chosen to represent the WA population. Data were pooled and weighted to account for sampling design and adjusted for gender, age and areas of residence to a single standard population to allow for comparisons over time. Post-estimation adjustment was used to correct for under or over representation using the 2011 Estimated Resident Population for WA aged 18–64 years (the year of the most recent census at the time of analysis) . The survey design setting in Stata was used in the following way: svyset _n [pweight = probselect], poststrata(stdallyrs) postweight(pop2011) vce(linearized) singleunit(missing). The “probselect” refers to the pooled probability of sample selection, and “pop2011” refers to the 2–11 Estimated Resident Population for WA 18–64 years.
Descriptive statistics report the prevalence of cereal food consumption by survey year. Multiple binary and multinomial logistic regressions were used to assess factors associated with each of the cereal food type measured. Covariates in the full model include: gender, age group, education, household income, employment status, whether living with children, country of birth, area of residence (metropolitan versus non-metropolitan), BMI category, attention paid to diet, and attempts to lose weight. Only variables with p value <.05 were retained in the final model and reported, with the exception of survey year which was retained in the model regardless of its significance.
All analyses were performed using the survey module of Stata software version 12.0 (StataCorp LP, College Station, TX).
Sample characteristics of the 7044 adults presented in Table 1 shows the sample characteristics and Table 2 shows consumption patterns. Across all survey years, 78% of respondents said they ate bread and 50% ate breakfast cereal the day prior to the survey. In 2012, 37.2% of respondents ate no whole-grain cereal foods compared with 51.1% in 1995 (p < .001).
The proportion of respondents consuming bread decreased from 88.4% in 1995 to 70.4% in 2012 (p < .001). Among bread consumers, the amount eaten decreased from 4.1 slices in 1995 to 2.4 in 2012 (p < .001). Thirty nine percent of respondents consumed whole-grain bread and this did not change over time. Overall, 22% of respondents ate bread substitutes (bread muffins, pita bread, crumpets, scones, or crackers). Among the consumers, the mean servings of bread substitutes rose from 2.4 serves in 1995 to 3.6 serves in 2004 (p < .001).
Rice and pasta
The proportion of respondents eating rice increased from 22.7% in 1995 to 25.7% in 2012 (p = .02) and 85–90% choose white rice. Among rice consumers, the amount eaten decreased from 1.5 cups in 1995 to 1.1 cups in 2012 (p < .001). Across all surveys, 21% of respondents ate pasta on the day prior to the survey and 7% chose wholemeal varieties. Among pasta consumers, the amount eaten decreased from 1.8 cups in 2001 to 1.3 cups in 2009 and 2012 (p < .001).
Factors associated with cereal food consumption
Multiple logistic regression modelling showed a step-wise decrease in the likelihood of consuming bread over time (Odds Ratio OR = 0.31; 95% Confidence Interval; 0.24–0.40 in 2012 versus 1995) and that those more likely to consume bread were male (OR = 1.44; 1.23–1.68), shown in Table 3. The likelihood of consuming rice decreased with age (OR = 0.60; 0.43–0.84 in those aged 55–64 years compared to 18 to 24 years) and those more likely to consume rice were born outside of Australia, the UK and Ireland (OR = 2.90; 2.37–3.56), University or high school educated (OR = 1.56; 1.27–1.92 and OR = 1.27; 1.00–1.61 respectively). Obese respondents were less likely to consume rice than those of a healthy weight (OR = 0.71; 0.57–0.87) as were those living outside the metropolitan area (OR = 0.83; 0.70–0.99). Pasta consumers were less likely to be born in the UK and Ireland than in Australia (OR = 0.74; 0.60–0.92). Overweight or obese respondents were less likely to eat pasta than those who were a healthy weight (OR = 0.81; 0.68–0.98 and OR = 0.78; 0.63–0.96 respectively), shown in Table 3.
Breakfast cereal consumption prevalence decreased in 2009 and 2012 compared to 1995 (OR = 0.79; 0.65–0.97 and OR = 0.72; 0.58–0.90 respectively). Breakfast cereal consumers were more likely to be male (OR = 1.18; 1.04–1.34), aged 55–64 years compared to 18–24 years (OR = 1.59; 1.23–2.05), and to have a high school (OR = 1.30; 1.09–1.55), college (OR = 1.35; 1.13–1.62), or tertiary education (OR = 1.39; 1.19–1.63). Breakfast cereal consumers were less likely to be unemployed (OR = 0.84; 0.73–0.97), born in countries other than Australia/UK/Ireland (OR = 0.77; 0.65–0.92). Respondents who did not think about the health aspects of their diet (OR = 0.38; 0.29–0.49) or only took a bit of notice (OR = 0.79; 0.70–0.90) were less likely to consume breakfast cereal than those who paid a lot attention, shown in Table 3.
Whole-grain consumption prevalence decreased between 1998 and 2004 compared to 1995 (OR = 0.81; 0.66–0.99, OR = 0.44; 0.35–0.54, and OR = 0.69; 0.56–0.86 respectively) and increased in 2009 (OR = 1.27; 1.02–1.58). Whole-grain consumers were more likely to be older (45–54 years OR = 1.32; 1.01–1.72 and 55 to 64 years OR = 1.74; 1.33–2.28 compared to 18–24 years), to have a college or tertiary education (OR = 1.23; 1.01–1.50 and OR = 1.67; 1.41–1.98 respectively), and pay a lot of attention to the health aspect of their diet (compared to those who did not think about a healthful diet (OR = 0.33; 0.25–0.45) or those who only took a bit of notice (OR = 0.54; 0.47–0.61)), shown in Table 3.
Knowledge of dietary recommendations for cereal foods
The proportion of respondents correctly identifying the number of servings of cereal foods recommended per day decreased over time, from 26% in 1995 to only 6.3% in 2012 (p < .001), shown in Table 4.
Logistic regression models showed the proportion correctly identifying the recommended number of cereal foods servings decreased from 2004 (Relative Risk Ratio (RRR) = 0.46; 0.35–0.60 in 2004, RRR = 0.37; 0.28–0.48 in 2009, and RRR = 0.20; 0.15–0.27 in 2012) compared to 1995, Table 5. The odds of correctly identifying the recommended number of cereal food servings were lower among males (RRR = 0.77; 0.65–0.99), people over 35 years of age (35–44 years RRR = 0.76; 0.58–0.91, 45–54 years RRR = 0.66; 0.49–0.87 and RRR = 0.53; 0.39–0.73 respectively) and respondents who did not think about the health aspects of their diet (RRR = 0.49; 0.34–0.71). Respondents who held a university degree were twice as likely to correctly identify cereal recommendations than those who had less than high school education (RRR = 1.98; 1.60–2.44).
Barriers and promoters of cereal food consumption
The proportion of respondents not thinking about increasing the amount of cereal foods they ate, increased from 74.9% in 1995 to 83.6% in 2012 (p < .001), see Table 4. The main reasons respondents said they would increase their cereal food intake were to improve their general health (30.7%), or ‘weight or diet-related’ (24.0%), shown in Table 6. The main barriers to increasing consumption were ‘not liking cereals or not interested’ (9.8%), ‘no time for breakfast’ (5.4%) or ‘not liking eating in the morning or breakfast’ (5.3%).
The proportion who had tried to decrease the amount of cereal foods they ate increased from 4.3% in 1995 to 21.7% in 2012 (p < .001). Most respondents had not tried to change their cereal intake in the past year and of those who had tried to increase cereals, most had tried to increase breakfast cereal intake (58.6% to 80.1%). The proportion who tried to increase the amount of pasta they ate in 2012 was less than in 1995 (16.5% compared to 54.5%, (p < .001)).
Factors associated with attempts to change cereal foods intake
Multinomial logistic regressions showed that respondents were 11 times more likely in 2012 to have tried to decrease their cereal food intake compared to 1995 (RRR = 10.88; 6.81–17.4), see Table 7. Overweight and obese respondents were more likely to have tried to increased their cereal intake in the last 12 months compared to those of a healthy weight (RRR = 1.65; 1.22–2.24 and RRR = 1.88; 1.35–2.63 respectively) as were those who identify the correct number of cereal serves ((RRR = 1.56; 1.09–2.23). Males (RRR = 0.46; 0.35–0.60), older respondents (aged 55–64 years and 45–54 years, RRR = 0.55; 0.33–0.93 and RRR = 0.61; 0.38–1.00 compared to those 18–25 years respectively) were likely to have tried to decreased their cereal intake in the last 12 month. Respondents who did not pay attention to the health aspects of the food they eat and those that only took a bit of notice were more likely to have tried to increase their cereal food intake in the previous 12 months (RRR = 0.43; 0.22–0.84 and RRR = 0.55; 0.42–0.71 respectively) but also less likely to be currently trying to eat more cereal foods (RRR = 0.51; 0.32–0.81).
The proportion of Western Australian adults consuming cereal foods has decreased over the past two decades. The amount eaten has also decreased, yet most adults were unaware of the recommended intake and believed they were eating enough. In 2012, only 6% were able to identify the correct number of servings for cereals.
Western Australians were more likely to eat bread than any other type of cereal food although the proportion of adults eating bread declined from 88.4% in 1995 to 70.4% in 2012. A similar decline in bread consumption is evident from Australian dietary surveys using 24-h dietary recall methods, from 81% of adults consuming bread in 1995 to 65% in 2011–12 [10, 11]. The amount of bread consumed also decreased from 4.1 slices in 1995 to 2.6 slices in 2012 in the current study, compared to a decline in the national surveys from 2.7 slices (109 g) of regular bread and rolls in 1995 to 2.2 slices (88 g) in 2011/12 [10, 11]. While the proportion consuming bread alternatives (e.g. bread muffins, pita bread, or rice crackers) in the current study remained unchanged, the amount of these types of bread alternatives consumed increased over the two decades.
Cultural similarities and differences in bread consumption are seen when the current study findings are compared to intakes in other countries. Adult bread consumption in the UK declined in the decade preceding 2011 by around 12%  to an average of 186 g / day , whereas in 2011 98% of the Swedish population ate bread and intake had not changed since 1989 . Despite this, in 1992–1998 the average Swedish bread consumption of 56 g / day was less than the intake from surrounding countries Norway and Denmark (127 g / day and 142 g / day respectively) . Wheat bread intake in the United States (US) in 2003–6 NHANES accounted for 7.2% of energy intake , similar to Australian dietary surveys.
The current study found the proportion consuming breakfast cereals remained constant at about 50% with no change in the amount consumed (around two cups among those consuming) over the survey years. Australian dietary surveys also show breakfast cereal consumption has remained constant [10, 11], however, in contrast to the current study, they report increasing prevalence of ready-to-eat cereals (from 26.4% in 1995 to 34.5% in 2012) [10, 11]. The difference in prevalence may be due to different survey methodology including the categorisation of breakfast cereals or seasonality differences. In general, UK and Scandinavian national surveys show a lower mean intake of breakfast cereals compared with Australia, an average of 26 g of breakfast cereals per day among UK adults in 2008–11 , and Norway, Sweden and Denmark averaged 21 g per day, while Swedish adults consumed 51 g per day .
The findings on cereal food consumption are policy relevant, as the Australian Government uses food consumption information to inform food fortification and regulation policy to address public health nutrition deficiencies and prevent neural-tube defects. This has occurred through mandatory fortification of bread flour with thiamin since the 1970s, and folic acid and iodised salt since 2009 . The current study findings suggest that further research is required to explore the impact of declining bread intake on the effectiveness of these regulatory policies.
The proportion of WA adults consuming whole-grain cereal foods increased in 2009 with health conscious eaters and those with higher educational attainment more likely to eat whole-grain foods. The diet of regular whole-grain consumer is likely to be more nutrient dense diet compared with non-consumers [16, 18]. Given the importance of dietary whole-grains to reducing the population risk of non-communicable diseases , it is concerning that there has been little change in intake over twenty years. Although a larger proportion of bread consumers selected whole-grain or wholemeal breads, the decline in prevalence and amount of bread eaten suggest there has been no change in the overall population intake of whole-grain bread. This finding is consistent with Australian manufacturing industry reports of a shift toward whole-grain and seeded varieties of bread , despite the ongoing popularity of traditional white bread . Bread and breakfast cereals are the main contributors of whole-grains in the current study and in the US and UK . In the UK bread provides almost half and breakfast cereals about one-third of dietary whole-grains . Population surveys reveal cultural differences in whole-grain food consumption which is typically higher in Scandinavian countries than in many European countries, the US  and Australia. Only 7% of adults from Denmark, Sweden and Norway  did not consume any foods containing whole-grains compared to 46% in this study, 18% of UK adults , 42% of US adults  and 68% of French adults .
Knowledge of the amount of cereal food recommended for good health was low, only 6% of WA adults knew the recommendation in 2012, with most giving an incorrect amount of less than four servings. Consumer misperceptions, typically perpetuated by the media and celebrity diets, that carbohydrates and cereal foods are fattening  or bloating or gastrointestinal discomfort indicative of allergy or food intolerances [30, 40] may contribute to declining intakes. About one in ten Australian adults avoided wheat containing foods due to perceived gastrointestinal discomfort without any formal diagnosis in 2011 . Although coeliac disease affects approximately 1 % of the Australian , US , and European populations  and about 13% of Australian  and US  adults report self-diagnosed gluten sensitivity, there has been a rapid proliferation of wheat-free and gluten-free food products on supermarket shelves in the last decade or so . Some consumers mistakenly believe that gluten free eating assists with weight loss . Combined with low awareness of health benefits of eating whole-grains, these food avoidance perceptions may be contributing to the declining cereal food intake . Further research is needed to understand the impact of popular or fad food and diet trends on perceptions of and adherence to ADG.
Although dietary cereal intake is less than recommended, in 2012, most WA adults were not thinking about increasing the amount they ate and many believed they already ate enough. The low awareness of the recommended cereal intake and misperceptions of dietary adequacy are barriers to adhering to dietary guidelines.
Cost has also been identified as a barrier to consuming whole-grain foods  and whole-grain food consumption is lower among Australian low income households . However, whole-grain cereal foods, for example, rice, pasta and bread are priced equivalent to their refined versions, suggesting an opportunity for practical education to encourage consumption. Other barriers to increasing whole-grain consumption include taste [24, 30], particularly for bread , lack of understanding of the health benefits, inability to identify whole-grain foods, poor preparation skills, and the influence of family members, particularly young children .
All of these barriers could be addressed through a public education program such as the Danish health promotion campaign to increase whole-grain consumption which increased the average whole-grain intake from 36 g to 63 g per day per 10 MJ between 2008 and 2014 . The multi-strategy Danish campaign included: increasing whole-grain content of commercial food products; mass communication to improve consumers’ knowledge about whole-grain foods and their health benefits; and a certification logo on foods with a high whole-grain content (which also met strict criteria for total sugar, fat, and sodium) . Similarly, following the widespread media attention regarding the 2005 US Dietary Guidelines which included a recommended amount of whole-grains for the first time, sales of whole-grain pasta, bread, rice and flour increased and new and reformulated products increased the availability and sales of all whole-grain foods . Food industry action to improve the availability, accessibility, and affordability of whole-grain cereal foods can work in tandem with public education to increase awareness of the need to eat more and the benefits of eating more cereal foods.
ADG promotion has been very limited in Australia with the exception of the government-led comprehensive multi-strategy Gofor2&5© fruit and vegetable social marketing campaign. Triggered by similar consumer misperceptions regarding adequacy of consumption, Gofor2&5© successfully increased awareness of the need to eat more fruit and vegetables with population increases in consumption . Current findings suggest that a similar strategy for cereal foods, particularly for wholegrains, is warranted. The newly formed Australian Government’s Healthy Food Partnership has the potential to put such a strategy in place as it brings together the public health sector, food industry and government to improve the dietary habits of Australians .
A potential limitation of the current study is the cross-sectional self-report dietary intake methodology which restricts assessment of percentage contribution to total energy intake and the potential for social desirability bias. However, the similarity between the current study findings and the 24 food recall national dietary survey results suggest otherwise. A strength is that surveys have been repeated over time so the population prevalence of consumption, mean intake and consumer beliefs and attitudes have been monitored, particularly in the absence of a routine Australian dietary monitoring system. The cultural difference in dietary intakes described previously, suggest that the study findings are likely to be generalizable only in the Australian context, however, the attitudes and barriers may be similar in other countries.
Cereal food consumption by Western Australian adults continues to decrease and whole-grain consumption has not improved, yet there is a common misconception of dietary adequacy and low awareness of the amount that should be eaten for good health. The decline in bread consumption is particularly concerning as bread is the primary vehicle for folate, thiamine and iodine fortification. The WA population would benefit from a health promotion intervention to increase awareness of the importance of cereal foods, in particular breads and whole-grains, and assistance with overcoming practical barriers to incorporating these foods into their diet.
Australian dietary guidelines
Body mass index
95% Confidence interval
Nutrition Monitor Survey Series
Relative Risk Ratio
United States of America
Chen G-C, Tong X, Xu J-Y, et al. Whole-grain intake and total, cardiovascular, and cancer mortality: a systematic review and meta-analysis of prospective studies. The Am J Clin Nutr. 2016;104(1):164–72.
Cho SS, Qi L, Fahey GC Jr, Klurfeld DM. Consumption of cereal fiber, mixtures of whole grains and bran, and whole grains and risk reduction in type 2 diabetes, obesity, and cardiovascular disease. Am J Clin Nutr. 2013;98(2):594–619.
Gil A, Ortega R, Maldonado J. Wholegrain cereals and bread: a duet of the Mediterranean diet for the prevention of chronic diseases. Public Health Nutr. 2011;14(12A):2316–22.
Williams PG, Grafenauer SJ, O'Shea JE. Cereal grains, legumes, and weight management: a comprehensive review of the scientific evidence. Nutr Rev. 2008;66(4):171–82.
World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization; 2013.
National Health and Medical Research Council. Dietary Guidelines for Australians. Canberra: Australian Government Publishing Service., 1992.
National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Canberra: Australian Government Publishing Service, 2003.
National Health and Medical Research Council. Australian Dietary Guidelines. Providing the scientific evidence for healthier Australian diets. Canberra: Commonwealth of Australia, 2013.
Mishra G, Schoenaker D, Mihrshahi S, Dobson A. How do women's diets compare with the new Australian dietary guidelines? Public Health Nutr. 2015;18(02):218–25.
Australian Bureau of Statistics. National Nutrition Survey: Foods Eaten, Australia. cat. no.: 4804.0. Canberra: Commonwealth of Australia. 1995;1999
Australian Bureau of Statistics. Nutrition first results - foods and nutrients, 2011–2012 Internet: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.007?OpenDocument. Accessed 8 Oct 2015.
Korczak R, Marquart L, Slavin JL, et al. Thinking critically about whole-grain definitions: summary report of an interdisciplinary roundtable discussion at the 2015 whole grains summit. Am J Clin Nutr. 2016;104(6):1508–14.
Jacobs DR Jr. Grain v. Cereal: an impediment to public understanding of food and a study in language. Brit J Nutr. 2001;86(4):543–4.
Dietary Guidelines for Australians. Journal of Food and Nutrition 1981;38(3):111–9.
Kyrø C, Skeie G, Dragsted L, et al. Intake of whole grains in Scandinavia is associated with healthy lifestyle, socio-economic and dietary factors. Scandaniavian J Pub Health. 2012;40(1):76–84.
Mann KD, Pearce MS, McKevith B, Thielecke F, Seal CJ. Whole grain intake and its association with intakes of other foods, nutrients and markers of health in the National Diet and nutrition survey rolling programme 2008–11. Brit J Nutr. 2015;113(10):1595–602.
Jacobs D, Meyer H, Solvoll K. Reduced mortality among whole grain bread eaters in men and women in the Norwegian County study. Eur J Clin Nutr. 2001;55(2):137–43.
O'Neil CE, Nicklas TA, Zanovec M, Cho S. Whole-grain consumption is associated with diet quality and nutrient intake in adults: the National Health and nutrition examination survey, 1999-2004. J Am Diet Assoc. 2010;110(10):1461–8.
Lang R, Jebb SA. Who consumes whole grains, and how much? Proc Nutr Soc. 2003;62(01):123–7.
Harland J, Garton L. Whole-grain intake as a marker of healthy body weight and adiposity. Pub Health Nutr. 2008;11(06):554–63.
Mann KD, Pearce MS, McKevith B, Thielecke F, Seal CJ. Low whole grain intake in the UK: results from the National Diet and nutrition survey rolling programme 2008–11. Brit J Nutr. 2015;113(10):1643–51.
Bellisle F, Hébel P, Colin J, Reyé B, Hopkins S. Consumption of whole grains in French children, adolescents and adults. Brit J Nutr. 2014;112(10):1674–84.
Hendrie GA, Coveney J, Cox D. Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample. Public Health Nutr. 2008;11(12):1365–71.
McMackin E, Dean M, Woodside JV, McKinley MC. Whole grains and health: attitudes to whole grains against a prevailing background of increased marketing and promotion. Public Health Nutr. 2013;16(04):743–51.
Turrell G. Compliance with the Australian dietary guidelines in the early 1990's: have population-based health promotion programs been effective? Nutr Health. 1997;11(4):271–88.
Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. Prog Behav Modif. 1992;28:183–218.
Hayes AJ, Kortt MA, Clarke PM, Brandrup JD. Estimating equations to correct self-reported height and weight: implications for prevalence of overweight and obesity in Australia. Aust NZ J Pub Health. 2008;32(6):542–5.
World Health Organization Body Mass Index (BMI) http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Accessed 18 June 2017.
Australian Bureau of Statistics. Body Mass Index (BMI) Classification. Internet: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Dec%202011?OpenDocument. Accessed 8 Oct 2015.
O'Connor Á. Bread consumption in the UK: what are the main attitudinal factors affecting current intake and its place in a healthy diet? Nutr Bull. 2012;37(4):368–79.
Bates B, Lennox A, Prentice A, et al. National diet and nutrition survey results from years 1, 2, 3 and 4 (combined) of the rolling programme (2008/2009–2011/2012). London: Pub Health England; 2014.
Sandvik P, Kihlberg I, Lindroos AK, Marklinder I, Nydahl M. Bread consumption patterns in a Swedish national dietary survey focusing particularly on whole-grain and rye bread. Food & Nutr Res. 2014;58
Engeset D, Hofoss D, Nilsson L, Olsen A, Tjønneland A, Skeie G. Dietary patterns and whole grain cereals in the Scandinavian countries–differences and similarities. The HELGA project Public Health Nutr. 2014:1–11.
Probst YC, Cunningham J. An overview of the influential developments and stakeholders within the food composition program of Australia. Trends in Food Sci Technol. 2015;42(2):173–82.
Langley S. Internet: http://www.ausfoodnews.com.au/2014/09/08/bread-and-cake-producers-struggle-with-changingconsumer-tastes-ibisworld.html. Accessed 8 Oct 2015.
Wahlquist A. The rise and fall of our daily bread. The Australian 2010. Internet: http://www.theaustralian.com.au/opinion/the-rise-and-fall-of-our-daily-bread/news-story/bc21cfa0a9fb390610ab9f1d73116099. Accessed 8 Oct 2015.
Seal C, Jones A, Whitney A. Whole grains uncovered. Nutr Bull. 2006;31(2):129–37.
Lang R, Thane CW, Bolton-Smith C, Jebb SA. Consumption of whole-grain foods by British adults: findings from further analysis of two national dietary surveys. Public Health Nutr. 2003;6(5):479–84.
Reicks M, Jonnalagadda S, Albertson AM, Joshi N. Total dietary fiber intakes in the US population are related to whole grain consumption: results from the National Health and nutrition examination survey 2009 to 2010. Nutr Res. 2014;34(3):226–34.
Golley S, Corsini N, Topping D, Morell M, Mohr P. Motivations for avoiding wheat consumption in Australia: results from a population survey. Public Health Nutr. 2015;18(03):490–9.
Stein K. Severely restricted diets in the absence of Medical necessity: the unintended consequences. J Acad Nutr Diet. 2014;114(7):986–94.
Mustalahti K, Catassi C, Reunanen A, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Ann Med. 2010;42(8):587–95.
Aziz I, Lewis N, Hadjivassiliou M, et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroen Hepat. 2014;26(1):33–9.
Moore LR. “but we're not hypochondriacs”: the changing shape of gluten-free dieting and the contested illness experience. Soc Sci Med. 2014;105:76–83.
Worsley A, Blasche R, Ball K, Crawford D. Income differences in food consumption in the 1995 Australian National Nutrition Survey. Eur J Clin Nutr. 2003;57(10):1198–211.
Bakke A, Vickers Z. Consumer liking of refined and whole wheat breads. JFS. 2007;72(7):S473–S80.
Greve C, Neess RI. The evolution of the whole grain Partnership in Denmark. Copenhagen Business School and the Danish Whole Grain Partnership: Copenhagen; 2014.
Mancino L, Kuchler F, Leibtag E. Getting consumers to eat more whole-grains: the role of policy, information, and food manufacturers. Food Policy. 2008;33(6):489–96.
Pollard CM, Miller MR, Daly AM, et al. Increasing fruit and vegetable consumption: success of the Western Australian go for 2&5® campaign. Public Health Nutr. 2008;11(03):314–20.
Australian Government. Health. Healthy food partnership. About the partnership Internet. http://www.health.gov.au/internet/main/publishing.nsf/Content/about-the-partnership. Accessed 13 Jan 2016.
We acknowledge Ms. Margaret Miller for conceiving and developing the Department of Health’s Nutrition Monitoring Survey Series (NMSS) for use in planning, developing, implementing and evaluating nutrition programs consistent with Australian Dietary Guidelines.
The Nutrition Monitoring Survey Series (NMSS) is owned and funded by the Department of Health in Western Australia. Healthway, the Western Australian Health Promotion Foundation, funded Curtin University to assist the translation of research into practice through the “Food Law, Policy and Communications to Improve Public Health Project.” Claire Pulker is supported by a Healthway Health Promotion Research Training Scholarship.
The Department of Health had no role in the analysis, interpretation of data and in writing the manuscript. Healthway had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Availability of data and materials
The datasets generated and/or analysed during the current study are not publicly available as the data custodian is the Department of Health in Western Australia, but they are available from the corresponding author on reasonable request.
CMP acquired the data and XM and CMP conceived the paper, XM conducted the statistical analysis, CMP, CEP, FCD drafted the manuscript, CMP, VAS, JAS, DAK reviewed, revised and edited the manuscript for critical content. All authors have read and approved the final version of this manuscript.
The authors declare that they have no competing interest to declare.
Consent for publication
Ethics approval and consent to participate
Ethics approval was granted by the WA Department of Health (#2011/65) and Curtin University Human Research Ethics Committees (RD22–11). For each survey, each participant gave their verbal consent after the consent information was read out by the interviewer as the study was conducted via the telephone. This method of consent was approved by the Health Department’s Research Ethics Committee.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Pollard, C.M., Pulker, C.E., Meng, X. et al. Consumer attitudes and misperceptions associated with trends in self-reported cereal foods consumption: cross-sectional study of Western Australian adults, 1995 to 2012. BMC Public Health 17, 597 (2017). https://doi.org/10.1186/s12889-017-4511-5
- Cereal foods
- Breakfast cereal