Plant-based diets: Not always a free choice for rural adults.

Supporting population-level dietary transitions to plant-based diets (PBDs) for human and environmental health demands a comprehensive understanding of lived experience and human behavior. This study examined how diverse identities shape PBD behavior. Using the Theory of Planned Behavior (TPB) and Intersectionality, we implemented multi-group structural equation models with a national sample of US rural adults (n = 1908) to predict adherence to a PBD. In the main model, attitude (β = 1.117, p < 0.001) was the only predictor of intention to consume a PBD. Intention (β=0.630, p < 0.001) and perceived behavioral control (β=0.092, p = 0.001) jointly predicted PBD behavior. Across intersectional models, attitude toward PBDs (all p < 0.001) was the strongest predictor of intention to consume a PBD. However, respondents with different intersectional identities experienced and responded to social pressure and structural constraints differently. The results suggest that among socially advantaged rural adults, PBDs are a choice enabled by personal beliefs and resources. However, high-income adults (β = -0.057, p = 0.045) and White men with higher education (β = -0.163, p = 0.014), resisted PBDs with increasing social pressure. Among socially disadvantaged adults, such as less-educated and low-income women, PBDs may be indicative of economic distress and systemic challenges suggesting that increasing resources would result in shifts away from plant-based eating. For low-income adults with higher education (β = -0.189, p = 0.037), PBDs were a last resort. Taken together, this study highlights the need to consider context, identity, and values when designing strategies to promote PBDs, especially among socially disadvantaged rural adults. This study also lays the groundwork for more research on intersectional inquiries of sustainable dietary patterns.