Musselshell County, Mont., a county in the south-central part of the state with a population of 4,500 people, is the least healthful county in the nation in terms of grocery shopping, according to a new study by the National Bureau of Economic Research.

Citizens of the rural county generally purchase high fat and sugar items, few fruits and vegetables and products low in protein, the paper revealed. It acknowledged that researchers long believed that communities like Musselshell eat poorly because of a lack of access they can’t afford healthy foods and often don’t find them in their local grocery stores.

But the new study argues that local “culture” and simple disinterest in healthful groceries among these groups across the country could be the problem. The paper said that those groups are made up of consumers who are mainly low-income, have less education, have limited nutrition knowledge and live in specific areas – like south-central Montana.

“Economists have a problem with the word ‘culture,’ ” Hunt Allcott, the paper’s lead author, told The Washington Post. But a region’s food culture, he said, “could make a big difference in the formation of food preferences.”

For the study, Allcott and his team looked at 12 years of Nielsen Holdings grocery data collected from 100,000 homes in the U.S. They also analyzed what happened after grocery stores that offered healthy foods moved into these previously “food desert” areas and the study said that there were no major changes made to a household’s food-buying decisions. There wasn’t a demand for these items in these areas.

The team hypothesized that the cuisines that dominate different regions of the country dictate what people eat as children which then largely commands what people eat and how they make food decisions for the rest of their lives.

“We know that your early life experiences play a large role in how you eat,” Allcott said. “That suggests there’s a possible intergenerational transmission of preferences.”