Creating a culture that supports food security and health equity at higher education institutions.

Food insecurity on college campuses is a major public health problem and has been documented for the last decade. Sufficient food access is a crucial social determinant of health, thus campuses across the country have implemented various programmes, systems and policies to enhance access to food which have included food pantries, campus gardens, farmers' markets, meal share or voucher programmes, mobile food applications, campus food gleaning, food recovery efforts, meal deliveries and task force/working groups. However, little is understood about how to best address food insecurity and support students who are struggling with basic needs. The impact of food insecurity on students' academic and social success, in addition to their overall well-being, should be investigated and prioritised at each higher education institution. This is especially true for marginalised students, such as minority or first-generation students, who are at heightened risk for food insecurity. In order to create a culture of health equity, in which most at-risk students are provided resources and opportunities to achieve optimal well-being, higher education institutions must prioritise mitigating food insecurity on the college campus. Higher education institutions could benefit from adopting comprehensive and individualised approaches to promoting food security for marginalised students in order to facilitate equal opportunity for optimal scholastic achievement among students of all socio-demographic backgrounds.

Growing Healthy Minds, Bodies, and Communities: early childhood teachers' perceptions of a nutrition-integrated pilot curriculum.

OBJECTIVE: Healthy eating behaviours are often developed early in life, yet nutrition is rarely emphasised in early childhood education. Integration of nutrition into academic content is warranted, still its ability to positively impact teaching and learning has been understudied. Therefore, the current study explored the feasibility of application in the classroom and the perceived usability of a nutrition-integrated pilot curriculum. DESIGN: Early childhood teachers' perceptions of four nutrition-integrated lessons were explored through a qualitative research approach. Data were collected through pre- and post-focus groups, lesson observations and teacher feedback. Focus group transcripts were analysed using inductive thematic analysis and supplemented with observations and lesson feedback. SETTING: This pilot study took place in Northwest Mississippi at three pre-schools which are part of the Mississippi Early Learning Collaborative. PARTICIPANTS: A non-probability convenience sample was utilised to acquire participants. Ten early childhood teachers and 132 Pre-K4 students participated in the study. RESULTS: Three themes emerged and were categorised accordingly: (a) preconceived concern of the unknown v. experienced reality, (b) promoting buy-in and engagement through hands-on learning experiences and (c) manifestation of perceived prioritisation. CONCLUSIONS: Nutrition-integrated lessons were reported to be creative, facilitate positive food behaviours and highly engaging for teachers and children. Concerns for new and unfamiliar curriculum were noted but could be alleviated with more detailed instructions. Future nutrition-integrated curriculum efforts should include detailed video instructions and offer a gradual and flexible schedule allowing teacher autonomy in how to prioritise implementation.

College student sleep quality and mental and physical health are associated with food insecurity in a multi-campus study.

OBJECTIVE: To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students. DESIGN: An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health. SETTING: Twenty-two higher education institutions. PARTICIPANTS: College students (n 17 686) enrolled at one of twenty-two participating universities. RESULTS: Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04). CONCLUSIONS: College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.

Copycat snacks: Can students differentiate between school and store snacks?

In 2014, the national Smart Snacks in School nutrition standards placed regulations on all snack foods sold in schools. Many food companies reformulated common snack food products for sale in schools, called "copycat snacks", which look similar to nutritionally different foods sold in stores. It is possible that these snacks create consumer confusion among students. The purpose of this study was to determine if middle school students could differentiate, in taste and appearance, between school (copycat) and store versions of common snacks. Seventy-six middle school students evaluated three different food products offered in schools: Froot Loops, Rice Krispy Treats, and Doritos. Students tasted snacks in a series of triangle tests for difference, one for each snack food, including school and store versions. Students were also presented with packages, school and store versions of the same products, and asked to determine the expected taste, purchase intentions, and perceived healthfulness. Students could determine taste differences between school and store Rice Krispy Treats yet could not differentiate between Froot Loop and Dorito varieties. Students rated store versions of all three snacks with greater expected taste, higher intention to purchase, and as less healthy. While it seems product confusion concerning copycat snacks may not be severe in this sample, snack food brands are still a prominent feature in schools. It is possible that these copycat snacks can confuse students' perceptions of healthy foods. Alternative packaging for school foods or reformation of store versions of snack foods may be viable solutions to this problem.

National Food Affordability: A County-Level Analysis.

The purpose of this study was to explore the sociodemographic factors that contribute to food affordability across space, with specific emphasis on rural and urban differences in the United States. A regression analysis was used to predict food affordability from several predictors in rural and urban areas, with a subanalysis of Appalachian and Delta counties. Rural households had significantly higher food expenditures to income ratios compared with urban counties; Appalachian and Delta counties had the highest on average food expenditure to income ratio. Affordable food buffers vulnerable families against food insecurity and subsequent chronic health issues, which are especially relevant in the Appalachian and Delta counties.

Parenting practices toward food and children's behavior: Eating away from home versus at home.

Parenting style influences a child's overall diet quality and establishes food preferences. Parenting style and "food rules" for children differ by eating at home or away from home. Eating meals away from home is increasing despite associations with consumption of unhealthy foods and higher weight status. The objective of the current study was to compare parenting practices and decision-making at restaurants versus at home. A mixed methods approach was utilized: facilitated, individual interviews to explore decision-making and parenting practices; written questionnaires for socio-demographic information; and body mass index. Summaries and emergent themes were generated based on examination of tapes and transcripts. Descriptive statistics were computed for questionnaire data. Twenty-five mothers of children of five to eight years who ate at restaurants at least two times per week participated. Mothers reported more permissive food rules at restaurants yet maintained higher behavioral expectations. Mothers were also more likely to make decisions about whether they eat out, where to eat, and children's meal selections than their children. The findings suggest that parenting practices toward overall behavior and food choices may differ at restaurants than at home, highlighting the importance of healthy menu options, further research, and educational strategies.

The Availability of Competitive Foods and Beverages to Middle School Students in Appalachian Virginia Before Implementation of the 2014 Smart Snacks in School Standards.

The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture's Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.5%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (62.2%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.

Food security as a basic need: College students need greater support from institutional administration.

Food insecurity among college students has become a growing concern, with reports documenting its prevalence for over a decade. As the demographics of university and college students change, with more first-generation, nontraditional, and minority students, the risk of food insecurity is heightened. This viewpoint contends that food security is an essential basic need among college students, and when left unmet, it significantly impacts their well-being, resulting in an increased risk of poor academic performance or departure from higher education before degree completion. To combat this issue, universities and colleges must develop and sustain food security initiatives and programs, with administrators playing a critical role. We highlight key areas in which institutional administration can take actionable steps to dedicate the necessary support and resources to proposed and ongoing programs, foster an equitable campus culture, and be advocates for policies at the state and federal level that promote students' food security.

Food Insecurity Knowledge and Training Among College Students in Health Majors.

OBJECTIVE: To describe current food insecurity (FI)-related training among nutrition/dietetics, public health, and social work students. METHODS: A cross-sectional online survey was used among students (n = 306) enrolled in health-related programs at 12 US universities. Participants reported FI-related course-based and extracurricular experiences and rated confidence to address FI on a scale of 1-3. Open-ended questions investigated perceived definitions of FI and impactful course activities. Descriptive statistics and thematic analysis were used for data analysis. RESULTS: Participants' FI definitions were multifaceted. Most (80.6%) reported FI being covered in at least 1 course. The overall mean confidence to address FI was 2.2 ± 0.48. Participants suggested increasing application-based opportunities and skills training. CONCLUSIONS AND IMPLICATIONS: Most students have a basic understanding of FI and report high confidence to address it in the future. Impactful FI-related experiences and participants' suggestions guide developing an FI training resource to enhance student FI competency and sensitivity.

Impact of Smart Snacks Intervention on College Students' Vending Selections.

OBJECTIVES: To place Smart Snacks in vending machines and determine if different sales strategies affect Smart Snack selection. PARTICIPANTS: University students living in resident halls. METHODS: Vending machines included 50% Smart Snacks and 50% non compliant snacks. Three sales strategies targeted student selection of Smart Snacks: Reduced price, signage, and nutrition education activities. Three-way ANOVA was used for analysis. RESULTS: There was a statistically significant three-way interaction on snack selection between sales strategy, study period, and snack type, F(4, 77) = 3.33, P = .01. There were no statistically significant simple two-way interaction between study period and sales strategy for either Smart Snack, F(1, 77) = 1.62, P = 0.18, or NC snack types, F(1, 77) = 2.02, P = 0.07. CONCLUSIONS: Sales strategies did not affect Smart Snack selections. Advocates for healthier snacks in vending machines can align with university administrations to establish nutrient guidelines.

Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities.

OBJECTIVES: To quantify the number and type of students failing to secure basic needs. PARTICIPANTS: Students attending 22 postsecondary schools in the United States in Fall 2019. METHODS: The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities. RESULTS: Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen. CONCLUSIONS: High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.

Food pantry offerings and awareness at a southeastern public university.

OBJECTIVE: This study documents campus awareness of an on-campus food pantry and the value of its nutritional offerings in order to provide tailored recommendations for improving this particular emergency resource for food insecure students. PARTICIPANTS: This study surveyed 253 students, and 185 faculty and staff at the Southeastern Flagship Institution. METHODS: This mixed methods study combined a quantitative survey administered to 438 participants with an in-depth nutritional analysis of the food pantry's offerings. RESULTS: Results showed low levels of awareness by faculty and staff and limited offerings of fresh fruits and vegetables, dark leafy greens, and whole grains in the on-campus food pantry. CONCLUSIONS: This research helps to fill critical gaps regarding faculty and staff awareness of on-campus food pantries. Importantly, this article provides recommendations for campus food pantries to improve their campus awareness and nutritional offerings through engaging University stakeholders with long-term appointments and increasing donor education.

Measuring university students' beliefs toward healthy snack selection.

Objectives: Understanding university students' beliefs toward selecting healthy snacks is important in developing effective programs targeting healthy eating behaviors. The purpose of this research was to assess students' beliefs toward healthy snack selection and consumption. Participants: In November 2017, a convenience sample of 779 undergraduate students living on campus completed an online survey. Methods: A survey was developed to measure students' beliefs about eating healthy snacks. Paired t-tests were used to compare differences in beliefs and their importance. Independent t-tests were used to compare differences in belief responses by gender. Results: Students believed that healthy snacks were good for health and assisting with weight management. However, time management, motivation, preparation needs, and poor taste were reported as barriers to selection and consumption of healthy snacks. Conclusions: Increasing students' awareness of available food preparation facilities, developing food preparation skills, and motivation for consumption of healthy-good tasting snacks may increase healthier snacking.

Impact of food affordability on diabetes-related preventable hospitalization.

OBJECTIVES: This study aims to estimate the burden of food affordability on diabetes-related preventable hospitalizations among Medicaid enrollees in the United States. STUDY DESIGN: This study used a retrospective observational design with Medicaid administrative claims data from 17 states from 2014. METHODS: Data were linked with county-level social determinants of health (SDOH) from the American Community Survey. The rate of diabetes-related preventable hospitalizations was measured using the Agency for Healthcare Research and Quality's Prevention Quality Diabetes Composite, which includes hospitalization for short-term complications, long-term complications, lower extremity amputations, and uncontrolled diabetes. Multivariable logistic regression was used to predict the occurrence of diabetes-related preventable hospitalization. RESULTS: Among the 16 million eligible individuals, diabetes-related preventable hospitalizations were identified at the rate of 1.91 per 1000 individuals and contributed to more than $160 million in charges. Rates were higher among men compared with women (0.25% vs 0.15%; P < .001) and among Black adults compared with White adults (0.29% vs 0.18%; P < .001). Compared with individuals residing in counties with low food affordability, those residing in counties with high (odds ratio [OR], 0.84; 95% CI, 0.78-0.91; P < .001) or medium (OR, 0.85; 95% CI, 0.81-0.90; P < .001) food affordability had lower odds of hospitalization. CONCLUSIONS: This study provides real-world evidence about the impact of SDOH on diabetes-related preventable hospitalizations. Federal and state policies that can help improve accessibility of healthy foods are needed to ameliorate the burden of diabetes on society.

Validity of a Market Basket Assessment Tool for Use in Supplemental Nutrition Assistance Program Education Healthy Retail Initiatives.

OBJECTIVE: To assess the validity of the Market Basket Analysis Tool (MBAT) for food environment quality within various retail environments compared to the Nutrition Environment Measures Survey in Stores (NEMS-S). METHODS: In-store assessments using the MBAT and the NEMS-S on the same day in a given store were conducted in grocery stores, corner stores, pharmacies, and dollar stores in a metropolis, and urban and rural counties across 4 states: Louisiana, Mississippi, North Carolina, and Virginia. Descriptive statistics, correlations, and ANOVAs were used to assess store location, store type differences, and MBAT and NEMS-S scores. RESULTS: Market Basket Analysis Tool and NEMS-S data were collected from 114 stores. Market Basket Analysis Tool and NEMS-S total and all individual component scores were significantly correlated (r = 0.84, P ≤ 0.0001; r range, 0.51-0.88; P ≤ 0.0001). CONCLUSIONS AND IMPLICATIONS: The MBAT offers a methodology to measure the food retail environment focusing on the availability of healthful food items with a reduced training time and streamlined data collection compared with the NEMS-S. Future work can assess the completion time of the MBAT compared with the NEMS-S and the ability of the MBAT to detect changes in food environment quality post healthy food retail interventions.

Barriers, Enablers, and Possible Solutions for Student Wellness: A Qualitative Analysis of Student, Administrators, and Staff Perspectives.

BACKGROUND: Child well-being, which includes physical, mental, and social health, has a critical effect on academic performance. Schools face many challenges in meeting needs for child well-being. Schools in low-resource areas, including the Mississippi Delta, face greater challenges when meeting student needs. METHODS: Eleven focus groups with middle school students and 12 interviews with teachers, staff, and administration in one Mississippi Delta middle school were completed in 2019. The Social Ecological Model and Theory of Organizational Readiness for Change were used as a framework for the study. RESULTS: Focus group data with middle school students and interviews with teachers, staff, and administrators show that academic stressors play a major role in student well-being; yet, teachers, staff, and administrators face immense pressure to achieve high test scores. However, students seem to be encouraged by a positive school environment, which could help minimize some stressors. CONCLUSIONS: It seems that small improvements to the school environment could have a significant effect on student well-being, especially when school infrastructure and limited resources do not support comprehensive changes.

School Nutrition Director Perceptions of Flexible Regulations for School Nutrition Programs in One Southeastern State.

BACKGROUND: Schools are a promising site for influencing the dietary intake of children and adolescents. The US Department of Agriculture recently released flexibilities to requirements for whole-grains, sodium, and low-fat milk in schools who demonstrated difficulty meeting nutrition standards for school meal programs. The support of School Nutrition Directors (SNDs) is vital to the success of school food environment changes; however, few studies have explored SNDs perceptions to changes in nutrition standards. METHODS: Experiences and perspectives toward nutrition standards of 10 SNDs, and their satisfaction with flexibilities for whole-grains, sodium, and low-fat milk were explored using a semi-structured interview. Responses were analyzed using an inductive approach with thematic analysis. RESULTS: Three broad categories emerged challenges with the Healthy, Hunger-Free Kids Act, food preferences and acceptability, and support and representation. A greater need for internal and external support, assistance in equipment and staff, procurement of foods compliant with regulations and acceptable to students, and more input on federal decisions and policies were perceived as important. CONCLUSIONS: Results provide critical insight into the implementation of nutrition standards. Future research and changes to school nutrition programs should consider these challenges as they strive to meet the needs of this important population.

Smart snacks in universities: possibilities for university vending.

Background: The study goal was to evaluate the nutritional impact of a healthy snack intervention on a southern university campus. Methods: This quasi-experimental study was conducted during the fall 2017 semester weekly for 14 weeks in a large southern U.S. university. For the intervention, half of vending snacks in four campus residential halls (housing from 216 to 361 students) were substituted with snacks complying with federal Smart Snacks in School nutrition standards for K-12 schools. For analysis, data from the Nutrition Facts labels of 14 vending machines or from manufacturer's websites was collected by trained graduate and undergraduate researchers. Results: On average, for each Smart Snack sold, there was a statistically significant reduction of 99.38 calories (CI=42.32, 156.43), 4 g saturated fat (CI = 2.23, 5.75), and 10.06 g of sugar(CI=2.92, 17.20). An average reduction of 41.88 mg in sodium and an increase of 0.81g in fiber was also found, but was not statistically significant. There was a significant difference (t(16)=3.02, P < 0.025, 95% CI = 10.77, 55.79) between the Quality Score of Smart Snacks (M=59.13,SD= ± 36.50) and that of non-compliant snacks (M=25.85, SD= ± 24.72). Conclusion: The nutritional impact with even a 50% Smart Snack replacement is promising. Many available comparable snacks mimic the mouthfeel, taste, and appearance of their original full-fat, full-sodium, and full-sugar counterparts. Including healthier snack choices in vending machines may be a viable option for universities to transform the campus eating environment.

Smart Snacks in School Legislation Does Not Change Self-Reported Snack Food and Beverage Intake of Middle School Students in Rural Appalachian Region.

OBJECTIVE: To assess the effects of the national Smart Snacks in School standards, which include nutrient and ingredient limitations for school competitive foods and beverages effective July, 2014, on student intake in low-income rural Appalachian middle schools. METHODS: Food-frequency questionnaires were administered to students before and after implementation. Multiple ordinal logistic regression models were conducted to examine effects from year of data collection, grade, and free or reduced price lunch participation rates. RESULTS: No significant changes were observed after implementation except a decrease in consumption of 1% or nonfat flavored milk at school. CONCLUSIONS AND IMPLICATIONS: Smart Snacks in School standards did not result in significant dietary changes in this study. Longitudinal studies could evaluate long-term impacts of nutrition standards.