Food Access and Nutrition Literacy in College Students: A Conceptual Framework and Intervention “Project Feed the Future”

Abstract

Food access and nutrition literacy are critical, foundational components for a healthy life. These constructs are often studied in lower income communities; consequently, there has been little research conducted on college students due to their geographic locations in more affluent areas. As a result of their location, college campuses are unable to be defined as a food desert according to the United States Department of Agriculture’s (USDA) definition, even though a review of 31 studies found that between 9% and 5% of college students are food insecure in a nationwide sample. This article dissects the issues of food access and nutrition literacy on college campuses and proposes Project Feed the Future program. Project Feed the Future is, to the writer’s knowledge, the only program that addresses both structural and individual levels of food access and nutrition literacy in the college student population.

Keywords: food access, nutritional literacy, college

Introduction

Food access and nutrition literacy are serious public health issues: Adequate nutrition serves as the basis for a healthy life. It is complex to pinpoint the constructs associated with these public health issues because they are intertwined with other fundamental social determinants of health such as educational attainment, employment status, income, and place of residence. College students are subject to a unique combination of these social determinants and thus have an acute and interesting change in food access and demand for nutrition education. College students typically experience living independently of their family for the first time in their lives and find themselves responsible for providing their own food and maintaining nutritional standards. The new living situation, transportation options, various time and fiscal restraints, and many other stressors make it complicated for college students to navigate the process of providing food and nutrition for themselves. In addition to adjusting to various environmental changes, limited personal experience and proficiency in preparing food can also introduce barriers to adequate food access and nutrition literacy. Author Serah Theuri and editor Rosalie Garner state that “lack of knowledge, skills and resources necessary for basic food preparation increases the risk for food insecurity” in a recent book on food insecurity (Theuri & Garner, 2016).

There are many stakeholders in the health and well-being of college students, which will be considered in the proposal for the Project Feed the Future program. Chief among the stakeholders are the students themselves, as the focus of the program, and their acceptance and belief in the program is critical to its uptake and success. Because of their proximity to college students, school administrators are also a crucial stakeholder in the program. They are invested in student health for several reasons. First, tuition payments are a significant motivator for administrators to keep students in school, and healthier students stay in school. Second, a healthier population of students with a strong graduation rate makes the institution more appealing and better at attracting a new class of students. As students graduate out of the institution and become alumni, their support, financial or otherwise, of the institution places them in a stakeholder position. The last two groups of major stakeholders are students’ immediate families and the workforce. In the transition of independence, that is, higher education, students are between times when the larger part of their social education and norms is framed by familial life and into a place where they are shaped by workplace expectations.

Conceptual Framework

The two outcomes of interest in the proposed program are food access and nutrition literacy. A conceptual model of these outcomes is presented in Appendix A. The United States Department of Agriculture (USDA) defines food access as constraints on the consumer’s choices in spending on food items by factors such as travel time to shopping, availability of healthy foods, and food prices (USDA, 2019). A working definition of nutrition literacy is derived from the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) definition of health literacy. The nutrition literacy definition reads as follows: “the degree to which individuals have the capacity to obtain, process, and understand nutrition information and skills needed to make appropriate nutrition decisions” (Gibbs, 2012). These outcomes are closely related, both affecting the physical and mental well-being of the individual. However, they should be measured and addressed separately because of their independent pathways of manifestation.

There are three key components that are closely related to food access and nutrition literacy: location of food source(s), financial status, and educational status. Location of food source and financial status are the major contributors to levels of food access on college campuses. Educational status works similarly to financial status as a main contributor to nutrition literacy in the general population.

Location of food source refers to the geographic relationship between the individual’s housing and their food source. In this context, food source is used to describe a grocery store–style establishment that reliably stocks nutrient-dense foods—specifically, fresh produce, whole grains, and lean protein that can be used to create meals suitable for any dietary regimen. These specific food items are important because the U.S. Centers for Disease Control and Prevention (CDC) identifies them as being associated with healthy eating patterns and lowered risk of chronic diseases (CDC, 2015). It is also important to note that ideal food sources will have prices that are reasonable. For example, a prolific problem on college campuses is convenience stores marking up prices for the same goods, which may even be compromised in quality, because of their accessible location.

Financial status is intended to encompass all factors that contribute to an individual’s fiscal well-being. For students, this includes, but is not limited to, income, financial aid, expenditures, and disposable income. Food is a necessary purchase; however, individuals have control over how much of a discretionary budget is spent on food goods. If that budget is low and if there are many financial stressors, there will be less money left to purchase nutritious foods. This is the case for many college students who face high costs of living and tuition payments that have increased by 2.3% in the last academic year alone (College Board, 2019). This could result in not having enough food or consuming calorie-dense and nutrient-lacking foods. Highly processed foods tend to be cheaper and more filling at the cost of lower nutritional value. For example, a McDonald’s cheeseburger provides roughly 300 calories per dollar spent, whereas a homemade cheeseburger made with lean ground beef and a whole wheat bun provides only 147 calories per dollar (McDonald’s, 2018).

Educational status has been cited as a key determinant of nutrition literacy specifically, with higher educated individuals having higher nutrition literacy (Theuri & Garner, 2016). Education is moderately controlled for by the population of interest and the fact that they are all enrolled at a college or university. Consequently, the conceptual model (Appendix A) includes moderating factors that consider individual belief in the importance of nutrition and personal attainment of nutrition literacy. Regardless of the level of nutrition literacy students are entering with, these factors, when high, can increase the strength of the relationship between education status and increased nutrition literacy and make excellent targets for intervention programs.

Traveling distally in the conceptual framework (Appendix A), we find factors that are largely working in the background, either laying the groundwork for more proximal factors or modifying the relationship between proximal factors and outcomes. In this framework, foundational constructs include familial socioeconomic status (SES) and housing status. For our purposes, familial SES (Appendix A) is defined as the social and economic capital of the individual student’s immediate family. Often, this is who the student lived with before moving to college. As individuals in the early stages of their autonomy, the student’s educational, financial, and housing statuses will be highly impacted by those same factors in the environment they came from. For these reasons, familial SES serves as the absolute base for this model and to some degree informs all factors in it. Housing status is directly impacted by familial SES, and financial status (what students can afford) is limited by these two factors and the housing market on and around the college campus. The U.S. Census Bureau has defined affordable housing as spending 30% or less of the monthly household income on housing costs (Schwartz & Willson, 2007). Data from the U.S. Census Bureau on housing affordability show that in 2006 individuals in the age range of college students who rented housing were spending approximately 60% of their monthly household income on housing costs, double the affordability rule of thumb (Schwartz & Willson, 2007). In addition, in 2008, 98.2% of current renters under the age of 25 who lived with unrelated peers, a common living arrangement during the college years, could not afford modest housing in their area (Wilson & Callis, 2013). These shocking statistics attest to the fact that an overwhelming majority of a student’s funds are immediately funneled into securing housing, leaving little left over to spend on nutritious foods.

Housing also dictates the proximity to an adequate food source which is instrumental in issues of food access. Distal factors that moderate the relationship between the location of food source and food access are time and transportation. The type of transportation available to students is dependent on their financial status. Cars are expensive to purchase and operate but often provide the most reliable and flexible transportation to food sources, giving the owner more autonomy in their food choice and shopping experience. Public transportation is cheaper but in many cities is notoriously underfunded. Fares and other income only finance 36.3% of public transit, and national ridership fell by nearly 1 billion trips between 2014 and 2018, leaving a crumbling infrastructure that results in frustrated users who are unable to move freely and timely to places like grocery stores (Mallett, 2019). A cross-sectional study on collegiate students revealed that between 37% and 46% reported experiencing time constraints that affected their diet-related behaviors (Pelletier & Laska, 2012), showing it is easy to fall into time-saving food habits that can be detrimental to health, such as eating fast foods or largely shopping at convenience stores. Time also limits what transportation methods are viable to use in getting to a food source, compounding the need to participate in time-saving but unhealthy food habits.

Individuals will experience each factor and relationships between the factors in the conceptual model (Appendix A) in different ways and to varying degrees of severity. For example, for students who continue living with their family throughout college, the familial SES component may feel more proximal to food access and nutrition literacy than is illustrated in the conceptual model (Appendix A). However, the model is intended to generalize the experience of food access and nutrition literacy among college students enough to inform an intervention program that will improve both outcomes, which will then be continually informed and adjusted by target population and stakeholder feedback in an agile manner.

Areas for Intervention

This paper serves as a proposal for Project Feed the Future, an intervention program that aims to reduce the barriers to access to nutritious food at a structural level and simultaneously increase nutrition literacy in college student populations using educational programming. Working from the above conceptual framework, elements were developed with the location of food source, financial status, and educational status in mind. These factors were chosen because of their direct proximity to the two outcomes of interest. Structural changes will be made to reduce barriers around the location of food source and financial status, whereas targeted and interactive educational messaging will be used to increase efficacy and strengthen the relationship between educational status and nutrition literacy.

Project Feed the Future will be implemented exclusively on college campuses. Because of the immense self-regulating power that academic institutions possess, they are highly changeable environments, both physically and fiscally. Administrators are able to designate physical space and funds to the intervention. In addition, the campus environment promotes self-evaluation and learning. The combination of the structural and individual-level interventions will promote improvements in food access and nutrition literacy.

To ensure that the program is best serving the population of interest and to increase participation on campuses and change in both the structural environment and student population behaviors, a series of surveys and focus groups will be held on campuses before and throughout the implementation of the program. Surveys will roll out on the campuses via student emails before implementation and will assess students’ experiences and needs in food access and nutrition literacy. A sample of this survey can be found in Appendix B. Similar surveys will be conducted throughout the implementation of the program to follow up on perception of needs and wants for the program being met, as well as tracking statistics on the outcomes of interest. Overall, surveys will help inform the structural portion of Project Feed the Future. Focus groups will be used mainly during implementation to create space for dialoguing with the population to assess whether needs are being met in real time and to field requests for changes. The groups will be led by project managers at the college and will allow each individual institution to respond to its unique population. Because the educational portion of the program is targeted to the specific audience, the focus groups are best suited to inform, evaluate, and adjust the methods.

Intervention Strategy

Project Feed the Future is an intervention targeting barriers in food source location, financial status, and educational status to ultimately improve food access and nutrition literacy on college campuses.

Structural changes will include the construction of one or more adequate food sources on campus and the establishment of a universal grant for students that will be informed by the structure of the Supplemental Nutrition Assistance Program (SNAP). SNAP is a federally funded program that provides nutrition assistance to eligible individuals and households through monthly benefits on an Electronic Benefits Transfer (EBT) that is similar to a debit card (USDA, 2018). The food source(s) will be built within walking distance of academic buildings and on- and off-campus student residences. The goal of introducing the campus food source is to eliminate geographical barriers in food access. By strategically placing it near academic buildings and residences, the program strives to eliminate the need for students to divert time from their busy academic and work schedules to access adequate nutrition. The convenient location will also eliminate the barrier of transportation because institutions and students can use existing campus transportation such as free and reliable campus buses or the students could walk or bike to the food source.

Logistic factors of the campus food source will be planned based on stakeholder participation through surveys and community meetings at the initiation of the project. Administrative officials and students at the institution will work together, guided by Project Feed the Future project managers, to pick the location of the campus food source. The construction will be funded by the academic institution aided by alumni investments, university health system, and institutional corporate partners. Local grocers can bid to brand and operate the campus food source, with a stipulation of meeting the nutritional quality standards laid out by registered dietitians and supporting health and wellness consultants. Working with local grocers as opposed to large chains can help facilitate a community feeling through building partnerships. It will also aid in keeping the program agile by allowing for a direct pathway of communication and change between the college, students, and the grocer. Once built, hours of operation will be determined by students through surveys to ensure that time-based obstacles are completely removed (Appendix B).

In addition, a line item grant will be included in the financial aid package of every single student. This grant is a yearly food allowance which will be broken into a biweekly stipend, deposited onto the student’s identification card and redeemable only at the campus food source. By giving students a livable fund for food, Project Feed the Future intends to remove financial barriers to access. Students will no longer need to stretch their dollar in an already tight budget by relying on cheap, processed, calorie-dense, and nutrient-poor foods. By removing the stressors of financial constrictions tied to food habits, the campuses can expect to see an increase in consumption of nutrient-rich foods and freedom to engage in experiential learning with food habits and nutrition.

The amount of money allocated to each student per year for their food allowance will be standard across a college campus but could potentially differ between college campuses due to cost of living in the area and the need for grocers to maintain a profit to incentivize continual participation. For deriving the yearly allowance, schools will survey students on how much they spend on average per month on food and how that number would change if money was not an issue. Cost of living and the power of dollar in the region of the campus would also be considerations because although there is often a bubble effect on a college campus, campuses are deeply connected to the cities and states in which they reside in. In addition, continual qualitative and quantitative feedback will be collected from students on their spending habits at the campus food source to inform the yearly allowance amount, as this amount could be highly malleable for several years after the introduction of the program to a campus. To avoid participant burden, changes will be made in a timely manner, not to exceed more than two semesters after the data are collected. When distributing the biweekly deposits, it is crucial that they come in when students can conveniently use them and that they do not create a rush at the campus food source such that there is less access due to increased demand. To address these anticipated challenges, students will be asked for the days they currently shop and the days they would like to shop to inform a day of the week for benefit dispersion. The administration will use academic year to split the campus into alternate dispersion weeks. For example, for alternating A and B dispersion weeks, freshmen and juniors will be assigned A weeks and sophomores and seniors will be assigned B weeks. If this does not reduce the immediate demand and there are still access issues, the school can move to a model where dispersion is split by A and B weeks as well as days of the week. Administration will also work with the grocer to increase supply on and immediately after fund dispersion days.

The nutrition literacy outcome will be addressed through a targeted educational program centered on the belief in the importance of nutrition literacy and self-efficacy (Appendix A). Key components of the educational program are a campus-wide media campaign, live interactive demonstrations at campus food sources, and nutrition education–based events.

The campus-wide media campaign will utilize campus social media influencers on platforms such as Instagram, Snapchat, and Twitter. Continuation of platforms and incorporation of new ones will be informed by student responses. Campus social media influencers might include popular athletes, student government officials, and other prominent figures in the campus setting who already possess a large following. These individuals may differ extensively between campuses; therefore, the recruitment and specific messaging will be developed and evaluated on a campus-to-campus basis. This feature of the intervention draws on the peer education model that dietitians cite as being highly effective in postsecondary populations and in nutrition education programming (Dworatzek & Stier, 2016). The goal is to use relatable, yet inspirational figures to promote active learning about nutrition. Media posts will promote the use of the campus food source, share facts about the importance of good nutrition, and give tips and tricks to incorporate nutritional food habits into day-to-day routines. These posts will speak to the importance of nutrition and nutrition literacy while also providing easy solutions to build self-efficacy in improving nutrition literacy. Examples may include ideas for nutritious breakfasts on the go, meal prepping plans for exam week, or how to navigate the dining hall in search of healthy meals, with more ideas, from the surveys administered to students before the implementation of the program and continual feedback, added throughout the program. Posts will also meet students where they are at in the home setting, which is more convenient and comfortable for students. If the posts do not meet these goals as assessed by visibility surveys on social media platforms and random surveying of students at the campus food source as if they have used the ideas, the selection of influencers will be reexamined and tested with a new cohort. If that does not solve the problem, a focus group of stakeholders will develop a new method for outreach and nudging-style behavior modification.

Campus food sources will be built with education integrated throughout the store. The highlight will be demonstration kitchens that will give live tutorials on preparing healthy meals, give samples of the foods, and offer nutrition lessons that align with the live demonstration both verbally and through written materials. These demonstrations will occur periodically throughout the week and at various times during the day. The goals of these demonstrations and informal mini lessons are to establish the relationship between food access and nutrition literacy, bolster confidence in kitchen skills, and ignite creativity in shoppers. Following proper implementation of the proposed Project Feed the Future, structural issues such as transportation and financial barriers will be eliminated by introducing the campus food source(s). The next step is to bring nutrition literacy tools to where the students are. Using visual learning and the incentive of free food, the demonstration stations captivate audiences and encourage learning kitchen skills and the nutritional value of foods. Both skill sets can be transferred to various diets and are thus applicable for a diverse population. In addition to the visual and audio learning, the demonstration stations will employ written materials that students can refer back to when practicing these new skills. This support will help build confidence. The written materials will contain the recipe and accompanying shopping list for the dish being made at the station to immediately encourage use of the lessons and aid students as they expand their food comfort zone. The materials will always be supplemented with tips for reading and interpreting nutrition labels, as this is a key measure of nutrition literacy.

The final component of the nutrition literacy arm of Project Feed the Future is an extension of the demonstration station that allows groups of students to sign up to participate in a joint cooking lesson and nutrition crash course. These sessions could be booked by student organizations, friend groups, or even first year immersion programs and would be promoted by the social media campaign. The nutrition crash course will be taught by a registered dietitian and will first teach a foundation curriculum that cements the importance of nutrition and nutrition literacy followed by a lesson that reflects the wants and needs of the group that has signed up. In the cooking lessons, students will have the opportunity to grow their confidence in preparing healthy foods with hands-on practice. By bringing together the importance of nutrition and the confidence boosting execution of nutritious food habits, Project Feed the Future will increase the nutrition literacy on college campuses.

Conclusion

College students are at a malleable, transitional phase in their lives. They are emerging young adults who are in the process of learning skills for their future careers and habits that will shape and sustain their lives. Struggling with nutrition issues has been linked to lower grade point averages, an indication that failing to address this issue could jeopardize students’ futures (Maroto, Snelling, & Linck, 2015). Project Feed the Future aims to address the issues of food access and nutrition literacy in this population through both primary and tertiary preventive measures. College students face a unique set of socioeconomic barriers. Their housing is almost ubiquitously unaffordable by U.S. Census Bureau standards and typically places them farther away from adequate food sources. Students have very limited financial means, much of which is influenced by their immediate family’s SES. As a result, their food habits are constrained even further through efforts to stretch the dollar when purchasing food. Finally, even though this population will attain a higher level of education, they are transitioning from beliefs and self-efficacy around nutrition dictated by their familial SES into their own.

Academic institutions, students, alumni, corporate partners, and communities should support Project Feed the Future because of its potential for advancements in financial status, prestige, and sustainable community health. When students have access to healthy foods and high levels of nutrition literacy, they are better able to participate in the academic community. They stay enrolled in school, graduate with better job prospects, and attract new cohorts of students to the school. This means more funds flow into the school from tuition payments from current and new students. In addition, students who are healthier have a better foundation to perform well in school, which leads to increased job opportunities, lifetime incomes, and the potential for institutions to garner more alumni donations. For alumni who left before the implementation of Project Feed the Future, their degrees will still garner more prestige as the school grows, thus leading to more alumni support opportunities. Finally, by eliminating barriers to food access and bolstering nutrition literacy in the college years, Project Feed the Future is setting individuals up to live healthier lives, raise healthier families, and create healthier communities. Project Feed the Future will make college campuses attractive to prospective students and have impacts for generations to come.

References

• Centers for Disease Control and Prevention. (2015). Dietary guidelines for Americans 2015–2020 (8th ed.). Atlanta, GA: Author.
• College Board. (2019). Trends in College Pricing. New York, NY: Author.
• Dworatzek, P. D. N., & Stier, J. (2016). Dietitians’ attitudes and beliefs regarding peer education in nutrition. Canadian Journal of Dietetic Practice and Research, 77(4), 170–176. https://doi.org/10.3148/cjdpr-2016-009
• Gibbs, H. D. (2012). Nutrition literacy: Foundations and development of an instrument for assessment. Champaign: University of Illinois at Urbana-Champaign.
• Mallett, W. J. (2019). Federal public transportation program: In brief. Retrieved from https://fas.org/sgp/crs/misc/R42706.pdf
• Maroto, M. E., Snelling, A., & Linck, H. (2015). Food insecurity among community college students: Prevalence and association with grade point average. Community College Journal of Research and Practice, 39, 515–526. https://doi.org/10.1080/10668926.2013.850758
• McDonald’s. (2018). McDonald’s nutrition calculator. Retrieved from https://www.mcdonalds.com/us/en-us/about-our-food/nutrition-calculator.html
• Pelletier, J. E., & Laska, M. N. (2012). Balancing healthy meals and busy lives: Associations between work, school, and family responsibilities and perceived time constraints among young adults. Journal of Nutrition Education and Behavior, 44, 481–489. https://doi.org/10.1016/j.jneb.2012.04.001
• Schwartz, M., & Willson, E. (2007). Who can afford to live in a home?: A look at data from the 2006 American Community Survey. Retrieved from https://paa2008.princeton.edu/abstracts/81324
• Theuri, S., & Garner, R. (2016). Food insecurity: Patterns, prevalence and risk factors. Hauppauge, NY: Nova Science Publishers.
• United States Department of Agriculture. (2018). Supplemental nutrition assistance program. Washington, DC: Author.
• United States Department of Agriculture. (2019). Food access. Retrieved from http://www.ers.usda.gov/topics/food-choices-health/food-access.aspx
• U.S. Government Accountability Office. (2018). Food insecurity: Better information could help eligible college students access federal food assistance benefits (GAO-19-95). Washington, DC: Author.
• Wilson, E., & Callis, R. R. (2013). Affordability of families and unrelated individuals for a modestly priced home.

Appendix A

Appendix B