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Dey P, De Souza-Kenney L. Public Health Challenges for Post-secondary Students During COVID-19: A Scoping Review. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241257561. [PMID: 38821889 DOI: 10.1177/2752535x241257561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Research about public health impacts of COVID-19 on post-secondary students is slowly beginning to emerge. This scoping review identified common public health challenges among post-secondary students in higher-income countries during the COVID-19 pandemic. Five databases were searched to find relevant peer-reviewed literature up to March 2022. Results were categorized according to reported public health challenges and relevant socio-economic variables. After screening, 53 articles were reviewed. Most articles were from the USA (39/53). The seven main public health challenges identified were mental health (35/53), financial instability (25/53), physical health (13/53), food insecurity (12/53), social well-being (8/53), digital access (7/53), and housing or relocation (6/53). Students with low socioeconomic status experienced heightened public health challenges. This review offers insight and opportunities for the development of longitudinal tools to support social determinants of health in post-secondary populations in high-income countries and may offer insight into similar experiences for students in other settings.
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Affiliation(s)
- Pooja Dey
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Leanne De Souza-Kenney
- University College, University of Toronto, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social Work, Institute for Life Course and Aging, University of Toronto,Toronto, ON, Canada
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2
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Round EK, Weatherston S, Stretesky PB, Defeyter MA. Predicting food insecurity among UK university students during the COVID-19 pandemic. Public Health Nutr 2024; 27:e126. [PMID: 38698611 DOI: 10.1017/s1368980024001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVE The present study investigated potential predictors of food insecurity among UK university students during the COVID-19 pandemic. DESIGN Close-ended questionnaire administered to a cross-sectional sample of UK university students. SETTING Data were collected using an online survey platform in October 2020, during the COVID-19 pandemic. PARTICIPANTS A nationally representative sample of UK university students (n 640). RESULTS Odds ratios (OR) obtained from logistic regression were statistically significant for three measures of economic hardship. First, students who relied on financial aid from student loans were 1·9 times more likely to report being food insecure than students who did not rely on financial aid from student loans. Second, students who could not pay their utility bill (v. those that could pay) were 3·1 times the odds of being food insecure. Finally, as perceived difficulty in paying for accommodation increased across the sample, the odds of being food insecure also increased (OR = 1·9). We also found that students who were recently ill were 2·2 times more likely to be food insecure compared with students who were not recently ill. We did not find any evidence that testing positive for COVID-19 predicted food insecurity, and university supplied food parcels/boxes did not reduce student food insecurity. CONCLUSIONS Both economic factors and illness play a significant role in self-reported food insecurity in higher education students during pandemic lockdown. Further research is needed to explore food insecurity, economic factors and illness outside of a pandemic context.
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Affiliation(s)
- Emily K Round
- Healthy Living Lab, Faculty of Health & Life Sciences, Northumbria University, Newcastle-Upon-TyneNE1 8ST, UK
| | - Sarah Weatherston
- Healthy Living Lab, Faculty of Health & Life Sciences, Northumbria University, Newcastle-Upon-TyneNE1 8ST, UK
| | - Paul B Stretesky
- School of Social and Political Science, University of Lincoln, Brayford Pool, LincolnLN6 7TS, UK
| | - Margaret Anne Defeyter
- Healthy Living Lab, Faculty of Health & Life Sciences, Northumbria University, Newcastle-Upon-TyneNE1 8ST, UK
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Pacenta J, Starkoff BE, Lenz EK, Shearer A. Prevalence of and Contributors to Food Insecurity among College Athletes: A Scoping Review. Nutrients 2024; 16:1346. [PMID: 38732593 PMCID: PMC11085294 DOI: 10.3390/nu16091346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/27/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Given the financial demands of attending college, the transition to new living situations, abrupt changes in social support, and overall lifestyle adjustments, college students are at an increased risk of food insecurity (FI) compared to the general population. Collegiate athletes experience an even greater risk of FI as a result of greater time commitments and energy demands associated with their sports. This heightened vulnerability poses a tremendous threat to student-athletes' academic and athletic achievements. This study aims to address the prevalence and primary determinants of FI among collegiate athletes while providing potential solutions to navigate and alleviate the effects of diminished food security among this demographic. To address these aims, a total of 18 articles were selected from both peer-reviewed and gray literature. The U.S. Household Food Security Survey Module (US-HFSSM) survey tools were predominantly utilized across universities throughout the United States to gather data on FI. Student-athletes reported experiencing FI across various regions of the United States, including universities in the northeastern states (n = 5), the southwest region (n = 3), the southeast region (n = 3), the northwest (n = 1), and the Midwest (n = 1). Overall, FI prevalence rates ranged from 9.9% to 65%, and the most significant contributors included limited financial resources, time management, meal plans, and housing location/amenities. These findings highlight a need for screening, education, and interventions to address FI among collegiate athletes.
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Affiliation(s)
- Jamie Pacenta
- The Ohio State University, School of Health and Rehabilitation Sciences, Columbus, OH 43210, USA
| | - Brooke E. Starkoff
- The Ohio State University, School of Health and Rehabilitation Sciences, Columbus, OH 43210, USA
| | - Elizabeth K. Lenz
- SUNY Brockport, Department of Kinesiology, Sport Studies, and Physical Education, Brockport, NY 14420, USA; (E.K.L.)
| | - Amanda Shearer
- SUNY Brockport, Department of Kinesiology, Sport Studies, and Physical Education, Brockport, NY 14420, USA; (E.K.L.)
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Dinour LM, Alsaidi M, Snyder C. Qualitative assessment of changes to university students' dietary intake by food security status in the context of COVID-19. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-15. [PMID: 38442358 DOI: 10.1080/07448481.2024.2319195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To explore how university students' dietary intakes changed during COVID-19, and whether these changes differed by food security status. PARTICIPANTS Six hundred students attending a New Jersey public university. METHODS A cross-sectional online survey asked about student intake. Food security status was measured using the 18-item US Household Food Security Survey. Open-ended questions were content analyzed and themes were compared between food secure (FS) and food insecure (FI) students. RESULTS The most frequently reported dietary changes for FI students were food source/sourcing (22.7%), food variety (19.7%), and food/meal properties (19.7%). For FS students, themes differed: no change (31.5%), food source/sourcing (31.3%), and health/nutrition (13.7%). CONCLUSIONS Students indicated dietary changes during the pandemic regardless of food security status, although FI students more frequently reported smaller, less healthy, and less varied meals. Colleges and universities can provide support through enhanced outreach and assistance during emergencies or extended periods of disruption.
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Affiliation(s)
- Lauren M Dinour
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ, USA
| | - Manar Alsaidi
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ, USA
| | - Christopher Snyder
- PSEG Institute for Sustainability Studies, Montclair State University, Montclair, NJ, USA
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Aldubaybi AA, Coneyworth LJ, Jethwa PH. Assessing the prevalence and potential drivers of food insecurity and the relationship with mental wellbeing in UK university students: A cross-sectional study. NUTR BULL 2024; 49:96-107. [PMID: 38311588 DOI: 10.1111/nbu.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
Food insecurity (FI) among university students in the United States has been associated with poor mental wellbeing, but very little is known about the relationship between FI and mental wellbeing in the UK university population. Here we examined the prevalence of FI, determined potential drivers for it and its relationship with mental wellbeing and coping ability. Students studying at UK universities (n = 289) completed an online self-reported questionnaire to obtain socio-economic characteristics including financial status, FI status (Household Food Insecurity Access scale), mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale) and coping ability (coping flexibility scale). FI was observed in 28% of the participants and was associated with financial independence, running out of money, borrowing money and lacking confidence to purchase healthy foods (p < 0.05). Although we cannot determine directionality, logistic regression analysis revealed those who were judged as FI were more likely to shop often (OR = 3.139 95% CI 1.533-6.429), never snacked between meals (OR = 4.261 95% CI 1.309-13.875) and the amount of food purchased was affected by perceptions of the price of food in general (OR = 2.954 95% CI 1.675-5.210). Financial instability and the inability to access nutritious food may contribute to the decrease in mental wellbeing (p < 0.01) and lower ability to cope with stressful situations (p < 0.01) in food-insecure students although the direction of these relationships cannot be determined from this cross-sectional study. This study has identified that there is a need to develop appropriate strategies to combat FI in university students and to improve mental health.
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Affiliation(s)
- Afnan A Aldubaybi
- Divisions of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, UK
| | - Lisa J Coneyworth
- Divisions of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, UK
| | - Preeti H Jethwa
- Divisions of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Loughborough, UK
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Radtke MD, Steinberg FM, Scherr RE. Methods for Assessing Health Outcomes Associated with Food Insecurity in the United States College Student Population: A Narrative Review. Adv Nutr 2024; 15:100131. [PMID: 37865221 PMCID: PMC10831897 DOI: 10.1016/j.advnut.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
In the United States, college students experience disproportionate food insecurity (FI) rates compared to the national prevalence. The experience of acute and chronic FI has been associated with negative physical and mental health outcomes in this population. This narrative review aims to summarize the current methodologies for assessing health outcomes associated with the experience of FI in college students in the United States. To date, assessing the health outcomes of FI has predominately consisted of subjective assessments, such as self-reported measures of dietary intake, perceived health status, stress, depression, anxiety, and sleep behaviors. This review, along with the emergence of FI as an international public health concern, establishes the need for novel, innovative, and objective biomarkers to evaluate the short- and long-term impacts of FI on physical and mental health outcomes in college students. The inclusion of objective biomarkers will further elucidate the relationship between FI and a multitude of health outcomes to better inform strategies for reducing the pervasiveness of FI in the United States college student population.
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Affiliation(s)
- Marcela D Radtke
- Propel Postdoctoral Fellow, Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Palo Alto, CA, USA 94305
| | | | - Rachel E Scherr
- Family, Interiors, Nutrition & Apparel Department, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, USA, 94132; Scherr Nutrition Science Consulting, San Francisco, CA, 94115.
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Mitchell AI, Prescott MP. Evaluating a Campus Food Pantry's Potential Impact on Nutrition Security using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Curr Dev Nutr 2023; 7:101984. [PMID: 37662700 PMCID: PMC10469059 DOI: 10.1016/j.cdnut.2023.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Background Campus food pantries are uniquely positioned to promote health equity with the foods they make accessible to food-insecure students. Objectives This study assessed the implementation and effectiveness of a client-choice campus food pantry to understand its potential impact on nutrition security and to inform future implementation. Methods This observational study was designed using the reach, effectiveness, adoption, implementation, and maintenance framework, leveraging administrative data collected from a client-choice campus food pantry at a large Midwest university from August 2020 to May 2022. Pantry staff tracked student usage and item inventory. Items were analyzed for specific nutrients using the Nutrition Data System for Research. The mean nutrients and servings per food group distributed per visit were calculated and compared with dietary recommendations (effectiveness). Characteristics of pantry operation and setup were detailed (adoption). The percentage of openings with adequate stock to meet distribution guidelines was determined (implementation). Descriptive statistics were calculated, and multiple linear regressions determined whether significant changes in nutrients and food were distributed based on distribution guidelines and stock available. Results Effectiveness: Vitamin D, fruits, vegetables, and whole grains were below 3 d of the recommended intake for all students, and energy, fiber, potassium, vitamin A, and grains were low for male students. Adoption: The pantry was established through a collaboration with a pre-existing community food pantry and operates as a 501(c) and is managed by campus recreation staff. Implementation: The pantry supplied enough produce for 72% of openings to meet distribution guidelines and enough dairy for 63% of openings. Conclusions The food and nutrients distributed in limited amounts are consistent with those underconsumed according to the Dietary Guidelines for Americans. More research is needed to understand how pantry implementation can best support nutrition security through the adequate distribution of key nutrients and food groups.
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Affiliation(s)
- Ana I. Mitchell
- Division of Nutritional Sciences, University of Illinois at Urbana, Champaign, IL, United States
| | - Melissa P. Prescott
- Division of Nutritional Sciences and Food Science and Human Nutrition, University of Illinois at Urbana, Champaign, IL, United States
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Assoumou B, Pharr J, Coughenour C. Food insecurity and risky sexual behaviors among college students during the COVID-19 pandemic. BMC Public Health 2023; 23:1552. [PMID: 37582703 PMCID: PMC10428526 DOI: 10.1186/s12889-023-16330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the early-stages of the COVID-19 pandemic. METHODS This was a cross-sectional study from a convenience sample of 320 students enrolled at the University of Nevada, Las Vegas during the 2020 Fall semester. Data was collected using an online survey. Univariate and multivariate logistic regression analyses were conducted. RESULTS Food insecure students were 2.9 times more likely to report receiving or giving fellatio without using a condom at least once in the past 6 months (P < 0.01) compared to food secure students. There was no significant association between food insecurity and other RSBs evaluated in this study. CONCLUSIONS The current study provides valuable information on food insecurity and RSB among college students during the early stages of the COVID-19 pandemic. Larger and longitudinal studies are needed to assess the trajectory of the association between food insecurity and fellatio with no condom use and other RSB among college students.
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Affiliation(s)
- Bertille Assoumou
- School of Public Health, University of Nevada, 4700 S. Maryland Parkway Suite # 335, Las Vegas, NV, 89119, USA.
| | - Jennifer Pharr
- School of Public Health, University of Nevada, 4700 S. Maryland Parkway Suite # 335, Las Vegas, NV, 89119, USA
| | - Courtney Coughenour
- School of Public Health, University of Nevada, 4700 S. Maryland Parkway Suite # 335, Las Vegas, NV, 89119, USA
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Dana LM, Wright J, Ward R, Dantas JAR, Dhaliwal SS, Lawrence B, O'Connor M, Booth S, Kerr DA, Pollard CM. Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020. Nutrients 2023; 15:nu15112431. [PMID: 37299396 DOI: 10.3390/nu15112431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.
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Affiliation(s)
- Liyuwork Mitiku Dana
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
| | - Janine Wright
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
| | - Rebecca Ward
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
| | - Jaya A R Dantas
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
| | - Satvinder S Dhaliwal
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Duke-NUS Medical School, National University of Singapore, College Road, Singapore 169857, Singapore
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Jalan Inovasi, George Town 11800 USM, Malaysia
- Office of the Provost, Singapore University of Social Sciences, 463 Clementi Rd, Singapore 599494, Singapore
| | - Blake Lawrence
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
| | - Moira O'Connor
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Enable Institute, Curtin University, Bentley, WA 6102, Australia
| | - Sue Booth
- College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, Adelaide, SA 5042, Australia
| | - Deborah A Kerr
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Christina M Pollard
- School of Population Health, Faculty of Health Science, Curtin University, Bentley, WA 6102, Australia
- Enable Institute, Curtin University, Bentley, WA 6102, Australia
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Loofbourrow BM, Scherr RE. Food Insecurity in Higher Education: A Contemporary Review of Impacts and Explorations of Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105884. [PMID: 37239614 DOI: 10.3390/ijerph20105884] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Food insecurity is a global phenomenon which impacts a variety of social, economic, and life-stage groups. One such group affected by food insecurity is college students, who tend to experience food insecurity at a prevalence which exceeds the average of their local communities. The impacts of food insecurity in this population are multifaceted and have implications for their college experience and beyond. Food insecurity has been observed to have negative effects on college student academic performance, physical health, and mental health. This review explores the impacts of and solutions for food insecurity in this population globally, with particular emphasis on the United States, and specifically California.
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Affiliation(s)
| | - Rachel E Scherr
- Family, Interiors, Nutrition and Apparel, San Francisco State University, San Francisco, CA 94132, USA
- Scherr Nutrition Science Consulting, San Francisco, CA 94115, USA
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Sumsion RM, June HM, Cope MR. Measuring Food Insecurity: The Problem with Semantics. Foods 2023; 12:foods12091816. [PMID: 37174353 PMCID: PMC10178861 DOI: 10.3390/foods12091816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Rising rates of hunger and food insecurity have sparked a major re-evaluation of all aspects of food systems. Because of the multifaceted nature of food insecurity, however, determining what actions should be taken is challenging, especially since reevaluation efforts are led by experts from several disciplines and there is no consensus about which indicators should be used and how they should be measured. Confusion surrounding the meaning of the terms 'food security' and 'food insecurity' has contributed to this lack of consensus. As indicators inform action, such confusion has slowed those committed to alleviating hunger in identifying the most pressing targets. This review highlights (1) the importance of clearly defining food security and food insecurity and (2) how such definitions affect measures of food insecurity in the United States. While some might say that definitions are an issue of the past or a trivial matter of semantics, we believe that the world's present rates of hunger and malnutrition are attributable, at least in part, to the lack of consensus on these definitions and their accompanying measurements and indicators. Although the present review can be helpful to academics and policy makers, the primary purpose is to be a resource to those involved in the day-to-day production of food, such as ranchers and farmers by providing an overview of definitions, indicators, and measurements used when discussing food security.
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Affiliation(s)
- Rachel M Sumsion
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA
| | - Haylie M June
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA
| | - Michael R Cope
- Department of Sociology, Brigham Young University, Provo, UT 84602, USA
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12
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Tripathy K, Bhasin R, McKinzie R, Sackett A, Storrs ME, Janda KM. Food insecurity disparities and impact on academic and social experiences among college students at a large public university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 36996426 PMCID: PMC10544684 DOI: 10.1080/07448481.2023.2194435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/18/2023] [Accepted: 03/14/2023] [Indexed: 05/24/2023]
Abstract
Objective: This research seeks to understand food insecurity experiences among students at a large public university in the southern United States. Participants: Participants consented and completed an online survey disseminated on campus in April-May 2021 (N = 418). The participants sampled were predominantly undergraduate (78.2%), females (72.4%), who lived off campus (54.1%), and were racially/ethnically diverse. Methods: Descriptive statistics, multivariable logistic regression, and chi-squared tests were used to examine the differences and association between demographic characteristics and behaviors and food insecurity status. Results: About 32% students surveyed had experienced food insecurity in the last year, which resembles national trends. There were significant differences in students' food insecurity status by race, sexual orientation, first-generation status, residential category, and main mode of transportation. Food insecurity impacted academic and socioeconomic student behaviors. Conclusions: This research has implications for improving the academic, physical, and psychological wellbeing of university students and should inform future programs and policies.
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Affiliation(s)
- Krisha Tripathy
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Ria Bhasin
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Riley McKinzie
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Abigail Sackett
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Martha-Ellen Storrs
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Kathryn M. Janda
- Baylor University, Robbins College of Health and Human Sciences, Department of Public Health, Waco, Texas, USA
- UTHealth Science Center School of Public Health – Austin Campus, Austin, Texas, USA
- Michael and Susan Dell Center for Healthy Living, Austin, Texas, USA
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13
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Loofbourrow BM, Jones AM, Martinez SM, Kemp LC, George GL, Scherr RE. Understanding the Role of CalFresh Participation and Food Insecurity on Academic Outcomes among College Students during the COVID-19 Pandemic. Nutrients 2023; 15:nu15040898. [PMID: 36839256 PMCID: PMC9964191 DOI: 10.3390/nu15040898] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Food insecurity (FI) is associated with many adverse outcomes in college students. The Supplemental Nutrition Assistance Program (SNAP, known as CalFresh in California) has been observed to alleviate FI; however, on college campuses, the benefits of food assistance programs are not well understood. This study investigated whether college students benefit from CalFresh participation. It was hypothesized that students would experience increased FI over time and that CalFresh participation would moderate the effect of FI on grade point average (GPA). A comprehensive FI and CalFresh questionnaires were distributed during the 2020-2021 academic year to 849 students. The chi-square test of independence assessed differences between FI and student factors. A Friedman test assessed differences in FI during the three quarters. Moderation analysis assessed whether CalFresh participation moderated FI's effect on GPA. Differences were observed among food security scores in Winter 2021 (median = 1.69) and Fall 2020 (median = 2.14; p = 0.013) and Spring 2020 (median = 2.17; p = 0.009). In the moderation model, the interaction of FI score and CalFresh participation was positively correlated with GPA (B = 0.11; p = 0.002). These results indicate that SNAP/CalFresh participation was particularly beneficial for mitigating the negative effects of FI on GPA. Given these benefits, encouraging SNAP/CalFresh enrollment should be a priority for university administrators.
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Affiliation(s)
- Brittany M. Loofbourrow
- Department of Nutrition, University of California, Davis 1 Shields Ave, Davis, CA 95616, USA
| | - Anna M. Jones
- CalFresh Healthy Living, University of California, 1632 DaVinci Court #31, Davis, CA 95618, USA
| | - Suzanna M. Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco 550 16th St, San Francisco, CA 94158, USA
| | - Leslie C. Kemp
- Aggie Compass Basic Needs Center, University of California, Davis 1 Shields Ave, Davis, CA 95616, USA
| | - Gretchen L. George
- Family, Interiors, Nutrition & Apparel, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA
| | - Rachel E. Scherr
- Family, Interiors, Nutrition & Apparel, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA
- Scherr Nutrition Science Consulting, San Francisco, CA 94115, USA
- Correspondence: ; Tel.: +1-818-519-3245
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14
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Bauch C, Torheim LE, Almendingen K, Molin M, Terragni L. Food Habits and Forms of Food Insecurity among International University Students in Oslo: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2694. [PMID: 36768058 PMCID: PMC9915265 DOI: 10.3390/ijerph20032694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
A growing number of studies indicate that university students and especially international students are prone to experiencing food insecurity (FI). Still, few studies have investigated forms of FI among international students in Europe. Thus, this qualitative study aims to explore experiences regarding FI among international university students in Oslo. Sixteen semi-structured interviews were conducted between May and June 2022 and analyzed using a thematic approach. The sustainable livelihood approach (SLA) was used as a framework for analyzing and interpreting the data. The students experienced food prices as being high and found food variety at the grocery stores to be low, resulting in struggles to fulfil their food preferences and keep a varied diet. Particularly, social aspects of eating were affected due to high dining prices or inadequate cooking facilities in student homes. However, no student openly reported skipping meals and many mentioned attention for healthy eating. Considering our results, it seems of importance to give more attention to cultural and social aspects related to FI when assessing FI among international students. As the number of international students is increasing, knowing more about this phenomenon can support the promotion of initiatives addressing FI in this population.
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Affiliation(s)
- Charlotte Bauch
- Faculty of Oecotrophology, University of Applied Sciences Fulda, 36037 Fulda, Germany
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), 0130 Oslo, Norway
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), 0130 Oslo, Norway
| | - Marianne Molin
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), 0130 Oslo, Norway
- Faculty of Health Sciences, Kristiania University College, 0153 Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), 0130 Oslo, Norway
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15
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Food Insecurity among a Cohort of Division I Student-Athletes. Nutrients 2022; 14:nu14214703. [PMID: 36364965 PMCID: PMC9655568 DOI: 10.3390/nu14214703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Though the vulnerability of college students to food insecurity is well established, there is a paucity of studies focusing on the prevalence of food insecurity among student-athletes. Methods: A cross-sectional survey was conducted with collegiate athletes in the northwestern United States via an anonymous online survey. Food security status was assessed using the 10-item US Department of Agriculture Adult Food Security Survey. Results: Participating athletes (45/307, 14%) were primarily White, non-Hispanic (78%) females (73%) who lived and consumed meals off-campus (62% and 69%, respectively). Food insecurity was more prevalent among collegiate athletes than the general university population, 60% vs. 42%, respectively. Being a track or football athlete significantly predicted food security status (p = 0.002, p < 0.001, respectively). The risk for food insecurity was higher among collegiate football players (effect size, η2 = 0.86) compared with track athletes (effect size, η2 = 0.40). Conclusion: A statistically significant risk for food insecurity emerged among members of the football team. Factors contributing to disparate rates of food insecurity among college populations were explored and unique considerations for collegiate athletes discussed.
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16
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ElTohamy A, Wang JJ, Chen JA, Stevens C, Liu CH. Association Between College Course Delivery Model and Rates of Psychological Distress During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2244270. [PMID: 36449292 PMCID: PMC9713601 DOI: 10.1001/jamanetworkopen.2022.44270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE College students in the US have been heavily affected by the COVID-19 pandemic. In addition to increased rates of depression and anxiety, college students have faced unprecedented stressors, such as geographic relocation and abrupt conversion from in-person classes to online classes. OBJECTIVE To study the association between course delivery model and psychological distress among US college students. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used national data from the American College Health Association-National College Health Assessment III data set. Data were gathered from a web-based survey administered from January to early June 2021 to full-time US college students attending 4-year programs. EXPOSURE Course delivery model was self-reported. MAIN OUTCOMES AND MEASURES Psychological distress was measured using the Kessler Screening Scale for Psychological Distress. RESULTS This study evaluated 59 250 full-time undergraduate students (68.1% women; 51.5% White students; mean [SD] age, 21.2 [4.3] years); 3.5% attended fully in-person classes, 61.2% attended fully online classes, and 35.3% attended a mixed format of in-person and online classes. Students who attended classes fully online reported higher levels of psychological distress than those who attended a mix of online and in-person classes (b = 0.76 [99% CI, 0.64-0.88]; P < .001). This association remained significant after controlling for geographic region, year in school, gender, race and ethnicity, food security, current anxiety and/or depressive disorders, COVID-19 concerns, and residence (living on campus, off campus with family, or other off-campus arrangements) (b = 0.18 [99% CI, 0.04-0.31]; P = .001), as well as time spent socializing with friends (b = 0.13 [99% CI, 0.002-0.26]; P = .009). CONCLUSIONS AND RELEVANCE The findings of this study suggest that mental health professionals may wish to consider the association of course delivery models with mental health outcomes when working with college students. Colleges should be aware of the mental health burden associated with attending fully online classes and consider possible in-person components and supports for students.
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Affiliation(s)
- Abdelrahman ElTohamy
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Justin A. Chen
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Courtney Stevens
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Psychology, Willamette University, Salem, Oregon
| | - Cindy H. Liu
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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17
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Mitchell A, Ellison B, Bruening M. Persistent and Episodic Food Insecurity and Associated Coping Strategies Among College Students. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:972-981. [PMID: 36184354 DOI: 10.1016/j.jneb.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the rates of episodic and persistent food insecurity among college students and whether coping strategies employed differs on the basis of food security status. DESIGN Online cross-sectional survey administered in March 2021. SETTING A large Midwestern university. PARTICIPANTS A random sample of students (n = 5,000) were invited to participate via email with a response rate of 20% (n = 888). MAIN OUTCOME MEASURES Food insecurity was assessed using the 10-item US Department of Agriculture Adult Food Security Survey Module. Food acquisition and management coping strategies were measured using modified questionnaires. ANALYSIS Pearson's chi-squared tests, 1-way ANOVAs, and post hoc analyses were conducted to examine associations of sociodemographic factors and coping strategies with food security status. Linear regression models were used to estimate the association between the coping strategies scale and subscales with food insecurity status. RESULTS The food insecurity rate was 22%, with 11% and 10% of students experiencing episodic and persistent food insecurity, respectively. Coping strategies varied significantly by food security status (P < 0.001), with students facing persistent food insecurity employing coping strategies most frequently. CONCLUSIONS AND IMPLICATIONS Future research is needed to better understand the persistent nature of food insecurity and coping strategies to develop tailored policies and programs for the college student population.
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Affiliation(s)
- Ana Mitchell
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL.
| | - Brenna Ellison
- Agricultural Economics, Purdue University, West Lafayette, IN
| | - Meg Bruening
- College of Health Solutions, Arizona State University, Phoenix, AZ
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18
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Mihrshahi S, Dharmayani PNA, Amin J, Bhatti A, Chau JY, Ronto R, Turnip D, Taylor M. Higher Prevalence of Food Insecurity and Psychological Distress among International University Students during the COVID-19 Pandemic: An Australian Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114101. [PMID: 36360979 PMCID: PMC9658209 DOI: 10.3390/ijerph192114101] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic and related disruptions have not only affected university students' learning and academic outcomes, but also other issues, such as food security status, mental health and employment. In Australia, international students faced additional pressures due to sudden border closures and lack of eligibility for government-provided financial support. This study explored the experiences of domestic and international university students residing in Australia during the early stages of the COVID-19 pandemic across a range of outcomes. A cross-sectional online survey was conducted between July and September 2020 at Macquarie University in Sydney, Australia. The online survey included food insecurity status, mental health (psychological distress), disruptions to study, employment and sleep. A total of 105 students (n = 66 domestic and n = 39 international) completed the survey. Respondents reported having food insecurity (41.9%) and psychological distress (52.2%, with high and very high levels), with international students reporting significantly higher food insecurity (OR = 9.86 (95% CI 3.9-24.8), p < 0.001) and psychological distress scores (t(90) = 2.68, 95% CI: 1.30 to 8.81, p = 0.009) than domestic students. About one quarter of all respondents reported disruptions to study and employment status around the time of the survey. When asked what government support should be provided for international students, 'financial aid' was the most frequently suggested form of support. This research may help governments and educational institutions design appropriate support, particularly financial and psychological, for both international and domestic university students.
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Affiliation(s)
- Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
- Correspondence:
| | - Putu Novi Arfirsta Dharmayani
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Janaki Amin
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Alexandra Bhatti
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Josephine Y. Chau
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Rimante Ronto
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Diana Turnip
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Melanie Taylor
- School of Psychological Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
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19
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Matthews CR, Rodriguez AX, Kabiri LS, Perkins-Ball AM, Perkins HY, Diep CS. Dietary behaviors and food insecurity among Houston college students during the COVID-19 pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-7. [PMID: 36170520 DOI: 10.1080/07448481.2022.2122722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Objective: This study assessed the impact of the COVID-19 pandemic on college students' nutrition, including dietary behaviors and food security status. Participants: Participants included 140 students between 18 and 25 years of age, who were enrolled in a college or university in the greater Houston area. Methods: Analyses included descriptive statistics, t tests, and ANOVAs to analyze differences in dietary behaviors by demographic variables, and chi-square tests to assess characteristics associated with food security status. Results: The majority of participants reported changing their diets due to the COVID-19 pandemic. There were no significant differences by demographics. However, there were significant differences in food security status by race/ethnicity and social class. Conclusion: This study identified changes and disparities in college students' dietary behaviors and food security status during the COVID-19 pandemic. Findings help inform future policy, programs, and research to address college students' nutrition during the ongoing COVID-19 pandemic.
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Affiliation(s)
| | | | - Laura S Kabiri
- Kinesiology Department, Rice University, Houston, Texas, USA
| | | | - Heidi Y Perkins
- Kinesiology Department, Rice University, Houston, Texas, USA
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20
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Kent K, Visentin D, Peterson C, Ayre I, Elliott C, Primo C, Murray S. Severity of Food Insecurity among Australian University Students, Professional and Academic Staff. Nutrients 2022; 14:nu14193956. [PMID: 36235608 PMCID: PMC9571391 DOI: 10.3390/nu14193956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Assessments of the severity of food insecurity within Australian university students are lacking, and the experience of food insecurity in Australian university staff is unknown. A cross-sectional online survey in March 2022 aimed to characterize the severity of food insecurity in students, professional and academic staff at the University of Tasmania (UTAS). The Household Food Security Survey Module six-item short form assessed food security status in addition to seven demographic and education characteristics for students and six demographic and employment characteristics for staff. Participants were categorized as having high, marginal, low, or very low food security. Multivariate binary logistic regression identified students and staff at higher risk of food insecurity. Among student respondents (n = 1257), the prevalence of food insecurity was 41.9% comprising 8.2% marginal, 16.5% low, and 17.3% very low food security. Younger, non-binary, first-year enrolled, on campus, and international students were at significantly higher risk of food insecurity. Among staff (n = 560), 16.3% were food insecure comprising 3.8% marginal, 5.5% low, and 7.0% very low food security. Professional staff, staff on casual contracts, and staff recently employed, were at significantly higher risk of food insecurity. Our findings suggest a high occurrence of food insecurity in UTAS students and staff, with a large proportion of food insecure staff and students experiencing very low food security. Our findings have implications for efforts towards reducing food insecurity at university campuses through a holistic and integrated approach, advocating for food systems that support healthy, sustainable, and equitable food procurement and provision for both university students and staff.
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Affiliation(s)
- Katherine Kent
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
- Correspondence: (K.K.); (S.M.)
| | - Denis Visentin
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Corey Peterson
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Ian Ayre
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Catherine Elliott
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Carmen Primo
- Sustainability Unit, University of Tasmania, Launceston, TAS 7250, Australia
| | - Sandra Murray
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751, Australia
- Correspondence: (K.K.); (S.M.)
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21
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Hussain BM, Ryan R, Deierlein AL, Lal S, Bihuniak JD, Parekh N. Food Insecurity and Health Behaviors Among a Sample of Undergraduate Students at an Urban University. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2119119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Bridget Murphy Hussain
- Public Health Nutrition, School of Global Public Health, New York University, New York, NY, USA
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA
| | - Rachel Ryan
- Department of Nutrition and Food Studies, New York University Steinhardt, New York, NY, USA
| | - Andrea L. Deierlein
- Public Health Nutrition, School of Global Public Health, New York University, New York, NY, USA
- Department of Population Health at New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
| | - Supriya Lal
- Public Health Nutrition, School of Global Public Health, New York University, New York, NY, USA
| | - Jessica D. Bihuniak
- Department of Nutrition and Food Studies, New York University Steinhardt, New York, NY, USA
| | - Niyati Parekh
- Public Health Nutrition, School of Global Public Health, New York University, New York, NY, USA
- Department of Population Health at New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA
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22
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Camacho-Rivera M, Islam JY, Rodriguez DR, Vidot DC, Bailey Z. Food Insecurity Disparities and Mental Health Impacts Among Cancer Survivors During the COVID-19 Pandemic. Health Equity 2022; 6:729-737. [PMID: 36225657 PMCID: PMC9536346 DOI: 10.1089/heq.2021.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Methods: Results: Conclusion:
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- Address correspondence to: Marlene Camacho-Rivera, ScD, MPH, Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
| | - Jessica Yasmine Islam
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, UNC Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diane R. Rodriguez
- Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
| | - Denise C. Vidot
- Sylvester Comprehensive Cancer Center, School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
| | - Zinzi Bailey
- Sylvester Comprehensive Cancer Center, School of Nursing and Health Studies, University of Miami, Miami, Florida, USA
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23
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Effect of COVID-19 outbreak on the diet, body weight and food security status of students of higher education: a systematic review. Br J Nutr 2022; 129:1916-1928. [PMID: 35946073 DOI: 10.1017/s0007114522002604] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has impacted college students' lifestyles and placed them at a greater risk of obesity and food insecurity. The purpose of the systematic review was to consolidate evidence for the effect of Covid-19 on students' dietary quality, dietary habits, body weight and food security status. A comprehensive literature search was conducted utilising various databases including Google Scholar, MEDLINE, ScienceDirect, Embase and Scopus to identify relevant studies. To be incorporated in this review, studies had to include higher education students, measure the prevalence of food insecurity and assess the dietary and body weight changes during the COVID-19 pandemic. The studies showed that the diet quality of college students was compromised during the pandemic in many nations due to the decrease in the intake of whole grains, dairy products, legumes, nuts, fruits and vegetables and the increase in consumption of alcohol, confectionery products and refined grains. There was an increase in the frequency of cooking, binge eating, breakfast skipping and unhealthy snacking. These modifications, in return, were associated with body weight changes, with no less than 20 to 30 % of students gaining weight during the pandemic. The pandemic also impacted food security status of students, with over 30% being food insecure worldwide. The COVID-19 outbreak has exacerbated the students' diet quality and dietary habits and placed them under high risk of weight gain and food insecurity. Higher education institutions and governments should improve students' access to nutritious foods and incorporate nutrition education interventions in the curricula.
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24
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Hagedorn‐Hatfield RL, Richards R, Qamar Z, Hood LB, Landry MJ, Savoie‐Roskos MR, Vogelzang JL, Machado SS, OoNorasak K, Cuite CL, Heying E, Patton‐López MM, Snelling AM. Campus‐based programmes to address food insecurity vary in leadership, funding and evaluation strategies. NUTR BULL 2022; 47:322-332. [DOI: 10.1111/nbu.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Rickelle Richards
- Department of Nutrition, Dietetics and Food Science Brigham Young University Provo Utah USA
| | - Zubaida Qamar
- Family, Interiors, Nutrition and Apparel (FINA) San Francisco State University San Francisco California USA
| | - Lanae B. Hood
- Department of Nutrition, Health and Human Performance Meredith College Raleigh North Carolina USA
| | - Matthew J. Landry
- Stanford Prevention Research Center Stanford University Palo Alto California USA
| | | | - Jody L. Vogelzang
- School of Interdisciplinary Health, Allied Health Sciences Grand Valley State University Grand Rapids Michigan USA
| | - Stephanie S. Machado
- Department of Public Health & Health Services Administration California State University Chico California USA
| | - Kendra OoNorasak
- Department of Dietetics and Human Nutrition University of Kentucky Lexington Kentucky USA
| | - Cara L. Cuite
- Department of Human Ecology School of Environmental and Biological Sciences Rutgers University New Brunswick New Jersey USA
| | - Emily Heying
- Department of Nutrition College of Saint Benedict & Saint John’s University Saint Joseph Minnesota USA
| | | | - Anastasia M. Snelling
- Department of Health Studies American University Washington District of Columbia USA
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25
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Miller A, Bochner R, Sohler N, Calixte R, Chan C, Umpaichitra V, Shalmiyev E, Novikova N, Desai N, Seigel W, Chin V, Periasamy S, Waldman L, Bamji M, Nagpal N, Duh‐Leong C, Reznik M, Messito M, Bargman R. Modified body mass index z-scores in children in New York City during the COVID-19 pandemic. Pediatr Obes 2022; 17:e12958. [PMID: 35770679 PMCID: PMC9350030 DOI: 10.1111/ijpo.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Determine whether the negative impact of the COVID-19 pandemic on weight gain trajectories among children attending well-child visits in New York City persisted after the public health restrictions were reduced. STUDY DESIGN Multicenter retrospective chart review study of 7150 children aged 3-19 years seen for well-child care between 1 January 2018 and 4 December 2021 in the NYC Health and Hospitals system. Primary outcome was the difference in annual change of modified body mass index z-score (mBMIz) between the pre-pandemic and early- and late-pandemic periods. The mBMIz allows for tracking of a greater range of BMI values than the traditional BMI z-score. The secondary outcome was odds of overweight, obesity, or severe obesity. Multivariable analyses were conducted with each outcome as the dependent variable, and year, age category, sex, race/ethnicity, insurance status, NYC borough, and baseline weight category as independent variables. RESULTS The difference in annual mBMIz change for pre-pandemic to early-pandemic = 0.18 (95% confidence interval [CI]: 0.15, 0.20) and for pre-pandemic to late-pandemic = 0.04 (95% CI: 0.01, 0.06). There was a statistically significant interaction between period and baseline weight category. Those with severe obesity at baseline had the greatest mBMIz increase during both pandemic periods and those with underweight at baseline had the lowest mBMIz increase during both pandemic periods. CONCLUSION In NYC, the worsening mBMIz trajectories for children associated with COVID-19 restrictions did not reverse by 2021. Decisions about continuing restrictions, such as school closures, should carefully weigh the negative health impact of these policies.
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Affiliation(s)
- Assia Miller
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Risa Bochner
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Nancy Sohler
- City University of New York School of MedicineManhattanNew YorkUSA
| | - Rose Calixte
- State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Cameron Chan
- City University of New York School of MedicineManhattanNew YorkUSA
| | - Vatcharapan Umpaichitra
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Elman Shalmiyev
- New York City Health and Hospitals Central OfficeManhattanNew YorkUSA
| | - Natalia Novikova
- New York City Health and Hospitals Central OfficeManhattanNew YorkUSA
| | - Ninad Desai
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA
| | - Warren Seigel
- New York City Health and Hospitals Coney Island HospitalBrooklynNew YorkUSA
| | - Vivian Chin
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Sundari Periasamy
- New York City Health and Hospitals Harlem HospitalManhattanNew YorkUSA
| | - Lee Waldman
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA
| | - Mahrukh Bamji
- New York City Health and Hospitals Metropolitan HospitalManhattanNew YorkUSA
| | - Nikita Nagpal
- New York City Health and Hospitals Bellevue HospitalManhattanNew YorkUSA,New York University Grossman School of MedicineManhattanNew YorkUSA
| | - Carol Duh‐Leong
- New York City Health and Hospitals Bellevue HospitalManhattanNew YorkUSA,New York University Grossman School of MedicineManhattanNew YorkUSA
| | - Makhmood Reznik
- New York City Health and Hospitals Coney Island HospitalBrooklynNew YorkUSA
| | - Mary Messito
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,New York University Grossman School of MedicineManhattanNew YorkUSA
| | - Renee Bargman
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA,New York City Health and Hospitals Coney Island HospitalBrooklynNew YorkUSA
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26
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Sooriyaarachchi P, Francis TV, Jayawardena R. Fruit and vegetable consumption during the COVID-19 lockdown in Sri Lanka: an online survey. NUTRIRE : REVISTA DE SOCIEDADE BRASILEIRA DE ALIMENTACAO E NUTRICAO = JOURNAL OF THE BRAZILIAN SOCIETY OF FOOD AND NUTRITION 2022; 47:12. [PMID: 38625301 PMCID: PMC9205284 DOI: 10.1186/s41110-022-00161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022]
Abstract
Purpose The COVID-19 pandemic has drastically altered the dietary patterns of individuals. This study aimed to investigate the changes in the purchase and consumption of fruit and vegetables in Sri Lanka during the COVID-19 pandemic. Methods An online cross-sectional survey assessed the self-reported changes in fruit and vegetable consumption and purchase using Google forms. Logistic regression analyses were performed to assess the association between decreased consumption of imported fruits and increased home-grown food intake with socio-demographic variables. Results Among the 3621 survey respondents, 63.0% and 43.3% reported a decreased intake of imported and local fruits purchased from the market, respectively. Although the overall vegetable consumption has declined, the leafy vegetable consumption has increased by 40.7%. Imported fruit intake has significantly reduced among youngsters, males, respondents living in municipal areas, employed, and those with lower monthly incomes. Among the respondent, 48.9% declared an increased consumption of home-grown fruits or vegetables. Responders living away from Colombo and rural areas were more likely to report a higher intake of home-grown fruits and vegetables (OR 2.021; 95% CI, 1.762-2.318, P < 0.001). Employed males residing in municipal areas were less likely to report an increased intake (OR 0.689; 95% CI, 0.574-0.827, P < 0.001). Conclusion Purchase of imported and local fruits from the market has reduced. Although the overall vegetable consumption was decreased, there has been an increase in the consumption of leafy vegetables. Furthermore, consumption of home-grown fruits and vegetables has increased considerably. Well-established food distribution programs are essential in future pandemics to promote healthy eating.
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Affiliation(s)
- Piumika Sooriyaarachchi
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Tormalli V. Francis
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ranil Jayawardena
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD Australia
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Undergraduate nursing and medical students’ perceptions of food security and access to healthy food in Qatar: a photovoice study. J Nutr Sci 2022; 11:e32. [PMID: 35573461 PMCID: PMC9066330 DOI: 10.1017/jns.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
The present study explored nursing and medical students’ perceptions of food security, their access to healthy food and the circumstances that affect their access to healthy food in Qatar. The photovoice method was adopted in the present study. Students submitted their photos pertaining to food security and their access to healthy food in Qatar. Afterwards, the students completed an online synchronous semi-structured interview. The interviews were transcribed verbatim and thematically analysed. After the data analysis, a focus group discussion was conducted for member checking. The present study is a collaborative project between two universities in Qatar: The University of Calgary in Qatar (UCQ) and Qatar University (QU). Undergraduate students (seven nursing students and nine medical students) were recruited, asked to collect photos and interviewed. Four themes emerged from the data. First, food retail environments promoted unhealthy eating. Second, fast food under stressful circumstances: a sense of comfort. Third, food as a symbol of culture and socialisation. Finally, the paradox of access to affordable and healthy food in Qatar. Undergraduate students highlighted various circumstances that affect their perceptions of food security and their access to healthy food in Qatar. Future research that aims at understanding the facilitators and barriers to access healthy food at the university campus may help to improve nutrition interventions targeting those students. Future initiatives should focus on leveraging various resources to assist universities in tailoring their food initiatives to suit their students’ local needs.
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Abbey EL, Brown M, Karpinski C. Prevalence of Food Insecurity in the General College Population and Student-Athletes: a Review of the Literature. Curr Nutr Rep 2022; 11:185-205. [PMID: 35218475 PMCID: PMC8881554 DOI: 10.1007/s13668-022-00394-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the prevalence of food insecurity (FI) among the general college student population with a focus on student-athletes and the impact of the COVID-19 pandemic on FI in these groups. RECENT FINDINGS FI is estimated to be more prevalent in college students than in the general population, although ranges vary widely. Less is known about FI among college student-athletes. Data on changes in FI prevalence pre-pandemic and during is mixed. Colleges and universities should invest in interventions to address FI on their campuses, and further research on FI among student-athletes and the impact of the COVID-19 pandemic on FI is needed.
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Affiliation(s)
- Elizabeth L Abbey
- Department of Health Sciences, Whitworth University, 300 W. Hawthorne Rd., Spokane, WA, 99251, USA.
| | - Melissa Brown
- Department of Nutrition and Public Health, University of Saint Joseph, 1678 Asylum Ave., West Hartford, CT, 06117, USA
| | - Christine Karpinski
- Department of Nutrition, West Chester University, 855 S. New St., West Chester, PA, 19383, USA
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Food Insecurity and Associated Factors in Brazilian Undergraduates during the COVID-19 Pandemic. Nutrients 2022; 14:nu14020358. [PMID: 35057539 PMCID: PMC8780004 DOI: 10.3390/nu14020358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 12/17/2022] Open
Abstract
Undergraduates may face challenges to assure food security, related to economic and mental distress, especially during the COVID-19 pandemic. This study aimed to assess food insecurity and its associated factors in undergraduates during the COVID-19 pandemic. An online cross-sectional study was conducted from August 2020 to February 2021 with 4775 undergraduates from all Brazilian regions. The questionnaire contained socio-economic variables, the validated Brazilian food insecurity scale, and the ESQUADA scale to assess diet quality. The median age of the students was 22.0 years, and 48.0% reported income decreasing with the pandemic. Food insecurity was present in 38.6% of the students, 4.5% with severe food insecurity and 7.7% moderate. Logistic regressions showed students with brown and black skin color/race presented the highest OR for food insecurity; both income and weight increase or reduction during the pandemic was also associated with a higher OR for food insecurity, and better diet quality was associated with decreased OR for food insecurity. Our study showed a considerable presence of food insecurity in undergraduates. Policy for this population must be directed to the most vulnerable: those with brown and black skin color/race, who changed income during the pandemic, and those presented with difficulties maintaining weight and with poor diet quality.
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Maneerattanasuporn T, Techakriengkrai T, Jamphon A, Riebroy Kim S, Muangtuk Mba T. Food Insecurity Situation among Undergrad Students During the COVID-19 Pandemic. Asia Pac J Public Health 2021; 34:276-278. [PMID: 34872369 DOI: 10.1177/10105395211062862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Amporn Jamphon
- Department of Home Economics, Kasetsart University, Bangkok, Thailand
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Pung CYY, Tan ST, Tan SS, Tan CX. Eating Behaviors among Online Learning Undergraduates during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312820. [PMID: 34886546 PMCID: PMC8657465 DOI: 10.3390/ijerph182312820] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
The outbreak of Coronavirus Disease-2019 (COVID-19) has upended education systems. The pandemic switched traditional face-to-face classes to online classes. Poor eating behaviors in undergraduate students' lives may affect the well-being of their later stages of life. This study aimed to investigate the eating behaviors among online learning undergraduates during the COVID-19 pandemic. A total of 122 students were recruited. The results revealed more than half of the respondents (52.46%) skipped meals. Breakfast (46.72%) was the most skipped meal. The majority of the respondents (94.26%) snacked between meals. Biscuits (88.52%), bread (84.43%), and fruits (80.33%) were the most common snacked foods. Meal skipping was found to be associated with gender (χ2 = 6.83, p < 0.05). In the future, more health interventions program aimed to promote healthy eating behaviors among undergraduates are highly warranted.
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Affiliation(s)
- Christine Yeong Ying Pung
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Jalan Universiti Bandar Barat, Kampar 31900, Perak, Malaysia;
| | - Seok Tyug Tan
- Department of Healthcare Professional, Faculty of Health and Life Sciences, Management and Science University, University Drive, Off Persiaran Olahraga, Seksyen 13, Shah Alam 40100, Selangor, Malaysia;
| | - Seok Shin Tan
- Department of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia;
| | - Chin Xuan Tan
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Jalan Universiti Bandar Barat, Kampar 31900, Perak, Malaysia;
- Correspondence:
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Chernova A, Frajo-Apor B, Pardeller S, Tutzer F, Plattner B, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. The Mediating Role of Resilience and Extraversion on Psychological Distress and Loneliness Among the General Population of Tyrol, Austria Between the First and the Second Wave of the COVID-19 Pandemic. Front Psychiatry 2021; 12:766261. [PMID: 34777068 PMCID: PMC8578839 DOI: 10.3389/fpsyt.2021.766261] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/27/2021] [Indexed: 01/16/2023] Open
Abstract
Background: During the first 3 weeks of the COVID-19 pandemic, the federal state of Tyrol, Austria had one of the strictest curfews in Austria and worldwide. The aim of the current study was to investigate the assumingly protective role of resilience and extraversion and its impact on mental health following such an uncertain and unpredictable situation. Methods: Between the first and the second wave of the pandemic, adult residents of Tyrol were invited to participate in an online survey. Next to the assessment of sociodemographic and COVID-19-related variables the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Resilience Scaled, and the Big Five Inventory were used to assess psychological distress, loneliness, resilience, and extraversion. Mediation analysis was used to investigate the role of resilience and extraversion in the context of age-, sex-, and partnership- related differences in psychological distress and loneliness. Results: One hundred and forty-five participants took part in the survey (68.2% female). Overall, psychological distress and severe loneliness were more often detected in women and singles. They also were less resilient, while men and singles presented with a lower degree of extraversion. Study participants under the age of 30 experienced severe loneliness more frequently than older people, whereas psychological distress, resilience, and extraversion were comparable between age groups. Resilience significantly mediated the relationship between both study participants' sex and partnership situation on one hand and psychological distress and severe loneliness on the other. In addition, extraversion significantly mediated the relationship between participants' partnership situation and psychological distress. Discussion: Our findings suggest that women, singles, and young people may be particularly affected by the measures and sequelae of the COVID-19 pandemic. Interventions promoting resilience and extraversion among these groups are urgently needed to foster mental health. Ideally, they can be utilized at home in case of renewed mobility restrictions or quarantine in the future.
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Affiliation(s)
- Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, Bolzano, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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