WISH4Campus: Evaluating College Food Insecurity and Promoting Solutions for Student Wellbeing

Introduction: Interest in college food insecurity has increased in previous years, however, little research focuses on the Appalachian and Southeastern regions of the United States resulting in limited understanding of food insecurity’s impact on college students in these regions. Additionally, resources to help food insecure students are often sparse with universities lacking evidence-based programming to implement for student benefit. Aims: This dissertation aims to (1) investigate the correlates and behavioral consequences of food insecurity on college students at an Appalachian university, (2) expand college food insecurity research to a regional investigation in the Appalachian and Southeastern regions, and (3) develop and evaluate a toolkit of food insecurity initiatives that can assist higher education institutions in providing adequate resources for food insecure students. Methods: A 56 item, cross sectional survey was utilized for aims 1 and 2. Surveys were distributed to students attending 10 public universities in the Appalachian and Southeastern Regions between Spring 2016 and Spring 2018. Food security status was measured using the United States Department of Agriculture Adult Food Security Screener (USDA AFSS). This survey also included demographic, behavioral, health, and economic independent variables. Forward selection logistic regression was used to determine variables that increased the likelihood of being food insecure. Aim 3 used online survey data collection to capture feedback on the WISH4Campus (Wellbeing Increased by Security from Hunger) toolkit. Experts (n=126) from land-grant universities were sent a 27-question survey to determine perceptions of food insecurity and evaluation of specific toolkit components. Descriptive statistics and frequency analyses were performed on quantitative data and thematic analysis was used to analyze qualitative data. Results: Students at an Appalachian university (n=692) reported food insecurity prevalence at 36.6%. Results of the forward selection logistic regression showed money expenditure (MES), coping strategies (CSS), health, and academic year were significant predictors of food insecurity in college students. When expanded to a regional investigation of 13,642 college students, prevalence of food insecurity at the universities ranged from 22.4-51.8% with an average prevalence of 30.5%. From the forward selection logistic regression model, MES, CSS, academic performance (APS), grade point average (GPA), academic year, perceived health status, race/ethnicity, financial aid, cooking frequency, and health insurance were significant predictors of food security status. For aim 3, thirty experts completed the toolkit evaluation survey. Evaluation feedback covered four main topics: layout, overall content, initiatives, and application. Eight themes emerged from the coding and categorization of responses: visual appeal, organization, value, provoking, comprehensive, barriers, collaboration, and efficiency. Conclusion: Limited research has focused on college food insecurity in the Appalachian and Southeastern regions. Findings from these studies suggest food insecurity is a public health problem among college students in this region, and that continuing efforts are needed to assist affected students in getting greater access to safe, nutritious food. The developed toolkit is suggested to be a potential tool to help university personnel provide resources to students. Future research should aim to implement and evaluate food insecurity initiatives

Food Insecurity and Behavioral Characteristics for Academic Success in Young Adults Attending an Appalachian University

In order to investigate the impact of food insecurity on college students in a highly health disparate region we (1) assessed the prevalence of food insecurity among young adults at a large, rural university in Appalachia, and (2) investigated the relationship between food insecurity and behavioral characteristics including academic performance, coping strategies, and money expenditure. A cross-sectional design was used to capture a representative sample of young adults attending a large, central Appalachian university in Fall 2016. The United States Department of Agriculture (USDA) Adult Food Security Survey was used to measure food insecurity. Independent variables include money expenditure (MES), coping strategies (CSS), academic performance (APS), and demographic, health, economic and culinary variables. Participant responses (n = 692) showed one third (36.6%) of respondents were food-insecure. Students with higher scores for MES and CSS had significantly higher odds of being food-insecure (odds ratio (OR) = 2.07; 95% confidence interval (CI) 1.81 to 2.38 and OR = 1.20; 95% CI 1.16 to 1.23, respectively). The odds of high APS scores (OR = 0.79; 95% CI 0.73 to 0.86) were inversely related to food insecurity. Results of the logistic regression showed MES, CSS, health, and school year remained a significant predictor of food insecurity in college students. These findings suggest behavioral differences in terms of coping strategies, money expenditure, and academic progress among food-insecure students and can be used to identify and target at-risk students to promote student food security and well-being

Experiences of Multidisciplinary Health Professionals From a Culinary Medicine Cultural Immersion: Qualitative Analysis

Purpose: Increasing Culinary Health Opportunities for Professionals (iCHOP) aimed to educate future and current health pro- fessionals on nutrition as medicine. Methods: Two cohorts each participated in a 16-week course followed by a cultural immersion in Tuscany, Italy. The course took place online through West Virginia University. After the course, participants traveled to Tuscany, Italy for a 2-week cultural im- mersion. The online course covered culinary medicine, the Mediterranean Diet, and cultural comparisons. The cultural immersion consisted of hands-on activities including culinary lessons, food production and organic farm tours, and tastings of Mediterranean foods. Data was collected through personal journaling in order to capture participants’ thoughts and experiences during the im- mersion. Journal entries were analyzed using NVIVO Software Version 12 in order to generate themes. Results: Cohort1(n1⁄415)consistedofcurrentlypracticinghealthprofessionalsandCohort2(n1⁄414)consistedofaspiringhealth professionals. 20 themes and 5 subthemes were generated from 9 journal topics. Themes showed that participants had an increase and knowledge and self-efficacy and applied new information to personal and professional settings. Conclusions: Cultural immersions can be an effective way to educate health professionals on nutrition as medicine and using journaling as a data collection method can effectively capture participants’ experiences

Relationship between Diet and Mental Health in a Young Adult Appalachian College Population

Young adults in Appalachia may face poor nutritional status due to low access to healthy food and high mental health symptoms attributed to high stress and the college environment. A cross-sectional design was used to investigate the relationship between diet intake and mental health status of this population via surveys. Participant responses (n = 1956) showed students’ mean number of depressed days over the past 30 days was 9.67 ± 8.80, and of anxious days, 14.1 ± 10.03. The mean fruit and vegetable intake was 1.80 ± 1.27 times per day and the mean added sugars intake was 1.79 ± 1.26 times per day. 36.7% of students were found to be food insecure. One-way ANOVA and Chi-Squared analyses were used to determine relationship between variables. Significant variables were placed into a full logistic regression model. Food insecurity and fruit and vegetable intake remained significant predictors of depression in males (odds ratio (OR) = 2.33 95% CI 1.47–3.71 and OR = 68 95% CI 50–89, respectively) and in females food insecurity remained a significant predictor of depression (OR = 2.26 95% CI 1.67–3.07). Food insecurity and added sugars intake were significant predictor of anxiety in males (OR = 2.33 95% CI 1.47–3.71 and OR = 1.09 95% CI 0.91–1.3, respectively) and for anxiety in females, added sugars intake and food insecurity were significant predictors (OR = 1.18 95% CI 1.05–1.32 and OR = 1.65 95% CI 1.27–2.16, respectively). Improving college student’s diet intake through increased access to healthy foods could improve the mental health and well-being of students

Teens Implementing a Childhood Obesity Prevention Program in the Community: Feasibility and Perceptions of a Partnership with HSTA and iCook 4-H

High school student researchers and teen leaders from the Health Science Technology Academy (HSTA), under the supervision of HSTA teachers, led a childhood obesity prevention (COP) program (iCook 4-H). The objective was to evaluate the feasibility and perceptions of having teen leaders implement a COP program for dyads of youth (9–10 years old) and their primary adult food preparer. Behavior change and perceptions were assessed through surveys and open-ended interviews. Across eight HSTA organizations, 43 teen leaders participated in teaching the iCook 4-H program to 24 dyads. Increased frequency of culinary skills, physical activity and mealtime behavior were reported by youth. Almost all adults (93%) reported that their youth had learned kitchen skills and that the program provided youth-adult quality time and developed culinary skills. Youth echoed adult perceptions with additional themes of food safety and physical activity. HSTA teen leaders perceived the program to be successful and reported the training they received to implement the program was adequate 98% of the time. HSTA teachers found the program to be beneficial for HSTA students in improving leadership, confidence and responsibility. iCook 4-H was feasible to be disseminated through teen leaders in the HSTA program. This teen-led approach could serve as a model for youth health-related programming

Choice Architecture in Appalachian High Schools: Evaluating and Improving Cafeteria Environments

School meals are a primary source of nutrition for many adolescents. Determining factors that influence the selection of various foods can provide insight on strategies to improve students’ cafeteria choices. This evaluation and observation was conducted at three Appalachian high schools to assess the cafeteria environment. The study developed and implemented an assessment tool created using principles of choice architecture and behavioral economics building on the work of the Cornell Center for Behavioral Economics in Child Nutrition Programs (BEN Center). The assessment tool scored eight components of the lunchroom—the exterior, hot serving area, cold serving area, salad bar, beverage area, payment station, dining area and grab-n-go, where a higher score equals healthier components offered. High school (HS) #1 earned 73/128 points (57%), HS #2 earned 69/128 (54%), and HS #3 earned 53/102 (52%). HS #3 did not have a grab-n-go option and the final score was out of 102. Video observation was used to collect data on lunchroom activity during mealtimes. Each school received reports that highlight the results and suggest improvements to raise their score. The scoring tool represents a novel way to assess the health of school lunches, provide insights on how to improve the healthfulness of students’ lunch choice, and improve overall nutrition status

eB4CAST: An Evidence-Based Tool to Promote Dissemination and Implementation in Community-Based, Public Health Research

eB4CAST, evidence-Based forecast C-capture, A-assemble, S-sustain, T-timelessness (eB4CAST), framework was developed from existing dissemination and implementation (D & I) constructs as a dissemination tool to promote community-based program usability and future application in targeted populations. eB4CAST captures and transforms research findings into a dissemination report that shows program need and impact to endorse program continuation and expansion. This is achieved through direct and indirect data collection of community factors and program impact that can showcase the need for program sustainability and potential for future dissemination sites. Testimonials, individual feedback, and program process and outcomes contribute to the direct data while data collected from census, county, and state databases and reports allow for indirect information to be captured and analyzed. Capturing data in the two levels allow eB4CAST to forecast program need and highlight program impact through a footprint. eB4CAST framework for dissemination tool creation is organized into four sections: Capture, Assemble, Sustainability, and Timelessness. Capture encompasses the collection of indirect and direct data related to intervention goals. Assemble is the compilation of the data into a visually appealing and easily understood media. Sustainability encourages the use of dissemination tools to provide forecast of program need and footprint of program impact back to community participants, program leaders, and key stakeholders to endorse program sustainability. Lastly, timelessness encourages cyclic movement through these constructs to continue program monitoring and data sharing to ensure timeless program evaluation and conformation to change in needs. The eB4CAST framework provides a systematic method to capture justification of program need and impact of community-based research that can be modified to fit diverse public health interventions providing a necessary D & I tool