A Text-based Intervention: The Impact of Food Insecurity on Dietary Habits, Stress Management, and Food Assistance Resources Among College Students

Abstract

Food insecurity among college student is an issue that has received increased attention recently. The risk factors for food insecurity among college students include: age, race/ethnicity, living arrangement, work for pay, having children, financial independence and lack of food resource management skills. Food insecurity in college students is associated with lower grade point average (GPA), lower self-reported health, poor dietary habits (unbalanced meals, cutting size of meals, skipping meals and lower fruit and vegetable intake), inadequate sleep, and mental health issues (aggression, anxiety and depression). Implementing nutrition and health interventions among college students is necessary to mitigate the negative health outcomes associated with food insecurity. A cross-sectional study to assess the prevalence and factors associated with food insecurity among college students was conducted. Additionally, in-depth interviews were conducted to explore the lived experiences of food insecure college students. These two studies were conducted as part of a needs assessment to develop an appropriate and directed nutrition and health intervention. Thirty-one percent of the surveyed students were food insecure, with 14% categorized as very low food security status. Students who reported living on-campus alone and smoking 6-11 cigarettes a day had higher odds of being food insecure. Food insecure students cope with food insecurity by skipping eating occurrences, cutting the portion sizes, or reducing the quality of their meals. Food insecurity impacts mental, physical, and social health of the affected students. Additionally, food insecure students report that their concentration in class and grades are affected. A 7-week text-based randomized control study was implemented to modify dietary habits (fruit and vegetable, sugar sweetened beverages intake, and mealtime behavior), stress management behaviors and create awareness of food assistance resources. The intervention group (n=22) received 3 intervention text messages per week for 7 weeks and the control group (n=24) received one email attachment containing the intervention messages at post-intervention. An online baseline and post-intervention survey to assess demographic characteristics (age, classification, gender and race/ethnicity – baseline only), anthropometric data (height and weight) fruit and vegetable intake, sugar sweetened beverage intake, food assistance resource awareness, Perceived stress, mealtime behavior, hours of sleep, and text message evaluation (post-intervention only) was administered. At baseline, the food secure students had more hours of sleep than the food insecure students (7.90 ± 1.29 vs 6.68 ± 1.22, respectively; P < 0.05). Repeated measures ANOVA with fixed effects of time and group demonstrated that perceived stress scores for the intervention and control groups reduced significantly at post-intervention. Text delivered intervention was acceptable and had promising outcomes among college students. Future studies should include visual aids and use repetitive text messages.