College Food Insecurity: how Big is the Problem?

Working while attending college or university is also associated with food insecurity. 4,5,9 Higher rates of food insecurity have been reported among students working longer hours. 4,5 Rates of food insecurity for students working over 20 hours per week have ranged from 38-46%. 4,5 In addition, university students who live off campus and those who do not have a meal plan tend to have an increased risk for food insecurity as compared to students living on campus and those with meal plans. 4 Although having a meal plan and living on campus appear to be protective factors, these students are not immune to food insecurity.

For example, studies have shown between 26-43% of university students with meal plans and 26% of students living on campus have experienced food insecurity.

Food insecurity can have a detrimental impact on students' academic success, as well as their physical and mental health. Food insecurity is negatively correlated with academic achievement and lower grade point averages (GPA's) in colleges and universities. 8,9,19–21 In addition to contributing to a students' inability to perform well academically, food insecurity may also lead students to discontinue their education. 5 For example, Dubick et al, reported 32% of food insecure students believed that hunger or housing problems impacted their education, with 55% reporting these problems caused them not to purchase a required textbook, 53% reported missing a class, and 25% reported dropping a course. 5 Students with food insecurity are more likely to experience poorer self-reported physical health. 8,13,22–26 Inadequate resources may result in the purchasing of low nutrient-dense, high-energy foods, as these items, such as grains and refined sugars, are often less expensive than more nutrient-dense options like fruits and vegetables.27 Food insecurity has been associated with poor diet quality in youth (9-18 years of age), including insufficient intake of fruits, vegetables, and dairy, as well as inadequate intake of various vitamins and minerals.28 In addition to physical health, the risk of developing mental health symptoms and conditions, such as depression, can be increased for students experiencing food insecurity.13,23–25,29 Food insecure students have also reported higher perceived stress than food secure students. 20 As food insecurity can have deleterious effects on a student's overall health and academic success, there is a growing concern and important need to address this complex problem.

Resources and Services

The aforementioned body of research has shown light on the issue of food insecurity on campus, making it more visible to institutional leaders and stakeholders. Institutions have been working towards effective strategies to secure the basic needs of students and to address current problems, including food insecurity. 16 Two common on-campus resources and services include student food pantries and institutional offices which connect students to local support. Food pantries provide valuable assistance to students who are in need of food and are considered a charitable, short-term response to the poverty epidemic facing college and university students today. 30 A growing awareness of food insecurity on campuses and the associated adverse effects, has led to the implementation of hundreds of campus food panties throughout the nation.30 The College and University Food Bank Alliance (CUFBA), an organization which aims to provide support, resources, and training to on-campus food pantries, has grown from 88 members in 2012 to now more than 650 members as of 2018 at colleges and universities across the nation.30 Despite the popularity and increase in creation of campus food pantries, certain barriers may be preventing students from utilizing this service. According to the results from a 2017 survey of 262 colleges and universities, the most common outreach strategies used to promote food panties were informal, such as "word of mouth", which may limit students' awareness of these resources. 30 The study also noted that student usage of food panties was highly variable among the surveyed institutions, with majority (53%) serving between 100 to 299 students per year and only 15% serving 1,000 students or more per year. 30 A recent 2018 study surveyed 899 students from the University of Florida and found that only 38% of food insecure students reported using the on campus food pantry. 31 Results from this novel study identified one of the major barriers to using the food pantry was insufficient information regarding the food pantry (33.8%), including how the pantry works, hours, location, and eligibility criteria. 31 Other major barriers included social stigma (36.8%), self-identity or feeling they did not qualify for use (17.6%), and inconvenient hours of operation (11.8%). 31 Further evaluation of campus food pantries is needed to address barriers and determine best outreach strategies. Another common service available to students includes large institutional offices, such as a Dean of Students Office, that can connect students to support and even issue grants for emergency needs. 5 Some campuses have partnered with Single Stop, a national nonprofit organization that helps universities create a one-stop-shop program to connect students to basic need services such as access to food stamps. 4 Although, little publically accessible information can be found on the effectiveness and usage of these types of multi-service offices, requiring more research in this area.

Evaluation of Programs & Services

Many studies have examined the prevalence of food insecurity in higher education, yet there have been very few studies to rigorously measure the impact of interventions and programs created to remedy student food insecurity. 16 Researchers have started to document on some of the food security support programs and services available at institutions, however, to ensure that students are receiving adequate assistance, the focus must shift towards meticulously evaluating current programs. 4 A few institutions are beginning to evaluate their assistance programs, especially newly piloted programs implemented to help students afford food. Bunker Hill Community College (BHCC) in Boston, MA is piloting a One Solid Meal (OSM) program, which provides self-identifying, food insecure students with meal vouchers to be used within the college food service venues on campus.16 Houston Community College (HCC) has partnered with a local food bank to distribute "food scholarships" to qualifying food insecure students.16 Both BHCC and HCC have plans to evaluate their pilot programs with data available in late 2018. 16 Research in this area continues to be lacking and there is a need for more rigorous program evaluation to ensure that the programs and systems in place are meeting the needs of food insecure students as intended and to address barriers leading to improved access and effectiveness.

A common tool used in community-based and public health program evaluation is the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. 32 The RE-AIM model can be applied in order to evaluate the effectiveness and public health impact of programs and interventions in a real world setting. 32 Glasgow, Vogt and Boles' first proposed the RE-AIM model in their 1999 seminal paper titled, "Evaluating the public health impact of health promotion interventions: The RE-AIM framework", as a framework for evaluating public health interventions.33 In this model, reach is considered the number of individuals who participated in the program and can be determined by dividing the total number of program participants by the total number of people in the studied population, such as a clinic or worksite.33 Another component of reach, is sample representativeness, which can be determined by assessing participant and population (non-participant) demographic information.33 Effectiveness of a program is measured in this framework by the positive and negative outcomes of the intervention, focusing on behavioral outcomes of participants as well as staff involved in providing the intervention.33 Adoption assesses the characteristics of the studied setting that adopted the program or intervention of interest.33 Adoption or the failure of a setting to adopt an intervention, can be measured by direct observation or by conducting interviews with staff to determine the strengths and barrier to incorporating the program.33 Implementation of a program refers to how accurately the intervention was carried out, as originally intended or designed, by participating staff members and how well participants adhered to the program.33 Lastly, maintenance is measured to assess the long term sustainability and adoption of a program and behavioral outcomes over time.33 Each of the five dimensions are measured on a scale of 0% to 100% and multiplication of all five dimensions provides the programs' public health impact score.33 Since its inception in 1999, the RE-AIM model has been utilized in over 100 publications in diverse public health fields, including dietary change, medication adherence, cancer screening, weight loss, diabetes prevention, and health policy. 32 More recently, a 2017 study utilized the RE-AIM framework to assess the implementation of a food insecurity screening and referral program administered in free health clinics in San Diego, CA.34 Results indicated a 92.5% screening participation rate (or reach) with 74% of screened participants identifying as food insecure and a 100% participation and adoption of the program by all clinics approached.34 Applying the RE-AIM model allowed researchers to assess the effectiveness and impact of the screening and referral program, in which they concluded can serve as a useful tool in identifying and addressing food insecurity in a clinical setting.34

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