College campuses' influence on student weight and related behaviours: A review of observational and intervention research

How Sugar Labeling Affects Consumer Sugar Reduction: A Case of Sucrose Grade Labels in China

The effectiveness of sugar labeling depends not only on direct sugar reduction but also on the extent to which compensatory eating occurs. This study focuses on the use of sucrose grade labels in the Chinese market to investigate not only consumers' willingness to pay (WTP) for different sucrose labels but also the consistency of their sugar control behavior when confronted with unlabeled processed foods. The findings reveal that consumers are willing to pay approximately 4%, 7%, and 7% more for yogurt labeled as "low sucrose", "no sucrose", and "no sucrose with sugar substitutes", respectively, compared to yogurt labeled as "regular sucrose." Furthermore, when subsequently presented with unlabeled toast, a significant proportion of consumers who initially chose "no sucrose" yogurt continued to select wholewheat toast, which contains less sugar than white and coconut toast. This indicates their commitment to maintaining their sugar control behavior. The study provides valuable experimental evidence for researchers, food manufacturers, and policymakers regarding the efficacy of sucrose grade labels. In particular, it offers policymakers insights into guiding consumers to promote sustainable healthy diets.

Factors Associated with the Health-Related Quality of Life of Malaysian Young Adults Post-Pandemic

The transition from school to university brings significant adjustments in lifestyle, body weight, and living environment for young adults, potentially impacting their quality of life. Emerging evidence suggests the coronavirus disease of 2019 (COVID-19) pandemic may have exacerbated these changes. This cross-sectional study involved 361 young adults (18-25 years) from Malaysian tertiary institutions, aiming to identify factors associated with health-related quality of life (HRQOL) post-COVID-19 restrictions. Data were collected online between April and July 2022, utilizing the WHOQOL-BREF for HRQOL assessment. Participants, with a median age of 23, scored highest in the physical health domain (mean: 63.2, SD = 16.2) and lowest in psychological health (mean: 58.2, SD = 16.9). Physical health domain scores varied by ethnicity, the field of study, weight category, and prescription medicine usage; environmental health scores by ethnicity and household income; and social health scores by age. Moderate perceived stress and low perceived support were significant predictors of poor HRQOL. Across the weight categories, sleep quality, perceived stress, and support have consistently impacted the HRQOL domain scores. This study underscores the multifaceted influences on young adults' quality of life during the transition to university, especially in post-pandemic adjustments, highlighting the importance of addressing factors such as perceived stress and support to enhance overall well-being.

Implementation of nutrition and physical activity-related policies and practices on college campuses participating in the Healthier Campus initiative

Objective: To evaluate implementation of nutrition/physical activity-related policies/practices at colleges participating in a healthy campus initiative and campus health leaders' perceptions of policies/practices' support for student health and ease of/barriers to implementation. Participants: Health leaders at colleges participating in the Healthier Campus Initiative (HCI), with completed or ongoing three-year HCI commitments. Methods: Surveys asked which of 41 guidelines were implemented and perceptions around support for student health and ease of/barriers to implementation. Qualitative interviews explored similar domains. Results: Campuses with completed HCI commitments (n = 17) averaged 27.6 guidelines implemented, versus 21.1 on campuses with commitments ongoing (n = 13; p = 0.003). Perceived support for student health and implementation ease varied by guideline. Common implementation barriers included financial costs and time. Interviews largely reinforced these findings. Conclusions: Completion of a campus environmental change initiative may be associated with more health-supporting practices. Campuses may benefit from implementing coordinated policy/practice changes supporting healthy eating and physical activity.

Effects of Covid-19-related anxiety on overeating and weight gain in a diverse college sample

The outbreak of the Covid-19 pandemic has been linked with caloric overeating and weight gain. We employed a mediation analysis to determine whether pandemic-associated overeating was a direct effect of Covid-19-related anxiety (affect regulation theory) or mediated by a coping mechanism of escape eating (escape theory). A diverse pool of college students participated in a repeated cross-sectional study during three separate waves: May 2021 (wave 1, n = 349), December 2021 (wave 2, n = 253), and March 2022 (wave 3, n = 132). The results revealed a significant indirect effect of Covid-19-related anxiety on high-caloric overeating mediated by escape eating, but no direct path between Covid-19-related anxiety and caloric overeating. Analysis of racial/ethnic status uncovered significantly greater Covid-weight gain in Hispanic participants compared with White, Black, and Asian participants. Our results suggest that Covid-19 weight gain is a byproduct of a mediated escape mechanism differentially affecting racial/ethnic groups.

Methods for Assessing Health Outcomes Associated with Food Insecurity in the United States College Student Population: A Narrative Review

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.

The campus food environment and postsecondary student diet: a systematic review

Objective: Examine the impact of the campus food environment on postsecondary students' dietary behaviors (e.g., dietary intake) and food purchasing. Participants: Students currently attending a postsecondary institution, all ages and geographic locations included. Methods: A systematic search from January 2000-October 2022 was conducted in six databases using postsecondary education, food environment, and diet related keywords. Results: In total, 25 quantitative and 10 qualitative studies were extracted. All quantitative studies that conducted statistical analyses (n = 15) reported a statistically significant relationship between the campus food environment and dietary intake, including both positive and negative effects. All qualitative studies (n = 10) discussed students' experience of the campus food environment influencing their diet. Conclusions: This review found moderate evidence that the campus food environment has an impact on postsecondary students' dietary behaviors. A campus environment that has healthy foods accessible, affordable, and acceptable for postsecondary students may have a beneficial impact on students' dietary intake.

Systematic Review of Easy-to-Learn Behavioral Interventions for Dietary Changes Among Young Adults

INTRODUCTION

Improving the diet quality of young adults may support chronic disease prevention. The approaches used and efficacy of promoting small dietary behavior changes through easy-to-learn (ETL) interventions (requiring no more than 1 hour to teach the behavior) among young adults have not yet been systematically reviewed.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 independent electronic searches across 6 databases were conducted to identify any articles describing ETL interventions among young adults (aged 18-35 years) and reporting dietary intake outcomes.

RESULTS

Among 9,538 articles identified, 9 studies met eligibility criteria. Five studies reported significant improvement in the selected dietary outcome. Of these, 3 studies used an implementation intentions approach, in which participants were given or asked to write out a simple dietary behavior directive and carry it on their person. Less than half of included studies were rated as positive for overall quality.

DISCUSSION

The available evidence suggests that ETL interventions targeting the dietary behaviors of young adults may be effective in improving dietary intake. Limitations of included studies were lack of follow-up after the intervention period and low generalizability.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Further dietary intervention studies targeting young adults should systematically evaluate the efficacy of ETL intervention approaches among diverse samples.

Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis

Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.

Associations Between College/University Physical Activity Requirements and Student Physical Activity

Background: Most U.S. college students do not meet physical activity guidelines. Physical activity requirements (PAR) are a proposed solution for increasing undergraduate physical activity. Purpose: To determine whether college/university PAR are associated with undergraduates' self-reported physical activity. Methods: Undergraduate students (N = 383,632) attending colleges and universities taking part in the American College Health Association-National College Health Assessment II survey (2015-2019) self-reported physical activity and demographics. Using websites and course catalogs, researchers coded schools to indicate binary PAR status. Bayesian Hierarchical Logistic Regression was used to determine the percentage of students meeting physical activity guidelines; interactions between PAR status and student characteristics (sex, BMI) were examined. Results: PAR status was positively associated with percent of students meeting physical activity guidelines (PAR: 43.3%, without: 40.5%; difference score 95% Highest Density Interval [HDI; 1.0, 4.5]). A greater percentage of students attending schools with PAR, versus without, met physical activity guidelines across all categories of sex and weight. However, the positive relationship between PAR status and physical activity was stronger among male students (PAR: 46.7%, without: 43.2%; 95% HDI [1.6, 5.4]) compared to female students (PAR: 39.9%, without: 37.9%; 95% HCI [0.2, 3.8]), and among students with underweight (PAR: 39.2%, without: 35.5%; 95% HDI [1.2, 6.3]) or obesity (PAR: 37.1%, without: 33.7%; 95% HDI [1.4, 5.3]) compared to normal weight (PAR: 49.3%, without: 47.4%; 95% HDI [0.1, 3.7]) or overweight (PAR: 47.5%, without: 45.5%; 95% HDI [0.1, 4.0]). Conclusions: PAR are associated with meeting physical activity guidelines, particularly among college/university students with underweight or obesity.

Nutritional quality of snacks and beverages sold through vending machines in a large Hispanic-serving urban college campus in the United States: A cross-sectional study

Students from nutritionally-vulnerable neighborhoods face dietary challenges through built environment of college vending machines. In this cross-sectional study, snacks and beverages sold in vending machines for a 4-week period in a Bronx-based Hispanic-serving college were recorded. Nutritional information was recorded from nutrition labels. Proportion of low- and high-sodium foods, "smart snacks" with a limit of 200 kcal and 200 mg of sodium, and foods with added sugar were recorded. Snacks had significantly higher calories and sodium per serving (227 kcal, 208 mg) than beverages (132 kcal, 90 mg) (t-test, p < 0.001). Almost a third of the snacks (32%) qualified as "smart snacks" for calories and 62% qualified as "smart snacks" for sodium. Beverages contained less than half the number of ingredients as snacks. About 53% of beverages and almost 60% of snacks listed sugar among the first five ingredients. Results underscore the need for colleges to promote less-processed entities with less added sugar.

Association of the gut microbiome with fecal short-chain fatty acids, lipopolysaccharides, and obesity in young Chinese college students

Introduction

Obesity is a growing health problem among young people worldwide and is associated with gut conditions. This study aimed to explore the relationship between obesity, intestinal microbiota, fecal short-chain fatty acids (SCFAs), and lipopolysaccharide (LPS) in young college students.

Methods

16S rRNA gene sequences, SCFA and LPS contents, and obesity status were analyzed in 68 young college students (20-25 years old).

Results

There were significant differences in intestinal microbial beta diversity among students with different body mass index (BMI). The abundance and proportion of Firmicutes and Bacteroides had no significant correlation with BMI. The contents of butyric acid and valeric acid in the feces of obese students were low, and the content of SCFAs had no significant correlation with BMI and LPS. The content of LPS in the feces of obese people was significantly higher than that in healthy people, and there was a significant positive correlation between LPS content and BMI.

Conclusion

In general, there was a correlation between intestinal microbiota, SCFA, LPS, and BMI in young college students. Our results may enrich the understanding of the relationship between intestinal conditions and obesity and contribute to the study of obesity in young college students.

Health behavior interventions for university students measuring mental health outcomes: A scoping review

Introduction

Many university students have poor mental health, and co-occurring health risk behaviors. Targeting health behavior change in this population may improve mental health outcomes. This scoping review describes the extent and range of randomized controlled trials (RCT) evaluating interventions targeting health risk behaviors and measuring a mental health outcome, among university students.

Methods

Six electronic databases were searched for RCTs published until the 18^th May 2021. Eligible RCTs included university students, evaluated interventions that promoted health behavior change (i.e., dietary intake, physical activity, sedentary behavior, alcohol and drug use, smoking, and sleep), and measured a mental health-related outcome.

Results

Fifty-nine RCTs met the inclusion criteria that were published from 2000 to 2021, and over half (n = 33) were conducted in the United States. Interventions evaluated within the RCTs (n = 92) predominantly targeted changes to dietary intake (n = 41 interventions), physical activity (n = 39), or alcohol intake (n = 35). Most interventions targeted one (n = 51) or two (n = 27) health behaviors only. Included RCTs considered mental ill health outcomes (n = 24), psychological wellbeing outcomes (n = 20), or both (n = 15).

Discussion

This scoping review identified a moderate volume of experimental research investigating the impact of health behavior interventions on university students' mental health. There is scope for further research examining health behavior interventions targeting university students, particularly interventions taking a multi-behavioral approach.

Is there a difference in student physical activity between a field school and a traditional classroom setting?

OBJECTIVES

We compared the physical activity of nine students participating in an anthropological field school to their activity expenditures in traditional classrooms. We predicted that the students would exhibit higher physical activity during the field school due to the substantial physical requirements associated with the program compared to traditional classroom environments which are frequently more sedentary.

METHODS

Participants (n = 9) wore wrist accelerometers for ~23 h each day for 6 days during an anthropological field school and also in a traditional classroom environment. Accelerometers were programed with participant height, weight, age, and sex. Each accelerometer recorded total energy expenditure in kilocalories (kcal), step counts, and time in four physical activity levels (vigorous, moderate, easy, and very easy) between the field school and traditional classroom settings.

RESULTS

During the field school portion of the study, participants burned more calories (p < .01), took more steps (p < .0001), and engaged in more moderate and easy exercise (p < .0001).

CONCLUSIONS

This study provides insights into the physical benefits of study abroad programs and field schools. Our multi-day accelerometer data revealed significant differences in even relatively low intensities of physical activity. This is particularly pertinent in the United States where sedentary lifestyles are increasing among college students. Taken together, the results underscore the importance of study abroad programs, field schools, and other applied learning opportunities beyond the educational, professional, and social benefits.

The Barriers to Sustainable Nutrition for Sustainable Health among Zayed University Students in the UAE

Unhealthy and unsustainable nutrition is a major concern globally, including in the United Arab Emirates. Although many education programs have been conducted, diet-related illnesses remain prevalent. This study aims to identify the barriers between knowledge and practice of sustainable healthy diets to achieve long-term health, among students of Zayed University in the United Arab Emirates. An online questionnaire was sent to Zayed University (ZU) students over 18 years of age, using snowball sampling. The participants achieved a mean score of 5.6 out of 11 in nutritional knowledge, and a mean score of 3.4 out of 6 in healthy habits. The only barrier that significantly affected dietary habits was not knowing how to plan a diet (p = 0.025). Accordingly, having good nutritional knowledge was significantly related to improved dietary habits (p < 0.001). In addition, school curriculums (p = 0.004), doing one’s own research (p < 0.001), and social media (p < 0.001) were significantly related to improved nutritional knowledge. The most commonly reported motivators for a healthier diet were “to keep their body healthy for a long time” and “to maintain a healthy weight” (72.6% and 70.1%, respectively). Overall, among ZU students the most significant barrier to achieving sustainable healthy nutrition was lack of knowledge. Education methods such as school curriculums, individual research, and social media were effective. Topics such as how to plan a diet, how to keep the body healthy, and how to maintain a healthy weight are of general interest.

The Risk of T2DM in College Women: The Predictive Power of Financial versus Residential Status in a Cross-Sectional Pilot Study in Turkey

Aim: This study aimed to investigate the relationships between dietary habits, income levels and type 2 diabetes mellitus (T2DM) risk in Turkish female university students who are living with their family or in the dormitory. Materials and Methods: This work was a cross-sectional pilot study conducted during December 2016–January 2017 in Istanbul Yeni Yuzyıl University. A survey was administered to 100 female students, 60 living with their family and 40 in dormitories. Income level was determined based on TURKSTAT 2015 percentiles. T2DM risk was determined using the Finnish Diabetes Association Type 2 Diabetes Risk Assessment Form (FINDRISC). Food frequency questionnaire and 24 h dietary recall results were analyzed by the diet analysis software Beslenme Bilgi Sistemi (BeBiS), specially developed for Turkey. Results: Results indicated inadequacies and imbalanced nutrition among female college students overall. Notably, there was a statistically significant higher diet quality for the students living with their families compared to those living in dormitories. Income level was consistently positively associated with better nutritional outcomes, while negatively associated with T2DM risk, but interestingly, only in the case of students living in the dormitory and not for those living with family. Conclusions: Our findings indicated that financial status, rather than living in the dormitory versus with family, is positively associated with increased T2DM risk as assessed via FINDRISC among Turkish female college students. This study’s results indicate a potential need for educational programs and nutritional support for students, particularly those living away from family.

The physical activity and health promotion activities of global university students: a review of reviews

University students globally are reportedly living unhealthy lifestyles, challenging universities to develop physical activity (PA) and health promotion (HP) intervention strategies. The current study aimed to review global universities' physical activity and health promotion activities to inform the PA and HP guidelines for Eswatini university students in the Sub-Saharan region. An electronic search was performed for review articles published between 1996 and 2021, using Cochrane, Google Scholar, PubMed Central, Scopus, and Medline Web of Science databases. The documents reviewed showed that some global universities under investigation follow the health promoting university (HPU) concept influenced by the Ottawa charter (1986). The review articles further showed that implementing the healthy university concept differs due to cultural and contextual differences from one institution to another. The reviews showed the main item areas as smoking control/alcohol and drug abuse, mental health, sexual health, physical activities, healthy eating habits/diet categorized under health promotion. The main PA activities were pedometer activity tracking, measurement of PA using validated questionnaires, sports, games, among other intervention activities. The HPU concept is thus a good starting point that can be promoted and spread to all other universities globally with different charters' guidance, including the Ottawa charter and the Okanagan charter.

Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity

This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m². For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.

Associations between college/university campus characteristics and student body mass index

Background

Campus environments are associated with undergraduate weight. However, few studies have examined campus type and geographic location in relation to student weight. This article aimed to identify college/university students with elevated BMIs by campus type and region.

Methods

Linear mixed effects regression models were fit to data from the American College Health Association-National College Health Assessment II. Analyses tested associations between campus type/region and student self-reported BMI.

Results

The sample included 404,987 students from 445 schools with mean BMI 24.9 ± 5.8. Across all school types/regions, BMI confidence intervals included overweight values. Two-year and public school students had higher BMIs compared to four-year and private school students, respectively. Students in the Midwest had higher BMIs compared to students in the Northeast. In the South only, Minority Serving Institution (MSI) students had higher BMIs compared to non-MSI students.

Conclusion

Healthy weight maintenance programs should be made available to undergraduate students.

Prevalence of Physical Activity Requirements Among US Colleges/Universities Participating in the American College Health Association-National College Health Assessment II

Physical activity requirements (PAR; ie, courses required for graduation) have been proposed as a policy solution for increasing undergraduate physical activity. This study aimed to report prevalence of PAR among US colleges/universities participating in the American College Health Association-National College Health Assessment (ACHA-NCHA) and to understand whether these requirements were associated with campus characteristics. Data from the American College Health Association-National College Health Assessment II serial cross-sectional survey (2015–2019) were merged with researcher coded variables (2019): binary PAR status, nature of PAR (activity-based, conceptual, or combination), and number of courses required to fulfill the PAR. Logistic regression determined whether campus characteristics were associated with PAR in 2019. Nonparametric tests examined differences in nature and number of PAR courses. Of 379 schools, 59 (15.6%) had PAR, with 36 (61.0%) having activity-based PAR and 23 (39.0%) having a combination. Compared to public and four-year schools, private (OR=3.47 [1.77, 6.80]) and two-year schools (OR=6.55 [2.21, 19.45]) had significantly increased odds of having PAR. Private schools required significantly more PAR courses compared to public schools (2.42 vs. 1.73, P=.005). PAR were less prevalent in this sample than reported historically, indicating need for campus leadership attention to this issue. Research is needed to understand what barriers exist to implementing and maintaining PAR on college/university campuses, particularly among public and four-year schools. Understanding health promotion practices among ACHA member schools, which have made leadership commitments to promote student health, can provide greater knowledge of PAR barriers and best practices in schools across the United States and globally.