Designing Incentives to Change Behaviors: Examining College Student Intent Toward Healthy Diets

An incentive-based health program using MyPlate: a pilot study analyzing college students' dietary intake behavior

Is dietary education, incentivized by financial rewards, effective in achieving improved dietary intake behavior of college students? Participants: Fifty-seven undergraduates (18-24 years old), non-nutrition major students. Methods: The intervention group participated in weekly nutrition education meetings which focused on MyPlate for four weeks. Both the control and the intervention groups completed two online surveys that assessed the students' knowledge and dietary behavior at the beginning and at the end of the 4-week education program. The respondents' diet quality was determined by their compliance with MyPlate and their Healthy Eating Index's recommendations. Results: Students who received education showed the most improvement regarding their knowledge and dietary behavior. These respondents tripled their average per capita consumption of whole grains and increased their fruit and vegetable intakes. Conclusions: Educating college students to work toward improving their diets with the assistance of incentives may have positive effect on their health behaviors.

The 8-Hour Challenge: Incentivizing Sleep during End-of-Term Assessments

Sleep is critical to physical health, mental well-being, attention, and creativity. During the week of final exams, however, fewer than 10% of undergraduate students maintain the recommended average of 8 hours/night (or, even the recommended minimum of 7 hours/night). For students completing multifaceted projects in studio-based majors (e.g., interior design, architecture, graphic design, studio art), anecdotal and questionnaire data suggest that the end-of-semester reduction in sleep duration may be even worse. One potential solution is to offer students an incentive to maintain healthy sleep durations. We offered interior design students, who were enrolled in a freshman-level graphics studio course, an optional extra credit incentive to maintain optimal sleep durations for five nights leading up to the due date of their final project. If participants maintained an average sleep duration of ≥ 8.0 hours for five nights, they would earn extra credit. By contrast, if they slept an average of 7.0-7.9 hours, there would be no grade change, and if they slept an average of ≤ 6.9 hours, they were instructed that they would lose points (no points were actually deducted). Of the 28 students enrolled in the course, 22 students attempted the challenge (78.6%), and we monitored their sleep duration objectively using wristband actigraphy devices. We compared their sleep duration to that of a group of 22 non-incentivized students enrolled in the same program. In the non-incentivized comparison group, very few students averaged 8 hours (9%) or even 7 hours (14%) of sleep per night. In dramatic contrast, the eight-hour challenge increased the percentage of 8-hour and 7-hour sleepers to 59% and 86%, respectively. Participants who took the eight-hour challenge slept an average of 98 minutes more each night than non-incentivized students and 82 minutes more than they self-reported to sleeping during the semester. The substantial increase in nightly sleep duration did not come at a cost to project performance. Individuals who opted in to the sleep challenge performed as well on the final project as students who did not opt in, and students who showed more consistent sleep (i.e., fewer nights of poor sleep followed by rebound sleep) performed better than students who showed inconsistent sleep. Thus, even during highly stressful "deadline" weeks, students can maintain healthy sleeping patterns without exacting a cost on their project performance.

We Don't Have a Lot of Healthy Options: Food Environment Perceptions of First-Year, Minority College Students Attending a Food Desert Campus

First-year college students are at particular risk of dietary maladaptation during their transition to adulthood. A college environment that facilitates consistent access to nutritious food is critical to ensuring dietary adequacy among students. The objective of the study was to examine perceptions of the campus food environment and its influence on the eating choices of first-year students attending a minority-serving university located in a food desert. Focus group interviews with twenty-one first-year students were conducted from November 2016 to January 2017. Students participated in 1 of 5 focus groups. Most interviewees identified as being of Hispanic/Latino or Asian/Pacific Islander origin. A grounded theory approach was applied for inductive identification of relevant concepts and deductive interpretation of patterns and relationships among themes. Themes related to the perceived food environment included adequacy (i.e., variety and quality), acceptability (i.e., familiarity and preferences), affordability, and accessibility (i.e., convenience and accommodation). Subjective norms and processes of decisional balance and agency were themes characterizing interpersonal and personal factors affecting students' eating choices. The perceived environment appeared to closely interact with subjective norms to inform internal processes of decision-making and agency around the eating choices of first-year students attending a minority-serving university campus located in a food desert.

Point-of-Purchase Labels and Reward Cards Improve Sales of Healthy Foods in University Dining Halls

Purpose: To compare sales of Food Resources and Education for Student Health (FRESH) Approved versus non-FRESH Approved menu cycle items pre- and postimplementation of the FRESH program.

Methods: Sales data from 2011–2015 of FRESH Approved versus non-FRESH Approved menu items were analyzed. Fruit and milk items sold, net sales, and the cost of free fruit and milk redeemed through the FRESH Reward Card (FRC) program, were also analyzed.

Results: FRESH Approved items sold more often than non-FRESH Approved items in the latter 2 years (P = 0.01). Prices of FRESH Approved menu items were significantly lower than non-FRESH Approved items for all years (e.g., $1.52 ± $0.94 vs $2.21 ± $1.02 per serving in 2014–2015; P < 0.001). Across all FRESH implementation years, FRESH Approved menu items were found more often on the 6-week menu (P < 0.05). The number of fruit items sold increased from a baseline of 143 052 to 170 954, and net sales increased from $135 450 to $154 248 after 3 years of the FRC implementation.

Conclusions: FRESH Approved items were less expensive, available more often, and had higher sales. The FRC increased net fruit sales despite the cost of free fruit. Highlighting and reducing the cost of healthy foods are promising practices to improve campus food environments.

A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes

BACKGROUND

Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits.

OBJECTIVE

To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School.

METHODS

The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling.

RESULTS

The course was well-received, earning a ranking of 4.9/5 at the school.

CONCLUSIONS

A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.