Assessing the effectiveness of nutrition interventions implemented among US college students to promote healthy behaviors: A systematic review

Knowledge, attitudes and behavior of Gulf medical students in relation to Food Dome dietary guidelines: a mixed-method research

This mixed-methods research is the first to explore knowledge, attitudes and behaviours in relation to the Food Dome dietary guidelines (FDDG) among Gulf medical students. Quantitative phase included the administration of Food Dome questionnaire among n = 414 students; qualitative phase used focus group discussions. The quantitative findings show that more than half the sample reported that they had heard of the FDDG (55.3%), of which 15.7% followed and 39.6% did not follow the FDDG. An average female knew more about and behaved more in line with the guidelines, Bahrainis and Saudis were more aware than Kuwaitis on average, and those aged 21 or more showed, on average, more behaviour consistency with the FDDG. The qualitative findings show that the food choices of the Gulf medical students largely depend on time, university load, availability, and taste. Suggested recommendations include educational campaigns, FDDG application examples, teaching children from an early age.

Effectiveness of nutrition interventions targeting university-level student populations across the League of Arab States: a systematic scoping review

The university setting is an ideal setting to implement nutrition education interventions. Because the transition to college life often overlaps with young adults' increase in independence in food choice and nutrition related behavior, this is an optimal time to target this population and several models exist to best utilize the college setting to support nutrition education interventions. This review aimed to examine the effectiveness of nutrition interventions in university student populations across the League of Arab States. A scoping review following the PRISMA-ScR guidelines was conducted across 14 databases for relevant publications published through May 2023 to find studies conducted across Arab countries. Quality assessment was conducted using the Effective Public Health Practice Project tool. Seven primary studies were included in this review. Although the interventions and outcome measures were disparate, there were positive impacts of the interventions, including improved nutrition knowledge and nutrition habits, knowledge of nutrient sources, and knowledge about the relationship between diet and disease. Recommendations to maximize the efficacy of nutrition interventions conducted across the League of Arab States include purposeful design of the intervention based on a theoretical framework, the use of a control group in the research design, and follow-up measures to examine post-intervention effects. Consideration should also be given to intervention duration and availability in college-students' schedules. Adaptation of intervention materials, measures and delivery methodologies should emphasize local foods, food culture and dietary practices.

An internet-based self-help intervention for the reduction of consumption of ultra-processed products and increase of physical activity in Mexican university population: study protocol for a randomized controlled trial

Introduction

The consumption of ultra-processed products has been associated with the etiology of various diseases, mainly metabolic diseases. On the other hand, physical activity acts as a protective factor that helps prevent the appearance of this type of disease. In addition to the physical effects, both the consumption of ultra-processed products (UPPs) and sedentary behaviors have been associated with a significant impact on people's mental health. These problems occur significantly in university students. Online internet interventions are an alternative that has the advantage of reaching a broader sample size and adapting to various problems.

Methods

A randomized controlled clinical superiority trial with two independent groups will be developed with 176 participants. Participants in both groups will be evaluated in 5 steps: (1) pretest, (2) middle of the intervention, (3) post-test, (4) follow-up at 3 months, and (5) follow-up at 6 months. In the experimental group ("UNISALUD"), participants will receive an intervention composed of 11 sessions with interactive elements such as videos, audio, and infographics created through the user experience (UX) principles and based on the health action process approach (HAPA). The participants in the control group will be on the waiting list and will receive treatment 27 days after fulfilling the inclusion criteria. Thus, participants will not receive the treatment immediately.

Discussion

The study is expected to establish the feasibility of a self-help internet-based intervention created based on the user experience methodology and the health action process model, leading to a significant decrease and increase in the consumption of UPPs, ultra-healthy products, and physical activity, respectively.

Conclusion

Internet-based interventions are scarce in Latin America. Due to their potential, this study will provide data about consumption of UPPs, physical activity, and mental health of the Mexican population, which will influence the reduction of health-related complications through prevention strategies or measures.Clinical Trial Registration:ClinicalTrials.gov, NCT05834842.

Dietary Knowledge, Attitude, Practice Survey and Nutritional Knowledge-Based Intervention: A Cross-Sectional and Randomized Controlled Trial Study among College Undergraduates in China

BACKGROUND

Understanding undergraduates' dietary literacy, including dietary knowledge, attitude and practice (KAP), is important for future health promotion policies. Therefore, this study aimed to investigate the current status and influencing factors of dietary literacy in Chinese college undergraduates and explore whether a nutritional lecture could improve their dietary literacy.

METHODS

This study included two parts: a cross-sectional study (n = 1026) conducted by a dietary literacy questionnaire, and a randomized controlled trail (RCT) that enrolled 99 college undergraduates who were randomized to a control group or a nutritional lecture group. Data from the questionnaire and 72 h food records were obtained on day 0, day 3 and day 100 before and after intervention.

RESULTS

This cross-sectional study showed that the mean scores of dietary KAP were respectively 100.0 (33.3), 59.1 (13.6) and 71.7 (11.7), with an excellent rate of 36.6%, 1.9% and 3.4%. Female upper-grade undergraduates and those with medicine-related majors illustrated higher dietary knowledge scores (p < 0.001). Dietary attitude rather than dietary knowledge had a significant impact on dietary practice (p < 0.001). This finding was in line with the results in the RCT study. Compared with the control group, dietary knowledge was significantly improved in the nutritional lecture group on both day 3 (p = 0.002) and day 100 (p = 0.023) after intervention. However, dietary behavior was improved only on day 3 post nutritional lecture (p = 0.029) but decreased to the original level 100 days later (p < 0.001).

CONCLUSIONS

This study discovered the unsatisfying status and discrepancy between dietary literacy among college undergraduates of different sex, majors and college years. Dietary attitude instead of dietary knowledge was discovered as a determining role in dietary practice. One nutritional lecture could improve undergraduates' dietary literacy but the effect was not long-lasting. Further studies with more reinforced and durable interventions are warranted.

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.

SNAP-Ed Programming for College Students Experiencing Food Insecurity: A Qualitative Process-Focused Evaluation

BACKGROUND

Growing recognition of food insecurity experienced by college students has led to efforts on college campuses to provide students with food assistance benefits and related nutrition education. A Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program was developed for college students as one of these efforts.

OBJECTIVE

To explore program content, recruitment, and implementation through experiences of program implementers in a novel SNAP-Ed intervention among college students.

DESIGN

This qualitative study used focus groups and a case study approach to elicit program implementers' experiences delivering SNAP-Ed to college students.

PARTICIPANTS/SETTING

Students, staff, and faculty (n = 26) implementing SNAP-Ed with college students experiencing food insecurity across eight campuses in the California State University system participated in 8 focus groups in 2021-2022.

MAIN OUTCOME MEASURES

A process evaluation framework was used to evaluate content fit and orientation; recruitment, retention, and reach; and structure and capacity for implementation.

ANALYSES PERFORMED

Focus groups were recorded, transcribed, and coded via thematic analysis using NVivo (QSR International, Burlington, MA).

RESULTS

Five themes were identified: (1) need for this work to extend college-based basic needs services; (2) importance of aligning programming with college student context/needs; (3) common factors important for attracting/engaging the audience; (4) program barriers; and (5) training/team sharing for extending ideas.

CONCLUSIONS

Study findings suggest tailoring SNAP-Ed programming to the needs of college students experiencing food insecurity, such as integrating student-relevant cooking skills, recipes, and topics of interest. Additional intervention and research efforts may lead to a new model for serving college students with SNAP-Ed.

Interoception and self-regulation of eating behaviors and weight status in college students

OBJECTIVE

To determine the associations between interoception, self-regulation, eating behaviors, and weight status among college students.

PARTICIPANTS

229 female undergraduates, predominantly classified as Juniors (51.1%) and identified as Hispanic/Latinx (75%) with a mean age of 23.4 (SD = 6.3), were examined.

METHODS

Cross-sectional data using baseline measures from a larger, longitudinal study, were examined. Confirmatory factor analyses and structural equation modeling were conducted to test hypotheses.

RESULTS

Interoception was directly associated to self-regulation. Interoception and self-regulation were inversely associated with non-purposeful eating. Non-purposeful eating was directly associated with weight status.

CONCLUSION

This study provided empirical evidence on the associations between interoception, self-regulation, eating behaviors, and weight status. Our results support the need for programs that target college students' cognitive skills to reduce unhealthy eating behaviors and optimize weight status. Future interventions are needed to enhance interoception and self-regulation skills so that college students can be more purposeful in their eating habits.

Preliminary evaluation of a scenario-based nutrition literacy online programme for college students: a pilot study

OBJECTIVE

This study aimed to develop and evaluate a scenario-based nutrition literacy (NL) online programme for Taiwanese college students.

DESIGN

A randomised pilot trial design was used in this study.

SETTING

The study was conducted at a university in Taiwan. The intervention consisted of a five-unit web-based NL programme including videos of real-life scenario-based stories, situational analysis teaching and after-unit quizzes. Theme-related website information and smartphone apps (both iOS and Android systems) were offered for reference in every unit. The NL measure consisted of a self-rated scale, a scenario-based test and a healthy eating behaviour survey. Paired sample t-tests and ANCOVA were performed to test the effects on NL and healthy eating behaviour.

PARTICIPANTS

Participants were ninety-eight students, with a retention rate of 98 %. The ratio of men to women was 0·2:1. Most students were freshmen (48 %).

RESULTS

Compared with the control group, the experimental group showed significant post-intervention improvements in the NL and healthy eating behaviours after controlling for pretest scores.

CONCLUSIONS

This pilot study offers preliminary evidence of the potential positive effects of implementing a scenario-based NL online programme for college students. It offers a possibly novel strategy to enhance health-promoting behaviours in Taiwanese universities. Further research with larger sample sizes and more rigorous designs is warranted to confirm and build upon these initial findings.

Eating together more but feeling worse: Discrepancies between observed and reported well-being of Latino(a/x) students at a Hispanic-Serving Institution

Objective. Past research suggests that eating alone is associated with less social support and poorer physical health. The current study examines the comparative health and well-being of Hispanic/Latino(a/x) and non-Hispanic/Latino(a/x) students, with a focus on comparing self-reported well-being to the observed marker of social well-being that is eating alone.Participants. Undergraduate students from a college dining hall completed online surveys in exchange for a gift card.Methods. Participants completed measures of eating alone in the dining hall, food choices, social support, quality of life, and overall health.Results. Although, compared to their non-Hispanic/Latino(a/x) peers, Hispanic/Latino(a/x) students were much more likely to be eating with others, both groups reported similar levels of social support and life satisfaction. Furthermore, Hispanic/Latino(a/x) students reported poorer physical health and chose unhealthier meals.Conclusion. Although Hispanic/Latino(a/x) students appeared to be more socially connected than their peers, these connections did not translate to better well-being.

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.

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant’s survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages—most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.

Implementation of a Healthy Food and Beverage Policy at a Public University

University nutrition policies are a useful step toward improving the food environment for students, faculty, and staff, leading to improved health outcomes for the campus community. As 1 of the first universities to adopt and implement a campus-wide nutrition policy, the objective of this report is to share the university's experience with policy development, implementation, monitoring and evaluation, challenges, facilitators, and recommendations to inform these processes for future university nutrition policies.

The Application of Systems Science in Nutrition-Related Behaviors and Outcomes Implementation Research: A Scoping Review

Use of systems science can improve the dissemination and implementation (D&I) process. However, little is known about use of systems science in nutrition D&I research. The purpose of this article is to synthesize the ways in which systems science methodology is applied in nutrition D&I research. Scoping review methodology involved searching 6 academic databases for full-text, peer-reviewed, English articles published between 1970 and 2020 that employed systems science within nutrition D&I research. Data extraction included intervention type, population, study aim, methods, theoretical approach, outcomes, and results. Descriptive statistics and qualitative thematic analysis followed. Thirty-four retained articles qualitatively identified benefits (successful planning and organization of complex interventions) and challenges (limited resources, trainings, and lack of knowledge) to utilizing systems science in nutrition D&I research. Future research should work toward building knowledge capacity among nutrition practitioners by increasing available trainings and resources to enhance the utilization of systems science in nutrition D&I research.

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

Research indicates that most college students are not meeting dietary and physical activity guidelines, and the average student gains an estimated 1.6-3.0 kg during 4 years of study. College administrations are well-positioned to influence student weight-related health behaviours by ensuring that campus environments/policies promote health. However, to date, campus health interventions have largely addressed individual and interpersonal factors rather than environmental/policy-level changes. Using an ecological perspective, this narrative review synthesizes the literature on campus environmental/policy-level factors (e.g., food availability, physical activity requirements) associated with student diet, physical activity and weight, as well as campus interventions to address these factors. Web of Science and PubMed databases were searched between December 2018 and November 2019. Results indicate that campus food environments may contribute to overconsumption and weight gain, and the number of campuses requiring students to participate in physical activity courses is in decline. Eight examples of environmental/policy-level campus interventions are presented: nutrition labels in dining halls, campus-wide healthy choice marketing campaigns, restricted payment methods for à la cart dining, trayless dining, health-themed residence halls, peer health education programmes, active classroom spaces and physical activity course requirements. Implications for research and health promotion programmes/policies in the field of college health are discussed.

Weight status, dietary habits, physical activity, screen time and sleep duration among university students

BACKGROUND

University life is a crucial period when dietary habits and lifestyle behaviours are formed and may have long-lasting effects on the development of obesity and related chronic diseases.

AIM

To investigate the association of overweight/obesity with dietary habits, physical activity, screen time and sleep duration among university students.

METHODS

A total of 438 students aged 18-26 years were recruited from Mohammed V University in Rabat, Morocco. Anthropometric measurements were assessed using standardized equipment. Data regarding dietary habits, physical and sedentary activities were collected via a self-administered questionnaire.

RESULTS

The prevalence of overweight and obesity was 14.8% and 1.6%, respectively. Students who reported frequent consumption (>3 times/week) of fast food, fried potatoes and sugary drinks were more likely to be overweight/obese than peers who did not. Similarly, odds of being overweight/obese were slightly higher among females who reported non-daily intake of fruits and milk or dairy products and among males who ate vegetables less frequently (<7 times/week). Approximately 26% of students were physically inactive, with a higher proportion of females (35.8%) than males (10.7%). Both short and long sleep durations were associated with an increased risk of overweight/obesity in males. In contrast, physical inactivity and increased screen time were associated with a slightly reduced risk of overweight/obesity, particularly in females.

CONCLUSIONS

Overall, unhealthy dietary habits were associated with an increased risk of overweight/obesity. A similar trend was also observed between abnormal sleep duration and overweight/obesity in males. Interventions to promote healthy dietary and lifestyle habits and prevent overweight/obesity in this population are needed.

Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria

BACKGROUND

National programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early childhood education) and in the political economic context (e.g. presence of external funding agencies). Context is shaped by the economy, population, religion, and poverty, which impact everyday lives. Considering these contexts, a roadmap was developed and validated. The aim of this paper is to report expert review and stakeholder validation to determine feasibility of the developed contextualised roadmap for two Nigerian states.

METHODS

A validation tool was developed and reviewed using three experts. The content review occurred in two rounds to obtain recommendation and revisions of the developed roadmap and the validation tool. A pilot test of the roadmap and validation tool was done using two stakeholders in South Africa. The roadmap and the validation tool were then sent to the stakeholders and potential end-users in Nigeria using electronic media. Two research assistants were also engaged to deliver and collect hard copies to those who preferred it.

RESULTS

Of the ten stakeholders invited, nine responded. All participants showed an adequate understanding of the roadmap as evidenced by the scores given. Responses regarding the translation of the roadmap to implementation varied. The majority (86,6%) either strongly agreed or agreed that the actions were translatable (43.0 and 43.6% respectively).

CONCLUSIONS

The final roadmap comprises of actions that are appropriate for the state's context. It is recommended that stakeholders or end-users of any programme must be involved in the validation of such contextual programmes to improve chances of success.

Relationship between nutrition knowledge, education and other determinants of food intake and lifestyle habits among adolescents from urban and rural secondary schools in Tyrol, Western Austria

Objective:

The aim of this study was to investigate the association of the number of hours of nutrition education and teachers’ qualifications with nutrition knowledge and dietary behaviour in students.

Design:

In this representative cross-sectional study, socio-demographic data, anthropometric measurements, socio-economic status (SES), physical fitness, nutrition knowledge and eating habits were assessed. Differences between groups were tested by χ² and t tests. Multiple linear and logistic regression modelling was used to examine the relationship between demographic characteristics, lifestyle and dietary behaviours, nutrition knowledge, nutrition-trained teachers and number of nutrition lessons.

Setting:

Sixteen secondary schools in urban (n 6) and rural regions (n 10) of Tyrol, Western Austria.

Participants:

Students (n 513) aged 14·2 (sd 0·7) years.

Results:

Higher nutrition knowledge was significantly associated with attending rural school (P = 0·001), having no migration background (P < 0·001), (very) good physical activity behaviour (P = 0·040), non-trained teacher (P = 0·006) but higher number of hours of nutrition education (P = 0·013). Regression models showed that higher nutrition knowledge was independently associated with lower intake of meat and iced tea and higher intake of vegetables and plant-based oils. A higher amount of nutrition education (h/week) was significantly associated with higher intake of dark (wholegrain) bread, lower intake of meat and of energy drinks sweetened with sweeteners.

Conclusions:

Our results suggest that more hours in nutrition education result in higher nutrition knowledge and greater nutrition literacy, which may lead to health-promoting dietary habits. School-based nutrition education can be seen as preventive measure to increase nutritional competences in adolescents independent of their SES.

Serious Games for Nutritional Education: Online Survey on Preferences, Motives, and Behaviors Among Young Adults at University

Background

Data on nutritional information and digital gameplay are limited among young adults in Germany.

Objective

This survey aimed to gather data on nutritional information sources and digital games for nutritional education (preferences, motives, and behaviors) among young adults at both Munich universities in Germany.

Methods

An online survey was developed by an multidisciplinary research group using EvaSys, an in-house survey software. The questionnaire (47 items) covered questions about baseline characteristics (eg, housing situation and weight), nutrition (eg, nutritional information sources), and digital (nutritional) gameplay (eg, preferences, motives, and behaviors). A feedback field was also provided. This publication is based on a selection of 20 questions (7 baseline characteristics, 2 nutrition, 11 gameplay). Young adults, primarily Munich university students aged from 18 to 24 years, were invited to participate by digital and nondigital communication channels between 2016 and 2017. Statistical analyses were performed using Excel 2013 (Microsoft Corp) and R version 3.1.3 (R Foundation for Statistical Computing).

Results

In total, 468 young adults (342/468, 73.1% women; 379/468, 81.0% university students) participated. Most of the participants (269/468, 57.5%) were aged 18 to 24 years with a BMI in the normal weight range (346/447, 77.4%). Mean body weight was 65.5 [SD 14.0] kg. Most participants reported getting nutritional information from the internet (372/467, 79.7%) and printed media (298/467, 63.8%), less than 1.0% (2/467, 0.4%) named digital games. Apps (100/461, 21.7%) and university/workplace (146/461, 31.7%) were the most desired sources for additional information about nutrition, while 10.0% (46/461, 10.0%) of participants stated wanting digital games. Almost two-thirds (293/468, 62.6%) of participants played digital games, while one-fifth (97/456, 21.3%) played digital games daily using smartphones or tablets. Finally, most respondents (343/468, 73.3%), mainly women, expressed interest in obtaining nutritional information during digital gameplay. However, significant gender differences were shown for nutritional acquisition behaviors and digital gameplay preferences, motives, and behaviors.

Conclusions

Our survey population reported playing digital games (especially men) and wanting nutritional information during digital gameplay (especially women). Furthermore, university or workplace are named as preferred settings for nutritional information. Therefore, a digital game app might have the potential to be a tool for nutritional education among young adults within the university or workplace environment.