Evaluation of the food store environment on and near the campus of 15 postsecondary institutions

Availability and consumption of hyper-palatable foods in an all-you-can-eat cafeteria among college freshmen

INTRODUCTION

College campuses provide an expansive food environment, which may contribute to elevated risk of excess energy intake and weight gain among college students. All-you-can-eat style cafeterias often expose students to hyper-palatable foods (HPF), which may promote overeating. This study aimed to examine the availability of HPF in an all-you-can-eat college cafeteria, and to examine HPF intake during meals among undergraduates.

METHOD

Publicly available cafeteria menu data from a Midwestern university were analyzed and included 25 meals. To determine the availability of HPF within the cafeteria meals, the standardized definition of HPF by Fazzino et al. (2019) was used, which specifies combinations of palatability-inducing nutrients at quantitative thresholds that may induce hyper-palatability. Participants (N = 225) who ate in the cafeteria in the past 24 h were presented with a list of all menu items for their corresponding cafeteria meal, and self-reported all items consumed.

RESULTS

On average, 40 % (SD = 1.4) of total food items available per meal were HPF, with 68 % (SD = 3.6) of items with elevated fat and sodium. Regarding intake of HPF among students, approximately 64 % (SD = 31.4) of foods consumed were HPF, and 51 % (SD = 32.3) of items consumed had elevated fat and sodium.

CONCLUSION

Findings indicated that college students may be regularly exposed to HPF in all-you-can-eat college cafeteria environments, and that students may consume cafeteria meals that are primarily comprised of HPF.

Advancing college food security: priority research gaps

Despite over a decade of both quantitative and qualitative studies, food insecurity among US college/university students remains a pervasive problem within higher education. The purpose of this perspective piece was to highlight research gaps in the area of college food insecurity and provide rationale for the research community to focus on these gaps going forward. A group of food insecurity researchers from a variety of higher education institutions across the United States identified five thematic areas of research gaps: screening and estimates of food insecurity; longitudinal changes in food insecurity; impact of food insecurity on broader health and academic outcomes; evaluation of impact, sustainability and cost effectiveness of existing programmes and initiatives; and state and federal policies and programmes. Within these thematic areas, nineteen specific research gaps were identified that have limited or no peer-reviewed, published research. These research gaps result in a limited understanding of the magnitude, severity and persistence of college food insecurity, the negative short- and long-term impacts of food insecurity on health, academic performance and overall college experience, and effective solutions and policies to prevent or meaningfully address food insecurity among college students. Research in these identified priority areas may help accelerate action and interdisciplinary collaboration to alleviate food insecurity among college students and play a critical role in informing the development or refinement of programmes and services that better support college student food security needs.

Assessing the Healthfulness of University Food Environments: A Systematic Review of Methods and Tools

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

Analysis of adherence to a healthy lifestyle among vegetarian and non-vegetarian Peruvian university students: A cross-sectional survey

BACKGROUND

Evidence shows that a healthy lifestyle can promote physical and mental well-being in the general population. However, there are few studies that assess the adherence to a healthy lifestyle in vegetarian and non-vegetarian university students. The purpose of this study was to evaluate the differences in adherence to a healthy lifestyle between vegetarian and non-vegetarian university students in Peru.

METHODS

A cross-sectional study was carried out considering data from 6,846 students selected by non-probabilistic convenience sampling. The Diet and Healthy Lifestyle Scale (DEVS), the Peruvian validation of the Vegetarian Lifestyle Index (VLI), was used. In addition, sociodemographic and anthropometric data such as weight and height were collected. Body mass index (BMI) was also calculated.

RESULTS

Semi-vegetarian and vegetarian students had a high healthy lifestyle score compared to non-vegetarians. In addition, vegetarian diets showed a significantly higher proportion among students with a lower BMI (normal and underweight). Students with excess body weight (overweight and obesity) were less likely to report healthy lifestyle. In the overall population analyzed, it was observed that the levels of health and lifestyle behaviors, such as daily exercise and sunlight exposure, were mostly moderate and low. Additionally, sweets intake was high, while healthy food consumption such as fruits, vegetables, legumes, and whole grains was low.

CONCLUSION

The current findings show that although vegetarians had better adherence to a healthy lifestyle, interventions in the university setting are needed to improve healthy lifestyle in university students.

Consumer nutrition environment measurements for nutrient-dense food availability and food sustainability: a scoping review

Consumer nutrition environments are defined as places in which consumers interact with the food they eat; these food choices can impact human and planetary health. Assessment measures for consumer nutrition environments are numerous, and vary widely on what, and how, they assess the food environment. The objective of this scoping review was to synthesize existing evidence on nutrition environment measurements and their capacity to assess nutrient-dense food access and food sustainability capacity. Eligibility criteria were developed to capture relevant peer-reviewed literature about auditing measures designed to assess nutrient-dense foods and food sustainability capacity in the consumer nutrition environment. A search strategy was conducted to collect articles published between January 1, 2002-June 4, 2022, using PubMed, Web of Science, Scopus, PsycINFO and the Cochrane library electronic databases. After screening 2457 manuscripts, 58 met inclusion criteria. Study aims, funding source(s), types of retailers assessed, assessment format and name, constructs measured, food categories measured, assessment of validity and/or reliability, and other relevant data were extracted from each manuscript. Results showed that most measures use checklists, surveys, questionnaires or similar methods to assess availability, quality, and price of select food items as assessment constructs. Most do not assess nutrient-dense food availability, and even fewer assess food sustainability. Development of comprehensive, reliable, and valid consumer nutrition environment measures that assess nutrient-dense food availability and food sustainability is important for research, planning, evaluation and advocacy aimed at improving consumer food environments for human and planetary health.

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.

Health, health behaviors, and medical care utilization among college students with obesity

Objective: The study assessed perceived health, health behaviors and conditions, and medical care utilization among students of different weight categories. Participants: Participants were college students (n = 37,583) from 58 institutions who responded to a national survey of student health behaviors. Methods: Chi-squared and mixed model analyses were completed. Results: Compared to healthy weight students, those with obesity were less likely to report excellent health and meet dietary and physical activity recommendations, and more likely to have obesity-related chronic conditions and to have attended a medical appointment in the prior 12 months. Students with obesity (84%) and overweight (70%) were more likely to be attempting weight loss compared to students of healthy weight (35%). Conclusions: Students with obesity have poorer health and health behaviors relative to students of healthy weight; students with overweight were in between. Adapting and implementing evidence-based weight management programs within colleges/universities may be beneficial for student health.

Content validity and reliability of a university food environment assessment instrument

This study aimed to evaluate the content validity and reliability of an instrument for evaluating the university food environment. A checklist was developed to assess establishments that sell food and beverages in the university environment. The content validation encompassed the development of the instrument, expert evaluation and pretest performance. Reliability was evaluated using a convenience sample (n=64) of establishments distributed across seven campuses of three public universities and was carried out using interobserver (IO) and test-retest (TR) evaluations. Categorical and count variables were analyzed by calculating the percentage agreement (PA), kappa coefficient (k) and prevalence-adjusted, bias-adjusted kappa (ka), and continuous variables were analyzed by the intraclass correlation coefficient (ICC). The checklist consisted of 204 items distributed in seven domains. The instrument's performance was considered excellent or very good for 91.3% (PA) of the items when evaluated. For IO, 68.3% (k) and 96.5% (ka) had excellent, very good or good agreement, while for TR, 65% (k) and 96.5% (ka) had excellent agreement. The instrument showed satisfactory content validity and reliability for characterizing the food environment at Brazilian universities.

On-campus food environment, purchase behaviours, preferences and opinions in a Norwegian university community

OBJECTIVE

To assess the food environment at OsloMet, through the nutritional profile and processing level of available commercial foods and drinks, as well as to determine food-purchasing behaviours, preferences and opinions on the food environment, in order to identify whether interventions on campus need to be conducted.

DESIGN

Cross-sectional descriptive study.

SETTING

Pilestredet and Kjeller campus of OsloMet (Norway).

PARTICIPANTS

To analyse the nutritional profile of products offered at all food outlets (seven canteens, three coffee shops and two vending machines) at the main campuses three criteria were applied: those proposed by the Spanish Agency for Food Safety and Nutrition, the UK nutrient profiling model and those of the Food and Drink Industry Professional Practices Committee Norway. In addition, products were classified by processing level, using the NOVA system. Food purchasing, food choice behaviours and opinions were analysed through a survey online, in which 129 subjects participated.

RESULTS

With regard to the first of the objectives, the combination of the above-mentioned criteria showed that 39·8 % of the products were 'unhealthy' and 85·9 % were 'ultra-processed'. Regarding the second objective, the most important determinants of food choice were taste, convenience, and cost and nutrition/health value. The most common improvements suggested were lowering the cost, improving the allergen information on labelling and increasing the variety of fresh and healthy foods.

CONCLUSIONS

A high proportion of the products offered were considered 'unhealthy' and highly processed. Interventions that improve food prices, availability and information on labelling would be well-received in this community.

Life of a vegetarian college student: Health, lifestyle, and environmental perceptions

Objective To examine health behavior and environmental perception differences among vegetarian and nonvegetarian students. Participants: First-year university students (n = 1078) from eight United States universities. Methods: Data were obtained from base 2015 and followup 2016 assessments. Vegetarians and nonvegetarians were compared for anthropometrics, lifestyle behaviors, and campus environmental perceptions (CEPS). Results: Vegetarians had smaller waist circumference, lower systolic blood pressure, higher fruit and vegetable consumption, lower percentage of energy obtained from fat, and higher perceived stress. Vegetarians expressed a lower rating of perceptions of health policies on campus. Conclusion: A clear difference in indicators of physical health does not appear, however, vegetarian students show positive dietary patterns which can promote positive health outcomes. Further, vegetarians had lower perceptions of health policies on campus. Results can be used by administrators to ensure policies are in place to support health of students as currently vegetarian students see limitations in the environmental health policies.

Development of the University Food Environment Assessment (Uni-Food) Tool and Process to Benchmark the Healthiness, Equity, and Environmental Sustainability of University Food Environments

Globally, there is increasing interest in monitoring actions to create healthy, equitable and environmentally sustainable food environments. Currently, there is a lack of detailed tools for monitoring and benchmarking university food environments. This study aimed to develop the University Food Environment Assessment (Uni-Food) tool and process to benchmark the healthiness, equity, and environmental sustainability of food environments in tertiary education settings, and pilot test its implementation in three Australian universities in 2021. The Uni-Food tool development was informed by a review of the literature and input from an expert advisory panel. It comprises three components: (1) university systems and governance, (2) campus facilities and environments, and (3) food retail outlets. The process for implementing the tool is designed for universities to self-assess the extent to which they have implemented recommended practice in 68 indicators, across 16 domains, weighted based on their relative importance. The pilot implementation of the tool identified moderate diversity in food environments across universities and highlighted several opportunities for improvements at each institution. The assessment process was found to be reliable, with assessors rating the tool as easy to use, requiring minimal resources. Broad application of the tool has the potential to increase accountability and guide best practice in tertiary education and other complex institutional settings.

Toward a Healthy and Environmentally Sustainable Campus Food Environment: A Scoping Review of Postsecondary Food Interventions

Interventions are urgently needed to transform the food system and shift population eating patterns toward those consistent with human health and environmental sustainability. Postsecondary campuses offer a naturalistic setting to trial interventions to improve the health of students and provide insight into interventions that could be scaled up in other settings. However, the current state of the evidence on interventions to support healthy and environmentally sustainable eating within postsecondary settings is not well understood. A scoping review of food- and nutrition-related interventions implemented and evaluated on postsecondary campuses was conducted to determine the extent to which they integrate considerations related to human health and/or environmental sustainability, as well as to synthesize the nature and effectiveness of interventions and to identify knowledge gaps in the literature. MEDLINE (via PubMed), CINAHL, Scopus, and ERIC were searched to identify articles describing naturalistic campus food interventions published in English from January 2015 to December 2019. Data were extracted from 38 peer-reviewed articles, representing 37 unique interventions, and synthesized according to policy domains within the World Cancer Research Foundation's NOURISHING framework. Most interventions were focused on supporting human health, whereas considerations related to environmental sustainability were minimal. Interventions to support human health primarily sought to increase nutrition knowledge or to make complementary shifts in food environments, such as through nutrition labeling at point of purchase. Interventions to support environmental sustainability often focused on reducing food waste and few emphasized consumption patterns with lower environmental impacts. The implementation of integrated approaches considering the complexity and interconnectivity of human and planetary health is needed. Such approaches must go beyond the individual to alter the structural determinants that shape our food system and eating patterns.

The Healthfulness of Eateries at the University of Waterloo: A Comparison across 2 Time Points

Purpose: The aim of this study was to assess the healthfulness of a sample of campus eateries at 2 time points, 2 years apart. Methods: Five eateries at the University of Waterloo were audited using the Nutrition Environment Measures Survey adapted for university campuses (NEMS-UC) in 2015 and late 2017-early 2018. Based on the availability of healthy options and facilitators of and barriers to healthy eating, possible NEMS-UC scores ranged from -5 to 23 points. Results: Scores were low, ranging from 7 to 14 (mean = 10.8, SD = 2.59) points in 2015 and 7 to 13 (mean = 9.6, SD = 2.19) points in 2017-2018. For all eateries except 1 residence cafeteria, scores at time 2 were the same or lower than scores at time 1. All venues carried whole fruit and vegetable options and lower-fat milks, and most offered whole-wheat options. However, healthier items were often located in low-traffic areas, priced higher than less healthy options, and sometimes limited to prepackaged items. Misleading health messaging was also evident. Conclusions: Increased availability, accessibility, and visibility of healthy offerings is needed to enhance campus food environments and support healthy eating patterns, while barriers such as contradictory messaging should be minimized.

eB4CAST Approach Improves Science Communication With Stakeholders in a College-Based Health Program

Communicating scientific results with community partners is often lacking in intervention programs, thus eB4CAST was developed to facilitate impact sharing. This article investigated using the eB4CAST dissemination tool to communicate impact from a campus-based obesity prevention program. Data from Get Fruved RCT university sites collected at baseline were used to generate eB4CAST reports. Experts (n = 13) and RCT sites (n = 15) were asked to provide feedback on eB4CAST reports based on appeal, understanding, and clarity. On all Likert items, participants rated above 7 on each (out of 10). Positive responses from open-ended questions included eB4CAST reports being clear, visually appealing, and aid in program understanding. Overall, eB4CAST was successful in relaying data and information for the Get Fruved program, thus a means for science communication that could be used in interventions. Utilizing infographics to report data and information is a feasible way to disseminate and communicate in a cost-effective, timely manner.

A free-produce stand on campus: impact on fruit and vegetable intake in Dutch university students

OBJECTIVE

To investigate the effects of providing free fruit and snack vegetables at a university on students' fruit intake, snack vegetable intake and total vegetable intake.

DESIGN

Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university's main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires.

SETTING

A Dutch university of applied science.

PARTICIPANTS

Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students.

RESULTS

Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions.

CONCLUSIONS

Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes.

Development and Validation of a Simple Convenience Store SHELF Audit

Background This paper describes the development, reliability, and convergent validity of a practical tool—the Convenience Store Supportive Healthy Environment for Life-Promoting Food (SHELF) Audit. Methods Audit items included: a variety of fresh, processed, and frozen fruits and vegetables; low-fat dairy products; healthy staples and frozen meals; healthy food incentive programs; items sold in check-out areas; portion/cup sizes; and pricing. Each audit item was scored using a five-point semantic-differential scale (1 = provides little or no support for healthful foods to 5 = provides high support for healthful foods). Convergent validity was examined by comparing the SHELF audit to Ghirardelli et al. and Laska et al. store audits. Statistical analysis included: Factor analysis, ANOVA, and Spearman correlations. Results SHELF included three factors: a Fruits/Vegetables scale (eight items, α = 0.79; total potential points = 34); a Healthy Foods scale (four items, α = 0.72; total potential points = 16); and a Supports scale (four items, α = 0.685; total potential points = 16). Only 6% of the 124 convenience stores assessed scored in the most healthful range (46–66). The assessed drug stores (n = 15) scored higher than convenience stores (n = 81) on the Healthy Foods and Supports scales but not the Fruits/Vegetables scale. The SHELF sub-scores were highly correlated with other audit tools indicating convergent validity. Conclusion The SHELF convenience store audit is a valid, reliable tool for assessing the degree to which convenience stores support healthfulness regarding Fruits/Vegetables, Healthy Foods, and Supports for choosing healthy.

Appraisal of short and long versions of the Nutrition Environment Measures Survey (NEMS-S and NEMS-R) in Australia

OBJECTIVE

Research has begun to take a more ecological view of eating behaviour, examining multiple levels of influence: personal, social and environmental. The food environment is a major influence on eating behaviour, attracting the attention of researchers who have measured it in a number of ways. The present paper examines the short-form version, in comparison to the long-form version, of the Nutrition Environment Measures Survey (NEMS) - an observational food outlet audit tool.

DESIGN

Both the short-form and long-form were examined to qualitatively appraise the dimensions of the food environment assessed by each measure. Data from 135 food outlets in Australia were then used to compare results obtained using the short-form with the results from the long-form method, to consider the utility of the short-form measure.

SETTING

The retail food environment in Australia.ParticipantsOne hundred and thirty-five food outlets in Australia.

RESULTS

Results indicate that the short-form predominantly assessed availability of healthful foods (one aspect of the food environment). Several critical dimensions of the food environment known to influence eating behaviour were not assessed. For this data set, the short-form produced scores inconsistent with the longer version of the measure, delivering inflated estimates for stores and deflated estimates for restaurants.

CONCLUSIONS

Scores between the long-form and short-form versions were not comparable in this Australian study. Further development of food environment measures is recommended and must balance instrument brevity with the need to accurately capture important aspects of the food environment known to influence eating behaviour.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores

Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. Results: Controlling for gender, HMI was negatively associated with SSBs (β = −0.859) and %kcal/fat (β = −1.057) and positively with whole-grains (β = 0.186) and fruits/vegetables intake (β = 0.267); %Kcal/fat was positively (β = 0.098) and fruits/vegetables intake (β = −0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (β = 0.214, β = 0.129) and directly/negatively to BMI (β = −2.657, β = −1.124). Conclusions: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

eB4CAST: An Evidence-Based Tool to Promote Dissemination and Implementation in Community-Based, Public Health Research

eB4CAST, evidence-Based forecast C-capture, A-assemble, S-sustain, T-timelessness (eB4CAST), framework was developed from existing dissemination and implementation (D & I) constructs as a dissemination tool to promote community-based program usability and future application in targeted populations. eB4CAST captures and transforms research findings into a dissemination report that shows program need and impact to endorse program continuation and expansion. This is achieved through direct and indirect data collection of community factors and program impact that can showcase the need for program sustainability and potential for future dissemination sites. Testimonials, individual feedback, and program process and outcomes contribute to the direct data while data collected from census, county, and state databases and reports allow for indirect information to be captured and analyzed. Capturing data in the two levels allow eB4CAST to forecast program need and highlight program impact through a footprint. eB4CAST framework for dissemination tool creation is organized into four sections: Capture, Assemble, Sustainability, and Timelessness. Capture encompasses the collection of indirect and direct data related to intervention goals. Assemble is the compilation of the data into a visually appealing and easily understood media. Sustainability encourages the use of dissemination tools to provide forecast of program need and footprint of program impact back to community participants, program leaders, and key stakeholders to endorse program sustainability. Lastly, timelessness encourages cyclic movement through these constructs to continue program monitoring and data sharing to ensure timeless program evaluation and conformation to change in needs. The eB4CAST framework provides a systematic method to capture justification of program need and impact of community-based research that can be modified to fit diverse public health interventions providing a necessary D & I tool.

A Community Based Participatory Approach to Training Young Adults to Design and Implement a Social Marketing Framed Lifestyle Intervention on Their College Campus

Background: Using a Community-Based Participatory Research (CBPR) approach may increase the likelihood of relevance and acceptability of the designed intervention, especially on a college campus. Furthermore, recruiting and training college students to design a social marketing framed healthy lifestyle intervention for their peers will allow the intervention to be tailored to the needs of the campus. Objectives: To describe the process of online-course training college students to develop a campus-based, social marketing health promotion intervention. Methods: Four universities recruited current college students (18+ y.o.) to develop a social marketing and environmental intervention (SMEI), which was completed during a 16-week, online/in-person hybrid semester course. Researchers and Extension professionals trained students to design 24 weeks of intervention events that would be implemented the upcoming year. Results: Seventy-eight students enrolled in the study and social marketing and environmental intervention course among the four intervention states (Florida = 30, South Dakota = 8, Tennessee = 13, West Virginia = 27); students were predominately Caucasian (65.8%), females (84.0%), and sophomore status in college (64.9%). Throughout the semester, students assessed their campus environments, set priorities, and developed weekly events and resources needed to implement the intervention on their campuses. By the end of the semester, with researcher support, students had designed 24 weeks of intervention events (marketing, recruiting, and implementation) focusing on nutrition/food/diet, physical activity, stress management, sleep, and time management. These events and resources were catalogued into a digital toolkit of instructions and activities for each week of intervention events. Conclusion: Using a Community-Based Participatory Research approach with college students interested in health allows for the development of an intervention that stems from grass roots efforts and is tailored to the acceptability and needs of their peers.

Indicators of the relative availability of healthy versus unhealthy foods in supermarkets: a validation study

Background

In-store availability of healthy and unhealthy foods may influence consumer purchases. Methods used to measure food availability, however, vary widely. A simple, valid, and reliable indicator to collect comparable data on in-store food availability is needed.

Methods

Cumulative linear shelf length of and variety within 22 healthy and 28 unhealthy food groups, determined based on a comparison of three nutrient profiling systems, were measured in 15 New Zealand supermarkets. Inter-rater reliability was tested in one supermarket by a second researcher. The construct validity of five simple indicators of relative availability of healthy versus unhealthy foods was assessed against this ‘gold standard’.

Results

Cumulative linear shelf length was a more sensitive and feasible measure of food availability than variety. Four out of five shelf length ratio indicators were significantly associated with the gold standard (ρ = 0.70–0.75). Based on a non-significant difference from the ‘gold standard’ (d = 0.053 ± 0.040) and feasibility, the ratio of cumulative linear shelf length of fresh and frozen fruits and vegetables versus soft and energy drinks, crisps and snacks, sweet biscuits and confectionery performed best for use in New Zealand supermarkets.

Conclusions

Four out of the five shelf length ratio indicators of the relative availability of healthy versus unhealthy foods in-store tested could be used for future research and monitoring, but additional validation studies in other settings and countries are recommended. Consistent use of those shelf length ratio indicators could enhance comparability of supermarket food availability between studies, and help inform policies to create healthy consumer food retail environments.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0512-0) contains supplementary material, which is available to authorized users.

Developing a Questionnaire to Evaluate College Students' Knowledge, Attitude, Behavior, Self-efficacy, and Environmental Factors Related to Canned Foods

OBJECTIVE

Develop a questionnaire to measure students' knowledge, attitude, behavior, self-efficacy, and environmental factors related to the use of canned foods.

METHODS

The Knowledge-Attitude-Behavior Model, Social Cognitive Theory, and Canned Foods Alliance survey were used as frameworks for questionnaire development. Cognitive interviews were conducted with college students (n = 8). Nutrition and survey experts assessed content validity. Reliability was measured via Cronbach α and 2 rounds (1, n = 81; 2, n = 65) of test-retest statistics. Means and frequencies were used.

RESULTS

The 65-item questionnaire had a test-retest reliability of .69. Cronbach α scores were .87 for knowledge (9 items), .86 for attitude (30 items), .80 for self-efficacy (12 items), .68 for canned foods use (8 items), and .30 for environment (6 items).

CONCLUSIONS AND IMPLICATIONS

A reliable questionnaire was developed to measure perceptions and use of canned foods. Nutrition educators may find this questionnaire useful to evaluate pretest-posttest changes from canned foods-based interventions among college students.

Measures of the food environment: A systematic review of the field, 2007-2015

BACKGROUND

Many studies have examined the relationship between the food environment and health-related outcomes, but fewer consider the integrity of measures used to assess the food environment. The present review builds on and makes comparisons with a previous review examining food environment measures and expands the previous review to include a more in depth examination of reliability and validity of measures and study designs employed.

METHODS

We conducted a systematic review of studies measuring the food environment published between 2007 and 2015. We identified these articles through: PubMed, Embase, Web of Science, PsycINFO, and Global Health databases; tables of contents of relevant journals; and the National Cancer Institute's Measures of the Food Environment website. This search yielded 11,928 citations. We retained and abstracted data from 432 studies.

RESULTS

The most common methodology used to study the food environment was geographic analysis (65% of articles) and the domination of this methodology has persisted since the last review. Only 25.9% of studies in this review reported the reliability of measures and 28.2% reported validity, but this was an improvement as compared to the earlier review. Very few of the studies reported construct validity. Studies reporting measures of the school or worksite environment have decreased since the previous review. Only 13.9% of the studies used a longitudinal design.

CONCLUSIONS

To strengthen research examining the relationship between the food environment and population health, there is a need for robust and psychometrically-sound measures and more sophisticated study designs.

Description, measurement and evaluation of tertiary-education food environments

Obesity in young adults is an increasing health problem in Australia and many other countries. Evidence-based information is needed to guide interventions that reduce the obesity-promoting elements in tertiary-education environments. In a food environmental audit survey, 252 outlets were audited across seven institutions: three universities and four technical and further education institutions campuses. A scoring instrument called the food environment-quality index was developed and used to assess all food outlets on these campuses. Information was collated on the availability, accessibility and promotion of foods and beverages and a composite score (maximum score=148; higher score indicates healthier outlets) was calculated. Each outlet and the overall campus were ranked into tertiles based on their ‘healthiness’. Differences in median scores for each outcome measure were compared between institutions and outlet types using one-way ANOVA with post hoc Scheffe’s testing, χ2 tests, Kruskal–Wallis H test and the Mann–Whitney U test. Binomial logistic regressions were used to compare the proportion of healthy v. unhealthy food categories across different types of outlets. Overall, the most frequently available items were sugar-sweetened beverages (20 % of all food/drink items) followed by chocolates (12 %), high-energy (>600 kJ/serve) foods (10 %), chips (10 %) and confectionery (10 %). Healthy food and beverages were observed to be less available, accessible and promoted than unhealthy options. The median score across all outlets was 72 (interquartile range=7). Tertiary-education food environments are dominated by high-energy, nutrient-poor foods and beverages. Interventions to decrease availability, accessibility and promotion of unhealthy foods are needed.

Assessment of a University Campus Food Environment, California, 2015

Introduction

University campuses offer an opportunity to study the extent to which modifying the food environment influences eating, but in-depth characterizations of campus food environments are needed to identify potential targets for intervention. The objective of this project was to describe the availability, accessibility, and quality of healthful food choices in dining venues and food stores at or near a public, 4-year university in California.

Methods

Trained assessors used the Nutrition Environment Measures Survey for campus dining (NEMS-CD) to evaluate all 18 campus dining venues, and NEMS for stores (NEMS-S) to evaluate 2 on-campus and 37 off-campus food stores. We calculated prevalence of healthful and unhealthful constructs (eg, availability of selected food items, presence of signage encouraging healthful eating, pricing options that encourage healthful eating), based on the NEMS and compared scores across different types of venues.

Results

NEMS-CD scores ranged from 4 to 47 (mean [SD], 26.0 [14.4]) out of a possible maximum score of 97; 12% of entrées and 36% of main dish salads served in these venues were classified as healthful. NEMS-S score for the 2 on-campus food stores (24 for both) was intermediate between off-campus convenience stores (mean [SD], 12.0 [5.3]) and grocery/supermarket stores (mean [SD], 31.1 [10.0]), with a possible maximum score of 54.

Conclusion

Standardized environmental evaluation provides insights into both positive and negative aspects of campus community food venues. Environmental assessment identifies potential targets for modification and baseline data for designing and implementing action-oriented research aimed at improving the campus food environment’s support of healthful food choices for college students.

Concordance of self-report and measured height and weight of college students

OBJECTIVE

This study examined associations between college students' self-report and measured height and weight.

METHODS

Participants (N = 1,686) were 77% white, 62% female, aged 18-24 years (mean ± SD, 19.1 ± 1.1 years), and enrolled at 8 US universities. Body mass index (BMI) was calculated for self-report (via online survey); trained researchers measured height and weight and categorized them as normal (18.5 to < 25), overweight (25 to < 30), obese (30 to < 35), and morbidly obese (≥ 35).

RESULTS

Concordance of self-report vs objectively measured BMI groups using chi-square revealed that 93% were accurate, 4% were underestimated, and 2.7% were overestimated. Pearson correlations and adjusted linear regression revealed significant associations between self-report and measured BMI (r = .97; P < .001) and BMI adjusted for age, gender, and race/ethnicity (R² = .94). Concordance was also high between BMI categories (kappa = 0.77; P < .001).

CONCLUSIONS AND IMPLICATIONS

Findings provide support for the utility of self-report height and weight for survey research in college students.

Development of Young Adults Eating and Active for Health (YEAH) internet-based intervention via a community-based participatory research model

OBJECTIVE

To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model.

DESIGN

Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery.

RESULTS

Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed.

CONCLUSIONS AND IMPLICATIONS

Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.

Coronary heart disease risk factors in college students

More than one-half of young adults aged 18-24 y have at least 1 coronary heart disease (CHD) risk factor and nearly one-quarter have advanced atherosclerotic lesions. The extent of atherosclerosis is directly correlated with the number of risk factors. Unhealthy dietary choices made by this age group contribute to weight gain and dyslipidemia. Risk factor profiles in young adulthood strongly predict long-term CHD risk. Early detection is critical to identify individuals at risk and to promote lifestyle changes before disease progression occurs. Despite the presence of risk factors and pathological changes, risk assessment and disease prevention efforts are lacking in this age group. Most young adults are not screened and are unaware of their risk. This review provides pathological evidence along with current risk factor prevalence data to demonstrate the need for early detection. Eighty percent of heart disease is preventable through diet and lifestyle, and young adults are ideal targets for prevention efforts because they are in the process of establishing lifestyle habits, which track forward into adulthood. This review aims to establish the need for increased screening, risk assessment, education, and management in young adults. These essential screening efforts should include the assessment of all CHD risk factors and lifestyle habits (diet, exercise, and smoking), blood pressure, glucose, and body mass index in addition to the traditional lipid panel for effective long-term risk reduction.

Using PRECEDE to develop a weight management program for disadvantaged young adults

OBJECTIVE

To conduct a needs assessment using the PRECEDE model for the development of a weight management program for low-income young adults.

DESIGN

Four phases were implemented using qualitative (focus groups and interviews) and quantitative (survey) methodologies, with steering committee guidance.

SETTING

Northeastern residential vocational center.

PARTICIPANTS

Convenience sample of low-income young adults, 18-24 years old (total n = 203), who were attending a job training vocational center.

PHENOMENON OF INTEREST

General themes of life satisfaction determinants and issues related to weight, self-reported weight and related behavior, existing environmental supports, and desired changes of behavioral and environmental influences of weight.

ANALYSIS

Content analysis of qualitative data; descriptive analysis and Student t test.

RESULTS

Self-image and discrimination were themes for weight issues. More than half of participants were overweight or obese (57%) and had low levels of physical activity (58%). Self-reported fruit and vegetable intake was inadequate (<2.5 cups/d). Identified environmental factors most needing improvement were accessibility for walking and biking and availability of healthful food. Participants reported exercising, getting adequate sleep, eating healthful snacks, and effectively managing stress as behavior they were willing to change.

CONCLUSIONS AND IMPLICATIONS

The PRECEDE model was useful to identify concerns, priorities, and modifiable factors among a young adult community that can increase the relevancy of a weight management program.

PACES: a Physical Activity Campus Environmental Supports Audit on university campuses

PURPOSE

This study evaluated the policy and built and recreation environmental supports for physical activity on 13 university campuses.

DESIGN

Environmental audit survey.

SETTING

Thirteen U.S. universities, 2009. Subjects. University policies, recreation programs and facilities, and at least five additional buildings per campus.

MEASURES

The Physical Activity Campus Environmental Supports Audit was developed for this study.

ANALYSIS

Analysis of variance with post hoc Tukey's B and χ(2) assessed differences by institution and building type.

RESULTS

The mean obesogenic policy score was significantly lower than the desired score, ≥7 (p = .002), with only one campus scoring 10. The mean built environment audit score (5.4 ± 1.7) was low, with significant differences between institutions (p < .001) and only three campuses scoring above the desired score, ≥7. Although generally stairwells were clean and well lighted, there was a lack of signage to encourage stair use (p < .001). Overall, recreation programs (7.1 ± .7) and facilities (7.1 ± 1.2) scored well, but amenities scores were lower for satellite (2.8 ± 1.6) versus main (4.1 ± 1.8) recreation facilities (p = .04).

CONCLUSION

On these 13 university campuses, recreation programs and facilities were supportive of healthful lifestyles for obesity prevention, but policies and the built environment were not. This physical activity environmental audit survey requires testing in a wider sample of postsecondary institutions to corroborate its utility and provide evidence to support initiatives to improve campus environments for physical activity.