Institutional Determinants of Food Insecurity and Dietary Behaviors Among Postsecondary Students in the United States: A Multilevel Analysis

Abstract

Background

US postsecondary education students have disproportionately high rates of food insecurity and sugar-sweetened beverage consumption, and low rates of fruit and vegetable consumption. No large-scale study has investigated institutional factors predictive of these public health challenges.

Objective

To examine whether institutional characteristics are predictive of food insecurity and dietary behaviors, including institutional minority designation, region, size, setting, Carnegie Classification, percentage of students living with family, and percentage of first-generation college students.

Design

Data were from the National College Health Assessment-III fall 2021 to fall 2022 cross-sectional surveys.

Participants and setting

Students (N = 129 295) from 204 US colleges and universities.

Main outcome measures

Self-reported food insecurity and consumption of 0 fruits (vs ≥ 1), 0 vegetables (vs ≥ 1), and ≥1 sugar-sweetened beverages (vs 0) daily.

Statistical analysis performed

Random-intercept Poisson multilevel models, adjusted for individual sociodemographic characteristics and institutional factors.

Results

The prevalence of food insecurity and of consuming 0 fruits, 0 vegetables, and ≥1 sugar-sweetened beverages daily was 40%, 16%, 11%, and 67%, respectively. Attending an institution that was predominantly White (vs minority serving), in the US South (vs Northeast/Midwest), with 10 percentage-points fewer students living with family, or 10 percentage-points more first-generation college students was associated with a 13% (95% CI 1.05 to 1.20), 9% (95% CI 1.02 to 1.15), 3% (95% CI 1.01 to 1.06), and 15% (95% CI 1.12 to 1.19) higher prevalence of food insecurity, respectively. Institutional factors associated with consuming 0 fruits, 0 vegetables, or ≥1 sugar-sweetened beverages daily included being located within the US South (fruits: prevalence ratio [PR] 1.13, 95% CI 1.06 to 1.20); sugar-sweetened beverages: PR 1.03, 95% CI 1.01 to 1.05), enrolling 10 000 to 19 999 students (fruits: PR 1.15, 95% CI 1.04 to 1.27; vegetables: PR 1.16, 95% CI 1.02 to 1.32) or ≥20 000 students (fruits: PR 1.12, 95% CI 1.01 to 1.25) vs <5000 students, or having a higher percentage of first-generation college students (vegetables: PR 1.07; 95% CI 1.03 to 1.12; sugar-sweetened beverages: PR 1.04, 95% CI 1.02 to 1.05).

Conclusions

Food insecurity and unhealthy dietary behaviors at US postsecondary institutions is a nationwide problem. Institutions with identified characteristics associated with these outcomes would benefit from efforts to promote access to healthy, affordable foods.