What’s for Lunch? Examining the Factors Associated with Food Choices and Food Insecurity Among CUNY College Students- A Mixed Methods Study

Background: The growing rates of food insecurity in college students points to the need to examine food choices within the context of a socio-ecological framework with an emphasis on the contribution of financial constraints and limited food access on food-based decisions. Methods: A mixed-methods study design using both primary and secondary data analysis was developed for this dissertation. Primary data examining undergraduate college students was collected on three CUNY campuses including: semi-structured in-depth interviews (N=33), computerized 24-hour dietary recalls using the ASA24 program (N=45), three focus groups (N=26) with students who utilize on-campus food assistance programs, and key informant interviews (N=5) with staff who work with the food assistance programs on campus. Secondary data analysis was conducted using the 2017 Health CUNY Health Survey, administered across the twenty five campuses that comprise the City University of New York public university system to examine the relationship between household income and food insecurity status. Results: Student Interviews: Participants reported many individual, social environmental, community and institutional level factors involved in food choices. Time and financial constraints, as well as the role of family and peer relationships are major factors associated with food decision making for undergraduate students. Students consistently reported being unsatisfied with campus dining venues, primarily stating high prices and lack of variety and quality as reasons for avoiding campus cafeterias.Computerized 24-hour Dietary Recalls: ASA24 recalls revealed limited statistically significant differences in dietary intake among students, likely due to small sample size. Students who used food assistance programs consumed smaller amounts of protein than those who did not (mean difference= 22.970, p\u3c0.05). Students who reported to being worried about running out of food consumed less carbohydrates (Spearman rho=-.323, p\u3c0.05) and sugar intake (Spearman rho= -.318, P\u3c0.05) than students who did not worry about running out of food. Focus Groups: Five themes, related to the needs of food insecure students emerged: financial stressors, eating strategies, struggling to feed dependent children, utilization of university-based food assistance programs, and enrollment in the Supplemental Nutrition Assistance Program (SNAP). Key Informant Interviews: The key informant interviews revealed six strategies that have been put in place to create effective food assistance programs for students: increasing access, securing funding, procurement/distribution of healthy foods, partnerships, outreach, and decreasing stigmatization. 2017 Healthy CUNY Health Survey: Multiple linear regression analysis revealed that the family income category of less than $30,000 per year increased risk of food insecurity by 11% . Conclusion: These studies fill in the gaps on food insecurity and dietary intake in college students who attend large universities in urban neighborhoods. Time and financial constraints play a major role in food-based decisions for college students, system-level changes that allow for students to meet their basic needs of nourishment. This includes changes to campus dining to include healthy food items that are affordable and appealing to students. It was found that food insecurity is a significant problem for students with an annual household income of below $30,000. This highlights the need for necessary policy changes that allow increased access to food for college students, such as changing eligibility requirements for SNAP and providing free meals on-campus to students in need. The food assistance programs at CUNY have been successful in providing support for students and are well-rated by program users, however, a large population of students are unaware of these programs pointing to the need for a concerted outreach effort to increase utilization of the food assistance programs. Overall, this research builds on the body of literature on the factors associated with food intake and food insecurity in a diverse student population