ABSTRACT

With food insecurity becoming an increasingly widespread issue among U.S college students, public health researchers have begun investigating potential socioeconomic determinants and health outcomes. To gain a better understanding of the issue at hand and what can plausibly be achieved to resolve it, this literature review will evaluate a selection of studies on different U.S college student populations and general U.S adult populations to reflect on how each publication corroborates one another with regards to food insecurity and its impact on the higher education student body. The latter set of populations will be taken into consideration because there is a shortage of current research surrounding negative health outcomes college students experience, especially as a result of their time as college students. This is due to a misconception among researchers that college students come from strong financial backgrounds that render them unlikely to suffer negative health outcomes from food insecurity; it is an idea that has existed since the 1600s (2). Out of the existing literature on food insecurity among U.S college students, an ample fraction suggests that it may originate from the imposed financial responsibility of covering university tuition and off campus housing with a low income job while handling the social expectations of attending college and studying full-time. The studies also agree that these strenuous obligations may lead to an increase in cardiovascular disease, obesity, diabetes, and mental health disorders like depression and anxiety. This paper serves to raise awareness about food insecurity and its impact on the higher education student body and recommend a course of action for research organizations, public health administrations, academic institutions, and government programs to alleviate the problem.

INTRODUCTION

The nutritional narrative surrounding the average U.S college student is one that requires its audience to read between the lines, for the humorous dialogue students exchange of routinely consuming instant noodles and energy drinks belies a reality that is comparatively disquieting; i.e, the U.S college student's progressive familiarity with malnourishment and starvation. In fact, according to the U.S Department of Agriculture (USDA), the percentage of college students who are food-insecure surpasses that of the national average of food-insecure citizens (7). Considering the unique situation college students find themselves in, in which they are neither the adolescent dependent on their guardians nor the well-adjusted adult, it comes as no surprise that they would present as a particularly vulnerable population. This article aims to supply public health administrations the information they need in order to advocate for programs or policies that ensure adequate access to healthy, organic food and mitigate the negative health outcomes associated with food insecurity. To fulfill that objective, the rest of the review will be divided into the four following parts: defining food insecurity, investigating its emergence through social determinants, exploring the potential resulting health outcomes, and recommendations for courses of action.

DEFINING FOOD INSECURITY

In order to address food insecurity, one must first understand what it entails. That can be challenging, however, when the definition of food insecurity varies from researcher to researcher and student to student.

 Some definitions of food insecurity focus on the distinction between access to nutritious food and food in general, while other definitions of food insecurity center more around the ability to acquire the food. For example, in a study evaluating the influence of food insecurity over college student GPA, dietetics investigators Maya E. Maroto, Anastasia Snelling, and Henry Linck recognized the presence of food insecurity when “the ability to acquire foods in socially acceptable ways is limited or uncertain” (8). Nina Camille Burruss and her team held a similar perspective, albeit there was no reference to the social aspect of acquiring food; instead, they saw food insecurity as an "inconsistent access to food due to social or economic constraints that limit intake and nutrition" (3). The USDA, in contrast, characterized food insecurity using deficits in calorie intake, nutritionally varied diet, and weight (7). Although each research team has their own ways of interpreting food insecurity, they all based their assessments of food insecurity around self-report surveys that followed the USDA's Adult Food Security Survey Module. The responses U.S college students submitted with regards to affirming their struggle with food were then divided into three nutritional statuses: food secure (0-1 affirmative responses), low food secure (2-4 affirmative responses), and very low food secure (5-6 affirmative responses) (9). Depending on the researcher and their study's objective, low food secure and very low food secure statuses can both fall under food insecurity. 

However, this categorical approach to describing food insecurity can overlook its social and emotional components, which also play a role in the health of U.S college students. To combat this setback, the University of North Texas conducted a unique research study where they held interviews with twenty seven of their students; these students all generally perceived food insecurity as a personal and emotional experience of “constantly searching, worrying, and wondering about food” (7). They also noted that the obstacles they faced with food insecurity often propagated into other struggles such as the inability to maintain a strong support network, good grades, and a sense of dignity (6). A similar study took place in UC Berkeley, where 25 students were selected from a food pantry: out of this sample, some students expressed a fear of disappointing their families for struggling with food insecurity, while others remarked how sad they felt over their impact of their circumstances on them (10). It is important to not only consider the different ways researchers measure food insecurity but also how students experience food insecurity; failure to do so may prevent public health organizations and academic institutions from gaining a holistic view of the issue and impede on their ability to explore effective solutions. For the purposes of this review, food insecurity will be defined as the nutrition status one carries when they face reduced or unreliable access to sufficient, nutritious food as determined by their social and economic circumstances.

The Emergence and Development of Food Insecurity in U.S College Students

After establishing the type of issue food insecurity poses, researchers can begin the investigation for factors that lead to its emergence. Generally, demographic information (i.e age, race, ethnicity, sex, and gender) is the first set of data researchers collect. This practice ensure that all variables potentially correlated with the research topic of interest are accounted for. Demographic data can also provide a basis for comparisons between different populations within the sample. With regards to food insecurity, it is necessary to include demographic data because systemic and social biases can disproportionately predispose individuals to food insecurity depending on the demographic they belong to. However, demographic information alone is not sufficient to explain the emergence of food insecurity in college students: it fails to account for the college experience, which plays a central role in every student's life. To explore further as to how pursuing higher education may lead to the emergence of food insecurity in U.S college students, this section of the paper will be divided into subsections focusing on the potential economic determinants of food insecurity in U.S college students and the potential social determinants.

Economic Determinants

It is common knowledge that higher education in the United States is far from inexpensive. In fact, according to the National Center for Education Statistics, university tuition fees in the United States during the 2022-2023 ranged anywhere from $4000 to $17,700 for two year institutions and $9,700 to $38,800 on average per year for four year institutions (12). This has not always been the case, however. In 2010, tuition fees were as low as $3,500 and $17,800 for two year institutions and $9,100 to $34,000 on average per year for four year institutions (12). Given that the cost of undergraduate studies has increased between the 2010 and 2023, it is likely that the costs will continue to rise. And yet, despite this imminent inflation of tuition fees, the culture of pursuing higher education has not diminished. This is because the job market currently favors bachelor degrees as a prerequisite for academic background over other alternative types of experience (1). The economic situation, consequently, becomes an interesting paradox: in order to enter the job market for livable wages, one must possess at least a bachelor's degree, yet to earn the degree, one must spend a considerable sum of their livable wages to fund their higher education. 

Unsurprisingly, a majority of college students do not possess this pre-existing financial reserve because they are just beginning to learn how to be financially steady on their own feet; as a result, they become more vulnerable to experiencing food insecurity. Dr. Devon C. Payne-Sturges and her team affirms this idea in their research study involving a mid-Atlantic public university, stating that food insecure students attending that university were less likely to be financially supported by family members and more likely to be employed in comparison to food secure people (14). Without a strong financial background, U.S college students are obligated to find employment to cover their costs or risk discontinuing their education. Furthermore, out of the food insecure student sample in the same study, 91% were living off campus and 83% did not have access to a university meal plan (14). Housing and food arrangements are costs that students must account for in addition to college tuition fees; if they live off campus, they likely worry about saving money for rent. A separate research study also found that 78.5% of students sampled at a midsize rural university in Oregon made an income less than $15,000 while another 88.4% were in credit card debt (13). With low income and debt, food insecure students likely prioritize earning money at any cost (even if that means reducing their ability to eat healthy and sufficiently). Lastly, approximately 54.99% of 2,377 students in Georgia had less than $200 in discretionary income (15). Discretionary income refers to money left after meeting essential needs; when discretionary income is low, that indicates the pressure students encounter when fulfilling financial obligations. These studies work together to strengthen the idea that such economically taxing conditions can prevent a student from having the funds to buy and consume nutritious food, allowing for the emergence of food insecurity.

Social Determinants

The pursuit of higher education in the United States is unique in that it is socially enforced. For example, it is commonly accepted among American households that once an individual reaches the age of adulthood, that being eighteen years, they are ready to move out. This is supported by a longitudinal study that surveyed 9000 individuals over the timespan of 1997 to 2012; the researchers plotted a graph observing the percentage of young adults who moved out at different ages, and identified a steep incline between the ages 17 and 18 (5). While the idea of moving out at eighteen has been around for some time, whether it is recommendable or not is subject to debate. But this can explain why, in the “Defining Food Insecurity” section, some food insecure students felt fearful as to how their families would react to their predicament; they did not meet the social expectation their family had set for them to not struggle while living independently (9). The essential takeaway from this expectation is that it adds to the individual's pressure of needing to attend college in order to be independent and lead a successful life. And by committing to higher education, college students put themselves at risk of encountering the issues previously mentioned in the “Economic Determinants” section, once again leading to the emergence of food insecurity. In conclusion, the social expectation for young adults to move out from their family's homes and pursue college can increase their predisposition towards food insecurity. 

Another potential social determinant are the expectations U.S college students are held to. Once again, it is important to remember that college students can comprise of people at various stages of the transition from late adolescence to young adulthood. For the younger end of the spectrum, there is an implicit societal expectation for them to learn certain life skills as quickly as possible, such as managing tasks, paying bills, and cooking. And while these skills are essential for survival, performing these tasks while maintaining a full-time university course load may cut into time and energy. In the mid-Atlantic public university study, the average amount of sleep that the food insecure student sample got was less than six and a half hours per day (13). Another study validated this finding by pointing out correlations between the inability to fall and remain asleep with food insecurity (11). It is understandable that, with most of their college careers spent on either studying and working, students would possess disrupted sleep schedules. Unfortunately, the inability to receive enough hours of sleep is not ideal, as it can take away from the the time and energy necessary to obtain nutritious food. This could, again, predispose students towards experiencing food insecurity.

Food Insecurity: Health Outcomes and their Socioeconomic Origins

Physical Health Outcomes

It is expected that neglecting the basic need of eating healthy will yield physically adverse health effects. Of these effects, a few candidates have been identified by researchers that are the most probable to result from food insecurity. For Dr. Hilary K. Seligman and her team, it was diabetes, as indicated by its independent correlation with food insecurity using cross-sectional data from a sample that represented the U.S national population (16). On the other hand, a study sampling U.S households of varying nutrition statuses were able to associate low food secure households with both diabetes and cardiovascular disease (3). The correlation between food insecurity and cardiovascular was supported by another cross-sectional study (also led by Dr. Hilary K Seligman) which noted an association between food insecurity and the risk factors for cardiovascular disease (17). Finally, food insecure students sampled from ten UC campuses in California were more likely to have a higher BMI (a risk factor for obesity) (9). This last finding aligned with a separate meta-analysis that noticed, in samples concerning U.S nonelderly adults, individuals who were concerned for their food security (and therefore food insecure) were more likely to be obese (6).

 Now that the general economic context surrounding U.S college students has been made clear, one can utilize it to explain the unfavorable health consequences that may result from experiencing food insecurity. For example, it is important to remember that food insecurity is not simply an absence or lack of food (the association between obesity and food insecurity would appear contradictory otherwise), but an absence and lack of nutritious food. In the United States, food items that are processed and calorie dense tend to sell for cheaper than their organic and nutritious counterparts. It is reasonable to assume then that when a food-insecure student has some disposable income for their next meal, they are very likely to settle on the cheaper alternative that will satiate their hunger longer and also be easier to prepare and consume. This reasoning is supported by Dr. Devon C. Payne-Sturges, who stated that food insecure students were more likely than their food secure counterparts to admit to eating less and being unable to eat balanced meals due to financial deficits (14). Choosing these less healthier food options may contribute to increased cholesterol levels, adipose tissue, and insulin resistance, which would result in detrimental health outcomes like cardiovascular disease, obesity, and diabetes.

Mental Health Outcomes

Moreover, food insecurity has been shown to have significant associations with mental health issues. A study utilizing cross-sectional data from the National Longitudinal Study of Adolescent to Adult Health found that food-insecure young adults had higher chances of possessing a diagnosis with regards to depression, anxiety, or panic disorders (11). Their data was validated by another study researching college students from Georgia — the researchers there noted not only a correlation between food insecurity and depression, but between food insecurity and stress (15). Lastly, a study in Arizona State University sampled 209 survey responders from their freshman class, a unique population given the population's immediate transition from high school to college, and found that food insecure freshman possessed "higher odds" of suffering from symptoms of stress, depression, and anxiety in comparison to their food secure counterparts (4, (true 4)) . Despite surveying different populations, these findings corroborate strongly with one another to show the struggle U.S college students share when they are food insecure. The results of the studies are also plausible with regards to the social context of being a college student in the U.S. Students in the current era are expected to manage their time between studying and working which is a responsibility that requires immense effort and energy. With food insecurity to combat in addition to those obligations, students may begin to feel exhausted and overwhelmed. In response, students'; stress levels may increase and, in turn, develop symptoms of depression and anxiety.

Conclusions

Summary

Researchers are beginning to acknowledge the likeliness of a college students’ socioeconomic status uniquely disadvantaging their ability to maintain a reliable access to nutritious food. They have strengthened this hypothesis by sampling from both the U.S. college student body and general U.S adult population. From that sample, they collected important data such as dietary habits, sleeping habits, employment status, personal income if employed, use of financial aid from either family, grants, or loans (or lack thereof), possession of a meal plan, and housing situation. Using that information, they sorted students by nutrition status (food secure vs food insecure) and looked for any significant associations that can provide a reason as to why certain students are more food-insecure than others. Some researchers have lately observed that, in a population of food-insecure students, a majority of them were employed, housed off-campus, and lacked financial support from family. As previously mentioned, these conditions, along with the transition period of adolescence to young adulthood and being a full-time student, can culminate into the emergence of the food-insecurity status. Researchers have also investigated the long-term health outcomes of food insecurity in the general U.S population and found that food insecurity was commonly associated with coronary artery disease, diabetes, obesity, depression, and anxiety. The physical health outcomes are likely to result from the economic stress put on students to choose cheaper, calorie dense, and processed food over their pricier, organic alternatives while the mental health outcomes come from the social stress of having to manage several taxing responsibilities as a college student. In spite of food insecurity still being a nascent research topic, the research compiled so far evidently demonstrates that it exists as an underlying issue among college students and must be addressed as swiftly as possible.

Future Directions

Although the aforementioned findings are promising, further comprehensive investigations would be beneficial. Public health investigators currently recognize that there is no singular economic or social determinant college students possess that is responsible for food insecurity, only that a combination of several factors that come with being a college student yield a food-insecure lifestyle. However, that agreement does not clarify a means to solve the dilemma. Instead, researchers should direct their studies towards isolating and identifying the most common socioeconomic factor that afflicts the university student population. Establishing the socioeconomic factor that has the strongest association to food insecurity can enable public health officials, university administrations, and government programs to move forward with devising achievable solutions that can effectively and efficiently combat the issue. This stage of further investigation would likely require another few years of collecting data from participants to ensure confidence in the association between food insecurity and the socioeconomic condition in question. Nevertheless, that reality should not discourage administrations from constructing programs in the meantime to help alleviate students’ burden of securing adequate, nutritious food.