Persistent and Changing Food Insecurity Among Students at a Midwestern University is Associated With Behavioral and Mental Health Outcomes

Purpose: To assess associations between persistent and changing food insecurity and behavioral and mental health outcomes in college students. Design: Online surveys conducted November 2018 and March 2019 (freshman year), and March 2020 (sophomore year) were used to assess food insecurity, which was then used to create 4 food security transitions: persistent food insecurity, emergent food insecurity, emergent food security, and persistent food security. Setting: Large Midwestern university. Sample: 593 students completing all 3 surveys. Measures: Dietary intake and behavioral and mental health outcomes (eating disorders, anxiety, depression, sleep quality) were assessed using validated instruments. Analysis: Associations between food security transitions and dietary intake, behavioral, and mental health outcomes were examined using generalized linear models. Results: Compared to persistent food security, emergent and persistent food insecurity was associated with lower (7% and 13% respectively) intake of fruits and vegetables combined; persistent food insecurity was associated with 17% lower intake of fruits, 6% lower intake of fiber and 10% higher intake of added sugar from beverages. Compared to persistent food secure students, eating disorder symptom risk was higher for emergent food insecure (OR = 7.61, 95% CI: 3.32, 17.48), and persistent food insecure (OR = 6.60, 95% CI: 2.60, 16.72) students; emergent (OR = 2.05, 95% CI: 1.14, 3.71) and persistent (OR = 2.55, 95% CI: 1.34, 4.87) food insecure students had higher odds of poor sleep quality, and persistent food insecure, emergent food insecure, and emergent food secure students had higher odds of anxiety and depression (OR range 2.35-2.85). Conclusion: Food security transitions were associated with aspects of low diet quality and poorer behavioral and mental health outcomes among college students.