College Students' Food Insecurity: A Growing Public Health Concern

Abstract

Food insecurity, defined as limited or uncertain access to adequate food due to financial constraints, remains a pressing issue in the United States, affecting 13.5% of households in 2023. Among college students, the prevalence is even higher, with approximately one in three experiencing food insecurity. This issue negatively impacts students’ physical and mental health, academic performance, and retention. Despite growing awareness, there is no validated tool specifically designed to assess food and nutrition security in college populations. Nutrition security, which emphasizes consistent access to nutritious, safe, and affordable food that supports health and well-being, is also under-assessed in this demographic. This dissertation aimed to address this gap by developing and validating a survey instrument tailored to college students. The study (1) reviewed existing tools used to measure food insecurity among college students, (2) evaluated the applicability of the USDA 10-item Food Security Survey Module (FSSM) through cognitive interviews, (3) developed a new College Student Food and Nutrition Security Survey Module (CS-FNSSM), and (4) assessed its psychometric properties. A systematic review revealed that most studies relied on the USDA-FSSM, which lacks validation for college populations and often yields inconsistent prevalence rates due to varied methodologies. Cognitive interviews with students highlighted misinterpretations of key terms and difficulty recalling food experiences over a 12-month period, underscoring the need for a more appropriate tool. Using a mixed-methods approach, including expert panel input, surveys, and cognitive interviews, the CS-FNSSM was developed to reflect the lived experiences of college students. Rasch analysis demonstrated strong item performance and structural validity. The CS-FNSSM showed good internal consistency (Cronbach’s alpha = 0.79), moderate test-retest reliability (r = 0.59), and high sensitivity (89%) and specificity (76%). Qualitative findings confirmed the tool’s clarity and relevance. The CS-FNSSM offers a validated, student-centered approach to measuring both food and nutrition security, providing a critical resource for researchers, campus administrators, and policymakers to design effective interventions and support student well-being.