Date Published: April 24, 2019
Publisher: Public Library of Science
Author(s): Cassandra J. Nikolaus, Brenna Ellison, Sharon M. Nickols-Richardson, Tamar Ringel-Kulka.
A growing body of literature suggests that post-secondary students experience food insecurity (FI) at greater rates than the general population. However, these rates vary dramatically across institutions and studies. FI assessment methods commonly used in studies with college students have not been scrutinized for psychometric properties, and varying protocols may influence resulting FI prevalence estimates. The objective of this study was to assess the performance of standard food security assessment protocols and to evaluate their agreement as well as the relative accuracy of these protocols in identifying student FI. A randomized sample of 4,000 undergraduate students were invited to participate in an online survey (Qualtrics, LLC, Provo, Utah, USA) that evaluated sociodemographic characteristics and FI with the 2-item food sufficiency screener and the 10-item USDA Adult Food Security Survey Module (FSSM; containing the abbreviated 6-item module). Four hundred sixty-two eligible responses were included in the final sample. The psychometric analysis revealed inconsistencies in college student response patterns on the FSSM when compared to national evaluations. Agreement between FI protocols was generally high (>90%) but was lessened when compared with a protocol that incorporated the 2-item screener. The 10-item FSSM with the 2-item screener had the best model fit (McFadden’s R2 = 0.15 and Bayesian Information Criterion = -2049.72) and emerged as the tool providing the greatest relative accuracy for identifying students with FI. Though the 10-item FSSM and 2-item screener yields the most accuracy in this sample, it is unknown why students respond to FSSM items differently than the general population. Further qualitative and quantitative evaluations are needed to determine which assessment protocol is the most valid and reliable for use in accurately identifying FI in post-secondary students across the U.S.
A rapidly growing body of literature has developed on the topic of food insecurity (FI), defined as the unavailability of sufficient food, among post-secondary students. Recent reviews estimate that 32.9% to 50.9% of college students in the U.S. experience FI [1,2]. Compared to the 2016 U.S. estimate indicating 12.3% of American households experience FI , students seem to be more susceptible to FI. This is concerning, as evidence suggests that FI among adults is associated with lower quality dietary patterns [4–6], more mental health concerns [7,8], diminished physical health [9,10], and greater risk for chronic diseases [11,12]. Studies conducted specifically in college settings indicate that students experiencing FI are more likely to have lower quality dietary patterns, physical health status, and academic success . Though the culmination of findings from studies on university campuses indicate FI is a prevalent issue among college students, the evidence is hindered by limited psychometric testing of food security questionnaires used and thus, related concerns about accuracy in reported estimates.
A total of 633 responses were received for the online survey. Of these, 44 respondents did not consent to participate, 22 individuals did not meet inclusion criteria, 80 completed less than half of the 10-item FSSM, and 25 completed the survey twice (the second response or incomplete responses were removed), resulting in a final response rate of 11.5% and sample of 462 participants. Sociodemographic characteristics of participants and comparisons with the institution’s undergraduate student body are reported in Table 2.
The aim of this study was to evaluate the standard food security assessment protocols when used among undergraduate college students. Specifically, cross-sectional data from 462 students were used to assess the psychometric properties of the overall survey and then compare the agreement and relative accuracy of four FI estimation procedures. Data supported both proposed hypotheses. First, student responses on the USDA FSSM did not follow the expected difficulty pattern and fit statistics indicated some potential issues on the item-level. Then, when protocols were compared, agreement was generally high. However, agreement was lowest for the FSSMs when paired with the 2-item screener, which resulted in the two lowest FI estimates among students. Finally, this lowest prevalence of FI was supported as the most relatively accurate when predicted by student sociodemographic characteristics.
Results from the current study indicate that the psychometric properties of FSSMs when used in college students were not ideal. These results warrant additional qualitative investigations of the FSSMs and possible adaptations for FI assessments in the college student population. Until these survey modifications are made, results of this protocol comparison analysis provide evidence that the way that FI is estimated among college students makes a substantial difference in reported prevalence, particularly with use of screeners. Given the limited resources available for universities to identify and serve students living with FI, it is vital that the way FI is assessed will accurately identify students most critically in need, such that the true impact of interventions may be evaluated. Current results suggest that the 10-item FSSM used along with the 2-item screener is the best currently available measure; however, replicating these analyses with a larger and more diverse sample is warranted.