Mean added sugar intake across intervention groups from baseline to three-months to six-months ranged from 3.1 teaspoons to 6.1 teaspoons across all intervention groups. This reported intake is much lower than national estimates. Ervin & Ogden (2013), using data from the 2005-2010 NHANES Survey reported that men over the age of 20 years old consumed 335 kcals from added sugars, which is the equivalent of 20.9 teaspoons of added sugar. Women over the age of 20 years old consumed 239 kcals from added sugar, the equivalent of 14.9 teaspoons of added sugar.137 It is unknown why such low reporting might be present in the sample, but some reasons may include reporting error or selection bias. Nutrition studies tend to be more prone to reporting bias as individuals tend to under-report behaviors viewed as inappropriate.138 If there was a measurement or reporting error, it would be more difficult to see a difference in added sugar intake among intervention groups, if there were any. However, these results do emphasize a need for better methods for studying diet, especially in the context of NOVA, food- based dietary guidelines, and food processing.
Mean intake of fruits and vegetables, whole grains, added sugars, and ultra-processed food intake did not show any statistical differences from baseline to three-month to six-month follow-up among any of the intervention groups. This might be attributed to limited sample size, which decreased statistical power to detect mean differences in consumption. A review by Lua and Elena (2012), examined the impact of nutrition education interventions on the dietary habits of college students. The authors reported that studies with significant differences in dietary habits occurred in sample sizes of at least 30 participants.139 Future research on the impact of nutrition education on college students should have larger sample sizes, especially when there are multiple intervention groups.139
The results from the dietary screener questionnaire emphasize the difficulty of capturing ultra- processed food consumption, since a validated dietary assessment that includes ultra-processed food
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intake does not currently exist. Nutrition education tools for NOVA messages and concepts also do not exist. Also, the concept of NOVA themes and limiting “ultra-processed” products might be a new concept for many individuals. As NOVA-based concepts are still relatively novel, it can be assumed most
individuals are only taught the importance of nutrient-based dietary guidelines and less about food-based dietary guidelines. In the U.S., most individuals have only been taught nutrition education provided by the USDA’s US Dietary Guidelines, which utilize a nutrient-based approach. Future research should specifically examine ultra-processed food consumption among college students, as well as best methods on how to deliver NOVA-related nutrition education to college students.
4.3. Nutrition knowledge
There were no statistically significant changes observed among any of the intervention groups or control group in regards to nutrition knowledge. Nutrition knowledge is part of an individual’s overall food literacy. Food literacy is defined as “understanding the impact of your food choices on your health, the environment, and our economy.”140 As the concept and definition of food literacy changes from initiative to initiative,140 a scoping review by Truman et al., (2017) identified six themes to best describe the term “food literacy.” These themes included cognitive (knowledge) and functional skills (skills and behaviors) at the individual level (food/health choices) and social level (culture, emotions, food systems). However, with such variability in themes, the authors discussed that successful food literacy according to one standard may not be successful compared to another standard.141
Our study focused on the nutrition knowledge aspect of food literacy as it relates to MyPlate and NOVA-related concepts. Potential reasons for the lack of any changes in nutrition knowledge might be that there was no way to verify if students actually read the nutrition education interventions. NOVA is also a novel concept and educational messages were not validated. Limited sample size was also a factor. Future studies should examine the impact that food literacy has on college students’ dietary habits. The UC Global Food Initiative discussed the important role universities play in supporting food literacy, through both academic instruction and the food environment.142 Food literacy is a potential confounder in
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this study but it was not assessed. With all of the analyses, unaccounted confounders could have influenced our findings in either direction.
To the best of our knowledge, this study was the first to examine the association between CalFresh participation and its powerful impact on decreasing college food insecurity. This study demonstrates the value and importance food resources have for college students and how significantly they can decrease food insecurity on college campuses. Decreasing food insecurity might help students perform better academically and positively affect their mental and physical health. Although there were no significant differences in any of the nutrition education interventions, this study can serve as a pilot for future nutrition education interventions related to NOVA education. NOVA-related nutrition education could lead to decreased nutrition-related chronic diseases. Higher education is an opportune platform to promote a lifestyle of good health and well-being that college students can take with them for the rest of their lives.
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