Study Design and Conceptual Framework of an Observational Study of Food Insecurity and Life's Essential 8 in College Students: The FRESH Study.

BACKGROUND: Food insecurity affects 30% to 40% of US college students, yet the chronicity of food insecurity and potential mechanisms related to poor cardiovascular and metabolic health (CVMH) in this population remain unclear. The FRESH (Food, Rest, Exercise, and Student Health) study aims to (1) determine if chronic food insecurity predicts poor CVMH over time; (2) explore if chronic food insecurity relates to CVMH factors via CVMH behaviors; and (3) assess the role of emerging adulthood factors as moderators or mediators within the proposed conceptual model. METHODS: FRESH is a 2-year observational cohort study targeting to recruit 340 second-year students at the University of California, Santa Cruz, and enrolled a total of 350 participants. Twelve monthly surveys assess food security status, environmental context, and emerging adulthood factors. Behavioral and biological markers of CVMH (eg, diet, anthropometrics, blood glucose) are assessed at baseline, and 1-year and 2-year follow-ups. Multivariate regression analysis will examine the association between chronic food insecurity and CVMH. Structural equation modeling will estimate the effects of food insecurity on CVMH behaviors and factors. Moderation and mediation analyses will explore the role of emerging adulthood factors and psychosocial stress in the relationship between food insecurity and CVMH. CONCLUSIONS: By examining the mechanisms linking chronic food insecurity to poor CVMH, FRESH aims to inform interventions and health policy that promote optimal cardiovascular and metabolic health in college students.