Title: Social and Racial Inequalities as Factors in Food Insecurity for Health Professions Students
Authors: Beneshia Robinson, MAMSc, Gagandeep Rai, MAMSc, Kwshay Murray, MAMSc, Lelani Lealiiee-Sjoden, MAMSc
Introduction
Food Insecurity (FI) is defined by the US Department of Agriculture as a household-level economic and social condition of limited or uncertain access to adequate food. FI is associated with reduced academic performance and decreased mental and overall health. A tenet of Osteopathic Medicine is that the body is a unit. This strongly implies adequate availability, accessibility, utilization, and stability of food for students, allowing them to become their best physical, mental, and academic selves. This paper will analyze peer-reviewed literature to investigate the consequences of FI in students who are in graduate health professional programs. The complexity of FI’s relationship with social and racial inequities as contributing factors will be considered.
Methods
Investigation of peer-reviewed literature was completed by search of PubMed, Google Scholar, CINAHL, and TripPro. Keyword searches were combinations of “FI, graduate students with FI, FI factors, health professions, and effects of FI.” Exclusion factors were studies performed outside of the United States, articles published before 2012, undergraduate participants, and studies published in languages other than English.
Results
21 peer-reviewed studies were evaluated and were notable for an average of 28.43% of graduate health professions students indicating FI. We found that these studies illustrated a negative influence on academic success and mental and physical health. There is a large recurrent correlation between higher levels of FI and People of Color, nonbinary and transgender people, and students who utilized school loans. Students reported being reluctant to share their FI data, alluding to concern about the stigma if peers found out. Under Maslow’s Theory, food security falls under the physiological requirement. If a student is unable to meet their basic needs, they may never achieve the self-actualization level and subsequently their fullest potential. We observed themes which were: higher levels of FI were inversely related to GPA (higher FI, lower GPA), directly related to students of underserved communities, and negatively impacted students’ mental and physical health.
Discussion
Our literature review demonstrates a negative correlation between FI students and their academic success. There is a shortage of research on graduate students in health professions programs, especially involving potential contributing factors. Furthermore, there is no current literature on the alleviation of FI through the implementation of campus-based food pantry.
Great article on a subject that is so important.
Thank you for reporting on this important topic. Did any of the literature discuss institutional interventions that positively impacted food insecurity?
Thank you for your question, Dr. Habecker. From the literature that we reviewed, we did not see any research on the positive impact of an intervention similar to or like the food pantry. Many of the articles referenced implementing food pantries, however one article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163327/) noted that while the food pantry was implemented, social stigma keeps many of the students from accessing it. We believe that there needs to be more research done on decreasing the social stigma of utilizing food assistance for us to gain a more comprehensive answer of the positive effects of a food pantry.
Thanks for this presentation, I am one of your judges. I found it interesting that food insecurity varied by graduate program. Is there a correlation with race or socioeconomic status and enrollment in a particular program that may reflect the differences you observed in food insecurity?
Thank you so much for your question. In the article “Food Insecurity Among Students in Six Health Professions’ Training Programs” it was noted the College of pharmacy had the highest rates of food insecurity among students (nearly 60%) followed by the Physician Assistant program (40%). In the six health graduate programs studied African American, Hispanic, and First-Generation students reported higher levels of food insecurity. Another study which looked at food insecurity among pharmacy students, “Bringing to Light the Risk of Food and Housing Insecurity in Pharmacy Students” cited two studies demonstrating increased rates of food insecurity among Hispanic and African American graduate students. Lastly in “Food Insecurity in Medical Students: Preliminary Data From Yale School of Medicine” it was noted underrepresented minority students are at a higher risk to experience food insecurity. “Food insecurity among nursing students: A mixed methods Study” stated a significant portion of the nursing students relied on income from jobs they worked outside of nursing school to make ends meet. Nearly 40% of nursing students were often afraid their food would run out before their next income arrived and 52% of nursing students sometimes could not afford adequate food. Approximately 13% of nursing students reported losing weight due to food shortage. Some recommendations made to alleviate food insecurity were to make meal plans more affordable and making food pantries easier to access on campus.
Judge: Thank you for sharing your research on this very critical topic. Other than a campus-based food pantry, I’m curious if you have additional recommendations for how learning institutions can help mitigate FI amongst their student learners, especially for those who are located in rural/remote areas?
Thank you for your question, Jennifer.
Disclaimer: Our review did not include any additional recommendations as we were looking to assess food insecurity prevalence among students. Institutions that are trying to mitigate the issue utilize food pantries and meal plans if these options are available to the students. Through supplemental research we were able to conclude the following with additional links that were not included in our research presentation:
• Initially surveying the students to evaluate their needs and barriers to obtaining food and eating healthy, then utilizing the survey results to customize a plan to mitigate the food insecurity on campus. The plan can be centered around the school and population needs. This would also give space to the component of a rural setting to be evaluated and included.
• Reducing the stigma associated with food insecurities.
• Federal nutrition programs (i.e. SNAP, WIC, Emergency Food Assistant Program, etc)
• Campus dining services- incorporating Swipe Out Hunger, allows students to donate unused meal credits to other students in need through the GET CBORD Student app. Once students donate meals through the mobile app, donations are tracked, pooled, and distributed through the backend CBORD campus card system. For students facing food insecurity, each school provides a discrete method to request dining hall swipes, reducing the stigma that typically discourages those in need from accessing resources. https://www.restaurantbusinessonline.com/food/schools-work-develop-methods-mitigate-food-insecurity#:~:text=Establishing%20food%20programs%20to%20combat,program%20and%20No%20Kid%20Hungry.
• Campus Kitchen- volunteers could prepare meals utilizing pantry or donated items for student consumption (similar structure to shelters), incorporating culinary medicine for the students.
• Campus Garden
• Support measures for expanding the National School Lunch and Breakfast Program for higher education. https://hope4college.com/wp-content/uploads/2018/09/Wisconsin-HOPE-Expand-Lunch_Program.pdf
Thank you for your presentation. I am one of the judges evaluating your poster. What does the literature say about FI amongst graduate students in fields outside of health sciences and how do the rates compare?
Hello, thank you for your comment. We did end up with some articles that highlighted both undergraduate and graduate programs outside of the health sciences. Some of the numbers that we noticed included a high of 67.7 % of students in graduate programs from one study reported FI in the fall term. That same study had a high of 60.8% reported FI amongst graduate students in the spring term. That same study posted an interesting graph (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237637#sec003) where we noticed the difference between their graduate students and medical students who reported FI was not too different. In the fall 20.8 % of graduate students reported FI and 20 % of medical students did. In the spring 18.6 % of graduate students reported FI, whereas 16.3 %of medical students reported FI. So, in this study, they were similar. That being said overall we noticed in a couple other studies that we reviewed that graduate program students reported less FI than their health professions graduate counterparts. Here it was 17.8% https://www.sciencedirect.com/science/article/pii/S2211335519300257 and here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197841/) it was 28% of graduate students- where our noted average was 28.43% with a range of 19.6% – 40%.
Additionally, there was a study that was published by Portland State that we thought was interesting but did not include because it is technically considered grey literature (here is the link: https://tinyurl.com/psufistudy). This article reported that 37% of graduate students reported FI and 51% of undergraduate students reported FI.
Some comments that we noticed were ” the amount charged for my masters program exceeded the amount of loans I was able to take out and landed me in a tough financial situation. The course load also doesn’t allow for much work time… How can I learn and teach when I’m worried about being able to eat and live?
Meal options for graduate students on campus are not still pay out of pocket for all the student fees
Thank you again!
Thank you for your question, Dr. Habecker. From the literature that we reviewed, we did not see any research on the positive impact of an intervention similar to or like the food pantry. Many of the articles referenced implementing food pantries, however one article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163327/) noted that while the food pantry was implemented, social stigma keeps many of the students from accessing it. We believe that there needs to be more research done on decreasing the social stigma of utilizing food assistance for us to gain a more comprehensive answer of the positive effects of a food pantry.