Emerging young adulthood, or the transition through late adolescence and young adult years, is a distinct stage of life associated with declines in healthy lifestyle behaviors [1,2]. Young adults face an increased risk of unhealthy weight gain, poor dietary patterns, poor mental health, and increasingly sedentary lifestyles. The dramatic changes in living and social situations associated with emerging adulthood have been linked to adverse health outcomes. The escalating cost of higher education and uncertainty in the global and local economies may further challenge their ability to make healthy choices [1,2]. To address these concerns, young adults need timely and personalized information, as well as evidence-based tools and programs to enhance their health and well-being. The overarching goal of this multistate research project is to cultivate an understanding of how to create environments and opportunities that nudge young adults toward healthy lifestyles that support better diet quality, adequate physical activity, and overall improved health quality of life (HQOL) as well as prevent lifestyle-related chronic disease.

Young adults (aged 18-34) are facing worse HQOL than any other age group, putting them at greater risk for chronic disease. Nationally, 18% of young adults aged 18-24 years old are obese [3]. Similarly, a majority (60%) of college students report weight gain (7.5 lbs) in their first year of college attendance [4]. Like all age groups, young adults have experienced rising rates of overweight/obesity; however, those in this life stage gain weight faster than any other period of adulthood [5]. Young adults who experience excessive weight gain are at an increased risk of developing diet-related diseases, including obesity, heart disease, hypertension, and type 2 diabetes. Obesity alone currently affects 93.3 million adults in the US, with an estimated cost of $315.8 billion in associated healthcare costs [3].

Health Eating Index (HEI) scores for this age group are poor, averaging 49 out of 100 points. Key shortfalls are fruits/vegetables and whole grains, whereas fat, added sugar, and sodium intakes exceed recommended levels. Healthy diets are essential during this life stage to prevent disease conditions that track throughout adulthood, endangering lifelong health. Additionally, 30-40% of emerging adults attending college are food insecure and struggle with food access, which limits their ability to nourish themselves adequately and contributes to both poor physical and mental health. 

Improving the health, diet quality, and food access of young adults is imperative to prevent future onset of chronic lifestyle-related diseases such as obesity, type 2 diabetes, and hypertension, and to help ensure an able/active workforce and economic stability. Universities and colleges serve as a key intervention point to address poor lifestyle behaviors of young adults, with the potential to reach over 12 million college students in the U.S.—more than one-third of the entire population in this age group. Additionally, through Cooperative Extension partnerships, these efforts can be extended to engage non-college young adults, broadening the impact of health promotion initiatives. Encouragement and facilitation of beneficial behaviors, such as healthy eating, food resource management skills, and good mental health practices, through lifestyle behavior changes can help young adults reduce the risk of developing chronic diseases later in life [6].

Existing interventions and assessment tools have not adequately addressed the unique needs and challenges of this population [7]. Unwanted weight gain and obesity prevention programs have mainly overlooked young adults and may not adequately consider their unique attitudes, motivations, and perceptions [7-11]. Young adulthood is a critical period for developing healthy weight management behaviors. Unfortunately, most obesity prevention programs have focused on changing individual behaviors and/or knowledge, with limited attention to environmental factors [11,12]. When access to nutritious foods or safe spaces for physical activity is restricted, it becomes difficult for individuals to adopt healthy behaviors. Perceived and actual environments do not always align, and individuals may be unable to recognize opportunities that could support healthy behaviors. Therefore, understanding the eating behaviors, lifestyle choices, and perceptions of young adults is essential for reducing the burden of illness, improving the quality of life, and addressing the public health impact of obesity [6].

The concept of Food is Medicine (FIM) has gained prominence in recent years as health professionals and researchers recognize the pivotal role of diet in preventing and managing chronic illnesses, and the FIM approach connects dietary choices and overall health in all populations. For example, prescription programs that provide vouchers for fruits and vegetables have been tested in the U.S. and Europe [13]. A recent review of FIM interventions and models by the U.S. Department of Health and Human Services defined FIM programs to have five key principles: (1) nourishment to essential to overall health; (2) facilitates access to healthy food; (3) guides the connection between diet and health; (4) utilizes key partnerships and stakeholders in the model; and (5) invests in community capacity [14]. Although most FIM literature focuses on general adult populations, young adults represent a unique demographic undergoing a critical life stage during which long-term health habits are formed. Further, the university environment presents unique opportunities for implementing FIM strategies, especially in light of rising rates of stress, poor dietary habits, and food insecurity among students.

Numerous studies support the efficacy of FIM programs, particularly for managing chronic diseases such as diabetes, cardiovascular conditions, and obesity [14,15]. For instance, Doyle et al. (2024) and Biber (2023) demonstrate that intensive nutrition-based interventions can significantly improve glycemic control and reduce healthcare utilization [16,17]. Programs like Recipe4Health and FAME-D demonstrate that medically tailored meals and produce prescriptions can significantly improve health outcomes for food-insecure populations [18,19]. Because FIM has traditionally focused on managing chronic diseases, its potential role in preventive care is often overlooked. Yet, interventions that prevent disease, while likely cost effective, would also appeal to both healthcare providers and the general public [20]. Therefore, focusing on FIM for prevention is especially timely for college populations, where many emerging adults are establishing lifelong dietary habits. 

University and college settings are an ideal place to launch programs that reflect FIM approaches. Some examples that can work on college campuses include: campus gardens and local food sourcing that encourage hands-on learning and provide fresh produce to dining halls and food pantries [21]. Student-run food pantries and meal swipe donation programs aim to reduce food insecurity by providing equitable access to nutritious meals [22]. Nutrition education programs, such as workshops or cooking classes, can equip students with the skills necessary to make healthier food choices and prepare meals on a budget [21]. Health-promoting dining services are also adopting plant-forward menus and incorporating evidence-based nutrition guidelines to promote a more nutritious diet [23,24]. One area that makes this multi-state research team especially well-suited for this research is that community-engaged interventions are a cornerstone of practical FIM efforts. This multistate team has a solid history of conducting community-engaged interventions [25-35]. Responsive to the calls from Ridberg et al. (2024) and the Food is Medicine National Summit to institutionalize interventions for sustainable, long-term benefits, this team is well-positioned to facilitate the institutionalization of FIM interventions on college campuses due to its nationwide network of partners [14,15].

Culinary medicine, which combines nutrition science with hands-on cooking education, is increasingly recognized as an essential clinical tool [36]. Thomas and Kudesia (2025) further extend this approach to reproductive health, showing its relevance across life stages [37]. Many of the researchers on this team have extensive experience developing, evaluating, and disseminating culinary programs. This experience could be utilized to create FIM culinary programs on college campuses. Such efforts align with current recommendations to integrate FIM into campus-based strategies that improve food access [38]. Addressing food insecurity is foundational in implementing FIM programs in higher education settings. By collaborating with other objectives proposed by this multi-state team to address food insecurity on college campuses, integrating FIM concepts into food insecurity research can enable efforts to be leveraged and produce synergistic outcomes [39,40].

Mental health is another focus of this proposal, where the integration of FIM can be meaningfully explored in the research. An emerging theme in the FIM literature is the role of nutrition in mental and behavioral health. Radtke et al. (2025) report that FIM interventions can lead to reductions in anxiety and depressive symptoms [41]. With 36% of young adults reporting a mental illness, the highest prevalence of any age group, exploring the role FIM can play in promoting better mental and physical health in this age group is imperative [42]. There is evidence to support that young adults associate dietary changes with mood improvement, emphasizing the psychosocial potential of nutritional therapies [43-45].

Integrating FIM approaches into college life could have significant health benefits for students. Nutritional interventions have been linked to improved concentration, reduced symptoms of anxiety and depression, better immune function, and improved metabolic health [45]. Programs that emphasize meals rich in omega-3 fatty acids, antioxidants, and complex carbohydrates can support mental and physical health during a period of rapid cognitive and emotional development [44,46]. Nutrition is often absent from college health services or treated as secondary to mental health and academic support. Partnering with college health services to develop novel, university-funded FIM programs that assist in treating mental health issues and provide educational support are additional steps this group could take to meet this objective.

Our Healthy Campus Research Consortium (HCRC) includes 26 accomplished researchers and 20-30 talented graduate students with more than two decades of collaborative experience working with young adults. Cumulatively, our interventions have improved young adults’ food, physical activity, and stress management behaviors, and our surveys have elucidated environmental conditions that make the healthful choice the easy choice for young adults at colleges and universities nationwide. Our integration of teaching, research, and extension leverages the expertise of our members across multiple states, thereby widening our scope and impact.

The absence of efficient, reliable, and valid tools has limited the ability of obesity prevention programs to evaluate both perceived and actual environmental influences on obesity. To overcome this, HCRC has identified individual and environmental factors that predispose, enable, and reinforce healthy eating and activity behaviors among young adults [47-52]. The HCRC team has developed valid, reliable, and efficient tools to assess food, physical activity, and policy environments on college campuses [53-55]. Researchers and Extension professionals across the US use these tools to benchmark and monitor campus environments. They also guide the development of health promotion programs tailored to young adults [3]. These tools support stakeholders and decision makers in identifying community needs and planning effective strategies to create healthier environments [8,50,56-65]. As this work continues, the HCRC team will deepen its understanding of the needs and perceptions of young adults to decrease the risk of chronic disease. 

This project aligns with USDA’s new research priorities by supporting nutrition education, improving access to healthy foods, and generating evidence that strengthens the role of food as medicine in promoting health and well-being. The research focus advances USDA’s priority areas related to improving nutrition, supporting public health, and strengthening the food system for communities with limited access to nutritious foods.

Proposed participating stations and other project members: 

AL, IL, KS, KY, LA, ME, MN, MO, MS, NE, NH, NJ, OH, RI, TN, TX, WV