Duration: 10/01/2026 to 09/30/2031

Administrative Advisor(s):

NIFA Reps:

Non-Technical Summary

Statement of Issues and Justification

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) and 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 healthy levels. Healthy diets are essential during this life stage to prevent health behaviors that track throughout adulthood, endangering lifelong health. Additionally, 30-40% of emerging adults attending college are food insecure, which limits their ability to nourish themselves adequately and contributes to poor mental health. 

Improving the health and diet quality 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 would likely 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 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 FIMFIM 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. 

 

Proposed participating stations and other project members: 

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

 

Related, Current and Previous Work

This proposed research builds on more than 20 years of collaborative, multistate research, rooted in the community-based participatory research (CBPR) approach, and addresses eating, physical activity, and stress management behaviors. The work focused on theory-based interventions to change individual behavior and evaluated environmental changes to support lasting desired behaviors. We have examined and explored young adult behaviors, perceptions, and environments through the Stage-Tailored Multi-Modal Intervention Study (64), WebHealth (65), and Project YEAH (8,12,13,16,55,56). The Stage-Tailored Multi-Modal Intervention Study, a USDA/IFAFS study that partnered with Extension, improved fruit and vegetable consumption in economically disadvantaged young adults (50).  Using a randomized, controlled design, Web Health (65), a USDA/NRI Integrated Project, tested the impact of a non-dieting online intervention for college students on biological and psychosocial health indicators. This 10-week online nutrition and physical activity intervention encouraged competence in making healthful food and eating decisions, had positive and lasting effects on fruit and vegetable intake, and maintained baseline physical activity levels in a population that otherwise experiences a significant decline in healthful behaviors (65). Project YEAH (Young adults Eating and Active for Health) (8,12,13,16,55,56), a USDA/NRI Integrated Project and a web-based intervention for obesity prevention among college and non-college young adults, was developed using the PRECEDE-PROCEED process of CBPR. The experimental participants showed significant improvements in several key areas: the number of cups of fruit and vegetables consumed, minutes of vigorous physical activity in females, reduction in the percentage of energy from fat, self-instruction, and regulation of mealtime behavior. Additionally, they experienced increased hours of sleep at six months (post-intervention) compared to control participants. There was also a significantly greater proportion of experimental participants than control participants in the action/maintenance stages for fruit and vegetable intake and physical activity (66).

In addition to developing interventions to promote healthful behaviors, we have also focused on fostering environmental changes to support these behaviors. One of the first steps in identifying needs is to assess the community for support and perceptions about environmental healthfulness. The Healthy Campus Environmental Audit (HCEA) (9,14-16,18,20,58-63) was developed to evaluate the environment. The HCEA comprises seven validated and published tools to assess food (including access and availability in vending machines, convenience stores, dining halls, and restaurants), physical activity (such as walkability, bike-ability, and recreation), and the health-related policy environment. HCEAs are used to assess, monitor, and advocate for environmental changes to improve health. 

To assess perceptions of the healthfulness of the environment, we developed and validated the Behavior Environment Perception Survey (BEPS) (17, 19, 57). BEPS is a tool used to assess environmental perceptions of physical activity, healthful eating, mental health, and peer influences in college campuses. By capturing these multidimensional aspects, BEPS provides valuable insights into how environmental factors shape individual behaviors and well-being. This tool enables researchers and policymakers to better understand the intersection between ecological attributes and personal perceptions, facilitating the identification and prioritization of targeted environmental modifications that can effectively promote healthier lifestyles and improve overall campus well-being. 

Given the effectiveness and feasibility of the validated BEPS-Campus tool in assessing college students' perceptions of their campus's healthfulness, the research team sought to adapt the tool for use in other communities, particularly those in low-income neighborhoods. After reviewing the questionnaire, experts from this research team identified areas that were too specific to college campuses and recognized the need for additional items to capture broader environmental factors. To refine the adaptation, the team conducted formative interviews and focus groups with three target audiences: nutrition educators from the Supplemental Nutrition Assistance Program (SNAP) and the Expanded Food and Nutrition Education Program (EFNEP), key community stakeholders, and community residents. These discussions aimed to identify gaps and explore additional domains requiring further assessment. 

Between 2017 and 2018, 15 focus groups and 17 interviews were conducted with 97 participants across nine states: Florida, Kansas, Mississippi, Nebraska, New Hampshire, Rhode Island, South Dakota, Tennessee, and West Virginia. These participants were nutrition educators working for the SNAP and EFNEP programs. Participants were asked about their perceptions of the challenges, opportunities, and resource recommendations necessary to promote a healthy lifestyle in their communities. Across locations, nutrition educators identified similar barriers, including limited access to nutritious and affordable foods, transportation challenges, and financial insecurity. They also highlighted key opportunities, such as the availability of trustworthy and free nutrition education resources and programs, as well as access to food banks, food pantries, and healthcare professionals, which could support a more healthful lifestyle.

After learning from nutrition educators, insights were gained from key community stakeholders who have a vested interest in supporting the needs of these communities. Stakeholders included individuals from various sectors, such as local government, healthcare, community organizations, and other services that promote community well-being. To maintain consistency and ensure comparability across the two groups, we asked the same questions used in the previous interviews with nutrition educators. This allowed us to explore the perspectives of both groups on similar challenges, opportunities, and resource needs. Between 2019 and 2021, in-depth interviews were conducted with 31 individuals across 11 states (Alabama, Kansas, Mississippi, South Dakota, Rhode Island, Maine, Florida, Nebraska, New Hampshire, Tennessee, and West Virginia), aiming to capture a comprehensive understanding of the broader community dynamics and how stakeholders view their role in addressing the health and nutrition needs of underserved populations.

Across all states, stakeholders described a healthy lifestyle as multidimensional, specifically highlighting healthy eating and physical activity as key components of a healthy lifestyle. As perceived by stakeholders, barriers to a healthy lifestyle included the limited availability of healthy and affordable foods, a lack of knowledge about food preparation and basic nutrition, and community resistance to change due to pre-existing cultural beliefs and the absence of intrinsic motivation. Despite these barriers, stakeholders identified several factors that facilitate a healthier lifestyle. These included access to trustworthy and credible information from health professionals and government agencies, improved referral systems, and access to emergency food assistance. Finally, stakeholders emphasized that increased access to affordable primary care and mental health services would significantly improve the quality of life for the entire community, offering a more holistic approach to supporting health and well-being.

As the study was preparing to transition into phase 3, which involved interviewing community residents, the COVID-19 pandemic emerged, significantly altering the global landscape. In light of these unprecedented circumstances, the research team recognized the need to add an objective to the study to understand the impact of the pandemic on health and nutrition within the communities under this study. Consequently, the team decided to conduct interviews and focus groups with nutrition educators and key community stakeholders to capture the changing environment brought about by the pandemic. This additional round of data provided valuable insights into the new challenges, opportunities, and resource gaps that emerged due to COVID-19, allowing the study to adapt to the evolving context and continue addressing the needs of the communities effectively.

A total of 77 nutrition educators (NEs) and 26 key community stakeholders (CSs) participated in this study phase, conducted between 2021 and 2022, within the same states as the previous phase. Overall, both NEs and CSs reported that COVID-19 exacerbated existing barriers, such as limited access to healthy foods, transportation, nutrition education, and physical activity and mental health resources, while also creating new challenges, including COVID-19 restrictions, exposure risks, and resource allocation issues. NEs highlighted that individuals struggled to access services and resources due to a lack of awareness about available resources. In contrast, CSs emphasized that low participation was primarily due to individuals’ lack of motivation to engage in healthful practices. Both groups identified new opportunities to mitigate COVID-19-related barriers, such as virtual programming, COVID-19 relief programs, and food distribution initiatives. However, they noted that poor social marketing strategies and limited access to technology and internet connectivity further hindered individuals' ability to access these resources within the communities.

Between 2023 and 2024, we conducted focus groups and interviews with community residents, using the same set of questions posed to NEs and CSs. This approach enabled us to gather direct input from residents about their experiences and challenges, offering valuable insights into how the pandemic and related interventions were perceived at the community level. The data collected during this phase helped contextualize the findings from previous participant groups while revealing unique challenges and opportunities specific to residents, contributing to a more comprehensive understanding of the community’s health and nutrition needs in the post-pandemic context.

Although most of the multistate research team interventions have been focused on young adults in college and/or from communities, the researchers involved have a wide breadth of knowledge and experience developing, implementing, and evaluating healthy weight management and obesity prevention interventions with participants ranging in age from preschool to young adults (67-71). The most recent study by the multistate team, Get FRUVED, focused on high school and college-age students (72). This intervention aimed to assist university and high school campuses in utilizing previously developed environmental tools and to create a social marketing obesity prevention campaign called  Get FRUVED FRUit and Vegetable Education). Student-led activities promoted healthy eating, physical activity, and stress management. A Get FRUVED toolkit (73) was developed and disseminated to over 90 college and university campuses and 22 high schools across the US. The toolkit provides guidance for using our assessments and tools, which help identify campus needs and create a locally targeted campaign to promote healthy behaviors, environments, and policies.

Another significant outcome from the Get FRUVED work was the development of a novel, evidence-based method for collecting public and intervention-specific data, called eB4CAST74. Each campus or community was provided with a personalized narrative that described its needs and the impacts of interventions, which were summarized from the data. This easy-to-use tool offers public program deliverers a means to share their impact story with communities, stakeholders, and administrators.

To disseminate the work of NC1193, a USDA-NIFA Conference grant was secured to share educational materials and tools that help professionals more effectively assess their college environments and develop relevant health promotion programs. The conference aimed to facilitate partnerships among communities to promote healthy behaviors and support a positive environmental culture on college campuses. The conference shared information on interventions that aim to improve behaviors and environmental factors that support healthy behaviors associated with the prevention of unwanted weight gain and the subsequent risk of chronic diseases among young adult audiences.

Further, with the rich datasets the multistate has acquired over the years of collaboration, we have directed efforts to use this big data to describe young adult health over the past 15 years. The next iteration of this multistate project will build on the momentum of the past three decades of collaborative work. 

Objectives

1. Evaluate and interpret variables impacting emerging and young adults’ nutrition, health, and quality of life, including lifestyle behaviors and environmental influences, using new and existing NC1193 and national data sets to inform the development of future health promotion programs.
   
2. Establish, deliver, and/or evaluate prevention-focused Food Is Medicine (FIM) programs for emerging and young adults that support a comprehensive approach to health promotion, integrating nutrition education, access to and consumption of whole foods.
   

Methods

Objective 1: Evaluate and interpret variables impacting emerging and young adults’ nutrition, health, and quality of life, including lifestyle behaviors and environmental influences, using new and existing NC1193 and national data sets to inform the development of future health promotion programs. 

To accomplish Objective 1, there will be two parts, part 1: establishing rich data sets to explore emerging and young adult health and analyzing previous, and part 2: analyzing existing NC1193 and national data to inform the development of FIM interventions.  

Part 1: Establish an annual electronic survey to benchmark young adults’ mental and physical health cognitions and behaviors affecting their health quality of life. Students will be recruited from large general education courses such as psychology, biology, economics, and introduction to nutrition. Following IRB-approved procedures, participants will give informed consent and the de-identified data will be used for research. Survey items to be included on the annual survey will consist of demographic characteristics, health cognitions, dietary intake behaviors, physical activity, sleep hygiene, anthropometric data (e.g., height, weight), health quality of life, mental health (e.g., satisfaction with life, self-esteem, coping practices, self-regulation, loneliness/ belongness, depression, stress, anxiety screeners), eating behaviors (e.g., emotional eating, mindful eating), health practices (e.g., self-care, substance use), and food/nutrition security (e.g., meal history, social provisions, financial security), and social support. In year 1, we will refine a comprehensive electronic survey pilot-tested by 4 member states during the current work plan. Refinement will include ensuring a comprehensive array of scales are incorporated and that all scales used are reliable and valid, and creating a complete codebook for all scale items to permit other researchers to answer an array of research questions from the data set. In years 2 to 5, we will implement the survey among the multistate group and invite universities outside the multistate group to participate. Additionally, the data will be analyzed annually and prepared for continued analysis as described in Objective 1, Part 2. Annually, results will be disseminated via peer-reviewed journal articles and presentations at professional meetings (e.g., American Society for Nutrition, Food and Nutrition Conference and Exhibition, Society for Nutrition Education, American College Health Association, etc.).

Part 2: Analyze existing NC1193 and national data. Our NC1193 network maintains data collected over the past 20 years. Using these data allows us to examine nutrition, health, and quality of life trends among emerging and young adults. Utilizing national data allows us to study the emerging and young adults regardless of education status. Our research team will generate a variety of research questions utilizing existing NC1193 and national data. The findings will influence our prevention-focused FIM program(s).

 The following NC1193 datasets have been collected to date and range from longitudinal studies following young adults for at least one year to cross-sectional studies:

• The Stage-Tailored Multi-Modal Intervention Study64 (S. Nitzke, PI, USDA/IFAFS, 2001-2005). The purpose was to evaluate the effectiveness of an intervention aimed at enhancing fruit and vegetable consumption among economically disadvantaged young adults. The study was a randomized treatment-control, pre-post, follow-up design conducted in 10 states. Young adults (n = 2024, ages 18–24) were recruited from non-college venues; 1255 (62%) completed assessment interviews at 0, 4, and 12 months. 
• WebHealth65 (G. Greene, PI, USDA/NRI, 2005-2009). The project was designed to test the impact of a non-dieting online intervention for college students on biological and psychosocial health indicators using a randomized, controlled design. College students (n = 1689, aged 18-24) were recruited from eight universities; 1144 students (67.7%) completed the study, with assessments conducted at baseline, 3 months, and 15 months. 
• Project YEAH8,12,13,16,55,56,66(Young Adults Eating & Active for Health) (K. Kattelmann, PI, USDA/NRI, 2008-2012). The purpose was to develop a web-based intervention for obesity prevention among young adults. The design was a 15-month (10-week intensive intervention with a 12-month follow-up) randomized, controlled trial delivered via the internet and email. Young adults (n = 1639, aged 18-24) were recruited from 13 college campuses; 973 participants (59%) completed the study, with assessments conducted at baseline, 3 months, and 15 months. 
• Get FRUVED72,73 (Fruit and Vegetable Education) (S. Colby, PI, USDA/AFRI, 2014-2020). This project aimed to increase fruit and vegetable intake and improve health outcomes through a peer-mentoring social marketing campaign. Followed a nested cohort design using a control-treatment, pre-test, post-test trial with assessments.
• Healthy Campus Environmental Audit (HCEA)9,14-16,18,20,58-63(Horacek, Lead, 2008-2020)4,10-15. Includes validated/published tools to assess the food (e.g., food access and availability in vending machines, convenience stores, cafeterias, and restaurants), physical activity (e.g., walkability, bike-ability, recreation), and health-related policy environment. HCEAs are used to assess, monitor, and advocate for environmental changes to improve health. Beta-tested at seven universities to update the training and dissemination materials in Spring 2025.
• Behavior, Environment, and Changeability Survey (BECS)105 (White, Lead, 2009-2011). The purpose was to develop and test the validity of BECS to identify the importance and changeability of nutrition, exercise, stress management behavior, and related aspects of the environment. A cross-sectional, online survey was designed to include 10 universities and consisted of a convenience sample of college students (n = 1283, aged 18-24).
• College Environmental Perceptions Survey (CEPS) 53, (Colby, Lead, 2012-2016). Designed to assess students’ perception of walkability/bike-ability, recreation facilities, health policies, stress management, health initiatives/programs, and campus food environment. Surveys completed by college students from 8 universities (N = 1147) were used to test internal structure (factor analysis) and internal consistency (Cronbach's alpha).
• Behavioral Environmental Perceptions Survey (BEPS)17,19,57 (Greene/McNamara Lead, 2017-2019). The purpose was to create a tool to measure college students’ perceptions of the healthfulness of their environment. Cross-sectional, online survey design with 10 college campuses. Time point 1 (n = 120 cognitive interviews; n = 922 factor analysis); time point 2 (n = 2,676), convenience sample of undergraduate students.

Potential research questions of interest can also be answered using data from peer research groups or the federal government. External data sets often include young adults who are not enrolled in college or are enrolled in a college not represented by our research team. In addition to the data sets presented above, we will also explore and use as applicable other data sets like the National Health and Nutrition Examination Study (NHANES), the American Time Use Survey, National Survey of Young Adult Nutrition (Racine/Hess, 2024), and American College Health Association's National College Health Assessment (ACHA, 2025).  With this data, we can address research questions that examine the relationship between young adult dietary behaviors and chronic disease status, other health behaviors, food security, mental health, financial security, and time poverty. These data will also allow us to control for or stratify by college attendance. College enrollment may predict eating behavior or diet quality.

In Year 1, the team will develop research questions and the appropriate dataset necessary to answer each research question. Existing NC1193 data integration and analysis will continue, ensuring systematic incorporation of multistate and external datasets. Preliminary analyses will assess data quality and refine key research questions. During the annual meeting, an overview of proposed research questions with a summary of the data source and data analysis methodology will be presented to facilitate collaboration and identify methodological gaps.

In Year 2, the team will continue to refine analytical frameworks and methodologies while conducting more advanced analyses to ensure consistency across datasets. Efforts will focus on improving statistical models and data harmonization approaches. Funding will  be pursued to support ongoing and expanded analytical work, with institutional resources leveraged where available. Findings from initial analyses will inform the development of our FIM program(s). 

In Years 3 and 4, the team will intensify data analysis efforts, applying more complex modeling and integrative techniques to address key research questions. Funding opportunities will continue to be explored to support advanced analyses. As findings emerge, manuscript preparation and dissemination efforts will accelerate. The team will also refine key themes, improve predictive modeling, and develop translational insights to inform future research directions.

In Year 5, the team will finalize and disseminate findings, with a strong focus on publishing manuscripts in peer-reviewed journals and presenting results at scientific conferences. Emerging findings will inform continued funding applications to support the next research phase. The effectiveness of data integration and analytical strategies will be evaluated to refine methodologies for future work.

Objective 2: Establish, deliver, and/or evaluate prevention-focused Food Is Medicine (FIM) programs for emerging and young adults that support a comprehensive approach to health promotion, integrating nutrition education, access to and consumption of whole foods. 

We will be following the model of Food Is Medicine which means that food and nutrition can improve health and is essential for well-being (USDA). The pyramid figure designed by Tufts University (Figure 1) provides a visual on the type of interventions that are expected and how they would affect populations. At the base of the pyramid are 2 levels of prevention programs that focus on policy, programs and nutrition security that are intended to impact the most general population. Interventions will be tied to biomarkers to show effective outcomes of whole food consumption. The biomarkers that we intend to collect are: spectroscopy-based skin carotenoid levels, abdominal adiposity, blood pressure, blood glucose, blood lipid profiles, and others.

See Figure 1 HERE

Part I (Years 1-2):  Utilizing a systematic approach, we will prepare a scoping review of studies around Food Is Medicine (FIM) approaches and interventions among emerging and young adults to identify and evaluate related studies, gaps in the literature, study methods, and/or related information to support preparing a journal article for publication. During Year 1, a thorough search of the current evidence surrounding young adults and prevention-focused FIM approaches will be conducted by multistate members. During Year 2, members will write the scoping review journal article and submit it for publication.

Part II (Years 3-5): Utilize current and prospective data to capture the state of FIM on college campuses through a campus needs assessment, electronic surveys, and campus environment assessments. Across the multistate group in Year 3, members will investigate the current and ongoing initiatives on their campuses that utilize FIM approaches through survey data and environmental assessment (collected as part of Objective 1). Following the Year 3 data collection, a network will be developed to compile initiatives into a single resource guide for dissemination in Year 4. To capitalize on this data, two peer-reviewed publications will be written and published in Year 5 to share the results of the needs assessment and provide a discussion on challenges and best practices in prevention-focused FIM programs to help guide future research.

To accomplish the two parts of Objective 2, we plan to achieve the following in Years 1-5:

In Year 1, a scoping review will be conducted of the literature surrounding prevention-focused FIM approaches specific to emerging and young adult populations. We will additionally utilize previous data from the group's historical projects to provide background and premise (collected as part of Objective 1). Literature will be reviewed for current efforts or programs that are evidence-based examples of prevention-focused FIM programming in emerging and young adults. 

In Year 2, information from the scoping review will be utilized to publish a peer-reviewed journal article (i.e., Journal of American College Health) on the current landscape of prevention-focused FIM programming in emerging and young adults. 

In Year 3, an on-campus needs assessment will be conducted to identify current initiatives utilizing prevention-focused FIM approaches. Using the expertise of the multistate group and previously developed assessment tools (i.e., Healthy Campus Environmental Audit) and survey data, information will be compiled regarding efforts on campuses that use prevention-focused FIM programming.   

In Year 4, data from Year 3 will be used to develop an information network of emerging and young adult tailored resources, lessons learned, and potential partnerships for prevention-focused FIM programming for this population. The resource guide will serve as an interactive, live document, with website links to efforts, general explanations of these programs, and challenges or lessons learned from these program leaders. 

In Year 5, dissemination of needs assessment data and the prevention-focused FIM network resource guide will be shared through a peer-reviewed publication. To guide future work of this multistate group, and prevention-focused FIM  programming for emerging and young adults, challenges, best practices, and evaluations of prevention-focused FIM programs/interventions will be shared and published.

Measurement of Progress and Results

Outputs

• Analyzed survey results from cross-sectional longitudinal dataset
• Three or more peer-reviewed manuscripts utilizing the NC1193 existing data/national datasets informing future prevention-focused FIM programs.
• A scoping review regarding prevention-focused FIM approaches and interventions in the emerging and young adult population.
• A needs assessment report of NC1193 universities of prevention-focused FIM initiatives and programs for emerging and young adults.
• A network and resource guide to capture the current landscape of prevention-focused FIM initiatives and programs for emerging and young adults.
• A position paper addressing prevention-focused FIM programming for the emerging and young adult population and related policy and practice implications.

Outcomes or Projected Impacts

• 1. The goal of NC1193 is to support communities where emerging and young adults live, creating healthier environments and promoting health. The numerous outcomes of this project include evidence-based tools, resources, and programs to address the unique needs and health of today’s emerging and young adults. By disseminating evidence-based tools, assessing environmental perceptions, and evaluating the environmental influences on health, this research team will facilitate the adoption of healthier habits by more people. Good health means a better quality of life, reduced healthcare costs, and an able workforce in communities across the U.S.
• 2. The mechanisms of interaction between lifestyle behaviors, perceptions, and environmental factors in influencing healthful behaviors and health status among young adults will be determined, and the results will be disseminated for use in health and wellness programming (Objective 1). Big data merging and analysis are essential for continuing the work of large collaborative groups. By exploring previous, current, and applicable external data sets, NC1193 will provide potential solutions regarding the health and wellness of students in the following areas for college campuses: cost-savings, recruitment and retention, marketing and promotion, understanding current and future needs of students, innovative intervention development, and/or customized and dynamic learning programs.
• 3. There are limited peer-reviewed research studies around prevention-focused FIM programs addressing emerging and young adults. This project will 1) identify key gaps in knowledge around prevention-focused FIM efforts in communities in which emerging young adults live and work, ultimately supporting future research; 2) provide and disseminate a synthesis of best practices for prevention-focused FIM programming for emerging and young adults; and 3) aim to create knowledge, avenues for further work, and extend the field around prevention-focused FIM for emerging and young adults to support their health and well-being during a time of of critical transition and the establishment of lifelong patterns.

Milestones

(1):Develop research questions to track emerging health trends in this population; Identify survey items to assess young adult health; Pursue funding opportunities to support big data analysis and interpretation Identify appropriate research models, frameworks, and/or methodologies for scoping review.; Conduct a comprehensive literature review to identify work done on food is medicine in the young adult and emerging adult population.

(2):Continue to track emerging health trends in this population; Distribute the electronic surveys and/or environmental assessments; Pursue funding opportunities to support big data analysis and interpretation; Conduct advanced data analyses, apply integrative modeling techniques, and identify themes from analysis results. Complete the comprehensive literature review to identify work done on food is medicine in the young adult and emerging adult population.

(3):Continue to track emerging health trends in this population; Distribute the electronic surveys and/or environmental assessments; Dissemination of findings in refereed venues; Pursue funding opportunities to support big data analysis and interpretation; Conduct advanced data analyses, apply integrative modeling techniques, and identify themes from analysis results. Identify key research questions targeting the identified population and the unique approach of food is medicine in the research design.; Identify appropriate research models, frameworks, and/or methodologies.; Conduct a needs assessment of current or past FIM initiatives across the multistate team.

(4):Continue to track emerging health trends in this population; Distribute the electronic surveys and/or environmental assessments; Dissemination of findings in refereed venues; Pursue funding opportunities to support big data analysis and interpretation; Conduct advanced data analyses, apply integrative modeling techniques, and identify themes from analysis results. Conduct a needs assessment of current or past FIM initiatives across the multistate team.; Collect, clean, and analyze data through translation and interpretation.; Prepare manuscripts on best practices and evidence-based FIM approaches for young adults.; Prepare a position paper on prevention-focused Food Is Medicine (FIM) programs for emerging and young adults

(5):Continue to track emerging health trends in this population; Distribute the electronic surveys and/or environmental assessments; Dissemination of findings in refereed venues; Pursue funding opportunities to support big data analysis and interpretation; Conduct advanced data analyses, apply integrative modeling techniques, and identify themes from analysis results. Prepare a position paper on prevention-focused Food Is Medicine (FIM) programs for emerging and young adults; Pursue funding opportunities to support approaches such as food is medicine or similar.; Continue to have more state partners join the process as funding and data-collection capacity in other states increase.; Dissemination of findings in refereed venues

Projected Participation

View Appendix E: Participation

Outreach Plan

The outcomes from the development of the tools are expected to be disseminated through presentations at local, regional, and national meetings. Additionally, manuscripts will be submitted to peer-reviewed journals that are appropriate for their content. To facilitate collaboration and the sharing of data and costs among group members, we have established, as part of our multistate policies and procedures manual, a plan to manage data and costs associated with data management and analysis.

Organization/Governance

The NC1193 Multistate group has developed and adopted a policy and procedures manual that guides the group's functioning. An Executive Committee (chair, chair-elect, and secretary) has the administrative oversight and organization for the multistate group. The members elect the chair, chair-elect, and secretary to serve for one-year terms. The term begins on 1 October of each respective year. It is the responsibility of the chair to set the meeting dates, develop and post agendas, and conduct the meetings. The chair-elect assumes the duties in the chair's absence. The secretary maintains the minutes and posts them on the multistate website. Additional administrative subcommittees, with respective chairs and recorders, have been established to serve the research needs and operational functioning of the multistate group. The Policies and Procedures, Reports, and Awards sub-committee is responsible for maintaining the policy and procedure manual, submitting the annual report, chairing the renewal committee, and preparing additional documents such as awards submissions. The Publications and Presentations sub-committee maintains a current list (including a copy of the document) of journal articles, abstracts, posters, and major presentations by group members relevant to multistate objectives. This group is also responsible for maintaining and approving requests to use multistate data (Project Submission) forms. The Data Management subcommittee oversees the quality, storage, access, dissemination, archiving, and preservation of HCRC datasets. The Program Planning sub-committee plans and arranges for the annual meeting. The multistate members meet regularly (monthly) via teleconference and annually face-to-face at a date and place that the entire group selects.

To maintain a successful and productive multistate research group, members must actively participate in, collaborate on, and contribute to the HCRC's research and administrative activities. Each member will be assigned to at least one subcommittee related to committee management and one subcommittee focused on research activities, participate in regularly scheduled teleconferences, and lead state-specific research initiatives. Members who choose not to participate actively will be asked to resign from the HCRC group, and the NC1193 Administrative Advisor will contact that member’s Ag Experiment Station Director. Active participation involves attending at least 50% of teleconference calls and contributing to collaborative research and administrative activities. Consideration for terminating group membership due to inactive status will be presented on the agenda and discussed by the whole group membership, followed by a vote at the next group meeting (either face-to-face or via teleconference). If a ballot favors member termination, a request for formal removal from the project will be made to the respective State Ag Experiment Station Director and the regional NIMSS system administration.

Policies on cost-sharing, research topics, data sharing, publications, presentations, and research procedures have been established. All NC1193 publications and related materials should credit the multistate project and other relevant grants. A password-protected website has been developed to archive minutes and other documents used by the multistate members. One of the members also maintains a list-serv to facilitate communication.

 

Literature Cited

Attachments

Land Grant Participating States/Institutions

KS, KY, LA, ME, MO, MS, NE, NJ, TN, TX

Non Land Grant Participating States/Institutions