Assessing the Healthfulness of University Food Environments: A Systematic Review of Methods and Tools

Abstract

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

Keywords: access to healthy foods; assessment; emerging adults; food environment; food services; food supply; measurement; social ecological model; university students.

Figure 1

The conceptual framework for this systematic review was informed by the Social Ecological Model to understand four nested levels of influence within the campus food environment. The levels of the model are distinguished by grayscale circles. For example, on an individual level, people hold knowledge, attitudes, skills, and behavioral choices while navigating the food environment. Interpersonal factors such as personal relationships with family, peers, and advisors may influence how an individual responds to the food environment, such as where they dine. Community factors create opportunities or barriers, such as the placement of dining spaces. Lastly, societal factors like campuswide dining policies may determine the types of food offered or meal plans required.

Figure 2

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of identified, screened, and included articles.