The food environment and student dietary behaviour determinants in an urban Chinese university: implication for healthy eating

Abstract

Unhealthy diets increase the risk of various metabolic issues, especially among university students. The food environment has been implicated in creating an obesogenic generation, but little evidence was found in a Chinese university context. In this thesis, we aimed to understand the environmental and personal determinants of dietary behaviour among Chinese university students. Our systematic review identified 11 studies on how the food environment impacted student dietary behaviours, but in Western university settings only. Taste, availability, price, and nutrition literacy substantially influenced students’ dietary behaviours. We used the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S), a validated tool, to audit the food service context, food availability, and healthier options in an urban Chinese university food environment. A total of 52 outlets were audited in three on-campus canteens and further categorized into eight subtypes. Total C-NEMS-S scores (P = 0.0024) and food availability scores for starchy tubers (P < 0.001), dry beans (P < 0.001), vegetables (P = 0.0225), and fruits (P < 0.001) were significantly different across food outlet subtypes. The digital ethnography study built on the food environment audit. It aimed to explore how environmental factors influenced and were perceived by Chinese university students. We collected 90 days’ video, audio, graphic, and textual data on every eating occasion from 10 participants at Hebei Medical University. Thematic analysis identified three major thematic categories: social and environmental, food-related, and intrapersonal determinants. Students’ dietary behaviours were substantially influenced by interpersonal factors and food accessibility both on campus and at home. Diet interventions might target modifiable determinants, including increased healthy food availability and nutrition knowledge and skills to promote diet autonomy. Developing a comprehensive, reliable, and valid food environment audit tool would thoroughly contextualize the food environment lived by Chinese university students. Controlled diet interventions, quantification of diet intake, and diet quality assessment are warranted to evaluate the effectiveness of interfering with modifiable determinants. Findings of this thesis could inform university and government policymakers on healthy eating guidelines for university students, provided that further research evidence is synthesized from diverse university settings in China.