Hunger on Campus: a Multi-Method Study of Food Insecurity Among Post- Secondary Students at the University of Alberta
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Hunger on Campus: A Multi-Method Study of Food Insecurity among Post- Secondary Students at the University of Alberta by Mahitab A Hanbazaza A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nutrition and Metabolism Department of Agricultural, Food and Nutritional Science University of Alberta ©Mahitab A Hanbazaza, 2016 Abstract Individuals who are food insecure have insufficient access to food due to financial resource constraints. As an increasing number of students seek food assistance from the Campus Food Bank (CFB) Society at the University of Alberta (UAlberta), research is needed to understand why post-secondary students experience food insecurity. The primary focus of this multi-method research was to identify and describe food insecurity among post-secondary students using the CFB at the UAlberta. The secondary focus was to explore and understand the experiences and consequences of food insecurity among international post-secondary students using the CFB at the UAlberta. Three related studies were performed. First, a cross-sectional study was done to characterize the sociodemographic and educational characteristics of student clients (n=568) of the CFB using an existing database that housed data from registered users. These data were compared to publically available information on the UAlberta student body (n=38,774). Second, a cross-sectional study was conducted that involved a structured interview with student clients of the CFB (n=58). This study included the collection of data on participants’ sociodemographic and educational characteristics, food insecurity status, general health and well-being, diet quality, coping strategies, and academic performance. Third, a descriptive, qualitative study was completed using semi-structured individual interviews with international student clients of the CFB (n=11) who had moderate or severe food insecurity. Collectively, data derived from this multi-method research provided a better understanding of food insecurity in post-secondary students, and international students in particular. Specifically, we found that the majority of CFB clients were students and that international and graduate students were overrepresented among CFB student clients. Compared to students with Canadian citizenship, international students were younger, more likely to be graduate students, and rated their mental health more positively. ii Limited income was the main issue that contributed to food insecurity among post-secondary students. International students were less likely to ask for food from friends or relatives or apply for loans or bursaries to cope with food insecurity. The use of more severe coping strategies in response to long-term food insecurity might lead to adverse health effects in this population that can have a negative impact on their well-being and academic performance. Findings suggested that international students faced unique challenges and different experiences compared to their Canadian peers, which highlighted the value of targeted strategies to mitigate the influence of food insecurity within both domestic and international student groups. Post-secondary students require increased financial assistance and/or reduced education-related expenses to mitigate food insecurity. Longitudinal research with larger sample sizes is needed to provide a clearer picture on the long-term consequences of food insecurity on post-secondary students. iii Preface This thesis is an original work by Mahitab Hanbazaza. The research projects, of which this thesis is a part, received research ethics approval from the University of Alberta Research Ethics Board, first project name, “Retrospective analysis of Campus Food Bank users”, No. Pro00035077, January 16, 2013. Second project name “Hunger on Campus – Food insecurity among students”, No. Pro00032195, March 12, 2013. Third project name “Qualitative research with student clients of the University of Alberta Campus Food Bank” No. Pro00040231, August 20, 2013. Chapter 5 of this thesis has been accepted for publication as M. Hanbazaza, G.D.C. Ball, A.P. Farmer, K. Maximova, and N.D. Willows, “Filling a need: Sociodemographic and educational characteristics among student clients using a University-based campus food bank,” Journal of Hunger & Environmental Nutrition. I was responsible for the data cleaning, data analysis, and the writing of the manuscript. G.D.C. Ball and A.P. Farmer contributed to the manuscript edits. K. Maximova contributed to the data analysis plan and manuscript edits. N.D Willows was the supervisory author, and was involved with concept formation, the data analysis plan, and manuscript edits. Chapter 6 of this thesis will be submitted for publication as M. Hanbazaza, G.D.C. Ball, A.P. Farmer, K. Maximova, J. Farahbakhsh and N.D. Willows, “A descriptive study of food insecurity on a Canadian campus: A comparison between international and domestic postsecondary students,” Canadian Journal of Dietetic Practice and Research. I contributed to research design, and I was responsible for the data collection, data analysis, and manuscript writing. G.D.C. Ball iv and A.P Farmer contributed to research design and manuscript edits. K. Maximova contributed to research design, data analysis, and manuscript edits. J. Farahbakhsh contributed to research design, data collection and manuscript edits. N.D Willows was the supervisory author, and was involved with study concept formation, data analysis, and manuscript edits. Chapter 7 of this thesis has been submitted for publication and currently under review as M. Hanbazaza, G.D.C. Ball, A.P. Farmer, K. Maximova, and N.D. Willows, “Exploring food insecurity among international postsecondary students using a campus food bank at a Canadian university,” Journal of Qualitative Health Research. I contributed to research design, and I was responsible for the data collection, data analysis, and manuscript writing. G.D.C. Ball and A.P Farmer contributed to data analysis and manuscript edits. K. Maximova contributed to manuscript edits. N.D Willows was the supervisory author, and was involved with study concept formation, data analysis, and manuscript edits. Chapter 8 of this thesis has been submitted for publication and currently under review as M. Hanbazaza, G.D.C. Ball, A.P. Farmer, K. Maximova, and N.D. Willows, ““I am always thinking about food”: A qualitative study to explore food insecurity among international students studying at a Canadian university,” Journal of Immigrant & Refugee Studies. I contributed to research design, and I was responsible for the data collection, data analysis, and manuscript writing. G.D.C. Ball and A.P Farmer contributed to data analysis and manuscript edits. K. Maximova contributed to manuscript edits. N.D Willows was the supervisory author, and was involved with study concept formation, data analysis, and manuscript edits. v Acknowledgement This dissertation would not have been possible without the contribution of many people. A special thanks goes to my wonderful husband Murad Baothman, I would not be who I am without you. You complete me and bring out the best in me. Thank you for standing up for me, supporting me, pushing me to keep going, and being by my side all these years. My gorgeous children Mays, Mohammad and Mira, you are my inspiration and the reason for my success. I would like to thank my advisors Drs. Noreen Willows and Geoff Ball for their continuous encouragement, guidance and support. Without their help I wouldn't have been able to get through the research. The feedback and advice they provided me allowed me to become a better researcher and writer. I would like to thank my thesis committee, Drs. Anna Farmer and Katerina Maximova for their contributions to my studies. Thank you for sharing your time and knowledge. I wish to sincerely thank all of the participants that took part in the both the quantitative and qualitative study, as well as Mr. Marc LeBlanc (past CFB Executive Director) and Ms. Caitlin Phare (current CFB Executive Director) for supporting this research and providing access to valuable data, as well as other staff and volunteers at the CFB for their support during data collection. Thanks also to the graduate research team, especially Jasmine Farahbakhsh, for being there when I needed someone to talk to. vi Finally, I would like to thank my family and friends for their encouragement and support over the past 4 years. I would not be who I am today without my family. Words cannot express how grateful I am to my mother Maha, my father Adly, my sister Mahenaz and my brother Muhab, for their love, encouragement, and belief in me. vii List of Abbreviations CFB Campus Food Bank UAlberta University of Alberta ECHA Edmonton Clinic Health Academy FSSM Food Security Survey Module HFSSM Household Food Security Survey Module AFSSM Adult Food Security Survey Module USDA United States Department of Agriculture CCHS Canadian Community Health Survey NFB Nutritious Food Basket NCI The National Cancer Institute DSQ Dietary Screener Questionnaire viii Table of Contents CHAPTER 1: INTRODUCTION ...............................................................................................................1 1.1 PROBLEM STATEMENT ...................................................................................................................... 3 1.2 PURPOSE OF THE RESEARCH ............................................................................................................... 3 1.3 RESEARCH