Food insecurity is rising among college students and minority groups in the United States. This is closely associated with poor health outcomes, including chronic health risks and poor mental health outcomes. Two key parameters, namely physical access and affordability have been commonly employed for assessing food insecurity by various institutions and researchers. While the food security is assessed for US populations and hinged upon measuring access to healthy and nutritious foods, food security among international students is difficult to comprehend. Moreover, perceptions and experiences of food access for international students does not encompass access to healthy and culturally appropriate foods. Therefore, if international students cannot access healthy and culturally appropriate foods, they are more likely to be food insecure and therefore, suffer from poor health and behavioral outcomes. The aim of this study is to explore perceived access to healthy and culturally appropriate foods for South Asian students that mitigate their food related health risk. The main research question examines if international students experience poor health and behavioral outcomes due to food inaccessibility than domestic students. Three hypotheses were tested to investigate the main research question. The first hypothesis is that international students perceive greater food inaccessibility than domestic students. The second hypothesis is that international students perceive greater food insecurity due to food inaccessibility than domestic students. The third hypothesis is that international students perceive poor health and behavior outcomes due to food insecurity than domestic students. Using mixed-methods research approach, quantitative assessment (n=427) was supplemented with qualitative – thematic coding to understand the perceptions of accessing healthy and culturally appropriate foods for Indian students (n=88) which formed the majority of the sample population (77%). Additionally, to comprehend the local-level access to foods, built area analysis (n=53) was conducted for one university in the Midwest (with the maximum responses) to explore the experiences of accessing healthy and culturally appropriate foods and the parameters of the modes of transit (mode of transportation, frequency of trips, travel time).The quantitative assessment utilized chi-square test for hypothesis one and two and logistic regression for the third hypothesis. The affirmation of all three hypotheses showed that access is a critical aspect in assessing food security/insecurity and in turn, good health and behavior outcomes for international students studying in the US universities. The qualitative assessment was based on interviews (n=88) and food journal responses (n=87). This method illustrates two important factors. First, the key definition for culturally appropriate foods emerged from interviews and second, acceptability to healthy and culturally appropriate foods was most preferred among interviewees. However, it was ranked lower in all other dimensions of access, i.e., accessibility, accommodation, availability, and affordability. The built area analysis (n=53) helped in understanding the local level assessment of the food environment of one university. The study concludes with recommendations on improving access to healthy and culturally appropriate foods through interventions at local planning level in three area- zoning, mobility, and governance.
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