Nutrition and Physical Activity: Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity Among Students at Institutions of Higher Education

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends digital health and telephone interventions implemented at institutions of higher education focused on improving healthy eating and physical activity behaviors among students interested in improving these behaviors.

Systematic review evidence shows these interventions demonstrated meaningful changes in select dietary and weight-related outcomes.

Students who met or exceeded recommended levels of physical activity at baseline (U.S. Department of Health and Human Services, 2018) maintained physical activity levels.

The CPSTF has related findings for the following:

The full CPSTF Finding and Rationale Statement and supporting documents for Nutrition and Physical Activity: Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity Among Students at Institutions of Higher Education are available in The Community Guide Collection on CDC Stacks.

Intervention

These interventions aim to increase healthy eating and physical activity using websites, mobile apps, text messages, emails, or one-on-one telephone calls. Interventions include educational information plus one or more of the following:

Coaching or counseling from trained professionals
Self-monitoring to record healthy eating, physical activity or weight
Goal setting
Computer-generated feedback that provides tailored information

Interventions also may include one or more of the following:

Social support from peers through social media, internet forums, or discussion groups
Motivational strategies that include incentives, rewards, prompts, and gaming techniques

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 17 studies with 18 study arms (search period: January 2009-February 2021).

Study Characteristics

Included studies were conducted in the United States (14 studies), Australia (1 study), and the United Kingdom (2 studies).
Fifteen studies were conducted at institutions of higher education offering baccalaureate, graduate, or professional degrees; one was conducted in an institution of higher education offering an associate’s degree or other two-year training program; and one at a vocational institution of higher education.
Thirteen studies were conducted at public institutions of higher education. None of the included studies were conducted in historically Black colleges or universities, tribal colleges or universities, or Hispanic-serving colleges or universities.
Six studies (7 study arms) reported whether students commuted or lived on campus. Four studies reported more than half of the students lived on campus; one reported nearly half the students lived on campus; and one reported all students commuted.
Four studies reported on population density, three in urban and one in rural locations.
Across all studies, participants had a mean age of 19.7 years. Studies reported higher proportions of females than males (on average, 69% were female).
Three studies reported socioeconomic status (SES). One study took place at a vocational school geared toward low-income students; one study at a two-year college reported 67.9% of students made less than $12,000 per year; and one study at a four-year university reported 33% of participants were Pell-grant eligible (U.S. Department of Education, 2021) and 37% did not feel they always had enough money to buy food.
Six of the studies from the United States reported racial and ethnic distributions. Studies included participants who self-identified as White (median 64.8%; 14 studies), Black or African American (median 14.6%; 14 studies), Hispanic or Latino (median 6.0%; 10 studies), Asian (median: 10.8%; 9 studies), American Indian or Alaska Native (0.8%; 1 study), Native Hawaiian or Other Pacific Islander (0.4%; 1 study), or other race/ethnicity (median 10.3%; 5 studies).
Intervention duration ranged from one month to 24 months, with a median duration of 2.5 months.
Baseline dietary and physical activity behaviors varied. Participants in four studies exceeded the dietary guidelines at baseline, and participants in six studies were below recommended guidelines. Additionally, participants in twelve studies exceeded Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2018) at baseline.
Baseline weight status also varied. Five studies reported a mean BMI that would be considered a classification of overweight or obesity, and seven studies reported a mean BMI that would be considered a healthy weight.

Summary of Results

The systematic review included 17 studies.

Dietary Behaviors

Fruit and vegetable intake increased by a median of 0.40 servings per day (9 studies with 10 study arms).
Fat intake decreased (5 studies with 6 study arms).

Physical Activity

For participants with baseline physical activity above recommended levels: Time spent engaged in physical activity increased by a median of 3.74% (10 studies with 11 study arms).
For participants with baseline physical activity below recommended levels: Time spent engaged in physical activity increased by 17.27% (1 study).

Weight-related

Body mass index (BMI) results decreased by a median of 0.20 kilograms per meter squared (3 arms) for study participants with overweight at baseline. For study participants with healthy weight at baseline, there was no change (7 arms) in BMI.
Weight results decreased by a median of 0.02 kilograms (4 studies).

Clinical

Clinical outcomes including systolic blood pressure, diastolic blood pressure, total cholesterol, and glucose did not change (2 studies).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

The CPSTF finding should be applicable to all working adults who are interested in improving these behaviors regardless of sex, income level, race, or ethnicity.

Evidence Gaps

How effective are these interventions when implemented at historically Black colleges and universities, Hispanic serving institutions, or tribal institutions of higher education?
How effective are these interventions when implemented at institutions of higher education with a high proportion of nontraditional students, such as 2-year institutions of higher education or vocational schools?
Does effectiveness differ by students who commute versus live on campus?
How effective are these interventions when implemented at institutions of higher education with existing healthier food campus policies?
Does perceived safety of campus environment affect participation in these interventions?
Are these interventions effective in rural areas?
How effective are interventions among students with food insecurity?
How effective are these interventions among students with low baseline levels of physical activity?

Implementation Considerations and Resources

It is important to note that these interventions were conducted among students; therefore, not all populations would benefit to the same degree. Additionally, the CPSTF does not endorse any specific digital health intervention.

Implementers may want to tailor the intervention based on gender, race/ethnicity, health literacy, urbanicity (rural vs. urban), or other student characteristics.
Interventions may be implemented by various student services within institutions of higher education (e.g., student life, housing, dining, student health centers).
Programs may want to consider the food environment (e.g., policies in place for types of food offered), built environment (e.g., places for physical activity), and safety (e.g., adequate lighting on walkways).
Data security and privacy issues need to be considered when individuals enter personal information electronically.
CPSTF suggests implementers make these programs accessible to workers of all types of jobs and all races/ethnicities.
Digital health is rapidly evolving. Newer digital health interventions, such as those that incorporate social media platforms, were not represented in this body of evidence.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.