Interventions to Reduce Food and Nutrition Insecurity Among Dental Students

ABSTRACT

Purpose/Objective

The prevalence of food insecurity (FI) on university campuses is increasing. This study explored the prevalence of food and nutrition insecurity (NI) among dental students and barriers and interventions to address them.

Methods

A cross‐sectional web‐based survey was conducted. Validated tools were used to assess FI and NI. Univariate binary logistic regressions and a multivariable logistic regression model identified factors independently associated with FI.

Results

The response rate was 11.9% (n = 67). The mean age was 28.4 years; 67% were D1/D2 students; 53.7% were female, 15.2% identified as Hispanic, and 50.7% as White. Forty percent experienced FI; 24.2% had low nutrition security (NS), and 26.9% reported partial or full responsibility for others' living expenses. Twenty‐four percent were married, 25.8% used a food pantry; 11.1% had unsuccessfully applied for Supplemental Nutrition Assistance Program benefits. In the adjusted model, low NS, nonmarried status, and food pantry use increased the likelihood of FI (odds ratios of 16.854, 10.182, and 9.123, respectively). Common barriers and potential interventions to address FI and NI were explored.

Conclusions

The prevalence of FI in this sample was greater than the national average. Those who were unmarried, had low NS, and used a food pantry were significantly more likely to have FI. Proposed interventions include student services enhancements and curriculum modifications on nutrition and wellness. Further research is necessary with a larger sample to understand factors contributing to NI and FI among dental students.

1. Introduction

Food insecurity (FI) is defined by the United States Department of Agriculture (USDA) as “limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways” [1]. It leads to a lack of access to safe, healthy, and adequate food to meet nutritional needs, which in turn results in a nutrient‐poor diet and increased risk of chronic diseases [2, 3]. Poor diet is a risk factor for several of the leading causes of death in the United States, including heart disease, cancer, stroke, and diabetes [4]. While the definition of FI includes the word “nutritionally,” most validated tools to assess FI focus on access to food in sufficient quantities, not diet quality. Hence, it differs from nutrition security (NS). NS is defined as “having consistent access, availability, and affordability of foods and beverages that promote well‐being and prevent (and if needed, treat) disease” [5]. Assessing NS alongside FI can identify those at risk for poor diet due to lack of access to affordable healthy foods. Research has supported the value of food and nutrition security screening to identify individuals at the highest risk for poor dietary quality and quantity and associated negative health outcomes [6].

FI is increasingly prevalent among university students [7, 8]. Prior research on health profession students’ FI has documented a prevalence of 17%–29% [8, 9, 10, 11, 12]. Shi et al. found that international students may have additional issues with FI due to the lack of availability of customary foods and component ingredients [13]. Marshall et al. found that 46.9% of dental students at a Midwest US dental school had varying levels of FI [14]. This study also found that those with FI were more likely to experience greater stress, sleep difficulty, lower grades, and academic performance problems than their food secure counterparts. A subsequent study of two US dental schools (one in the Midwest and one in the Midatlantic region) during COVID found that 46% of the students had FI and that students with FI had a lower diet quality than their food‐secure counterparts [10].

There is limited research on the prevalence of FI among dental students, and no studies exploring NS in dental or other health professions students were identified. Additionally, no studies were found that addressed student‐perceived barriers and interventions to address FI and low NS. Dental students are graduate students and often face different issues than undergraduates, such as living off campus and having additional financial needs, including dependents [8]. Marshall et al. identified that FI is associated with poor diet, sleep, and academic performance in dental students [14]. Given that student academic success and systemic and mental health can be negatively impacted by FI, this study sought to determine the prevalence of FI and low NS among dental students at a northeastern US public university dental school. The aims of this study extended beyond the prevalence of FI and low NS to include student‐perceived barriers to and potential interventions (as suggested by students participating in the survey) to address both FI and low NS. Identifying barriers and potential interventions for students will be the first step toward addressing the matter in dental students.

2. Methods and Materials

2.1. Study Design

This study employed a cross‐sectional web‐based survey design to assess FI and low NS among predoctoral dental students and postgraduate advanced education dental students. The university's Institutional Review Board approved the study (Pro 2023002207).

2.2. Study Instrument

The survey was designed using both validated instruments and questions adapted with permission from authors of prior surveys on FI [9, 10, 11]. Questions regarding demographic and academic characteristics, environmental and financial barriers dental students face in accessing food, and potential solutions to overcome the barriers were adapted with permission from a survey conducted by the University of Iowa College of Dentistry. The principal investigator of this study participated in developing that instrument, and the co‐investigators collaborated on revisions to some questions for this study. Additional sections included the validated Hunger Vital Sign 2‐item screener, which has been validated in adults to measure FI [15, 16]. This 2‐item screener categorizes respondents as food secure or FI based on their responses to questions regarding the availability of adequate and nutritious food. Gunderson et al used data from US Current Population Survey Supplement (2013) to validate the 2‐item Hunger Vital Sign in adults [16]. They found a sensitivity of >97% and a specificity of >70% [16]. NS was measured using a validated 4‐item instrument created by the Center for Nutrition & Health Impact [6, 17]. This instrument uses a scoring system ranging from 0 to 4, with higher scores reflecting NS and greater access to a nutritious diet and lower scores reflecting low NS. This NS tool is a relatively new but validated instrument. It demonstrates strong construct validity, with households scoring higher on the new measures showing significantly better dietary behaviors, financial stability, and health outcomes. It has undergone rigorous development, including cognitive interviews, pilot testing, and psychometric evaluation, ensuring its reliability and validity for assessing NS [6, 18]. Scoring for both tools is detailed in Figure 1.

FIGURE 1.

Hunger Vital Sign screener and Nutrition Security screener.

These two instruments’ NS and FI questions (Figure 1) were combined into a single survey instrument that also included questions about demographic and academic characteristics, environmental and financial barriers dental students face in accessing food, and potential interventions to overcome the barriers. Barriers and potential intervention questions were asked using a series of multiple‐choice questions. Participants could select all that apply with an option to add other perceived barriers and potential solutions. The Qualtrics platform (QualtricsXM, Provo, UT) was used to administer the survey to all enrolled dental and advanced education students.

2.3. Sample

All matriculated predoctoral dental students (D1, D2, D3, and D4) and advanced education (postdoctoral) students at this public, northeast US dental school were invited to participate in this electronic survey. Additionally, when a new cohort of the internationally educated dentist group entered the school (as D2 students) one month later, they were invited to participate. The total sample was comprised of the school's entire student body (562 students). Given the exploratory nature of this study, a formal power analysis was not conducted, as the primary aim was to generate data for future, more rigorously designed investigations with a larger sample size.

2.4. Recruitment

The initial student sample received an email invitation with a link to the survey, and up to three email reminders (sent only to non‐respondents) were sent on days 5, 12, and 19 following the initial email. The survey took approximately 15–20 min to complete. The internationally educated students also received their initial email invitations with up to three email reminders. Students received up to two additional brief reminders in live classes and/or via announcement in the school's learning management system by co‐investigators. Participation was voluntary, and students provided online informed consent before accessing the survey. All respondents completing the survey had the opportunity to complete a second survey to submit their email addresses to receive a $10.00 Amazon E‐Gift card; this survey data was not connected to the research study and was optional to retain student anonymity.

2.5. Data Analysis

Descriptive statistics were used to summarize the demographic characteristics of the respondents. Categorical data were presented as frequencies and percentages, while continuous data was reported as mean ± standard deviation (SD). Univariate binary logistic regressions were conducted to examine the independent associations between pre‐selected covariates (listed in Table 2) and food security status (dependent variable). Covariates with a p‐value less than 0.10 in the univariate analysis were included in a subsequent multivariable logistic regression model to identify factors independently associated with FI among dental students. These covariates were selected based on their established associations with FI in the literature. Factors such as marital status, financial responsibility, academic level, and socioeconomic indicators like SNAP receipt, sex, ethnicity, and race have been consistently linked to FI in various populations [6, 9, 10, 12]. Additionally, using a food pantry is a direct indicator of FI and can help identify specific subgroups of students who may be at higher risk. By adjusting for these variables, we can better isolate the true impact of FI on dental students and identify potential interventions to address this issue.

TABLE 2.

Odds of having food insecurity (N = 67).

Model predicting odds of being food insecure
	Unadjusted		Adjusted a
Variable	OR (95% CI)	p value	OR (95% CI)	p value
Nutrition security [Low Nutrition Security vs. Greater Nutrition Security]	19.923 (3.979, 99.744)	0.0003 *	16.854 (2.772, 102.477)	0.0022 *
Marital status Divorced/Separated/Widowed/Single vs. Married/Partnered	3.852 (0.978, 15.166)	0.0538 b	10.182 (1.014, 102.278)	0.0487 *
Responsibility Always/Often/Sometimes Responsible vs. Rarely/Never Responsible	2.353 (0.783, 7.07)	0.1274
Dental school year D1 & D2 vs. D3 & D4	2.08 (0.635, 6.818)	0.6906
Dental school year PG vs. D3 & D4	2.6 (0.284, 23.814)	0.5727
Currently receive SNAP benefits Yes vs. No	3.25 (0.279, 37.8)	0.3465
Applied for and been refused SNAP Yes vs. No	4.868 (0.863, 27.477)	0.0731 b	0.952 (0.097, 9.301)	0.9661
Sex Female vs. Male	0.686 (0.257, 1.831)	0.4522
Hispanic Ethnicity No vs. Yes	0.238 (0.055, 1.024)	0.0538 b	0.135 (0.016, 1.171)	0.0693
Race Asian vs. White	2 (0.654, 6.112)	0.6468
Race Black or African American vs. White	4.799 (0.754, 30.544)	0.4304
Race Middle Eastern vs. White	2.4 (0.136, 42.249)	0.9554
Race Multiracial/other vs. White	4.799 (0.39, 59.125)	0.5466
Used a food pantry Yes vs. No	6 (1.783, 20.191)	0.0038 *	9.123 (1.349, 61.698)	0.0234 *
Age	0.995 (0.913, 1.085)	0.9119

Abbreviations: D = dental school year; PG = postgraduate.

^a Nutrition security, marital status, SNAP application history, ethnicity, and food pantry usage were all independently associated with food insecurity (p < 0.1), so they were adjusted for in the final model.

^b Not statistically significant but meets the threshold of p = 0.10 to be included in the adjusted model.

^*Statistically significant.

SAS software (version 9.4, SAS Institute Inc, Cary, NC, 2011) was used, and a two‐tailed p‐value of less than 0.05 was considered statistically significant. Free response comments were reviewed; no formal coding was completed.

3. Results

3.1. Sample

The response rate was 11.9% (n = 67); the mean age was 28.4 years. Two‐thirds of the sample were D1 and D2 students (67.2%) (Table 1). The demographic profile was diverse, with 53.7% female students, 15.2% identifying as Hispanic, and 50.7% as White (Table 1).

TABLE 1.

Demographic characteristics and food & nutrition insecurity.

	Food secure (N = 40) n (%)	Food insecure (N = 27) n (%)	Totaln (%)	p value
Nutrition security (n = 66)				< 0.0001 a , *
Greater nutrition security	37 (94.9%)	13 (48.1%)	50 (75.8%)
Low nutrition security	2 (5.1%)	14 (51.9%)	16 (24.2%)
Year in dental school (n = 66)				0.7575 a
D1	10 (25.0%)	8 (29.6%)	18 (26.9%)
D2	15 (37.5%)	12 (44.4%)	27 (40.3%)
D3	6 (15.0%)	3 (11.1%)	9 (13.4%)
D4	7 (17.5%)	2 (7.4%)	9 (13.4%)
Postgraduate (residents)	2 (5.0%)	2 (7.4%)	4 (6.0%)
Gender identity (n = 67)				0.3948 a
Male	17 (42.5%)	13 (48.1%)	30 (44.8%)
Female	23 (57.5%)	13 (48.1%)	36 (53.7%)
Trans man	0 (0.0%)	1 (3.7%)	1 (1.5%)
Spanish, Hispanic, or Latinx (n = 66)				0.0422 a , *
Yes	3 (7.7%)	7 (25.9%)	10 (15.2%)
No	36 (92.3%)	20 (74.1%)	56 (84.8%)
Racial identity (n = 67)				0.3312 a
Asian	12 (30.0%)	10 (37.0%)	22 (32.8%)
Black or African American	2 (5.0%)	4 (14.8%)	6 (9.0%)
Middle Eastern	1 (2.5%)	1 (3.7%)	2 (3.0%)
White	24 (60.0%)	10 (37.0%)	34 (50.7%)
Multiracial/other	1 (2.5%)	2 (7.4%)	3 (4.5%)
Marital status (n = 67)				0.2015 a
Married	12 (30.0%)	3 (11.1%)	15 (22.4%)
Partnered	1 (2.5%)	0 (0.0%)	1 (1.5%)
Divorced	0 (0.0%)	1 (3.7%)	1 (1.5%)
Separated	1 (2.5%)	2 (7.4%)	3 (4.5%)
Widowed	0 (0.0%)	1 (3.7%)	1 (1.5%)
Single/never married	26 (65.0%)	20 (74.1%)	46 (68.7%)
Fully or partially responsible for another individual's (spouse, partner, children, parent, sibling) living expenses including food (n = 67)				0.0478 a , *
Always responsible	4 (10.0%)	3 (11.1%)	7 (10.4%)
Often responsible	3 (7.5%)	1 (3.7%)	4 (6.0%)
Sometimes responsible	1 (2.5%)	6 (22.2%)	7 (10.4%)
Rarely responsible	8 (20.0%)	1 (3.7%)	9 (13.4%)
Never responsible	24 (60.0%)	16 (59.3%)	40 (59.7%)
Use the university and/or community food pantries (n = 66)				0.00231 a , *
Yes	5 (12.5%)	12 (46.2%)	17 (25.8%)
No	35 (87.5%)	14 (53.8%)	49 (74.2%)
Receive SNAP benefits (n = 66)				0.32241
Yes	1 (2.5%)	2 (7.7%)	3 (4.5%)
No	39 (97.5%)	24 (92.3%)	63 (95.5%)
Applied for and been refused SNAP benefits (n = 63)				0.05411 a
Yes	2 (5.1%)	5 (20.8%)	7 (11.1%)
No	37 (94.9%)	19 (79.2%)	56 (88.9%)

^a Chi square p value.

^*Statistically significant.

3.2. Food and Nutrition Security Status

The prevalence of FI in this sample of students was 40.3%; 24.2% had low NS (Table 1). Low NS was significantly associated with FI (p < 0.0001); 87.5% of those with low NS also had FI. Twenty‐seven percent (26.9%) of the respondents reported partial or full responsibility for others' living expenses, and 23.9% were married (Table 1). Eleven percent had unsuccessfully applied for SNAP benefits (Table 1) and 4.5% were currently receiving SNAP. One quarter (25.8%) of students have used a food pantry. Students were asked why they did not use the food pantry. The most common response to this multiple choice question was “Other people need it more than I do,” followed by “The hours of operation conflict with my schedule,” “The location is not easily accessible,” and “I don't want others to know my food is limited.”

NS, marital status, SNAP application history, ethnicity, and food pantry usage were all independently associated with FI (p < 0.1) and included in the multivariable logistic regression model (Table 2). These were all adjusted for in the final model (Table 2). In the unadjusted model, univariate logistic regression identified low NS and food pantry usage as significant predictors of FI, with odds ratios of 19.92 (95% CI: 3.979, 99.744) and 6.00 (95% CI: 1.783, 20191), respectively (Table 2). The adjusted model reaffirmed the impact of low NS, non‐married status, and food pantry usage on the likelihood of experiencing FI, with respective odds ratios of 16.85, 10.18, and 9.12 (Table 2). However, the small sample size resulted in wide confidence intervals, reducing the precision of these estimates.

3.3. Barriers to Food and Nutrition Security

Table 3 presents barriers to students’ nutrition and food security (as identified through multiple‐choice questions). Of those who reported barriers, the most common ones were lack of funds to purchase food, lack of time to shop for groceries, inability to cook for themselves, lack of availability of preferred foods, lack of resources (refrigerator, stovetop, oven) to store and prepare food, and lack of transportation to grocery stores. Another barrier 14.9% of the respondents faced was food allergies/intolerance or religious or other preferences limiting their ability to eat food offered at school events. These included gluten intolerance, irritable bowel syndrome, diabetes, and religious preferences (Halal, Kosher, etc.). Those with FI experienced these barriers as much as or more frequently than those with food security.

TABLE 3.

Barriers to nutrition and food security.

	Food secure n (%)	Food insecure n (%)	Total n (%)	p value
Barriers preventing students from consuming what they wanted to eat
I did not have sufficient money to purchase food. b	0 (0.0%)	7 (100.0%)	7 (100.0%)
Unable to get to a store that sold the food they wanted b	3 (100.0%)	3 (100.0%)	6 (100.0%)
No time to grocery shop. b	3 (100.0%)	10 (100.0%)	13 (100.0%)
Unable to cook for themselves (i.e., do not know how; lack cookware, etc.). b	2 (100.0%)	6 (100.0%)	8 (100.0%)
Preferred food is not available in local grocery stores or other food retail outlets. b	3 (100.0%)	4 (100.0%)	7 (100.0%)
Availability of preferred foods/ingredients in the local community or online				0.0025 a , *
Always available	26 (65.0%)	6 (23.1%)	32 (48.5%)
Often available	7 (17.5%)	8 (30.8%)	15 (22.7%)
Sometimes available	7 (17.5%)	8 (30.8%)	15 (22.7%)
Rarely available	0 (0.0%)	4 (15.4%)	4 (6.1%)
Transportation barriers that limit the ability to go to grocery stores, food banks or pantries, or other food sources				0.1504 a
Always	2 (5.0%)	4 (14.8%)	6 (9.0%)
Often	2 (5.0%)	3 (11.1%)	5 (7.5%)
Sometimes	1 (2.5%)	3 (11.1%)	4 (6.0%)
Rarely	6 (15.0%)	5 (18.5%)	11 (16.4%)
Never	29 (72.5%)	12 (44.4%)	41 (61.2%)
Sufficient resources (i.e., utensils, refrigerator, stovetop) to prepare and store food				0.1774 a
Always	32 (80.0%)	17 (63.0%)	49 (73.1%)
Often	3 (7.5%)	6 (22.2%)	9 (13.4%)
Sometimes	3 (7.5%)	3 (11.1%)	6 (9.0%)
Rarely	0 (0.0%)	1 (3.7%)	1 (1.5%)
Never	2 (5.0%)	0 (0.0%)	2 (3.0%)
Times during the school year when students struggle more with hunger and limited access to food				0.00081 *
Yes	2 (5.0%)	10 (37.0%)	12 (17.9%)
No	38 (95.0%)	17 (63.0%)	55 (82.1%)

^a Chi square p value.

^b The sample sizes for these responses were too low to do chi‐square or Fisher's exact tests.

^*Statistically significant.

Respondents were also asked about potential interventions that the dental school might provide to help them overcome these barriers. Of those who responded to these questions, 92.3% reported that they would participate in budgeting programming if the school offered it. Respondents stated they would take advantage of school‐offered gift cards to local grocery stores, an in‐house food pantry, and meal cards to campus cafeterias if offered as possible interventions. Some suggested the campus shuttle buses include stops at the local supermarket close to the campus to allow them to conveniently shop for groceries at more competitive prices; others suggested training on budgeting.

4. Discussion

The current study explored the prevalence of FI and low NS among dental students in a single northeast U.S. public dental school. Respondents were also asked about perceived barriers and potential interventions to address both issues. The prevalence of FI identified in this population was 40%, slightly less than Marshall et al. (46.9%) found during the second year of the pandemic in a midwestern public dental school [14]. It was, however, double the prevalence identified by Riddle et al. (20%) and Hammad and Leung (17.4%) among medical and graduate students and health professions students, respectively [8, 12]. One quarter (24.2%) of the students who responded had low NS; low NS was also a predictor of FI. Given the dearth of research on the prevalence of NS among health professions or, more specifically dental students, there were no published studies for comparison.

The findings revealed that those who were unmarried, had low NS, and used the food pantry were more likely to be food insecure. While there was a significant association between ethnicity and FI in bivariate analyses, ethnicity was not significant in the final model. In contrast to prior research, we found no association between race and FI or NS. This may be in part due to the small sample size.

The lack of consistent and available access to adequate amounts of healthy foods and beverages for a significant portion of our student body is of concern. For example, students with FI often forgo fruits and vegetables in favor of less expensive, often heavily processed foods [7, 10]. Studies have found FI in university students to be associated with adverse mental health outcomes, including increased depression and anxiety [19, 20, 21], as well as reduced academic performance compared to food secure peers [19, 20]. Threse findings support previous research suggesting dental schools should consider concerted efforts to support student wellness needs, including addressing FI and low NS [10, 22] Lack of access to healthy and adequate foods for dental students challenges the mental health of our future healthcare workforce. Advocacy for access to adequate and healthy food is necessary at all levels of academia and nationally by educational organizations, including the American Dental Education Association (ADEA), the Accreditation Council for Graduate Medical Education (ACGME), the Accreditation Council for Education in Nutrition and Dietetics (ACEND), and others [10, 23]. Efforts must be made to recognize and confront FI and low NS among students. For example, institutions can work to promote access to food pantries for students. Additionally, students should have readily available access to school counselors, social workers, and community health workers who can help them apply for the federal Supplemental Nutrition Assistance Program (SNAP), if appropriate. Those not eligible for SNAP should be assisted in determining other avenues to access adequate amounts of healthy foods regularly.

The primary barriers preventing students from consuming their preferred foods identified by respondents were time to shop, followed by insufficient money to purchase food. In exploring the availability of preferred foods/ingredients, almost one‐third of the respondents indicated that preferred foods were “rarely‐sometimes” available; this proportion increased to 46% among those with FI. Transportation barriers to grocery stores and food pantries were sometimes, often, or always a problem for 22.5% of the study population; of those with FI, 37% cited this as a barrier. This study was conducted at an institution in an urban area with limited public transportation, which may significantly impact students’ ability to obtain preferred foods. The dental school is on the university's health sciences campus. There is a weekly food pantry, which is only open for a 3‐h period; hence, access for students is somewhat limited. Education about and expansion of available support services within the university, such as food pantries and transportation, may help mitigate these difficulties [22]. Schools should consider establishing transportation to local food stores, including stores offering a selection of culturally diverse foods, particularly in areas where reliable, safe, and affordable public transportation may be limited [24]. Communication regarding food pantry resources emphasizing its accessibility to anyone who thinks they may benefit from it is critical to reduce the incidence of students thinking, “Others need it more than I do.” Given that some respondents to this survey avoided the food pantry because they did not “want others to know my food is limited,” strategies to reduce the stigma around the use of a food pantry are essential [23]. Faculty and staff serving in an advisory capacity should be aware of and able to direct students to resources [25]. Furthermore, institutions should consider surveying students regarding preferred foods when establishing food pantries to help ensure they meet the student population's needs [24, 26].

Given the stress [27] and concerns about burnout in dental education programs, recommendations for programming on physical and mental wellness are increasingly important [22]. In the current study, 25% of the respondents had low NS; it was significantly more frequent in those with FI (Table 1). Similarly, a study on self‐care habits of dental hygiene students found students reported poor dietary behaviors, including inadequate fruit, vegetable, and dairy intake, and excessive sugar consumption [28]. Krasniqi suggested programming to improve student dietary habits in this population [28]. A recent single institution survey of medical students found that most students usually strove to eat a healthy diet, but identified some barriers, including time and financial concerns and eating for emotional regulation [29]. Intervention and educational programming regarding how to eat a low‐cost, balanced diet may benefit the dental student population to increase NS and promote student wellness. It is essential that such programming be culturally sensitive and represent a wide variety of dietary needs and preferences reflective of the student population.

Education regarding maintaining a healthy lifestyle and practicing recommendations presented to patients has been suggested for medical education [29], and this recommendation can be extended to dental education programs as well. Dental schools may consider integrating programming on how to purchase and prepare a healthy diet into the nutrition elements of the curriculum. Interprofessional education and collaborative teaching and practice are recommended for training in dental programs on the connections between oral health, nutrition, and obesity prevention [30]. The addition of a “teaching kitchen lab” for students focused on developing personal health values and habits promoting a healthy lifestyle through a healthy diet may be integrated into interprofessional education curricula or presented to diverse groups of health professions students [31, 32]. Healthy eating and eating on a budget would address some of the issues raised by students and provide an opportunity for interprofessional collaboration between dentistry and nutrition faculty and students [13, 33]. This model may be efficient for schools and provide opportunities for increased collaboration between programs and students and promote future interprofessional practice. Additionally, programs should consider longitudinal programming promoting wellness, including diet and nutrition, to develop student values around these behaviors [34]. Such education and value development may improve the ability of students to implement the recommendations [34] and impart them to their patients [29].

4.1. Strengths, Limitations, and Future Research

The study's strengths included the use of validated tools to assess food and nutrition security. Identifying student perceived barriers and potential interventions to address food and nutrition insecurity in our dental student population are additional strengths. Approaches to addressing barriers and interventions can be explored to reduce the incidence of FI and NI in the student body. Study limitations include the small sample size, which increased the chances of a response bias and resulted in wide confidence intervals, reducing the precision of the estimates. While the sample size of 67 students limits the generalizability of our findings, this exploratory study provides valuable insights into the prevalence and correlates of FI among dental students. Future studies with larger sample sizes can further validate and expand upon these preliminary results. This limitation underscores the need for further research with a larger cohort to enhance the accuracy of the findings and better understand the factors contributing to FI among dental students. Several factors may have contributed to the low response rate. Students who personally faced FI or knew someone who did may have been more likely to complete the surveys than those whose own experiences were further removed. The survey was long; there were 47 questions; the estimated time to complete the survey was 15–20 min. Although the survey was anonymous and data were aggregated for analyses, students may have hesitated to reveal information that they felt could potentially identify them. Although there were no other dental school surveys open at the time of this survey, the students may have received surveys from other university units.

Additionally, although email reminders were only sent to non‐respondents, the use of in‐class reminders created the opportunity for students to respond more than once. Given the survey length, this was unlikely but may have been a potential limitation. The results of this study cannot be generalized, as the population was limited to students at one dental school in a metropolitan area with an associated high cost of living. These limitations underscore the need for further research with a larger cohort to enhance the accuracy of the findings and better understand the factors contributing to FI among dental students.

5. Conclusions

The prevalence of FI in this sample of dental students was higher than the U.S. national average for individuals and families. Those who were unmarried, had low NS, and used a food pantry were significantly more likely to have FI. Students identified barriers to accessing food, including inadequate finances, lack of time due to their academic schedule, lack of transportation, and availability of preferred foods and resources to prepare and store food. Potential interventions to address student FI identified by students provide insights for initiatives to combat FI and offer opportunities for interprofessional collaboration. Nutrition curricula in dental schools can be expanded to include “hands‐on” culinary diet/nutrition sessions on healthy eating on a budget. These programs can include dental and nutrition faculty and students working together and learning from each other about oral health and diet, respectively.

Some of the possible interventions to address food and nutrition insecurity, eating on a budget, and accessing services to address FI can be addressed through interprofessional education (IPE) efforts between dental, dietetics and nutrition, and social work programs. These innovative approaches provide a mechanism to address a major student well‐being problem and educate students across professions.

Further research with a larger cohort is necessary to enhance the accuracy of the findings, better understand factors contributing to FI among dental students, and inform recommendations for the prevention and mitigation of FI and low NS. Additional research into the diet and nutrition habits of the dental student population, similar to Krasniqi et al., may help inform future programming to address FI and low NS [28].

Conflicts of Interest

The authors declare no conflicts of interest.

Touger‐Decker R., Sabato E., Singer S. R., et al. “Interventions to Reduce Food and Nutrition Insecurity Among Dental Students.” Journal of Dental Education 89, no. 8 (2025): 89, 1284–1293. 10.1002/jdd.13839