Abstract
Objective
This study was conducted to assess the food environment (FE) within a historically Black university (HBU) and to examine the association between campus FE factors and metabolic health markers.
Design
Cross-sectional study and geographic information system (GIS) mapping.
Setting
Online survey among students of an HBU in Texas and GIS mapping of FE within 10 miles of the campus.
Participants
College students (n=390) 18-21 years of age, predominantly women (72.8%).
Result
Most of the participants obtained their fresh fruits and vegetables (FV) off campus from farmers’ markets (2.8%), grocery shops within the county (7.3%), and grocery shops outside the county (43%). A majority (57.0%) of the participants carried out physical exercises less than 5 d/wk. Over 70% were unaware of the food pantry or meal share program, only 7.2% and 13.7%, respectively, used these campus resources. Food pantry awareness had significant associations with high blood pressure (P=.047) and high cholesterol (P=.048). Prediabetes was associated with quality of fresh FV (P=.017), the availability of a large selection of FV (P=.002), affordability of fresh FV (P=.008), and physical activity (P=.041). The campus FE variables explored significantly predicted prediabetes; participants who disagreed with the affordability of FV were more likely to have prediabetes (P=.044; odds ratio = 3.269; 95% confidence interval, [1.030, 10.375]).
Conclusions
Associations between campus FE factors and metabolic health indicators among this HBU population highlight the significance of interventions aimed at improving diet quality and increasing access to nutritious foods on campus.
Keywords: Food Environment, College Students, Fresh Produce, Metabolic Markers, HBU
Introduction
One of the most important modifiable determinants of chronic disease risk is diet, with poor diet quality contributing substantially to the prevalence of obesity, cardiovascular disease, type 2 diabetes, and some cancers globally.1 Excess intake of calories, saturated fat, processed meats, sodium, added sugars, and physical inactivity alongside inadequate consumption of fruits, vegetables, whole grains, nuts, seeds, and omega-3-rich foods underlie most diet-related chronic diseases.2 In the United States, poor diet accounts for more than half a million deaths annually as well as billion of dollars in annual health care expenditures.3,4 Over the past several decades, obesity and other diet-associated chronic illnesses such as hypertension, hyperlipidemia, and type 2 diabetes have surged in tandem with changes in food production, processing, affordability, and consumption patterns.5,6
The food environment (FE), which refers to the physical, social, economic, and policy conditions that impact people’s access to and choices about food, plays a huge role in dietary choices.7 The FE can be defined as the number and type of food outlets available, food pricing, food marketing, and nutrition policies that shape what food options are accessible in a community or setting. Two primary pathways through which the built environment impacts health outcomes have been delineated8: (1) behavior, encompassing factors such as physical activity and dietary habits, and (2) direct exposure, wherein biological responses to environmental elements such as air pollution may impact health, for example, through inflammation-induced weight changes. Research shows that the FE influences dietary behaviors and risks for obesity and chronic diseases.7 The FE can be characterized by aggressive marketing and advertisements of food and drinks with low nutritional quality, which have the potential to encourage excessive food intake and contribute to weight gain, and by low availability, accessibility, and affordability of items with high nutritious quality.9 The campus FE encompasses a variety of elements, including dining facilities, on-campus eateries, vending options, and the broader food culture within the academic community. An understanding of how these factors interact is essential for promoting healthy eating habits and fostering an environment conducive to overall student health. College campuses and surrounding neighborhoods can lack outlets such as grocery stores that provide healthy, affordable food and may have a high density of convenient stores and fast-food restaurants that market unhealthy options.10,11 The food choices students make are intrinsically linked to their immediate surroundings. In an earlier study, college students often struggled to maintain a balanced diet due to limited access to affordable, nutritious food options on campus.12 In another study, students often turned to fast food options due to time constraints, limited cooking skills, or the allure of aggressively marketed unhealthy food options.13 These limited FEs promote poor diets high in fat, sugar, and calories.
Metabolic health refers to the optimal functioning of the body’s metabolism, encompassing the chemical reactions in cells that sustain life and enable efficient bodily functions. A body that is metabolically healthy effectively regulates energy, maintains healthy blood pressure, controls blood sugar levels, processes food, and balances cholesterol.14 Clinically, metabolic health is defined by ideal levels of 5 markers without medication: triglycerides, blood sugar, blood pressure, high-density lipoprotein (HDL) cholesterol, and waist circumference. The opposite condition, known as metabolic syndrome, is diagnosed when 3 or more risk factors—high blood pressure, abdominal obesity, hyperglycemia, hypertriglyceridemia, and low HDL cholesterol—are present.15 The campus FE significantly impacts students’ metabolic health by influencing the range of available food options, food marketing strategies, and lifestyle behaviors.16 A healthy campus FE is crucial for shaping students’ dietary habits, nutritional well-being, and overall health. Poor diet can lead to increased risks of obesity, insulin resistance, hypertension, and other metabolic disorders. According to Li et al.,17 students with easy access to high-calorie processed foods are more likely to gain weight and develop metabolic syndrome.
The college campus, with its diverse student population, is a critical setting where lifestyle choices are formed. As diet-related diseases increase globally, an understanding of the relationship between the campus FE and these diseases is essential for promoting student health.18 Nutrition-related health disparities often start with early life inequalities and become worse in college settings. Historically Black colleges and universities (HBCUs) and institutions serving Hispanic students have many first-generation, low-income, and marginalized students of color who struggle with food and housing insecurity, financial issues, and other challenges during college.18,19 The historical context, cultural preferences, and socioeconomic and environmental factors of HBCUs make it difficult for students to adopt and maintain healthy dietary habits.20 Racially minoritized students, especially at minority-serving institutions such as HBCUs, have higher rates of overweight, obesity, diabetes, and metabolic issues compared with students at other universities.20,21 However, research on diet habits among college students has heavily focused on mostly White schools, with few studies looking at schools that serve mainly minority students.22 Limited, repetitive dining hall options lacking nutritious choices combined with high prices create barriers for students trying to maintain a healthy diet.23 The transition to college life represents a critical juncture where young adults often gain greater autonomy over their dietary choices. Students also face constraints such as tight budgets that restrict affordable choices, lack of cooking skills/equipment especially in dorms, lack of familiarity with specialty food items, time scarcity through juggling hectic schedules, and picky eating habits leaning toward convenience options high in fat, salt, and sugar.7,9,10 Taken together, these multilevel determinants spanning systemic campus-level barriers and individual concerns and motivations significantly shape daily eating behaviors linked to escalating prediabetes, obesity, and projected long-term diabetes trends.24 The present study was conducted to explore the FE at an historically Black university (HBU) with a student population that was 83.9% Black and African American and located in a food desert in Texas. The availability and accessibility of nutritious options and their association with metabolic health markers among students were evaluated.
Methods
Study Design and Population
An online cross-sectional survey open to all students at a Texas HBU was conducted via Qualtrics XM 2020 (Qualtrics, Seattle, Washington). An email invitation to participate with a link to the questionnaire was sent out to all the college students (about 9000) in April 2023. An in-person contact was also incorporated by the use of a recruitment flyer with a scan code that linked to the survey questions. This approach was incorporated to eliminate the potential bias of exclusively selecting participants who access their email inboxes often. Eligibility criteria were being a college student at least 18 years old, not having any dietary restrictions or medical conditions that limit consumption of fruits and vegetables (FV), and having access to an electronic device. Individuals who did not meet the criteria were excluded from the survey. The study participants were 390 students (4.3% response rate) who filled out the survey and provided the required information. The survey was conducted for 3 months. Each participant provided written informed consent, and the study was authorized by the university’s Institutional Review Board and was carried out in compliance with the moral guidelines established in the Helsinki Declaration of 1964.
Data Collection
The pretested online questionnaire was self-developed for this study to determine the prevalence of diet-related chronic diseases such as prediabetes, diabetes, high cholesterol, and high blood pressure among students at the HBU. The questionnaire was validated through expert review and administered to a similar group of respondents to assess the reliability of responses. The questionnaire was posted on Qualtrics where participants self-reported 3 of the 5 markers of metabolic health: diabetes (blood sugar levels), high cholesterol, and high blood pressure. The survey also assessed access to fresh produce and awareness and utilization of campus food resources and federal food assistance programs. An environmental map of the campus FE was made with geographic information system (GIS) software (ArcMap 10.8.2, ESRI, Redlands, California) to evaluate the availability and accessibility of convenience stores, restaurants, farmers’ markets, walking trails/parks, gyms, grocery stores, and food pantries within a 10-mile radius of the campus. The GIS map was made to provide objective measures of the actual FE and physical activity environment to augment students’ self-report data of food and dining establishments and physical activity places so as not to rely on only self-report measures.
Statistical Analysis
Descriptive statistics were utilized to calculate frequencies and percentages, and the Pearson chi-square test was applied to assess associations. Binary logistic regression was conducted to determine the FE predictors of prediabetes, diabetes, high cholesterol, and high blood pressure diagnoses. Missing data were excluded from the analysis. Data were analyzed using the Statistical Package for Social Sciences (SPSS 28.0, IBM, Armonk, New York); differences with a P value of <0.05 were considered significant.
Results
The 390 students in the study were predominantly women (72.8%) between the ages of 18 and 21 (50.7%) and were non-Hispanic Black/African American (84.5%). Most were undergraduates, with 25.3% sophomores and 23.7% juniors. Over half (55%) lived on campus. Nearly half were not working, and 92% were single (data not shown). Most of the participants rated their health as good (36.2%), very good (32.1%), or excellent (11.6%) (Table 1). A high percentage of participants reported a family history of obesity (52.3%), diabetes (47.7%), and hypertension (75.4%). Among the participants, 18.4% had prediabetes, 1.3% had diabetes, 13.4% had high blood pressure, and 12.3% had high cholesterol. The majority (57.0%) of the participants carried out physical exercises less than 5 d/wk.
Table 1.
General well-being of study participants
| Variable | Frequency, n (%) |
|---|---|
| Self-rated health | |
| Excellent | 45 (11.6) |
| Very good | 125 (32.1) |
| Good | 141 (36.2) |
| Fair | 72 (18.5) |
| Poor | 3 (0.8) |
| Don’t know | 3 (0.8) |
| Family history of obesity | |
| Yes | 204 (52.3) |
| No | 186 (47.7) |
| Family history of type 2 diabetes | |
| Yes | 186 (47.7) |
| No | 204 (52.3) |
| Family history of high blood pressure | |
| Yes | 294 (75.4) |
| No | 96 (24.6) |
| Diagnosed with prediabetes or borderline diabetes | |
| Yes | 72 (18.4) |
| No | 319 (81.6) |
| Diagnosed with diabetes | |
| Yes | 5 (1.3) |
| No | 386 (98.7) |
| Diagnosed with high blood pressure | |
| Yes | 52 (13.4) |
| No | 336 (86.6) |
| Diagnosed with high cholesterol | |
| Yes | 48 (12.3) |
| No | 342 (87.7) |
| Physical activity for 30 minutes or more | |
| Less than 5 d/wk | 223 (57.0) |
| 5 d/wk | 111 (28.4) |
| More than 5 d/wk | 57 (14.6) |
A small proportion of the participants obtained their fresh produce on campus, from the campus food pantry (0.5%) or the cafeteria (25.9%) (Table 2). Most of the participants reported obtaining their fresh FV off campus from farmers’ markets (2.8%), a grocery shop within the county (7.3%), or a grocery shop outside the county (43%). Over 70% of participants were unaware of the food pantry or meal share program on campus, and very few (7.2% and 13.7%, respectively) used these campus resources. Many of the participants disputed that it was easy to buy fresh FV nor that there is a wide variety of fresh FV available and most (97.9%) will take more FV if they had access to more.
Table 2.
Campus food environment
| Variable | Frequency, n (%) |
|---|---|
| Where do you often obtain fresh FV? | |
| Student center cafeteria | 100 (25.9) |
| Campus food pantry | 2 (0.5) |
| Farmers’ market | 11 (2.8) |
| Brookshire Brothers | 28 (7.3) |
| Grocery shop at Cypress | 166 (43.0) |
| Grocery shop/supermarket | 20 (5.2) |
| Other | 59 (15.3) |
| Do you know if there is a food pantry on campus? | |
| Yes | 112 (28.7) |
| No | 278 (71.3) |
| Do you go to the food pantry to pick up food? | |
| Yes | 28 (7.2) |
| No | 360 (92.8) |
| Do you know about the meal share program on campus? | |
| Yes | 109 (28.2) |
| No | 277 (71.8) |
| Do you use or have you ever benefited from the meal share program? | |
| Yes | 53 (13.7) |
| No | 335 (86.3) |
| For the following statements about where you live as a student, how much do you agree or disagree? | |
| It is easy to buy fresh FV | |
| Strongly disagree | 64 (16.9) |
| Disagree | 125 (33.1) |
| Don’t know | 49 (13.0) |
| Agree | 105 (27.8) |
| Strongly agree | 35 (9.3) |
| There is a large selection of fresh FV | |
| Strongly disagree | 63 (16.8) |
| Disagree | 125 (33.2) |
| Don’t know | 65 (17.3) |
| Agree | 88 (23.4) |
| Strongly agree | 35 (9.3) |
| The fresh FV are affordable | |
| Strongly disagree | 42 (11.4) |
| Disagree | 97 (26.3) |
| Don’t know | 105 (28.5) |
| Agree | 106 (28.7) |
| Strongly agree | 19 (5.1) |
FV, fruits and vegetables
Food pantry awareness had significant associations with high blood pressure (P=.047) and high cholesterol (P=.048), and meal share program awareness was associated with high cholesterol (P=.009) (Table 3). Ease of accessibility to fresh FV was associated with diabetes, high blood pressure, high cholesterol, and how the participants perceived their health. Prediabetes was associated with quality of fresh FV (P=.017), the availability of a large selection of FV (P=.002), affordability of fresh FV (P=.008), and physical activities (P=.041). Diabetes was associated with quality of fresh FV (P<.001) and affordability of fresh FV (P=.006). High cholesterol was also associated with availability of large selection of fresh FV (P=.027) and quality of fresh FV (P=.003).
Table 3.
Association (P value) of campus food environment (FE) factors with metabolic indicators
| FE factor | Prediabetes | Diabetes | High blood pressure | High cholesterol | Self-rated health |
|---|---|---|---|---|---|
| FV source | .625 | .494 | .060 | .055 | .522 |
| Food pantry awareness | .118 | .153 | .047 | .048 | .410 |
| Meal share awareness | .846 | .158 | .377 | .009 | .203 |
| Meal usage | .485 | .371 | .655 | .248 | .302 |
| Ease of accessibility to fresh FV | .071 | .003 | .034 | .004 | .039 |
| Large selection of fresh FV | .002 | .103 | .119 | .027 | .175 |
| Quality of fresh FV | .017 | <.001 | .338 | .003 | .126 |
| Affordability of fresh FV | .008 | .006 | .375 | .234 | .932 |
| Physical activities | .041 | .804 | .817 | .178 | <.001 |
FV, fruits and vegetables
The GIS map of convenience stores, restaurants, farmers’ markets, walking trail/parks, gyms, grocery stores, and food pantries available to students and residents within a 10-mile radius of campus is shown in Figure 1. There were only 2 main grocery stores, 4 farmers’ markets, 3 food pantries, and very few places to be physically active; however, there were 21 fast food restaurants, 7 sit-down establishments, and 23 convenience stores.
Figure 1.
Food and physical activity places within 10 miles of the campus
The significant results of 4 binary logistic regression models predicting the incidence of prediabetes, diabetes, high cholesterol, and high blood pressure are shown in Table 4. Even though all the associated FE variables from Table 3 were initially put into the 4 models, only significant predictors are shown in Table 4. The perception of the availability (“there is a large selection of fresh fruits and vegetables”) was significantly associated (P=.006) with the incidence of prediabetes among students. Those who strongly disagreed with this statement were 4.25 times more likely to have prediabetes (P=.022, odds ratio [OR] = 4.25, 95% confidence interval [CI] [1.235, 14.635]). Those who strongly agreed that “the fresh fruits and vegetables are high quality” were less likely to have prediabetes (P=.044, OR = 0.155, 95% CI [0.025, 0.955]). Those who disagreed with the statement “fresh fruits and vegetables are affordable” were more likely to have prediabetes (P=.044, OR = 3.269, 95% CI [1.030, 10.375]). None of the predictor variables significantly predicted the incidence of diabetes and high blood pressure. There was only 1 significant predictor variable for high cholesterol among the participants. Students who were aware of the meal share program had significantly lower odds of having high cholesterol (P=.017, OR = 0.308, 95% CI [0.117, 0.810]).
Table 4.
Predictors of metabolic health markers
| Dependent variable/predictora | P value | Odds ratio | 95% CI |
|---|---|---|---|
| Prediabetes | |||
| There’s a large selection of fresh FV | |||
| Strongly disagree | .006 | ||
| Disagree | .022 | 4.25 | 1.235-14.635 |
| Don’t know | .057 | 4.33 | 0.960-19.498 |
| Agree | .973 | 1.03 | 0.248-4.237 |
| Strongly agree | .050 | 11.78 | 0.001-138.657 |
| Quality of fresh FV | |||
| Strongly disagree | .269 | ||
| Disagree | .689 | 0.788 | 0.245-2.533 |
| Don’t know | .975 | 0.979 | 0.254-3.778 |
| Agree | .836 | 0.853 | 0.191-3.811 |
| Strongly agree | .044 | 0.155 | 0.025-.955 |
| Affordability of fresh FV | |||
| Strongly disagree | .355 | ||
| Disagree | .102. | 2.475 | 0.836-7.335 |
| Don’t know | .080 | 2.807 | 0.884-8.912 |
| Agree | .044 | 3.269 | 1.030-10.375 |
| Strongly agree | .370 | 2.194 | 0.394-12.207 |
| High cholesterol | |||
| Do you know about the meal share program | .017 | 0.308 | 0.117-0.810 |
FV, fruits and vegetables
None of the predictor variables significantly predicted the incidence of diabetes and high blood pressure
Discussion
The findings from this study give valuable insights into the FE and health status among students at an HBU. The high rates of chronic disease risk factors such as family history of obesity (52.3%), diabetes (47.7%), and hypertension (75.4%) underscore the urgent need for prevention among HBCU students. Racial health disparities account for some excess disease burden in communities of color,25 but targeted screening and early lifestyle changes on campus could mitigate risks.26 Even though many of the participants rated their health as good or very good, there was still a somewhat high prevalence of prediabetes (17.6%) and high cholesterol (12.3%) among them. In a previous study, similar levels of prediabetes (14.5%) were found among this age group in Saudi Arabia,27 and in India Subramani et al28 reported a much lower prevalence of prediabetes (4.6%). An increasing incidence of prediabetes has been reported among young adults in the United States.29,30
Few of the participants obtained fresh FV from campus food pantries (0.5%) or meal assistance programs (1.9%). In a study across 34 Texas universities, most students with food challenges did not access campus food pantries, even when available.31 Barriers such as stigma, lack of awareness, and restricted hours can prevent utilization.32 Targeted outreach and expanded pantry capacity could connect more HBCU students to existing food resources. Limited affordability, quality, selection, and access to fresh produce were frequently cited barriers, affirmed by prior work on poor retail FEs in low-income minority areas.33 Enhancing affordability, convenience, and appeal of healthy foods on campus and in surrounding neighborhoods could promote higher produce consumption among students.33,34
The significant association between inadequate physical activity and prediabetes aligns with evidence indicating that exercise protects against diabetes onset34; only 14.6% of students reported exercising 5 or more days per week, and more than half exercised less than 5 d/wk. Previous studies and systematic reviews have confirmed that exercise reduces diabetes risk by improving insulin sensitivity, glycemic control, and body composition.19,27 Health promotion for diabetes prevention at HBCUs should emphasize regular physical activity through campus fitness resources, active transportation options, and walkable built environments alongside diet quality.
There were significant associations between ease of accessibility to fresh FV and diabetes, high blood pressure, high cholesterol, and how the participants perceived their health. Prediabetes was associated with quality of fresh FV, the availability of a large selection of FV, affordability of fresh FV, and physical activities. Diabetes was associated with whether the participants had received information on how to budget and the quality and affordability of fresh FV. This finding aligns with those of other studies in which food insecure students had worse diet quality and physical health compared with food secure peers. Ensuring that food insecure students can readily obtain nutritious foods may have protective effects on cardiovascular health.19 College students facing food insecurity consume more processed foods and have lower intakes of FV, protein, fiber, calcium, and iron compared with food secure students.35,36 Thus, increasing access to healthy foods among food insecure students could potentially improve diet quality and reduce cardiovascular disease risks. Though HBCUs offer food assistance programs, most students lacked awareness or faced barriers accessing these programs, indicating a need to enhance visibility, convenience, and flexibility of emergency food resources to meet diverse student needs and schedules.19
The binary logistic regression analyses conducted in this study provide valuable insights into the factors associated with prediabetes and high cholesterol among college students. The study revealed that students who disagreed or were uncertain about the availability and affordability of fresh FV were more likely to report prediabetes. This finding aligns with previous research highlighting the importance of perceived food affordability in dietary choices and health outcomes. In an earlier study, perceived affordability was a significant barrier to FV consumption, particularly among low-income populations.36 This finding underscores the need for interventions to improve the affordability and accessibility of healthy foods on college campuses. Awareness of the Panther Meal Share program among the study participants was associated with a lower likelihood of reporting high cholesterol. This finding underscores the potential health benefits of meal assistance programs and suggests that such initiatives may contribute to improved dietary quality among students. Food insecurity is associated with poor health outcomes, including cardiometabolic risks, among college students.23,37
The GIS map of the campus FE provided extensive detail on establishments for food, dining, and physical activity within 10 miles of the campus. The food options mapped within a 10-mile radius of the campus appears to be similar to those documented at some other HBCUs. A study of the nutrition environments at 5 HBCUs in North Carolina revealed few establishments within 1 mile of campus, limited healthy choices, and just 1 grocery store across all 5 schools.7 Greater emphasis needs to be put on improving the food environment on and around campuses to promote metabolic health. A comprehensive strategy would be to ensure the ready availability and affordability of nutrient-dense meals, as highlighted by Mujahid et al.16 Limited access to healthy food options, such as fresh FV, often results in poor dietary choices that can lead to metabolic conditions such as obesity, prediabetes, and high cholesterol. Many studies of college students have highlighted the prevalence of food insecurity linked to poor dietary intake, weight gain, and an increased risk of metabolic syndrome, which is exacerbated by the scarcity of affordable, nutritious food on campuses.19,37,38
Our study has some limitations. First, the reliance upon self-provided data for health conditions introduces potential biases and inaccuracies. Self-reporting can lead to underreporting or overreporting of certain conditions due to recall bias, social desirability bias, or misunderstanding of medical terminology. Consequently, the accuracy and reliability of the health condition data may be compromised. Second, the study’s cross-sectional design hinders our ability to identify causes. As a result, we cannot ascertain whether the observed associations are indicative of cause-and-effect relationships or merely correlations. Longitudinal studies or randomized controlled trials would be necessary to establish causality with greater confidence. The exclusion of students with dietary restrictions to lay the groundwork for a future intervention study may impact generalizability of the findings of the current study.
Conclusion
Campus FEs shape student access to nutritious affordable options amidst challenging schedules and budgets. Greater emphasis needs to be put on improving the FE on campuses to promote metabolic health. A comprehensive strategy would be to ensure the ready availability and affordability of nutrient-dense meals, as highlighted by Mujahid et al.16 Revamping the campus FE to advocate healthier dietary behaviors is a collective responsibility. University administrators, food suppliers, and especially students themselves all have a role to play. Continuous research is necessary to evaluate the impact of the campus FE on changes in students’ dietary practices and ultimately their metabolic wellness. By fostering a healthier food environment, universities can nurture not only students’ academic potential but also their long-term health. These findings highlight opportunities for HBCUs to enhance visibility and reduce barriers around existing food assistance programs to connect more food insecure students with available resources. Such initiatives can promote food and health equity among vulnerable college subgroups facing disproportionate risk factors. Strategies to improve overall diet quality through nutrition education, healthier FEs, and policies directed at food industry practices are promising avenues to prevent diet-related chronic diseases and mitigate rising rates.3,35 Continuous survey of students’ diet, health, and food insecurity is needed to guide data-driven campus food system reforms.
Footnotes
Conflict of Interest: No conflict of interest reported by authors.
Author Contributions: Research concept and design: Antwi; Acquisition of data: Olawuyi, Ifafore, Opara; Data analysis and interpretation: Antwi, Olawuyi, Dunyo, Ofori-Panyin; Manuscript: Antwi, Olawuyi, Ifafore, Opara, Dunyo, Ofori-Panyin; Obtaining funding: Antwi; Administrative, technical or material support: Antwi, Olawuyi, Ifafore, Opara, Dunyo, Ofori-Panyin; Supervision: Antwi
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