Statement of the Problem:

Emerging adulthood, or the transition through late adolescence and young adult years, is a distinct stage of life associated with declines in healthy lifestyle behaviors.^1-4 Young adults are at risk for unhealthy weight gain and dietary patterns, as well as more sedentary lifestyles. The dramatic changes in living and social situations associated with emerging adulthood have been linked to adverse health outcomes. These outcomes may be further challenged by the escalating cost of higher education and uncertainty in the global and local economies.^1-4 Campuses and communities where young adults reside will benefit from timely and personalized information, as well as utilization of evidence-based tools and programs to enhance the health and well-being of this population. The overarching goal of this multistate project is to support campuses and other communities in creating environments and opportunities that embrace young adults’ unique barriers to a healthy lifestyle, promote healthier weights, and reduce health disparities among vulnerable members, who are the fastest grown segments within the United States (US).

Statement of the Issues:

In 2020, over 30 million American adults are between the ages of 18-26 years.⁵ These years of emerging adulthood have long been recognized as a transformative period due to the numerous and significant transitions (e.g., completion of education, leaving the family home, securing full-time employment, living independently, partnering and cohabitation).^4,6,7 The Institute of Medicine and National Research Council published a report in 2014, following changes in the Affordable Care Act, to encourage scientists and policymakers to consider the age group of 18-26 years as a separate demographic with unique social, economic, and policy needs. ⁷  However, attention to and research about this distinct subpopulation is lacking overall; especially as it relates to lifestyle behaviors such as dietary patterns.^8-20 While the US surveillance systems may include all ages in their sampling protocols, methodologies limit the inclusion of those with transient residency status or young adults living outside traditional households. These data systems frequently combine young adult data with teenagers (e.g., 16-19 years) or older adults (e.g., 18-35 years), which fails to identify this group’s unique status adequately.

Today, young adults face unique challenges that differ from their parents and grandparents. For example, regardless of income level, young adults born between 1996-2001 have grown up with ubiquitous access to information (both accurate and misleading) through household computer, tablet or smartphone²¹ and have spent their entire adolescence navigating the advantages and disadvantages of social media.^22,23 Today’s young adults are more likely to identify as a race other than white (16% in 1976 to 44% in 2017)²⁴, and they are more likely to delay marriage and parenting much later than previous generations.^25,26 Young adulthood is an established time of psychological vulnerability with data from 2017 suggesting that the prevalence of any mental illness is highest in young adults (25.8%) when compared to older age groups. While previous generations have experienced economic uncertainties and/or global crises, today’s young adults report higher rates of anxiety than previous generations²⁷ and now face an unprecedented economic landscape^28,29 with the scope, duration, and impact of the global pandemic unknown. The impacts of this pandemic, along with other crises facing our nation’s young adults, which we have named influential disruptive factors (IDFs), on long-term health consequences are a much-needed focus of current health-related research.

While young adults experience diverse pathways, they are more likely to attend an institution of higher education post high school than previous generations. Currently, 40% of 18-24 year-old individuals enroll in a degree-granting postsecondary institution, representing an 11% increase since 2007.^26,30 This increase is largely attributable to the rising number of first-generation college students, a group more vulnerable to health disparities.^31-36 Despite the benefits of earning an advanced degree, today’s college students face higher dropout rates,²⁴ high rates of food insecurity^10,11,37-46, and difficulties repaying student debt⁴⁷ as compared to previous cohorts. In 2015-16, the average student had borrowed $24,480 by the time of degree completion compared to $14,260 in 1999-2000.³⁰ The influence of the additional debt facing college graduates on long-term health is unclear; however, college students with higher credit card debt are less likely to participate in healthier behaviors and more likely to have a higher Body Mass Index (BMI).⁴⁸

The emerging adult years are linked to declines in healthy behaviors and high rates of weight gain, yet existing interventions and assessment tools have not adequately addressed this population’s unique needs and challenges.⁴⁹ These individuals were born in a global obesity epidemic that has failed to wane. Nationally, 18% of young adults 18-24 years old report weight status that would be classified as obese.⁵⁰ Like all age groups, young adults have experienced rising rates of overweight/obesity; however, young adults gain weight faster than any other period of adulthood,⁵¹ and a majority (60%) of college students report weight gain (7.5 lbs) in their first year of college attendance.⁵² Young adults who experience excessive weight gain are at an increased risk of developing diet-related diseases, including obesity, heart disease, hypertension, and type 2 diabetes. Obesity alone currently affects 93.3 million adults in the US, with an estimated cost of $315.8 billion.⁵⁰

Obesity prevention programs have largely overlooked young adults and may not adequately consider their attitudes, motivations, and perceptions.^14,49,53,54 Emerging adulthood is a critical period for developing healthful weight management behaviors. Unfortunately, most obesity prevention programs have focused on changing individual behaviors and/or knowledge with limited attention on the environment. Environments with limited access to healthy foods, such as fruits and vegetables, or opportunities for physical activity make it difficult for individuals to engage in healthful behaviors. An individual’s perception (subjectivity) of the environment and resources available may differ from the actual (objective) environment, individuals may be unable to recognize opportunities that could support healthful behaviors. Therefore, investigating young adults’ eating behaviors and lifestyle choices as well as their perceptions have never been more important nor more urgent to reduce the burden of illness, increase the quality of life, and improve societal impact from obesity.

Justification of the Proposed Work:

Our Healthy Campus Research Consortium (HCRC) includes 17 accomplished researchers, along with 20-30 talented graduate students, who have more than two decades of collaborative experience working with young adults. Cumulatively, our interventions have improved young adults’ food, physical activity, and stress management behaviors, and our surveys have elucidated environmental conditions that make the healthful choice the easy choice for young adults at colleges and universities across the nation. Our integration of teaching, research, and extension leverage the expertise of members in many states, widening our scope and impact.

Consideration of the perceived and actual environment in obesity prevention programs has been hindered by a lack of efficient, reliable, and valid tools. To overcome this, HCRC has identified individual and environmental factors that predispose, enable, and reinforce healthy eating and activity behaviors among young adults.^{8,12,13,16,55,56} Valid, reliable, and efficient tools have been developed to assess the food, physical activity, and policy environments of college campuses.^17,19,57 These tools are being used by researchers and extension professionals around the US to benchmark and track environmental conditions and perceptions and create health promotion programs for young adults.⁵⁰ They are also helping stakeholders and decision makers who work with target communities to identify needs and efforts to develop healthier environments.^{9,14-16,18,20,58-63}

During the current global pandemic, the need to elucidate how IDFs (e.g., discrimination, pandemic/viral outbreak, natural disasters, opioid epidemic, recession/depression) interact with health promotion efforts and weight management interventions is paramount. As HCRC work continues, we will expand our understanding of the needs and perceptions of young adult groups at greatest risk to the impact of IDFs on weight-related behaviors and health outcomes.