International Journal of Environmental Health Research

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Food insecurity, Mediterranean diet adherence,

and psychosocial health among university
students in Türkiye

Kubra Esin & Feride Ayyıldız

To cite this article: Kubra Esin & Feride Ayyıldız (2024) Food insecurity, Mediterranean
diet adherence, and psychosocial health among university students in Türkiye,
International Journal of Environmental Health Research, 34:1, 649-659, DOI:
10.1080/09603123.2023.2300405

To link to this article: https://doi.org/10.1080/09603123.2023.2300405

Published online: 22 Jan 2024.

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INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH
2024, VOL. 34, NO. 1, 649–659
https://doi.org/10.1080/09603123.2023.2300405

Food insecurity, Mediterranean diet adherence, and psychosocial

health among university students in Türkiye
a b
Kubra Esin and Feride Ayyıldız
a
Department of Nutrition and Dietetics, Tokat Gaziosmanpaşa University, Tokat, Türkiye; bDepartment of Nutrition
and Dietetics, Gazi University, Ankara, Türkiye

ABSTRACT ARTICLE HISTORY

The aim was to examine the relationship between food insecurity and Received 18 September 2023
adherence to the Mediterranean diet, academic achievement, depression, Accepted 26 December 2023
anxiety, and stress among university students. This cross-sectional study KEYWORDS
was conducted with 2039 university students studying in Türkiye. Sixty- Food security; Mediterranean
eight point two per cent of the students were food insecure. Food security diet; depression; anxiety;
(FS) scores were negatively associated with adherence to the MD and stress
academic achievement, and positively associated with depression, anxi­
ety, and stress scores. A 1-unit increase in FS score resulted in a statistically
significant increase of 0.458, 0.468, and 0.400 units in depression, anxiety,
and stress scores, respectively, and a significant decrease of 0.140 units in
the MD adherence screener score. Food insecurity among university
students in Türkiye is very common, and students with food insecurity
have low adherence to the MD and low academic achievement and high
depression, anxiety, and stress scores. Financial support as well as financial
and food literacy provided to students play an important role in managing
food insecurity.

Introduction
Food insecurity is a major public health concern in both developed and developing countries
(Pereira and Hodge 2015). It is defined as “individuals” physical, economic and social access to
sufficient, safe and nutritious food that meets their needs for an active and healthy life”. Food
security has four dimensions: availability, access, utilization, and stability. Food insecurity is defined
as a deficit in any of these dimensions (Food and Agriculture Organization of the United Nations
2012).
Despite the increasing need for food in the world, many factors such as limitations in
production, climate change, and economics have led to an increase in food insecurity. Food
insecurity can be experienced by children, young people, and the elderly in every community
worldwide (Silenzi et al. 2023). University students are among the at-risk groups for food
insecurity due to economic reasons such as limited financial resources, low purchasing power,
and rising housing and food costs (Marques et al. 2022). The prevalence of food insecurity
among university students may vary according to various factors such as demographic char­
acteristics (e.g. ethnicity), grade level at university, and place of residence (home/dormitory)
(Soldavini et al. 2019). University students may also be more vulnerable to food insecurity due
to a lack of grocery stores on campus, inadequate transportation, inadequate cooking facilities,
and lack of cooking skills (Meza et al. 2019; Marques et al. 2022). The rate of food insecurity

CONTACT Kubra Esin kubra.esin@gop.edu.tr Department of Nutrition and Dietetics, Tokat Gaziosmanpaşa University,
Tokat, Türkiye
© 2024 Informa UK Limited, trading as Taylor & Francis Group
650 K. ESIN AND F. AYYILDIZ

among university students is reported to be 3–4 times higher than that in the general popula­
tion in the same region (Leung et al. 2019). In a systematic review of 18 studies from five
countries, the rate of food insecurity among university students was shown to range from 12.5%
to 84%, with an average of 42% (Bruening et al. 2017). Another systematic review found that the
prevalence of food insecurity among university students in the United States was 43.5%, with
a range of 21% to 58.8% (Nazmi et al. 2019). Studies conducted in Türkiye found that the
prevalence of food insecurity among university students ranges from 33% (Niyaz 2020) to 35.5%
(Celik et al. 2023).
Food insecurity is an important risk factor that primarily affects nutritional status (Myers 2020).
It is associated with unhealthy eating behaviors among university students (Becerra and Becerra
2020). Students with food insecurity were shown to consume less healthy foods such as vegetables,
fruits, whole grains, and legumes and more unhealthy foods (with added sugar, sugary drinks, and
fast food). It was also found that food insecure students consumed home-cooked meals, breakfast,
and dinner less frequently (Farahbakhsh et al. 2017; Shi et al. 2021). Due to all these factors, these
students are less likely to adhere to healthy eating patterns (Theodoridis et al. 2018). Promoting
adherence to the Mediterranean diet, which plays a globally accepted role in good health, may
counter the negative effects of food insecurity (Gregório et al. 2018).
Prolonged exposure to food insecurity due to unhealthy eating behaviors can lead to obesity and
its complications (Bruening et al. 2018; El Zein et al. 2019). Food insecurity also affects academic
achievement in university students (Martinez et al. 2019). Students who are food insecure are more
likely to have low grade point averages (GPAs), fail courses, graduate late, and have low attendance
rates and low concentration (Camelo and Elliott 2019; Zigmont et al. 2021). It is also reported that
students with food insecurity are more likely to experience stress, depression, anxiety, exhaustion/
fatigue, loneliness, and self-harm behaviors (Oh et al. 2022).
Food insecurity is a critical issue for the long-term health and success of university students
(Meza et al. 2019). There are approximately seven million university students in Türkiye and
approximately one in every 12 people in the entire population is a university student (Turkish
Statistical Institute 2022; The Council of Higher Education 2023). The number of studies on the
prevalence of food insecurity among university students in Türkiye is quite limited and the scope of
these studies is mostly regional (Niyaz 2020; Celik et al. 2023). There are also limited data on the
relationship between food insecurity, Mediterranean diet adherence, psychosocial health, and
academic achievement in university students. Thus, the aim of the present study was to examine
the relationship between food insecurity and adherence to the Mediterranean diet, academic
achievement, depression, anxiety, and stress among university students.

Materials and methods

Study population and data collection
The study was conducted with Turkish university students studying in Türkiye. A total of 2039
university students with a mean age of 20.9 ± 1.50 years and a mean BMI of 22.3 ± 3.57 kg/m2
participated. The software G*Power (version 3.1.9.7, Universität Düsseldorf, Düsseldorf, Germany)
was used to determine the required sample size. According to the results of the power analysis, at
90% confidence interval and a 5% margin of error, at least 271 participants over the age of 18 were
required.
Snowball sampling was used. Undergraduate and graduate level Turkish university students who
volunteered to participate in the study were included. Non-Turkish students and those who refused
to participate were excluded. The questionnaire prepared Google Forms was sent to university
students via WhatsApp or e-mail. The students were included in the study on a voluntary basis.
Before the beginning of the questionnaires, informed consent was obtained from all the participants
and all participation was anonymous.
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 651

The questionnaire included questions on demographic data (age, sex, etc.), socioeconomic status
(employment, income, and scholarship status), academic achievement (GPA), anthropometric
measurements (body weight and height), food security status, diet quality and meal habits (number
of snacks and main meals consumed), and psychosocial health status (depression, anxiety, and
stress).

Anthropometric measurements
The body weight (kg) and height (cm) values of the participants were recorded based on self-report. Body
mass index (BMI) was calculated using the body weight and height of the individuals, i.e. BMI = Body
weight (kg)/Height (m)2. According to the classification by the World Health Organization, those below
18.50 kg/m2 are underweight, those between 18.50 and 24.99 kg/m2 are normal weight, those between
25.0 and 29.99 kg/m2 are overweight, and those above 30 kg/m2 are obese (WHO World Health
Organisation 2023).

Food security
The prevalence of food insecurity over the last 12 months was assessed using the 10-item validated
U.S. Department of Agriculture (USDA) Adult Food Security Survey Module (USDA 2012). The
number of affirmative responses was summed to obtain a raw score ranging from 0 to 10. The
students were then designated to one of four food security categories: high food security (food
security score zero), marginal food security (food security score 1–2), low food security (food
security score 3–5), or very low food security (food security score 6–10). According to the USDA
definitions, these categories were further collapsed into either FS (high and marginal food security
status) or FI (low or very low food security status) (USDA 2023). In the present study, the scale had
a Cronbach’s alpha coefficient of 0.8472.

Mediterranean diet adherence screener (MEDAS)

The 14-item MEDAS was used to determine the adherence of individuals to the Mediterranean diet
(Schröder et al. 2011; Martínez-González et al. 2012). The scale was adapted into Turkish by
Pehlivanoğlu et al., who reported that the scale had a Cronbach’s alpha coefficient of 0.829. This
value shows that the scale is reliable (Pehlivanoğlu et al. 2020). The MEDAS consists of 14 items
assigned scores of 0 or 1 points according to the amount of food consumed. A total score of 7 and
above indicates that the individual has appropriate Mediterranean diet adherence (León-Munoz
et al. 2012). In the present study, participants with a score of < 7 constituted the non-adherence
group and those with ≤ 7 the appropriate adherence group.

Depression anxiety stress scale-21 (DASS-21)

The depression, anxiety, and stress of the participants were evaluated with the Depression, Anxiety,
and Stress Scale-21 (DASS-21). The scale was developed by Lovibond and Lovibond (Lovibond and
Lovibond 1995) and the validity and reliability of the Turkish version were confirmed by Sarıçam
(Sariçam 2018). The answers given to items related to depression, anxiety, and stress are scored
from 0 to 3 (0=Never, 1=Sometimes, 2=Quite often, 3=Always). Higher scores indicate higher levels
of depression, anxiety, and stress. Sarıçam reported the Cronbach’s alpha coefficients of the scale as
0.85 for depression, 0.85 for anxiety, and 0.81 for stress (Sariçam 2018). In our study, the
Cronbach’s alpha coefficient was 0.88 for depression, 0.84 for anxiety, and 0.84 for stress.
652 K. ESIN AND F. AYYILDIZ

Statistical analysis
The data obtained were analyzed by appropriate statistical methods using IBM SPSS 24.0. Mean and
standard deviation were calculated for descriptive analyses, and frequency and percentage were
calculated for nominal and ordinal variables. Skewness and kurtosis tests were conducted to determine
whether the data were normally distributed. The statistical analyses were performed using parametric
tests in accordance with the normality of distribution of the data. Intervariable analyses were
conducted using the t-test. The chi-squared test was used to compare categorical variables.
Pearson’s correlation test was performed between continuous variables. A linear regression model
was developed to examine the relationship between food security and depression, anxiety, stress, and
MEDAS scores. The level of significance was p < 0.05 in all the statistical analyses.

Results
It was determined that 68.20% of the participants were food insecure. The sociodemographic
characteristics of the participants according to their food security classification are given in
Table 1. The age and grade level of the university students did not differ according to food security
status (p > 0.05). The GPAs of the food secure participants were higher than those of the food
insecure ones, while there was also a significant difference between the groups according to the
educational status of their parents (p < 0.01). The place of residence of the students differed
according to food security (p < 0.01). The number of individuals the participants lived with was
higher in the food insecure group (p < 0.01) among those living with family, relatives, or friends.
The family income status and monthly allowance of the food secure group was significantly higher
(p < 0.01). The number of main and snack meals was also significantly higher in the food secure
group (p < 0.01). The rate of individuals with normal body weight according to BMI was 67.7% in
the food secure group and 71.3% in the food insecure group. The percentage of individuals with
above-normal body weight was 20.9% in the food secure group and 17.7% in the food insecure
group.

Table 1. The sociodemographic characteristics of the participants according to their food security classification.
Sociodemographic Characteristics Food Security (n:647) Food Insecurity (n:1392) p
Age (year) 20.8 ± 1.57 20.9 ± 1.47 0.52
Year of university 2.6 ± 1.14 2.6 ± 1.14 0.97
Grade point average (GPA) 3.1 ± 0.40 2.9 ± 0.41 <0.01
Mother’s education level
Primary-Middle-High School n:530%81.9) n:117%18.1) <0.01
University- Postgraduate n:1216%87.4) n:176%12.6)
Father’s education level
Primary-Middle-High School n:430%66.5) n:217%33.5) <0.01
University- Postgraduate n:1101%79.1) n:291%20.9)
Place of residence
Living with family 263%40.6) 406%29.2) <0.01
Living with relatives 9%1.4) 11%0.8)
Living with friends 60%9.3) 122%8.8)
Alone 27%4.2) 37%2.7)
State dormitory 241%37.2) 722%51.9)
Private dormitory 47%7.3) 90%6.5)
Household live with family 4.2 ± 1.27 (n:263) 4.6 ± 1.39 (n:410) <0.01
Household live with relatives/friends 3.55 ± 1.73 (n:384) 3.9 ± 1.75 (n:983) <0.01
Family income (TRY) 13618,6 ± 9416.9 9779,9 ± 8988,8 <0.01
≤2825 TL (minimum wage) n:43%6.6) n:195%10.9) <0.01
>2825 TL (minimum wage) n:604%93.4) n:1240%89.1)
Montly allowence (TRY) 1921.0 ± 1957.9 1381.3 ± 2251.9 <0.01
Main meals 2.4 ± 0.54 2.3 ± 0.54 <0.01
Snacks 1.8 ± 0.87 1.6 ± 0.93 <0.01
*t test and chi-square were used. TRY: Turkish Lira.
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 653

Figure 1. Evaluation of BMI, MEDAS and DASS scores according to food security status. (FI: Food Insecurity, FS: Food Security,
MEDAS: Mediterranean Diet Adherence Screener, DASS-21: Depression, Anxiety, and Stress Scale)

The comparison of BMI, MEDAS, and DASS scores according to food security status is shown in
Figure 1. There was no significant difference between BMI values according to food security status.
Total MEDAS score was higher in the food secure group compared to the food insecure group (FS:
6.0 ± 2.02 and FI: 5.3 ± 1.82, respectively) (p < 0.01). The total DASS score (FI: 22.4 ± 12.45 com­
pared to FS: 15.9 ± 11.66), depression score (FI: 7.9 ± 4.79 compared to FS: 5.6 ± 4.64), anxiety score
(FI: 6.5 ± 4.40 compared to FS: 4.3 ± 3.91), and stress score (FI: 7.9 ± 4.42 compared to FS: 5.9 ±
4.31) of the food insecure group were significantly higher (p < 0.01).
The MEDAS, depression, anxiety, and stress classifications of the participants showed
a significant difference according to food security status (p < 0.01). The rate of those who adhered
to the Mediterranean diet was 40.2% in the food secure group and 23.8% in the food insecure group
(p < 0.01).
The correlation between FS, MEDAS, DASS, and BMI is shown in Table 2. While there was
a negative correlation between total FS score and total MEDAS score, there was a positive correla­
tion between total FS score and total DASS and subscale (depression, anxiety, and stress) scores.

Table 2. The correlation among FS, MEDAS, DASS-21 and BMI.

Variables 1 2 3 4 5 6 7 8
1.FS total score 1 −0.205* 0.293* 0.264* 0.296* 0.247* −0.200 −0.085*
2.MEDAS total score 1 −0.141* −0.148 −0.116* −0.122* −0.046* 0.018
3.DASS–21 total score 1 0.913* 0.906* 0.929* 0.004 −0.067*
4.Depression score 1 0.719 0.773* 0.001 −0.083*
5.Anxiety score 1 0.785* −0.010 −0.047*
6.Stress score 1 0.020* −0.052*
7.BMI 1 −0.025
8. GPA 1
Pearson correlation *p < 0.01. FS: Food Security, MEDAS: Mediterranean Diet Adherence Screener, DASS: Depression, Anxiety, and
Stress Scale, BMI: Body Mass Index, GPA: Grade Point Averages.
654 K. ESIN AND F. AYYILDIZ

Table 3. Linear regression models of the relationship between FS total score and DASS, depression, anxiety, stress and MEDAS
scores.
Model 1 Model 2

Β coefficient (95%Cl) SE p R2 Β coefficient (95%Cl) SE p R2

DASS total score FS total score 1.275 0.092 <0.01 0.086 1.326 0.91 <0.01 0.111
(1.095–1.456) (1.147–1.505)
Depression score 0.444 0.036 <0.01 0.070 0.458 0.036 <0.01 0.083
(0.374–0.515) (0.388–0.529)
Anxiety score 0.448 0.032 <0.01 0.088 0.468 0.032 <0.01 0.121
(0.385–0.511) (0.406–0.530)
Stress score 0.383 0.033 <0.01 0.061 0.400 0.033 <0.01 0.084
(0.318–0.448) (0.335–0.465)
MEDAS score −.136 0.014 <0.01 0.042 −0.140 0.014 <0.01 0.050
(−0.164–0.108) (−0.168–0.112)
Confidence Intervals; FS: Food Insecurity. Model 1: unadjusted model. Model 2: adjusted for gender, age and BMI, FS: Food
Security, MEDAS: Mediterranean Diet Adherence Screener, DASS-21: Depression, Anxiety, and Stress Scale.

There was also a negative significant correlation between BMI and total MEDAS score (p < 0.01).
No significant correlation was observed between the other variables (p > 0.05). There was
a significant negative correlation between GPA and total FS score, total DASS, and subscale scores
(p < 0.01).
The relationships between total FS score and DASS, depression, anxiety, stress, and MEDAS
scores are presented in Table 3 using regression models. In both models, the relationship between
the parameters was statistically significant. Model 2 was adjusted for sex, age, and BMI, which led to
an increase in β coefficient values. According to Model 2, a 1-unit increase in total FS score resulted
in a statistically significant increase of 0.458, 0.468, and 0.400 units in depression, anxiety, and stress
scores, respectively, and a significant decrease of 0.140 units in MEDAS score.

Discussion
The aim of the present study was to examine the relationship between food insecurity and
adherence to the Mediterranean diet, academic achievement, depression, anxiety, and stress
among university students. Food insecurity was determined in 68.2% of the students, which was
associated with low adherence to the Mediterranean diet and low academic performance and high
depression, anxiety, and stress.
Food insecurity is a growing concern among university students (Loofbourrow and Scherr 2023).
The prevalence of food insecurity in this group is high, 43.5% in the United States (Nazmi et al.
2019), 38% in Australia (Murray et al. 2021), 17.3% in Portugal (Marques et al. 2022), 62.8% in
Malaysia (Ahmad et al. 2021), 59% in Lebanon, and 33% in Germany (Rizk et al. 2023). In the
present study, 68.2% of university students were food insecure, which is a higher prevalence than in
the aforementioned countries. Türkiye is a developing country and the high general and food
inflation rate in recent years (Turkish Statistical Institute 2023) can cause problems in terms of
access to food and thus food insecurity. In addition, the high rate of food insecurity found may have
been due to the differences in study samples, methods of measuring food insecurity, and its
classifications between studies.
University students tend to experience higher food insecurity due to factors such as lack of
family support, difficulty in accessing culturally appropriate foods, and high food prices (Shi
et al. 2020). The prevalence of food insecurity among university students may vary according to
various factors such as demographic characteristics (e.g. ethnicity), grade level at university, and
place of residence (home/dormitory) (Soldavini et al. 2019). In the present study, place of
residence and parents’ educational status differed significantly according to food security. In
addition, the number of individuals the participants lived with was significantly higher in the
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 655

food insecure group. Food security and income status are closely related. Especially for students
living away from their families, housing, health, transportation, and nutritional costs are
extremely high (Loofbourrow and Scherr 2023). In the present study, both the family income
and allowance of the students in the food security group were significantly higher. While
students may have sufficient knowledge and skills to manage their finances, this knowledge
may not be sufficient to protect them from excessive financial burden when faced with
numerous financial constraints (Vidgen and Gallegos 2014; Loofbourrow and Scherr 2023).
This shows that not only financial literacy but also food literacy (the knowledge, skills, and
behaviors needed to manage one’s dietary intake) are important for food security. Limited
financial literacy coupled with low income can further hinder food security and food literacy
(Vidgen and Gallegos 2014). A study conducted in Lebanon showed that there were significant
differences regarding food literacy behaviors according to food security status in students. For
example, participants were found to be significantly less likely to choose nutritionally balanced
meals, read nutritional information before, or buy healthy foods in the food insecure group
compared to the food secure group (Jomaa et al. 2022). In addition to financial aid for students,
developing policies to increase food and financial literacy can also help prevent food insecurity
among university students (Abu et al. 2023).
Food insecure students were reported to eat fewer meals compared to food secure students
(Farahbakhsh et al. 2017). Similarly, in the present study, the number of main meals and snacks was
lower in those who were food insecure. A systematic review found that some food insecure students
consumed breakfast and evening meals less frequently than food secure students did. In addition,
healthy food intake was lower and unhealthy food intake was higher among students with food
insecurity (Shi et al. 2021). University students experiencing food insecurity consume unhealthy
foods because they may have limited knowledge, time, and resources to adopt healthy eating habits
(El Zein et al. 2020). It is reported that while the consumption of fruits, vegetables, and whole grains
is low among food-insecure students, the consumption of fast foods, added sugars, sugar-sweetened
beverages, saturated fat, and salt is high (Shi et al. 2021; Celik et al. 2023). Moreover, they consume
low-cost foods that are high in energy and low in nutrients to cut food expenditures, which may put
them at risk of becoming obese or overweight (El Zein et al. 2020). Studies on the relationship
between food insecurity and obesity in university students have contradictory results, with some
having found a positive relationship between these variables (Martinez et al. 2019; Owens et al.
2020; El Zein et al. 2020), while others (El Zein et al. 2019; Celik et al. 2023) found none. In our
study, BMI did not differ significantly between the groups according to food security. Varying
results between studies may be due to differences in sampling and methodology. In addition,
unhealthy eating behaviors due to food insecurity may not be reflected by BMI scores due to the
high metabolic rate of university students, with them being a young population.
Promoting adherence to the Mediterranean diet, which plays an important role in good
health, may counter the negative effects of food insecurity (Gregório et al. 2018). In the
present study, the MEDAS scores of individuals in the food secure group were significantly
higher than those in the food insecure group. A 1-unit increase in total FS score led to
a significant decrease of 0.140 units in MEDAS scores. The negative association between food
security and MEDAS scores suggests that increasing food security may also help to increase
adherence to the Mediterranean diet, which has an important role in maintaining good
health. Moreover, the significant negative correlation between BMI and MEDAS suggests
that adherence to the Mediterranean diet may help body weight control. Similarly,
a Portuguese study in university students found that food insecurity was associated with
lower adherence to the Mediterranean diet (Gregório et al. 2018). Similarly, a study con­
ducted in Greece showed that food insecurity was associated with lower adherence to the
Mediterranean diet and the adoption of a cheaper and lower quality diet (Theodoridis et al.
2018). However, in another study, conducted by Rizk et al. (Rizk et al. 2023) in university
students, no relationship was found between MEDAS and FS scores. This may have been due
656 K. ESIN AND F. AYYILDIZ

to the fact that young people are moving away from the Mediterranean diet with the change
in their general dietary patterns.
Food insecurity is associated with lower academic performance in university students (Weaver
et al. 2020; Tin et al. 2022). The GPAs of food insecure students are reported to be 0.17 points lower
than those of food secure students (Phillips et al. 2018). In the present study, the GPAs of the food
insecure students were lower than those of the food secure group. Food insecurity can have direct
and indirect effects on students’ academic performance. Food insecurity is reported to reduce
cognitive function, increase fatigue, and cause loss of concentration (Weaver et al. 2020; Martinez
et al. 2020). Food insecurity is also associated with poorer mental health, which can lead to lower
academic performance (Raskind et al. 2019). Similarly, we found a significant negative relationship
between students’ GPAs and their total DASS and subscale scores.
Food insecurity negatively affects mental health (Myers 2020) and is associated with higher rates
of depression, stress, and anxiety in university students (Reeder et al. 2020; Ahmad et al. 2021; Dana
et al. 2023). Similar to other studies, in the current study a positive relationship was found between
food insecurity and depression, anxiety, and stress. Food insecure students also more commonly
had stress, anxiety, and depression. Food insecurity is hypothesized to be a “toxic” stressor that
impairs physiological functioning and mental health (Raskind et al. 2019). Food insecurity can
negatively affect students’ mental health since it causes them to be unable to have an adequate and
balanced diet, have anxiety about not having enough money for food, and consume affordable
unhealthy food (Ahmad et al. 2021).
The most important strength of our study is the fact that, to the best of our knowledge, it was the
first in the literature to examine food insecurity and Mediterranean dietary adherence, depression,
stress, and anxiety in university students. The sample size of the study is another strength.
Developing countries are more vulnerable to food insecurity (Bozsik et al. 2022). Since, unlike
the extensive literature on food insecurity and related factors among university students in devel­
oped countries (Camelo and Elliott 2019; El Zein et al. 2019; Murray et al. 2021; Tin et al. 2022;
Marques et al. 2022; Dana et al. 2023), our study was conducted with university students in Türkiye,
a developing country, it is thought to be another contribution of this study to the literature.
However, there are some limitations to our study. Firstly, the body weight and height of the
participants were self-reported. Secondly, the study did not involve a clinical examination of
individuals’ psychological health. Lastly, the cross-sectional study design limited the ability to
draw conclusions about causal relationships between the examined factors and food insecurity.

Conclusion
Food insecurity among university students in Türkiye is very common, and students with food
insecurity have low adherence to the Mediterranean diet and low academic achievement and high
depression, anxiety, and stress scores. Parents’ educational status, students’ place of residence, the
number of individuals they live with, family income status, and monthly allowance are some socio­
economic factors associated with food security. Financial support as well as financial and food literacy
provided to students plays an important role in managing food insecurity. Education on this subject
can contribute to raising students’ awareness and improving their health and academic performance.
Further long-term studies on these types of training and their outcomes are needed.

Compliance with ethical standards

This research involved human participants. Ethics committee approval was obtained from Social
and Human Sciences Ethics Committee of Tokat Gaziosmanpaşa University (Number: 15.40, Date:
30.11.2022). The research was carried out in compliance with the policy set out in the Declaration of
Helsinki, and informed consent in written form was obtained from the parents and child assent was
obtained.
 INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 657

Acknowledgements
We would like to thank all participants who helped us during this project.

Author contributions
KE: conceptualization, data curation, methodology, writing – original draft, writing – review, and editing.
FA: conceptualization, methodology, formal analysis, writing – original draft, writing – review, and editing.
The authors have approved the final version submitted.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
The author(s) reported there is no funding associated with the work featured in this article.

ORCID
Kubra Esin http://orcid.org/0000-0002-2687-1811
Feride Ayyıldız http://orcid.org/0000-0003-2828-3850

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