Development and testing of the university health index for nutrition and physical activity

Background and significance: The university health environment may influence development and maintenance of health habits during the transition from older adolescence to young adulthood. Purpose: To develop and validate a tool to assess the university health environment. Methods: The University Health Index (UHI) included four modules: 1) Health Education; 2) Recreational Sports and Fitness; 3) Health Promotion; and 4) Built Environment. A cross-sectional design was used to analyze associations between health behaviors and outcomes related to diet, physical activity (PA), and weight from the National College Health Assessment (NCHA) for 9,460 students at thirteen universities. Data were analyzed via ordinary linear regression adjusting for clustering effects, with statistical significance set at p < 0.05. Results: Vigorous PA was positively associated with Module 3 score (p = 0.046). Strength was positively associated with having adequate indoor recreational sport/fitness space (p = 0.025). Higher fruit/vegetable intake was positively associated with recreational indoor sport instruction (p = 0.024), active transportation infrastructure (p = 0.047), and recreational sport/fitness facility space (p = 0.034). BMI was negatively associated with recreational indoor sport instruction (p =0.027) and a well-established walk/run/bike path (p = 0.023), and was positively associated with recreational sport special events (p = 0.004) and health promotion student reach (p = 0.010). Conclusion: Tools to assess characteristics of the university health environment need further development using readily available and defined measures. A prospective design assessing initial health behaviors and change over four years associated with university characteristics would strengthen validation of these tools.