Nutrition and Physical Activity: Digital Health and Telephone Interventions to Increase Healthy Eating and Physical Activity Among Students at Institutions of Higher Education

The CPSTF finding is based on evidence from a systematic review of 17 studies with 18 study arms (search period: January 2009-February 2021).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to nutrition, physical activity, and obesity prevention and control.

Internet use among young adults is nearly universal (Pew Research Center, 2021), and over 40% of young adults attend an institution of higher education (National Center for Education Statistics, 2020a).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 17 studies.

Dietary Behaviors

• Fruit and vegetable intake increased by a median of 0.40 servings per day (9 studies with 10 study arms).
• Fat intake decreased (5 studies with 6 study arms).

Physical Activity

• For participants with baseline physical activity above recommended levels: Time spent engaged in physical activity increased by a median of 3.74% (10 studies with 11 study arms).
• For participants with baseline physical activity below recommended levels: Time spent engaged in physical activity increased by 17.27% (1 study).

Weight-related

• Body mass index (BMI) results decreased by a median of 0.20 kilograms per meter squared (3 arms) for study participants with overweight at baseline. For study participants with healthy weight at baseline, there was no change (7 arms) in BMI.
• Weight results decreased by a median of 0.02 kilograms (4 studies).

Clinical

• Clinical outcomes including systolic blood pressure, diastolic blood pressure, total cholesterol, and glucose did not change (2 studies).

A systematic review of economic evidence has not been conducted.

The CPSTF finding should be applicable to all students at institutions of higher education who are interested in improving these behaviors regardless of gender, age, income level, race, or ethnicity.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How effective are these interventions when implemented at historically Black colleges and universities, Hispanic serving institutions, or tribal institutions of higher education?
• How effective are these interventions when implemented at institutions of higher education with a high proportion of nontraditional students, such as 2-year institutions of higher education or vocational schools?
• Does effectiveness differ by students who commute versus live on campus?
• How effective are these interventions when implemented at institutions of higher education with existing healthier food campus policies?
• Does perceived safety of campus environment affect participation in these interventions?
• Are these interventions effective in rural areas?
• How effective are interventions among students with food insecurity?
• How effective are these interventions among students with low baseline levels of physical activity?

• Included studies were conducted in the United States (14 studies), Australia (1 study), and the United Kingdom (2 studies).
• Fifteen studies were conducted at institutions of higher education offering baccalaureate, graduate, or professional degrees; one was conducted in an institution of higher education offering an associate’s degree or other two-year training program; and one at a vocational institution of higher education.
• Thirteen studies were conducted at public institutions of higher education. None of the included studies were conducted in historically Black colleges or universities, tribal colleges or universities, or Hispanic-serving colleges or universities.
• Six studies (7 study arms) reported whether students commuted or lived on campus. Four studies reported more than half of the students lived on campus; one reported nearly half the students lived on campus; and one reported all students commuted.
• Four studies reported on population density, three in urban and one in rural locations.
• Across all studies, participants had a mean age of 19.7 years. Studies reported higher proportions of females than males (on average, 69% were female).
• Three studies reported socioeconomic status (SES). One study took place at a vocational school geared toward low-income students; one study at a two-year college reported 67.9% of students made less than $12,000 per year; and one study at a four-year university reported 33% of participants were Pell-grant eligible (U.S. Department of Education, 2021) and 37% did not feel they always had enough money to buy food.
• Six of the studies from the United States reported racial and ethnic distributions. Studies included participants who self-identified as White (median 64.8%; 14 studies), Black or African American (median 14.6%; 14 studies), Hispanic or Latino (median 6.0%; 10 studies), Asian (median: 10.8%; 9 studies), American Indian or Alaska Native (0.8%; 1 study), Native Hawaiian or Other Pacific Islander (0.4%; 1 study), or other race/ethnicity (median 10.3%; 5 studies).
• Intervention duration ranged from one month to 24 months, with a median duration of 2.5 months.
• Baseline dietary and physical activity behaviors varied. Participants in four studies exceeded the dietary guidelines at baseline, and participants in six studies were below recommended guidelines. Additionally, participants in twelve studies exceeded Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2018) at baseline.
• Baseline weight status also varied. Five studies reported a mean BMI that would be considered a classification of overweight or obesity, and seven studies reported a mean BMI that would be considered a healthy weight.

Effectiveness Review

• Logic Model
• Text Description

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Cameron et al. A theory-based online health behaviour intervention for new university students (U@Uni: lifeGuide): results from a repeat randomized controlled trial. Trials 2015;16:555.

Dennis et al. Weight gain prevention for college freshmen: comparing two social cognitive theory-based interventions with and without explicit self-regulation training. J Obes 2012:803769.

Epton et al. A theory-based online health behaviour intervention for new university students (U@Uni): results from a randomised controlled trial. BMC Public Health 2014;5;14:563.

Greene et al. Impact of an online healthful eating and physical activity program for college students. Am J Health Promot 2012;27[2]:e47 e58.

Gow et al. Preventing weight gain in first year college students: an online intervention to prevent the “freshman fifteen.” Eat Behav 2010;11(1):33-9.

Kattelman et al. The effects of young adults eating and active for health (YEAH): a theory-based web-delivered intervention. J Nutr Educ Behav 2014;46(6):S27-41.

LaChausse. My student body: effects of an internet-based prevention program to decrease obesity among college students. J Am Coll Health 2012;60(4):324-30.

Laska et al. Results of a 2-year randomized, controlled obesity prevention trial: Effects on diet, activity and sleep behaviors in an at-risk young adult population. Prev Med 2016;89:230-6.

Lytle et al. Weight-gain reduction among 2-Year college students: the CHOICES RCT. Am J Prev Med 2017;52(2):183-191.

Lyzwinski et al. The mindfulness app trial for weight, weight-related behaviors, and stress in university students: randomized controlled trial. JMIR Mhealth Uhealth 2019;7(4):e12210.

Maurer. Choosing health: An online intervention to change eating/exercise (project choice). Dissertation 2015

O’Brien et al. Efficacy of a brief web-based intervention with and without SMS to enhance healthy eating behaviors among university students. Eat Behav 2016;23:104-109

Pope et al. Use of wearable technology and social media to improve physical activity and dietary behaviors among college student: a 12-week pilot study. Int J Environ Res Public Health 2019;25;16(19):3579

Quintiliani et al. Results of a nutrition and physical activity peer counseling intervention among nontraditional college students. J Cancer Educ 2016;31(2):366-74.

Sandrick et al. Effect of a counseling session bolstered by text messaging on self-selected health behaviors in college students: a preliminary randomized controlled trial. JMIR Mhealth Uhealth 2017;17;5(5):e67.

Schweitzer et al. An electronic wellness program to improve diet and exercise in college students: A pilot study. JMIR Res Protoc 2016;29;5(1):e29.

Walsh et al. Stage-based healthy lifestyles program for non-college young adults. Health Education 2017;117;2:148-161.

West et al. A technology-mediated behavioral weight gain prevention intervention for college students: Controlled, quasi-experimental study. J Med Internet Res 2016;13;18(6):e133.

Effectiveness Review

The following outlines the search strategy used for systematic reviews of digital health and telephone interventions in community settings, worksites, and institutions of higher education.

Database: Ovid MEDLINE

1 exp “Physical Education and Training”/ or exp Sports/ or exp Exercise/ or exp Physical Fitness/ or exp Exercise Therapy/ or exp Motor Activity/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diet/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Body Weight Maintenance/

9 exp Obesity Management/

10 exp Weight Reduction Programs/

11 exp body weight changes/

12 OR/8-11

13 ((Weight adj2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

14 12 OR 13

15 exp Feedback/

16 exp Health Education/

17 exp Teaching/

18 exp Reminder Systems/

19 Goals/

20 Intention/

21 Mentoring/

22 Counseling/

23 Social Support/

24 OR/15-23

25 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

26 24 OR 25

27 (6 OR 7 OR 14) AND 26

28 exp Telemedicine/ or exp Computer-Assisted Instruction/ or exp Blogging/ or exp Cell Phone/ or exp Computer Graphics/ or Computers/ or exp Computers, Handheld/ or Educational Technology/ or Electronic Mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Games/ or Webcasts as Topic/ or Wireless Technology/

29 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or FB or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

30 28 OR 29

31 27 AND 30

32 Evaluation Studies/ or Program Evaluation/

33 (evaluation or randomly or placebo* or trial* or group*).ab. or (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

34 (“controlled clinical trial” or “randomized controlled trial”).pt.

35 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

36 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

37 32 OR 33 OR 34 OR 35 OR 36

38 31 AND 37

39 exp Adult/ or Young Adult/

40 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

41 ((college adj2 student*) or (university adj2 student*)).ti,ab.

42 aged.sh.

43 39 OR 40 OR 41 OR 42

44 38 AND 43

Database: Ovid Embase

1 exp “Physical Education”/ or exp Sport/ or exp Exercise/ or exp Fitness/ or exp Kinesiotherapy/ or exp Motor Activity/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diet/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Body Weight Maintenance/

9 exp Obesity Management/

10 exp Weight Reduction Programs/

11 exp body weight changes/

12 OR/8-11

13 ((Weight adj2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

14 12 OR 13

15 exp Feedback/

16 exp Health Education/

17 exp Teaching/

18 exp Reminder Systems/

19 Goals/

20 Intention/

21 Mentoring/

22 Counseling/

23 Social Support/

24 OR/15-23

25 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

26 24 OR 25

27 (6 OR 7 OR 14) AND 26

28 exp Telemedicine/ or exp Blogging/ or exp Mobile Phone/ or exp Computer Graphics/ or Computers/ or exp Personal Digital Assistant/ or Educational Technology/ or e-mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Game/ or Webcast/ or Wireless Communication/

29 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or ‘FB’ or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

30 28 OR 29

31 27 AND 30

32 evaluation study/ or program evaluation/

33 (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

34 (random* or placebo* or double-blind*).ti,ab,kw.

35 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

36 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

37 32 OR 33 OR 34 OR 35 OR 36

38 31 AND 37

39 exp Adult/ or Young Adult/ or exp College student/ or exp University student/

40 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

41 ((college adj2 student*) or (university adj2 student*)).ti,ab,kw.

42 aged.sh.

43 39 OR 40 OR 41 OR 42

44 38 AND 43

Database: Ovid PsycINFO

1 exp Sports/ or exp Exercise/ or exp Physical Fitness/

2 ((((sedentary adj2 behavior*) or (physical adj2 activi*) or (physical adj2 inactivi*) or sport* or exercis* or (muscle adj2 stretch*) or (resistance adj2 training) or walk* or bicycle* or cycling or swim* or running or jogging or gymnastic* or yoga or dancing or pilates or gardening or (physical adj2 conditioning) or circuit-based or endurance or high-intensity) adj2 interval) or “HIIT” or plyometric* or resistance or running or jogging or swimming or walking or sports or stair climbing or (cardiorespiratory adj2 fitness) or (motion adj2 therapy) or (physical adj2 (education or training or fitness)) or (motor adj2 activity) or (active adj2 living)).ti,ab.

3 1 OR 2

4 exp Diets/

5 (nutrition or diet* or (intake adj2 (calorie or caloric or restriction*)) or fasting or (mindful adj2 eating) or (healthy adj2 diet*) or (healthy adj2 eating) or (vending adj2 machine*) or (eating adj2 behavior*) or candy or candies or sweet* or fruit* or vegetable* or vegetarian* or vegan* or sweetened drink* or sugar sweetened beverage* or soda* or carbonated or low-fat or gluten-free or water or food* or pop or dessert* or cake* or cookie* or brownie* or (baked adj2 goods*) or carbohydrate* or sugar* or soft drink* or soda*).ti,ab.

6 4 OR 5

7 3 AND 6

8 exp Weight control/ or exp Weight loss/

9 ((Weight adj2 (program or change or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight).ti,ab.

10 8 OR 9

11 exp Feedback/

12 exp Health Education/

13 exp Teaching/

14 Goals/

15 Intention/

16 Mentoring/

17 Counseling/

18 Social Support/

19 OR/11-18

20 (self-monitor* or (goal* adj2 setting) or intention* or track* or behavior or behaviour or coach* or mentor* or counsel* or (social adj2 support*) or feedback or educat* or (teach* adj2 skill*) or monitor* or (health adj2 educat*) or reminder).mp.

21 19 OR 20

22 (6 OR 7 OR 10) AND 21

23 exp Telemedicine/ or exp Computer-Assisted Instruction/ or exp Blogging/ or exp Cell Phone/ or exp Computer Graphics/ or Computers/ or exp Computers, Handheld/ or Educational Technology/ or Electronic Mail/ or Internet/ or Multimedia/ or Technology/ or Text Messaging/ or user-computer interface/ or exp Videoconferencing/ or exp Video Games/ or Webcasts as Topic/ or Wireless Technology/

24 ((instant adj2 messag*) or IM or (Interactive adj2 voice adj2 response) or IVR or (personal adj2 digital adj2 assistant) or PDA or (social adj2 network*) or (text adj2 messag*) or “SMS” or (world adj2 wide adj2 web) or website* or (apple adj2 watch) or automated or blog* or Bluetooth or chat or (chat adj2 room) or (communication adj2 network) or (computer adj2 assisted) or (computer adj2 interface) or computer* or computer-based or computerized or laptop* or (digital adj2 assistant*) or ecoach* or (educational adj2 technolog*) or edutainment or e-health or ehealth or (electronic adj2 feedback) or (electronic adj2 health) or e-mail or (electronic adj2 mail) or Facebook or FB or fitbit* or (fitness adj2 tracker*) or graphic* or (handheld adj2 computer*) or (health adj2 information*) or technolog* or hypermedia or individualized or Instagram or interactive or (internet adj2 based) or internet or iOTA or mhealth or m-health or (mobile adj2 app*) or (mobile adj2 technolog*) or (mobile adj2 health) or mobile or (mobile adj2 phone*) or android* or smartphone* or (smart adj2 phone*) or (cell* adj2 phone*) or (mobile adj2 device*) or iphone or multimedia or (new adj2 technolog*) or online or on-line or (personal adj2 electronic adj2 device*) or podcast* or programmed or prompt* or (remote adj2 consultation*) or remote or (short adj2 message adj2 service*) or (social adj2 media) or software or tablet* or tailored or telecare or telehealth or telemonitoring or twitter or tweet or (video adj2 conferenc*) or (video adj2 game*) or (virtual adj2 reality) or web-based or webcast* or wireless* or apps or iOs or (digital adj2 health)).mp.

25 23 OR 24

26 22 AND 25

27 Program Evaluation/

28 (evaluation or randomly or placebo* or trial* or group*).ab. or (effectiveness or intervention or (program* adj6 evaluat*)).ti,ab.

29 (double-blind or random: assigned or control).tw.

30 (pre-adj5 post- or (pretest adj5 posttest)).ti,ab.

31 (control* or before or (before and after stud*) or follow up assessment).ti,ab.

32 OR/28-31

33 26 AND 32

34 (geriatric* or senior* or adult* or m?n or wom?n or participant*).ti,ab.

35 ((college adj2 student*) or (university adj2 student*)).ti,ab.

36 34 OR 35

37 33 AND 36

Cochrane Database

#1 MeSH descriptor: [Physical Education and Training] explode all trees

#2 MeSH descriptor: [Sports] this term only

#3 MeSH descriptor: [Exercise] this term only

#4 MeSH descriptor: [Physical Fitness] this term only

#5 MeSH descriptor: [Exercise Therapy] this term only

#6 MeSH descriptor: [Motor Activity] this term only

#7 ((sedentary NEAR/2 behavior*) OR (physical NEAR/2 activi*) OR (physical NEAR/2 inactivi*) OR sport* OR exercis* OR (muscle NEAR/2 stretch*) OR (resistance NEAR/2 training) OR walk* OR bicycle* OR cycling OR swim* OR running OR jogging OR gymnastic* OR yoga OR dancing OR pilates OR gardening OR (physical NEAR/2 conditioning) OR circuit-based OR endurance OR (high-intensity NEAR/2 interval) OR HIIT OR plyometric* OR resistance OR running OR jogging OR swimming OR walking OR sports OR (stair NEAR/2 climbing) OR (cardiorespiratory NEAR/2 fitness) OR (motion NEAR/2 therapy) OR (physical NEAR/2 (education OR training OR fitness)) OR (motor NEAR/2 activity) OR (active NEAR/2 living)):ab,ti

#8 {OR #1-#7}

#9 MeSH descriptor: [Diet] this term only

#10 (nutrition OR diet* OR (intake NEAR/2 (calorie OR caloric OR restriction*)) OR fasting OR (mindful NEAR/2 eating) OR (healthy NEAR/2 diet*) OR (healthy NEAR/2 eating) OR (vending NEAR/2 machine*) OR (eating NEAR/2 behavior*) OR candy OR candies OR sweet* OR fruit* OR vegetable* OR vegetarian* OR vegan* OR “sweetened drink” OR “sugar sweetened beverage*” OR soda* OR carbonated OR low-fat OR gluten-free OR water OR food* OR pop OR dessert* OR cake* OR cookie* OR brownie* OR (baked NEAR/2 goods*) OR carbohydrate* OR sugar* OR “soft drink*” OR soda):ab,ti

#11 #9 OR #10

#12 #8 AND #11

#13 MeSH descriptor: [Body Weight Maintenance] this term only

#14 MeSH descriptor: [Obesity Management] this term only

#15 MeSH descriptor: [Weight Reduction Programs] explode all trees

#16 (((Weight NEAR/2 (program or loss or reduction or maintenance or maintain* or management or trajector*)) or body-weight)):ab,ti

#17 {OR #13-#16}

#18 MeSH descriptor: [Feedback] explode all trees

#19 MeSH descriptor: [Health Education] this term only

#20 MeSH descriptor: [Teaching] explode all trees

#21 MeSH descriptor: [Reminder Systems] explode all trees

#22 MeSH descriptor: [Goals] explode all trees

#23 MeSH descriptor: [Intention] explode all trees

#24 MeSH descriptor: [Mentoring] explode all trees

#25 MeSH descriptor: [Counseling] explode all trees

#26 MeSH descriptor: [Social Support] explode all trees

#27 (self-monitor* OR (goal* NEAR/2 setting) OR intention* OR track* OR behavior OR behaviour OR coach* OR mentor* OR counsel* OR (social NEAR/2 support*) OR feedback OR educat* OR (teach* NEAR/2 skill*) OR monitor* OR (health NEAR/2 educat*) OR reminder):ab,ti

#28 {OR #18-#27}

#29 #11 OR #12 OR #17

#30 #28 AND #29

#31 MeSH descriptor: [Telemedicine] explode all trees

#32 MeSH descriptor: [Computer-Assisted Instruction] explode all trees

#33 MeSH descriptor: [Blogging] explode all trees

#34 MeSH descriptor: [Cell Phone] explode all trees

#35 MeSH descriptor: [Computer Graphics] explode all trees

#36 MeSH descriptor: [Computers] explode all trees

#37 MeSH descriptor: [Computers, Handheld] explode all trees

#38 MeSH descriptor: [Educational Technology] explode all trees

#39 MeSH descriptor: [Internet] explode all trees

#40 MeSH descriptor: [Multimedia] explode all trees

#41 MeSH descriptor: [Technology] explode all trees

#42 MeSH descriptor: [Text Messaging] explode all trees

#43 MeSH descriptor: [User-Computer Interface] explode all trees

#44 MeSH descriptor: [Videoconferencing] explode all trees

#45 MeSH descriptor: [Video Games] explode all trees

#46 MeSH descriptor: [Webcasts as Topic] explode all trees

#47 MeSH descriptor: [Wireless Technology] explode all trees

#48 ((instant NEAR/2 messag*) OR IM OR (Interactive NEAR/2 voice NEAR/2 response) OR IVR OR (personal NEAR/2 digital NEAR/2 assistant) OR PDA OR (social NEAR/2 network*) OR (text NEAR/2 messag*) OR SMS OR (world NEAR/2 wide NEAR/2 web) OR website* OR (apple NEAR/2 watch) OR automated OR blog* OR Bluetooth OR chat OR (chat NEAR/2 room) OR (communication NEAR/2 network) OR (computer NEAR/2 assisted) OR (computer NEAR/2 interface) OR computer* OR computer-based OR computerized OR laptop* OR (digital NEAR/2 assistant*) OR ecoach* OR (educational NEAR/2 technolog*) OR edutainment OR e-health OR ehealth OR (electronic NEAR/2 feedback) OR (electronic NEAR/2 health) OR e-mail OR (electronic NEAR/2 mail) OR Facebook OR FB OR fitbit* OR (fitness NEAR/2 tracker*) OR graphic* OR (handheld NEAR/2 computer*) OR (health NEAR/2 information*) OR technolog* OR hypermedia OR individualized OR Instagram OR interactive OR (internet NEAR/2 based) OR internet OR iOTA OR mhealth OR m-health OR (mobile NEAR/2 app*) OR (mobile NEAR/2 technolog*) OR (mobile NEAR/2 health) OR mobile OR (mobile NEAR/2 phone*) OR android* OR smartphone* OR (smart NEAR/2 phone*) OR (cell* NEAR/2 phone*) OR (mobile NEAR/2 device*) OR iphone OR multimedia OR (new NEAR/2 technolog*) OR online OR on-line OR (personal NEAR/2 electronic NEAR/2 device*) OR podcast* OR programmed OR prompt* OR (remote NEAR/2 consultation*) OR remote OR (short NEAR/2 message NEAR/2 service*) OR (social NEAR/2 media) OR software OR tablet* OR tailored OR telecare OR telehealth OR telemonitoring OR twitter OR tweet OR (video NEAR/2 conferenc*) OR (video NEAR/2 game*) OR (virtual NEAR/2 reality) OR web-based OR webcast* OR wireless* OR apps OR iOs OR (digital NEAR/2 health)):ab,ti

#49 {OR #31-#48}

#50 #30 AND #49

#51 MeSH descriptor: [Program Evaluation] explode all trees

#52 (effectiveness or intervention or (program* NEAR/2 evaluat*)):ab,ti

#53 ((pre NEAR/5 post) OR (pretest NEAR/5 posttest)):ab,ti

#54 ((control* or before or (before and after stud*) or follow up assessment)):ab,ti

#55 {OR #51-#54}

#56 #50 AND #55

#57 MeSH descriptor: [Adult] explode all trees

#58 MeSH descriptor: [Young Adult] explode all trees

#59 ((college NEAR/2 student*) OR (university NEAR/2 student)):ab,ti

#60 (geriatric* OR senior* OR adult* OR m?n OR wom?n or participant*):ab,ti

#61 {OR #57-#60}

Abbreviations: exp, explode; mp, multi-purpose; ti; title; ab, abstract; adj, adjacency; pt, publication type; kw, keyword heading; sh, MESH subject headings; *, unlimited suffix variations

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

Pew Research Center. Internet/Broadband Fact Sheet, 2021. Date Accessed 7/2/2021. Available at: https://www.pewresearch.org/internet/fact-sheet/internet-broadband/.

National Center for Education Statistics. Digest of education statistics, 2020a. Date Accessed 7/2/2021. Available at: https://nces.ed.gov/programs/digest/d20/tables/dt20_302.60.asp.

The following considerations for implementation are drawn from studies included in the evidence review, the broader literature, and expert opinion, as noted below. It is important to note that these interventions were conducted among students; therefore, not all populations would benefit to the same degree. Additionally, the CPSTF does not endorse any specific digital health intervention.

• Implementers may want to tailor the intervention based on gender, race/ethnicity, health literacy, urbanicity (rural vs. urban), or other student characteristics.
• Interventions may be implemented by various student services within institutions of higher education (e.g., student life, housing, dining, student health centers).
• Programs may want to consider the food environment (e.g., policies in place for types of food offered), built environment (e.g., places for physical activity), and safety (e.g., adequate lighting on walkways).
• Data security and privacy issues need to be considered when individuals enter personal information electronically.
• Digital health is rapidly evolving. Newer digital health interventions, such as those that incorporate social media platforms, were not represented in this body of evidence.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of adults who do no physical activity in their free time — PA-01
• Increase the proportion of adults who do enough aerobic physical activity for substantial health benefits — PA-02
• Increase the proportion of adults who do enough muscle-strengthening activity — PA-04
• Increase fruit consumption by people aged 2 years and over — NWS-06
• Increase vegetable consumption by people aged 2 years and older — NWS-07
• Increase consumption of dark green vegetables, red and orange vegetables, and beans and peas by people aged 2 years and over — NWS-08
• Increase whole grain consumption by people aged 2 years and over — NWS-09
• Reduce consumption of saturated fat by people aged 2 years and over — NWS-11