The Fitness, Rest, and Exercise for Strength and Health (FRESH) Study: A Three-Year Comparison of College Students'...

The undergraduate college years are a critical transition period for young adults in establishing life-long health behaviors. Background/Objective: Within the FRESH Study, we aimed to understand the relationship between perceived physical health, perceived mental health, and specific health metrics (e.g., physical activity, food insecurity, sleep quality) among college students following the COVID-19 pandemic. Methods: First-year undergraduate students (n = 271) from an urban university were recruited in three study waves (2021-2022, 2022-2023, and 2023-2024). Participants answered online surveys on demographics, health perceptions, physical activity, dietary patterns, beverage consumption, food insecurity, stress, and sleep quality. Results: Overall, participants rated their physical health better than their mental health ('good', 'very good', or 'excellent'; 89.6% vs. 62.2%), even though 30.7% were not of 'healthy weight' status, 34.5% did not meet physical activity recommendations, and 42.2% of students consumed some sugar-sweetened beverages (SSBs). Students reporting suboptimal ('fair' or 'poor') physical and mental health were more likely to report food insecurity (p < 0.001, p = 0.010), poor sleep quality (p = 0.012, p < 0.001), and elevated stress (p = 0.001, p < 0.001). In addition, fast-food consumption (p < 0.001), breakfast consumption (p = 0.031), and food insecurity (p = 0.004) showed changes over three years. Conclusions: These findings call for targeted wellness initiatives addressing nutrition, food insecurity, stress management, sleep improvement, and physical activity among students and in university health programs. The FRESH Study emphasizes the need for continued longitudinal research to track health behaviors and inform future interventions.