Table 3 Key interpretation issues on the 10-item Adult Food Security Survey Module in cognitive interviews with college students

“Money for more” or another monetary clause in each item

- Monetary aspect of question overlooked by students

- Variable interpretations based on heterogenous financial support sources (e.g., employment, savings, meal plan)

- Dining hall meal plans used as sole reference and other support sources ignored

“It’s not that it’s too expensive, no. It’s fine. I probably should have looked at it better. Yeah, I think I can afford all that with the foods I need.” (21 years old, male, food insecure)

“I work for [a recreation centre]. It’s like an okay check. So, I literally call it my food money. I got that job for food, because it’s hard to force yourself to eat in the dining hall.” (19 years old, female, food insecure)

“Like my meal plan and if I had any cash, like cash on me” (19 years old, female, food insecure)

“I’m just going to think of the dining hall because that’s the, the easiest way to look at it. You know for [campus convenience stores] or uh, you know, somewhere I can buy food for myself, there’s a lot of different, you know, variables related to that, so we’ll just forget about that” (18 years old, male, food secure)

“Balanced meals” in HH4

- Confusion between being able to afford healthy food and actual dietary patterns

- Non-financial reasons for not eating “balanced meals” given

“So I guess cost really wasn’t a driving factor for me starting to eat less balanced meals or anything. It just kind of happened.” (20 years old, male, food insecure)

“I don’t want to go out to like buy all these ingredients. And it’s like such a hassle. So I think that’s why I can’t afford to eat balanced meals” (18 years old, female, food insecure).

“Eat less than should” in AD2 and “cut size of meals” in AD1

- Items considered repetitive to students

- Buffet-style of university dining halls made responses more complex

“Um, yes because the last one was a yes and it was pretty easy since it was such a similar question. I felt like this question just reinstates the last question” (18 years old, female, food insecure).

“I did eat less because I wasn’t eating the regular two meals

per day. So one meal a day. So I would end up eating a lot more just cause I was afraid like ... I wasn’t sure of the next time I would be able to eat, which is why I tend to overate at the dining hall” (18 years old, female, food insecure)

“Hunger but didn’t eat” in AD3

- Various interpretations of “real hunger” and whether experiences of students counted as hungry

“Hungry is kind of like a broad definition you know, like I was not like starving, but I mean I’m hungry right now, and I skipped lunch. (Soft laugh) But, it’s not like painful hungry or like horrible hungry. It’s fine” (18 years old, male, food insecure).

“Lost weight” in AD4

- Students did not monitor and were not aware of their weight

“Uh, I think I put “no”. And I should have put “don’t know” cuz I don’t know if I’ve lost weight. I’ve only been to the doctor once at the beginning of the school year and I don’t have a scale.” (19 years old, female, food insecure)