Determinants of health-related lifestyles among university students

TLDR: This study provides robust evidence that the health-related lifestyles of the student population are worrying and suggests that the trend in chronic diseases associated with unhealthy lifestyles sustained over years might be unlikely to change in future generations.

Abstract: Aims:The aim of this study was to investigate students’ health-related lifestyles and to identify barriers and social determinants of healthier lifestyles.Methods:An online survey, two focus groups...

Figures

Table 3: Adjusted ORs* of Demographic and Lifestyle Factors Associated with Nutrition among University Students. London 2015

Table 1: Physical Activity, Nutrition, Mental Wellbeing, Alcohol, Nicotine and Illegal Drugs Use by Gender among University Students. London 2015

Table 4: Adjusted ORs* of Demographic and Lifestyle Factors Associated with Mental Wellbeing among University Students. London 2015

Table 2: Adjusted ORs* of Demographic and Lifestyle Factors Associated with Physical Activity among University Students. London 2015

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Aceijas, Carmen ORCID logoORCID: https://orcid.org/0000-0002-3652-6536, Waldhäusl,
Sabrina, Lambert, Nicky ORCID logoORCID: https://orcid.org/0000-0001-8785-4719, Cassar,
Simon and Bello-Corassa, Rafael (2017) Determinants of health-related lifestyles among
university students. Perspectives in Public Health, 137 (4) . pp. 227-236. ISSN 1757-9139
[Article] (doi:10.1177/1757913916666875)
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1
DETERMINANTS OF HEALTH RELATED LIFESTYLES AMONG
UNIVERSITY STUDENTS
Aceijas C
a
, Waldhäusl S
b
., Lambert N
c
., Cassar S
d
., Bello-Corassa R
e
.,
a
Department of Natural Sciences. School of Science and Technology.
Middlesex University. London. UK.
b
Department of Natural Sciences. School of Science and Technology.
Middlesex University. London. UK.
c
Department of Mental Health and Social Work. Middlesex University. London.
UK.
d
Wellbeing Service. Middlesex University. London. UK.
e
Universidade Federal dos Vales do Jequitinhonha e Mucuri. Alto da Jacuba.
Brazil.
Corresponding author: Dr Carmen Aceijas, PhD. Department of Natural
Sciences. School of Science and Technology Middlesex University. The
Burroughs Hendon. Town Hall extension building. London, NW4 4BT. UK. Tel.
no.: 07930278749. Email address: c.aceijas@mdx.ac.uk
Source of support: The study was funded by the Department of Mental Health
and Social Work under the small grants scheme 2014/5.

2
Abstract
AIMS: To investigate students’ health-related lifestyles and to identify barriers
and social determinants of healthier lifestyles. METHODS: An online survey,
two focus groups, and three in-depth interviews across 2014/15. A stratified by
School size and random sample [n=468] of university students answered a 67-
item questionnaire comprising six scales: RAPA, REAP-S, CAGE, FTND,
SWEMWBS
and ad hoc scale for drug use/misuse. Stratified by gender X
2
tests
were run to test associations/estimate risks and three multivariate Logistic
Regression models were adjusted. A thematic approach guided the analysis of
qualitative data. RESULTS: 60% of the respondents were insufficiently
physically active, 47% had an unbalanced diet and 30% had low mental
wellbeing. Alcohol drinkers vs. abstinent were almost equally distributed. 42% of
alcohol drinkers reported getting drunk at least once a month. Smokers
accounted for 16% of the respondents. Identified risk factors for suboptimal
physical activity were: Being a woman, not using the university gym and
smoking. For unbalanced diet: low mental wellbeing and drugs use. Poor
mental wellbeing was predicted by unbalanced diet, not feeling like shopping
and cooking frequently, and a lack of help-seeking behaviour in case of
distress. Qualitative analysis revealed seven thematic categories: transition to
new life, university environment and systems, finances, academic pressure,
health promotion in campus and recommendations. CONCLUSIONS: This
study provides robust evidence that the health-related lifestyles of the student
population are worrying and suggests that the trend in chronic diseases

3
associated with unhealthy lifestyles sustained over years might be unlikely to
change in future generations. University students’ health-related lifestyle is a
concern. Nine out of the identified ten predictors of problematic physical activity,
nutrition and mental wellbeing, were environmental/societal or institutional
barriers. Universities must expand corporate responsibilities to include the
promotion of health as part of their core values.
Key words: healthy lifestyles, surveys, students, public health

4
Introduction
The importance of lifestyle related non-communicable diseases (NCDs) in
explaining the health of populations cannot be overstated. Approximately two
thirds of the global mortality is caused by NCDs, mainly due to cardiovascular
diseases (CVDs), diabetes, cancers and chronic respiratory diseases.
1
Unhealthy lifestyles characterised by physical inactivity, poor diet, tobacco
smoking and excessive alcohol use, as well as mental ill health are seen as the
main risk factors for chronic diseases and premature deaths.
1–3
In combination
they account for a significant amount of preventable deaths worldwide, with
tobacco smoking alone claiming 6 million annual deaths, physical inactivity 3.2
million, harmful alcohol use 2.3 million, overweight and obesity 2.8 million,
1
and
dietary risks 11.3 million.
4
Furthermore, mental health and substance use
disorders are the leading cause of disability worldwide, accounting for 22.9% of
years lived with disability (YLDs) and 7.4% of all disability-adjusted life years
(DALYs).
5
The impact of these individual issues is exacerbated by the interactions
between major risk factors, which further endanger the populations’ health. For
instance, overweight/obesity, poor diet, and physical inactivity are linked to
increased risk for CVDs, type-2 diabetes, cancer and depression.
6
Mental
illness raises the risk for CVD, diabetes, cancer and obesity,
3
and is also
associated with higher rates of substance use.
7
The reduction of risk factors by
adoption of healthy lifestyles, including regular physical activity, reduced alcohol

Frequently asked questions

Q1. What are the main risk factors for chronic diseases and premature deaths?

Unhealthy lifestyles characterised by physical inactivity, poor diet, tobacco smoking and excessive alcohol use, as well as mental ill health are seen as the main risk factors for chronic diseases and premature deaths. 

Q2. What are the contributions in this paper?

In this paper, the authors presented a study aimed at strengthening the evidence on health-related lifestyles, in main areas directly connected to major NCDs: physical activity, nutrition, mental health, smoking, drugs and alcohol use, among UK UG university students. 

Q3. What were the main predictors of poor mental wellbeing?

Poor mental wellbeing was predicted by unbalanced diet, not feeling like shopping and cooking frequently, and a lack of help-seeking behaviour in case of distress. 

Q4. What is the main reason why students are becoming more prone to unhealthy eating habits?

19 Stress exposure negatively encourages deleterious eating habits with increasing tendencies to snack, skip breakfast, and consume larger portions. 

Q5. What were the common factors associated with poor physical activity?

For men only, suffering from some disability (OR=5.1; 95%CI=1.03 – 24.92; p=0.04) and living away from parental/guardian houses (p=0.03) were both associated with poor physical activity. 

Q6. What were the main factors that impacted the health of students?

4) Finances: Economic hardship makes healthy living a challenge with the University gym’s annual fee, for instance, decreasing its use, and high food prices on campus competing with the broad range of cheap fast food restaurants off-site; 5) Academic pressure: Smoking and alcohol use were perceived as stress-relieving strategies which increased students’ vulnerability to poorer health. 

Q7. How many minutes of moderate intensity physical activity per week?

The reduction of risk factors by adoption of healthy lifestyles, including regular physical activity, reduced alcoholuse and balanced diet could save many of lives and prevent large proportions of NCDs.1 WHO guidelines for adults recommend >150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity per week. 

Q8. What were the seven categories of thematic analysis?

Qualitative analysis revealed seven thematic categories: transition to new life, university environment and systems, finances, academic pressure, health promotion in campus and recommendations. 

Q9. What were the main factors that influenced the health of the respondents?

RESULTS: 60% of the respondents were insufficiently physically active, 47% had an unbalanced diet and 30% had low mental wellbeing. 

Q10. What are the main reasons for the deterioration of student dietary patterns?

13 Additionally, students’ dietary patterns deteriorate with increases in sugar, fat and sodium intake and suboptimal consumption of fruits, vegetables and whole grains. 

Q11. What was the purpose of the study?

This study aimed at strengthening the evidence on health-related lifestyles, in main areas directly connected to major NCDs: physical activity, nutrition, mental health, smoking, drugs and alcohol use, among UK UG university students. 

Q12. What was the main reason for not using the gym?

89% of respondents did not use the university gym with 30% saying their main reason was the price and 40% because they lacked time to use it. 

Q13. What is the risk of having an unbalanced diet?

Students in the Schools of Science & Technology and Business School had 3.5 and 2.8 times the risk of having an unbalanced diet respectively compared to students in Art & Design (ref category) (Science & Technology : OR=3.5; 95%CI=1.5–8.2; p=0.01. 

Q14. What were the predictors of problematic physical activity, nutrition and mental wellbeing?

Nine out of the identified ten predictors of problematic physical activity, nutrition and mental wellbeing, were environmental/societal or institutional barriers. 

Q15. What was the significant association between gender and physical activity?

Gender was strongly associated with physical activity with women having almost twice the risk of insufficient physical activity compared to men (OR=1.9 95% CI=1.2 – 2.9; p=0.00). 

Q16. What were the main factors that affected the health of students?

2) University Environment: Students felt their health was negatively impacted by food facilities on campus (unhealthy food with a few limited and costly healthier choices) and by the culture in the University living residences.