The European Health and Behaviour Survey: rationale, methods and initial results from the United Kingdom

Predicting oral hygiene practices through health behavior, perceived stress and self-efficacy in undergraduate dental students of Pakistan: a national survey

BACKGROUND

Dental students face the rigorous demands of coursework, which can lead to feelings of inadequacy and stress. These pressures can negatively influence self-efficacy and cause neglect in practicing healthy behaviors that encompass oral health. Identifying the associations of these variables with oral hygiene practices can help in the formulation of interventions tailored toward supporting young students. Therefore, this study aimed to investigate the impact of health behaviors, perceived stress and self-efficacy on oral hygiene practices among undergraduate dental students in Pakistan.

METHODS

A national online survey was carried out among 904 students across the dental colleges of Pakistan. The survey assessed general health behaviors such as tobacco use, sleep, and exercise, among other demographic variables. Perceived stress was evaluated via the Perceived Stress Scale (PSS-10), and self-efficacy was evaluated via the General Self-Efficacy Scale (GSES). Twice daily brushing, brushing for 2 min, and changing toothbrushes after 3 months informed oral hygiene practice of the participants.

RESULTS

The students experienced moderate perceived stress (20.82 ± 5.92) and high self-efficacy (29.19 ± 5.43). The majority of participants were in their third year (31.9%), were female (65.9%), and resided in home during their studies (64.4%). Perceived stress was observed to have no significant effect on the oral practice of participants. Female gender, non tobacco user, regular exercise, frequent dental visits and higher self-efficacy were associated with good oral hygiene practices.

CONCLUSIONS

The results highlight the importance of addressing stress, enhancing self-efficacy and encouraging healthy behaviors among dental students to improve their oral health, which could be reflected in their professional practice and personal well-being. This study contributes to the understanding of behavioral determinants and emphasizes the need for supportive measures to foster better health behaviors in future dental professionals.

Positive parenting, adolescent adjustment, and quality of adolescent diet in nine countries

INTRODUCTION

We sought to understand the relation between positive parenting and adolescent diet, whether adolescents' internalizing and externalizing behaviors mediate relations between positive parenting and adolescent diet, and whether the same associations hold for both boys and girls and across cultural groups.

METHODS

Adolescents (N = 1334) in 12 cultural groups in nine countries were followed longitudinally from age 12 to 15. We estimated two sets of multiple group structural equation models, one by gender and one by cultural group.

RESULTS

Modeling by gender, our findings suggest a direct effect of positive parenting at age 12 on a higher quality diet at age 15 for males (β = .140; 95% CI: 0.057, 0.229), but an indirect effect of positive parenting at age 12 on a higher quality diet at age 15 by decreasing externalizing behaviors at age 14 for females (β = .011; 95% CI: 0.002, 0.029). Modeling by cultural group, we found no significant direct effect of positive parenting at age 12 on the quality of adolescent diet at age 15. There was a significant negative effect of positive parenting at age 12 on internalizing (β = -.065; 95% CI: -0.119, -0.009) and externalizing at age 14 (β = -.033; 95% CI: -0.086, -0.018).

CONCLUSIONS

We founder gender differences in the relations among positive parenting, adolescents' externalizing and internalizing behaviors, and adolescent diet. Our findings indicate that quality of parenting is important not only in promoting adolescent mental health but potentially also in promoting the quality of adolescents' diet.

The Validity and Reliability of the FANTASTIC Questionnaire for Nutritional and Lifestyle Studies in University Students

The FANTASTIC questionnaire is a scientific instrument that can be used by health professionals for quickly and effectively measuring the quality of life and lifestyle of people. It is a simple questionnaire that measures different dimensions including nutritional status, but the possibility of using it as a resource for studies in the nutritional field (regardless of its correlation with this) has never been considered, nor has it been used for studies in university populations. The aim was to validate the FANTASTIC questionnaire to report on the participant’s lifestyle in a Spanish university population by using a cross-sectional study. A sample of 501 participants was obtained. The study was approved by the Ethics Research Committee of Catholic University of Valencia, and written informed consent was obtained from all participants. Sociodemographic, lifestyle variables, habitual diet, and nutrition-related lifestyle were collected individually. Participants also completed the self-administered FANTASTIC questionnaire. The reliability analysis of the FANTASTIC questionnaire revealed a Cronbach’s Alpha statistic result of 0.797. The Kaiser–Meyer–Olkin (KMO) value was 0.786, with a significant Bartlett’s Test of Sphericity (p = 0.000). This shows that the FANTASTIC questionnaire has good internal consistency and good construct validity. A retest was performed in four weeks’ time, showing excellent intraclass correlation values. We consider the applicability of the FANTASTIC questionnaire for nutritional studies in Spanish university students to be appropriate, and most students have high scores in the nutritional aspects of the questionnaire, showing correct diet implementation and good cooking skills.

Assessment of energy and nutrient intakes among undergraduate students attending a University in the North of England

Background: Unhealthy diets are typical of university students and are often thought to be unrepresentative of the general population. The main aim was to determine the energy and nutrient intakes of a large cohort of undergraduate university students; and to compare to gender-specific dietary reference values (DRVs) and nutrient data from the general population. Methodology: Data was collected from 639 university students aged 18-24 years who completed 4-day diet diaries. The energy and nutrient intake was determined and percentage energy values calculated and compared with dietary reference values (DRVs) and the National Diet and Nutrition Survey (NDNS) and Family Food Statistics. Logistic regression methods were used to identify micronutrients functioning as predictors of exceeding DRVs. Results: Energy intakes were lower than the DRV. The percentage total energy values for protein, fat, saturated fat and carbohydrate exceeded DRVs but the percentage energy from alcohol was below the maximum 5%. The DRVs were met for vitamin C, thiamin, and sodium/salt. Iron and calcium intakes were met in males but not in females. Intakes for fibre and vitamin A were below the DRV. Student data was comparable to the NDNS, with the exception of alcohol, fibre, vitamin A, calcium and sodium/salt, which were all lower than the NDNS. Conclusions: This study contradicts the stereotypical assumption that students are following a high energy, fat, saturated fat, total sugars, salt and alcohol diet compared with the general population.

Digital nudges to stimulate healthy and pro-environmental food choices in E-groceries

In response to the detrimental health- and environmental impacts of European consumers' dietary patterns, Nutri-Scores and Eco-Scores have been introduced on packages as guidance for choices. Whereas the scores are promising to improve food choices from a nutritional point of view, the scant available literature suggests very limited effects on the environmental impact of food choices. Therefore, there remains a need to explore ways to bring about improvements in both areas. As a growing share of consumers buys food groceries online, new opportunities to steer food choices are being created. This article explores the potential of several digital functionalities to further stimulate healthier and pro-environmental food choices amongst consumers. These functionalities included product recommendation agents, product scores, a real-time average impact score of the chosen food basket and a personalised social norm. Those were tested in a two-stage randomized controlled trial with 1000 Belgian household food decision makers in a mock-up E-grocery. Indices reflecting the nutritional quality (NQI) and environmental impact (EII) of the selected food baskets were calculated. The results indicate that at first, displaying a combined Nutri- and Eco-Score at product level led to improved NQI's, but not EII's. However, the scores also led to shifting behaviour in EII's when facilitated with recommendation agents. The display of the average impact scores of the selected basket and of social norms did not lead to additional improvements. Hence, a combined Nutri- and Eco-Score labelling system is recommended, but an enabling environment to consider both scores is important to realise a shift towards more healthy and environmentally friendly food choices. Apart from manifesting healthier and environmentally friendly products with a centralised labelling system, improving their accessibility should be considered at least as important for behavioural changes.

Health Literacy, Health Behaviors, and Body Mass Index Impacts on Quality of Life: Cross-Sectional Study of University Students in Surabaya, Indonesia

University student life is an important transformation stage with many potential factors that can impact negatively on the Quality of Life (QOL) and the adoption of unhealthy behaviors. Health literacy (HL), Health Behaviors (HBs), and Body Mass Index (BMI) have been found to be essential components in influencing QOL, in addition to socioeconomic determinants. To identify the influential factors of QOL, we performed a cross-sectional survey in a university, and 955 undergraduate students were enrolled as respondents. We measured two different aspects of HL, i.e., Comprehensive Health Literacy (CHL) and Functional Health Literacy (FHL). Overall, QOL scores in four domains did not differ, regarded as medium with averages ranging from 57.00–63.98, and no significant difference between male and female students. In multivariate analysis, CHL had a significant positive influence on all domains, while FHL only affected the psychological and environmental domains with negative associations. Academic performance had a significant positive association with physical and psychological domains. Students from education majors had higher QOL in the psychological and social domains. Moreover, students with normal or underweight BMI status had better psychological QOL, and physical exercise had a positive association with the social relationship and environmental domains. The findings confirmed that CHL and FHL had significant associations with QOL domains in different ways that should be addressed accordingly. Public health practitioners should carefully empower students to use both CHL and FHL as decision-making skills by incorporating them into related curricula.

Associations of serious physical injuries with posttraumatic stress and depressive symptoms: a cross-sectional survey among university students in 26 countries

Background

Evidence of the relationship between serious physical injury and poor mental health among university students from low- and middle-income countries is limited. The aim of the study is to assess the association between serious physical injury and posttraumatic stress disorder (PTSD) and depressive symptoms in university students from low- and middle-income countries.

Methods

In a cross-sectional survey, 18,382 university students from 26 countries responded to a short screening scale for DSM-IV PTSD, Center for Epidemiologic Studies Depression Scale as well as questions on injury and sociodemographics.

Results

The overall prevalence of past 12-month serious physical injury was 24.7%. In adjusted logistic regression analysis, compared to having no past 12-month serious physical injury, having a past 12-month serious injury was associated with 1.35 (95% CI 1.18, 1.56) times higher odds for PTSD symptoms and 1.49 (95% CI 1.32, 1.67) times higher odds for depressive symptoms in university students.

Conclusion

Compared to students who had not sustained a serious physical injury in the past 12 months, students with an injury had significantly higher PTSD and depressive symptoms. Mental health support of students who sustained physical injuries may prevent PTSD and depressive symptoms.

Associations of physical partner violence and sexual violence victimization on health risk behaviours and mental health among university students from 25 countries

BACKGROUND

The study aimed to investigate the associations between physical partner violence victimization (IPV) and/or sexual violence victimization and various health risk behaviours and mental health in university students in 25 countries.

METHODS

Using a cross-sectional study design, 18,335 university students with a median age of 20 years from 25 countries in Africa, the Americas and Asia, replied to self-reported measures of interpersonal violence, health compromising behaviours, mental health measures and protective factors.

RESULTS

In adjusted logistic regression analysis, physical IPV and/or sexual violence victimization was associated, among men and/or among women, with sexual risk behaviours (multiple sexual partners, alcohol use in the context of sex, diagnosed with HIV and pregnancy), violence related behaviour (in a physical fight and carrying a weapon), poor mental health (depression, loneliness, post-traumatic stress disorder, sleeping problem and short sleep), addictive behaviour (binge drinking, tobacco and drug use), and other health risk behaviour (skipping breakfast and frequent salt intake).

CONCLUSIONS

We found evidence that physical IPV and/or sexual violence victimization among female and/or male university students was associated with 4 of 5 sexual risk behaviours, 2 violence related behaviours, 5 of 5 poor mental health indicators, 3 of 3 addictive behaviours and 2 of 7 other health risk behaviours.

A systematic integrative review of the literature on midwives and student midwives engaged in problematic substance use

OBJECTIVE

The objective of this systematic integrative review was to review the literature in relation to problematic substance use (PSU) in midwifery populations. Associated aims were to aggregate existing knowledge about midwives and student midwives' personal engagement in PSU, to generate a holistic conceptualisation and synthesis of the existing literature regarding midwives and student midwives personally engaged in PSU and to present new understandings and perspectives to inform the development of future research questions. This review is the first of its kind.

DESIGN

Systematic searches were conducted in CINAHL, Academic Search Complete, MEDLINE, PSYCInfo, Scopus and the Cochrane Library. Findings were grouped into themes and subthemes relating to both midwives and student midwives and then analysed critically in relation to the wider literature. A quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). The PRISMA statement was used to guide reporting.

SETTING

Included studies were conducted in Scotland, Ireland, Australia and New Zealand.

PARTICIPANTS

Studies included a total of 6,182 participants.

FINDINGS

A total of 3 studies were included. All included study types comprised quantitative survey designs, yet one also included a mixed methods design with the use of semi structured interviews. Two overarching themes emerged relating to both midwives and student midwives engaged in problematic substance use. For midwives, three subthemes are described: harmful daily alcohol consumption, working hours and harmful daily alcohol consumption and features associated with harmful daily alcohol consumption. For student midwives, two subthemes are presented: escape avoidance and alcohol, tobacco and cannabis use.

KEY CONCLUSIONS

There is limited evidence available in relation to problematic substance use in midwifery populations in comparison to that available for other healthcare populations. Further research is required, and could usefully focus upon midwives and student midwives as distinct professions to be separated out from the wider healthcare workforce.

IMPLICATIONS FOR PRACTICE

Problematic substance use among the healthcare workforce is associated with an increase in medical errors and inadequate care. Those affected can be reluctant to seek help, experience psychological distress and even contemplate suicide. Whilst evidence remains lacking for midwifery populations, they form a part of the general healthcare workforce and are exposed to similar workplace stressors. As such, it is likely that they too would be affected in similar ways.

Sedentary Behaviour, Physical Activity and Life Satisfaction, Happiness and Perceived Health Status in University Students from 24 Countries

The aim of this investigation was to estimate the independent and combined associations of sedentary behaviour (SB) and physical activity (PA) with life satisfaction, happiness and perceived health in university students. In a cross-sectional survey, 12,492 university students (median age 20 years, interquartile range = 3) from 24 countries responded to a questionnaire on SB, PA and well-being indicators. In adjusted linear regression, higher SB (4 to <8 h and ≥8 h) was associated with poorer life satisfaction (β = −0.21, confidence interval (CI): −0.27 to −0.14) and lower happiness (β = −0.31, CI: −0.46 to −0.17), and higher SB (≥8 h) was associated with lower perceived health (β = −0.08, CI: −0.13 to 0.03). In addition, moderate and/or high PA increased the odds for higher life satisfaction (β = 0.10, CI: 0.04 to 0.16), greater happiness (β = 0.27, CI: 0.15 to 0.39) and better perceived health (β = 0.12, CI: 0.08 to 0.15). Programmes that reduce SB and increase PA may promote life satisfaction, happiness and perceived health status in this university student population.

The centrality of health behaviours: A network analytic approach

OBJECTIVES

Since behavioural risk factors are the foremost causes of disability and premature mortality, developing new perspectives for understanding them is of utmost importance. This paper describes an innovative approach that conceptualizes health-related behaviours as nodes in a weighted network.

DESIGN & METHODS

Using self-reported data from a representative sample (n = 374), a network of 37 health behaviours was analysed, with the aim of identifying 'central' nodes, that is, behaviours that are likely to co-occur with others and potentially influence them.

RESULTS

In line with conservation of resources theory, the analysis indicated that behaviours related to basic physiological needs (nutrition and sleep) were most central. Behaviour centrality also varied across subpopulations: Periodic medical examinations, eating meals regularly, and sleep hygiene were more central among high- compared to low-socio-economic status participants; behaviours related to supportive social relationships and sun protection were more central among women compared to men.

CONCLUSION

By emphasizing behavioural connectivity, the approach applied herein has identified core health behaviours with potentially high impact on healthy lifestyle behaviours. Statement of Contribution What is already known on this subject? Many health behaviours are related to each other. Engagement in one health behaviour can affect engagement in other behaviours. What does this study add? Health behaviour can be viewed and analysed as a network. Sleep and nutrition behaviours are the most central behaviours in the network. Centrality varies as a function of socio-economic status and gender.

Social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries: a multi-country cross-sectional study

While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, cross-sectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to select universities and students, respectively. A structured questionnaire was translated into national languages of the participating countries and used to collect data from the selected students in the classrooms. Using STATA, Chi-square test was used to test differences in proportions, and multinomial logistic regression analyses were performed to obtain relative risk ratios and 95% confidence intervals. Multivariate logistic regression analysis was performed with to identify independent social and behavioural factors associated with non-condom use at last sexual intercourse. In total, 8,836 students with a mean age of 20.6 (SD = 2.0) participated in the study. Most of them (98.5%) were unmarried. In all countries, male students were significantly more likely to have two or more sexual partners in the past 12 months compared to female students (4.8% vs. 1.1%, p < 0.001). Female students were significantly more likely to report unprotected sex compared to male students (50.5% vs. 58.8%, p = 0.01). Results of multivariable logistic regression analyses showed that students who reported having two or more partners in the past 12 months were significantly more likely to be male, be aged between 20-30, be current tobacco smokers, be binge drinkers, have severe depressive symptoms, and have been in a physical fight in the past 12 months, compared to students who reported having less than two sexual partners in the past 12 months. Health intervention programmes to prevent and control STIs, especially HIV infection, should focus on university students having the social and behavioural characteristics that are associated with risky sexual behaviours.

Health Education for Musicians

Context and aims: Many musicians suffer for their art, and health is often compromised during training. The Health Promotion in Schools of Music (HPSM) project has recommended that health education should be included in core curricula, although few such courses have been evaluated to date. The aim of the study was to design, implement and evaluate a compulsory health education course at a UK conservatoire of music. Methods: The course design was informed by a critical appraisal of the literature on musicians' health problems and their management, existing health education courses for musicians, and the HPSM recommendations. It was delivered by a team of appropriately-qualified tutors over 5 months to 104 first-year undergraduate students, and evaluated by means of questionnaires at the beginning and end of the course. Thirty-three students who had been in their first year the year before the course was introduced served as a control group, completing the questionnaire on one occasion only. Items concerned: hearing and use of hearing protection; primary outcomes including perceived knowledge and importance of the topics taught on the course; and secondary outcomes including physical and psychological health and health-promoting behaviors. The content of the essays written by the first-year students as part of their course assessment served as a guide to the topics they found most interesting and relevant. Results: Comparatively few respondents reported using hearing protection when practicing alone, although there was some evidence of hearing loss, tinnitus, and hyperacusis. Perceived knowledge of the topics on the course, and awareness of the risks to health associated with performing music, increased, as did self-efficacy; otherwise, there were negative effects on secondary outcomes, and few differences between the intervention and control groups. The topics most frequently covered in students' essays were managing music performance anxiety, and life skills and behavior change techniques. Conclusion: There is considerable scope for improving music students' physical and psychological health and health-related behaviors through health education, and persuading senior managers, educators and students themselves that health education can contribute to performance enhancement.

The relationship between frequency of performance and perceived importance of health behaviours

The relationship between performance of health behaviours and their perceived importance was examined among 250 adults. Frequency of performance and perceived importance of 21 health behaviours, self-assessed health and the Big Five personality traits were measured. As expected, importance and performance were positively correlated. Self-assessed health was more strongly associated with performance than importance, and a model wherein importance affects performance, which in turn affects self-assessed health, was superior to a model wherein performance affects importance. The Big Five significantly explained performance, particularly conscientiousness, and importance explained performance beyond this effect. Consequently, importance perceptions should be considered when developing behavioural interventions.

Health and behavioral factors associated with binge drinking among university students in nine ASEAN countries

Background

Heavy drinking among university students has been globally recognized as a major public health burden. In the Association of Southeast Asian Nations (ASEAN) region, studies on this issue have been scant, country-specific and in different time frames. The aim of this study was to identify social and behavioral factors associated with binge drinking among university students in nine ASEAN countries.

Methods

This cross-sectional study was conducted in 2015 among 8809 undergraduate university students from 13 universities in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam using self-administered questionnaire. Multivariate logistic regression analyses were conducted to explore the associated factors.

Results

More than half (62.3%) of the study sample were female with a mean age of 20.5 (SD = 2.0) years. Of total, 12.8% were infrequent (<once per month) and 6.4% frequent (≥ once per month) binge drinkers. After adjustment, among males, higher binge drinking remained significantly associated with being in older age groups, living with parents or guardians, lower level of non-organized religious activity, lack of knowledge on alcohol-heart disease relationship, weak beliefs in the importance of limiting alcohol use, poor subjective health status, lower level of life satisfaction, tobacco and illicit drug use, depressive symptoms and high level physical activity. Among females, higher prevalence of binge drinking remained significantly associated with being in the older age groups, poorer family background, living in an upper-middle- or high-income country, lower level of non-organized religious activity, lack of knowledge on alcohol-heart disease relationship, lack of knowledge on alcohol-high blood pressure relationship, weak beliefs in the importance of limiting alcohol use, lower level of life satisfaction, use of other substances such as tobacco and illicit drug, depressive symptoms and high level of physical activity.

Conclusions

Findings from this study indicate a need for devising or refining university health promotion programs that integrate binge drinking, other substance use, co-occurring addictive behaviors and health beliefs in the respective countries.

Sleep Duration, Sleep Quality, Body Mass Index, and Waist Circumference among Young Adults from 24 Low- and Middle-Income and Two High-Income Countries

Obesity and its comorbidities have emerged as a leading public health concern. The aim of this study was to explore the relationship between body mass index (BMI), waist circumference (WC) and sleep patterns, including duration and disturbances. A cross-sectional questionnaire survey and anthropometric measurements were conducted with undergraduate university students that were randomly recruited in 26 universities in 24 low- and middle-income and two high-income countries. The sample included 18,211 (42.1% male and 57.9% female, mean age 21.0 in male and 20.7 years in female students) undergraduate university students. The overall BMI was a mean of 22.5 kg/m² for men and 22.0 kg/m² for women, and the mean WC was 78.4 cm for men and 73.8 cm for women. More than 39% of the students reported short sleep duration (≤6 h/day) and over 30% reported moderate to extreme sleep problems. In a linear multivariable regression, adjusted for sociodemographic and lifestyle factors, short sleep duration was positively associated with BMI in both men and women, and was positively associated with WC among women but not among men. Sleep quality or problems among men were not associated with BMI, while among women mild sleep problems were inversely associated with BMI, and poor sleep quality or problems were positively associated with WC both among men and women. The study confirmed an association between short sleep duration and increased BMI and, among women, increased WC, and an association between poor sleep quality and increased WC but not BMI. Further, differences in the association between sleep characteristics and BMI and WC were found by region and country income.

Prevalence and associated factors of illicit drug use among university students in the association of southeast Asian nations (ASEAN)

BACKGROUND

Illicit drug use among university students has been recognized as a global public health issue in recent years. It may lead to poor academic performance that in turn leads to poor productivity in their later life. This study explores prevalence of and factors associated with illicit drug use among university students in the Association of Southeast Asian Nations (ASEAN).

METHODS

This multi-country cross-sectional study was conducted in 2015 in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam. A multi-stage cluster sampling was used to select undergraduate students from one or two universities in each country for self-administered questionnaire survey. Multivariate logistic regression analyses was performed to explore risk factors related to illicit drug use.

RESULTS

Participants included 7,923 students with a mean age of 20.6 years (SD = 2.8), ranging from 18-30 years. The overall prevalence of frequent (≥10 times), infrequent (1-9 times) and ever (at least once) illicit drug use in the past 12 months was 2.2, 14.7, and 16.9%, respectively. After adjustment, male students were significantly less likely to be infrequent (1-9 times vs. never), but significantly more likely to be ever users compared to females. Compared to those living with parents/guardians, students living away from parents/guardians were significantly less likely to be frequent (≥10 times vs. never) and infrequent users. Students from lower-middle-income countries were significantly more likely to be frequent and infrequent users, but significantly less likely to be ever users compared to those from upper-middle or high-income countries. Students with poor subjective health status were significantly more likely to be frequent users compared to those who reported good subjective health status. Students who reported binge drinking in the past month were significantly more likely to be infrequent users, but significantly less likely to be ever users.

CONCLUSIONS

Our findings indicate that prevalence of illicit drug use among university students in the ASEAN region varied by country. Concerted social intervention programs should be designed to address related health and behavioral problems such as illicit drug use and alcohol drinking with particular emphasis on at-risk subgroups of this young population.

Are University Students in Singapore Meeting the International and National Recommended Daily Servings of Fruits and Vegetables?

Data are lacking on fruit and vegetable (FV) consumption among young adults in the Asia-Pacific region. The aim of this study is to assess the prevalence of students who met the international and national recommendation of daily consumption of 5 and 4 FV servings, respectively, in a university in Singapore and the factors associated with meeting the national recommendation. A cross-sectional survey using proportional stratified random sampling was conducted on 884 undergraduates in 2013. The prevalence of meeting the international and national recommendation was 13.6% and 27.1%, respectively. The significant factors of meeting national recommendation were those from higher socioeconomic status, those making conscious effort to eat food high in fiber, those not skipping breakfast, those having a lower frequency of deep fried food consumption and those with higher meal frequency. Behavioral and structural interventions to educate, motivate and nudge university students to promote FV consumption are required in Singapore.

Dental health status and oral health behavior among university students from five ASEAN countries

The aim of this study was to investigate dental health status and oral health behavior and associated factors among university students in five ASEAN countries (Indonesia, Malaysia, Myanmar, Thailand and Vietnam). Using anonymous questionnaires, data were collected from 3,344 undergraduate university students (mean age 20.5, SD=1.6; 58.3% female) from five ASEAN countries. Results indicate that 27.7% of students reported to have sometimes, most of the time or always having tooth ache in the past 12 months, 39.4% reported to have one or more cavities, 20.3% did not brush their teeth twice or more times a day, and 30.9% had never been to a dentist (or did not know it). In multivariate logistic regression analysis, older age, living in a lower middle income country, consumption of chocolate or candy, having made a dental care visit, and poor mental health was associated with tooth ache in the past 12 months. Being male, being 20 to 21 years old, coming from a wealthier family background, living in a lower middle income country, frequent consumption of soft drinks, not having consulted with a dentist in the past 12 months and weak beliefs in the benefits of tooth brushing were associated with inadequate tooth brushing frequency ( Collapse

Key Words

• ASEAN
• dental health status
• health risk behavior
• oral health behavior
• university students

Collapse

MESH Headings

• Adolescent
• Adult
• Female
• Health Status
• Humans
• Logistic Models
• Male
• Mental Health
• Multivariate Analysis
• Oral Health
• Risk Factors
• Socioeconomic Factors
• Stress Disorders, Post-Traumatic/epidemiology
• Students/statistics & numerical data
• Surveys and Questionnaires
• Universities
• Young Adult

Collapse

Grants Collapse

Affiliation(s)

Karl Peltzer Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
Supa Pengpid ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand Department of Research Development and Innovation, University of Limpopo, Polokwane, South Africa

Collapse

Religiosity and Health Risk Behaviour Among University Students in 26 Low, Middle and High Income Countries

The aim of this study was to assess religiosity and health risk behaviours among university students from 26 low, middle and high income countries. Using anonymous questionnaires, data were collected from 20,222 undergraduate university students (mean age 20.8, SD = 2. 8) from 27 universities in 26 countries across Asia, Africa and the Americas. Among all students, 41.1 % engaged at least once a week in organized religious activity, 35.8 % practised a non-organized religious activity daily or more than once daily, and more or less two-thirds of the students agreed to the three different statements on intrinsic of subjective religiosity. In multivariate logistic regression analysis, higher reported involvement in organized religious activity was associated with addictive, injury, sexual and oral health risk behaviour, while lower reported involvement in organized religious activity was associated with physical inactivity and oral health risk behaviour. Lower reported involvement in non-organized religious activity was associated with addictive, nutrition risk, injury, sexual and oral health risk behaviour, while higher reported involvement in non-organized religious activity was associated with physical inactivity. Finally, lower reported intrinsic religiosity was associated with addictive and sexual risk behaviour, while higher reported intrinsic religiosity was associated with nutrition risk behaviour, physical inactivity and oral health risk behaviour.

Eating behaviour of university students in Germany: Dietary intake, barriers to healthy eating and changes in eating behaviour since the time of matriculation

A healthy diet plays a key role in preventing obesity and non-communicable diseases such as type 2 diabetes. This is true for all age groups, including young adults. While unhealthy eating habits among young adults, in particular university students, have been identified in former studies, this group has been neglected in existing health promotion strategies. Our aim was to explore baseline dietary intake, common barriers to healthy eating, and changes in eating behaviour among university students since the time of matriculation. We used data from the quantitative part of the Nutrition and Physical Activity Study (NuPhA), a cross-sectional online survey (data collection: 2014/10/31-2015/01/15). Students were recruited from all over Germany. Overall, 689 university students (30.5% male; mean age: 22.69) from more than 40 universities across Germany participated. We found that there is room for improvement with regard to the consumption of specific food groups, for example, fruits and vegetables. The main barriers to healthy eating were lack of time due to studies, lack of healthy meals at the university canteen, and high prices of healthy foods. Cluster analysis revealed that barriers to healthy eating might affect only specific subgroups, for instance freshmen. Changes in eating behaviour since matriculation were found in the consumption of meat, fish, and regular meals. Future qualitative studies may help to explore why university students change their eating behaviour since the time of matriculation. Such knowledge is necessary to inform health promotion strategies in the university setting.

Testicular Cancer Awareness and Screening Practices: A Systematic Review

PURPOSE/OBJECTIVES

To critically appraise empirical evidence gathered from studies that (a) explored men's knowledge, awareness, and attitudes toward testicular cancer (TC) and its screening; (b) addressed their testicular self-examination (TSE) practice; and/or (c) highlighted barriers and facilitators to this practice.
.

DATA SOURCES

MEDLINE®, CINAHL®, and EMBASE®.
.

DATA SYNTHESIS

25 articles met the inclusion criteria. Knowledge deficits regarding TC and its screening were seen. Participants who did not perform TSE often were uninformed about this practice. The majority of men perceived TC education as a positive step toward raising awareness about this malignancy.
.

CONCLUSIONS

Very few men were informed about TC and TSE. Future studies should include valid and reliable tools to assess TC knowledge and screening, address the means through which TC knowledge is delivered, explore the individual's experience with TC screening, and focus on TC awareness and screening among minority groups. 
.

IMPLICATIONS FOR NURSING

Although regular screening for TC is a controversial issue, nurses should encourage young men to seek medical attention in the event of discovering scrotal abnormalities.

Consumer attitude and purchase intention towards processed meat products with natural compounds and a reduced level of nitrite

This study investigates consumer attitude and purchase intention towards processed meat products with added natural compounds and a reduced level of nitrite. The rationale for such innovation relates to nitrite's negative health image as a chemical additive among consumers, versus the perception of compounds from fruits and vegetables as being natural and healthy. Cross-sectional data were collected through online questionnaires on knowledge about, interest in, attitude and intentions towards such new type of processed meat products in Belgium, The Netherlands, Italy and Germany (n=2057). Consumers generally had limited knowledge about nitrite being added to meat products. Yet, they expressed favourable attitudes and purchase intentions towards the new processed meat products. Purchase intention associated positively with: attitude; preference for natural over chemical additives; perceived harmfulness of chemical additives; risk importance; domain specific innovativeness; awareness of nitrite added; education; general health interest; and processed meat consumption frequency. Consumers from Italy and Germany had a lower level of purchase intention compared to Belgium. Four consumer segments were identified based on attitude and purchase intention: 'enthusiasts' (39.3% of the sample), 'accepters' (11.9%), 'half-hearted' (42.3%) and 'uninterested' (6.6%). This study provides valuable insight for further product development and effective tailoring of marketing communication strategies of innovative processed meat products.

Heavy Drinking and Social and Health Factors in University Students from 24 Low, Middle Income and Emerging Economy Countries

The aim of this study was to investigate heavy drinking and social and health correlates in university students in low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected in a cross-sectional survey of 17,590 undergraduate university students (mean age 20.8, SD 2.9) from 25 universities in 24 countries across Asia, Africa and the Americas. Overall, 71.6 % were non-drinkers, 17.1 % moderate and 11.3 % heavy alcohol drinkers (14.2 % in men and 9.2 % in women) in the past 2 weeks. In a multivariate logistic regression analysis, older age, poorer family background, living in a higher income country, weak beliefs in the importance of limiting alcohol use, higher country per capita alcohol consumption, other substance use (tobacco and illicit drug use), and poor life satisfaction was associated with heavy drinking. Addressing health beliefs and co-occurring addictive behaviors may be crucial in the prevention of heavy drinking in this population.

Traumatic experiences, posttraumatic stress symptoms, depression, and health-risk behavior in relation to injury among University of Nairobi students in Kenya

OBJECTIVE

To describe the prevalence and types of injuries in relation to traumatic experiences, posttraumatic stress symptoms, depression, and health-risk behaviors among university students in Kenya.

METHOD

A cross-sectional study collected data on a random sample of university students using a questionnaire to record sociodemographic variables while injuries experiences recorded using the Centers for Disease control criteria and Breslau's seven-item screener was used to identify post-traumatic stress disorder (PTSD) symptoms. Depressive symptoms were measured using Center for Epidemiological Studies Short Depression Scale.

RESULTS

Nine hundred and twenty-three students (525 male and 365 female) were included in the study, mean age 23 years (SD 4.0). Serious injury in the previous 12 months was reported by 29.00% of the students. PTSD was present in 15.67% (men 15.39% and women 16.1%). Out of the total, 41.33% of the students had depressive symptoms (35.71% mild-moderate symptoms and 5.62% severe). In the multivariable logistic regression being poor, binge drinking, tobacco use, ever been diagnosed with HIV, physically abused as a child, high PTSD score, and depression (adjusted odds ratio 5.49, 95% confidence interval 4.32-13.21) were significantly (p value<5%) associated with injury in the last 12 months.

CONCLUSION

Unintentional injuries and PTSD symptoms are common in this student population and are positively linked to depression and other risky behaviors. Measures aimed at improving the mental health, such as early identification and treatment of depression, may be useful in reducing the prevalence of such injuries among the youth.

Low knowledge of physical health behaviours is associated with poor diet and chronic illness in adults

Governments invest heavily in health promotion strategies to improve physical health behaviours. However, the dietary and physical activity practices of many Australians fail to meet minimum levels for health, leading to the unacceptably high prevalence of chronic and complex illness. Health literacy is known to impact on health behaviour, and to be related to health knowledge; however, no studies have specifically examined knowledge of physical health behaviours in an Australian context. We assessed knowledge of physical health behaviours in 1244 adults in Queensland, Australia. Almost two-thirds of respondents had a ‘Good’ knowledge of physical health behaviour. People with ‘Good’ knowledge of physical health behaviours were more likely to be female, educated beyond secondary school, be employed and have an annual household income of >$52000 (P<0.05). People with ‘Low’ knowledge of physical health behaviours were significantly more likely to report insufficient intake of vegetables and have at least one chronic illness (P<0.05). Binary logistic regression shows low daily intake of vegetables to have the strongest association with low knowledge of physical health behaviours. Given the association between health knowledge and health literacy, assessment of the knowledge of physical health behaviours may provide considerable insight into the effectiveness of future health promotion interventions.

The globalization of whitening: prevalence of skin lighteners (or bleachers) use and its social correlates among university students in 26 countries

BACKGROUND

The aim of this study was to investigate the use of skin lighteners and its social correlates in university students from 26 low, middle income, and emerging economy countries.

METHODS

Using anonymous questionnaires, data were collected from 19,624 undergraduate university students (mean age 20.8, SD 2.8) from 27 universities in 26 countries across Asia, Africa, and the Americas. Multivariate logistic regression analysis was used to identify associations between sociodemographic, social, health risk, mental health and abuse, and the use of skin lighteners.

RESULTS

Overall, the prevalence of previous 12-month skin lightener use was 24.5, and 16.7% in male and 30.0% in female students. The use of skin lighteners varied by country, ranging from 0% in Turkey to 83.8% in Thailand. In multivariate logistic regression analysis among both men and women, social variables (highly-organized religious activity and lack of personal mastery) and health variables (inconsistent condom use) were associated with skin lightening use. In addition, male students from a lower income country, having a lack of social support, and a history of childhood sexual abuse were more likely to use skin lighteners, and women aged 20-21 years old, residing on the university campus, being a student of health and welfare, and having a lack of personal control, inadequate physical activity, and depressive symptoms were more likely users of skin-lightening products.

CONCLUSION

A high prevalence of skin lightener use was found in this large sample of university students, and social and health-related risk factors were identified.

Oral soft tissue infections: causes, therapeutic approaches and microbiological spectrum with focus on antibiotic treatment

INTRODUCTION

Intraoral soft tissue infections (OSTI) are a common problem in dentistry and oral surgery. These abscesses are mostly exacerbated dental infections (OIDC), and some emerge as postoperative infections (POI) after tooth extraction (OITR) or apicoectomy (OIRR). The main aim of this study was to compare OIDC with POI, especially looking at the bacteria involved. An additional question was, therefore, if different antibiotic treatments should be used with OSTI of differing aetiologies. The impact of third molars on OSTI was evaluated and also the rates of POI after removal of third molars were specified.

MATERIAL AND METHODS

Patient data was collected from the patients' medical records and the results were statistically evaluated with SPSS (SPSS version 21.0; SPSS, IBM; Chicago, IL, USA). The inclusion criterion was the outpatient treatment of a patient with an exacerbated oral infection; the exclusion criteria were an early stage of infiltration without abscess formation; and a need for inpatient treatment.

RESULTS

Periapical exacerbated infections, especially in the molar region were the commonest cause of OIDC. In the OITR group, mandibular tooth removal was the commonest factor (p=0.016). Remarkably, retained lower wisdom teeth led to significant number of cases in the OITR group (p=0.022).

CONCLUSIONS

In our study we could not define differences between the causal bacteria found in patients with OIDC and POI. Due to resistance rates we conclude that amoxicillin combined with clavulanic acid seems to be the antibiotic standard for exacerbated intraoral infections independent of their aetiology.

Knowledge, attitude and practice of breast self-examination among female university students from 24 low, middle income and emerging economy countries

The aim of this study was to investigate the knowledge, attitude and practice of Breast Self-Examination (BSE) among female university students from 24 low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected from 10,810 female undergraduate university students aged 16- 30 (mean age 20.7, SD=2.9) from 25 universities in 24 countries across Asia, Africa and the Americas. Overall, 50.4% of the female students indicated that they knew how to conduct BSE. Among all women, 59.3% had never practiced BSE in the past 12 months, 21.3% 1-2 times, 10.3% 3-10 times, and 9.1% monthly. The proportion of monthly BSE was above 20% in Nigeria and Laos and below 2% in Bangladesh, India, Singapore, Russia, and South Africa. Logistic regression found that BSE importance or positive attitude was highly associated with BSE practice. BSE practices were found to be inadequate and efforts should be made to develop programmes that can increase knowledge related to breast cancer as well as the practice of breast self-examination.

Quantifying consumer portion control practices. A cross-sectional study

The use of portion control practices has rarely been quantified. The present study aimed to: (1) explore which portion control practices are actually used by the general population and their association with cognitive restraint, demographic background and general health interest (GHI), and (2) examine how the usage of portion control practices predicts the estimated consumption of an energy dense food (i.e. pizza). Twenty-two portion control practices were rated in terms of their frequency of use from 'never' to 'very often' by a representative sample of 1012 consumers from the island of Ireland. Three factors were extracted and named: measurement-strategy scale, eating-strategy scale, and purchasing-strategy scale. The eating-strategy scale score was the highest, while the measurement-strategy scale carried the lowest frequency score. For each strategy scale score, the strongest predictor was GHI, followed by gender. Having higher GHI and being female were independently associated with more frequent portion control. Both the eating-strategy scale score and the purchasing-strategy scale score were negatively associated with pizza portion size consumption estimates. In conclusion, while this study demonstrates that the reported use of portion control practices is low, the findings provide preliminary evidence for their validity. Further studies are needed to explore how portion control practices are used in different kinds of portion size decisions and what their contribution is to the intake of food over an extended period of time.

Factors Associated with Unintentional Injury among University Students in 26 Countries

OBJECTIVE

The aim of this study was to determine estimates of the incidence and social correlates of nonfatal injury among university students in 26 low-, middle-, and high-income countries.

DESIGN AND SAMPLE

Using anonymous questionnaires, data were collected in a cross-sectional survey of 19,111 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa, and the Americas.

MEASURES

Questionnaire on health risk behaviors, psychological distress, personality, social variables, and injury requiring medical treatment or missing at least one day of usual activities.

RESULTS

The percentage of university students reporting one or more serious injuries within the past 12 months was 25.2% for all countries, in men 28.8% and women 21.1%. In multivariate logistic regression among men, socio-demographic variables, health risk behaviors, posttraumatic stress (PTSD) symptoms, lack of personal control and lack of social support, and among women, residing on campus, health risk behaviors, PTSD symptoms, lack of personal control, and lack of social support were associated with injury incidence.

CONCLUSIONS

Several risk factors were identified which will increase the understanding of public health nurses of injuries in university communities to design programs for injury prevention programs specifically targeting university students, staff, and university health center professionals.