Cognitive predictors of health behaviour in contrasting regions of Europe

Developing and validating the Sexual Health Literacy Scale in an Iranian adult sample

The literature has shown that sexual health literacy has limited applicability in many developing countries. The present study, therefore, aimed to develop and examine the validity and reliability of the Sexual Health Literacy Scale (SHLS) among a sample of 595 Iranian university students. The first analysis yielded themes obtained from a qualitative content analysis of the 118-item SHLS scale. Concepts were extracted using the method of latent content analysis (Bengtsson, NursingPlus Open 2:8-16, 2016). 327 initial codes were extracted and main categories (Elo and Kyngäs, J Adv Nurs. 62 (1): 107-115, 2007) or themes (Graneheim and Lundman, Nurse Education Today 24: 105-112, 2004) obtained consisting of the information source, individual barriers, understanding and application, capacity and motivation, damage, skills, sexual rights, and socio-cultural barriers. In the second analysis, the 595 students were randomly split into two groups. An exploratory factor analysis was conducted on the themes derived and quantified in Phase 1. 6 Factors were obtained and found to be consistent in both groups. Criterion-related validity of sexual health literacy was determined by stepwise multiple regression to predict marital satisfaction. The reliability of SHLS was also investigated. The third analysis examined the fit of the 6 factors obtained from the 595 students in the original sample to a new sample of 221 university students using cross-validation via confirmatory factor analysis. We developed and validated a six-factor structure of the Sexual Health Literacy Scale 106 (SHLS-106): factor 1, Sexual Skills; factor 2, Individual Socio-cultural Barriers; factor 3, Sexual Vulnerability; factor 4, Resources to Access Sexual Information; factor 5, Understanding and Application; factor 6, Capacity and Motivation. SHLS-106 shows good test-retest reliability and criterion, incremental and convergent validities. This is the first study to examine the validity and reliability of the Sexual Health Literacy Scale in an Iranian sample. Considering the acceptable validity and reliability of this instrument, the psychometric properties of SHLS-106 need to be further investigated in diverse, more extended samples to clarify the extent of application of this scale in different settings. SHLS-106 can effectively examine sexual health literacy, a dynamic scale in nature influenced by the individual, healthcare system, contextual, and social factors in different cultures.

Understanding Health Attitudes and Behavior

Individual attitudes and behavior related to health and disease are major components of clinical encounters. These factors shape lifestyle, presentation of symptoms, access to patient care, interactions between patients and physicians, adherence to medical advice, and response to treatment. Health attitudes and behavior may range from anxiety and worry about illness to various forms of denial, such as delay of seeking care and lack of adherence to treatment. When attitudes result in health-damaging behavior, they may be particularly difficult to understand and become a source of frustration to both physicians and patients. Devising appropriate responses by health care providers may contribute to improving final outcomes and decrease health care costs. In particular, health behavior is likely to play a major role in the process of convalescence, in self-management of chronic conditions, in determining a state of recovery, and whenever a rehabilitation process is involved. Understanding the spectrum of health attitudes and behavior is also crucial for motivating people to make beneficial changes (lifestyle medicine), as well as for implementing safety procedures in the community.

Prevalence and correlates of multiple behavioural risk factors of non-communicable diseases among university students from 24 countries

BACKGROUND

Globally non-communicable diseases (NCDs) are on the increase. The goal of the study was to estimate the prevalence and correlates of multiple behavioural risk factors of NCDs among university students from 24 countries.

METHODS

In a cross-sectional study, the sample included 18 017 university students from countries in Africa, the Americas and Asia.

RESULTS

indicate that prevalence of single behavioural NCD risk indicators were 38.2% for physical inactivity, 80.5% for inadequate fruit and vegetables intake, 23.1% for having overweight/obesity, 10.5% for heavy alcohol use and 11.8% for current tobacco use. Students had on average 1.6 (SD = 0.9), and 15.9% had three or more behavioural NCD risk factors. In adjusted linear regression, male sex was positively and stronger beliefs in health benefits were negatively associated with multiple behavioural NCD risk factors.

CONCLUSIONS

A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered. Several behavioural NCD risk factors, such as male sex and low health behaviour benefits beliefs, were found that could be utilized in targeted interventions.

Tobacco use and associated health risk behaviours among university students in 27 countries

Background Evidence of the relationship between tobacco use and multiple health risk behaviours is limited. Objectives The study aimed to investigate the relationship between tobacco use and health risk behaviours in university students across different cultures. Methods In a cross-sectional study the sample included 23,396 university students from 27 countries in Africa, Asia and the Americas. Results Indicate that 5.8 and 5.5% were daily and not daily tobacco users, respectively. In adjusted logistic regression analysis, less than daily and/or daily tobacco use was associated with nutrition and dietary risk behaviour (overweight or obesity, high sodium consumption, rarely or never having breakfast and not avoiding fat and cholesterol), addictive behaviour (binge drinking, drug use, and gambling), sleep risk behaviours (long sleep, poor sleep quality and restless sleep) and other health risk behaviour (having been in a physical fight, inadequate tooth brushing, and multiple sexual partners in the past year). Conclusions Compared to non-tobacco users, less than daily and/or daily tobacco users had significantly higher overweight or obesity, dietary risk behaviour, addictive behaviour, sleep risk behaviours and other health risk behaviour. These associations may be taken into account in health promotion strategies targeting multiple health compromising behaviours.

Exploring the psychometric properties of the CES-D-10 and its practicality in detecting depressive symptomatology in 27 low- and middle-income countries

The Center for Epidemiological Studies Depression-10 (CES-D-10) scale is known for its good psychometric properties in measuring depressive symptoms, however, some researchers question its applicability across various settings. This study explored the factor structure of the CES-D-10 in low- and middle-income countries (LMICs). This cross-sectional survey consisted of 16,723 university students across 27 LMICs that completed self-report instruments assessing socio-demographic information and depressive symptoms using the CES-D-10. Data analysis included: exploratory factor analysis, item response theory and differential item functioning. Results indicate that a two-factor model (depressive affect and positive affect) had the best fit for this population and accounted for 52% of the total observed variance with an internal consistency, α = .77 for the depressive affect items and α = .57 for the positive affect items. The graded response model (GRM), however, indicated that the depressive affect factor had a good fit, unlike the positive affect factor. The depressive affect factor was found to consistently model depression for females better than males. Relative to their Asian counterparts, African, Caribbean and South American participants of similar depressive affect responded differently on all items of the depressive affect factor. The depressive affect factor seems most ideal for LMICs and shows gender and cross-cultural variability.

Health Behaviors among Male and Female University Students in Cambodia: A Cross-Sectional Survey

Students go through a transition when they enter university, which involves major individual and contextual changes in every domain of life that may lead to several behavioral and health problems. This study examined a wide range of health behaviors and practices among 1,359 male and female students recruited from two public universities in Cambodia using a multistage cluster sampling method. Health-related information in different domains were collected using a structured questionnaire. We compared the variables in male and female students. Of the total, 50.8% were male and the mean age was 21.3 (SD = 2.3) years. The majority (79.5%) reported not having any vigorous-intensity activities, 25.9% not having moderate-intensity activities, and 33.5% not having walked continuously for 10 min over the last week. More than one-third (38.3%) reported drinking alcohol, 1.1% smoking tobacco, and 0.4% using an illicit drug in the past 12 months. About one in ten (10.6%) reported having sexual intercourse; of whom, 42.4% reported not using a condom in the last intercourse, and the mean number of sexual partners was 2.1 (SD = 2.4) in the past 12 months. Only 7.1% reported having been diagnosed with a sexually transmitted infection (STI) in the past 12 months; of whom, 60% sought for treatment for the most recent STI. About one-third (33.6%) reported eating fast food at least once over the last week. More than half (55.6%) had one to two servings of fruits or vegetables daily, and 9.9% did not eat any fruits or vegetables over the last week. Gender differences were observed in physical activities, dietary intakes, cigarette smoking, alcohol drinking, and sexual behaviors. Findings from this study indicate that public health and education policies should promote healthy behaviors among university students. The interventions may take advantage of and expand upon the positive health behaviors and consider gender differences.

Fruit and Vegetable Consumption is Protective from Short Sleep and Poor Sleep Quality Among University Students from 28 Countries

INTRODUCTION

The aim of the study was to investigate the association between fruit and vegetable (FV) consumption and sleep duration and sleep quality in university students.

METHODS

Using a cross-sectional study design, 21,027 university students with a median age of 20 years from 28 countries replied to self-reported measures of FV consumption and sleep duration and quality.

RESULTS

The prevalence of short and long sleep was 38.9% and 12.8%, respectively, and the prevalence of poor sleep quality was 9.6% and restless sleep 19.7%. There was a linear decrease in the prevalence of short sleep with increasing FV consumption beyond ≥2 FV servings/day (vs 0-1 FV servings/day). Consuming 2 FV servings/day (vs 0-1 FV servings/day) was associated with a 21% decreased (ARRR: 0.79, 95% CI: 0.70-0.80) and 7 or more FV servings/day with a 33% decreased odds (ARRR: 0.67, 95% CI: 0.55-0.81) for short sleep. Consuming 5 FV servings/day (vs 0-1 FV servings/day) was associated with a 34% decreased (ARRR: 0.79, 95% CI: 0.51-0.84) and 7 or more FV servings/day with a 34% decreased odds (ARRR: 0.66, 95% CI: 0.50-0.88) for long sleep. In the final adjusted logistic regression model, consuming 3 FV servings/day (vs 0-1 FV servings/day) was associated with a 49% decreased (AOR: 0.51, 95% CI: 0.42-0.0.62) and 7 or more FV servings/day with a 30% decreased odds (AOR: 0.70, 95% CI: 0.53-0.93) for poor sleep quality. Consuming 5 FV servings/day (vs 0-1 FV servings/day) was associated with a 34% decreased odds (AOR: 0.66, 95% CI: 0.54-0.81) for restless sleep.

CONCLUSION

The study extended previous findings of an association between inadequate FV consumption and short sleep and an inverse association between FV consumption and poor sleep quality and restless sleep.

Risk of disordered eating attitudes and its relation to mental health among university students in ASEAN

PURPOSE

Since there is a lack of information on eating disorders attitudes in Association of Southeast Asian Nations (ASEAN), the aim of this study was to explore the prevalence of eating disorder attitude and its relation to mental distress among university student populations in Indonesia, Malaysia, Myanmar, Thailand and Vietnam.

METHODS

A cross-sectional questionnaire survey and anthropometric measurement were conducted with undergraduate university students that were randomly recruited. The Eating Attitudes Test (EAT-26) was utilized to determine the prevalence of disordered eating attitudes. The sample included 3148 university students, with a mean age of 20.5 years, SD = 1.6.

RESULTS

Using the EAT-26, 11.5% of the students across all countries were classified as being at risk for an eating disorder, ranging from below 10% in Indonesia, Thailand and Vietnam to 13.8% in Malaysia and 20.6% in Myanmar. In multivariable logistic regression analysis, sociodemographic factors (wealthier subjective economic status, and living in a lower middle income country), underweight and overweight body weight perception, psychological factors (depression symptoms and pathological internet use), and being obese were associated with eating disorder risk.

CONCLUSIONS

Relatively high rates of eating disorder risk were found. This result calls for increased awareness, understanding of eating disorders and related risk factors and interventions in university students in ASEAN.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Prevalence, risk awareness and health beliefs of behavioural risk factors for cardiovascular disease among university students in nine ASEAN countries

Background

Understanding behavioural risk factors of cardiovascular disease (CVD) is of great importance for CVD prevention and control. The aim of the study was to investigate the prevalence, risk awareness and health beliefs of behavioural risk factors of cardiovascular disease among university students in Association of Southeast Asian Nations (ASEAN) member states.

Methods

In a cross-sectional survey 8806 (37.5% male and 62.5% female) university students (Mean age 20.6, SD = 2.0) from nine ASEAN countries responded to an anonymous questionnaire.

Results

Results indicate that across all nine countries, among men and women, 27.5% and 16.9%, respectively, were overweight or obese, 39.0% and 53.0% engaged in low physical activity, 6.9% and 2.5% were current tobacco users, 10.1% and 4.2% had engaged in binge drinking in the past month and 62.7% and 58.2%, respectively, did not avoid eating fat and cholesterol. After adjusting for socio-demographic factors, health status and health benefits, poor risk awareness was associated with tobacco use and binge drinking, and after adjusting for socio-demographic factors, health status and risk awareness, poorer health benefits beliefs predicted overweight, low physical activity, tobacco use, binge drinking and non-avoidance of fat and cholesterol.

Conclusion

The study found a high prevalence of behavioural risk factors of CVD. Results may inform health promotion strategies among university students in ASEAN.

Vigorous physical activity, perceived stress, sleep and mental health among university students from 23 low- and middle-income countries

Background Vigorous physical activity (VPA) may be beneficial for mental health. The aim of the study was to investigate cross-sectional associations between VPA, perceived stress, sleep quality and quantity and mental health among university students. Methods In a cross-sectional study, using anonymous questionnaires, data was collected from 15122 (42.1% male and 57.9% female) university students [mean age 20.6, standard deviation (SD) = 2.0] from 23 countries in the Americas, Africa and Asia. They were assessed using the International Physical Activity Questionnaire (short version), and measures of sociodemographic, health status, health behaviour and anthropometrics. Results Students who met VPA recommendations were less likely to report perceived stress, more likely to report subjective good health and depression than students without VPA. There was no association between VPA and sleep quality and quantity and PTSD symptoms. Conclusion This study only found partial benefits of VPA in relation to well-being of university students.

"Safe Foods" or "Fear Foods": the implications of food avoidance in college students from low- and middle-income countries

PURPOSE

The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge.

METHODS

This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants' diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms.

RESULTS

Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided.

CONCLUSION

Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

Current Psychosomatic Practice

Psychosomatic research has advanced over the past decades in dealing with complex biopsychosocial phenomena and may provide new effective modalities of patient care. Among psychosocial variables affecting individual vulnerability, course, and outcome of any medical disease, the role of chronic stress (allostatic load/overload) has emerged as a crucial factor. Assessment strategies include the Diagnostic Criteria for Psychosomatic Research. They are presented here in an updated version based on insights derived from studies carried out so far and encompass allostatic overload, type A behavior, alexithymia, the spectrum of maladaptive illness behavior, demoralization, irritable mood, and somatic symptoms secondary to a psychiatric disorder. Macroanalysis is a helpful tool for identifying the relationships between biological and psychosocial variables and the individual targets for medical intervention. The personalized and holistic approach to the patient includes integration of medical and psychological therapies in all phases of illness. In this respect, the development of a new psychotherapeutic modality, Well-Being Therapy, seems to be promising. The growth of subspecialties, such as psychooncology and psychodermatology, drives towards the multidisciplinary organization of health care to overcome artificial boundaries. There have been major transformations in health care needs in the past decades. From psychosomatic medicine, a land of innovative hypotheses and trends, many indications for changes in the current practice of medicine are now at hand. The aim of this critical review is to outline current and potential clinical applications of psychosomatic methods.

Risk of eating disorders among university students in Bangladesh

OBJECTIVE

As there is a lack of information on eating disorders in Bangladesh, the aim of this study was to explore the eating disorder attitudes and behaviors among undergraduate university students in the country.

MATERIALS AND METHODS

A cross-sectional questionnaire survey and anthropometric measurement were conducted with undergraduate students who were recruited randomly from classes. The Eating Attitudes Test (EAT-26) was used to determine the prevalence of disordered eating attitudes. The sample included 800 university students (56.6% men and 43.4% women), with a mean age of 21.0 years (SD=32.5).

RESULTS

Using the EAT-26, 37.6% of the students were classified as being at risk for an eating disorder. In multivariate analysis, being a late adolescent (17-19 years), high religious involvement, overweight body perception, low body appreciation, having had cosmetic surgery, and current binge drinking were found to be associated with an eating disorder risk.

DISCUSSION

Very high rates of eating disorder risk were found. This result calls for increased awareness and understanding of eating disorders, and related risk factors and interventions in university students in Bangladesh.

Contraceptive non-use and associated factors among university students in 22 countries

BACKGROUND

The aim of this study was to investigate contraceptive non-use and associated factors (socio-demographics, sexual behaviour, internal assets and mental health) among undergraduate university students in 22 countries.

METHODS

Using anonymous questionnaires, data was collected from 16979 undergraduate university students (mean age 20.8, SD=2.8) from 23 universities in 22 countries.

RESULTS

Of the total sample of 16979 undergraduate university students, 7032 (41.9%) reported to have been sexually active in the past 12 months. Of those who had been sexually active, 42.6% reported never (42.7% among male and 42.6% among female students) using contraceptives in the past 12 months. In multivariate regression analysis, among both men and women, younger age, religious affiliation (Hindu; and among women only being Muslim), intrinsic religiosity, and sexually protective behaviour were associated with contraceptive non-use. Lack of internal assets (among men, low life satisfaction and lack of personal control, and among women low personal mastery) ; among women not having depressive symptoms and among men having PTSD symptoms were associated with contraceptive non-use.

CONCLUSION

Low contraceptive use was found and several factors identified as associated with contraceptive non-use may help guide intervention efforts.

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.

Oral health behaviour and social and health factors in university students from 26 low, middle and high income countries

Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (<twice daily). Further, being a male, older age, coming from a not well off or poor family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, PTSD symptoms, illicit drug use, low physical activity, and low daily snacks frequency, skipping breakfast and inadequate fruit and vegetables consumption were associated with less than one annual dental care visit. Oral health behaviour among the students was found to be low. Various risk factors identified can be used to guide interventions to improve oral health behaviour among university students.

Heavy Internet use and its associations with health risk and health-promoting behaviours among Thai university students

The Internet provides significant benefits for learning about the world, but excessive Internet use can lead to negative outcomes. The aim of this study was to determine the associations between heavy Internet use and health-promoting behaviour, health risk behaviour and health outcomes among university students. The sample included 860 undergraduate university students chosen at random from Mae Fah Luang University in Thailand. Of the participants, 27.3% were male and and 72.7% were female in the age range of 18-25 years (M age=20.1 years, SD=1.3). Overall, students spent on average 5.3 h (SD=2.6) per day on the internet, and 35.3% engaged in heavy internet use (6 or more hours per day). In multivariate logistic regression adjusting for sociodemographics, lack of dental check-ups, three health risk behaviours (sedentary lifestyle, illicit drug use and gambling) and three health outcomes [being underweight, overweight or obese and having screened positive for post-traumatic stress disorder (PTSD)] were found to be associated with heavy Internet use. The results from this study may support the importance of developing early protective and preventive actions against problematic Internet use to promote university student health.

Prevalence of overweight/obesity and its associated factors among university students from 22 countries

Obesity among young people increases lifetime cardiovascular risk. This study assesses the prevalence of overweight/obesity and its associated factors among a random sample of university students from 22 universities in 22 low, middle income and emerging economy countries. This cross-sectional survey comprised of a self-administered questionnaire and collected anthropometric measurements. The study population was 6773 (43.2%) males and 8913 (56.8%) females, aged 16 to 30 years (mean 20.8 years, SD = 2.6). Body mass index (BMI) was used for weight status. Among men, the prevalence of underweight was 10.8%, normal weight 64.4%, overweight 18.9% and obesity 5.8%, while among women, the prevalence of underweight was 17.6%, normal weight 62.1%, overweight 14.1% and obesity 5.2%. Overall, 22% were overweight or obese (24.7% men and 19.3% women). In multivariate regression among men, younger age, coming from a higher income country, consciously avoiding fat and cholesterol, physically inactivity, current tobacco use and childhood physical abuse, and among women older age, coming from a higher income country, frequent organized religious activity, avoiding fat and cholesterol, posttraumatic stress symptoms and physical childhood abuse were associated overweight or obesity. Several gender specific risk factors identified can be utilized in health promotion programmes.

Nocturnal sleep problems among university students from 26 countries

BACKGROUND

The aim of this study is to estimate the prevalence of nocturnal sleeping problems and its associated factors among university students in mainly low- and middle-income countries.

METHODS

A cross-sectional survey was conducted with 20,222 undergraduate university students (mean age, 20.8; SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas.

RESULTS

Overall, 10.4% reported severe or extreme nocturnal sleeping problems (male, 10.2%; female, 10.5%) in the past month. Noctural sleeping problems differed by country, from 32.9% in Indonesia to 3.0 % in Thailand among Asian countries, from 13.7% in Mauritius to 7.5% in South Africa, and from 11.8% in Jamaica to 6.1% in Columbia in the Americas. In multivariate logistic regression analysis, coming from a poor family background, staying off campus (on their own or with parents or guardians), stress (history of child sexual abuse), poor mental health (depression and PTSD symptoms), health risk behaviour (tobacco use, heavy internet use, gambling, skipping breakfast and having sustained an injury), lack of social support and poor academic performance were associated with nocturnal sleeping problems.

CONCLUSIONS

A significant prevalence of past-month nocturnal sleeping problems was found. Potential factors associated with the risk of reporting sleeping complaints were identified, which may assist in prevention strategies to promote a better quality of sleep.

Prevalence of overweight/obesity and central obesity and its associated factors among a sample of university students in India

BACKGROUND

Obesity and the lifestyle characteristic of Indian society lead young people to conditions of potential cardiovascular risk. The purpose of this study was to assess the prevalence of overweight/obesity and central obesity and its associated factors in a sample of Indian university students.

METHODS

In a cross-sectional survey assessed anthropometric measurements and a self-administered questionnaire among a sample of randomly selected university students. The sample included 800 university students from non health (mainly sciences) courses Gitam University in India. The students were 541 (67.6%) males and 259 (32.4%) females in the age range of 17-20 years (M age 18.2 years, SD=1.0).

RESULTS

37.5% were overweight or obese, 26.8% overweight (≥23-27.4 BMI) and 10.7% obese (≥27.5 kg/m(2)), 11.7% underweight (<18.5 kg/m(2)) and 16.4% central obesity (WC ≥90 cm for men and ≥80 cm for women). In multivariate analysis among men lack of non-organised religious activity (odds ratio=OR 0.85, confidence interval=CI 0.77-0.95), lower dietary risk knowledge (OR=0.64, CI=0.41-0.99), tobacco use (OR=2.23, CI=1.14-4.38), and suffering from depression (OR=1.59, CI=1.00-2.47) were associated with overweight/obesity, and younger age (OR=0.32, CI=0.12-0.90), lives away from parents or guardians (OR=1.79, CI=1.04-3.07), healthy dietary practices (OR=1.95, CI=1.02-3.72) and 9 or more hours sleep duration (OR=0.28, CI=0.09-0.96) were associated with central obesity. In bivariate analysis among women, lack of social support, lower dietary risk knowledge, tobacco use, and 9 or more hours sleep duration were associated with overweight/obesity and lives away from parents or guardians and abstinence from alcohol associated with central obesity.

CONCLUSIONS

The study found a high prevalence of overweight/obesity and central obesity. Several gender specific health risk practices were identified including lack of dietary risk knowledge, shorter sleep duration, living away from parents or guardians, tobacco use and lack of social support and religiousness that can be utilised in health promotion programmes.

Prevalence of health risk behaviors and their associated factors among university students in Kyrgyzstan

BACKGROUND

With the advancements in knowledge about health promotion, public health professionals have been seeking determinants of personal health behaviors. The purpose of this study was to assess the prevalence of health risk behaviors and its associated factors in a sample of Kyrgyz university students.

METHODS

In a cross-sectional survey, health risk behaviors among a sample of randomly selected university students were assessed. The sample included 837 university students from health sciences undergraduate courses of the State Medical Academy in Kyrgyzstan. The students were 358 (42.8%) males and 479 (57.2%) females in the age range of 18-29 years (Median age=21.3 years, SD=1.5).

RESULTS

On average, students engaged in 9.4 (SD=2.3) out of 23 health risk behavior practices (range, 3-18). Generally, there was a high rate of insufficient fruit and vegetable intake (86.4%), eating red meat at least once a day (62%), usually adding salt to meals (78.3%), skipping breakfast (50.5%), current tobacco use (49.7%) and two or more sexual partners in the past 12 months (46.1%) among men, and never using a condom with a primary partner in the past 3 months (90.9%) among women. Furthermore, 60.8% of the women were physically inactive. In bivariate analysis among men, the lack of perceived benefits was associated with health risk behavior. In multivariate analysis among women, poorer family background, being Russian, high personal constraints or stress, and better subjective health were associated with the health risk behavior index.

CONCLUSIONS

Students had a high proportion of health risk behavior practices. Several high health risk practices were identified, including poor dietary behavior, physical inactivity, sexual risk behavior, and tobacco use. Gender specific predictors identified included sociodemographic characteristics and social and health variables, which can be utilized in health promotion programs.

Prevalence of health behaviors and their associated factors among a sample of university students in India

OBJECTIVE

With advances in knowledge about health promotion, public health professionals are in search for the determinants of personal health behaviors. The purpose of this study was to assess the prevalence of health behaviors and its associated factors in a sample of Indian university students.

MATERIALS AND METHODS

Using a cross-sectional survey, we assessed health behavior among a sample of randomly selected university students. The sample included 800 university students from non-health (mainly engineering and sciences) undergraduate courses of Gitam University, Visakhapatnam in India. The students were 541 (67.6%) males and 259 (32.4%) females in the age range of 17-20 years (Median age=18.2 years, SD=1.0).

RESULTS

On average, students engaged in 15.8 out of 25 health behavior practices. There was a high rate of overweight and obesity (26.8% and 10.7%, respectively), low rate of brushing teeth at least twice a day (28.6%), annual dental check-up (25.8%), habitual seatbelt use (23%), and poor dietary patterns (79% ate less than the recommended fruit and vegetable consumption of five servings a day, and 68.5% did not avoid eating fat and cholesterol). In multivariate analysis among men, personal constraints (Odds Ratio=OR 1.75, Confidence Interval=CI 1.09-2.82), health benefits (OR=2.01, CI=1.27-3.17), and not suffering from depression (OR=0.60, CI=0.22-0.94) were associated with the health behavior index. Among women, those who were living away from their parents or guardians (OR=1.94, CI=1.06-3.55), economically better off (OR=2.16, CI=1.00-4.63), and had higher social support (OR=3.65, CI=1.75-7.63), were associated with the health behavior index.

DISCUSSION

Students had a high proportion of health behavior practices. Several high health risk practices were identified, including overweight, poor dental practices, poor dietary and sleeping habits. It is hoped that the gender-specific predictors identified, including sociodemographics as well as social and mental health variables, can also be utilized in designing health promotion programs.

Unveiling Health Attitudes and Creating Good-For-You Foods: The Genomics Metaphor, Consumer Innovative Web-Based Technologies

This article presents an integrated analysis of three emerging knowledge bases in the nutrition and consumer products industries, and how they may effect the food industry. These knowledge bases produce new vistas for corporate product development, especially with respect to those foods that are positioned as 'good for you.' Couched within the current thinking of state-of-the-art knowledge and information, this article highlights how today's thinking about accelerated product development can be introduced into the food and health industries to complement these three research areas. The 3 knowledge bases are: the genomics revolution, which has opened new insights into understanding the interactions of personal needs of individual consumers with nutritionally relevant components of the foods; the investigation of food choice by scientific studies; the development of large scale databases (mega-studies) about the consumer mind. These knowledge bases, combined with new methods to understand the consumer through research, make possible a more focused development. The confluence of trends outlined in this article provides the corporation with the beginnings of a new path to a knowledge-based, principles-grounded product-development system. The approaches hold the potential to create foods based upon people's nutritional requirements combined with their individual preferences. Integrating these emerging knowledge areas with new consumer research techniques may well reshape how the food industry develops new products to satisfy consumer needs and wants.

Differences in health complaints among university students from three European countries

BACKGROUND

The purpose of this research was to assess the prevalence of somatic and psychosomatic health complaints in a cross-national population of university students and to study risk factors associated with health complaints.

METHODS

The analysis was based on samples of first-year students from Pamplona (Spain), Bielefeld (Germany), and Kaunas (Lithuania). The total sample included 2343 students. Ten health complaints were measured by a symptom checklist with a self-administered questionnaire. Sociodemographic and lifestyle data were also collected. Factor analysis was employed to develop three complaint scores.

RESULTS

Multifactorial logistic regression analysis revealed substantial associations between the factors female gender and psychosocial stress and high levels (>median) of complaint scores. Furthermore, after adjustment for age, sex, and lifestyle variables Lithuanian students were less likely to report gastrointestinal complaints (OR 0.62, CI 0.43-0.90) and neck ache/backache (OR 0.41, CI 0.28-0.61) compared to Spanish students. In addition, German students were less likely to report psychosomatic (OR 0.49, CI 0.35-0.69) and gastrointestinal complaints (OR 0.47, CI 0.34-0.65) than their Spanish peers.

CONCLUSIONS

Although the results cannot be generalized to the general population of the respective countries, the different profiles of reported complaints should give rise to special interventions in this young population.

Do health control beliefs predict behaviour in Russians?

BACKGROUND

Unhealthy lifestyles contribute substantially to Russia's high mortality. Health control beliefs influence lifestyles to some extent in the West but this relationship is not well studied in Russia.

METHOD

Data from a 1996 cross-sectional interview study in a multistage random Russian population sample (n=1599, response rate 66%) were analysed. These were belief in the ability to influence general health, risk of heart attack, or cancer; the prevalence of smoking, drinking alcohol several times weekly, binge drinking (>80 g alcohol per occasion), and obesity (self-reported body mass index >30); and several social characteristics.

RESULTS

Believing one could influence one's health (prevalence 63%) and reduce the risk of a heart attack (42%) and cancer (30%) was associated with younger age, male sex, and higher income after controlling for other socioeconomic factors. Associations between health control beliefs and behaviours were generally weak and inconsistent. Men believing they could influence their general health were somewhat less likely to smoke or drink regularly. Fewer women who believed that they could reduce their risk of cancer were obese.

CONCLUSIONS

Health control beliefs, commoner in younger and better off Russians, were weakly related to behaviours. This has implications for designing interventions to change health behaviours in Russia.

Depressive symptoms in relation to alcohol and tobacco use in South African university students

A questionnaire was administered to 793 randomly chosen Black university students whose ages ranged from 18 to 25 years. Analysis of variance suggested the association between depressive symptoms and alcohol use but not with tobacco use; however, alcohol and tobacco use were highly correlated. Regression analysis identified drinking status as predictor for depressive symptoms.

Health behaviour among black and white South Africans

Four important health behaviours--dietary fat avoidance, regular exercise, smoking and alcohol consumption--were assessed by questionnaire, together with measures of risk awareness, health status, health benefits, subjective health and well-being. The sample included 250 Blacks and 250 Whites chosen by systematic random sampling from telephone directories in formerly White and Black urban areas in the Northern Province of South Africa. Results indicate that Blacks avoided more fat and cholesterol, smoked less and drunk less alcohol than Whites did, while Whites exercised more than Blacks did. Blacks saw more health benefits in not smoking and avoiding fat than Whites did, while Whites rated more importance to regular exercise than Blacks. Among Blacks and Whites significant gender differences were found; on average women's behaviour was more healthy in terms of not smoking, limited or no alcohol consumption and the avoidance of fat and cholesterol, but there were no such differences for the practice of exercise. Lower socio-economic status was among Whites associated with avoidance of fat and among Blacks with non-smoking. Risk awareness in relation to disease was higher among Blacks than among Whites. The strongest predictors for various health behaviours were gender, ethnicity and age.

Health behaviour, risk awareness and emotional well-being in students from Eastern Europe and Western Europe

Life expectancy and other indices of health have deteriorated markedly in the former socialist countries of Eastern Europe over recent decades. The possible roles of lifestyles, knowledge about health and behaviour, emotional wellbeing and perceptions of control were assessed in a cross-sectional survey of young adults of similar educational status in Eastern and Western Europe. As part of the European Health and Behaviour Survey, data were collected in 1989-1991 from 4170 university students aged 18-30 years from Austria, Belgium, the Federal Republic of Germany, the Netherlands and Switzerland, and from 2293 students from the German Democratic Republic, Hungary and Poland. Measures were obtained of health behaviours, awareness of the role of lifestyle factors in health, depression, social support, health locus of control, and the value placed on health. After adjustment for age and sex, East European students had less healthy lifestyles than Western Europeans according to a composite index of 11 health behaviours, with significant differences for seven activities: regular exercise, drinking alcohol, avoiding dietary fat, eating fibre, adding salt to food, wearing a seat-belt, and using sunscreen protection. East European students were less likely to be aware of the relationship between lifestyle factors (smoking, exercise, fat and salt consumption) and cardiovascular disease risk. In addition, they were more depressed (adjusted odds of elevated scores on the Beck Depression Inventory of 2.46, 95% C.I. 1.95-3.09), reported lower social support, and had higher beliefs in the "chance" and "powerful others" locus of control. Internal locus of control levels did not differ across regions, and Eastern Europeans placed a higher valuation on their health. Unhealthy lifestyles associated with lack of information about health and behaviour, greater beliefs in uncontrollable influences, and diminished emotional well-being, may contribute to poor health status in Eastern Europe.

Differences in health and taste attitudes and reported behaviour among Finnish, Dutch and British consumers: a cross-national validation of the Health and Taste Attitude Scales (HTAS)

The Health and Taste Attitude Scales (HTAS) developed by Roininen, Lähteenmäki and Tuorila in 1999 measure the importance of health and taste aspects of foods in the food choice process. These multi-item scales consist of sets of statements, ranging from "strongly disagree" to "strongly agree", which further divide into three Health (General health interest, Light product interest and Natural product interest) and three Taste (Craving for sweet foods, Using food as a reward and Pleasure) sub-scales. Finnish (N=467), Dutch (N=477), and British (N=361) respondents completed a questionnaire which contained four components: the HTAS, a separate "paper and pencil task" of choosing a food for a snack; pleasantness, healthiness and frequency of consumption of eight foods; and the Restraint Eating Scale of the Dutch Eating Behaviour Questionnaire (DEBQ). The latter three components were included in order to validate various aspects of the HTAS. The factor structure of HTAS was found to be equal in all three countries. However, there were some minor differences in factor loadings among countries, e.g. the Natural product interest and Pleasure sub-scale items had lower factor loadings in the UK than in Finland and The Netherlands. Finnish respondents had the most positive attitude towards light products. Dutch and British respondents scored higher on all Taste sub-scales than their Finnish counterparts. Respondents' health-related attitudes were good predictors of their "healthy food choices" in the snack task and self-reported consumption. Two of the Taste sub-scales (Craving for sweet foods and Using food as a reward) predicted well respondents' self-reported consumption of, for example, full-fat chocolate bars. All the Health and two of the Taste sub-scales proved to be useful tools for characterizing consumer attitudes within and between countries.

PSYCHOSOCIAL CORRELATES OF HEALTHY LIFESTYLES IN BLACK AND WHITE SOUTH AFRICANS

The purpose of this study was to assess the prevalence and psychosocial correlates of healthy practices among 250 Black and 250 White South Africans chosen by systematic random sampling. Results indicated that Blacks practiced on average above 7 and Whites above 8 healthy behaviors from a total of 13. For most healthy practices significant differences were found between Whites and Blacks. Analysis of Variance showed that a number of sociodemographic variables, health benefits, subjective health and subjective well-being were positively associated with healthy practices. Multiple stepwise regression analysis found that independent predictors for the health practices index were women, having children, Whites, formal education, and worse health status.

Health Behaviour in Black South African University Students

Four important health behaviours – dietary fat avoidance, regular exercise, smoking and alcohol consumption - were assessed by questionnaire, together with measures of risk awareness, beliefs about the importance of each behaviour for health, health status, health locus and health value. The sample included 793 Black University students from non-health courses chosen at random from the University of the North, South Africa. The students were 370 (46.7%) males and 423 (53.3%) females in the age range of 18 to 25 years (M age 21.0 years, SD=3.48). The following prevalences for healthy behaviour was found: almost half (44.7%) avoided fat and cholesterol and likewise 48% had exercised in the past 14 days. More than 90% were non-smokers and 84% were non-drinkers or drank alcohol only very occasionally. Sex emerged as an independent predictor for smoking and drinking. Men smoked and drank more than women did. The level of risk awareness about healthy behaviour seemed to be low in this sample. Risk awareness and prevalence of health behaviour was only found to have significant effects for non-smoking and not for the other health behaviours (exercise, fat intake, alcohol consumption). Beliefs were more important independent predictors of dietary fat intake and exercises than was risk awareness.

Attitudes to food and the role of food in life in the U.S.A., Japan, Flemish Belgium and France: possible implications for the diet-health debate

For human beings, food is a critical contributor to physical well being, a major source of pleasure, worry and stress, a major occupant of waking time and, across the world, the single greatest category of expenditures. This is a first study of the way food functions in the minds and lives of people from four cultures. Adults and college students from Flemish Belgium, France, U.S.A. and Japan were surveyed with questions dealing with beliefs about the diet-health link, worry about food, the degree of consumption of foods modified to be "healthier" (e.g. reduced in salt or fat), the importance of food as a positive force in life, the tendency to associate foods with nutritional vs. culinary contexts, and satisfaction with the healthiness of one's own diet. In all domains except beliefs about the importance of diet for health, there are substantial country (and usually gender) differences. Generally, the group associating food most with health and least with pleasure is the Americans, and the group most food-pleasure-oriented and least food-health-oriented is the French. In all four countries, females, as opposed to males, show a pattern of attitudes that is more like the American pattern, and less like the French pattern. In either gender, French and Belgians tend to occupy the pleasure extreme, Americans the health extreme, with the Japanese in between. Ironically, the Americans, who do the most to alter their diet in the service of health, are the least likely to classify themselves as healthy eaters. We conclude that there are substantial cross-cultural differences in the extent to which food functions as a stressor vs. a pleasure. These differences may influence health and may partially account for national differences in rates of cardiovascular diseases (the "French paradox").

Quantification of consumer attitudes to health and hedonic characteristics of foods

Health and Taste Attitudes Questionnaires were developed to assess consumers' orientations toward the health and hedonic characteristics of foods. Items were generated in a qualitative study. The original 37 items on health and 44 on taste were rated from "strongly disagree" to "strongly agree" by a representative sample of 1005 Finnish adults (18-81 years). The number of items was reduced using factor and item analysis, resulting in 20 health- and 18 taste-related statements. Three health-related and three taste-related factors were extracted. The health-related factors were labelled as "General health interest", "Light product interest", and "Natural product interest". The taste-related factors were named "Craving for sweet foods", "Using food as a reward", and "Pleasure". Cronbach's alphas of the multi-item scales, based on the statements loading highly on each factor, ranged from 0.67 to 0.89. Age and gender affected the responses. Females were more interested in the health and taste aspects of foods than were males. Younger respondents were less concerned with health but more interested in taste than were older respondents. A preliminary test of predictive validity was conducted by analysing subjects' responses to foods with weak and strong connotations of health and taste, and currently the questionnaires are being validated with further behavioural tests.

Healthy behaviors among women in the United States and Ontario: the effect on use of preventive care

OBJECTIVES

This study examined how several healthy behaviors among women in Ontario and the United States explained (1) the use of preventive health services, (2) differences in use between socioeconomic groups, and (3) differences in use between the two health systems.

METHODS

1990 data on women from the Ontario Health Survey (n = 22,985) and the US National Health Interview Survey (n = 19,092) were analyzed. A woman who avoided smoking and obesity, used seatbelts, and regularly engaged in aerobic exercise was defined as having a healthy lifestyle. Women were considered screened if they reported a mammogram or a breast exam within the previous year or a Pap smear within 2 years.

RESULTS

A healthy lifestyle was more common in the United States than Canada among more highly educated groups (odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.22, 1.60 for college educated) but less common in the United States for those with less than a high school education (OR = 0.52; 95% CI = 0.40, 0.67). Each additional unhealthy behavior decreased the odds of having undergone a mammogram in the previous year by 20%. However, adjusting for the number of unhealthy behaviors did not substantially change the relationship between socioeconomic status and use of preventive services.

CONCLUSIONS

The number of healthy behaviors is an important measure of demand for preventive health services. This measure varies across country and socioeconomic group.

Caring for mentally ill people

Despite legislation to harmonise mental health practice throughout Europe and convergence in systems of training there remains an extraordinary diversity in psychiatric practice in Europe. Approaches to tackling substance misuse vary among nations; statistics on psychiatric morbidity are affected by different approaches to diagnosis and treatment of psychiatric disorders; attitudes towards mental illness show definite international differences. Everywhere, though, mental health care for patients with psychotic illnesses is a "cinderella service," and there is a general move towards care falling increasingly on the family and the community.