1 Lithuanian University of Health Sciences Faculty of Medicine Marah Gaber
Self-rated Health Evaluation and Lifestyle Factors Among Foreign
Students of LUHS.
Supervisor: Dr. Rita Raskeviciene Department of Environment and Occupational Medicine Public Health Faculty of LUHS Medicine Kaunas, Lithuania , 2017-20182
Table of Contents
SUMMARY ... 3 ACKNOWLEDGEMENTS ... 4 CONFLICT OF INTEREST ... 4 ETHICS COMMITTEE CLEARANCE ... 4 ABBREVIATIONS LIST: ... 6 INTRODUCTION ... 7 AIM AND OBJECTIVE OF THE THESIS: ... 8 LITREATRUE REVIEW ... 9 Alcohol: ... 9 Diet: ... 10 Tobacco use: ... 12 Physical activity: ... 13 RESEARCH METHODOLOGY ... 14 RESULTS ... 16 DISSCUSION ... 21 CONCLUSION ... 25 RECCOMINDATION ... 26 QUASTIANERE ... 313
SUMMARY
Author: Marah Gaber, VI year student of MF faculty of LUHS Title: Self-rated health evaluation and life style factors among foreign students of LUHS. Aim: the study aimed to determine the relationship between lifestyle factors and self- rated health evaluation among foreign students of LUHS. The research took in consideration the main lifestyle factors which affect the health of students, which include: alcohol consumption, tobacco use, unhealthy diet, physical activity. Objectives: 1. To evaluate prevalence of different lifestyle factors and self-rated health among foreign students of LUHS2. To define the relationship between different lifestyle factors and self-rated health of medical students.
3. To provide recommendations based on the results and conclusion of the research work. Methodology: A cross-sectional questionnaire-based study was conducted in 2017. 100 international students from different years of study from different faculties of LUHS participated in the study. The questionnaire used in the survey was made at the public health department based on questionnaires used in HBSC and other similar surveys.
Study participants: international students of LUHS.
Results: The study results demonstrate a correlation between unhealthy behaviors such as consuming fast food, alcohol drinking, tobacco and avoiding exercise. That can lead to various health problems including neck/back pain, headache, and hypertension. Also, the results raise contraindications. For Example, no significant correlation between eating fast food and smoking to neck / back pain was found. Also, a negative correlation between drinking alcohol and neck / back pain was found. Moreover, the result did not have any connection to headaches and physical activity.
Conclusion: The study concluded, that students, who eat fast food suffer more from hypertension and headache, those who avoid physical activity suffer more from neck and back pain, alcohol consumption and cigarettes smoking tend to cause more headaches. Finally, our results found, that negative lifestyle factors have negative implications on health of students.
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ACKNOWLEDGEMENTS
The author would like to thank the students who participated in the study and filled the questionnaire, and Dr. Rita Raskeviciene who contributed to this research.
CONFLICT OF INTEREST
The author reports no conflicts of interest.
ETHICS COMMITTEE CLEARANCE
Title: self –rated health evaluation and lifestyle factors among foreign students of LUHS. Number of issue: BEC-MF-96 Date of issue: 2017-11-28
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ABBREVIATIONS LIST
○ Gastroesophageal reflux disease (GERD) ○ Non-communicable disease (NCDs)7
INTRODUCTION
Lifestyle is different from nation to a nation and formed according to specific geographical, economic, cultural and religious groups. In the recent decades, lifestyle been playing an essential factor in public health and at the time it became more interesting for researchers. A study found that 60% of related factors to health and quality of life are correlated to the lifestyle. Millions of people around the world follow unhealthy lifestyles, and that can cause illnesses, disabilities, and death. Today the world faces a variety of health problems like malnutrition, unhealthy diet, tobacco use, alcohol consumption, stress. These factors exhibit unhealthy lifestyle that dominates the public health community. Unhealthy lifestyles are associated with numerous diseases which include, cardiovascular diseases, hypertension, diabetes, overweight end all these are the results from an unhealthy lifestyle (1)
University students represent a significant part of young adult’s population. During the transitional period when students enter the university, they become independent from their parents and family. This crucial period is characterized by rapid, interrelated change in body, mind, and social relationship. Even more, they develop new experiences that involve an increase in workload stress, altered patterns of life, and lack of sleep which contribute to an unhealthy lifestyle (2). The gender distinction, age, social support, family arrangement tobacco use, drinking, exercising, diet, psychosocial factors are different among university students have been noted by various studies. For example, women’s health is more influenced by psychological and structural factors such as stress, body image, and low self-esteem. On the other hand, men’s health is affected by behaviors such as smoking, drinking and physical activity (3).Research shows a high rate of tobacco usage, alcohol and drug consumption among university students. Smoking it’s carried out mainly because of stress or for pleasure. Alcohol consumption usually in cases of mental problems as well as drugs consumption is also high among university students. Diet is one of the major lifestyle factors that affect students' health (4).
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University year is known as an essential phase of every student life during which they develop risky behaviors and unhealthy lifestyle such as smoking, which it’s recognized as one of the most significant risk factors that have a health impact on people (5).
The multiplicative detrimental effect can occur when unhealthy behaviors cluster together. Studies that are done in USA show 65% of full-time female students age between (18-22 years old) at university exhibited two or more unhealthy behaviors. Another investigation among German students show about ¼ of students have risky practices, and all of these studies show how lifestyle and risky behaviors during university years can jeopardize the health and cause many wellness issues for students (6). There are five categories of behaviors that have been found to correlate with increased morbidity and mortality. It includes diet, rich calories food, nutrition fat, sodium, no physical activity, smoking, alcohol, and drugs consumptions. Moreover, healthy protective behaviors reduce and eliminate diseases, for instance, working out, walking, eating fruit and vegetables, being aware of the amount of medication and caffeine consuming (7).
AIM AND OBJECTIVE OF THE THESIS:
Aim:The study aimed to determine the relationship between lifestyle factors and self- rated health evaluation among foreign students of LUHS. The research took into consideration the main lifestyle factors which affect the health of students, which include: alcohol consumption, tobacco use, unhealthy diet, physical activity.
Objectives:
1. To evaluate prevalence of different lifestyle factors and self-rated health among foreign students of LUHS.
2. To define the relationship between different lifestyle factors and self-rated health of medical students.
3. To provide recommendations based on the results and conclusion of the research work.
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LITREATRUE REVIEW
Alcohol: Alcohol consumption is harmful and related to mental health problem among the public health issues in today’s society. The university environment provides an excellent social context that usually promotes excessive alcohol consumption. Additionally, students may be influenced by a range of developmental, environmental, and lifestyle changes that are associated with “rites of passage.” In many young students alcohol play a central role in their life, 21% of the young adult aged between 18-24 have been found to engage in risky drinking, and this behavior puts them at significant risk of short and long-term harms which associated with alcohol consumption (8). University students are at a specific stage of their life to experience more freedom in making personal choices about their health, university students in many countries and around the world are at an elevated risk for problem drinking (9) Moreover, studies that are done in Austria show that the young people at the university level are more likely to consume alcohol at harmful levels than their same-aged peers who are not at university. The main aim of the study was to investigate alcohol use and to determine alcohol-related harms among university students. The results show there’s a difference between the genders: males drank significantly higher level than the Females. More than half of the males drink alcohol at harmful levels at every year at the university, female less drinking at a harmful level. Male at the Final year 55.1 % drinking at a toxic level. Females 34.1 % drinking at harmful level (10). Furthermore, there’s different between the female and male classmates. Various studies found that male students reported significantly higher alcohol consumption than their female peers (11). Alcohol consumption associated with a notable health difficulty, it can cause more than 60 different kinds of diseases and conditions, which include injuries and mental and behavioral disorders. Many studies reported that there’s a relationship between alcohol drinking and missing class, impaired academic achievement, and violence among university students (12). Furthermore, research that is conducted in Austria in 2017 shows that 44% of participants reported consuming alcohol at harmful levels. Multiple analysis showed that students who were drinking alcohol at dangerous levels were 1.2 times more likely to report physiological distress than those with lower levels of alcohol consumption.10
The consequences they faced are being late for class, missing classes and inability to concentrate in lecture, Alcohol consumption has an adverse health effect that includes liver, pancreatic injury, a disorder of alimentary tract, circulatory system, mental disorder, neurological disorder and it is more likely to get cancer (13).
The prevalence of alcohol consumption in university students was increasing with the time and higher in developed countries. The study that was done in Ireland, and the aim of the study to compare alcohol use in Ireland, Germany, and other countries. The results show problematic alcohol use ranged between 2.5 in Germany to 53% in Ireland, and students alcohol consumption, in general, ranged from 22 %in Ethiopia to 94% in Ireland (14). Another different study also reported alcohol consumption was higher among students in Europe and North America than in Asia and Africa (9).
Diet:
Healthy nutritional choices are necessary for maintaining Healthy lifestyle (15). According to USA studies, the university is a period regarding unhealthy eating behaviors in students. Prevention of obesity and its related disease has become a worldwide challenge. Studies have shown that university years are a critical time for weight gain because of the transition from secondary school to university. Students need to adapt to a new environment, but when they fail to change this could have negative consequences towards their health behaviors and weight status. Eating behavior is correlated with physical activity, and it has a tremendous effect on students’ weight. According to studies which were conducted in US universities, students do not eat the recommended amount of fruit and vegetables, and they have a significant increase in the percentage of fat intake and alcohol consumption. Unhealthy eating and excessive alcohol consumption have a significant impact on students weight gain (16). The same pattern of weight gain in university students in Europe is occurring. According to European scientific literature, university students showed an increased intake of total and saturated fat and lowered intake of poly and monounsaturated fat and also decrease in the absorption of folate, vitamins, and fibers (17). Healthy eating has a central role in the prevention of chronic and infectious disease which has been documented. A balanced diet, and eating prepared food are important factors that contribute to maintaining a healthy lifestyle.
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Furthermore, typical factors that affect food choices in the students' population include changes in the living environment, financial resources, and the availability of fast food (18). Everyday unhealthy eating habits among students involve meal skipping, eating away from home, snacking, and fast food consumption. University students make their own food choices which depend on the cost of food, and the availability of cheap fast food. Additionally, university students usually have unhealthy snacking habits. Many students failed to meet the recommended intakes of fruits and vegetables (19). According to the study highest consumption of fruits had 25% lower risk to develop Gastroesophageal reflux disease (GERD) in comparison to those with the lowest intake (20).
Non-communicable disease (NCDs) is the leading cause of chronic illness, disability, and immobility. An unhealthy diet is one of the most preventable risk factors for NCDs. Studies show that low fibers intake and more fat consumption is a risk factor for obesity is a risk factor according to NCDs(21). Most of the cardiovascular diseases associated with risk factors like lack of physical activity, smoking, Diabetes mellitus, unhealthy diet, obesity, elevated lipid in the blood, and high blood pressure. A study took place at Jeddah, Saudi Arabia that investigated the connection between obesity and hypertension among university students. In the study 610 participated found that there were 46 (7.5 %) Students who suffer from hypertension (systolic 2.6% and diastolic 6.3%). The BMI of 315 (51.6 %) was in regular range (BMI< 24.9), and 182(29.8%) was overweight (BMI 25-29.9). There were 65 (10.7 %) moderately obese (BMI 30-34.9) and 48(7.9%) was severely obese (BMI>35) (14). Unhealthy diet has an impact on the gut health complication which includes ulcerative colitis, Crohn's disease, irritable bowel syndrome, and celiac disease. All of these diseases are the result of overgrowth and imbalance of the microbial flora which is located in the intestinal, and this related to the type of diet (22). The prevalence of eating habit and overweight and obesity 32.2% and dietary consumption below the recommended level this results according to research done in Lebanon, according to other researches that done in different countries the prevalence of eating habit and overweight increasing with the time among university students (23).
12 Tobacco use: Tobacco use is a major Public Health problem in the world. It’s known to be the single leading cause of preventable death and diseases. According to WHO, 5.4 million die every year from tobacco use (24).Tobacco contains nicotine and MAO inhibitor both of them combined to result in an addictive effect. American cancer society confirmed that prolonged smoking is one of the factors that cause a wide range of diseases that lead to premature morbidity and mortality. Also, it is the first leading cause of chronic obstructive lung disease and lung cancer (25).
There has been a dramatic increase over the past decade in the numbers of university smokers. According to recent studies, the prevalence of smoking increases from the first year to the final year among university students. Students who enter the university as non-smokers are 40% less likely to begin smoking if they live in smoke-free campus (26). Tobacco consumption is associated with multiple health problems and considered to be a preventable risk factor for six of the eight leading causes of morbidity and mortality. Future projections suggest that tobacco consumption will kill more than 8 million people each year worldwide by the year 2030. Smoking has many effects on health in general, and it is has been estimated that tobacco smokers die in 10 years earlier than non-smokers. Smoking leads to multiple diseases which include lung cancer, chronic obstructive lung disease, atherosclerosis, cardiovascular diseases, peptic ulcer, and many other diseases (27). Tobacco consumption is associated with lung cancer and is a leading cause of death (28).The chronic obstructive pulmonary disease is one of the diseases that have the most significant impact on world health. The Global Burden of disease study underlines that COPD was the sixth leading cause of death. Several studies were done to aid in understanding COPD among the different populations (29). Prevalence smoking in different countries it’s different. Various studies have reported that the prevalence of smoking among students in Iran at the considerable amount was 10% in 1990, and according to study done in 2000, the prevalence of smoking was 17.1%, and the next studies done in 2010 found the prevalence of smoking 30.8 %, dramatically increasing with the time. According to studies which done in Greece with the purpose to determine the prevalence of smoking among university students, the prevalence of smoking among university students at the age between 18 – 29 the prevalence is 50 % .very high. A study was done in Saudi Arabia in
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2013 to check tobacco consumption in the kingdom of Saudi Arabia, and the results from the national survey were: overall the prevalence of smoking 28.1% (21.6% for cigarettes, and 14.6 % for water pipe). In this study, smoking prevalence was compared with Malaysia, and the results were from 199 students who participated (29%) were smokers (30).
Physical activity:
The decrease in the physical activity leads to an increase the risk of various diseases which includes diabetes, breast and colon cancer, stroke, coronary heart disease and hypertension. Performing regular physical activity (PA) is known to improve quality of life (QOL). Previous studies reported that positive relationships between physical and various variety of life indicators. Few published studies have investigated that there’s a relationship between physical activity and satisfaction with life among healthy, young adults and university students. The college population is particular interest because this age is known that has experienced some stress during the transition from high school to university. During that period physical activity, decreases, and emotional and psychological stress increases (31)
According to the World Health Organization (WHO), recommend adults aged 18-64 years should do at least 150 min of moderate or 75 min vigorous-intensity aerobic physical activity weekly. Recent studies highlight that university students do not meet the recommended physical activity level (32). Physical activity (including active transportation) have a significant influence on students weight and overall health (33). Strategies to promote physical activity have become an essential public health approach for prevention of chronic diseases. Lack of excessive physical activity develops a risk for ischemic heart disease, stroke, type two diabetes, bone disease (osteoporosis) various cancers types and depression mood (34). In recent years, different studies have shown that prevalence of neck/ shoulder pain ( NSP) and low back pain (LBP) associated with many factors which including depression, lack of physical activity, and lifestyle factors (35). Back pain is a common clinical symptom among a high percentage of the world population. Young people are exposed to a sedentary lifestyle and lack of physical activity. It is due to their spending a lot of time at the desk and the computerization of learning process at home. This situation can lead to various problems which include spinal deformities and back pain later in life. The risk for deformation of physiological curvatures of the include
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numbers of factors. For instance, obesity, inadequate Paraspinal muscle tension, and incorrect posture when exercising (36). Different studies reported a high prevalence of lower back pain among medical students, due to a highly demanding curriculum. Previous researchers have found that medical students are exposed to stress and long hours of work in hospitals which may lead to lower back pain in this population (37). Studies that were done in different countries to check the prevalence of physical activity in different countries. The results show data from 20 countries, for most of the countries, balanced between the females and males in the physical activity level, except Colombia, Japan, and Lithuanian were found 60% of the samples were female(38). Another study was done in Malaysia to check the prevalence of physical activity among students; the participants contain 50% females students and 50% males, students. There were (14%) male participants in low physical activity daily and (30%) in moderate physical activity and (56%) show high physical activity. The females show (30%) low physical activity, (46% ) show moderate physical activity, ( 24%) indicate high physical activity levels (31).
RESEARCH METHODOLOGY
The study was conducted by asking a sample of 100 international students from different years at the Medical Academy of LUHS to fill out an anonymous questionnaire on self-rated health evaluation and lifestyle. The survey was devoted to investigating the relationship between lifestyle factors and health problems among international medical students at LUHS. The purpose of the study is to examine student's perception and knowledge about their health and lifestyle. In each year there are approximately 90 international students. My sample represents a random population of international students At LUHS. The sample was calculated with 100 people because having a large sample eliminates errors and represents a population more accurately. The study was approved by the Dean of the Medical faculty of the Lithuanian University of Health Sciences and the Ethical committee center at LUHS. The information and data that were collected are confidential and are exclusively used to advance knowledge about15
the well-being of students at LUHS. Data were obtained during three months from October (2017) until December (2017). The questionnaire was distributed to the students between lectures, at the auditorium, and also at the library of the university. The self-administered questionnaire contained two sections, and the first part has demographic information and health problems about the student. The second section provided questions about physical activity, diet, alcohol consumption, smoking, and mental health state of each student. The questionnaire had an introduction with explanation of the study purpose, written on the top of the questionnaire, and instructions for each student and how to fill the survey. On average the questionnaire was completed by students within 15-20 minutes and was collected on the same day. The first section of the questionnaire had part 1, which included social and demographic information, their college level, faculty, age, gender, and living place. The greater part 2 of the survey contained detailed and comprehensive questions about rating their health status and education results at the University. The first part of the questions was about health problems that students suffer in the past or currently. The survey had a merit process based on point, never, seldom, often, very often, permanently, and each selection have a corresponding point: Never = 1 point, Seldom =2 points, Often= 3 points, very often = 4 points, Permanently = 5 points. The second section contained parts 3 and 4 and had questions about the lifestyle factor and their effect on the health. The questions contained information about body status: height, weight, clothes size, and student's satisfaction with their body weight, appearance, and overall health. Even more, it contained questions about the status of physical activity to evaluate their daily physical activities. And which types of physical activity they did weekly and their frequency: Never = 1, Seldom = 2 points, few times a month =3 point, few times a week = 4 points, almost every day = 5 points. The last part of the survey had questions about quantity and quality of respondents' meals, which included the nutrition value in their opinion for each food. The choices they had were very healthy, healthy, unhealthy, and the time they took to consume food. The fourth part contained questions about alcohol consumption and smoking. The questions were about how much alcohol they drank and, if they did, how much per day.
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RESULTS
The results chapter include two parts. In the first part, we present descriptive statistics data regarding the following variables – age (18- 29 age), gender (females, males), nationality (international students), living place financial status and education. In addition, we will also present a P'earson correlations matrix between the continuous study variables. In the second part of the statistical analysis we will examine our research hypotheses using linear regression tests 1. Table 1 illustrates socio-demographic data regarding the research sample. Table 1. Socio-demographic data regarding the study participants Study participants Variable N Range S.D M Age 100 19-32 3.08 24.62 Education results 100 1-3 0.56 2.62 Health status 100 1-4 0.86 2.31 Financial status 100 1-4 0.71 1.99 Living place Hostel Apartment 100 21.6% 78.4% Gender Male Female 100 47.3% 52.7% Nationality Israel Other 100 94.6% 5.4% Faculty 100
1 Participants score in the variable "drinking alcohol" is the average of eight items relating to frequency and
quantity level of alcoholic drinking (Cocktails; Beer; Vine; Brandy/vodka/ whiskey).
17 Medical Pharmacy Odontology 87.8% 12.2% - * high average score indicates a high level of education results, health status and financial status. Table 2. Pearson correlations matrix between the continuous study variables. 1 2 3 4 5 6 7 8 9 10 11 1. daily physical activity - - - - - - - - - - - 2. Fast food eating -.548** - - - - - - - - - - 3. Drinking alcohol -.490** .509** - - - - - - - - - 4. Neck or back pain -.480** .296* .132 - - - - - - - - 5. Headache -.357** .396** .507** .473** - - - - 6. blood pressure -.608** .492** .160 .297* .260* - - - - - - 7. respiratory infection -.300* .029 .077 .464** .302** .355** - - - - - 8. Age -.103 .039 .101 -.052 .236* .129 -.245* - - - - 9. Education -.472** .471** .238* .577** .432** .506** .232* .042 - - - 10. health status -.460** .332** .151 .663** .351** .516** .559** -.012 .555** - - 11. Financial status -.430** .166 .222 .373** .189 .378** .188 .004 .361** .365** - Notes: p < 0.05; **p < 0.01; ***p < 0.001. The score 1 refers to "day-to-day sports 2. refers to eating fast foods , and so on ,according to the handover that appears in the rightest column." This is an acceptable way to build the table. In order to examine the relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to neck / back pain, we conducted a linear regression test. In the regression model we controlled the variables – gender, nationality, living place, financial status, age, and education results. The model was found statistically significant (P<0.001) with highly explained variance proportion – (R²=0.48). Table 3 presents linear regression test results regard the relationship between cigarette smoking, daily physical activity, eating fast food, and drinking alcohol and neck / back pain.
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Table 3. The relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to neck / back pain. Neck / back pain (N=69) B SD Beta Smoking (ref=not smoking) 0.302 0.206 0.145 Daily physical activity -.294 .167 -.232* Eating fast food .211 .183 .136 Drinking alcohol -.321 .190 -.191* Gender (ref= male) -.480 .202 -.237* Nationality (ref=jew) .238 .624 .039 Living place (ref=hostel) -.158 .257 -.064 Financial status .177 .159 .118 Age -.055 .036 -.165 Education results .771 .195 .427*** R² 0.48 Notes: p < 0.05; **p < 0.01; ***p < 0.001. As estimated, Table 3 shows a significant negative correlation between daily physical activity and neck / back pain (Betta=-0.232, P<0.05). However, no significant correlation between eating fast food (Betta=0.136, P>0.05) and smoking (Betta=0.145, P<0.05) to neck / back pain was found. Contrary with the research hypothesis, a negative correlation between drinking alcohol and neck / back pain (Betta=-0.191, P<0.05) was found. Further, using linear regression test, we examine the relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to headache pain. In the regression model we controlled the variables: gender, nationality, living place, financial status, age and education results. The model found statistically significant (P<0.001) with high explained variance proportion – (R²=0.57). Table 4 presents linear regression test results regard the relationship between cigarette smoking, daily physical activity, eating fast food, drinking alcohol, and headache pain.
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Table 4. The relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol and headache. Headache (N=1000 B SD Beta Smoking (ref=not smoking) .337 .142 .213* Daily physical activity .085 .115 .088 Eating fast food .315 .126 .267** Drinking alcohol 370 .131 .290** Gender (ref= male) -.434 .139 -.282** Nationality (ref=jew) 1.156 .430 .250** Living place (ref=hostel) .087 .177 .047 Financial status .050 .110 .044 Age -.002 .025 -.007 Education results 0.324 0.134 0.237 R² 0.57 Notes: p < 0.05; **p < 0.01; ***p < 0.001. As predicted, Table 4 shows a significant positive correlation between smoking (Betta=0.213, P<0.05), eating fast food (Betta=0.267, P<0.01) and drinking alcohol (Betta=0.290, P<0.01) and headache pain. However, we did not find significant correlation between physical activity and headache pain (Betta=0.088, P>0.05).In the next step, in order to examine the relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to blood pressure level, again, the conduction of a linear regression test. Similar to previous analyzes, in the regression model we controlled the variables – gender, nationality, living place, financial status, age and education results. The model found statistically significant (P<0.001) with high explained variance proportion – (R²=0.41). Table 5 presents linear regression test results regard the relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol and blood pressure level.
Table 5. The relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to blood pressure level.
20 Blood pressure level (N=100) B SD Beta Smoking (ref=not smoking) -.100 .185 -.058 Daily physical activity -.448 .150 -.421** Eating fast food .371 .165 .284* Drinking alcohol -.386 .171 -.273* Gender (ref= male) -.188 .182 -.111 Nationality (ref=jew) -.147 .562 -.029 Living place (ref=hostel) .198 .231 .095 Financial status .163 .143 .129 Age .021 .032 .075 Education results 0.249 0.175 0.164 R² 0.41 Notes: p < 0.05; **p < 0.01; ***p < 0.001.
As estimated, Table 5 shows a significant positive correlation between eating fast food (Betta=0.284, P<0.05) to blood pressure level. In addition, it found significant, negative and strong correlation between physical activity and blood pressure level (Betta=-0.421, P<0.01). However, it did not found significant correlation between smoking (Betta=-0.058, P>0.05) and blood pressure level. Furthermore, contrary with the research hypotheses, the statistical analysis found significant negative correlation between drinking alcohol and blood pressure level (Betta=-0.273, P<0.05).
Finally, using linear regression test, to examine the relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to respiratory infection (In the regression model we controlled the variables – gender, nationality, living place, financial status, age and education results). The model found statistically significant (P<0.001) with high explained variance proportion – (R²=0.48). Table 6 presents linear regression test results regard the relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol and respiratory infection.
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Table 6. The relationship between cigarette smoking, daily physical activity, eating fast food and drinking alcohol to respiratory infection. Respiratory infection (N=100) B SD Beta Smoking (ref=not smoking) -.264 .182 .145 Daily physical activity -.213 .147 -.191 Eating fast food -.097 .162 -.071 Drinking alcohol .101 .167 .069 Gender (ref= male) -.703 .178 -.394*** Nationality (ref=jew) 2.775 .551 .519*** Living place (ref=hostel) -.124 .226 -.057 Financial status .185 .140 .140 Age -.120 .032 -.412*** Education results 0.034 0.172 0.021 R² 0.48 Notes: p < 0.05; **p < 0.01; ***p < 0.001.
Contrary with the research hypotheses, Table 6 shows no significant relationship between smoking (Betta=0.145, P>0.05), daily physical activity (Betta=-0.191, P>0.05), eating fast food (Betta=-0.071, P>0.05) and drinking alcohol (Betta=0.069, P>0.05) to respiratory infection.
DISSCUSION
Previous studies have shown that many students tend to exhibit unhealthy lifestyle, including - fast food eating, drinking alcohol, avoiding exercise and cigarette smoking. These unhealthy lifestyle activities associated with serious health problems, such as overweight (8), chronic illness, diabetes (13), hypertension, cardiovascular diseases (21), injuries and behavioral disorders, impaired academic achievement (5), physiological distress (6), morbidity (21) and so on. In the current research sought to examine the relationship between four unhealthy lifestyle
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activities - fast food eating; drinking alcohol; avoiding exercise; and cigarette smoking, with four specific health problems among students: neck/back pain, headache pain, blood pressure level and respiratory infection. In line with the research hypothesis, the result shows a significant negative correlation between daily physical activity and neck/back pain and blood pressure level. This result shows that students who engage with higher physical activity level tend to reports lower levels of neck/back pain and blood pressure level compare to students who engage with lower levels of physical activity. These findings stand in line with the results of previous empirical researchers deploying the health benefits of exercise. In this regard, previous researches showed that decrease in the physical activity leads to an increase the risk of various diseases, such as - diabetes, breast and colon cancer, stroke, coronary heart disease and hypertension. Moreover, it was found that lack of excessive physical activity develops a risk for ischemic heart disease, stroke, type two diabetes, bone disease (osteoporosis) various cancers types and depression mood (27), neck/ shoulder pain ( NSP) and low back pain (LBP) (28).In light of the above, it is not surprising that our research findings showed a negative correlation between daily physical activity to neck/back pain and blood pressure level. However, it is important to note that contrary to expectations, the results showed no significant correlation between daily physical activity to headache pain and respiratory infection. In line with our expectations, the result shows a significant positive correlation between eating fast food to headache pain, as well as, blood pressure level. This result shows that students who engage with high levels of eating fast food tend to reports higher levels of headache pain and blood pressure levels. This result also stands in line with the findings of previous studies showing that eating patterns has a central role in the prevention of disease. In this regard, studies show that consumption reduces the likelihood of individuals to develop GERD in comparison to those with the lowest intake (12). It was also found that unhealthy diet is one of the most preventable risk factors for NCDs (13). Moreover, studies show that most of the cardiovascular diseases associated with risk factors like lack of unhealthy diet and obesity, elevated lipid in the blood, and high blood pressure. Furthermore, a study that took place at Jeddah, Saudi Arabia found that people with high BMI suffer more from hypertension compared to people with low BMI (16). Given all this, it is not surprising that our research
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findings showed a positive correlation between eating fast food to headache pain and blood pressure level. Contrary to expectations, our research results show no significant correlation between eating fast food to respiratory infection and blood and beck/back pain. In line with the research hypothesis, the result shows a significant negative correlation between smoking and headache pain. This result shows that students who engage with smoking tend to report lower levels of headache pain compared to non-smokers students. This result also consistent with previous empirical researchers findings examined the negative consequences of smoking. In this regard, as already noted, American cancer society confirmed that prolonged smoking causes a wide range of health problems. Previous studies found a correlation between smoking to lung disease and lung cancer (19), chronic obstructive lung disease, atherosclerosis, cardiovascular diseases, peptic ulcer, and many other diseases (21). Following the above, it is not surprising that the research findings showed a positive correlation between smoking and headache pain. However, contrary to our hypotheses, and with previous findings in the research literature, the research results show no significant relationship between smoking and blood pressure, respiratory infection and neck or back pain. Finally, as expected, the research results show a significant positive correlation between drinking alcohol and headache pain. This result shows that students who engage with higher levels of alcohol drinking tend to reports higher levels of headache pain compare with students who tend to engage with lower alcohol drinking. Again, this result stands in line with the findings of previous empirical researchers that illustrate the negative health consequences of alcohol consumption. In this regard, previous researchers found that alcohol consumption associated with more than 60 different kinds of disease and conditions, such as liver problems, pancreatic injury, the disorder of alimentary tract, circulatory system, mental disorder, neurological disorder and it is more likely to get cancer (14). The study results indicate that alcohol consumption also correlates with headache pain among students. Contrary to expectations, the results show no significant correlation between drinking of alcohol and respiratory infection. Unexpectedly, it was also found a negative correlation between drinking alcohol and neck/back pain and blood pressure level. This result shows that students who engage with high levels of drinking alcohol tend to reports lower levels of neck/back pain and blood pressure level compare with students who tend to
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engage with lower levels of alcohol drinking. While our study results show that unhealthy behaviors of fast food eating, drinking alcohol, avoiding exercise and cigarette smoking related to various of health problems (including -neck/back pain, headache pain, blood pressure level). The results also raise some contradictions. In this regard, in some cases, we did not find a significant correlation between unhealthy behaviors and negative health problems. Therefore, some question arises-Why avoidance of exercise was not found associated with headache pain and respiratory infection? How can we explain why eating fast food did not found related to respiratory infection and neck/back pain? Moreover, why smoking did not found related to respiratory infection, neck or back pain and blood pressure? Finally, what is the reason that drinking alcohol did not found related to increasing respiratory infection, neck/back pain and blood pressure level? To reconcile the gap between the above research findings with previous studies result, it is important to emphasize that the current research focused specifically on student's population. Students tend to be fairly young, and accordingly, the average age of our research participants is only 24. It is known that bad health habits (such as - fast food eating, drinking alcohol, avoiding exercise and cigarette smoking) leading over time, and following prolonged involvement, to health problems among people (30). Short-term involvement in unhealthy behaviors (over a limited number of years) is not always accompanied by direct health damage among young individuals (31). However, there is a firm basis to assume that over time, and with the rise in student age, the consequences of harmful health habits reflected in severe health problems (31, 32).The findings of the current research have great importance. In this regard, numerous previous research findings suggest that students tend to be involved in unhealthy behaviors. Similar to previous studies, the results of this study indicate that students who tend to lower levels of exercise tend to suffer more from neck and back pain, as well as, hypertension problems. It was also found that students who eat fast - food more often suffer from headaches and high blood pressure. Finally, we found that students who consume alcohol and cigarettes tend to have more headaches. These findings shed light on the severe consequences of poor health habits among students. While the results of this study have an essential contribution to literature, it is important to note that this study has several methodological limitations to consider. First, it should be noted that this study based on
25
correlational design only, since the study participants were not assigned to groups in a random manner. Therefore, it is not possible to conclude causal relationships between the research variables. Also, it is important to note that the participant's number in this study is relatively small (N=100) Given the small number of participants, the external validity of our research findings is doubtful. Also, the study participants were sampled using a "convenience" sampling that also reduces the external validity of the research findings. Moreover, following the small number of participants, a question arises regarding the validity of the statistical conclusions of the current research, since a small sample of participants increases the likelihood of a "type 2 error", that is, reduces the likelihood to find significant statistical differences/correlations. In light of the above, the results of this study should be examined with due care.
CONCLUSION
In summary, the findings of the current study show that students who tend to lower levels of exercise tend to suffer more from neck and back pain, as well as, hypertension problems. Moreover, The results indicate that students who eat fast - food more often suffer from headaches and high blood pressure. Finally, we found that students who consume alcohol and cigarettes tend to have more headaches. These findings reinforce the findings of previous studies indicating that negative lifestyle habits are associated with serious health problems serious. The findings of this study in the special context of students have unique importance. In this regard, many previous studies have shown that student population tends to be heavily involved in negative lifestyles habits. The results of this study reveal that these negative habits have negative implications on the health of students, although most of them are quite young.
26
RECCOMINDATION
In light of the current research findings, policymakers, and decision-makers in welfare and health ministries. As well as universities and colleges are requested to direct time and resources towards informational interventions about the serious implications of common unhealthy students' lifestyle behaviors, including-fast food eating, drinking alcohol, avoiding exercise and cigarette smoking. For example, a study design in which more participants will be sampled, participants will be tested using probabilistic and randomized sampling. Also, having experimental and control group to see the differences between them. The results of such study design would be characterized by higher internal (causation ability) and external (inclusion ability) validity. Besides, the validity of the statistical conclusions is such study design expected to be higher. Moreover, for further research, we recommend that we examine the hypotheses of this study under a stronger methodological framework. For further research, we recommend examining whether the relationship between unhealthy behaviors and health problems among students depends on various factors, such as age, gender, socioeconomic status, type of institution (college/ university), comorbidities, etc. Exploring other health consequences of an unhealthy lifestyle such as gastrointestinal problems, diabetes, stroke, sleep disorders, eating disorders, depression, etc are also recommended.27
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QUASTIANERE
Self-rated health evaluation and lifestyle factors Questionnaire Hi, I am Marah Garber, 6th year student of Medical faculty of LUHS and I am performing a study on self-rated health evaluation and life style factors among foreign students of LUHS. This anonymous questionnaire is devoted to investigate relationship between lifestyle factors and health problems and among foreign students of LUHS. We reassure, that your answers and the collected data is confidential, used exclusively for the purpose of this study. 1. .Your age:
2. Gender male (2) female (1) other
3. Faculty medical (1) pharmacy (2) odontology (3)
4. Nationality______2__________
5. You are staying in a hostel (1) in an apartment (2)
6. Your financial status is
very good (1) good (2) average (3) poor (4)
7. Your education results at the university are
Excellent □(1) very good □(2) average□ (3) poor□ (4)
8. Your health status is:
Excellent (1) very good (2) good (3) average (4) poor (5)
9. Do you have any of the following health problems? Never (1) Seldom (Few times a year) (2) Often (few times a month (3) Very often (few times a week) (4) Permanently (almost every day) (5) Neck pain or back pain Headache Joint pain Stomach ache Digestive symptoms Constipation or diarrhea Increased blood pressure Ocular symptoms (dry eye, tearing) Insomnia, sleep disorder (difficulty to fall asleep, frequent awaking
32 Depression Eating disorder Chronic fatigue Irritability , difficulty concentrating Anxiety /panic attack Flu, other respiratory infection 10. Did you miss any lectures because of health problems during the last three months? Yes (1) no (2) 11. You height is __________ 12. The size of your clothes is XS(1) S(2) M (3) L(4) XL (5) XXL(6)
13. Are you satisfied with your weight /appearance? Yes (1) No (2) Not fully (3)
14. Are you interested in healthy lifestyle programs? Yes (1) no (2) maybe (3) If yes, then in what programs? 14.1□ Program on physical activity 14.2□ Program on healthy nutrition 14.3□ Program on mental health and stress management 14.4□ Program on interpersonal relationship improvement 14.5□ Program on prevention of smoking and other addictions 14.6□ Other, specify________________________________________________________________ 15. Evaluate your daily physical activity
Very active (1) moderately active (2) lightly active (3)
16. Your daily physical activity takes up to 1 hour (1) 1-3 hours (2) more than 3 hours (3) 17. What kind of physical activity do you practice?
Never
(1)
Seldom
(few times a year) (2) few times a month (3) few times a week (4) almost every day (5) Sport club Jogging Walking Swimming Cycling Other, specify 18. What is your motivation for physical activity 1 .□ No particular motivation
33 2.□ To keep good health status 3.□ To look good 4.□ To develop strength and endurance 5.□ To have a good time 6.□ To spent time with friends 7.□ Other, specify________________________________________________________________ 19. 19.Your nutrition on your opinion is
very healthy □(1) healthy □ (2) unhealthy □(3)
20. Are you
vegan □(1) vegetarian □ (2) raw eater □(3) no special diet □(4) 21. Have you ever been on diet?
Never (1) Once (2) Few times (3) Often (4)
22. You have a meal
1-2 times a day □ (1) 3-4 times a day □ (2) more than 4 times a day □(3)
23. Do you have breakfast?
Never □(1) sometimes □(2) often □(3) always □(4)
24. Your lunch is
at 12:00 -13:00 □(1) at 14:00 -15:00 □(2) at 15:00 and later □ (3) irregular □(4) 25. Your last meal is
at 19:00-20:00 at 20:00-21:00 2 at 21:00-22:00 3 at 22:00-23:00 and later 4
26. How many fruits do you consume per day?
Less than 1 (1) 1-2 (2) 3-5 (3) more than 5 (4)
27. How many servings of vegetables do you have per day?
1 (1) 1-2 (2) 3-5 (3) more than 5 (4)
28. What kind of meal do you usually have?
Fast food (1) ready-made food from supermarket (2) homemade food (3) 29. How often do you eat fast food?
Never □ (1) sometimes □ (2) often □ (3) always □(4)
30. How many drinks do you have per day 0 glass (0) 1 glass (200 ml) ( 1) 2-3 glasses (400- 600 ml) (2) 4-5 glasses (800 ml- 1 l) (3) >5 glasses (>1 l) (4) Tea Coffee Soft drinks (Coca-Cola, Pepsi etc.) Energy drinks juice Water
34
32. Are you interested in ingredients of food products? Yes (1) no (2) not much (3)
32.1 Ingredients are not important to me, my choice depends on price, taste of the product If yes, specify what are you interested in: 32.2 The information on nutritional facts (amount of fat, proteins, carbohydrates) 32.3 The amount of calories 32.4 The information about food additives 33. Do you read labels on products in supermarket?
Never (1) sometimes (2) often (3) always (4)
34. What impact on your nutrition do your studies have? 1 No impact 2 My meals are irregular because of lecture schedule 3 I am eating too much because of high stress level 4 I have no appetite because of high stress level 5 I am eating too much late at night 6I am eating too much of fast food 7 Other, specify ________________ 35. Do you experience mental stress during your study at the university? 1 Never
2 Seldom (few times a year) 3 Often (few times a month) 4 Very often (few times a week) 5 Permanently (almost every day)
36. Do you smoke? Yes (1) no (2) quitted (3)
If yes, 36.1 For how long have you been smoking? ____years 36.2What kind of Tobacco do you smoke? cigarettes• (1) handmade cigarettes • (2)• Hookah •(3) electronic cigarettes•(4) 36.3How many cigarettes do you smoke per day? 1-5• (1) 6-10 •(2) 10-20 •(3) more than 20 •(4) 37. How often do you consume these drinks? Never (1) Seldom (few times a year) (2) Often (few times a month) (3) Very often (few times a week) (4) almost every day (5) Cocktails, cider Beer Vine Brandy, vodka, whiskey 38. Amount of the drinks you usually have
35 1-2 servings* (1) 3-5 servings* (2) 5 and more servings* (3) Cocktails, cider Beer Vine Brandy, vodka, whiskey *1 serving -330 ml of beer and cider, 150 ml of vine, 40 ml of vodka, brandy 39.If you drink alcoholic beverages, where usually do you drink? 39.1•At home 39.2•In club 39.3•In bar 39.4•Other places__________ 40.How do you spend leisure time usually? •Attending sport clubs, pool •In bars •Spending time with your friends •Attending concerts, •Reading books •Watching TV •Social media/internet •Playing computer games •Eating •Drinking alcohol •Smoking •Taking sedatives, pills
•Attending church/ mosque/ synagogu Have you ever experienced any of the following?
Never
(1) Seldom (few times a year) (2) Often (few times a month) (3) Very often (few times a week) (4) Permanentl y (almost every day) (5) 40.1Nervousness, irritability 40.2Anxiety or panic attacks 40.3 Stress 40.4 Sadness, passiveness 40.5depressive mood 40.6Lack of appetite 40.7Loneliness 40.8Apathy 40.9Lack of energy 40.10hopelessness 40.11Sleep disturbances
