Abstract
Introduction
University students generally face a variety of challenges. During this period of life, they practice some unhealthy eating patterns and lifestyles. Therefore, we aimed to assess the health awareness status of university students from the northeast part of Bangladesh and to evaluate its associated factors.
Methods
We conducted a cross-sectional study using a stratified random sampling among public and private university students from the northeast region of Bangladesh and interviewed 1143 students. We used a self-reported questionnaire, including questions related to awareness status, lifestyle practice, dietary habit and socio-demographic factors. To assess students’ health awareness status and its association with their lifestyle practices and socio-demographic factors, we used logistic regression models.
Results
The majority (61%) of the students were not aware of better health status and their dietary habits were not adequate. Smokers [odds ratio (OR): 0.66; 95% confidence interval (CI): 0.44, 0.99] were less likely to be aware of better health status. The participants who thought that they were leading a healthy lifestyle were less likely (OR: 0.71; CI: 0.56, 0.92) to be aware. Moreover, frequency of participating in sports and the psychological factors related to eating behaviors were significantly (p < 0.05) associated with health awareness status.
Conclusion
Our study findings may help to create a foundation for possible interventional programs on health awareness and nutritional education to improve the health awareness status and dietary behavior of university students. To prevent students from poor eating habits while feeling happy, effective programs (e.g. seminars, projects and media campaigns) should be held, which may include enhancing healthy and recommended amounts of food consumption.
Acknowledgment
We gratefully acknowledge the financial assistance of Shahjalal University of Science and Technology (SUST) Research Center.
Declarations
Authors’ contributions: MM conducted the analysis, interpreted the findings, and drafted the manuscript. MNI reviewed the manuscript. MABC designed the study, prepared the questionnaire and provided the guidelines in the analysis, reviewed results and the interpretation of the results. AA, FNZ, MFA, SNM, TAT, TA and TI participated in the data collection and data entry and checking. MJU lead the design and implementation of the study, participated in the analysis and drafting of the manuscript, and interpretation of the findings. All authors read and approved the final version of the manuscript.
Ethics approval and consent to participate: The Ethical Review Board of Shahjalal University of Science and Technology (SUST) Research Center approved the study with grant number: SUST-03(103). The purpose of the study was explained orally to the participants, and a written consent form was included at the top of the questionnaire with the title “Introduction and consent”. The study participants were assured that the information of the respondents would be confidential and anonymous and would be used only for research purposes. The students filled in the questionnaire after giving consent to participate in the study.
Funding and role of funding source: The study was funded by Shahjalal University of Science and Technology (SUST) Research Center. The funding source had no role in the study design, data collection, data analysis and interpretation, manuscript writing or the decision to submit the paper for publication.
Competing of interest: Authors declares no conflict of interest.
Submission declaration and verification: The work is not under consideration for publication elsewhere. The publication is approved by all authors. It will not be published elsewhere in the same form.
Availability of data and materials: The datasets generated during and/or analyzed during the current study are not publicly available since the Shahjalal University of Science and Technology (SUST) Research Center owns the data, however; the data used in this analysis is available from the corresponding author on reasonable request.
Appendix A
Stratified random sampling
Suppose a population consists of N units. This population is then divided into k sub-populations for stratification. Thus, the sub-populations are the strata and N1 + N2 + … + Nk = N. After identifying the strata, the sample of predetermined size are drawn. If n1, n2, …, nk denote the size of the sample to be drawn from strata, then n1 + n2 + … + nk = n. Consider “i” to denote the stratum and “j” the unit within the stratum.
In this study there were five stratum; 1st year, 2nd year, 3rd year, 4th year and MS. Then,
Ni = Total number of academic classes in academic year i in population strata
ni = Total number of sample academic classes in academic year i sample strata
a. Sample size estimation
For calculating the total number of observations to be included in the sample, the following equation is used:
where Vo is specified variance which is given by,
where the quantity e is regarded as bound on the error of estimation.
In our study, considering time and cost we took the bound on error estimation as e = 7.
b. Allocation of sample size to strata
Optimal allocation
Optimal allocation is one of the several methods of allocation of a sample of a fixed size over several strata.
The formula for calculating sample sizes ni is as follows:
Obtaining sample by optimal allocation is also known as disproportionate stratified sampling.
c. Margin of error and absolute effect size
Margin of error (ME) = (1.96 * SE) for 95% confidence interval.
Where, standard error (SE) = (1/Y) * sqrt {Σ [Yi2 * (1 – yi/Yi) * si2/yi]}
We found that the SE as 3.87 and the ME was 7.58.
And for the sample, Absolute effect size = (Y−y/Y) * 100.
We found the absolute effect size for the final sample size as 85%.
Appendix B
Table 5:
Estimation of total number of students at different stages of stratification from the northeast region of Bangladesh.
| Stratum no. (academic year) | Population strata | Sample strata | After data collection | ||
|---|---|---|---|---|---|
| Classes | Students | Classes | Students | Students | |
| Stratum I (1st Year) | 49 | 2799 | 7 | 498 | 296 |
| Stratum II (2nd Year) | 49 | 2634 | 7 | 412 | 251 |
| Stratum III (3rd Year) | 49 | 2521 | 7 | 302 | 290 |
| Stratum IV (4th Year) | 49 | 2585 | 7 | 418 | 242 |
| Stratum V (5th Year) | 18 | 799 | 2 | 72 | 64 |
| Total | 216 | 11338 | 30 | 1702 | 1143 |
Table 6:
Process of making the outcome variable “awareness status” from four variables.
| Variable names (questions) | Response (number) | Re-coded response (Re-coded number) |
|---|---|---|
| Step 1: Re-coding the outcome values for four variables | ||
| Trying dieting (Have you ever tried to diet?) | ||
| Yes (1) | Yes (1) | |
| No (2) | No (2) | |
| Consciousness of better health status (How conscious are you about a better health status) | ||
| I knew about this (1) | Yes (1) | |
| I want to learn about this (2) | ||
| I want to learn in the future (3) | ||
| I am not interested but need to know (4) | No (2) | |
| I am not interested (5) | ||
| Desire to change habit (Do you think you should change your eating habits?) | ||
| I want to change my eating habits (1) | Yes (1) | |
| I do not want to change (2) | No (2) | |
| I do not care (3) | ||
| Knowledge of nutrition (What type of food do you think has a balanced nutrition?) | ||
| Vegetables and beans (1) | No (2) | |
| Fruits (2) | ||
| Lean meat and poultry, fish (3) | ||
| Eggs, nuts and seeds (4) | ||
| Grain (cereal) foods, milk, cheese or alternatives, mostly reduced fat (5) | ||
| Combination of the above five items (6) | Yes (1) | |
| Step 2: Combing the four variables for making the variable “awareness status” | ||
| Combining four variables each with binary outcomes | Outcome numbers after combining four variables | Awareness status: Response (Recoded outcome numbers) |
| Trying to diet + Consciousness of better health status + desire to change habit + knowledge of nutrition | 0 | Not aware (0) |
| 1 | ||
| 2 | ||
| 3 | Aware (1) | |
| 4 | ||
Table 7:
Results from simple logistic regression models for awareness status of university students from the northeast region of Bangladesh.
| Variables | Total (%)/Mean ± SD | OR (95% CI)b | p-Value |
|---|---|---|---|
| Awareness statusa | 1143 (100) | ||
| Yes | 442(38.67) | ||
| No | 701(61.32) | ||
| Age | 21.32 ± 1.75 | 1.00 (0.94–1.08)c | 0.85c |
| Gender | 1143 (100) | 0.02 | |
| Female | 396 (34.65) | Ref | |
| Male | 747 (65.35) | 0.75 (0.58–0.96) | |
| Religion | 1143 (100) | 0.52c | |
| Muslim | 900 (78.74) | Ref | |
| Hindu | 224 (19.60) | 1.15 (0.86–1.55)c | |
| Other | 19 (1.66) | 0.75 (0.29–1.99)c | |
| Smoking status | 1143 (100) | 0.01 | |
| No | 1007 (88.10) | Ref | |
| Yes | 136 (11.90) | 0.60 (0.41–0.89)c | |
| Fibromyalgia | 1143 (100) | 0.02 | |
| No | 709 (62.03) | Ref | |
| Yes | 434 (37.97) | 1.33 (1.04–1.69) | |
| Perception of life | 1143 (100) | 0.00 | |
| Not healthy | 659 (57.66) | Ref | |
| Healthy | 484 (42.34) | 0.67 (0.53–0.86) | |
| Food preference | 1143 (100) | 0.24d | |
| Taste | 412 (36.05) | Ref | |
| Healthy and nutrition | 550 (48.12) | 1.23 (0.95–1.60)c | |
| Price and promotion | 181 (15.84) | 1.26 (0.88–1.80)c | |
| Playing games | 1143 (100) | 0.00 | |
| Never | 169 (14.79) | Ref | |
| Daily | 219 (19.16) | 0.54 (0.35–0.82) | |
| Rarely | 755 (66.05) | 1.07 (0.76–1.50)c | |
| Duration of exercise | 1143 (100) | 0.66d | |
| 150 min/week | 297 (25.98) | 1.05 (0.79–1.40)c | |
| 75 min/week | 167 (14.61) | 0.95 (0.67–1.36)c | |
| 2 or more days (daily activity)/week | 636 (55.64) | Ref | |
| More than 225 min/week | 43 (3.76) | 0.68 (0.35–1.33)c | |
| Eat because of feeling happy | 1143 (100) | 0.01 | |
| No | 958 (83.81) | Ref | |
| Yes | 550 (48.12) | 1.37 (1.08–1.74) |
aOutcome variable. bOdds ratio [95% confidence interval (CI)]. cNot significant: 95% confidence interval included the value 1. dNot significant: p-value > 0.20.
Appendix C
You are invited to join a research project to look at eating habits, health attitude and obesity indices of university students. In this step of study, we are evaluating the relationships between the awareness status of university students and socio-demographic and lifestyle factors. Moreover, we are going to evaluate the dietary behavior of university students. Our study findings will provide recommendations to facilitate the development of effective intervention programs aiming to promote healthy food choices, better lifestyle and health awareness of university students for body weight control and non-communicable disease prevention. We will keep information about you confidential and the data will be used only for research and academic purposes. If you agree to participate in the study, please circle (o) to the appropriate number in each question.
Anthropometric information:
| 1. Height, inch | |
| 2. Body weight, kg |
Socio-demographic information:
| 3. Gender | 1. Male 2. Female |
| 4. Date of birth (day-month-year) | |
| 5. Age | |
| 6. Marital status | 1. Single 2. Married 3. Other (e.g. separated, divorced) |
| 7. Religion | 1. Muslim 2. Hindu 3. Other (Christian, Buddha) |
| 8. Home district | 1. Barisal 2. Chittagong 3. Dhaka 4. Khulna 5. Mymensing 6. Rajshahi 7. Rangpur 8. Sylhet |
| 9. Living arrangement | 1. Parent’s home 2. Sibling’s home/relative’s home 3. University Dorm/mess |
| 10. University name | 1. SUST 2. Agricultural University 3. Leading University 4. Metropolitan University 5. International University 6. North-East University |
| 11. Name of the department | |
| 12. Academic year | 1. First 2. Second 3. Third 4. Fourth 5. Masters |
| 13. Father’s education | 1. Primary 2. Secondary 3. Higher secondary 4. Graduation (e.g. Bachelor’s degree/MBBS/LLB) 5. Post graduation |
| 14. Mother’s education | 1. Primary 2. Secondary 3. Higher secondary 4. Graduation 5. Post graduation |
| 15. Smoking status (currently smoking cigarettes) | 1. Yes (smoker) 2. No (not smoker) |
| 16. Do you have any disease like: (non-communicable disease: non-infectious or non-transmissible) (NCD) [circle all that apply] | 1. Diabetes 2. Hypertension (higher than 140/90) 3. Fibromyalgia (widespread pain, sleep disturbance patterns, irregular heartbeat and extreme exhaustion. Symptoms that intensify at times include memory and concentration difficulty, jaw pain, headaches, nasal congestion and irritable bowel syndrome.) 4. None |
Put a tick mark where applicable:
| Food choices (FC): [food items you choose to consume/eat in a week] | Daily | Three or more times per week | Once or twice per week | Rarely | Never |
|---|---|---|---|---|---|
| 1. Vegetables | |||||
| 2. Fruit | |||||
| 3. Lean meats and poultry (Meat without skin) | |||||
| 4. Fish | |||||
| 5. Eggs | |||||
| 6. Nuts | |||||
| 7. Milk | |||||
| 8. Cheese/alternative |
Health awareness status and lifestyle practice:
| Variables explaining awareness status and lifestyle practice | Questions explaining the variables | |
|---|---|---|
| 17. Trying for diet | Have you ever tried to be on diet? | 1. Yes 2. No |
| 18. Consciousness of better health status | How conscious are you of a better health status? | 1. I knew about this 2. I want to learn about this 3. I want to learn in the future 4. I am not interested but need to know 5. I am not interested |
| 19. Perception of lifestyle | What kind of lifestyle do you think you are leading now? (state of complete physical, mental and social well-being ) | 1. Healthy 2. Not healthy |
| 20. Desire to change habit | Do you think you should change your eating habit? | 1. I want to change my eating habit 2. I do not want to change 3. I do not care |
| 21. Knowledge of balanced nutrition | What type of food do you think to have a balanced nutrition? | 1. Vegetables and beans 2. Fruit 3. Lean meat and poultry, fish 4. Eggs, nuts and seeds 5. Grain (cereal) foods, milk, cheese or alternatives, mostly reduced fat. 6. Combination of the above five items |
| 22. Food preference | What do you consider most when you purchase food? | 1. Healthy and balanced 2. Price and promotions 3. Taste |
| 23. Duration of exercise | Duration of your exercise | 1. 150 min( brisk walking, shooting basketball)/week 2. 75 min (jogging or running)/week 3. 2 or more days ( making the bed, eating, washing dishes, etc.)/week 4. More than 225 min/week |
| 24. Participation in sports activity | How often do you play any game? (football/cricket/badminton/basket-ball, etc.) | 1. Daily 2. Rarely 3. Never |
| 25. Sitting for computer | On average, how long have you been sitting in front of a computer? | 1. 4 or less than 4 h/day 2. More than 4 h/day 3. None |
| 26. Factors affecting eating habit | Which factors are affecting your eating habits? (If you think you are eating more than required, or you are in a bad eating habit then what are the psychological factors?) [circle all that apply] (FAE) | 1. Eat because of feeling lonely 2. Eat because of feeling happy |
*Thank you for your cordial participation*
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