Health-Promoting Lifestyle of University Students in Saudi Arabia

Introduction

A health-promoting lifestyle is an important determinant of health status and is recognized as a major factor in the maintenance and improvement of health (Mirghafourvand et al., 2015). Lifestyle factors such as diet, physical activity, and sleep are widely perceived as modifiable issues that impact a person's health (Garcia-Toro et al., 2012). During the transition from adolescence to adulthood, students at the college level often experience unhealthy changes in lifestyle. A variety of lifestyle and health-related habits emerge at this stage, including poor diet leading to malnutrition or obesity, smoking, alcohol consumption, and reduced physical activity (Butler et al., 2004; Wengreen & Moncur, 2009). These unhealthy lifestyles have become increasingly prevalent among college students in recent years (Keating et al., 2005; Lund et al., 2010). Unfavorable changes in lifestyle have been shown to cause a range of health problems including cardiovascular diseases, hypertension, overweight, metabolic diseases, joint and skeletal problems, and depression (Bourre, 2006; Sarbadhikari & Saha, 2006). However, the existing evidence on the associations between these lifestyle factors and depression remains somewhat inconsistent (Averina et al., 2005; Demura & Sato, 2003; Song et al., 2012).

Many college students are living away from home for the first time, either in student housing or in nearby communities. They are faced with new responsibility for their personal health, lifestyle, and behavior. Young adults develop behaviors during this period that may remain part of their lifestyle into adulthood or that may jeopardize their health in later life. These behaviors include assuming responsibility for personal health, participating in physical activities, and acquiring good nutritional habits (Polat et al., 2015). University students occupy a dynamic transition period of growth and development that bridges adolescence and adulthood. This period is marked by rapid changes in the body, mind, and social relationships (WHO, 1977). At this stage, difficult life conditions and diverse lifestyle patterns within the university environment often lead students to engage in a wide range of unhealthy habits, including inadequate nutritional intake, insufficient rest, and limited exercise (Fujii et al., 1998; Hawks et al., 2003; Werch et al., 2007; Wei et al., 2008).

Several studies have examined the relationships between demographic variables and health-promoting behaviors. However, fewer studies have explored relationships between university year level and health-promoting behaviors. The purpose of this study is to determine whether relationships exist between university students' age, gender, living arrangements, body mass index (BMI), year level, and overall scores on the Health Promoting Lifestyle Profile II (HPLP-II) instrument, specifically regarding three subscales: health responsibility (HR), physical activity (PA), and nutrition (N). The study also aims to identify differences in health-promoting lifestyles between students in health colleges and those in non-health colleges. It is hoped that the results will provide useful information to university administrators and educators for general health education program awareness and health literacy dissemination, and help students adopt healthier lifestyles.

The study by Al-Kandari and Vidal (2007) examined the health-promoting lifestyle profile of 224 nursing students in Kuwait and correlated it with levels of enrollment in nursing courses as well as academic performance. The researchers used Walker's Health-Promoting Lifestyle Profile II instrument to measure students' lifestyle profiles. Academic performance was assessed using individual and group-level grade point averages. The researchers found significant differences between male and female students regarding their health-promoting lifestyle, physical activity, interpersonal relationships, and stress management techniques. Age, nationality, and marital status also correlated with health-promoting profiles. However, no association was found between health-promoting lifestyles and academic performance. One aim of the present study is to follow up on the findings of Al-Kandari and Vidal (2007) and address any gaps left by their research.

Review of Related Literature

The study by Farghaly, Ghazali, Al-Wabel et al. (2007) focused on the lifestyle habits of school students in Saudi Arabia, specifically examining the role of lifestyle and nutrition on student health. A two-stage random sample selected 767 male and female students across various levels of schooling. Participants completed a questionnaire from which information about weight, height, and body mass index was obtained. The findings showed that students suffering from poor health — typically obesity — were most commonly younger females at lower levels of education. The study indicated that poor health-promotion in student lifestyles can begin at an early age and that schools should do more to understand student lifestyles. The present study aims to build on this understanding so that student health can be more effectively addressed at the university level.

A total of 1,656 students from different colleges were available for analysis. The majority of participants were female (70.4%), while 29.6% were male. Regarding age, 57.4% were 20 years of age or younger, 40.0% were between 21 and 30 years old, 2.4% were between 31 and 40 years old, and only 0.2% were 41 or older. Regarding health status, 50% were of normal weight, 11.1% were underweight, 20.8% were overweight, and 11.3% were obese. Almost all participants came from a traditional family structure (76.1%), while 13.5% had an extended family structure and 10.4% came from single-parent homes. The majority of participants (94.9%) lived with their families; 1.2% lived with friends, 0.9% with relatives, 2.4% in university housing, and 0.3% lived alone. Only 12.8% of students had been diagnosed with a health problem.

Results

Differences in health-promoting lifestyle between non-health and health college students are summarized below. The analysis revealed significant differences between the two groups with respect to health responsibility. Only a small proportion of students in both health (11.5%) and non-health colleges (6%) reported any unusual signs or symptoms to a physician or other health professional. Approximately half of the students in both college types obtained information about and discussed health concerns with health professionals. Nearly half of students sometimes read about or watched television programs on improving their health. Nearly 70% of students in both college types never inspect their body at least monthly for physical changes. Furthermore, the majority of students in both groups do not attend educational programs on health care. A significant difference was found in seeking guidance or counseling, with more students in health colleges reporting this behavior (p = 0.001).

With regard to physical activity and exercise, significant differences were found between health and non-health college students in following a planned exercise program (p = 0.019) and taking part in leisure-time physical activities (p = 0.013). A total of 35.3% of non-health college students and 37.8% of health college students reported exercising vigorously for 20 or more minutes at least three times per week. A significant difference was also found in doing stretching exercises at least three times per week (p = 0.013). However, no significant difference was found in exercising during routine activities (p = 0.899) or in participating in light to moderate physical activity such as sustained walking for 30–40 minutes five or more times per week (p = 0.591).

Regarding nutrition and diet management, significant differences were found between the two groups in eating fruits and meat, poultry, and nuts each day (p = 0.001). The majority of students in both groups do not choose diets low in fat, saturated fat, and cholesterol. Only 6.7% of non-health college students and 7.5% of health college students reported limiting their use of sugar and sugar-containing foods. Approximately 90% of non-health college students consumed 2–3 servings of milk, yogurt, or cheese each day, compared to 71.4% of health college students (p = 0.001). No significant differences were found between the groups in eating breakfast (p = 0.254) or consuming 3–5 servings of vegetables each day (p = 0.231).

The multivariate analysis of factors associated with healthy lifestyle showed that gender, college type, college level, and family structure were significantly correlated with health lifestyle. Male students were more willing to engage in physical activity than female students (p = 0.001). College type was significantly associated with increased likelihood of health responsibility among students. Female students showed greater concern for diet management and nutrition than male students (p = 0.001). College level was significantly correlated with physical activity and exercise (p = 0.001). No significant associations were found for age, place of residence, or GPA with respect to health responsibility, physical activity, or nutrition.

Conclusion

The current study explored the health lifestyles of university students with regard to health responsibility, physical activity, and nutrition. As universities are ideal settings for implementing health promotion programs, planning and implementing such programs — aimed at motivating students to take responsibility for their own health, engage in regular physical activity, and practice healthy dietary habits — is of paramount importance for promoting health and preventing disease. Developing and implementing goal-oriented programs that address health responsibility, physical activity, and nutrition may promote healthier lifestyles among university students. Applications such as "Healthy University" and "Universities Humanizing Health" are also suggested as tools for enhancing student awareness of and engagement with healthy lifestyle practices.