Evaluation of health behaviour and its determinants amongPortuguese medical students
Alison José Nunes
Hugo Figueiredo
Joana Luísa da Silva
José António de Castro
Luís Frederico Gonçalves
Luís Guilherme Galego
Margarida Areias Marques
Maria Aurora Pinto
Pedro Nuno C. Prata de Andrade
Sérgio André Martins
Teresa Areias Marques
Adviser: Armando Teixeira Pinto Class number: 4
ABSTRACT
INTRODUCTION: Many of the health problems are direct consequences of lifestyle and increasingly more doctors induce people to change some habits which are risk factors to their individual health. So, theyhave a key role in health promotion/disease prevention and they should serve as preferential examples to all society of what a healthy conduct must be. Consequently, it is relevant studying the health behaviour of people that in a near future will this function in society.
The present study investigates the health-related life style of Portuguese medical students. It tries to define a pattern of health behaviour in this population as well as analyse the impact of several academic and social factors.Moreover, these results are compared with other different populations.
METHODS:This is a cross-sectional study which sample is constituted by students of the first and fourth years of Faculty of Medicine, University of Porto. There are not further inclusion criteria and no exclusion criteria. The Portuguese adaptation of the Health and Behaviour Survey (HBS) was the data collecting instrument.
RESULTS: In general Portuguese medical students have positive health habits regarding smoking, eating and other specific behaviours. On the other hand, in what concerns to physical activity, sleeping and alcohol consumption the behaviours are not so clearly positive. Several aspects of the health related lifestyle differ significantly mainly according to gender and residency status. There are no differences between students according toclassifications and year at college. Better health behaviour was detected in this population in comparison to western European college students.
DISCUSSION: Residency status and gender may condition students’ health behaviour, and on the contrary factors related to universitary knowledge transmission do not do so. Portuguese medical students have better health behaviourscomparatively than the general population of young European adults with the same age.
KEY-WORDS
Life style; medical students; health behaviour; habits.
INTRODUCTION
Background
"Lifestyle" is a broad concept that evokes the person as a whole and therefore includes several aspects. In public health, lifestyle generally means a pattern of individual practices and personal behavioural choices that are related to an elevated or reduced health risk (McGinnis et al., 1993). According to the World Health Organisation, health is defined as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” (WHO, 1993). So this concept of health have a strict association with our lifestyle, acting some of its elements as risk factors in diseases with high mortality or which simply severely condition the quality of life of our following days.
Thus, it is a crying need promoting the adoption of healthy behaviours, namely taking breakfast every day, not smoking, not consuming alcohol or consume moderately and practicing physical activity regularly as a way to avoid or at least postpone these problems. And as an effective way to act as a transmitter of healthy habits are doctors. Theyshouldalso serve to all society as evident examples of people whose lifestyle follows correct health behaviour.
It is therefore of interest to evaluate lifestyles of today’s medical students, particularly because it is thought that health behaviours are established in youth, setting the pattern for adulthood (Baranowski, 1997) and these students will be tomorrow’s doctors who will be involved in future health care (Webb, Ashton, Kelly, & Kamali, 1998). Consequently, having medical students not enough healthy behaviours is the first step for in the future being doctors who personally ignore what they know as the most correct and not serving as healthy examples, even “may also be predisposed to ignore health promotion opportunities with their patients” (Kamien, 1996).
Youngsters are many times considered as the healthiest group among the world human population (Bruhn, 1988). This lower susceptibility to adverse states associated with health does not mean that young people have good health behaviour (Steptoe & Wardle, 1996), what many times does not happen because of their radical life changes and stressful habits, needs and practices at university.In this context there are studies that investigate the health-related behaviour of university students and obviously there are also a few studies about health-related behaviour of medical students that have some interesting conclusions. For example, a study developed by Steptoe et al. (2002) verified that among the Europeans countries analyzed, Portugal is the one which have the lowest prevalence of physical exercise in the university students’ population in 2000 and is within the countries with lower prevalence of individual efforts to limit fat intake.
On the other hand, another study have evidenced that students living at parents home do not show major changes in their eating habits since entering to university, students living away from home often develop more unfavourable eating habits (Papadaki, Hondros, Scott & Kapsokefalou, 2007) and in general alcohol consumption increases significantly through their undergraduate medical studies (Newbury et al., 2001; Croen et al., 1997).
Studies showed that students whose sleep was restricted or optimized showed that there are respectively a worsening and an improvement in neurocognitive and academic performance (Curcio, Ferrara & De Gennaro, 2006).
Actually, the lifestyle of nowadays future doctors not only deeply influences their adulthood perspective towards their personal health (for example, with the maintenance of their eating habits formed in adolescence (Videon & Manning, 2003)) as well as towards community’s health habits.
So, medical schools must have a particularly and increasingly incisive action in promoting better habits in medical students.Such a thing that is not in accordance with several studies which indicate that alcohol consumption increases significantly through their undergraduate medical studies (Newbury et al., 2001; Croen et al., 1997).
There are a few studies about health behaviour of medical students but, as far as we know, none analyses the health-related lifestyle of Portuguese medical students, nor evaluates the impact of some social and academic factors in the health behaviour of this population, neither compares it with other populations of university students. So these are main the parameters that this study wants to analyse.
Consequently we consider as hypothesis, namely: whether medical students, specifically the Portuguese ones, generally follow insufficiently salutary conduct patterns and have life styles not enough healthful; and if health behaviours are associated with some academic and social factors.
Research Question and Aims
There are three main objectives for this study: (1) to describe health-related habits of Portuguese medical students; (2) to analyse the association between some academic and social characteristics and the student’s health behaviour; and (3) to compare these results with previous studies in different populations.
The principal health factors analysed are smoking, eating, sleeping, alcohol consumption and physical activity in the Portuguese medical students.
We will focus on differencesbetween first and fourth year students; males and females; students staying at relatives’ home with students living away from relatives’ home; and students with better classifications in some subjects with students with lower marks in the very same analysed subjects(Preventive Medicine and Anatomy).
The information obtained from the defined population was compared with patterns of health behaviour of European university students (Steptoe et al., 2001).
PARTICIPANTS AND METHODS
Study Design and Participants
This is a cross-sectional study (more specifically a survey) on the health habits of Portuguese medical students.
The target population of this study is the Portuguese medical students. The sample includes all medical students of the first year (n=277) and three randomly chosen classes from fourth year (n=99) of the Faculty of Medicine, University of Porto. 47 students were not in the class during the questionnaire delivering and 3 refused to answer it. So, it was obtained 328 answered questionnaires. Thus, among the students that answered to the questionnaire, 102 were male and 223 female. The distribution of subjects by gender and by year's course was as follows: 85 men (1 st year), 17 (4 th year), 161female (1 st year) and 62(4 th year).
This is a convenience sample because logistically it is impossible to us inquiring students from the rest of the Portuguese medical schools and from all of the six years that constitute the Portuguese medical studies. Besides, it is presumed a generalization from the chosen sample to all the target population because it is not expectable a high variability and notorious divergences between the faculty of the sample and the situation of the rest of the Portuguese medical schools.
There are two inclusion criteria which are being a first year student or a fourth year student at Faculty of Medicine, University of Porto. There are also no exclusion criteria.
In this very same sample, as well as in the majority of the behavioural studies, information about health habits was obtained by applying a self-report questionnaire. In order to get useful comparative data, it was used the same questionnaire as in previous surveys on university students (Dias et al., 2001; Geada et al., 1994; Steptoe & Wardle, 2001; Steptoe & Wardle, 2002) with some changes that were considered relevant to the study in question. So the data collection instrument in the present study was the Health and Behaviour Survey (Steptoe & Wardle, 1991) in its Portuguese version (Geada, Justo, Santos, Steptoe & Wardle, 1994).
This questionnaire, which was anonymous and voluntary, was delivered in person by some of the researchers during scheduled teaching sessions. This questionnaire administration was preceded by a short explanation of the nature of the present study. A response rate of 99% was obtained in the present students of each class. However, this questionnaire was not delivered to the absent students, which in reality give us a general response rate approximated to the attendance rate in each class at that: 87%.
The data was collected in April and May of 2008.
Data Collection Method
It was used the Health and Behaviour Survey (HBS) (Steptoe & Wardle, 1991) as the instrument to measure health behaviour, specifically in its Portuguese version (Geada, Justo, Santos, Steptoe & Wardle, 1994).
This questionnaire was developed by Steptoe and Wardle to generally analyze health related attitudes and behaviours. It consists of a number of sections in which are asked about various aspects of lifestyle. The section A is concerned about many aspects of health related lifestyle; section B is designed to evaluate the importance that students give to some health measures and section C concerns about what students know about several health problems. However, only the section A of this questionnaire is of interest to be used in this study, because it is there that the health habits are evaluated.
The test-retest reliability of this questionnaire in its original form was described as satisfactory (Steptoe & Wardle, 1991).
The HBS has been used in several surveys, and due to their particular relevance to this study it is important to enhance some: Dias et al., 2001; Geada et al., 1994; Steptoe & Wardle, 2001; and Steptoe et al., 2002.
Variables description
As dependent variables it was used the previously mentioned items present in the Section A of the questionnaire HBS, in its Portuguese version. This part of the HBS includes questions regarding smoking habits, eating habits, sleep habits, alcohol consumption, physical activity and other behaviours (the planned dependent variables).
It was analyzed differences in health behaviours of medical students according to some factors, which are the independent variables: gender; residency status (students staying at their relatives’ home with students living away from home); year at college (first or fourth); and grades (marks of the students in several curricular subjects of analyzed undergraduate study: Anatomy I, Anatomy and Preventive Medicine). These are the defined independents variables, the third and fourth ones were added to the introductory part of the questionnaire, because this kind of information is not obtained in the original one.
Statistical Analysis
Data were analysed using the SPSS Software Version 16.0. It was used statistical descriptive methods appropriated to each variable to summarize the health behaviour of medical students.
The chi-square was used to analyze the association between categorical variables. For continuous variables we will use the t-test if the normality assumption is verified or else the Wilcoxon signed rank test. Statistical significance will be defined as p<0.05.
The internal consistency of the variables’ answers, in which it was possible to be analysed, was checked (the categories of smoking, eating and alcohol consumption) and irrelevant or no incoherent results were found.
The hypothetical confounding influence of gender and residency status in health behaviours of students was tested and refuted.
A second data entry was done to secure that the first one and its consequent data base were well. This correctness was confirmed.
RESULTS
General(Table1)
The majority of Portuguese medical students have an excellent or very good opinion (62%) about their individual health. Students that live without relatives generally have a worse opinion of their health than students that live with relatives(p=0.001).
No significant differences were found regarding gender, year at college and classifications at Anatomy or Preventive Medicine.
Physical Activity(Table1)
Most of the students practiced exercise less than three times in the previous two weeks (62%) and would like to do it more (87%).
There were significant differences according to residency status. Students that live with their relatives do more physical activity than students living without their family (p=0.019). 45% of the students living with their relatives have done exercise between 3 and 14 days in the previous two weeks, while only 32% of the students living without their family make exercise with that frequency in referred period.
Differences between genders, year at college, and classifications at Anatomy and Preventive Medicine were not significant.
Smoking(Table1)
Only 5% of the students do usually smoke on average more than onecigarette per day. Among these, 60% would like to reduce the amount they smoke.
Students living with their relatives smoke less than students living away from their family (p=0.029). 92% of students living away from their family do not smoke or smoke less than one cigarette per day in comparison with 97 % of students living with their relatives.
Differences between genders, year at college and classifications at Anatomy and Preventive Medicine were not significant.
Eating(Table 2)
Most of the students have breakfast daily or almost every day (91%) and eat three or more meals per day (94%). 67% avoid eating aliments rich in fat an cholesterol, 75% have at least once per day a meal that includes meat, 67% of them eat fruit at least one time per day and 83% rarely or never add salt to prepared food. 65% of Portuguese medical students eat 2 or 3 times per day a between-meal snack and 29% eat it once. Most of the students think that they weight about right (80%) but only 64% are currently not trying to loose weight.
Clearly women have the breakfast more often (p=0.035) and eat more fruit(p=0.004) thanmen, and a higher percentageare trying to loose weight (p=0.023). 93% of female students eat breakfast daily or almost every day and only 86% of male students do it. 72% of the women and just 54% of men eat fruitat least once per day. 41% of women are trying to loose weight opposing to 28% of men.
On the other hand, students living with their family make more meals per day (p=0.015). The percentage of students that eat only one or two meals per day is 3% in students living with their relatives and 10% for students living away from their family. Furthermore, 13% of students living with their relatives in comparison to 21% of students living away from their family usually or sometimes add salt to prepared food (p=0.036).
No significant differences in the eating were between older and younger students or between students with a lower or higher mark in Anatomy and Preventive Medicine.
Sleeping (Table1)
78% of students get on average between six and eight hours of sleep per day.
Significant differences exist between genders (p=0.048). 16% of men and 7% of women sleep on average less than six hours, and 74% of men and 79% of women sleep on average between six and eight hours per night.
There are no significant differences between first and fourth year students, according to residency status and classifications at Anatomy and Preventive Medicine.
Alcoholconsumption (Table1)
58% of the students never drink or do only drink in very special occasions. Among those that drink more than the previous 53% have drunk in less than seven day in the previous two weeks. And the majority of them (89%) are not trying to reduce what they drink.
There was substantial variation between first and fourth years (p=0.038) and between genders (p=0.001). 55 % of first year medical students never drank or drank just in very special occasions, while 68 % of fourth year medical students had the same behaviour. 64% of females never drank or drank just in very special occasions and 45% of males have the same attitude.
On the other hand, only 3% of the students that live with their relatives wants to reduce what they drink and 17% of the students living without their family are in the same situation (p=0.008).
No significant differences were detected between students with a higher or lower classification at Anatomy and Preventive Medicine.
Other Behaviours(Table 2)
The majority of students uses regularly or always sun lotion at the beach (93%), brush their teeth twice or more a day (87%) and annually go to the dentist (73%). However just 37% of students annually go to the doctor for a check-up.
Women go more to the dentist(p=0.012) and use more sun lotion (p=0.007).According to classifications at Anatomy, less students with 13 or more annually go to the dentist in comparison to students with 12 or less as classification (p=0.032).