Barriers to Healthy Lifestyle among College-Going Students in a Selected College in Bengaluru Urban District.

CONTEXT: Cardiovascular diseases (CVDs) are influenced by factors acting at all stages of life. Healthy lifestyle practices among adolescents and youth are crucial in preventing CVDs in the later years. Many barriers prevent young people from practicing healthy lifestyles. AIMS: The aim of this study is to identify barriers to healthy lifestyle among college-going students in Bengaluru Urban District. SETTINGS AND
DESIGN: A cross-sectional study was conducted among 722 students aged 15-25 years, in a degree college in Bengaluru Urban district. SUBJECTS AND METHODS: A structured interview schedule with good internal consistency (Cronbach's alpha = 0.887), consisting of 50 questions scored on a 5-point Likert scale with five domains (diet, physical activity, tobacco use, alcohol consumption, and stress) was administered. The total score was classified into high-, moderate-, and low-barrier categories using percentiles. The barrier score for each domain and for each individual question was computed by multiplying the weight of the responses by their frequencies. STATISTICAL ANALYSIS USED: Barriers to healthy lifestyle and its association with sociodemographic variables were analyzed using inferential statistics such as t-test and ANOVA. Significant factors were entered into a multiple linear regression model.
RESULTS: The domain of stress emerged as the topmost barrier followed by diet. The main factors responsible for stress among college students were examinations (74.9%), long hours of the study (71.1%), and lack of time (69.6%).
CONCLUSIONS: Barriers to healthy lifestyle are common among adolescents and youth. The topmost barriers identified were stress- and diet-related barriers. Copyright:

INTRODUCTION

Noncommunicable diseases in India are increasing in prevalence. Roughly, 5.8 million Indians die from noncommunicable diseases such as heart and lung diseases, stroke, cancer, and diabetes.[1] Asian Indian Phenotype makes it more likely for Indians to develop diabetes at a younger age with increased subsequent risk of complications, including cardiovascular diseases.[2]

The risk of noncommunicable diseases is influenced by factors acting at all stages of life. Adolescents and youth are in the transition period, during which most of the risk factors develop. The behavioral patterns established during this developmental phase determine their current health status and the risk for developing some chronic diseases in the later years.[3]

Common lifestyle-associated risk factors in this age group are inappropriate dietary practices (fast food consumption, low fruit consumption), low physical activity, and experimentation with alcohol and smoking.[4] High levels of chronic stress are also linked to noncommunicable diseases.[5]

Lack of time, poor time management, lack of motivation, lack of knowledge, lack of accessibility, peer pressure, media influences, priority of studying, and lack of family and cultural support are the common barriers to healthy lifestyles among youth.[67] The WHO defines youth as those of 15–24 years of age.[8] As per 2011 census, in India, the population aged 15–24 years accounts for 18.4% (189.98 million) of the country's population.[9] This large chunk of population forms a critical group for targeted interventions against lifestyle-related diseases, as unhealthy habits picked up at college level generally persist in adult life.

If the barriers to a healthy lifestyle are identified and studied it would help to develop and adopt appropriate intervention strategies to counter these barriers. Therefore, this study was undertaken with the aim to identify barriers to healthy lifestyle among college-going students in Bengaluru Urban District.

SUBJECTS AND METHODS

This was a cross-sectional study done on 722 students aged 15–25 years at a degree college (St. Francis de sales, Hosur road) in Bengaluru urban district during the period from August to November 2015. After explaining the aims and procedures of the study, permission for the study was obtained from the administration of the college and individual consent and assent was obtained from participants.

With reference to a study done by Robbins et al.[10] who reported that 57.2% of the adolescent girls perceived self-consciousness about looks to be the most common barrier for regular physical activity, we estimated that a sample size of 376 students would be required for our study at an absolute precision of 5% and at 95% level of confidence. All the students pursuing various courses at the college were included in the study. Those who were on leave on the day of administration of the questionnaire were excluded from the study.

A face-validated interview schedule was administered to the students, which consists of two parts: (a) Sociodemographic details and (b) Barriers to healthy lifestyle of students. The barriers were classified into five domains, namely diet, physical activity, tobacco, alcohol, and stress. In all the five domains together, a total of 50 questions were constructed and scored on Likert's scale ([1] strongly disagree,[2] disagree,[3] neutral,[4] agree, and[5] strongly agree). Cronbach's alpha was found to be 0.887, which suggested good internal consistency. The maximum total barrier score was 250. The total barrier score was classified into low, moderate, and high based on tertiles (low barrier, moderate barrier, and high barrier). We identified top most barriers to healthy lifestyle. For this, a score for each item was obtained by multiplying the weightage into the frequency of responses. For each question, maximum possible score was 900.

The data were entered into Microsoft Excel and analyzed using the SPSS version 20 (Armonk, New York, USA). The sociodemographic detail of the study population was described using descriptive statistics such as frequencies. Barriers to healthy lifestyle and its association with sociodemographic variables were analyzed using inferential statistics such as t-test and ANOVA. Significant factors were entered into a multiple linear regression model.

RESULTS

A total of 722 students were included in the study. The participants ranged in age from 16 to 24 years (mean = 18.91). Majority (71.6%) of participants were in the age group 16–19 years. Males constitute 50.3% and females 49.7% of the students. B. Com students constitute 62.7% (453), BA 13.7%, followed by BBA (9.8%), BCA (9.1%), and BBM (4.6%). Out of the total study population, 4.6% gave a history of any form of tobacco use and 9.6% gave a history of alcohol use.

Table 1 represents the total barrier score and barrier score of each domain we studied (diet, physical activity, tobacco, alcohol, and stress), classified into low-, moderate-, and high-categories. This table shows that 52.4% had a moderate barrier score to health lifestyle, whereas 1.2% had a high-barrier score. The domain of stress had the highest proportion of patients in the high-barrier category (16.5%). Top barriers in each domain are depicted in Table 2.

Table 1

Frequency of barrier scores in different domains

Domains	Low barrier (%)	Moderate barrier (%)	High barrier (%)
Diet	208 (28.8)	491 (69.0)	23 (3.2)
Physical activity	301 (41.7)	389 (53.9)	32 (4.4)
Tobacco	593 (82.1)	115 (15.9)	14 (1.9)
Alcohol	561 (77.7)	142 (19.7)	19 (2.6)
Stress	119 (16.5)	484 (67.0)	119 (16.5)
All domains	335 (46.4)	378 (52.4)	9 (1.2)

Table 2

Top barriers in each domain

Barriers	Barriers in each domain	Weightage score (maximum: 900) (%)
Stress	I have stress during time of examinations	2705 (74.9)
	Long hours of study make me stressed	2565 (71.1)
	Lack of time make me stressed	2514 (69.6)
Diet	Don’t have access to healthy food in college canteen	2388 (66.1)
	I miss breakfast due to lack of time	2430 (67.3)
Physical activity	I don’t have time to do physical activities	2121 (58.8)
	I would rather play videogames or watch television than exercise	2078 (57.6)
Tobacco	I don’t know the dangers of tobacco	1414 (49.1)
	My friends use tobacco on a regular basis	1582 (43.8)
Alcohol	My friends drink alcohol on a regular basis	1538 (42.6)
	I don’t think it is wrong/bad to consume alcohol	1397 (38.7)

Association between sociodemographic variables and the barrier score of each domain was tested using independent t-test and ANNOVA and all items that were statistically significant with a value of P < 0.05, were included for the analysis by multiple linear regression. Males have more barriers to healthy lifestyle in domains diet, tobacco, and alcohol use compared to that of females. Barriers for physical activity were more among females compared to that of males. Furthermore, students' ≤19 years have more barriers to diet compared to those ≥20 years. We could not find a significant association between stress and any of these variables [Table 3].

Table 3

Multivariate linear regression- Association of demographic factors with each domain

Outcome variable	Predictor		Mean score	Regression coefficient	P
Total	Gender	Male Female	122.23±26.637 117.56±20.724	- 0.097	0.009
Diet	Gender	Male Female	32.30±6.794 31.79±6.770	- 0.120	0.009
	Age	≤19 ≥20	30.60±8.116 28.59±8.398	- 0.088	0.019
Physical activity	Gender	Male Female	29.22±8.956 30.86±7.372	0.094	0.011
Tobacco	Gender	Male Female	17.44±7.389 14.81±5.444	- 0.199	0.001
Alcohol	Gender	Male Female	17.96±8.110 15.23±6.118	- 0.197	0.001

DISCUSSION

Stress emerged as the top most barrier to healthy lifestyle among adolescents. Study done by Sani et al. in Saudi Arabia reported that long hours of the study, examinations and very tight time schedule were the top most barriers which is similar to this study.[11] This may be due to the strict education system and semester examinations in every 6 months.

Top most barrier in healthy diet was skipping breakfast due to lack of time which, in turn, can lead to obesity. Those who skip breakfast have increase appetite and will take large proportion in the next meal.[12] Students always prefer fast food due to personal taste preferences.[13] Here, due to easy access to junk foods in the canteen, students will be have large proportion of junk food in their next meal which intern increases their body mass index.[12]

Lack of time for physical activity and playing videogames or watching television are the barriers for physical activity. This may be due to academic pressures and preferences for other sedentary recreational activities, respectively.[14] Girls are less likely than boys to be interested in physical activity due to societal restrictions,[14] and they are self-conscious about their physical profile while exercising.[10]

Barriers to tobacco and alcohol use were more in females than in males. NFHS 4 reported that males consume tobacco and alcohol more than the females in the age group of 15–24.[15] Use of alcohol and tobacco use by friends is influencing the use of same by adolescents.[16] Overall barriers to healthy lifestyle was significantly higher among males than in females. This may be because of peer pressure and greater access to alcohol and tobacco.

CONCLUSIONS

Barriers to healthy lifestyles, especially stress and diet related, are common among adolescents and youth. Males had more barriers to healthy lifestyles than females, except in the domain of physical activity. Counseling sessions to help manage stress, health education sessions on diet, activity and addictions should be conducted regularly. Physical activity should be a part of the curriculum to have a healthy lifestyle.

Limitation

We calculated the barriers to healthy lifestyle using a quantitative method. For further exploration of barriers, a qualitative component is required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.