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Assessing HeAltHy nutrition AwAreness Among College students And tHe role of HeAltH

eduCAtion in Promotion

Hanaa Alamari Kuwait University

The purpose of this study was to assess the level of healthy nutrition awareness between college students, and its effect on their health. Healthy Nutrition plays an important role in preventing health prob- lems associated with unhealthy diet especially overweight and obesity. Three hundred and forty undergraduate college students participated in the study, The test scores were analyzed by using quantitative methods. Computer data entry and analysis were done by using SPSS (Statistical Package for the Social Sciences). The results of the study revealed that, a high percentage of college students at Kuwait University were unaware about healthy nutrition, and the risk factors resulting from eating unhealthy. Major variations among students were found accord- ing to their gender, age, level of study, and major. Statistical Analysis using T-Test showed that significant differences exist in the level of nutrition awareness among students, and male students tended to have a higher level of awareness than their counterparts in all aspects. Most of the students agreed that health education plays an important role in promoting a healthy nutrition among them.

Keywords: Healthy nutrition; awareness; college students; health ed- ucation; promotion

Introduction Nutrition is the science that investigates

the relationship between physiological func- tions and the essential elements of the food we eat. Nutrition is the area of health that focuses on selecting foods that contain nutrients, eval- uating food labels, eating the recommended daily amounts of foods from My Pyramid, following the Dietary Guidelines, planning a healthful diet that reduces the risk of mal- nutrition disease, and developing healthful eating habits.

Following the Dietary Guidelines in stu- dents diet is very important, in order to protect

them against foodborne illness, maintaining a desirable weight and body composition, and developing skills to prevent eating disorders, ( Laura &Kirsten, 2006). Nutrition education provides knowledge and increases awareness about healthy eating habits between college students. The food provided in the university is characterized by high level of fats, sugars, and carbohydrates, and low in nutrient con- tents. College students are not aware of what is the best and healthiest food to select, there are no nutrition labels on any package of each type of food offered at the university. Ingre- dients and components of any food should be

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stated on it, with the dietary guidance in order for the students to adopt healthy eating habits (Francis &Eleanor, 2005).

For a good health, college students should increase complex carbohydrates consumption to 48 percent of total calories, and reduce proteins to 12 percent, simple sugars to 10 percent, and less than 30 percent fat Low intake of vitamins, minerals, and water can also affect health, because they are necessary for healthy body function, but do not supply calories to our diet. Most diet-related diseases results from excess calories and an increased consumption of fat, (Cottrell, Girvan & McK- enzie, 2015).

The National Academy of Science, the National Cancer Institute, and the American Cancer Society (2007), have examined the role of diet in preventing cancer, To reduce the risk of developing cancer, college students should practice dietary guidelines by main- taining a healthy weight to prevent obesity, eat a variety of foods rich in antioxidants, eat foods rich in fibers, such as fruits, and vegeta- bles that are cruciferous, cut fat consumption, salted and smoked food, and avoid the con- sumption of alcoholic beverages.

Importance of Health Education in Promoting Healthy Nutrition

Health education programs help increase awareness between college students about healthy eating habits and its effect on their health. The interventions may target food pol- icy or nutrition education. Health education helps students develop the skills and knowl- edge about nutrition to modify their eating habits and avoid leading causes of death, illness, and injury, (US Department of Health and Human Services, 2010). Health educa- tors and nutritionists play an important role at the university level. In order to implement nutrition lectures among college students, teaching health education is important to help influence their knowledge about nutrition.

Health education campaigns offer programs to promote healthy nutritional attitudes, knowledge and behavior, including healthy eating among college students. (Eun-Jeong & Natalie, 2009).

Health education plays an important role in promoting healthy eating habits, It provides the health information needed to teach young people important life skills for nutrition. Diet affects a person’s health status in the present as well as in the future. A healthful diet is needed for growth and development. It pro- vides energy for daily activities, including ex- ercise. College students should eat a healthful diet to reduce the risk of developing certain diseases like obesity, high blood pressure, cardiovascular diseases, diabetes, and osteo- porosis. (Powers &Todd, 2006).

The main purpose of this study was to assess the differences in the levels of healthy nutrition awareness among college students, and their opinion about the importance of health education in promoting healthy eating habits between them.

Review of the Literature In their study, (Anding, Suminiski &

Boss, 2001), show the differences in the levels of perception among college students about a healthy nutrition and its effect on their health according to their gender. The study revealed that, the perception about healthy nutrition differs significantly among college students regarding the following as- pects: vitamin A deficiency affects growth and causes malnutrition diseases (p<0.05), protein deficiency affects growth (p<0.01), bread and whole grains are good sources of fibers and provide energy (p<0.005), dairy products are good source of vitamins, calci- um, and protein (p<0.005), Fruits and veg- etables are rich with vitamins and minerals (p<0.001).Female students are found to have a higher level of perception than their coun- terparts in all these aspects, while perception

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about meat and beans are rich with protein and iron (p<0.05) differed significantly, and it was found to be higher among male col- lege students than their counterparts,

There should be more emphasis on improv- ing dietary habits between college students, and this emphasis should be given in the college level, because the eating habits that a person develop in the college will usually, continue into adulthood. College campuses should have programs that target the student’s daily food consumption, such as the types of food they are eating, the amount of the food, and how often they are eating, to reduce health problems that they encounter, (Center for Disease Control and Prevention, 2012).

Haberman & luffy (2008) defined mal- nutrition as,” lacking the proper nutrition for the body to function at its best, and is much more common around college students, and Obesity is the body weight that is 20 percent or more over desirable body weight.

A study, at the department of food resourc- es at Kuwait Institute of Scientific Research (KISR), Al Houti, (2010) in coordination with the Ministry of Health in Kuwait, was designed to examine Kuwaiti’s eating habits and its relationship with some widespread diseases. The study showed that 70 percent of Kuwaiti men and 75 percent of Kuwaiti wom- en are overweight. There is a need to examine the eating habits and investigate the causes of widespread diseases and illnesses, namely: diabetes, obesity, cardiac troubles and high blood pressure. Such knowledge is vital to change the wrong eating habits. Those suf- fering from diabetes amounted to 15 percent. The spread among females was slightly high- er than among males. The study revealed that 22% of males and 27% of females suffered from low metabolism and 30% suffered from high cholesterol which reached 60 % among females aged 50 and above. Obesity threatens to become the leading health problem in the 21st century.

Potential health implications related to overweight may occur between college stu- dents, and affect their health, health education courses should be required at the university level to improve their nutritional knowledge. Justification is based on known linkages be- tween health education and nutrition. (Paul, Insel & Walton, 2006).

Obesity is described as epidemic in the United States, (Contento, Koch &Lee, 2010), and (the World Health Organization, 2012) describes obesity as an “escalating global ep- idemic “in many parts of the world”. College obesity is increasing, college students should achieve and maintain a healthy eating pattern that consisted of the four food groups, they should take adequate amounts of nutrients, and not to exceed energy needs, to maintain health and to prevent the development of high blood pressure, cardiovascular diseas- es, stroke and overweight, Being overweight is associated with the development of car- diovascular disease. Overweight students should work on losing weight to lower their risk cardiovascular disease. (Linda, Philip, &Randy, 2007).

The food guide is a nutrition education tool translating scientific knowledge and dietary standards and recommendations into understandable and practical for use by those who have little or no training in nutrition, (Lee, & Nieman, 2013). Food guides are problem oriented and address specific nutri- tional problems identified within the college students. Typically, foods are classified into basic food groups according to similarity of nutrient content or other criteria. If a certain number of servings from each groups is con- sumed, a balanced and adequate diet is likely to result a healthy nutrition. Health education programs related to nutrition offers basis for calculating the daily values.

According to American College Health Association (ACHA, 2007), studies show that most students at the college level are not

Assessing Healthy Nutrition Awareness Among College Students / 363

aware about the effect of iron deficiency and low vitamin (B12) intake on health. It is im- portant for college students to eat a variety of food, to get the right combination of antioxi- dants. Fruits and vegetables contain vitamin C.E, and A, which are antioxidants that help prevent cancer of the colon, rectum, prostate, stomach, esophagus, and lung. (Rebicca & Lorraine, 2009).

Healthy nutrition play an important role in preventing diseases. The risk of developing health problems between college students, can be reduced by eating a variety of foods, because when a person consumes a variety of foods, the body will have a combination of nutrients, which help in reducing the risk of cancer.eg various foods contain antioxi- dant-substances that protect cells from being damaged by oxidation, ( Ann, 2006).

Method The objective of this research was to assess

college student’s awareness about healthy nu- trition, and their opinion about the importance of health education in promoting healthy eat- ing habits between them. This research pres- ents a qualitative approach. For the purpose of the study, information were collected via a nutrition questionnaire, a standard survey tool by (Harris, 2004). Computer analysis and data entry were scored by using SPSS/PC (statistical package for the social sciences). Data analysis included frequency distribution, percentages, mean, standard deviation, t-test and Pearson Correlation Analysis test.

Sample The sample used to conduct the research

was made up of three hundred and forty undergraduate college students attending Kuwait University, their age ranges between 18-26 years, and from different levels of edu- cation, and majors.

Instruments A questionnaire was administered to

the students at different colleges at Kuwait University.

The questionnaire consists of three sec- tions. The first section requested demographic data including student’s gender, age, level of education, and college of study (Arts or Sci- ence). The second section of the questionnaire measures the differences in Perception among college students regarding their awareness about healthy nutrition, it consists of twelve aspects. The third section is about the role of Health Education in promoting healthy nutri- tion between college students, it consists of four aspects.

Reliability and Validity Cronbach’s alpha coefficients were calcu-

lated for the following scales: Healthy Nutri- tion, and Health Education. Alpha coefficients were evaluated using the guidelines suggested by (George & Mallery, 2016). The items for Healthy Nutrition Awareness had a Cron- bach’s alpha coefficient of 0.76, indicating acceptable reliability. The items for Health Education had a Cronbach’s alpha coefficient of 0.74, indicating acceptable reliability.

Results Frequencies and Percentages for Student’s Demographic

Three hundred and forty college students completed the questionnaires, the most fre- quently observed category of gender was female (n = 203, 60%). The most frequently observed category of level of education was Second (n = 128, 38%). The most frequently observed category of age was 18-22 (n = 214, 63%). The most frequently observed category of college of study was Arts College (n = 252, 74%). Frequencies and percentages are pre- sented in Table 1.

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Table 1. Frequency Distribution &Percentage for Various Nominal Independent Variables

Variable N %

Gender

Female 203 60

Male 137 40

Level

First 108 32

Second 128 38

Third Fourth 38 11

58 17

Missing 2

Age

18-22 214 63

22-24 84 25

24-26 35 10

Missing 7 2

College

Arts 252 74

Science 88 26

Missing 0 0

Table 2. Perception of college students about Healthy Nutrition:

Variable M SD N

Performing daily exercise increase the body ability to prevent overweight

4.25 0.93 340

Food additives and chemicals are related to cancer

4.23 1.21 339

Freezing food help to pre- serve it for a longer time

3.26 1.49 339

Eating healthy food helps prevent the spread of over- weight and obesity and is very important for a person’s overall health

4.06 1.05 335

Fruits and vegetables are rich with vitamins, minerals and fibers

4.00 1.02 339

Variable M SD N

Dairy products are rich with vitamin D, Calcium and phosphorus

4.15 1.02 340

People with high cholesterol should eat less fatty food

2.61 1.41 340

Protein deficiency cause mal-nutrition diseases

3.88 1.38 340

Vitamin A deficiency cause eye sight weakness

2.63 1.42 340

Vitamin D, Calcium, and phosphorus deficiency are the main cause for bone diseases

2.32 1.62 339

Vitamin B12 helps prevent blood Anemia

2.22 1.50 339

Bread and beans food group contain a high percentage of carbohydrates

3.59 1.32 339

Perception of college students about Healthy Nutrition:

As seen in table 2, the results according to ranking from the highest mean to the lowest Mean were as the following:

Performing daily exercise increase the body ability to prevent overweight”, (Mean =4.25, SD = 0.93). “Food additives and chem- icals added to food, are related to cancer”, (Mean = 4.23, SD = 1.21), “dairy products are rich with vitamin D, Calcium and phos- phorus, it helps the healing process of frac- tured bones” (Mean = 4.15, SD = 1.02), “eat- ing healthy food helps prevent the spread of overweight and obesity and is very important for a person’s overall health” ( Mean = 4.06, SD = 1.05), “fruits and vegetables are rich with vitamins, minerals and fibers” ( Mean = 4.00, SD = 1.02), “protein deficiency cause mal-nutrition diseases” ( Mean = 3.88, SD = 1.38), “Bread and beans food group contain a high percentage of carbohydrates and it’s a high source of energy” ( Mean = 3.59, SD = 1.32), “freezing food help preserve it for lon- ger time” ( Mean = 3.26, SD = 1.49), “vita- min A deficiency cause eyesight weakness ”(

Assessing Healthy Nutrition Awareness Among College Students / 365

Mean = 2.63, SD = 1.42), “people with high cholesterol should eat less fatty food” ( Mean = 2.61, SD = 1.41). “Vitamin D, Calcium, and phosphorus deficiency are the main cause for bone diseases” (Mean = 2.32, SD = 1.62), “vitamin B12 helps prevent blood Anemia”, (Mean = 2.22, SD = 1.50).

The study revealed that a high percentage of college students at Kuwait University are not aware about the health problems and the risk factors associated with unhealthy eating habits. The majority of the students did not know the fact that protein deficiency and vitamins deficiency cause malnutrition prob- lems and other health related problems e.g., Obesity, High blood pressure, High choles- terol, Anemia, Eyesight weakness, Bone illnesses. The results showed that college students at Kuwait University are unaware about vitamin A deficiency effects eyesight, fatty food increase the level of cholesterol, vitamin D deficiency causes osteoporosis and other bones illnesses, The students didn’t of know the importance vitamin B12 in protecting from Anemia.

Table 3. Perception of College Students about Health Education Promotion

Variable M SD N

Teaching health education to college students is very import- ant to develop healthy eating habits

4.14 1.19 340

Health education increases knowledge about malnutrition diseases

4.04 1.09 334

Teaching health education helps in promoting knowledge about human health and nutrition

3.18 1.42 337

Health education follows dif- ferent educational methods that increase healthy Nutrition

3.53 1.28 340

Perception of students about Health Education Promotion:

As seen in table 3,The results according to ranking from the highest Mean to the lowest Mean were as the following: “Teaching health education to college students is very import- ant to develop healthy eating habits”, (Mean= 4.14, SD = 1.19), “health education increas- es knowledge about malnutrition diseases”, (Mean= 4.04 and, SD = 1.09), “health educa- tion follow different educational methods that increase Healthy Nutrition ”, (Mean) = 3.53, SD = 1.28), “teaching health education at the university level helps in promoting knowl- edge about human health and nutrition”, (Mean = 3.18, SD = 1.42).

Independent Sample t-Test for Healthy Nutrition according to gender

An independent sample t-test (George et al 2016) was conducted, to detect if there is a significant difference between male and female college students in their levels of awareness about healthy Nutrition according to their gender.

Table 4 shows that t-test was not sig- nificant, t (338) = -0.04, p >.05 ( p =, 968), suggesting that the mean value of Healthy Nutrition, was not significantly different be- tween male and female students, but the mean values show that male students (M=3.36, SD=.58) possessed higher levels of knowl- edge about healthy nutrition, than female stu- dents (M=3.35, SD=, 64 ), but this difference is not statistically significant at, 05 level.

Independent Sample t-Test for Health Education promotion according to gender

An independent sample t-test was conduct- ed to detect if there is significant a difference between male and female college students in their opinion about the importance of Health Education in promoting healthy nutrition.

As seen from table 5, the result of the

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independent sample t-test was not significant, t (338) = 0.03, p>.05 (p =, 980) suggesting that the mean average of health education was not significantly different between male and female at, 05 level, but the mean values show that male students (M=3.72, SD=.90) and female students (M=3.72, SD =.97) agreed equivalently about the importance of Health Education in promoting healthy nutrition.

Pearson Correlation Analysis between Health Awareness and Student’s Health Ed- ucation Pearson correlation analysis was conducted between Health Education, and Healthy Nutrition. Table 6 presents the results of the Pearson Correlation Matrix between Health Educations and Healthy Nutrition.

Table 6 Pearson Correlation Matrix between (Health Educations) and (Healthy Nutrition)

Variable 1 2

1. (Health Education) -

2. (Healthy Nutrition) 0.25 -

Note. The critical values are 0.11, 0.14, and 0.18 for significance levels, 05,, 01, and, 001 respectively.

Cohen’s standard test (1988), was used to evaluate the strength of the relationship,

where coefficients between, 10 and, 29 repre- sent a small association, coefficients between, 30 and, 49 represent a moderate association, and coefficients above, 50 indicate a large association (Westfall & Henning, 2013).

As seen in table 6 there is a significant pos- itive correlation between Health Education and Healthy Nutrition (r = 0.25, p <, 001). The correlation coefficient between Health Education and Healthy Nutrition was 0.25 indicating a small relationship. This indicates that as Health Education increases, Healthy Nutrition Awareness, tends to increase. The study showed That Health Education is very important in increasing awareness of healthy eating habits between college students.

Discussion Teaching health education is important to

develop healthy eating habits and improve nutrition, it plays an important role in the promotion and prevention of malnutrition diseases, and promote physical and psycho- logical health and improve nutrition, and ac- cordingly, there should be more emphasis on improving the levels of knowledge between students about different methods conducting a healthy nutrition between them. The results

Table 4. Independent Sample t-Test for perception about Healthy Nutrition according to gender

Female Male

Variable M SD M SD T P D

Healthy Nutrition 3.35 0.64 3.36 0.58 -0.04 .968 0.00

Note. Degrees of Freedom for the t-statistic = 338. d represents Cohen’s d.

Table 5. Independent Sample t-Test for Health Education Promotion according to gender

Female Male

Variable M SD M SD T P D

Health Education Promotion 3.72 0.97 3.72 0.90 0.03 .980 0.00

Note. Degrees of Freedom for the t-statistic = 338. D represents Cohen’s

Assessing Healthy Nutrition Awareness Among College Students / 367

of the study, showed that there is a need to promote healthy nutrition between college students at Kuwait University, as proposed by the world health organization (WHO, 2012). Students should be involved in promoting a healthy nutrition and live a healthy life. These results supported the likely value of including nutrition knowledge as a target for health edu- cation campaigns aimed at promoting healthy eating. Colleges in general should institute a special department for nutrition education to help their students develop healthy eating habits, and increase the knowledge about healthy nutrition between them, improve their health and reduce the spread of malnutrition diseases among t

Conclusion We conclude from the study that a high

percentage of college students are not meeting dietary guidelines. Male students were found more aware about healthy nutrition than fe- male students. The study revealed that, most male and female students agreed equivalently, that teaching health education courses will increase the knowledge about nutrition and should be required for graduation. These re- sults cause serious impact on student’s health and should be taken into considerations

The findings of the study pave the way for other researchers, physicians, and health care specialists, to conduct future research of nu- tritional importance between college students. Interventions should be conducted by facilita- tion group sessions where nutritional educa- tion is promoted in order to spread awareness. There should be further studies to investigate the effect of malnutrition on college student’s health, their academic performance and the difficulties they will encounter because of un- healthy diet. (Trockel, Barnes &Egget, 2002).

Future efforts should include nutrition knowledge as a target for health education campaigns aimed at promoting healthy nutri- tion between college students.

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