Features of the first-year students’ lifestyle at the faculty of medicine: an observational study

Darina A. Yahagoeva, Darina A. Zhurtova, Аksana M. Kаrdаn-gushevа, Ilona S. Khagabanova, Elvira K. Appaeva, Dinara R. Zherukova. Features of the first-year students’ lifestyle at the faculty of medicine: an observational study. Cardiometry; Issue No. 27; May 2023; p. 211-220; DOI: 10.18137/cardiome-try.2023.27.211220; Available from: issues/no27-may-2023/features-first-year-students’-lifestyle

Preserving and strengthening the health of student youth as the future labor, reproductive, and defense potential of the country is the most important state task [1,2]. Educational institutions can make an invaluable contribution to strengthening the health of students and promoting a healthy lifestyle (HLS) in them [2-11]. Of particular interest is the preservation of the health and labor potential in medical students, whose specific educational and occupational pathways places high demands on their health [12,13,14]. The contradiction lies in the fact that an imbalance between the intensity of training loads and their free time can lead to the formation of behavioral habits with an expected negative impact on their health [15,16,17]. Studies devoted to the study of the lifestyle in medical students have shown that the students generally keep an unhealthy lifestyle with some differences in their lifestyle components, gender, courses of their study and areas of their occupational training [18-25]. Therefore, of particular scientific and practical interest is an identification and an analysis of some factors influencing the formation of a healthy lifestyle for future medical doctors at the initial stage of their study at a university.

The aim hereof is to study the lifestyle characteristics of the first-year students at the Faculty of Medicine and identify some key predictors of an unhealthy lifestyle.

METHODS

Study design

An observational cross-sectional study was conducted.

Research study conditions

The study was conducted at the Department of Public Health, Healthcare and Preventive Medicine of the Medical Faculty at the Kabardino-Balkarian State University (KBSU) named after I.I. HM. Berbekov.

Eligibility Criteria

Inclusion Criteria

The criteria for inclusion in the study were applicable as follows: the first-year studies at the Medical Faculty of KBSU, Russian citizenship, consent to participate in the study.

Criteria for non-inclusion

The study did not include foreign citizens and cases of no consent to participate in the study.

Exclusion Criteria

The exclusion criterion was no response to the invitation to take part in the survey.

Selection of participants in groups

The subject of the study was the cohort of the first-year students of the Faculty of Medicine as mentioned above. The selection of units of observation among the first-year students was carried out by the nesting method while maintaining the proportion characteristic of the general population.

Study duration

The study was conducted since October 20 till December 21, 2022.

Study Targets

Key research indicator

Lifestyle characteristics (physical activity (PA), daily routine, diet schedule and diet composition, bad habits available/not available) and predictors of un-

212 | Cardiometry | Issue 27. May 2023

healthy lifestyles in the first-year students of the Faculty of Medicine as indicated above.

Additional indicators

Additional outcomes were not included in the study design and therefore not identified.

Methods for measuring targets

The study was conducted using the online Google Forms Designer. The link to the survey was sent to the participants through the group leaders via e-mail and the WhatsApp messenger. An anonymous survey was carried out according to a specially designed questionnaire containing 80 questions to study the socio-demographic characteristics that make up the lifestyle (PA, daily routine, diet schedule and diet composition, the presence/absence of bad habits), well-being, attention to one’s own health.

Statistical analysis

Sample size principles

The required volume of the sample statistical population was calculated by the formula for determining the required number of observations (n) (Merkov A.M., Polyakov L.E., 1974). As a result of the calculations, the volume of the sample was to be 336 units of observation. The sample set reflected the properties of the general population both quantitatively and qualitatively (by gender and age).

Methods of statistical data analysis

Our statistical analysis of the data was carried out using STATISTICА 6.0 software (StatSoft Inc, USA). The results are presented as the mean and its standard deviation for continuous variables and as a proportion (percentage) for categorical variables. The construction of a logistic regression model was provided by the method of stepwise inclusion of prognostic factors. At p<0.05, the null hypothesis of model insignificance was rejected.

RESULTS

Formation and characteristics of the study sample

The subject of the survey was the cohort of the first-year students of the Medical Faculty at KBSU. The survey involved 506 students, 366 women (72.3%) and 140 men (27.7%) aged 16-29 (mean age 18.2±1.7 years) who met the applicable inclusion criteria. The response was recorded to be 89.2%. The first-year students surveyed by us studied according the curricula “General Medicine”, “Medical and Preventive Care”, “Pediatrics”, “Pharmacy” with the governmentally financed (12.2%), privately financed (76.9%) and employer-financed (10.9%) ) educational forms. The majority of the students were not married or married (97.1%), however only 2% of students started their own families, and the rest were divorced or widows/ widowers. Most of the students surveyed rented housing (43.9%). 16.8% of the students lived in their own private house, 10.9% resided in their own apartments, 15.6% lived together with their relatives or friends in their apartment, and 12.9% of the respondents noted other living conditions.

The main results of the study

Table 1

Distribution of students’ answers to the question “What circumstances currently do not allow you to keep a healthy lifestyle?” (%)

Students responses	Frequency rate (%)
High study/work load	51.0
Hypodynamia	1.0
Laziness	9.3
My social circle	0.4
Rich personal life	2.6
Lack of funds for a healthy diet	4.2
Lack of motivation	10.3
Other	21.2

An important component of a healthy lifestyle is physical activity (PA). Figure 1 given herein shows the PA structure of our respondents. The most popular types of physical activity among our students are walking (18.1%), running (10.7%), gym classes (10.7%), volleyball (8.2%), aerobics (7.9%), fitness (7.9%) and football (4.7%). It is noteworthy that 20.4% of the students we have surveyed are not involved in any type of PA.

With regard to the ways of plasticizing PA, 45.7% of the students have reported that they go in for sports on their own, 18.1% with the help of video resources,

Structure of types of PA, %

Figure 1. The structure of types of physical activity of the surveyed students

• ■    Walking

• ■    Volleyball

• ■    Fitness

• ■    Basketball

• ■    Fighting

• ■    Morning exercises

• ■    Kickboxing

Tennis

Swimming

Mountain climbing

Football

Other

• ■    Workout room

• ■    Aerobics

• ■    Badminton

• ■    Boxing

• ■    Gymnastics

• ■    Yoga

• ■    Athletics Powerlifting Taekwondo Dancing Judo

• 4.6 % with applications for smartphones, and 31.6% have chosen the answer “other”. 5.5% of the respondents go in for sports every day, those who go in for sports 6 times a week amount to 1.2%, 5 times a week reach 5.7%, 4 times a week amount to 5.9%, 3 times a week cover 22.1%, 2 times a week cover 21.2%, and once a week amount to 27.1%, those who have never gone in for sports include 11.3% of the students. The PA duration for the students we interviewed ranged from 30 minutes up to 4 hours. For more than half of the respondents (55.1%), the duration of the PA session was 1 hour, for a fifth of the respondents (21.2%) it was 2 hours, for 12.7% it was less than an hour, for 11.2% it was recorded to be more than 2 hours. A study of the reasons hindering physical activity at the present time have revealed the following: a lack of time in 53.2% of the respondents due to their high study/ work load, 10.7% of the respondents reported lack of motivation, 2% reported their financial problems, 1.5% noted their family problems and 32.6% indicated other reasons. At the same time, only 14.8% of the students were not satisfied with the level of their PA, 36.8% reported they were completely satisfied, and 45.7% of them recorded they were not completely satisfied, while 2.8% of them chose the answer “other”.

• 21.3 % of the respondents assess the level of their study load as very high, 46.3% of them as high, 30.8% of them as medium and 1.6% of the cohort as low. At the same time, the students spend 3.0 ± 1.9 hours per day in online classes, and 4.1 ± 2.8 hours for self- preparation for classes. Our respondents spend 5.3±4.3 hours daily using their own gadgets. The students’ answers to the question what was the purpose of spending time using their gadgets were distributed as follows: studying (63.4%), browsing social networks (13.6%), chatting in instant messengers (11.3%), playing games (2.2%), work (0.1%) and other (8.5%).

Insufficient PA of the students is accompanied by an improper organization of their daily routine. So, to the question “Can you say that you observe the scheduled daily routine?” 27.9% of the respondents answered “yes”, 14.0% - “no”, 58.1% - “partially”. The range of the duration of night sleep in our students was within 2-12 hours (average 6.5±2.6 hours). The main part of the respondents (73.4%) indicated the duration of their nightly sleep of 6-8 hours, 4.7% reported the duration thereof exceeding 8 hours, 24.9% less than 6 hours. An assessment of the sufficiency of the night sleep duration has demonstrated that 57,5% of the respondents do not always get enough sleep, 14.6% suffer from chronic sleep deprivation, 19.4% have optimal night sleep duration, 5.7% of the students have found it difficult to answer the question, 2.8% have chosen the answer “other”. An analysis of the conditions that do not allow them to get the necessary time for sleep, has revealed that 74.5% of the students have a high workload with study and work, 7.3% have a “desire to surf the Internet”, 1.4% have a hobby, 0.6% of them have some family circumstances, 11.7% of them have indicated other, and 4.5% has not answered the question.

The most important component of the students’ healthy lifestyle is rational nutrition. The students’ assessment of their diet has shown that 24.6% follow the proper diet, 59.4% are not sure about it, 16% are sure that their diet is wrong. Considering the circumstances that currently do not allow adhering to the proper diet, the students indicate their high workload with study / work (46.4%), lack of financial resources (7.3%), and some family circumstances (1.4%). It is noteworthy that 44.9% give the answer “other”. 27.9% of the students adhere to a healthy diet, 14.6% do not follow it, and 57.5% of the students evaluate their diet as “not quite” correct. Lack of financial resources (54.6%) prevails considering the conditions, which currently do not allow adhering to a healthy diet by them. 1.2% of the respondents report resistance thereto by their family and their relatives, and 44.2% have not given the reason thereof. The study of the representation of various products in the diets of the students (see Table 2 given herein) has shown that less than half of the respondents daily consume fruits (37%) and vegetables, greens (45.3%). Animal products are daily available in the diets of the students in the form of red meat (19.4%), poultry meat (18.6%), sausages (7.1%), eggs (24.1%), milk and fermented milk drinks, cottage cheese (29.7%), cheese (25.9%); cereals are available in the form of pasta (9.7%), groats, grits and porridge (18%). Sweets and pastries are consumed daily by 43.8% of the respondents. Only 3.4% of the students eat fish every day.

When asked about the presence of any addictions or bad habits, 19.4% of the students answered “yes”. 8.9% of the students smoke, while the majority of smokers consume less than 10 cigarettes a day (6.7%). For the students we have interviewed, smoking is associated with undoubted harm to health (52.2%), unpleasant odor (7.9%), constant financial costs (2.8%);

Table 2

Food types (%) available in the diets of students

Food	Every day	1-2 times a month	1-2 times a week	1-2 times a season	Never
Fruits	37.0	10.9	46.4	3.8	1.9
Vegetables, greens	45.3	9.3	41.3	2.4	1.7
Red meat	19.4	19.2	49.4	3.9	8.1
Poultry meat	18.6	15.8	52.6	4.0	9.0
Fish	3.4	47	13.8	22.8	13
Bakery products	68.8	5.7	21.3	1.6	2.6
Milk, dairy drinks and cottage cheese	29.7	18	41.0	3.8	7.5
Eggs	24.1	20.0	47.8	3	5.1
Pasta	9.7	28.9	55.1	3.3	3.0
Sausages	7.1	36.2	30.3	13.2	13.2
Groats, grits and porridge	18.0	30.8	36.2	7.3	7.7
Cheese	25.9	24.5	40.3	3.2	6.1
Sweets	43.8	12.9	37.3	2.3	3.7

smoking is an unpleasant addiction (16.6%), a way to relieve stress (2.3%), and only two students have considered smoking as an attribute of communication in the society, one student has it as a way to spend free time, and 17.2% have chosen the answer option “other”. More than half of the smoking students (51.1%) would like to give up smoking, 13.3% are not ready to give up smoking, and 24.4% of them find it difficult to answer. 62.2% of the smokers report that during the last month, the number of cigarettes smoked by them has decreased, while 20% of the students indicate an increase therein, and 17.8% report there are no changes therein. Only 9.7% of the students consume alcohol. Among them, only 8 students drink alcoholic beverages daily, 5 students several times a month, and 3 students several times a week. The majority of students who drink alcohol (67.4%) reported drinking alcohol several times a year.

The next set of questions is related to various unpleasant symptoms that students may experience (see Table 3 herein). Thus, more than half of the students surveyed by us (56.9%) experience daily fatigue, more than a third of them note their daily internal stress and irritability (36.2% each), a feeling of alarm, anxiety (35.8%; a fourth of the students indicate despair (25.1%) and a fifth of them report fear (21%), discomfort in the eyes (21.1%) and headache (17.8%).

Table 3

The occurrence of unpleasant symptoms in students (%)

Symptoms	Every day	1-2 times a month	1-2 times a week	Never
Headache	17.8	29.6	38.6	14.0
Fatigue	56.9	7.3	29.2	6.6
Despair	25.1	23.3	26.5	25.1
Feelings of alarm, anxiety	35.8	20.8	27.7	15.7
Fear	21	24.5	25.3	29.2
Internal stress	36.2	19.8	28.0	16.0
Irritability	36.2	18.2	31.4	14.2
Discomfort in the eyes	24.1	15.8	22.1	38.0

Table 4 given herein shows the answers of students about the measures they take to save their health. Thus, 28.1% of the students surveyed by us are engaged in physical activity in order to preserve their health, 19.4% wash their hands more often, 10.5% regularly carry out wet cleaning at home, 6.1% follow the daily routine, 5.3 % adhere to the proper diet, 4.4% give up bad habits, 3% use personal protective equipment, 2.2% avoid undesirable social contacts, and 1.8% practices environmental exposure cold training.

Table 4

Distribution of students’ answers to the question “What do you undertake to maintain your health?” (%)

Students’ responses	Frequency (%)
Physical activity	28.1
Environmental exposure cold training	1.8
Avoid undesirable social contacts	2.2
Use of personal protective equipment	3.0
Giving up bad habits	4.4
Cleaning my house regularly	10.5
Follow the scheduled daily routine	6.1
Adhering to the proper diet	5.3
Handwashing more often	19.4
Other	19.2

(54.6%). Every day she experiences fatigue (56.9%), internal stress and irritability (36.2%), alarm, anxiety (35.8%), despair (25.1%), fear (21%), discomfort in the eyes (24.1%) and headache (17.8%).

A multivariate regression analysis was carried out to identify and evaluate predictors of an unhealthy lifestyle. As possible predictors that hinder the maintenance of a healthy lifestyle, we considered the frequency of PA sessions per week and the duration of training, factors that interfere with PA sessions, satisfaction with the level of PA, walking, compliance with the daily regimen, the duration and sufficiency of night sleep, causes of lack of sleep, the level of study load, compliance with the nutrition regimen, factors interfering with dietary compliance, the schedule of food consumption, the presence of bad habits, the number of cigarettes smoked), alcohol consumption (rate of consumption and preferred drinks, the desire to stop drinking alcohol). After analyzing the factors influencing the diet, PA and the daily scheduled routine and the factors hindering a healthy lifestyle, a generalized model was built. The multiple correlation coefficient R is equal to 0.999, the multiple coefficient of determination R2 is equal to 0.999, which indicates a high significance of the features. 5 statistically significant predictors of the unhealthy lifestyle have been identified (see Table 5 given herein).

Adherence to an unhealthy lifestyle is aggravated by the presence of bad habits, the number of cigarettes smoked, non-compliance with the proper diet, and it is lowered due to availability of poultry meat and bakery products in the diet.

DISCUSSION

Summary of the main result of the study

The completed study made it possible to investigate the characteristics of the lifestyle of the first-year students of the Faculty of Medicine, identify significant predictors of an unhealthy lifestyle, and produce a social profile of a typical first-year student of the Faculty of Medicine. The results obtained by us can be used to adapt the curricula of the Medical Faculty for the formation of healthy lifestyles among the students.

Research limitations

Only the first-year medical students were included in the completed study.

Table 5

Summary data on the regression model of forecasting based on predictors of unhealthy lifestyle in students

	Regression coefficient (β)	Std. error	Equation parameters (B)	Std. error	Student’s criterion (t)	Statistical significance (p)
Free member			-1.149	0.031	-37.324	0.000003
Bad habits (addictions) available	1.126	0.026	1.139	0.027	42.769	0.000002
Occurrence of poultry meat in the diet	-0.154	0.022	-0.156	0.023	-6.885	0.002333
Occurrence of bakery products in the diet	-0.176	0.0 16	-0.179	0.016	-10.861	0.000408
Number of cigarettes smoked for the last month	0.077	0.012	0.078	0.012	6.688	0.002600
Failure to follow the proper diet	0.110	0.026	0.112	0.027	4.186	0.013851

Discussion of the main result of the study

Our study has shown that a little more than a third of the respondents consider their lifestyle to be healthy. When comparing the results of self-assessment of lifestyle by the medical students, obtained by us, with the data of other authors, it is noteworthy that approximately the same number of students consider their lifestyle to be healthy [5,12,13,15,17]. Among the reasons hindering to keep a healthy lifestyle, according to the students, the key factor is their high workload with studies/work. At the same time, the occurrence of such circumstances that impede a healthy lifestyle, such as laziness, lack of motivation, lack of financial resources, physical inactivity, among our students is found to be somewhat lower than in the papers of other researchers [5, 12,15].

One of the most important components of a healthy lifestyle is PA. It is noteworthy that one-fifth of our respondents do not engage in any type of PA. The low PA of the students is indicated by studies conducted in various regions of this country [7, 9, 13, 14, 17, 20, 27]. At the same time, only 1% of the students surveyed have indicated physical inactivity as a circumstance preventing a healthy lifestyle. The latter may indicate an insufficient level of awareness of the first-year students with the problems of healthy lifestyles. More than half of the students surveyed by us consider the high workload of studies as the reason preventing the PA, and 10.7% admit that they have no motivation to do it. The same results are obtained in a number of studies conducted in other regions [13, 14, 17, 20, 27]. Researchers believe that high educational loads lead to the fact that a significant part of students have reduced motivation for physical self-development, often there is no free time, motivation, and a convincing example for rational behavior [7]. At the same time, a third of the students have not indicated the reason preventing PA, which may show insufficient demands placed by them and optimism, which is characteristic of the age of the respondents [7]. Insufficient PA of the students we interviewed was accompanied by an improper organization of their daily routine. The high study loads, revealed in our students, lack of sleep, non-compliance with the daily scheduled routine, long time using gadgets for the purposes other than educational ones are also noted by other researchers [5, 13, 15]. The occurrence of bad habits among students in our region is traditionally low, as evidenced by the results of our earlier studies [10,24,25].

The most important component of the students’ healthy lifestyle is rational nutrition. An improper diet schedule and imbalance in daily food packages and meals, identified in our students, have been established by other researchers [16,17,19,22], too. These changes are typical for the student population in general, with slight differences across regions. Among the circumstances that impede keeping the proper diet of our students, high study loads are in the top, and among the reasons for poor nutrition the lack of financial resources prevails. An analysis of the data on the state of health, morbidity and lifestyle of students of medical universities in Russia has shown that most students eat irregularly and irrationally due to a busy study schedule, limited funds, and insufficient attention to health. A low consumption of vegetables, fruits, and dairy products has been established [17,19,22]. The problem of the student nutrition is multifaceted and requires a systematic approach. Of course, the educational process should provide time for meals, and buffets and canteens at universities should offer varied, high-quality, healthy, affordable meals. It is also important to cultivate the proper nutrition patterns in students.

With regard to the lifestyle of student youth, researchers identify a number of common problems: the lack of formation of positive stereotypes of the value of health in the educational environment, an unhealthy lifestyle, a high prevalence of bad habits and loyalty to them, an uncritical perception of negative symptoms and health risk situations [13]. Among the circumstances hindering a healthy lifestyle, researchers specify a high study load, laziness, lack of motivation, lack of financial resources among students [7,13,15,23]. Along with the characteristics common to all students, there are also some regional characteristics of health-damaging factors due to the territorial inhomogeneity of Russian students available [13, 14, 17, 24]. That is why, in order to develop and implement health-saving projects by educational institutions, it is necessary to assess the predictors of an unhealthy lifestyle of students at a given university.

Management of key predictors of lifestyle by influencing the factors, which determine them, is an important task of educational organizations [3]. The constantly changing situation in educational organizations requires an adaptation of approaches and technologies required for the formation of a health-saving environment at the university [3,6]. A multivariate regression analysis was carried out to identify and evaluate predictors of an unhealthy lifestyle. The analysis included the following possible predictors of an unhealthy lifestyle, such as the frequency of PA sessions per week and the duration of training, factors interfering with PA sessions, satisfaction with the level of PA, walking, compliance with the daily scheduled routine, the duration and sufficiency of night sleep, reasons for lack of sleep, the level of educational load , adherence to diet, factors interfering with diet keeping, scheduled meals, bad habits available, number of cigarettes consumed), alcohol consumption (rate of consumption and preferred drinks, desire to stop drinking alcohol). The predictors of an unhealthy lifestyle, which we have identified (bad habits, the number of cigarettes smoked, unhealthy diet), are correctable. Therefore it is of great practical importance to identify them at the initial stage of study at a university and develop preventive measures on their basis for the formation of a healthy lifestyle among students.

CONCLUSION

Our study of the characteristics of the lifestyle of the first-year students of the Faculty of Medicine has shown that more than half of the students surveyed (51.6%) consider their lifestyle to be not fully consistent with the principles of a healthy lifestyle. At the same time, 20.4% of them did not engage in any types of physical activity, only 27.9% of the students surveyed observed the daily scheduled routine, 24.9% had less than 6 hours of sleep, and only 24.6% of the students adhered to the proper diet. The number of smoking students was recorded to be 8.9%, those drinking alcohol was reported to reach 9.7%. Using the method of multiple logistic regression analysis, the key predictors of an unhealthy lifestyle were identified as listed below: bad habits, the number of cigarettes consumed, adherence to an unhealthy diet. Therefore it is necessary to adapt the actual curricula of the medical faculty for the formation of a healthy lifestyle for students using the results we have obtained. The main areas of the work should be to increase motivation for maintaining a healthy lifestyle and awareness of rational nutrition and of negative impact made by bad habits.

Funding

The authors declare that there is no sponsorship for the study.

Conflict of interest

The authors declare no conflict of interest.

Compliance with the principles of ethics

The conducted study complies with the standards of the Declaration of Helsinki, approved by the Independent Ethics Committee of the Federal State Budgetary Educational Institution of Higher Education “Kabardino-Balkarian State University named after I.I. HM. Berbekov”.

Contribution of authors.

Yakhagoeva D.A., Zhurtova D.A., Kardangusheva A.M., Khagabanova I.S., Appaeva E.K., Zherukova D.R. Kardangusheva A.M., Zhurtova D.A., Yakhago-eva D.A., Khagabanova I.S., Appaeva E.K. - development of the concept and design of the study;

Zhurtova D.A., Yakhagoeva D.A., Appaeva E.K. -data collection;

Zhurtova D.A., Khagabanova I.S., Yakhagoeva D.A. - analysis and interpretation of the results;

Zhurtova D.A., Yakhagoeva D.A., Zherukova D.R.

• - literature review, statistical analysis;

Kardangusheva A.M., Zherukova D.R. - drawing up a draft of the manuscript and the formation of its final version;

Kardangusheva A.M. - critical revision of the draft manuscript with the introduction of a valuable comment of intellectual content.

All authors approved the final version of the article before publication, agreed to be responsible for all aspects of the work, which implies the proper study and resolution of issues related to the accuracy and integrity of any part of the work.