Lifestyle behaviour of future medical professionals in a tertiary care institute in north-eastern India: a cross-sectional descriptive study

INTRODUCTION

India, the second populous country in the world, is facing the double burden of communicable and lifestyle diseases.¹ As per World Health Organization (WHO) report, approximately 60% of contributing factors to health and quality of life of individuals are concerned with lifestyle practices.² Healthy lifestyle is a way that includes physical activity, balanced diet, stress management and avoidance of substances use.³ The incidences of some non communicable diseases like hypertension, obesity, diabetes mellitus, and cardiovascular diseases have been rising in the country since few decades due to the unhealthy lifestyle of the people.⁴

Studies have documented that few NCDs have started presenting among the younger population.1 During the transition phase from school to college, students face certain difficulties which include getting acclimatized to new surroundings, deciding on the future perspectives and changes in lifestyle.⁵ The unhealthy lifestyle habits which are introduced during young adulthood tends to persist in later life which can increase the risk of several chronic diseases.⁶ Researches conducted among medical and nursing students shown that even though they are aware about the consequences of practicing unhealthy lifestyle but still they do not follow the suggested guidelines for healthy lifestyle.⁷ Several factors such as mental stress, performance anxiety in a competitive academic environment, depression, peer pressure, etc may be responsible for initiation of unhealthy behaviours in medical students.⁶

A healthy lifestyle of medical students would facilitate reduction of their own health risks and are more likely to promote similar behaviours in their patients.⁸ Various research works were carried out in United States of America and European countries to investigate the lifestyle behaviours of college students specially their diet; physical activity, and sleep pattern that helped in forming further guidelines to promote healthy behaviors.^9-11 There is limited literature on lifestyle behaviours among future health care professionals especially in north-eastern part of India. So the present study was conducted to assess lifestyle behaviour related to dietary pattern, physical activity, substance use, sleep, stress management, among MBBS and nursing students in a tertiary care centre in the capital city of the north-eastern state of Meghalaya.

METHODS

This cross-sectional descriptive study was done among the undergraduate medical students (MBBS and Nursing) to assess their lifestyle behaviour related to dietary pattern, physical activity, substance use, sleep, stress management, in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), a tertiary care institute situated in Shillong, the capital city of the north-eastern state, Meghalaya from March to April 2021.

Those students who gave consent to participate in the study were included and those who could not be contacted even after three consecutive visits were excluded from the study. Sampling was not done as it was intended to cover the whole of the study population.

The study variables were age, sex, stream, year of study whereas the outcome variables were lifestyle behaviour related to dietary pattern, physical activity, substance use, sleep, stress management. A self-administered pre-tested questionnaire was used for data collection which consisted of two sections, Section A with questions on demographic characteristics of the participant, and Section B which included questions on lifestyle behaviour related to dietary pattern, physical activity, substance use, sleep, stress management.

The questionnaires were distributed among the participants and after 15–20 minutes were again collected back. Data collected were checked for completeness and consistency. Data were entered in IBM SPSS version 21 for Windows (IBM Inc. Armonk, New York, USA) and were summarized by using descriptive statistics like percentages, mean.

The participants were assured about their anonymity. Identifiers like names were masked and informed verbal consent were obtained from the respondents. Data were accessible only to the investigators.

RESULTS

Table 1 shows the general profile of the participants. Majority of the participants were females (77.3%) and MBBS students (53.7%), belonged to second year (30%) followed by first year (29.4%), were Hindus (42.9%) followed by Christians (40.7%). Out of the total participants, 6.4% were having pre-existing ailments.

*include Buddhism, Jainism, etc

Table 2 shows responses on lifestyle behaviour related to sleep, dietary pattern, physical activity, substance use, stress management. Almost half (56.5%) of the participants used to sleep average of 6-8 hours; use of mobiles before sleeping (33.5%) was the commonest response for reasons for disturbed sleep. Regarding diet, only 3.5% of participants consume fruits and vegetables daily, majority (61.7%) rarely consume any carbonated drinks, more than half (57.5%) of participants consume average 1-2 litres of water everyday, very less participants (6.1%) consume fast food daily. When asked about physical activity for the last month, majority (48.9%) of the participants did not have any kind of activities, only 12.8% and 5.8% of participants used to do exercise for ≥30mins and 5 times a week respectively, which is according to WHO recommendations of having ≥30mins moderate workout atleast 5 times a week.

*includes insomnia, external noises, acidity problems. ** includes yoga, gym, sports. ¥ includes playing musical instruments, drawing, talk with friends. ᶲ includes backache, dizziness, nausea. ^£ includes reading novels, praying, watching movies, etc.

Half of the participants (50.2%) likes to be engaged in social media during spare time followed by internet browsing (46%). Regarding usage of gadgets, >1 hour is spent by majority of the participants (87.2%), most of them (59.7%) utilise the gadgets for social media (Facebook, Instagram, etc) followed by Whatsapp messaging (57.2%).

Out of the total participants, 12.7%, 6% and 2.2% give positive responses for intake of alcohol, smoking and chewing tobacco like gutkha, pan masala, etc respectively. Only 1%, 1.9% and 1% of total participants gives responses on daily intake of alcohol, smoking and chewing tobacco.

DISCUSSION

Lifestyle behaviours during teenage or young adulthood may have an effect on diseases related to lifestyle in the future. Primordial prevention basically targets the unhealthy lifestyle in young age, thereby preventing lifestyle related diseases in adulthood. This study provides an idea regarding unhealthy lifestyle practices among future health care professionals so that they can avoid those practices themselves and set an example to the patients and promote adopting healthy lifestyle practices.

Out of 313 students in the present study, only 3.5% participants had reported daily intake of fruits for last week which is very much less compared to study conducted by Kulkarni done in Central India.¹ In the present study, 23% and 6.4% participants reported frequent consumption of fast foods and carbonated drinks (pepsi, coca cola, thumbs up, etc) respectively. In another study conducted in Delhi, reported frequent consumption of carbonated drinks and fast food among 23.7% and 32% students respectively. Paul et al reported of 91.3% prevalence of consumption of fast food among medical students in South India which was much more than the present study.¹²

In the present study, only 18 (5.8%) participants had reported regular physical activity (5 times a week) when asked about the previous month. This was much less than findings of the other studies conducted in Delhi, Karachi and Bareilly.^13-15 The reason behind the contrast in findings may be because the present study defined regular physical activity according to the WHO recommendations of physical activity but for the rest of the studies were self reported. The self reported version of being physically inactive was given by 119 (38%) students which was very similar to the findings of Kulkarni1 and Paul et al.¹² In our study, 189 (60.4%) students reported sedentary activity of spending ≥2 hours per day on phone, tablets, laptops, television, computers, etc and majority of them (59.7% and 57.2%) use the gadgets for social and whatsapp messaging respectively. Watery eyes (33.2%) and headache (30%) were the common consequences faced by the students after using the gadgets like mobiles, laptops, etc.

In the present study, 19 (6%) students had reported of smoking cigarettes or bidhis, and among them, 6 (1.9%) used to smoke daily, while 3 (1%) students were daily tobacco chewers in form of gutkha, pan masala, etc and 3 (1%) report of daily intake of alcohol while 18 (5.8%) students were occasional users. The findings for substance use were less compared to studies done in other parts of the country.^12,13,15,16

When asked about sleep quality in this study, 111 (35.5%) students reported of less than 6 hours of average sleep duration per day, almost half (49.5%) took less than 15 minutes to fall asleep after turning off lights and less than half students (47.6%) self rated their sleep as good, whereas use of mobiles before sleep (33.5%) and stress (11.2%) were the common answers given for reasons of having disturbed sleep.

Difficulty to concentrate, feeling depressed, worrying and sleeplessness were major effects due to stress shown by studies done by Dahlin et al and Sajwani et al.^17,18 Regarding stress when asked, their academic performance and hectic schedule were the main factors which make them stressed out the most. Similar findings were seen in study done by Sundas.¹⁹

A study conducted in Spain had recommended campaigns based on nutritional education that included promotion of physical activity practices in the student group of population.²⁰

This study had few limitations as the answers were self reported, so some students might have given socially desirable answers and another factor was limitation to recall.

CONCLUSION

In this study, sedentary lifestyle, lack of any physical activity, use of gadgets like mobiles, laptops, etc for activities like social media, Whatsapp were found to be prevalent among the medical students. Even though the medical students are well aware about the consequences of adopting unhealthy lifestyle behaviour, they still do not follow the suggested guidelines for health lifestyle. Regular workshops regarding implementation of healthy life style habits will be helpful and will have positive effect on them. Appropriate preventive strategies should also be developed to avoid irrational use of internet.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Kulkarni MV. Lifestyle disease risk behaviour among medical students in Central India. Panacea Journal of Medical Sciences. 2016;6(2):92-5.
2. 2. Sharma SK, Mudgal SK, Thakur K, Gaur R, Aggarwal P. Lifestyle behavior of budding health care professionals: A cross-sectional descriptive study. J Family Med Prim Care. 2020;9:3525-31.
3. 3. Haddad LG, al Ma’aitah RM, Cameron SJ, Armstrong Stassen M. An Arabic language version of the health promotion lifestyle profile. Public Health Nurs.1998;15:74-81.
4. 4. Farhud DD. Impact of lifestyle on health. Iran J Public Health. 2015;44:1442-4.
5. 5. Nelson MC, Story M, Larson NI, Neumark Sztainer D, Lytle LA. Emerging adulthood and college aged youth: An overlooked age for weight related behavior change. Obesity (Silver Spring). 2008;16:2205-11.
6. 6. Patel PH, Malgaonkar AA, Kartikeyan S. Cross-sectional descriptive study of lifestyle patterns of undergraduate medical students in a metropolitan Medical College. Int J Community Med Public Health. 2016;3:2866-73.
7. 7. Al Qahtani MH. Dietary habits of Saudi medical students at University of Dammam. Int J Health Sci (Qassim). 2016;10:353-62.
8. 8. Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009;43(2):89-92.
9. 9. American College Health Association National College Health Assessment Spring 2006 reference group data report (abridged). J Am Col Health. 2007;55:195-206.
10. 10. Steptoe A, Wardle J, Cui W, Bellisle F, Zotti AM, Baranyai R, et al. Trends in smoking, diet, physical exercise and attitudes toward health in European university students from 13 countries. Prev Med. 2002;35:97-104.
11. 11. Sharma SK, Mudgal SK, Thakur K, Gaur R. How to calculate sample size for observational and experimental nursing research studies? Natl J Physiol Pharm Pharmacol. 2020;10:1-8.
12. 12. Paul B, Nayaki V, Sen M, Issac R. Prevalence of cardiovascular disease risk among medical students in South India. Indian Journal of Community Health. 2015;27(2):211-5.
13. 13. Rustagi N, Taneja DK, Mishra P, Ingle GK. Cardiovascular risk behaviour among students of a medical college in Delhi. NJCM. 2011;36(1):51-3.
14. 14. Aslam F, Mahmud H, Waheed A. Cardiovascular healthBehaviour of medical students in Karachi. J Pak Med Assoc. 2004;54(9):492-5.
15. 15. Mahmood SE, Ansari SH. Lifestyle disease risk factors among first year medical students in Barielly. NJIRM. 2013;4(2):50-4.
16. 16. Jagnany VK, Muraka S, Haider S, Kashyap V, Jagnany AK, Singh SB, et al. Pattern of substance abuse among the undergraduate students in a medical college hostel. Health and population. Perspectives and issues. 2008;31(3):212-9.
17. 17. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students; a cross sectional study. Med Teach. 2005;39(6):594-604.
18. 18. Rubina A, Sajwani, Shoukat S, Raja R. Knowledge and practice of healthy life style and dietary habits in non medical and medical students in Karachi, Pakisthan. J Pak med Assoc. 2009;59(9);650-5.
19. 19. Sundas N, Ghimire S, Bhusal S, Pandey R, Rana K, Dixit H. Sleep Quality among Medical Students of a Tertiary Care Hospital: A Descriptive Cross-sectional Study. J Nepal Med Assoc. 2020;58(222):76-9.
20. 20. Moreno-Gómeza C, Romaguera-Boscha D, TaulerRieraa P, Bennasar-Venya M, Pericas-Beltrana J, Martinez-Andreua S, et al. Clustering of lifestyle factors in Spanish university students: the relationship between smoking, alcohol consumption, physical activity and diet quality. Public Health Nutr. 2012;15(11):2131-9.