https://doi.org/10.15218/ejnm.2018.02 EJNM, Vol. 1, No. (1), May, 2018 Original Article Lifestyle Behaviors among Nursing Students in Hawler Medical University ABSTRACT INTRODUCTION The importance of proper nutrition and physical activity in reducing rates of dis- ease and death from chronic diseases has been well established. Poor diet and physi- cal inactivity cause deaths per year and are major contributors to disabilities that re- sult from diabetes, obesity, and stroke. Drug abuse is a more intense and often misuse of drugs may cause addiction. The focus of health promotion and lifestyle are on changing patterns of behavior to pro- mote health rather than simply to avoid illness. Health promotion involves focusing on persons and populations as a whole and diseases. Many factors affect health and these factors are integrated into an indi- vidual's lifestyle *1+. Tobacco smoking, di- et, and physical exercise are key aspects of lifestyle that influence the risk for the ma- jor diseases of rich societies such as cancer and coronary heart disease. Lifestyles and health beliefs appear to be established early in life, setting the pattern for later years *2+. The major determinants of health are socioeconomic factors, lifestyle factors and the physical environment. Life- style-related risk factors that were acknowledged in health report of the WHO included unhealthy nutrition, physical Background and objective: The importance of proper nutrition and physical activity in re- ducing rates of disease and death from chronic diseases has been well established. Poor diet and physical inactivity cause deaths and are major contributors to disabilities that result from diabetes, obesity, and stroke. Drug abuse is a more intense and misuse of drugs can result in addiction. The objectives of this study were to identify lifestyle behav- iors among students and to find out association between their lifestyles and some varia- bles (sex, stage, and body mass index) in the College of Nursing in Erbil City. Methods: A descriptive, cross sectional study was conducted on 100 students from four stages in the College of Nursing (25 students from each stage) during the period December 2016 to April 2017. A questionnaire was composed of two parts, socio-demographic char- acteristics and questions related to lifestyle behaviors (three domains) among students in the college. Frequency, percentage and chi-square test was used for interpretation of data. Results: Most of the study sample was aged between 18 and 24 years old from urban are- as. Near half of them was female and the highest percentage had normal weight based on body mass index assessment tool. There is a non-significant association between lifestyle behaviors and sex among the study sample (p-value 0.312, 0.346 and 0.385 respectively) and with body mass index in activity and nutrition (p-value 0.885 and 0.060 respectively). Conclusion: Most of the students sometimes practicing the different types of physical ac- tivities and exercises, while never abused of substances with sometimes eating more than usual of red meat, salt, and fatty foods. . Keywords: Lifestyle behaviors; Activity domain; Habit. Kareem Fattah Azeez; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. (Correspondence: kareem.fattah@nur.hmu.edu.krd) 10 Erbil Journal of Nursing & Midwifery Received: 2/9/2017 Accepted: 25/10/2017 Published: 5/5/2018 https://doi.org/10.15218/ejnm.2018.02 EJNM, Vol. 1, No. (1), May, 2018 Original Article inactivity, tobacco use and the use of alco- hol and illicit drugs *3+. Health-related be- havior in early life influences later risks for lifestyle-related disorders. It is therefore important to investigate health behaviors among young people. University students represent a major segment of the young adult population *3+. The promotion of general health and wellbeing *4+. A healthy lifestyle consists of accepting personal re- sponsibility for one’s own health, self- ful- fillment, health screenings, stress manage- ment, healthy diet and regular exercise *5+. Previous studies have suggested that life- style choices may account for as much as 50% of preventable deaths; lifestyle factors during childhood, adolescence, and adult- hood are major factors in human disease *6+. Behavior patterns are typically estab- lished during adolescence instruction of children and adolescents in health con- sciousness is more effective than alteration of adult behavior patterns. The extent to which, living conditions, and harmful occu- pational environments affect the establish- ment of a healthy lifestyle remains un- known *7+. The objective of the study was to identify lifestyle behaviors among stu- dents and identify association between their lifestyles and some variables (sex and of the students) in the College of Nursing in Erbil City. A descriptive cross sectional study was conducted on 100 students in different years at the College of Nursing/Hawler Medical University from 25 December 2016 to 1 April 2017, in Erbil city. Data were col- lected through direct interviews with stu- dents. A questionnaire format was used for data collection which composed of two parts: part one included demographic char- acteristics and part two included questions related to three main categories lifestyle behaviors of the Activities (walking, swim- ming, cycling, and running with regular weekly exercise), Substance abuse (smoking, alcohol drinking, and illegal drugs), and nutrition (red meat, salt, and fatty foods). The students responded to the part two through three response op- tions: never, sometimes, and always. Regarding ethical consideration the per- mission was taken from Ethical Committee of the college before beginning the re- search process. Informed consent was ob- tained from students and they were free to accept or reject the participation. The data were analyzed using SPSS Program version 23. Frequency, percentage, chi-square, and Fisher’s exact tests were used. Table 1 shows the demographic charac- teristics of the study participants. Most of the study sample was aged between 18 and 24 years old (95%), were from urban areas (64%). Nearly half of them were fe- male (51%) and the majority were of nor- mal weight (72%), while only 23% of the participants were overweight and obese based on body mass index assessment tool. Regarding the life style behaviors of study sample, which are presented in Table 2, the researcher assessed the three main domains of activity, substance abuse, and nutrition. Most of the study sample some- times practicing the different types of physical activities and exercises like walk- ing, swimming, cycling, and running with regular weekly exercise (80%) while most had never abused of substances such as cigarettes, alcohol, and illegal drugs (98%). More than half of the study sample indi- cated that they sometimes ate more than a usual amount of red meat, salt, and fatty foods (62%). METHODS 11 Erbil Journal of Nursing & Midwifery RESULTS https://doi.org/10.15218/ejnm.2018.02 EJNM, Vol. 1, No. (1), May, 2018 Original Article female, while most of them had normal BMI. These results agreed with results of the study done by Sauter who found that most of study sample had normal BMI *8+. Majority of the students practiced physical activities so this was agreed with results findings of Spear and Kulbok, which found that majority of study sample practice healthy lifestyles *7+. Regarding the do- main of drug abuse, most of the students reported never practicing this habit, which agreed with results of the study of Mamand and Al- Dosky who found that the number of drug abusers in Kurdistan re- gion were less than other country, and that this was related to cultures, social fac- tors and other traditional habits in the Kurdistan Region. Culture is one factor may affect the habit or behaviors *9+. Re- garding nutrition domain most of the stu- dents responded by sometimes that means majority of them practiced nutrition habit not properly and these findings agreed were with the study of Bryan et al who found that college students not practiced proper habit regarding nutrition domain *10+. The other results of the study indicate that there was no significant association between sex and three domains of life- styles, and this finding disagreed with the study of Li et al, which revealed that there was significant association between sex and lifestyles behaviors *11+. The findings of the study indicate that there was a sig- nificant association between student's year in school and activity domain while there was significant association between BMI and abuse domain so this finding was Table 1: Demographic characteristics of the study sample Table 3 presented the non-significant asso- ciation between lifestyle behaviors and sex among the study sample (p-value 0.312, 0.346 and 0.385 respectively). In associa- tion between body mass index and lifestyle behavior domains in Table 4, there is only substance abuse has a significant associa- tion with body mass index (BMI) (p-value 0.013) while activity and nutrition had a non-significant association (p-value 0.885 and 0.060 respectively). The study revealed that the majority of the cohort were from a city center and 12 DISCUSSION Erbil Journal of Nursing & Midwifery Lifestyle behaviors Never Sometimes Always Total F (%) F (%) F (%) F (%) Activity Domain 19 (19) 80 (80) 1 (1) 100 (100) Abuse Domain 98 (98) 1 (1) 1 (1) 100 (100) Nutrition Domain 13 (13) 62 (62) 25 (25) 100 (100) Table 2: lifestyle behaviors (three domains) Demographic characteristics F (%) Age group (years) 18-24 95 (95) 25-31 5 (5) Living location urban 64 (64) rural 17 (17) suburban 19 (19) Sex male 49 (49) female 51 (51) Body Mass Index (kg/m²) underweight < 18.5 5 (5) normal weight 18.5-24.9 72 (72) overweight 25 -29.9 17 (17) obesity ≥ 30 6 (6) https://doi.org/10.15218/ejnm.2018.02 EJNM, Vol. 1, No. (1), May, 2018 Original Article agreed with study of Barry and Petry who revealed that there was a significant associ- ation between BMI and abuse domain *12+. The majority of students reported some- times practicing physical activities and exercises, they never abused substances, and sometimes reported eating more than usual amount of red meat, salt, and fatty foods. The author reports no conflicts of interest. 13 Table 3: Association between Lifestyle behaviors and sex Table 4: Association between BMI and lifestyle behaviors Erbil Journal of Nursing & Midwifery Sex Lifestyle behaviors Male Female P-Value F (%) F (%) Activity Domain Never 7 (36.8) 12 (63.2) 0.312 NS Sometimes 41 (51.2) 39 (48.8) Always 1 (100) 0 (0) Abuse Domain Never 47 (48) 51 (52) 0.346 NS Sometimes 1 (100) 0 (0) Always 1 (100) 0 (0) Nutrition Domain Never 5 (38.5) 8 (61.5) 0.385 NS Sometimes 29 (46.8) 33 (53.2) Always 15 (60) 10 (40) BMI Life style behaviors Underweight Normal Overweight Obesity P-Value F (%) F (%) F (%) F (%) Activity Domain Never 0 (0) 13 (68.4) 4 (21.1) 2 (10.5) 0.855 NS Sometimes 5 (6.3) 58 (72.5) 13 (16.3) 4 (5) Always 0 (0) 1 (100) 0 (0) 0 (0) Abuse Domain Never 5 (5.1) 71 (72.4) 17 (17.3) 5 (5.1) 0.013 S Sometimes 0 (0) 1 (100) 0 (0) 0 (0) Always 0 (0) 1 (100) 0 (0) 0 (0) Nutrition Domain Never 0 (0) 12 (92.3) 1 (7.7) 0 (0) 0.060 NS Sometimes 2 (3.2) 45 (72.6) 13 (21) 2 (3.2) Always 3 (12) 15 (60) 3 (12) 4 (16) CONCLUSSION CONFLICTS OF INTEREST https://doi.org/10.15218/ejnm.2018.02 EJNM, Vol. 1, No. (1), May, 2018 Original Article REFERENCES The author would like to thank all par- ticipants and all staff and students who participated in conducting the study. *1+ Smith C, Maurer F. 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Associations between body mass index and substance use disorders differ by gender: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addictive behaviors. 2009 Jan 31;34(1):51-60. 14 ACKNOWLEDGEMENT Erbil Journal of Nursing & Midwifery