141J Contemp Med Sci | Vol. 2, No. 8, Autumn 2016: 141–147 Research A study of eating habits among female nursing students in the university of Babylon/Iraq Salma KJ,a Wafaa AA,b Zainab Ac ISSN 2413-0516 aDepartment of Community Health Nursing, College of Nursing, University of Babylon, Iraq. bDepartment of Maternal and Child Health Nursing, College of Nursing, University of Babylon, Iraq. cGraduate Nurse, College of Nursing, University of Babylon, Iraq. Correspondence to Salma KJ (email: salmakadhhum972@gmail.com). (Submitted: 6 September 2016 – Revised version received: 20 September 2016 – Accepted: 3 October 2016 – Published online: 26 December 2016) Objectives To assess socio demographic characteristics, the responses of eating habits among female nursing students and to determine the relationship between the socio demographic characteristics and the responses of eating habits. Methods A descriptive analytic design was conducted on a purposive sample of 100 female nursing students in the University of Babylon. A questionnaire has been used as a tool of data collection and consisting of socio demographic, the general responses, the responses related to dietary activity, behavioral responses of eating habits, data collected from the period of March 1 to June 20, 2016. Results The results of the study revealed that 64.0% of women aged between 22 and 24 years with Mean ± SD (52.46 ± 11.70), 61.0% of sample were found at grade 3 of study, 81.0% were single, 96.0% were home resident, 77.0% their original address in urban area, 86.0% study sample were not working. 56.0% were economic status satisfied to some extent. 67.0% were normal weight. 72.0% were non-dieting regimen. There is a significant relationship found between the demographical characteristics and responses related to dietary activity factors in like original address, marital status, and also between general responses and demographical characteristics, such as age groups, present BMI, and significant relationship between behavioral responses and demographical characteristics variables with occupation at P ≤ 0.05. Conclusion The study recommends that family can encourage their daughters to choose the healthiest food collections and schools, universities will assist in minimizing the consumption of fast foods and others. Keywords eating habits, female, nursing students Introduction People who wish to be fit should adapt to the ideal habits and behave differently. Gain knowledge of adopt and apply the habits, is the right way to achieve the success.1 Residing in the university and college is potentially an important intention for the promotion of healthy lifestyles of the adult population. Though information about the body mass index (BMI) distribution and nutritional and health- related behaviors are still few, the majority of students having a desire to be thinner.2 Students’, who join the university, dining plans are dealing daily with the food setting characterized by foods high in energy, fats, and added sugars, and low in nutrient density. This will put them in challenges what decide to eat beside having their food currently in an environment where no nutri- tion labeling is needed.3 Dietary patterns developed during adolescence may con- tribute to obesity and eating disorders and may increase the risk for several important chronic diseases later in life.4 Throughout a person’s life, certain events will occur which is of particular importance and is considered as a turning point in their lives. Breakfast as an example is the most impor- tant meal in the dietary plan of an adolescent.5 Adequate intake of animal and plant sources of protein is vital for adolescence. Vitamins and minerals such as calcium, iron, and iodine must be included in the adolescents’ diet. Best sources of vitamins are fruits and vegetables while milk and dairy products are the best sources of calcium.6 Today, the foods of Iraq reflect this rich inheritance as well as strong influences from the culinary traditions of Turkey and Iran and the Greater Syria area. Because of all these traditions and complex influences, Iraqi cuisine is enormously rich and varied.7 Most Asian countries have been shifting towards a diet higher in fat and meat, and lower in carbohydrates and fiber. Additionally, decreased levels of physical activity and leisure are linked to increases in the prevalence of an overweight condition, obesity and diet-related non-communicable diseases, although the prevalence of students who were overweight was very low in this study sample.8 Being tense and having fear of gaining weight or becoming fat even if at normal weight or underweight is another pattern of eating habits as one of the girls deal as well as unsuitable balance behavior to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting; or excessive exercise.9 Methodology Design of the Study A descriptive analytic study. Sample of the Study The probability (purposive sampling) was selected by a rand- omized system which consists of (100) female nursing students. Setting of the study The data were collected from the period between March 1 and June 20, 2016 at the College of Nursing, University of Babylon. 142 J Contemp Med Sci | Vol. 2, No. 8, Autumn 2016: 141–147 A study of eating habits among female nursing students Research Salma KJ et al. Instruments The questionnaire was constructed for the purpose of the study. The instruments consisted four parts as below: Part 1: Demographic Date Sheet: This part concerned with personal information include, the students age, grade, marital status, occupation, economic status, place of residence recently, original address, present body mass index, and dieting state at present. Part 2: Responses, 13 items as general responses. Part 3: Responses related to dietary activities, 12 items. Part 4: Behavioral responses, 6 items. These items are rated according to three level Likert scale (Always, Sometimes, and Never) and scored 3, 2, 1, respectively. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 19. Through the application of descrip- tive statistical data analysis include (Frequencies, Percentages, and Cumulative Percent) and arithmetic mean with standard deviation, Mean of score (M.S.) with their Standard Deviation (SD), Cutoff point = 3 + 2 + 1/3 = 2 and inferential statistics, and Relative Sufficiency (R.S.%), and their assessment by cutoff point (66.67%) due to scores (1, 2, 3) which are reported Pass and Failure (Under / Upper), as well as reassessment scoring by (Bad, Moderate, and Good) through the intervals (“33.33– 55.54”, “55.55–77.76”, and “77.77–100”), respectively. Results Table 1 shows the highest percentage of the sample reported at age ranged between 22 and 24 years, and they are accounted 64%, with mean age and standard deviation 22.01 ± 1.360. The greater number of them in third grade, and they are accounted 61%. The highest percentage of the sample place of residence recently was at home, and they are accounted (96%) while sample represents Urban residency at 77%. The majority of participants are not working. They constitute (86%). The study revealed that 56% of their economic status was satisfied to some extent, the greater number of them with normal BMI, they are accounted 67%. 72% of the sample was not on dieting regimen. Table 2 shows the highest percentage representing 40.0% of study samples answer sometimes “I am terrified about being overweight”. 47.0% of study samples were sometimes “avoid eating when hungry”, 41.1% of them were “always avoid soft drinks”, 47.0% of study participants were “sometimes cut food into small pieces”, 39.0% of study samples were “sometimes aware of the calorie content of food”, (36.0%) of study samples were “always avoid food with a high carbohydrate content” i.e. (bread, rice, potatoes, etc.), (77.0%) of students answer they “never vomit after eating”, (46.0%) of study subjects were “never guilty after eating”, ( 52.0%) of study samples were “sometimes think about burning up calories when exercising”, (48.0%) of population sample said “sometimes I take longer than others to eat my meals”, (45.0%) of study sample were “never eat diet foods”, (40.0%) of study samples were “sometimes feel that food controls their life”, (50.0%) of study samples were “sometimes l display self-control around food”, (41.0%) of study sample answer they “never feel that others pressure them to eat”. Table 3 shows the highest percentage representing 40.0% of study sample answer sometimes I give too much time and thought to food, 47.0% of them were sometimes feel uncomfortable after eating sweets and Table 1. Distribution of demographical characteristics among female nursing students (N = 100) Demographical variables No. and percents N Percentage (%) Cumulative percent Age 19–21 33 33 33 22–24 64 64 97 25–27 3 3 100 Mean ± SD 22.01 ± 1.360 Grade Year one 3 3.0 3 Two 14 14.0 17 Three 61 61.0 78 Four 22 22.0 100 Marital status single 81 81 81 married 17 17 88 divorce 2 2 100 Place of residence recently Home 96 96.0 96 Hostel 4 4.0 100 Original address Rural 23 23.0 23 Urban 77 77.0 100 Occupation Working 14 14.0 25.6 Not working 86 86.0 100 Economic status Satisfied 40 40.0 40 Satisfied to some extent 56 56.0 96 Un satisfied 4 4.0 100 BMI Underweight <18.5 5 5.0 5 Normal 18.5–24.9 67 67.0 72 Overweight 25–29.9 27 27.0 99 Obese 30–39.9 1 1.0 100 Dieting state present On dieting regimen 28 28.0 28 Non-dieting regimen 72 100.0 100 sugar, 43.0% of study sample was never engage in dieting behavior, and never like stomach to be empty, 48.0% of study samples were sometimes enjoy trying new rich foods, 41.0% of study samples were sometimes skipped breakfast, majority of participants representing 53.0% were sometimes skipped lunch, 51.0% of study samples were sometimes consumed at least 1≤ serving daily of dairies, while more than half of them, 58.0% were sometimes consume one serving of meat and eggs daily, 49.0% of study sample sometimes consume at least one serving 1≤ serving of fruits and vegetables daily, same time 48.0% of girls were sometimes taking meals regularly, and 39.0% of study sample were sometimes taking snacking. Table 4 deals with the behav- ioral responses, the results show that highest percentage repre- sented 52.0% of study sample were never gone on eating binges where feeling that unable to stop, while majority of participants accounted 66.0% of study sample were never (behaving as sick vomited to control or shape, majority of girls represented 71.0% never (use laxatives, diet pills or diuretics to control their weight Salma KJ et al. 143J Contemp Med Sci | Vol. 2, No. 8, Autumn 2016: 141–147 Research A study of eating habits among female nursing students Table 2. Distribution of the general responses among female nursing students with comparison significant Response of the sample Scoring levels No. % χ2-test P-value (*) MS SD RS 1. I am terrified about being overweight Never 25 25 1.9 0.772 1.90 .772 63.3 Sometimes 40 40 Always 35 35 2. Avoid eating when I am hungry Never 37 37 2.2 0.701 2.21 .701 73.6 Sometimes 47 47 Always 16 16 3. Cut my food into small pieces Never 37 37 2.1 0.780 2.09 .780 69.6 Sometimes 47 47 Always 16 16 4. I aware of the calorie content of foods that I eat Never 35 35 2.1 0.814 2.06 .814 68.6 Sometimes 39 39 Always 26 26 5. I particularly avoid food with a high carbohydrate content (i.e. Bread, rice, potatoes, etc.) Never 36 36 2.3 0.809 2.25 .809 75.0 Sometimes 34 34 Always 30 30 6. I vomit after I have eaten Never 77 77 2.7 0.529 2.73 .529 91.0 Sometimes 19 19 Always 4 4 7. I feel extremely guilty after eating Never 46 46 2.3 .0709 2.32 .709 77.3 Sometimes 40 40 Always 14 14 8. I think about burning up calories when I exercise Never 21 21 1.9 0.694 1.94 .694 64.6 Sometimes 52 52 Always 27 27 9. I take longer than others to eat my meals Never 29 29 2.1 0.722 2.06 .722 68.6 Sometimes 48 48 Always 23 23 10. I eat diet foods Never 45 45 2.3 0.770 2.25 .770 75.0 Sometimes 35 35 Always 20 20 11. I feel that food controls my life Never 39 39 2.2 0.757 2.18 .757 72.6 Sometimes 40 40 Always 21 21 12. I display self-control around food Never 18 18 1.9 0.697 1.86 .697 62.0 Sometimes 50 50 Always 32 32 13. I feel that others pressure me to eat Never 41 41 2.2 0.792 2.17 . 792 72.3 Sometimes 35 35 Always 24 24 (*)HS: Highly Sig. at P < 0.01; S: Sig. at P < 0.05; N S: Not Sig. at P > 0.05. The statistics based on the Chi Square test. χ2: Chi Square, P: Probability, MS: Mean of Score, SD: Standard deviation, RS: Relative sufficiency. or shape), 64.0% of study sample were never exercised more than 60 minutes a day to lose or to control weight, 66.0% of them never lost 20 pounds or more in the past 6 months, 76.0% of study participants were never been treated for an eating disorder. Table 5 summarizes of the subjects overall responses shows good assessment in regard to behavioral responses. Regarding “Responses” part results reported (Table 6) no significant relation- ship with “Demographical Characteristics” variables except with (age groups and present BMI) significant relationship were obtained at P < 0.05. Table 7 shows no significant relationship between responses related dietary activity element the with demographical characteristics variables except with (marital 144 J Contemp Med Sci | Vol. 2, No. 8, Autumn 2016: 141–147 A study of eating habits among female nursing students Research Salma KJ et al. Table 3. Distribution of the responses related to the dietary activity among female nursing students with comparison significant Response related to dietary activity Scoring levels No. % χ2-test P-value (*) MS SD RS 1. I Give too much time and thought to food Never 25 25 18.620 0.000 2.14 0.682 71.3 Sometimes 40 40 Always 35 35 2. I Feel uncomfortable after eating sweets and sugar Never 37 37 3.620 0.154 2.04 0.764 68.0 Sometimes 47 47 Always 16 16 3. I Engage in dieting behavior Never 43 43 10.820 0.004 2.25 0.744 75.0 Sometimes 39 39 Always 18 18 4. I Like my stomach to be empty Never 43 43 5.420 0.067 2.19 0.800 97.0 Sometimes 33 33 Always 24 24 5. I Enjoy trying new rich foods Never 9 9 27.020 0.000 1.66 0.639 55.3 Sometimes 48 48 Always 43 43 6. Skipped breakfast Never 29 29 2.660 0.264 1.99 0.722 66.6 Sometimes 41 41 Always 30 30 7. Skipped lunch Never 35 35 25.340 0.000 2.23 0.649 74.3 Sometimes 53 53 Always 12 12 8. Consumed at least ( 1≤ serving) daily of dairies Never 31 31 16.580 0.000 2.12 0.691 70.6 Sometimes 51 51 Always 18 18 9. Consume one serving of meat and eggs daily Never 25 25 4.460 0.108 2.08 0.646 69.3 Sometimes 58 58 Always 17 17 10. Consume at least one serving (1 ≤ serving)of fruits and vegetables daily Never 17 17 28.340 0.000 1.83 0.697 61.0 Sometimes 49 49 Always 34 34 11. Taking meals regularly Never 32 32 11.840 0.003 2.12 0.715 70.6 Sometimes 48 48 Always 20 20 12. Taking snacking Never 28 28 1.820 0.403 1.95 0.783 65.0 Sometimes 39 39 Always 33 33 (*)HS: Highly Sig. at P < 0.01; S: Sig. at P < 0.05; NS: Not Sig. at P > 0.05. The statistics based on the Chi Square test. χ2: Chi Square, P: Probability of chance, MS: Mean of Score, SD: Standard deviation, RS: Relative sufficiency. status and original address) highly significant correlation were obtained at P < 0.01. Table 8 shows no significant relationship between behavioral part and the sociodemographic characteris- tics variables except with occupation significant correlation ships was obtained at P < 0.05. Discussion The present study identified the eating habits among female nursing students. And aimed to study the eating habits in the context of avoid engaging in the negative eating behaviors. The age group revealed that students are in the middle ages, cultural, socio economic and some health attitudes play an important role in the development of eating habits. A study conducted in Sudan by (Elhassan) found that the age of most students was ranging from 19 to 24 years.10 The greater number of them in third grade. As the university students may need hostel, the results revealed that the majority are living at their homes, staying with the family may change the habits of stu- dents.11 This agree with the present study when they reported Salma KJ et al. 145J Contemp Med Sci | Vol. 2, No. 8, Autumn 2016: 141–147 Research A study of eating habits among female nursing students Table 4. Distribution of the studied sample behavioral responses among female nursing students with comparison significant Behavioral responses Scoring levels No. % χ2-test P-value (*) MS SD RS 1. Gone on eating binges where you feel that you may not be able to stop Never 52 52 20.540 0.000 2.37 0.734 79.0 Sometimes 33 33 Always 15 15 2. Ever made yourself sick (vomited) to control your weight or shape Never 66 66 51.860 0.000 2.57 0.655 85.6 Sometimes 25 25 Always 9 9 3. Ever used laxatives, diet pills or diuretics (water pills) to control your weight or shape Never 71 71 68.180 0.000 2.65 0.592 88.33 Sometimes 23 23 Always 6 6 4. Exercised more than 60 minutes a day to lose or to control your weight Never 64 64 50.960 0.000 2.58 .606 86.0 Sometimes 30 30 Always 6 6 5. Lost 20 pounds or more in the past 6 months Never 66 66 49.520 0.000 2.54 0.702 83.3 Sometimes 22 22 Always 12 12 6. Have you ever been treated for an eating disorder Never 76 76 84.061 0.000 2.66 0.673 88.6 Sometimes 13 13 Always 11 11 (*)HS: Highly Sig. at P < 0.01; S: Sig. at P < 0.05; NS: Not Sig. at P > 0.05. The statistics based on the Chi Square test. χ2: Chi Square, P: Probability of chance, MS: Mean of Score, SD: Standard deviation, RS: Relative sufficiency. Table 5. Summary statistics of eating habits among female nursing students Dietary habits No. Min. Max. GMS. RS. Ass. General responses 100 1.8 2.7 2.25 71.81 Mod. Response related to dietary activity 100 1.66 2.25 1.95 70.3 Mod. Behavioral responses 100 2.37 2.66 2.515 85.1 Good Min.: minimum; Max.: maximum; GMS.: grand mean of score; RS.: Relative sufficiency; Ass.: Assessment; No.: Number. Table 6. Relationship between general responses and sociodemographic characteristics among 100 students Relationships between general responses factors and demographical characteristics General responses C.C. Sig. C.S. Age groups 0.780 0.013 S Grade 0.534 0.869 NS Marital status 0.518 0.346 NS Occupation 0.392 0.381 NS Socio-economic status 0.518 0.346 NS Place of residence recently 0.480 0.665 NS Original address 0.445 0.102 NS Present BMI 0.951 0.041 S Dieting state now 0.400 0.324 SN (*)S: Sig P < 0.05; NS: Non Sig. at P > 0.05; C.C.: Contingency coefficients; C.S: Comparison significant. Table 7. Relationship between responses related to dietary activity factors and demographical characteristics variables and among 100 students Relationship between responses related to dietary activity factors and demographical characteristics variables Responses related to dietary activity C.C. Sig. C.S. Age groups 0.635 0.969 NS Grade 0.492 0.784 NS Marital status 0.628 0.000 HS Occupation 0.37 0.246 SN Socio-economic status 0.381 0.911 NS Place of residence recently 0.282 0.999 NS Original address 0.473 0.007 HS Present BMI 0.983 0.032 NS Dieting state now 0.341 0.436 SN that a mean study career of 3.0 ± 1.0 years and mentioned that more than half of the participants living at parental home and consumed more fruit and vegetables than those who resided outside of their family home. Our results further indicate that the subjects who are working while they study are only some, having a budget may help students improve their eating selec- tions, at the same time, the study revealed that part of our ele- ments are moderately satisfied economically, These findings were consistent with (Reyes) who indicated that money becomes the overwhelming factor (with 49.1%) of the sample when looking at working and lower- middle class students.12 The data showed that a majority of students would eat healthier if money was not a factor in deciding what to eat. With regard to BMI, greater number of them with the normal level, and not on dieting regimen at present time. A finding that is con- sistent with a study of (Majors). The results show that on average nutrition and non-nutrition students where within a normal BMI.13 146 J Contemp Med Sci | Vol. 2, No. 8, Autumn 2016: 141–147 A study of eating habits among female nursing students Research Salma KJ et al. General Responses This portion deals with eating responses in general, it is amazing to know that most of the items are considered as eating attitude and lifestyle practices and some can be as self-report to determine whether there is any eating disorder that needs professional attention. The current data show that girls demonstrated moderate to good reaction toward the eating attitudes, except with some of items that their answers show some fear from being overweight, think about burning up calories when exercise, show self-control around food and the effect of others on pattern of eating. These findings were consistent with (Alavi) who found that dietary behaviors of the majority of participants per evaluation were on the medium level (41 percent) with the participants’ attitude in most cases was very positive.14 And agree with so many studies as (Yahia) who illustrated that the university girls see the shape and weight of fashion models as the ideal body shape and figure to attain. Girls with such strong body weight perception can be at risk of devel- oping eating disorders.15 Other portions like this study revealed what (Musaiger) pointed out it is important to limit carbohydrate consumption, it is important to limit the amount of fat, About 42% and 81% of physicians and medical students, respectively, did not know the correct percentage of energy needed from fat, carbohydrates, and protein in a healthy diet.16 Also consistent with (Alakaam) Marywood University (USA) who found that, most of the students (80%) said that meals are home cooked, occur mostly at homes on a daily basis, are varied, filling, and small in portion size, and take place at a specific time during the day. While disagreeing with the fact of guilt feeling when pointed- out that several participants reported feelings of guilt in the US due to eating more meals and consuming unhealthy food.17 Table 8. Relationship between behavioral responses factors and demographical characteristics variables among 100 students Relationship between behavioral responses factors and demographical characteristics variables Behavioral Responses C.C. Sig. C.S. Age groups 0.650 0.177 NS Grade 0.399 0.873 NS Marital status 0.320 0.875 NS Occupation 0.415 0.014 S Socio-economic status 0.142 0.306 NS Place of residence recently 0.380 0.533 NS original address 0.220 0.825 NS present BMI 0.909 0.318 NS Dieting state now 0.288 0.434 SN Responses Related to Dietary Activity The results of this table demonstrated that the sample activities mainly of acceptable level, only with regard to trying new rich foods and eating less than required fruits and vegetables daily18 agree with the current study girls less frequently consumed breakfast, fruits, milk, sugar-sweetened drinks, and energy drinks, but significantly more frequently consumed French fries/potato chips, cakes/donuts, and sweets/chocolates. While the study came with that some healthy dietary activities like students are not Skipped breakfast or Skipped lunch. (Alavi) found that the 48.4% of the participants are not eating break- fast, 62.7% dairy products, and 27.7% meat and eggs.14 Behavioral Responses Results further indicate that these latter determinants become more vital when the population sample demonstrated that all their eating behavior come pass and away from having an eating dis- order, their assessment indicated that for example do not try to vomit after eating or using laxatives, diet pills or diuretics to con- trol weight or shape and so on. The results are consistent with (Payne) indicated that 20% of the study sample participated in binge eating, 21% fasted, 3% vomited and 2% admitted to laxative misuse, resulting in an overall eating disorder.19 With regard to physical activities, the sample show that sample less exercised more than 60 min a day to lose or to control their weight (Musaiger) showed that the mean number of minutes performing physical activity per week was significantly higher among boys than girls.20 Conclusion Based on the findings of this study, it can be concluded that the overall responses of nursing students is Moderate in General, and related to dietary activity it came good in behavioral assessment. However, it is found that there is a significant rela- tionship between general responses. Factors and demograph- ical characteristics (Age groups and present BMI) also have a high significant relationship between responses related to die- tary activity. Factors and marital status as well as original address, finally a significant relationship between behavioral responses and sample occupation was found. Recommendations Family can help grills in adopting healthy habits when selecting food collections, activating the educational programs as early as in adolescence about the importance of body image for females through giving health information to maintain healthy body. Schools and universities have a good role in encouraging the students to make their meals as fresh as possible and mini- mizing the fast foods and others. Motivate the population to stop imitating the others in unhealthy nutritional practices. Conflict of interest None. n References 1. Johnson C. 10 eating habits of the highly successful and fit: Women’s Health (2012). 2. Sakamaki R, Amamoto R, Mochida Y, Shinfuku N, Toyama K. A comparative study of food habits and body shape perception of university students in Japan and Korea. Nutr J. 2005;4:31. 3. 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