A qualitative study to investigate the barriers to adoption of a lifestyle associated with optimal peak bone mass acquisition

Background: Osteoporosis is a major public health problem through its association with fragility fracture. Peak bone mass is attained in the second or third decade and has been shown to be a major determinant of later osteoporosis risk. Important determinants of peak bone mass include weight bearing physical activity levels, diet, cigarette smoking, and alcohol consumption. Aim: This study aimed to elucidate knowledge of factors affecting bone health among young people and identify lifestyle barriers to attainment of peak bone mass. Methods: Participants were recruited through mass mailing of University students and staff aged 18-35 at Victoria University of Wellington. Six semi structured focus group interviews were conducted, where knowledge of factors associated with bone health and attitudes to lifestyles associated with beneficial health behaviors were explored. The interviews were audio taped and transcribed. A thematic approach for data analysis using constant comparative method was performed with Nvivo software. Results: A total of 28 students (7 males, 21 females, mean age 28 years) were included. Seven themes emerged with regard to knowledge about factors affecting bone health which included physical activity, dairy, menopause, aging, smoking, alcohol and lack of knowledge about osteoporosis. For barriers, broadly eight themes of lifestyle factors emerged that included time, lack of resources, student life, cost, weather, cultural factors, lack of motivation and lastly smoking and alcohol. Students had limited knowledge about bone health in general, prevention of osteoporosis, and the importance of weight bearing physical activity and diet in determining later bone health. Some participants, especially vegans, expressed difficulties with making diet choices adequate in calcium, while others reported time management was a barrier to incorporating physical activity into everyday life. A few voiced a lack of motivation to exercise in bad weather. Some participants reported behaviors detrimental to bone health such as smoking and heavy alcohol consumption, with peer pressure being one factor leading to an increase in such activities, compounded by cultural and social pressures. Many students aspired to a healthier lifestyle but felt that they had limited knowledge about bone health, and specifically what they might need do to improve it. Conclusions: These data highlights a lack of awareness of factors that impact peak bone mass among University students, an expressed desire to know more, and a keenness to adopt healthier behaviors. School-based education could provide stronger foundations with regards to knowledge of bone health. These observational data might help design interventions that encourage optimal peak bone mass in later life