The Health Status and Lifestyle Behaviours of University Students in Nigeria by Sex and Ethnicity

Background: The health determinant model indicates that certain sociocultural, sociodemographic, environmental, and lifestyle factors influence health status and wellbeing of any population group in any given nation (Dahlgren & Whitehead, 1991). Previous studies have suggested the need for regional and interregional comparison of health inequalities due to the interaction of these factors. However, few studies have undertaken such investigation, especially among university students in developing countries. The aim of this study was to investigate the health status and lifestyle behaviours by sex and ethnicity among university students in Nigeria. Method: The study was cross sectional. Full time university students were recruited from six universities within three ethnic groups in Nigeria for the study. Data collection was both subjective and objective. The subjective data was based on an anonymous questionnaire, while the objective data involved direct measurements of height in (m) weight in (kg), and blood pressure (mmHg). Ultimately, 1549 responses were valid, while 563 responses were rejected for various reasons including missing data especially sex and ethnicity. The variables examined were, socio-demographic, general health, mental health, cognitive resources and lifestyle behaviours. Descriptive tests, chi-square tests and analysis of variance (ANOVA) tests were conducted. Results: Regarding regional characteristics in socioeconomic status, the result indicated sex and ethnicity effects, and irrespective of ethnicity, female students had better monthly income than male students did. The result suggested that students from the Hausa ethnic group reported better monthly income than students from the other ethnic groups. There is evidence that income have a significant effect on health determinant factors. For example, income affects the choice of residential location, ability to pay for health care services, register for gym for physical activity, afford healthy lifestyles, (e.g. eating fruits and vegetables), participate in social activities and maintain positive self- esteem (WHO, 2006; Varela-Mato et al., 2012). With regard to social support, the result indicated sex*ethnicity effects, where female students from the Hausa and Igbo ethnic groups reported better social support than male students, in contrast to the Yoruba ethnic group, where male students reported better social support than females. Students from the Hausa ethnic group saw their GPs more often, had regular medications and had depression more than other ethnic groups. In addition, the result indicated higher prevalence of smoking and the use of psychotic drugs among students from the Hausa ethnic group than other groups. On the other hand, the Yoruba ethnic group had the lowest monthly income, saw their GPs few times and had less frequent medication than the other ethnic groups. In addition, students from the Yoruba ethnic group had low consumption of fruits and are more physically inactive compared to other ethnic groups. Regarding sex characteristics, the study suggested that irrespective of ethnicity female students are less healthy when compared to male students. In addition, significant sex *ethnic interaction effects (P < 0.001) were observed, in most variables examined in the study, indicating that the students health and lifestyles are both sex and ethnicity dependent. The study suggested that female students from the Hausa ethnic group reported better income and social support, compared to students from the other ethnic groups; however, they also reported regular medication, overweight or obesity, mental health problems, and poor cognitive health than female students from Igbo and Yoruba ethnic groups. In addition, the Hausa male students’ preferred smaller female body size compared to male students from the other ethnic groups. On the other hand, Igbo female students had a better cognitive health and preferred small female body size than female students from the other ethnic groups. The Yoruba female students are less overweight or obese, but had the highest preference for big female body size and are the least depressed group in the sample. With regard to male students, the result suggested that Igbo male students had regular medication and depression more than other male groups. They also preferred bigger female body size and had better cognitive health than other male groups. On the other hand, Yoruba males reported overweight or obese, than the other male groups. Conclusion: The findings indicated that the health of female students in the sample was poorer than the health of male students; with female students from the Hausa ethnic group, demonstrating the worst possible health outcome. The result also suggested that both high and low socioeconomic statuses are associated with health compromising behaviours among university students in Nigeria. The findings indicated that high cognitive health appraisal might be related to students reporting better mental health especially depression in both male and female students. This study is the first to report that there is an interaction between the different layers of health, in the health determinant model proposed by Dahlgren and Whitehead (1991). Secondly, this study has made a major contribution to the understanding that people who live among regions with conflict and violence may report poor health (both physical and mental) compared to those that live in a conflict free zones. Consequently, the results of the present study suggest that conflict and violence be included among the health determinant factors in the health determinant model proposed by Dahlgren and Whitehead (1991)