Understanding Incoming Canadian and US Veterinary Students’ Attitudes and Perceptions of Their Dietary Habits and Levels of Physical Activity
Publication: Journal of Veterinary Medical Education
Volume 48, Number 6
Abstract
As critical components of individual well-being, nutrition and physical activity have important physical and psychological implications. Veterinary students face demanding schedules and potentially high rates of psychological distress. Though veterinary students’ strategies for healthy eating have been explored, factors influencing their ability to achieve a healthy diet are less understood. This study assesses incoming veterinary students’ perceived attitudes to their dietary habits and physical activity levels. Incoming students (n = 322) at five Canadian and five randomly selected US veterinary schools completed a questionnaire inquiring about demographic information, dietary attitudes and habits, and activity levels. More than half (58%) of students perceived their diet to be moderately healthy. A desire to feel better and have more energy was the most reported (79%) motivating factor to modifying personal eating habits and was significantly associated with improved odds of having a perceived healthy diet (OR = 2.22, p < .024). A busy lifestyle was perceived as a barrier to changing current eating habits by 92% of respondents. Students reporting a desire to maintain their health (OR = 3.42, p < .001) and moderate (OR = 2.81, p < .003) or high (OR = 2.30, p < .044) routine physical activity levels were also more likely to perceive their diet as healthy. Findings show that incoming veterinary students’ perceptions may influence their goals of achieving a healthy lifestyle. An understanding of incoming veterinary students’ barriers and motivators could be applied in future research to assist students in achieving personalized goals.
Introduction
The challenges associated with the demands of university are well understood.1–3 University students’ lifestyle habits are of interest since behaviors acquired during postsecondary education may translate into lifelong habits.4 The university lifestyle introduces various barriers to the maintenance of students’ well-being. For example, a busy schedule may favor convenience over dedicating time and effort to preparing healthy meals or being physically active.1,2,3
Research has demonstrated that lifestyle is an important factor in students’ mental health. On the one hand, higher-intensity and more frequent physical activity is reported to be a predictor of better mental health.5 On the other hand, Zellner et al.6 have found that increased stress increased both consumption of high-fat, calorically dense foods and acts of overindulgence in eating by female undergraduate students. Moreover, it is recognized that implementing protective health behaviors, such as regular physical activity and healthy dietary intake, can substantially reduce the risk of many health conditions, including coronary heart disease, type 2 diabetes, and cancer, and may promote positive mental health when implemented consistently.5,7 For students enrolled in professional university programs, and for veterinary students in particular, various academic and non-academic stressors (e.g., health status and personal relationships) have been reported to potentially play a role in increasing levels of anxiety, stress, and depression.8,9
Although some research suggests that university students may learn to cope with barriers to healthy living, such as time constraints,1 research conducted with medical professionals in the United States has indicated that they continue to struggle to meet recommended health guidelines (e.g., adequate fruit and vegetable consumption and levels of exercise) throughout medical school and into practice as physicians.10 Some studies reveal that medical students’ nutrition habits may even decline throughout medical school. For example, fourth-year medical students in southern India have reported increased junk food consumption in both quantity and frequency, as well as greater irregularity in their eating habits, after starting medical school,11 and research with US medical students reveals that students’ vegetable intake declines from their freshman orientation to their senior year.12
Moreover, medical students are expected to develop an ability to confidently discuss and address health care concerns and preventive measures with their patients, which often involves nutritional counseling.10 The ability to discuss and address patients’ health care practices has been shown to be impacted by physicians’ own health practices. For example, their own smoking and exercise habits have been shown to have a strong influence on physicians’ clinical practice and the frequency of related patient counseling practices.10,13 Additionally, Lemaire et al.’s14 research results reveal that patients observe physicians for indicators of well-being, and these judgments may affect their subsequent perception of care and, ultimately, the doctor–patient relationship. Consequently, medical students’ personal perceptions about health behaviors may have important implications for patient care12,15 and personal health and well-being.5 Given that students’ perceptions of healthful behaviors decline throughout medical school, capturing and understanding such perceptions early in their career provides an opportunity to address, and possibly mitigate, any future negative personal and professional implications.
Veterinary students are also expected to confidently discuss and address nutrition and dietary concerns with pet owners.16 Insight and research regarding veterinary students’ own health behaviors and any consequential impacts on clinical practice have, however, been far less explored than medical students’. Royal et al.17 have investigated strategies used by veterinary students in all stages of their programs to improve their eating choices. This research reveals that most veterinary students already have some strategies for healthy eating, but the approaches used are diverse. The most common strategies include thinking about the benefits gained from eating healthy foods, trying an assortment of healthy options, and using self-encouragement. Furthermore, the results reveal that while most students (51%) rated their current diet to be good, over 40% rated their diet as poor or fair, with only 9% perceiving their current diet to be excellent. While these findings demonstrate that veterinary students might be making conscious efforts to adopt healthy eating strategies, students in the study recognized that there was room for improvement. Hafen et al.8 highlighted the importance of health perceptions when they identified that veterinary students with a poorer perception of their physical health were more likely to struggle academically in their first year.
Self-reported health perceptions may influence related behaviors. Research focusing on physical activity levels and dietary habits reveal that higher perceptions of personal health status is strongly associated with increased physical activity in older US adults,18 and Canadian adolescents who perceive themselves to be overweight are less likely to enroll in physical activities, meet exercise guidelines, and eat breakfast regularly.19 Another study examining Canadian youth similarly reports that perceptions of being overweight are associated with less physical activity and high sedentary behavior.20 Behavioral theory models, such as the Health Belief Model, posit that successfully targeting one’s health beliefs and perceptions (e.g., barriers and benefits) may lead to optimal behavior change.21 These models have been widely applied in research surrounding the promotion of preventive health behaviors.22
Veterinary students’ personal health perceptions are far less understood. Given the physical and psychological implications associated with poor health behaviors, our awareness of the increasing demands of the veterinary medical program, and the known relationship between health perceptions, dietary behaviors, and counseling attitudes, a better understanding of incoming veterinary students’ current perceptions of dietary and physical activity is important. This information may guide educators to implement well-being strategies into the veterinary curriculum to best support students and inform future research interventions for them using behavioral theory models. By capturing incoming veterinary students’ self-reported health measures, future applications can aim to improve students’ self-perceptions from the beginning of the veterinary program. Understanding and improving such perceptions may allow us to better support veterinary students by means of effective health promotion strategies to encourage good present and future health behaviors as well as optimal learning and counseling attitudes.
This study investigated dietary behaviors of incoming veterinary students. Specifically, the objectives were to understand incoming veterinary students’ attitudes and behaviors in regard to their perceived dietary habits and levels of physical activity, and to explore students’ motivations and barriers to making changes in these.
Methods
Study Design
In this multicenter cross-sectional study, all incoming Doctor of Veterinary Medicine degree (or equivalent) students (those commencing first year of studies) at the five Canadian veterinary schools and five randomly selected US veterinary schools were invited to complete an online questionnaire between September and November 2016. This study received University of Guelph’s Research Ethics Board approval (REB #16JA039) and ethics approval from all participating institutions.
Questionnaire Design
We developed a questionnaire based on a literature review and focus group discussions with veterinary students at the University of Guelph. The survey was distributed to participants in collaboration with another research questionnaire.23 The questionnaire included demographics, dietary attitudes and habits, and levels of physical activity. Questions were in multiple-choice or 5-point Likert scale format. For the multiple-choice questions, respondents had the opportunity to select more than one response and further elaborate on their response(s) by using an other category to best explain and describe their nutrition-related attitudes and habits.
Demographics
Using multiple-choice-style questions, students were asked their age, gender, previous program of study, whether they were a domestic or international student, and future career plans.
Dietary Attitudes and Habits
Students were asked, “What is healthy eating to you?” A variety of response options were presented (e.g., variation in foods, counting calories, more vegetables), and students could select multiple responses. Using a 5-point Likert scale, respondents were asked to rate their diet (1 = very unhealthy, 5 = very healthy) and the extent to which they think about their diet (1 = never, 5 = every time I eat).
Subsequent multiple-choice questions explored changes students would make to their diet if they wished to make it more healthy (e.g., more variety in foods, fewer calories, more vegetables), factors that would motivate them to make an effort to change their personal eating habits (e.g., physician’s recommendation, wanting to lose weight, wanting to gain weight, wanting to feel better and have more energy), and perceived difficulties they might face in changing their eating habits (e.g., price of healthy foods, busy lifestyle, family’s influence, friends’ influence). Using a 5-point Likert scale, students were asked to rate their confidence in their ability to make desired changes to their current diet (1 = strongly unconfident, 5 = strongly confident). Additionally, students were asked about the factors that influenced their eating habits on a daily basis (e.g., cost, time, social media) and factors influencing their grocery store purchases (e.g., cost, food preparation skills needed, food’s sugar content).
Levels of Physical Activity
Students were asked, with a multiple-choice-style question, “If you had more time, which of the following methods are you likely to use or continue to use as a form of having a healthy lifestyle?” Response options included choices such as being more active throughout the day, eating out less often, and consuming less caffeine. Students were then asked to rate their activity level using a 5-point Likert scale (1 = I do some light physical activity every day of the week, 5 = I do 20 minutes of vigorous physical activities, 3 or more days a week).
Questionnaire Distribution
Pilot testing for survey length, question clarity, and comprehensiveness was completed by six veterinary students during the second semester of their program at the research team’s home institution, and their feedback was used to further refine the questions and establish content validity. Question item reliability was satisfactory (Cronbach’s alpha = .76) for internal consistency of the questionnaire instrument. The questionnaire was distributed via Qualtrics© (2017, Provo, UT) by email invitation from each school’s student affairs or communications office. The questionnaire was anonymous. It was distributed in French to the French-language Canadian veterinary school and in English to all the others. Responses were not linked to any personal identifiers. Upon submission of the questionnaire, students were provided with an external link separate from the main questionnaire to enter an optional prize draw; this acted as an incentive to complete the questionnaire.
Questionnaire Data Analysis
Questionnaire data were entered into a Microsoft Excel spreadsheet for quantitative analyses using STATA15.1© (2017, College Station, TX). The initial univariate analysis involved verifying distributions. Perceived diet health was dichotomized, where categories 1, 2 and 3 (very unhealthy, moderately unhealthy, and neither healthy/unhealthy) were combined, and categories 4 and 5 (moderately healthy and very healthy) were combined to create a dichotomous variable (0 = unhealthy, 1 = healthy). Age, time spent thinking about diet, and activity level were each condensed into three categories. Age was reduced from six to three categories where categories 1 and 2 (< 20 and 20–22), 3 and 4 (23–25 and 25–27), and 5 and 6 (28–30 and > 30) were combined to create three overall categories (1 = < 22, 2 = 23–27, 3 = > 28). Time spent thinking about diet was condensed from the 5-point Likert scale to create four categories, where the original categories 2 and 3 were combined (1 = never, 2 = intermittently/unsure, 3 = regularly but not daily, 4 = every time I eat). Activity level was reduced from the original five categories, where categories 2 and 3 (I do moderate physical activities every week, but less than 30 minutes a day or 5 days a week and I do vigorous physical activities every week, but less than 20 minutes a day or 3 days a week) and categories 4 and 5 (I do 30 minutes or more a day of moderate physical activities, 5 or more days a week and I do 20 minutes or more a day of vigorous physical activities, 3 or more days a week) were combined to create three overall categories (1 = light activity level, 2 = moderate activity level, 3 = high activity level).
All predictor variables were prescreened with a liberal p value (p ≤ .2) for inclusion in their respective model, and a Spearman’s correlation analysis was performed to determine whether there were any pairwise correlations between the categorical independent variables. A likelihood ratio test was performed before removing any categorical variables that did not appear statistically significant (p < .05) from the final multivariable model. A logistic regression model was constructed to evaluate the effect of the predictor variables on perceived diet quality.
Measures of frequency were evaluated for perceived qualities of healthy eating; desired changes to make to current diet; perceived motivations and barriers to changing personal eating habits; desired approaches to having a healthier lifestyle if students had more time; factors influencing daily eating habits; factors influencing grocery store purchases; and activity level.
Results
Response Rate and Demographics
The questionnaire was distributed to 942 incoming veterinary students, 322 (34%) of whom completed the questionnaire. Participant demographics are summarized in Table 1. Most respondents (150/322, 47%) were under 22 years of age, and 89% (285/322) were female. Canadian respondents were slightly more represented (160/322, 50%) than were American (156/322, 48%), with the remaining respondents identifying as international students (4/322, 1%) or preferring not to disclose their background (2/322, 0.6%). The most commonly completed previous undergraduate degree was in animal biology (142/322, 44%). Respondents’ most popular career plans following graduation included entering a companion animal–exclusive practice (105/322, 33%) and entering a rural community practice with multiple species (82/322, 25%).
| Demographic variable | No.; n = 322 | % |
|---|---|---|
| Age (years) | ||
| < 22 | 150 | 46.6 |
| 23–27 | 145 | 45.0 |
| > 28 | 27 | 8.4 |
| Gender | ||
| Female | 285 | 88.5 |
| Male | 37 | 11.5 |
| Other identifier, please specify | 0 | 0.0 |
| Prefer not to answer | 0 | 0.0 |
| Residence | ||
| Canadian resident | 160 | 49.7 |
| US resident | 156 | 48.5 |
| International resident (neither US nor Canada) | 4 | 1.2 |
| Prefer not to answer | 2 | 0.6 |
| Previous program of study | ||
| Animal biology | 142 | 44.1 |
| Other, please specify | 92 | 28.6 |
| Biomedical science | 57 | 17.7 |
| Graduate school | 28 | 8.7 |
| Prefer not to answer | 3 | 0.0 |
| Nutrition | 0 | 0.0 |
| Career plans upon graduation | ||
| Companion animal–exclusive practice | 105 | 32.6 |
| Rural community practice (companion animal, equine, food animal) | 82 | 25.5 |
| Other, please specify | 64 | 19.9 |
| Equine-exclusive practice | 22 | 6.8 |
| Public health | 16 | 5.0 |
| Research | 14 | 4.4 |
| Prefer not to answer | 8 | 2.5 |
| Food animal–exclusive practice | 7 | 2.2 |
| Industry | 4 | 1.2 |
Dietary Attitudes and Habits
Most incoming veterinary students indicated opportunities for improving their current diet, with more than half (58%, 186/322) rating their current diet as moderately healthy. Few (3/322, 1%) rated their diet as very unhealthy, 13% (42/322) as moderately unhealthy, and 23% (74/322) as neither healthy nor unhealthy. Only 5% (17/322) rated their diet as very healthy.
When asked to select from a list of factors defining healthy eating to them, most respondents reported eating the right mix of different food groups (257/322, 80%) and consuming more vegetables (235/322, 73%) (Table 2). The latter choice was also the most desired change students wished to make to improve their dietary health (215/322, 67%). Over half of the respondents reported consuming less sugar than their current diet (182/322, 57%) and avoiding processed foods (163/322, 51%) as desired dietary changes. Having a busy lifestyle was the largest perceived barrier (297/322, 92%) to making these changes. Students were most likely to be motivated to modify personal eating habits in order to feel better and have more energy (255/322, 79%).
| Variable | n (Total: 322) | % |
|---|---|---|
| What is healthy eating? | ||
| The right mix of different food groups | 257 | 79.8 |
| More vegetables | 235 | 73.0 |
| Variation in foods | 204 | 63.4 |
| Avoiding processed foods | 180 | 55.9 |
| More fruit | 177 | 55.0 |
| Less sugar than current diet | 154 | 47.8 |
| Eating smaller portions | 135 | 41.9 |
| Mindful eating | 131 | 40.7 |
| Eating three meals per day | 120 | 37.3 |
| Less fatty foods than current diet | 96 | 29.8 |
| Eating locally sourced, non-GMO, organic foods | 79 | 24.5 |
| High protein | 79 | 24.5 |
| Less carbohydrates than current diet | 75 | 23.3 |
| Counting calories | 35 | 10.9 |
| Not snacking | 34 | 10.6 |
| Gluten-free | 9 | 2.8 |
| Other, please specify | 9 | 2.8 |
| Prefer not to answer | 0 | 0.0 |
| Desired changes to current eating habits to improve diet health | ||
| More vegetables | 215 | 66.8 |
| Less sugar than current diet | 182 | 56.5 |
| Avoiding processed foods | 163 | 50.6 |
| More variety in foods | 121 | 37.6 |
| Less carbohydrates than current diet | 109 | 33.9 |
| Less fatty foods than current diet | 103 | 32.0 |
| More fruit | 103 | 32.0 |
| Eating smaller portions | 98 | 30.4 |
| More protein | 95 | 29.5 |
| Less snacking than current diet | 94 | 29.2 |
| Consume fewer calories | 91 | 28.3 |
| Less caffeine | 65 | 20.2 |
| Eat locally sourced, organic foods | 58 | 18.0 |
| Less alcohol | 43 | 13.4 |
| Eat three meals per day | 36 | 11.2 |
| Stick to a vegetarian or vegan diet | 25 | 7.8 |
| Consume more calories | 9 | 2.8 |
| Gluten-free | 5 | 1.6 |
| Other, please specify | 5 | 1.6 |
| Prefer not to answer | 0 | 0.0 |
| Barriers to changing eating habits | ||
| Busy lifestyle | 297 | 92.2 |
| Price of healthy foods | 217 | 67.4 |
| No time | 207 | 64.3 |
| Cooking skills | 114 | 34.4 |
| Experts keep changing their minds | 38 | 11.8 |
| Friends’ influence | 35 | 10.9 |
| Lack of knowledge about healthy eating | 34 | 10.6 |
| Families’ influence | 28 | 8.7 |
| Other, please specify | 14 | 4.4 |
| Prefer not to answer | 0 | 0.0 |
| Motivations to changing eating habits | ||
| Wanting to feel better and have more energy | 255 | 79.2 |
| Wanting to prevent changes or improve physical appearance | 241 | 74.8 |
| Feel good about yourself | 231 | 71.7 |
| Being diagnosed with a health condition | 182 | 56.5 |
| Physician’s recommendations | 140 | 43.5 |
| Dietitian’s recommendations | 95 | 29.5 |
| Family and friends’ encouragement | 79 | 24.5 |
| Social media sites | 28 | 8.7 |
| Other, please specify | 11 | 3.4 |
| Prefer not to answer | 0 | 0.0 |
| Desired approaches to have a healthier lifestyle if students had more time | ||
| Spend more time exercising every week | 267 | 82.9 |
| Be more active throughout the day | 266 | 82.6 |
| Eating less processed foods | 172 | 53.4 |
| Preparing meals from scratch | 136 | 42.2 |
| Paying more attention to what you eat | 117 | 36.3 |
| Eating more slowly and attentively | 94 | 29.2 |
| Eating out less often | 90 | 28.0 |
| Eating more small meals throughout the day | 82 | 25.5 |
| Limit the number of calories in the foods you eat | 60 | 18.6 |
| Eating snacks less frequently | 57 | 17.7 |
| Less caffeine | 57 | 17.7 |
| Spend more time learning about healthy eating | 54 | 16.8 |
| Less alcohol | 41 | 12.7 |
| Other, please specify | 4 | 1.2 |
| Time is currently not an issue for my diet choices | 3 | 0.9 |
| Prefer not to answer | 0 | 0.0 |
| Factors influencing daily eating habits | ||
| Time | 291 | 90.4 |
| Convenience | 272 | 84.5 |
| Cost | 211 | 65.5 |
| Self-discipline | 181 | 56.2 |
| Desire to maintain health | 116 | 36.0 |
| Internet blogs about food/healthy eating | 14 | 4.3 |
| Family’s advice | 11 | 3.4 |
| Social media sites | 11 | 3.4 |
| Other, please specify | 7 | 2.2 |
| Friends’ advice | 5 | 1.6 |
| Prefer not to answer | 0 | 0.0 |
| Factors influencing grocery store purchases | ||
| Cost | 267 | 82.9 |
| Time and effort to prepare meal | 217 | 67.4 |
| The products I (and/or my family/friends) most enjoy eating | 165 | 51.2 |
| Food that doesn’t spoil easily | 136 | 42.2 |
| Food preparation skills needed | 101 | 31.4 |
| Variety of foods | 99 | 30.7 |
| Physical accessibility of store | 93 | 28.9 |
| Number of calories | 76 | 23.6 |
| Sugar content of food | 72 | 22.4 |
| Products that protect/support animal welfare | 67 | 20.8 |
| Products that protect/support the environment | 65 | 20.2 |
| Buying in bulk | 63 | 19.6 |
| Products that protect/support local communities | 56 | 17.4 |
| Fat content of food | 47 | 14.6 |
| Protein content of food | 45 | 14.0 |
| Packaging of food | 26 | 8.1 |
| Other, please specify | 6 | 1.9 |
| Prefer not to answer | 0 | 0.0 |
Note: Respondents could select more than one response for these questions.
Respondents’ daily eating habits were most influenced by time (291/322, 90%), convenience (272/322, 85%), and cost (211/322, 66%). When asked which factors were likely to influence grocery store purchases, most students indicated cost (267/322, 83%), time and effort to prepare a meal (217/322, 67%), and products that they and/or their families and friends most enjoy eating (165/322, 51%) as most influential. Factors influencing students’ attitudes toward their current dietary habits are summarized in Table 2.
Levels of Physical Activity
Most incoming veterinary students reported a moderate (130/322, 40%) or light (113/322, 35%) routine physical activity level, with only a quarter of students reporting a heavy (79/322, 25%) routine physical activity level. To lead a healthy lifestyle, many students would, if they had more time, spend more time exercising every week (267/322, 83%) and be more active throughout the day (266/322, 83%) (Table 2).
Regression Model Analysis: Factors Influencing Students’ Perceptions of Current Dietary Health Status
Table 3 highlights the results of a multivariable logistic regression analysis of variables associated with students’ perceived dietary health status. Students who reported not thinking about their diet as frequently (only intermittently [OR = 0.21, p < .003] or regularly, but not daily [OR = 0.49, p < .047]) were less likely to perceive their diet as healthy in comparison with those who reported thinking about their diet every time they eat. Students who indicated that, if they had more time, they would eat out less often (OR = 0.45, p < .022) as a form of having a healthy lifestyle were less likely to report a perceived healthy diet. Respondents who perceived their busy lifestyle (OR = 5.40, p < .004) as a barrier to making changes to current eating habits were more likely to consider their diet as healthy. Similarly, students who reported a desire to feel better and have more energy as a motivating factor to modify their personal eating habits were more than twice as likely (OR = 2.22, p < .024) to consider their diet as healthy, in comparison with students who were not motivated by such. Those who reported a desire to maintain one’s health (OR = 3.42, p < .001) and moderate (OR = 2.81, p < .003) or high (OR = 2.30, p < .044) routine physical activity levels were also more likely to perceive their diet as healthy.
| Variable | Odds ratio | 95% CI | p† |
|---|---|---|---|
| Perceived elements of healthy eating | |||
| Consuming less sugar than current diet | 0.33 | 0.17–0.65 | .001 |
| Consuming less fatty foods than current diet | 0.41 | 0.21–0.81 | .010 |
| Extent of thinking about diet (RG = every time I eat) | |||
| Intermittently | 0.21 | 0.08–0.58 | .003 |
| Regularly, but not daily | 0.49 | 0.24–0.99 | .047 |
| Desired changes to current diet to improve diet health | |||
| Eating three meals/day | 0.33 | 0.17–0.62 | .001 |
| Consuming fewer calories | 0.49 | 0.25–0.96 | .037 |
| Methods to use or continue to use as a form of having a healthy lifestyle, if you had more time | |||
| Eating out less often | 0.45 | 0.23–0.89 | .022 |
| Motivating factors to change personal eating habits | |||
| Wanting to feel better and have more energy | 2.22 | 1.11–4.42 | .024 |
| Perceived barriers to changing personal eating habits | |||
| Busy lifestyle | 5.40 | 1.74–16.80 | .004 |
| Lack of knowledge about healthy eating | 0.33 | 0.12–0.87 | .024 |
| Factors influencing daily eating habits | |||
| Convenience | 0.30 | 0.12–0.80 | .016 |
| Desire to maintain health | 3.42 | 1.61–7.30 | .001 |
| Factors influencing grocery store purchases | |||
| Sugar content of food | 3.50 | 1.42–8.63 | .007 |
| Products that protect/support animal welfare | 3.56 | 1.36–9.30 | .010 |
| Physical activity level (RG = light physical activity level) | |||
| Moderate physical activity level | 2.81 | 1.41–5.60 | .003 |
| High physical activity level | 2.30 | 1.02–5.20 | .044 |
RG = reference group
Note: Variables in bold indicate the specific variables that are mentioned in the section above.
*
Variables entered in the full model: gender, age, perceived elements of healthy eating, extent of thinking about what you eat, desired changes to current diet to make diet more healthy, methods to use or continue to use as a form of having a healthy lifestyle given more time, motivating factors to change personal eating habits, perceived barriers to changing personal eating habits, factors influencing daily eating habits, factors influencing grocery store purchases, and physical activity level
†
p value significant at < .05.
Discussion
This study explored incoming veterinary students’ attitudes and behaviors in regard to their dietary habits and levels of physical activity, as well as their perceived motivations and barriers to making related changes. Although 58% of respondents felt their diet was moderately healthy, very few perceived their diet to be very healthy. Consistent with previous literature among diverse university student populations,24 and veterinary students specifically,17 our results indicate that most incoming veterinary students feel they could make improvements to their current dietary habits.
Overall, most students in the present study believed consuming the right mix of different food groups to best define what healthy eating meant to them, while eating more vegetables was the second most described category of healthy eating and the most desired change to current dietary habits. Low vegetable consumption by young adults is commonly highlighted in the literature, where reported intake levels frequently fail to meet recommended guidelines.25 A systematic review on dietary interventions in university students reveals that the use of media-based education strategies to improve student dietary habits, including vegetable consumption, might result in greater odds of success than interventions lacking media components.26 Given the abundant use of smartphones and other technologies by young adults, media-based approaches may be appropriate interventions to improve vegetable intake and overall dietary habits in incoming veterinary students. Additionally, the use of point-of-purchase messages have proven effective in promoting vegetable consumption by students in university dining facilities.26 Since our study did not investigate eating habits and attitudes surrounding cafeterias at the attended universities or perceived marketing strategies at grocery stores, future research should investigate these areas to explore the use and effectiveness of point-of-purchase tactics on incoming veterinary students.
Further exploration of the veterinary students’ attitudes and behaviors in relation to on-campus dining opportunities may provide additional insight into perceptions on personal eating habits. Given that consuming less sugar and avoiding processed foods ranked highly as desired changes to current eating practices, and a busy lifestyle and cooking skills were common perceived barriers for students, convenience factors such as on-site cafeterias likely influence this group of students. Further, time and convenience were the most frequently reported influencing factors on students’ daily eating habits, and the reported daily influence of convenience on eating habits was negatively associated with perceived diet quality in our results.
Environment has been shown to have a significant effect on university student eating habits, as the majority of students prefer to purchase foods from on-campus dining facilities over other locations.2 Hilger et al.1 have identified a lack of healthy meals available at a campus canteen as a significant perceived barrier to healthy eating among university students. Although proximity to grocery stores offering healthy foods has been previously shown to be positively associated with purchasing quality ingredients such as fruits and vegetables,27 students in demanding programs such as veterinary medicine, who spend extended hours on campus with limited free time, may be more dependent on convenience items. Our results indicate that students who are currently most reliant on convenience foods (e.g., eating out) because of time restraints are less likely to think of their diet as healthy. Therefore, veterinary medical schools should ensure healthy eating options are affordable and accessible to their students in on-campus dining facilities to accommodate and promote healthy dietary habits alongside a demanding schedule.
In our study, lack of knowledge about healthy eating was a perceived barrier to changing current eating habits and was negatively associated with perceived diet quality. Others have shown that both food preparation skills and nutrition education enhance diet quality among young adults and support future eating habits.28,29,30 Hilger et al.1 indicate that a lack of nutrition knowledge and cooking skills may result in a greater reliance in university students on cafeteria food. Veterinary student well-being programs could thus consider incorporating personal health and nutrition classes and food preparation skills into their curriculum to promote nutritional value and consistency in students’ eating habits.1 Including such well-being aspects in the veterinary curriculum would benefit not only first-year students, but also students in subsequent years as the demands of veterinary school increase, in encouraging personal well-being. Further, such well-being initiatives may serve as a frequent reminder to students about the value of maintaining healthy dietary habits, since veterinary students who reported not frequently thinking about their diet were less likely to perceive their diet as healthy in comparison with those who reported thinking about their diet every time they eat.
Physical activity initiatives should be similarly considered in veterinary well-being programs. Only one quarter of students in our study reported a high routine level of physical activity, defined in this case as moderate physical activities five or more days per week or vigorous physical activities three or more days per week. Poor physical activity levels are consistent among studies examining other health care students, including nursing and medical students.31 Incoming veterinary students who reported moderate or high routine physical activity levels were at greater odds of perceiving their diet as healthy than were students who reported a low routine physical activity level. Physical exercise is significantly associated with low stress in pre-clinical medical students.32 Our results indicate that lack of time may be a significant barrier to allowing students to incorporate physical activity into their routine, given that spending more time exercising every week and being more active throughout the day were the most common responses given by students when they were asked what they would continue or change to lead a healthy lifestyle if they had more time. Given these findings, future research interventions should consider ways to assist veterinary students in managing their time to incorporate regular physical activity into their routines while also promoting the psychological benefits of physical activity in managing high stress and anxiety levels. Blake et al.33 have found that a 12-week personal text and email messaging intervention known as Acitve8! increases the frequency and duration of active travel (e.g., walking or cycling to and from places) and duration of moderate intensity physical activity among health care employees, and in their study, these behavioral changes continued up to 1 month after the messages ended. Inconsistent schedules, personal study preferences, and the introduction to shift work in later years of veterinary school may make veterinary students ideal candidates for such a personalized and flexible intervention. Other technology-based interventions have also proven effective in promoting physical activity levels within college and university student populations.34,35 Considering that a desire to feel better and have more energy was the biggest motivating factor to adopting healthy eating habits among incoming veterinary students in this study, and that this was significantly associated with improved odds of having a healthier perceived diet, educating students about the physical and psychological benefits of a healthy diet and routine physical activity would effectively complement well-being initiatives.36 Incoming veterinary students who reported their daily eating habits to be influenced by a desire to maintain their health were also significantly more likely to perceive their diet as healthy.
Our results indicate that personal health is valued by incoming veterinary students, made evident by shared desires to consume more vegetables, reduce the intake of sugar and processed foods, feel better and have more energy, and feel good about one’s self, as well as shared ambitions to spend more time exercising and increase one’s overall activity level. As individuals who may have a direct future professional role in food animal production, veterinary students’ pre-existing interests and perceptions may impact decisions they make in their future careers. Conversely, although this study showed no significant relationship, a future interest in food animal production may have influenced students’ present attitudes toward food, nutrition, and healthy eating. As documented in the literature, the health perceptions and behaviors of medical professionals are subject to decline throughout the program and into their careers.10,11,12 The self-reported perceived health attitudes and behaviors of incoming veterinary students captured in this study can be used in future interventions to improve upon such measures from the beginning of the program to promote the health and success of veterinary students and professionals.
While it provides insight into a previously under-explored area, there were limitations in our investigation. Previous literature has identified gender differences in nutrition practices and behaviors among students and young adults.2 Gender was not identified as a significant predictor of perceived diet quality in our findings, but a distinct gender bias was present, with 89% of respondents being female; however, this gender bias is consistent with other veterinary student populations.17 Despite the documented effects on students’ eating habits,1,2 data were not collected on the presence or influence of an on-campus cafeteria. Given that the questionnaire’s response options did not reflect this consideration, it may serve as a limitation and could have played a role on students’ responses of perceived nutrition and dietary attitudes and habits. To further understand veterinary students’ barriers, motivations, and attitudes to healthy eating, future studies should account for accessibility to on-campus dining facilities with healthy food choices. Moreover, prospective studies applying behavioral theories, such as the Health Belief Model, may be beneficial in better assessing constructs such as students’ perceived benefits, barriers, and self-efficacy in regard to dietary and physical activity behaviors. Such findings could form a basis to implementing well-being programs for the veterinary student population.
While this study investigated incoming veterinary students from veterinary medical schools in Canada and the US, results from the questionnaire may be less generalizable to veterinary students outside these two countries. Since our study focused on students’ personal habits and perceptions, the potential for social desirability bias exists due to the social and psychological value attributed to personal health. In an effort to overcome this, our questionnaire stressed that responses were anonymous. Finally, results of this study are at risk of nonresponse bias since participation by respondents was voluntary.
Our results provide insight into the perceptions and attitudes expressed by incoming veterinary students about their personal dietary and physical activity practices. Findings illustrate an opportunity to educate veterinary students on strategies to enhance diet choice and quality. The perceived motivations and barriers identified in this study may be used in future targeted intervention strategies to promote behavioral changes in veterinary students to support a healthy diet and physical activity level. While veterinary students may have particular perceptions about and goals for achieving a healthy diet, these results should encourage veterinary medical schools and students to develop ways to use this information to moderate the high demands of the veterinary medical program to help promote veterinary students’ individual well-being and, ultimately, successful careers.
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Journal of Veterinary Medical Education
Volume 48 • Number 6 • December 2021
Pages: 747 - 755
PubMed: 33657337
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2021 AAVMC.
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Published online: 3 March 2021
Published in print: December 2021
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Journal of Veterinary Medical Education 2021 48:6, 747-755
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