Individual behaviours such as tobacco consumption, physical inactivity, poor diet or excessive alcohol consumption are major risk factors for health-related morbidity and mortality in developed countries^{1, 2}. These behaviours are frequently correlated and are indicators of a broader unhealthy lifestyle^{3, 5}. The university constitutes an environmental change for young people in that they experience less parental control and are far more exposed to cigarettes and alcohol, for example. Thus, the university environment can play an important role in the development and manifestation of their health behaviours.

The objective of this study⁶ was to assess 1) the prevalence of major health risk behaviours in German university students and 2) their readiness to change their behaviours.

A cohort of German first-year university students

A cohort of first-year university students (n=1262) was recruited in the schools of law, education and medicine in Marburg, Germany. They were questioned on their fruit and vegetable consumption, physical activity, as well as smoking and drinking habits. Additionally, they were asked about their readiness to change these behaviours (stages of change⁷, specifically to eat at least five servings of fruits and vegetables a day, exercise strenuously 3x/week for a minimum of 20 minutes, quit smoking if currently smoking and quit binge drinking (> 4/5 drinks per occasion) if current binge drinkers. For example, to evaluate their readiness to increase their fruit and vegetable consumption to five or more servings per day they were asked if they planned to do so in the next 30 days (preparation stage) or 6 months (contemplation stage); if they already fulfilled the criterium, they were asked if they had done so for less than 6 months (action stage) or for more 6 months (maintenance stage). No intention to change defined the precontemplation stage.

Individual risk behaviours

• Only 3.8% of students reported eating the recommended five servings of fruits and vegetables per day. Education and law students had the lowest fruit and vegetable consumption compared to other students.
• Only 40% of the students performed strenuous physical activity three times a week for a minimum of 20 min.; 16% reported no physical activity at all. Law students had the lowest physical activity rates.
• More than 30% of all students were current smokers with smoking rates being the highest in education students and the lowest in medical students.
• Amongst all students, 9.1% were non-drinkers (no alcohol in the previous 30 days), and 62% reported binge drinking (at least one binge episode in 30 days). Law students had the highest binge drinking rate, whereas medical students had the lowest rate.
• Women ate more fruit and vegetables, spent less time exercising, and were less often smokers or drinkers than men.

Multiple risk behaviours

• When looking at potential risk factor combinations, only 2% of all students had none of the risk behaviours, 10.5% had one, 34.5% two, 34.8% three and 18.2% had all four risk behaviours. All behaviours were correlated and the highest correlation was observed between the number of cigarettes and the number of drinks consumed per week.
• Moreover, students generally reported being relatively unwilling to
  change their behaviours: only 6.5% were ready to change all their risk behaviours in the near future (preparation stage) and one-third were ready to change at least one of them.
• Smokers often showed multiple risk behaviours: they ate less than half as many fruits and vegetables compared to non-smokers, spent less time for physical activity and reported consuming more drinks than non-smokers.
• Overall, medical students showed fewer risk behaviours than the others. This result was expected because of the students’ self-selection into a health profession.

University: the right site for improvement of health risk behaviours

This study showed a high prevalence of health risk behaviours in a cohort of 1262 first-year university students in Germany, including low fruit and vegetable consumption, sedentary lifestyle, and smoking and drinking habits. These behaviours were correlated and smokers seemed to be at a relatively higher risk for poor health behaviours. Moreover, women showed a more favorable behaviour pattern except for physical activity, and medical students showed a slightly more favorable behaviour pattern than education and law students.

A university environment constitutes an environmental change for these students (less parental control, environmental exposure to cigarettes and alcohol, etc.) and should be the object of future studies. One-third of the students in the cohort reported being ready to change at least one of their behaviours; this indicates that there is an opportunity for stimulating change, and adequate interventions should be tailored to Promote health in university settings.

These results need to be replicated in other universities to identify high-risk populations and to identify avenues for promoting effective programs for health promotion in student populations.