الفهرس 
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Abstract
Noncommunicable diseases (NCDs), mainly cardiovascular diseases, cancers,
chronic respiratory diseases, and diabetes are the leading causes of death globally. They
are responsible for seven out of every ten deaths worldwide (accounting for 41 million) in
2019. Moreover, 84% of all deaths in Egypt are primarily due to NCDs.
The UN agenda for global sustainable development by the year 2030
recognizes NCDs as a major challenge for sustainable development in the 21st century.
Therfore, it sets a sustainable development goal (SDG target 3.4) for reducing premature
deaths from NCDs that occur between the ages of 30-69years by 1/3 by the year 2030
through prevention and prompt treatment.
An essential way to prevent NCDs is to focus on eliminating the major risk factors
for these diseases. The risk of suffering from NCDs is enhanced primarily due to four
major risk factors: the use of tobacco and alcohol, consumption of unhealthy diets, and
physical inactivity. Almost 70% of premature NCDs deaths in adults (before reaching 70
years of age) are due to behaviors started or well established during the adolescent period
or young adulthood that share common risk factors
In fact, the prevalence of the four major NCDs risk factors is rising among young
people globally and in the Arab region which sets the stage for NCDs incidence later in
life. Moreover, there is evidence that when young adults start university, they tend to
develop unhealthy behaviors that could raise the risk of developing serious health problems
including NCDs.
Surveillance and monitoring to track trends of NCDs risk factors are therefore
essential for predicting the future burden of NCDs in the younger population and also for
identifying potential interventions to reduce such future burden.
Accordingly, this study was conducted to determine the prevalence of risk factors for
NCDs among Alexandria university students.
A cross-sectional descriptive design was used to carry out this study. It was
conducted in all Faculties and Institutes affiliated to Alexandria University representing the
five main academic sectors namely; Health, Science, Engineering, Agriculture and Food,
and Social Science. The total sample was 1280 students, chosen from all academic years in
each faculty using a systematic random sampling technique.
Tools for data collection:
Data were collected using an instrument (version 3.1) of the WHO Stepwise
approach to noncommunicable disease risk factor surveillance (STEPS). Accordingly, the
following two tools were used:
Tool (I): Students’ behavioral risk factors self administered questionnaire. It included
sociodemographic and academic data, behavioral measurements (tobacco use, alcohol
consumption, diet, and physical activity), clinical/ medical history, lifestyle advice as well
as breast and cervical cancer screening.
Tool (II): Physical Measurements (blood pressure, height, body weight, waist
circumference).
The study tools were translated into Arabic and tested for content validity. Approvals
were obtained to carry out the study at the specified settings. A pilot study was carried out
and modifications in the study tools were done accordingly. Finally, data was analyzed
using SPSS (the statistical package for social science, version 20), and appropriate
descriptive and analytical statistics were carried out.
The main findings revealed from the study were as follows:
Students’ socio-demographic and academic data
Regarding students’ academic sectors, more than two thirds (69.0%) of students were
enrolled in Faculties affiliated to Social Science sector, followed by Engineering and
Health sectors (12.0% and 10.0% respectively), whereas the least proportion of
students were from Science, Agriculture and Food sectors (6.0% and 3.0%
respectively).
Concerning students’ age, it was ranged from 18 to 30 years, with means of
(20.81±1.59 and 20.28±1.41years) for males and females respectively.
The majority of both male and female students (87.7% and 93.7% respectively) were
living in urban areas.
More than one third (33.5%) of males as compared to only 11.4% of females were
working along with pursuing their education.
Tobacco use
About one quarter (22.4%) of males as compared to a very small percentage of
females (0.6%) were current tobacco smokers, with a statistically significant
difference between both sexes (X2=160.26, p>0.0001).
In relation to age at initiation of smoking among current smokers, it was noticed that
males started smoking at earlier ages than females with means of 17.24± 2.49 and
20.00 ± 0.816 years respectively for males and females, with a statistically
significant difference between males and females (t=2.21, p=0.029).
Moreover manufactured cigarettes was the only tobacco product consumed among
the only one female who smoked daily and the most frequently consumed among the
majority (94.2 %) of males followed by Shisha and hand-rolled cigarettes (23.8%
and 17.1% respectively), with statistically significant differences between males and
females regarding the consumption of manufactured cigarettes (Z=6.4, p>0.0001),
hand-rolled cigarettes (Z=11.4, p>0.0001), and Shisha (Z=13.6, p>0.0001).
Furthermore, only 0.2% of students were using smokeless tobacco products.
During the past 30 days, about half of both male and female students (49.1% and
47.9% respectively) reported that they were exposed to secondhand smoke (SHS) at
home. However, males were more frequently exposed to SHS outside the home than
females (81.7% and 74.7% respectively), with a statistically significant difference
between both sexes (X2= 9.12, P=0.003).
Alcohol consumption
About one tenth (10.1%) of males as compared to 1.7% of females reported that they
had consumed alcohol in their life, with statistically significant differences between
both sexes (X2=42.36, p>0.0001).
Among those who drank alcohol in their life, about two thirds of males (64.4%) and
one third (33.3%) of females reported that they had consumed alcohol in the past 12
months, with no significant difference between both sexes.
About two thirds of males (60.5%) as compared to only two of the four females of
those who drank alcohol in the past 12 months were current alcohol drinkers, with no
significant difference between both sexes.
With respect to heavy episodic drinking (HED) among current alcohol drinkers,
around one third of only the males had HED (once or two times) in the past 30 days,
with no statistically significant difference between both sexes.
Students who stopped drinking alcohol in the past 12 months due to health reasons
constituted only about one quarter of both sexes (27.6%), with no statistically
significant difference between males and females.
Diet (Fruits and vegetables consumption)
It was observed that males consumed more fruits and vegetables than females. Where
the mean number of servings of fruits was 2.19±1.29 and 2.04±1.03 servings/day for
males and females respectively and for vegetables was also higher among males than
among females (1.81±1.14 and 1.61 ±1.01 servings/day respectively), with
statistically significant differences between both sexes (t=2.35, p=0.019, and t=3.09,
p=0.002 respectively).
The overall percentage of students who consumed less than five servings of fruits
and/or vegetables on average per day was 87.2% (84.4% and 89.5% respectively) for
males and females, with a statistically significant difference between both sexes
(X2=7.26, p=0.007).
Physical activity
Concerning work-related physical activity, the majority of students have workrelated
activity with means of 98.67±82.07 and 77.46 ±54.89 minutes on average per
day for males and females respectively, with a statistically significant difference
between both sexes (t=4.18, p= >0.0001).
With respect to transport-related physical activity, it has been observed that males
spent a longer time in transport-related physical activity when compared to females,
with means of (44.42±35.87 and 34.08±26.36 minutes on average per day)
respectively, with a statistically significant difference between both sexes (t=5.52,
p>0.0001).
Regarding recreation-related physical activity, it has been found that males have
much more recreation-related activity than females (56.2% vs. 25.2%), with a
statistically significant difference (X2=128.37, p>0.0001) between both sexes.
The mean amount of time spent in physical activity (including work, transport, and
recreational) on average per day among students who were engaged in physical
activity behavior was higher among males than females (153.75±111.72 and 110.81±74.74 minutes respectively), with a statistically significant difference
between both sexes (t=9.56, p>0.0001).
The majority of students (84.6%) were considered to be physically active according
to WHO recommendations on physical activity, with no statistically significant
difference between males and females.
Clinical/medical history
More than one third (37.5%) of students; 46.2% of males and 29.2% of females
never had their blood pressure measured by a doctor or other health care worker,
with a statistically significant difference between males and females (X2=39.15,
p>0.0001).On the other hand, 16.2% of those who had measured their blood pressure
by a doctor or other health care worker were diagnosed with raised blood pressure
and almost three quarters (76.3%) of them were diagnosed in the last 12 months,
with no statistically significant difference between both sexes.
Only 17.4% of students had measured their blood sugar by a doctor or other health
care worker, and less than one tenth of them (7.2%) were diagnosed as having raised
blood sugar or diabetes, and three quarters of them (75%) were currently diagnosed
with diabetes i.e. in the past 12 months, with no statistically significant difference
between males and females.
Only 6.5% of students had measured their cholesterol (fat levels in the blood) by a
doctor or other health worker and more than one quarter (28.9%) of those were
diagnosed with raised cholesterol. In addition, nearly two thirds (62.5%) of them
were currently diagnosed with raised cholesterol in the past 12 months, with no
statistically significant difference between males and females.
The vast majority (98.6%) of them reported that they never had suffered from a heart
attack or chest pain from heart disease or a stroke.
Part II: Students’ Physical Measurements (STEP 2):
Blood pressure measurements
It was observed that the overall prevalence of raised blood pressure (i.e. SBP ≥140
and/or DBP ≥90 mmHg or currently on medication for raised BP) among students
was 6% and it was found to be higher among males than among females by 3.3 times
(9.7% vs. 2.9%), with a statistically significant difference between both sexes
(X2=26.48, p>0.0001).
Anthropometric measurements
With respect to Body Mass Index (BMI), about half of students (52.4%) had normal
weight (BMI=18.5-24.9 kg/m2), however, about one third of them (28.6%) and about
one tenth (14.1%) respectively were overweight or obese (BMI ≥25 kg/m2). No
statistically significant difference between males and females was found in this
respect.
Concerning students’ waist circumference (WC), the majority (80.1%) of students
had normal waist circumference, while one fifth (19.9%) of them had central obesity;
(23.9% and15.2%) among males and females respectively, with a statistically
significant difference between both sexes (X2=14.97, p>0.0001).
The prevalence of risk factors and combined risk factors for NCDs among Alexandria
University students
The most prevalent risk factor (87.2%) for NCDs among university students was the
consumption of less than five servings of F&V per day, followed by
overweight/obesity (42.7%), insufficient physical activity (15.4%), current tobacco
use (10.5%), and raised BP (6.0%). While current alcohol consumption was the least
prevalent (2.0%) risk factor.
Current tobacco use, current alcohol consumption, and raised BP were the most
prevalent risk factors for NCDs among males than females, with statistically
significant differences between both sexes in relation to the previously mentioned
risk factors (X2=131.17, p>0.0001, X2=22.02, p>0.0001, and X2=26.48, p>0.0001
respectively). On the other hand, the consumption of less than five servings of fruits
and/or vegetables per day was more prevalent among females as compared to males
(89.5% and 84.4% respectively), with a statistically significant difference between
both sexes (X2=7.26, p=0.007).
Concerning students’ combined risk factors, the overall mean of risk factors for
NCDs was 1.60±0.82 (1.67± 0.89 for males and 1.53±0.74 for females), with a
statistically significant difference between both sexes (t=3.03, p=0.002). It was found
that those who had 3-5 risk factors for NCDs (i.e. raised risk) represented more than
one tenth of students (12.6%); 16.6% of males as compared to 9.2% of females.
Part III: Relationship between the Prevalence of Risk Factors and Combined Risk
Factors for Noncommunicable Diseases (NCDs) and Alexandria University Students’
Socio-demographic and Academic Data.
Tobacco use
A significant association was found between tobacco use and students’ academic
sectors and their enrolled faculties and institutes (X4
2=29.77, p>0.0001 and
FET=50.91, p>0.0001) respectively. In this regard, more than one tenth (13.5% and
13.2% respectively) of students in Social Science and Agriculture and Food sectors
as compared to only small percentages (3.9%) in Health sector and (2.6%) in both
Science and Engineering sectors were tobacco users. Furthermore, the highest
prevalence of tobacco use was found among students in faculties of Dentistry,
Veterinary medicine, Specific education, Law, and Arts (25.0%, 23.1%, 20.0%,
15.8%, and 15.1%) respectively.
A statistically significant association was found between students’ tobacco use and
their sex (X2=160.26, p>0.0001). where the prevalence of tobacco use among males
was 37 times higher than that among females (22.4% and 0.6% respectively).
A significant association was observed between tobacco use and students’ age
(X2
2=39.27, p>0.0001). where the highest prevalence was found among those aged
24 years or more (36.4%) as compared to only 6.7% among students aged 18 to less
than 21 years.
Almost one quarter (24.7%) of working students were tobacco users as compared to
only 6.7% of non-working students, with a statistically significant association
between students’ working status and their tobacco use (X2=74.56, p>0.0001).
Alcohol consumption
A significant association was found with respect to students’ sex and alcohol
consumption (X2=22.02, p>0.0001). In this regard, males were 13 times higher than
females in the current consumption of alcohol (3.9% and 0.3% respectively).
A significant association was noticed between students’ working status and alcohol
consumption (X2=18.01, p>0.0001). where working students were almost 5 times
higher than non-working students in the current consumption of alcohol (5.1% and
1.1% respectively).
Consumption of less than 5 servings of fruits and/or vegetables per day
The consumption of less than five servings of fruits and/or vegetables per day was
significantly associated with students’ sex (X2=7.26, p= 0.007). where the majority
(89.5%) of females as compared to 84.4% of males eat less than five servings of
fruits and/or vegetables per day.
A statistically significant association was noticed between students’ working status
and the consumption of less than five servings of fruits and/or vegetables per day
(X2= 5.74, p=0.017). where the consumption of five or more servings of fruits
and/or vegetables per day was higher among working rather than non-working
students (17.1% and 11.6% respectively).
A statistically significant association was observed between students’ reported family
income and the consumption of less than five servings of fruits and/or vegetables per
day (X4
2=15.14, p=0.004). In this respect, almost one fifth (19.3%) of students who
reported the lowest monthly family income i.e. less than 1000 LE consumed five or
more servings of fruits and/or vegetables per day as compared to around only one
tenth (7.1%, 13.6%, 15.0%, and13.4%) of those who reported a higher monthly
family income i.e. 1000 to less than 2000 LE, 2000 to less than 3000 LE, 3000 to less
than 4000 LE, and more than 4000 LE respectively.
Physical inactivity
Statistically significant associations were noticed between physical inactivity and
students’ academic sectors and their enrolled faculties and institutes (X4
2=15.68,
p=0.003 and FET=34.11, p=0.011 respectively). In this regard, the highest
prevalence of physical inactivity was among students in the Health sector (26.6%) as
compared to the other academic sectors i.e. Social science, Engineering, Science, and
Agriculture and Food sectors (13.6%, 14.3%, 16.9%, and 21.1% respectively).
Moreover, the highest prevalence of physical inactivity was amongst students in
faculties of Veterinary medicine, Medicine, and Nursing (38.5%, 35.3%, and 25.0%
respectively).
There was a statistically significant association between physical inactivity and
students’ academic level/grade (X5
2= 11.38, p=0.044). where the highest prevalence
was noted among students who were enrolled in the Fifth and sixth grades (22.0%
and 50.0% respectively) as compared to (14.3% and 14.1%) among students who
were enrolled in the preparatory/first and second grades respectively.
A statistically significant association was observed between students’ working status
and physical inactivity (X2=9.48, p=0.002). It has been found that physical inactivity
was more prevalent among non-working as compared to working students (17.0% vs. 9.5%).