KNOWLEDGE, ATTITUDE, AND PRACTICE OF UNHEALTHY LIFESTYLE

HABITS AND ASSOCIATED RISK AMONG STUDENTS IN HIGHER LEARNING

INSTITUTIONS IN TANZANIA. A CASE OF MZUMBE AND SOKOINE
UNIVERSITY

Introduction

University students spend a critical period of their intellectual development at higher learning
institutions. It is during this time that they are involved in a fast-paced academic
environment, increased responsibilities, and potentially life-threatening behaviors. These
changes are associated with poor lifestyle habits that lead to unhealthy living and practices;
most students have unhealthy lifestyle habits, which increase the risk of developing non-
communicable diseases. However, information on the knowledge, attitude, and practice of
unhealthy lifestyle habits and associated dangers of university lifestyle among students from
public and private higher learning institutions in Tanzania is limited. This study, therefore,
aimed to assess the knowledge, attitude, and practice of unhealthy lifestyle habits and
associated risks among university students at MZUMBE University and SUA University.
Unhealthy lifestyle habits have been defined in the literature as undesirable habits that are not
morally or legally accepted but are performed to maintain, promote, and regain good health.
Some of the well-documented, well-established lifestyle factors that contribute to these habits
include smoking, excessive consumption of alcohol, eating high-energy foods, and low-
exercise energy(Kebede et al., 2022). These unhealthy lifestyle practices have negative
impacts on health; poor lifestyle choices contribute to diseases and have detrimental effects
on public health. Non-communicable diseases account for 29 percent of all deaths and 45
percent of premature deaths before the age of 70 years (Xue et al., 2021). More than 75% of
the total non-communicable disease deaths occurred in low- and middle-income countries,
and their prevalence was expected to increase(Xue et al., 2021). More than 80% of these
premature deaths from non-communicable diseases and their predisposing risk factors are
considered potentially preventable through the modification of lifestyle choices and other
contributing behaviors such as smoking, alcohol consumption, physical inactivity, and dietary
imbalance(Laar et al., 2020).

University students undergo significant lifestyle changes during their academic years. These
changes often lead to unhealthy habits such as poor dietary choices, physical inactivity, and
substance abuse. Such behaviors increase their risk for non-communicable diseases (NCDs),
which account for 45% of premature deaths globally and disproportionately affect low- and
middle-income countries like Tanzania. Despite these trends, limited research exists on the
knowledge, attitude, and practices (KAP) related to unhealthy lifestyle habits among students
in Tanzanian higher learning institutions. This study aims to fill this gap by investigating
KAP and associated health risks among students at Mzumbe and Sokoine Universities.

Literature Review

The literature review aimed to examine the evidence of students' knowledge, attitude, and
practice of unhealthy lifestyle habits and their association with the occurrence of associated
risks. This study reviewed relevant studies carried out in other countries to gain and
summarize the relevant findings that can be used to explain the problems, put into a
theoretical framework, and give support to the empirical findings. There is a sizeable body of
literature that aims at identifying the relationship between students' knowledge, attitudes,
practices, and the challenges of their involvement in unhealthy lifestyle behavior and its
association with the risks of developing NCDs. There is an understanding of the factors
associated with the involvement of youth in modifiable health-risk behaviors, particularly
dietary factors, physical inactivity, overweight, alcohol, tobacco, and their associated
significant risks with overweight and obesity, which are the leading causes of NCDs.
Furthermore, an investigation stated that students are not consuming enough nutrient-rich
food that is essential to their growth and development, and the promotion of unhealthy
lifestyle behavior leads to the development of large population-based risks of NCDs,
especially heart-related diseases, sedentary lifestyle, and obesity with its associated high fat
and calorie intakes(Cockerham, 2021). The trend could result in an increased incidence of
NCDs in the population in the future.

Methodology

This section discusses the research design and the overall framework through which the
processes and procedures of this study will be conducted. The section is divided into two
main parts. The first part discusses the research approach, including a conceptual framework.
The second part gives details about the study areas, sampling strategy, and datasets used,
including data collection procedures and measurement characteristics.
Research Approach

This study is an empirical research investigation that attempts to determine the degree of
strength from weak associations of knowledge, attitude, and practice of unhealthy lifestyles
of students with their accompanying consequences, including lifestyle diseases, by attending
their higher learning institutions vis-à-vis the associations and the contributing factors. The
study adopts a cross-sectional research design. A quantitative research methodology is best
suited for addressing the research questions for this particular study which are mostly
concerned with the magnitude, frequency, and severity of the outcomes among students of
higher learning institutions concerning knowledge, attitude, and practices of unhealthy
lifestyle habits and associated risks only, but not the cause-effect relationships.

Conceptual Model/Framework

This section presents a conceptual model or framework to guide the study. The choice of the
preferred conceptual framework for this study is guided by the nature of the research
questions in this study. It forms the basis of the subsequent multivariate modeling strategy
adopted to establish the significant and independent correlates of knowledge, attitudes, and
practices of unhealthy lifestyle habits and associated risks among university students, as well
as the strengths of these associations. Even though direct causality variables are not pursued
and tested in this study, it is necessary to discuss them thoroughly concerning their potential
influence in this study. Considerable understanding of the factors affecting knowledge,
attitude, and practice of unhealthy lifestyle habits will require a detailed and sometimes
different set of determinants such as socio-demographics, psychosocial factors, economic
conditions, health and moral attitudes, and broader aspects of life-coping strategies such as
conflict resolution abilities, supportive relationships, sexual behavior, parental monitoring,
and academic problems. These are activities that include health education programs
commonly offered by universities to promote adherence or regularly scheduled programs.
The decision to measure these direct and indirect variables and include them in the regression
modeling in this study was made under the understanding of the underlying theories when
applied to higher learning institutions. These initial agreements served as guiding principles
leading to the development of the structural relationships model among the KAPB.

Dependent Variable
The dependent variables are the items that the researchers used to measure the knowledge,
attitude, and practices of unhealthy lifestyle habits and associated risks among students in
higher learning institutions. The answers to the knowledge and attitude questions were
classified as "knowledgeable", "concerned attitude", "not concerned attitude", "not
knowledgeable", "not concerned attitude", and "attitude of no concern".

Independent Variables

The independent variables, also known as the explanatory or predictor variables, include age,
gender, education level or kind of schooling, place of residence, and socioeconomic status,
among others.

Health Belief Model

Most of the research concerning the problem of unhealthy lifestyle habits and associated risks
has been oriented towards determining justifications for existing and emerging problems to
propose solutions before the issue into an outbreak of diseases in the future, especially among
young people in higher learning institutions. Several health researchers have mentioned that it
is very essential to know what is known, the attitudes, and the practices of individuals about
unhealthy lifestyle habits contributing to rapidly increasing disease cases.

Several theories, models, and concepts have been frequently used to determine one's
decision-making process by taking known information, attitudes, and practices of existing or
emerging problems. They include the Health Belief Model, Theory of Planned Behavior,
Prochaska and DiClemente's Change Theory, Social Learning Theory, Health Promotion
Model, and Motivational Interviewing. In this study, the information, attitudes, and practices
of unhealthy lifestyle habits and associated risks are determined by the Health Belief Model.

Theory of Planned Behavior

The theory of planned behavior is frequently used in explaining behavior change related to
self-care, health, and safety practices. The theory assumes that attitudes and subjective norms
shape an individual's intention to participate in a particular behavior. In turn, the intention to
participate should be linked to actual behavior to the extent that the individual believes that
he or she has control over the situation to carry out the previous intentions. The theory's
postulations also posit that behavioral intentions are proximal to behaviors. The theory
assumes that behavioral performance potential is largely contingent upon the magnitude of
the individual behavioral adoption. The desired behavior is regarded as the pivotal link
between performance potential and behavioral performance. Variables such as resources,
skills, role preferences, and incentives also play a significant role in an individual's ability to
perform the behavior. Taken together, these factors play a crucial role in creating enabling
circumstances that will help the individual transform performance potential into actual
behavioral performance.

The theory has been emphasized in the interdisciplinary public health sub-disciplines,
including physical activity, eating behaviors, and bodies of the related literature. The
constructs making up the behavioral beliefs component consist of a salient behavior, referent
others' beliefs about each behavioral endorsement, and the outcome evaluations tied to each
particular belief. These beliefs are hypothesized to exert a direct influence on attitudes
towards the behavior by serving as one of the key contributors. Positive or negative affect
toward performing the behavior is derived from the attitudinal evaluations in the judgment
process. Further, the behavioral beliefs' outcome also serves as a powerful force in shaping
the overall attitude. Unlike other models, the main findings also suggest that the outsider's
subjective culture behooves the individual to assess whether normative expectations
accurately predict the collective's behavioral beliefs. An individual may resort to seeking out
the prevailing group norms to gauge whether the significant referent others are universally
respected. As a result, the distortion of salient judgment beliefs will vary directly with the
individual's social contact with those same referent others.

The key terms

The key terms used in this study have to be defined so that they are clearly understood to
avoid any ambiguity. The following are the general definitions applied here so that the whole
study is well understood.

Knowledge is the apprehension, awareness, or the fact of confronting and perceiving

information or something closely related to understanding it. In this case, knowledge refers to
experience, understanding, familiarity, firmness, and thorough understanding.

Attitude is the general and usual way of appreciating and evaluating something or just a
mental position on a matter of interest. It is the state of having an attitude or determination or
an expression of favor or disfavor. Attitude may also refer to a way of thinking or feeling and
an adopted or assumed outlook or position. It is about how things are seen and something that
arises out of feelings and values in an environment where a person is found.

Behavior explains a lot about how a person acts. It is how a person or animal carries him or
herself, moving and behaving; forms of behavior may include pressure behavior, human
behavior, and human reaction. In this study, unhealthy lifestyle behavior refers to a pattern
chosen by people in the population regarding eating habits, physical activity, and sedentary
lifestyle among others.

Practice is the set of methods to follow, methods of making and producing, are a usual way
of getting into action. The term practice refers to individual actions in and among them that
make up their environment.

Unhealthy lifestyle habits and associated risks are habits that are linked to physical
activities, food intake behavior, and sedentary activities which contribute to specific risks like
BMI, the prevalence of which contributes to increased levels. These may include smoking
cigarettes, drugs, and alcohol. Furthermore, these practice-related risks arise when people
perform specific activities, breaking their eating habits and physical activities, causing
disorders.

CHAPTER ONE

THE PROBLEM AND ITS BACKGROUND

Introduction

This chapter consisted background of the of the study, a statement of the problem, research
objectives, research questions, the significance of the study, the scope of the study,
limitations of the study, and organization of the study.

Background of the study

As lifestyle preferences are established during young adulthood, individuals usually undergo
heavy exposure to both healthy and unhealthy habits during this period. University students
are among young adults who are exposed to new and independent environments, with no
strict rules and free life choices. Previous works have indicated a high prevalence of
unhealthy lifestyle choices among students in higher learning institutions. The most reported
unhealthy lifestyle habits include physical inactivity, unhealthy diets, and tobacco, and
alcohol use, among others. Additionally, these unhealthy lifestyle habits are manifested with
the coexistence of other risky behaviors and environmental influences. The social network at
a university is among the leading factors that determine personality development, learning,
and future professional development. As such, it is the foundation of an individual’s future.

Unhealthy lifestyle habits are growing among young people and contribute to various health
risks including injury, non-communicable diseases, and mortality. A large number of
university students, particularly from low- and middle-income countries, engage in smoking,
alcohol abuse, unhealthy dietary practices, physical inactivity, and poor-quality sleep. Many
of these factors are readily attributed to student life experiences. This study aimed to examine
the knowledge, attitude, and practice of unhealthy lifestyle habits and associated health risks
among students at two universities in Tanzania. The study also assessed the relationship
between these habits and other student-related characteristics.

It is concluded that poor knowledge of risky behavior and lack of reference to unhealthy
habits is a significant problem among students at the two universities.

The development of habits such as a bad diet, consumption of alcohol, and inadequate
physical activity results from personal choices and is often affected by knowledge and
attitudes regarding various lifestyle-related health risks. Living an unhealthy lifestyle
characterized by a poor diet, inadequate physical activity, smoking, and alcohol consumption,
especially among university students, is a vital determinant factor for numerous non-
communicable diseases. Addressing these risky behaviors among university students is
essential because students are not safe from getting these diseases, their health-risk behaviors
affect academic outcomes, and they often develop lifelong health habits.

These habits can be positively or negatively influenced by their social behavior and
environment, including formal education. University culture can affect students' lives, with
learning being adversely affected by unhealthy lifestyle habits. Therefore, the study sought to
examine the relationship between students' lifestyle-modulating knowledge, their tendencies
toward specific health-risk behaviors and these identified health-risk behaviors in relation to
gender and background differences. The social environment of the university may differ from
the environment of institutions supporting continued secondary school education.
The landscape of unhealthy lifestyle habits among students in Tanzania has garnered
increasing attention, particularly within higher learning institutions such as Mzumbe and
Sokoine University. Urbanization, instigated by rapid socioeconomic transformations, has
significantly affected students' health behaviors, leading to a marked rise in unhealthy dietary
choices, sedentary lifestyles, and substance use, including alcohol and tobacco (Children
UN’s Fund et al., 2012). The pressures of academic life compound these habits, often
resulting in a neglect of physical well-being and inadequate health literacy (Muhanga et al.,
2020). Moreover, formative research indicates that while educational institutions strive to
promote health interventions, the effectiveness of these initiatives is undermined by students
persisting unfavorable attitudes towards health-impairing behaviors. Consequently,
addressing these intertwined issues demands a comprehensive understanding of the
precursors influencing lifestyle choices, alongside targeted educational strategies to foster
healthier practices within these academic environments.

Statement of the Problem

Good health is one of the fundamental rights of every individual but has become a challenge
for most people in Tanzania. It is further compounded by the occurrence of various
noncommunicable health problems which now account for more than half of the disease
burden in the country. Unhealthy lifestyle habits were singled out to be the leading
contributors to these emerging health problems. This study sought to find out potential factors
that influence university students to engage in unhealthy lifestyle habits and measures to
address the problems.

Even though the majority of students in higher learning institutions have longer periods of
achieving developmental potential and contribute effectively to the economic and social
livelihoods within the labor market, when the positive outcomes are linked with students'
lifestyles, they become a bit worrying. This includes behaviors leading to poor nutrition,
physical inactivity, and dangerous and delaying sexual behaviors that shape negative health
and are risk factors for chronic diseases in the long run. Thus, students, particularly in higher
learning institutions, are at risk of failing to fulfill their potential due to such behaviors. The
critical period for development is the frequent transition phase of students to university life
when they experience increased autonomy and lack of parental supervision. The lifestyle
behavioral patterns exhibit risky behavior with substantial negative effects, creating major
public health concerns.

It is of great concern that university students do not practice positive and healthy lifestyles at
any stage of development. The unhealthy lifestyle behaviors in the youth population, already
observed, should not appear as a generational effect. Rather than continuing to develop
strategies and interventions to combat these undesirable unhealthy lifestyle practices, it is
imperative to change behavior during the higher learning period. It is no exception; students
abuse substances including alcohol, tobacco, and illicit drugs, often lacking relevant
information regarding risky sexual behavior, and have failed to cultivate good hygiene
practices to help in preventing infections. For most of these problems, it is not the present;
rather, it is fear of balancing; the future cause is of great concern. The frequency of binge
drinking had a strong link to the number of destructive events reported. Similarly, the
frequency of drug use also revealed a higher likelihood of risky health behaviors.

Unhealthy lifestyle habits are a leading contributor to the rising prevalence of NCDs in
Tanzania. University students, who are transitioning to independent living, often lack
adequate knowledge about health risks and exhibit risky behaviors such as smoking,
excessive alcohol consumption, and poor dietary practices. Existing health interventions have
not adequately addressed these issues among students. This study seeks to explore the factors
influencing unhealthy habits and assess the levels of awareness and behaviors among students
at two prominent universities in Tanzania.

Research Question

The study was purposely designed to achieve the following objectives. Therefore, the specific
research questions in this study were as follows:

What is the bio-psycho-social resonance of lifestyle, including a gender perspective? This

sought to examine the definition of lifestyle regarding physical activities, dietary habits, and
substance use such as alcohol, cigarettes, and other psychoactive substances, as compared
between males and females.
Are there any observable differences in the knowledge, attitude, and practice of unhealthy
lifestyles about gender and other sociocultural factors? This aimed to explore the day-to-day
practices of students concerning the bio-psycho-social attitudes of lifestyle, including gender
factors. This further tried to find out by comparing different attitudes and how they differ
toward lifestyles depending on gender and other sociocultural factors. The specific areas
under investigation included dietary habits, physical activity, and muscular enhancement
methods for males and females.

What are the broad and specific areas of causation, the contribution of gender, and regional
and educational background to the propensity for unhealthy lifestyles? This sought to
investigate the relationship between the gender of students and lifestyle, including the
sociocultural background, as they may affect the lifestyles from the different territorial
settings of students in terms of alcohol, cigarettes, and the use of other drugs. The objective
of this study also included education and either a lack or a plethora of knowledge. What are
the levels and systems of disease prognoses through lifestyle stereotyping by which models
could be derived and solutions and recommendations offered, training about male and female
stereotypes?

Objectives

The main objective

to investigate the knowledge, attitude, and practice of unhealthy lifestyle habits and
associated risks among students in higher learning institutions in Tanzania. There are

specific objectives

to examine the knowledge of the students about unhealthy lifestyle habits and associated
risks and benefits;
 to assess the attitude of the students towards leading an unhealthy lifestyle; to evaluate
lifestyle practice among students; and

to assess the relationship between the practice of unhealthy lifestyle habits and associated
risks and demographic and environmental characteristics of the students.

Specifically, the study aimed at capturing information on knowledge of unhealthy lifestyle

habits and associated risks and promoting a healthy lifestyle, specifically regarding alcohol
use, physical inactivity, stress, unhealthy weight control methods, skipping breakfast, and
smoking.

The attitude of students towards leading an unhealthy lifestyle, specifically regarding alcohol
use, physical inactivity, stress, unhealthy weight control methods, skipping breakfast, and
smoking, as well as the practice of students in association with unhealthy lifestyle habits and
risks, specifically regarding alcohol use, physical inactivity, stress, unhealthy weight control
methods, skipping breakfast, and smoking, will determine the relationship between the
practice of unhealthy lifestyle habits and associated risks and demographic and
environmental characteristics of the students, specifically regarding gender, age, source of
income, time usage, place of residence, level of study, and religion, and influence appropriate
intervention on lifestyle habits in the case of danger.

Significance of the Study

In Eastern Africa, and particularly within Tanzania, the prevalence of NCDs has risen. NCDs
are closely linked with the poor lifestyle habits of students in higher learning institutions,
which put them at great risk of acquiring NCDs prematurely. There is increasing evidence of
rising cases of NCDs among students in higher learning institutions as a result of engaging in
unhealthy lifestyle habits. Universities and student organizations have established various
health-promoting initiatives and programs aimed at reducing the burden of student exposure
to unhealthy lifestyle habits, which have long-term impacts on their academic, social, and
physical health. Despite such efforts, the situation among students tends to have become
worse rather than improved. This is either due to a lack of or inadequate information,
attitudes, and practices regarding the implications of behaviors, including those that are
necessary for reducing the risks of engaging in unhealthy lifestyle habits.
Empowerment in knowledge, attitudes, and practices for reducing students' exposure to
unhealthy lifestyle habits is known to contribute to the desired change and willingness to
minimize the risk of chronic illness in the future. It is therefore necessary to identify
knowledge, attitudes, and practices related to unhealthy lifestyle habits in order to come up
with desirable solutions that act as both preventive measures and reduce the proportion of
infectious diseases, which would provide significant economic value to any country.
Moreover, due to the uniqueness of students, they represent an educated age group,
predominantly healthier, and want to stay healthy, voluntarily adopting and eager to
experience a healthier life. They are the carriers and means of transmission of information on
improving self-care, thereby leading to improved health for individuals as well as families;
hence, in the long run, the entire community.

The findings of this study are important since they will provide invaluable knowledge
concerning the understanding among students in higher learning institutions in Tanzania
regarding lifestyle habits and unhealthy behaviors and the risks associated with them. The
health of future leaders of Tanzania is extremely significant and essential for sustainable
growth, and it is our duty to ensure that higher learning institutions provide students with the
comprehensive information and practical life skills they will need to be lifelong health-
literate citizens. If this is not achieved, we run the risk of facing a future in which lifestyle
diseases are an increasing burden on society and the health status of individuals who suffer
from these diseases is compromised. Given that the student population is in a critical
transition from adolescence to adulthood characterized by significant lifestyle changes and
freedom from supervision, the findings from this study bear significance for policymaking by
the institutions and health educators in marriage lifestyle health promotion at the prevention
stage level in the institutions.

Constraints of unhealthy lifestyle practices among higher learning students in Tanzania show
that quality of life is impeded due to their effects on health. Therefore, the study is of great
significance in ensuring a promising future. The study will also act as a supplement to
available literature that may help to understand some of the lifestyle-related problems, and
policymakers might develop effective strategies in a bid to help college students make
healthy choices. The findings of this study will also be useful for parents and guardians of the
children of the students who are to join higher learning institutions in the country regarding
the lifestyle behaviors and the risks associated with unhealthy habits. Furthermore, the results
from the study may also inform public policymakers on how to improve education and health
systems in the country. The findings of the present study will also contribute to current
literature and, perhaps more importantly, inform and shape the objectives and roles of public
health in college settings, offering lessons in how to promote good health, prevent diseases,
and manage illness more effectively for improved college students.

Scope of the Study

The main scope of this study was to assess the knowledge, attitude, and practice of unhealthy
lifestyle habits and their associated diseases among students of higher learning institutions.
The study explores two kinds of students at higher learning institutions: students of Mzumbe
University and Sokoine University of Agriculture to investigate the breadth of the problem
through the following objectives: (i) health-risky behaviors and related NCDs' knowledge
among students at higher learning institutions, (ii) health-risky behaviors and related NCDs'
attitudes among students at higher learning institutions, and (iii) health-risky behaviors and
related NCDs' practices among students at higher learning institutions. This study is helpful
to higher education stakeholders in identifying unhealthy lifestyle habits among students in
higher learning institutions and designing strategies that can be used to reduce the problem.
The findings of this study will provide the government, health administration, non-
governmental organizations, lecturers, academic workers, study councils, families, and
students themselves with an understanding of how lifestyle behaviors lead to NCDs.

Limitation of the Study

The main limitation of this study during data collection was the lack of time and funds; the
intended sample could not be reached because the data collection in two institutions that are
located far apart took at least one month. However, this study used probability random
sampling, which selected sufficient samples regarding the calculation of the minimum sample
size required. Another limitation was the fact that the participants were not comfortable
responding to some questions, including sharing their family history, diet, and health status.
Participants mostly indicated that the questions were more sensitive due to the fact that they
were deeply rooted within them. Another limitation was the use of self-reporting data, such as
food frequency questionnaires, instead of referring to their actual diet frequency for a definite
period through reviewed nutrition data over an extended period of time.

Organization of the Study

This study will be organized into three chapters. Chapter one will deal with the background
of the study, statement of the problem, objectives of the study and its scope which inform the
study and its context, thus, it is providing justification of the study, chapter two will be on
literature review or literature related to this study. The major focus will on identification of
the knowledge gap or development of new knowledge from the literature review and current
study. Chapter three is concerned with the research methodology, data collection techniques
and tools for data analysis and data analysis techniques.

CHAPTER TWO

LITERATURE REVIEW

Overview of Lifestyle Habits and Health Risks

Unhealthy lifestyle habits, such as poor nutrition, lack of physical activity, excessive alcohol
consumption, smoking, and inadequate sleep, are significant contributors to non-
communicable diseases (NCDs) globally. These behaviors are especially prevalent among
young adults, including university students, who are at a critical stage of life where lifelong
habits are formed (World Health Organization [WHO], 2022). According to WHO, NCDs
accounted for approximately 41 million deaths in 2019, with many deaths linked to lifestyle-
related risk factors (WHO, 2022). Research shows that lifestyle choices made during young
adulthood can significantly influence long-term health outcomes, making it essential to
address unhealthy habits early (Lawrence et al., 2021).

In Tanzania, as in many other low- and middle-income countries, the prevalence of lifestyle-
related health issues is on the rise. The country is experiencing a shift from communicable
diseases to NCDs due to rapid urbanization, lifestyle changes, and increased consumption of
processed foods (Ministry of Health Tanzania, 2021). Studies show that young adults in
urban centers are more likely to engage in unhealthy dietary habits and reduced physical
activity, increasing their risk for obesity, diabetes, and cardiovascular disease (Shayo &
Mugusi, 2021). This shift underscores the need for effective health education and policy
interventions that can address these risk factors among university students.

Theoretical perspectives

Knowledge, attitude, and practice influenced by health risk among a community are mutually
attracting constructs. One's attitude can influence their knowledge or desire to engage in a
number of risky behaviors. For instance, there are plenty of people who know about the side
effects of alcohol but still consume it. This means that although acquiring knowledge about
the magnitude of the risk can be a critical first step toward preventative health action, the
correlation between knowledge on the nature of health risk and how people perceive them
does not imply that having information about the risk leads directly to changes in attitudes or
behavior.

Non-preventative health behavior can result in high risks of contracting chronic, preventable
non-communicable diseases, which contribute to illness and increased death. These diseases
are currently responsible for the majority of all deaths in developed and some developing
countries, mainly resulting from poor lifestyles such as smoking, tension, and low physical
activity, among others. It is critical to identify problems like knowledge, attitude, and practice
deficits related to such behaviors, and students are the target. They are the backbone of every
nation; therefore, the study generally focused on assessing the KAP of students.

Empirical Literature Review

Previous Studies on Unhealthy Lifestyle Habits Among Students

Previous studies from different parts of the world have reported a high prevalence of
unhealthy lifestyle habits among students in higher learning institutions, including university
students in Uganda, Egypt, and Sudan; college students in Mwanza; and female students in
Southern Iran, Turkey, India, Nigeria, and South Africa. Lifestyle habits are an important
influencing factor for the health of university students, which not only affects their current
study and work but also impacts their social life and even influences their lifelong health.
Due to the overhaul of curricula and certification requirements, along with changes in the
students themselves, medical schools in developed regions have developed health promotion,
education, and alteration programs that improve some risky habits. These include campaigns
targeting unhealthy lifestyle habits such as breakfast skipping, drinking, sedentary behavior,
e-cigarette use, smoking, and areca nut consumption, among others.

Studies on this theme have been carried out in Sub-Saharan countries, and the current
unhealthy lifestyle habits of students in these regions have been revealed. In Tanzania,
previous studies have reported a higher prevalence of unhealthy lifestyle habits among the
general population, but studies on specific populations of students in higher learning
institutions are scarce. Even when the available studies have enumerated these unhealthy
lifestyle habits among the students, the students' knowledge, attitude, and practices regarding
those habits and their risks have been lacking. The present study, therefore, aimed to
investigate the knowledge, attitude, and practice of unhealthy lifestyle habits and associated
risks among the students in higher learning institutions in Tanzania.

Unhealthy Lifestyle Habits and Associated Risks

Unhealthy lifestyle habits are recognized as the major cause of chronic health problems such
as obesity, type 2 diabetes, cardiovascular disease, and some types of cancer. These habits
pose a risk for hypertension, high blood pressure levels, and a sedentary lifestyle. They begin
to appear at an early age among students. Inequalities in emerging lifestyle-related health
conditions among students based on age, sex, nationality, and residence may contribute to
these disparities in adulthood and, accordingly, raise inequalities that will persist in the years
ahead. All this does not bode well for the future, as those who suffer the most are the least
privileged, those who rely the most on public health systems, which are, overall, the biggest
losers. The assessment of health behaviors and lifestyles of post-secondary students as future
professionals in their fields is of great importance, as it is a step that might guide health
policies and educational strategies that may contribute to their behavior change and set goals
that promote a healthier life. This study aimed to describe the knowledge, attitudes, and
practices regarding unhealthy lifestyle habits that could be developed from the inception of
academic education for students in higher education institutions. It also provided valuable
first-hand information on unhealthy lifestyle habits and emphasized the need for proactive
prevention at the onset of poor lifestyle habits among young adult students.
Theoretical Frameworks

The theoretical framework of this study was based on the Health Belief Model and the
Theory of Reasoned Action. This is informed by the restrictiveness to the use of the Health
Belief Model in analyzing the behavior of individuals to prevent ill health, which takes into
account young peers. The main assumptions of HBM are that there is a certain perception that
prevents illness and that individuals can determine their own health behavior, thereby altering
their negative elements in that health status. The Theory of Reasoned Action refers to a
model that explains health behavior by intending to form attitudes and subjective norms that
are determinants prior to health behavior attitudes and subjective norm interventions. Both
models are also coordinated into any prevention behavioral health model.

The Health Belief Model includes such concepts as perceived susceptibility, perceived
severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Perceived
susceptibility consists of an individual's perception of the risk of contracting a health
problem, focusing on both negative and positive aspects, and the ease of contracting the
problem. A criticism is that the model gives little attention to the prevention of illness and the
motivation for illness prevention. This underscores the necessity of potential outcomes
related to the health problem in question. Perception of severity must be taken into account
for setting or verifying the importance of a health problem. This may be established through
the history of a health problem or by direct knowledge. Perceived benefits are discussed in
terms of opportunities as one part of the model, which refer to the individual's beliefs about
the effectiveness of the advised health behavior in reducing the threat posed by the health
problem. Perceived barriers refer to the person's assessment of the actual and perceived costs
of the advised health behavior. Cues to action are strategies perceived to be effective in
preventing the problem. These include mass media campaigns, input from significant others,
or a conversation about a health or injury problem, and are supposed to apply motivation to
act.

Associated Health Risks

The key associated health risks of commonly reported unhealthy lifestyle behaviors include
overweight and obesity, raised blood pressure and hypertension, raised blood lipids and
triglycerides, impaired glucose tolerance, insulin resistance and diabetes, and depression,
anxiety, and stress. The relationship between unhealthy lifestyle risk behaviors and the
development of overweight and obesity is well established. Generally, the consumption of
high-fat, high-sugar food and sweetened beverages while engaging in low levels of physical
activity is strongly associated with an increased intake of energy and body weight gain.
Overweight and obesity are associated with significant complications such as impaired
glucose tolerance, insulin resistance, and diabetes. Gradual rises in blood pressure from a
young age are associated with significant increases in age-related morbidity and mortality.
Raised blood lipids and triglycerides, which are known cardiovascular risk factors, can occur
even in young individuals. It is also believed that a high-fat, high-sugar, and refined food diet
can contribute to dyslipidemia and elevated triglycerides. These risk factors for
cardiovascular diseases and hypertension can be exacerbated by negative health behaviors
such as stress, alcohol, smoking, and excessive food consumption. Moreover, students in
higher learning institutions, including undergraduate university students, also suffer from
cardiovascular risk factors, which may include unhealthy nutrition, physical inactivity,
smoking, alcohol consumption, obesity, insulin resistance, stress, decreased heart rate
variability, and raised blood pressure, providing further evidence of the imperative of
adopting healthy lifestyles early in life.

There are various health risks associated with unhealthy lifestyle habits. These include
obesity, cardiovascular diseases, abdominal adiposity, elevated blood pressure, metabolic
syndrome, and certain types of cancer. Obesity and overweight are affected by various
unhealthy lifestyle factors. Energy balance is an important factor that should be maintained to
avoid the accumulation of body fat. Generally, intake of energy should be equal to the output.
Neglect of physical activity norms can result in the body being unable to naturally fulfill the
effect by increasing or decreasing weight. Cardiovascular diseases are the result of many
factors, among them being cholesterol levels in the body. Diabetes mellitus is the result of a
combination of factors that occur in an individual. When lifestyle factors interact, the
resulting interaction may enhance the probability of developing diabetes. Abdominal
adiposity is due to an imbalance between energy and caloric intake. Abdominal body fat is
associated with physical activity. When there is a significant increase in body fat and muscle
mass, a larger increase in energy intake is required. Skipping breakfast and consumption of
energy-dense fast food are due to a lack of nutritional awareness, appetite regulation, and a
high-fiber diet. Behavioral variables constitute risk factors for non-communicable diseases
among the student population.
Previous Studies and Gaps

The problem of unhealthy lifestyle behavior of students in higher learning institutions has
begun to draw more attention from public health scientists in recent years. This problem
remains severe and requires more attention, especially in developing countries, because
students are usually influenced by new lifestyles and habits upon joining higher learning
institutions, for both academic and non-academic reasons, which are health-compromising
behaviors. There is a scarcity of literature on the specifics of how students perceive this
lifestyle and the steps needed to address a looming public health crisis. These problems can
be solved through a mixed-method approach comprising a self-administered questionnaire,
which is followed by interviews and focus group discussions. It is important to stress that the
survey components of lifestyle behaviors, like other questionnaires, are usually linked with
self-report bias. The researcher should pay close attention to the possibility that respondents
may assume that they should give what they believe to be "the right answers," without any
regard for their actual behavior. It is the researcher's role to stress the need for accurate
answers. This research aims to address the gaps and issues identified, propose some ways in
which they can be addressed, and suggest areas for future research.

Conceptual Framework

The conceptual framework shows the association between unhealthy lifestyle, health risk
factors such as obesity, and health behaviors. The independent variables included to
determine the occurrence of unhealthy lifestyle in this study were knowledge, attitude,
beliefs, and levels of physical activity. The lifestyle behavior variables included drinking
alcohol, skipping breakfast, drinking carbonated soft drinks, eating snacks, a sedentary
lifestyle, and eating in fast food restaurants. However, not all the behaviors lead to risky
eating behaviors. Secondary mediated factors, such as fat from meat, different ethnicities, or
areas that have their own unique eating habits, age, and education level, can affect one's
eating habits. In addition, those with more education may be more knowledgeable about the
risks of unhealthy eating and more likely to engage in healthy eating.

The belief that snacks are beneficial can increase the frequency of eating if the belief is
strong, and the belief may reduce the intake of fruits and vegetables. When meat supplies,
different dietary cultures, or higher fabrications are successful, the indicated risky eating
behavior may change. The belief that the Westernized lifestyle is beneficial and benign can
lead to a higher prevalence of the health-threatening traditional lifestyle. The Health Belief
Model and the Theory of Reasoned Action are among the well-documented psychological
models, and both can explain eating habits. The HBM suggests that before behavior occurs, a
person's beliefs must convincingly shift to enact the behavior, with desirable outcomes
aligned with these behaviors.

Conceptual Framework

A Conceptual framework is a visual illustrate that represent expected relationship between

cause and effect in the research (Saunders, 2002). It indicates the relationship between
independent variables that influence dependent variables.

In this study we have dependent variable and independent variables where by dependent
variable in our study is

Knowledge, Attitude, and Practice (KAP) Model

The relationship between knowledge, attitude, and practice has been widely examined and
remains a useful model at the global level in health-related behavior studies. The hypothesis
is based on the fact that when an individual has an adequate dose of knowledge about an
issue, he is likely to form positive attitudes and develop and practice healthy behavior.
However, there is often a gap between knowledge, attitude, and practice. Studies have shown
that a person might have in-depth knowledge but still engage in risky lifestyle practices or
generally not perform well in his health. Some say that knowledge alone might lead him to
negative attitudes and practices if associated with certain negative factors. It is important to
start by examining the relationship between knowledge, attitude, and practice. A person
might have knowledge but lack the appropriate attitude, which may lead to poor practices in
relation to a healthy lifestyle. Choosing a healthy lifestyle often requires a force of will and
perseverance despite one's convictions and emotions. It has also been found that people who
are knowledgeable about high-risk behavior tend to overestimate the likelihood of these
events occurring in their lives. A point comes when they weigh the benefits of healthy
behavior on their health status and performance, and they perceive that their good deeds in
daily practice require exposure to stress and strain in society. On the flip side of this
argument is the finding that a significant relationship exists among knowledge, attitude, and
practice. Since a lack of knowledge has been found to be a major barrier to health promotion,
it can be expected that enhancing knowledge will lead to changes in attitudes and practices.
The relationship between knowledge and attitudes has been one way that has been
successfully applied in educational realms. The question then becomes how much knowledge
is necessary and how much is too much? Can excess knowledge ultimately lead to something
dreadful? The study objectives were to assess health knowledge, attitude, and practice of
university students with regard to health and associated risks.

Prevalence of Unhealthy Lifestyle Habits Among Students

Students and intellectual professionals at any level, in any context, depend upon physical and
mental well-being for their entire future in their respective fields. It is within this process that
a considerable amount of mental and emotional strain is inscribed in any curriculum.
Generally, the period of adolescence and a few years beyond form a time of crucial
transitions that involve physical, behavioral, and environmental changes for the students, who
are mostly found in higher learning institutions. The students thus have the biggest challenge
of coping with new demands and responsibilities combined at many levels with their
academic work. Consequently, the transition period presents an attractive opportunity for
inappropriate behaviors to become established, and it is often adopted for long-term
durations. Frequent poor lifestyle behaviors throughout a person’s younger years can carry
negative effects on their adult lives and on chronic life-threatening diseases. The percentage
of risk factors among students and adults in any society is different; however, it is equally
essential to make a point of such behaviors up until late adolescence for both genders, so as to
mitigate all risk factors.

During an individual’s student life in a learning institution, their eating behavior can be
characterized as being determined by their lifestyle and those with whom they surround
themselves. Several studies have shown that inappropriate behaviors, including consuming
alcohol, smoking, and a lack of regular physical activity, are among the typical patterns
emerging in adult lifestyles. If long-term adherence to unhealthy lifestyle habits persists, it
can contribute to the development and progression of lifelong non-communicable diseases.
Although the combination of nutrition, physical activity, and radiation in primary prevention
is safe and has a high potential effect, it remains unclear whether this is the same for students
of higher learning institutions. In this study, we describe the prevalence of five lifestyle
factors, namely physical inactivity, the consumption of alcohol, smoking status, skipping
breakfast, and fruit and vegetable intake, which could be contributing factors to potential
unhealthy habits during young adulthood, i.e., their university or college life, with the above
health risk factors.

Factors Influencing Unhealthy Lifestyle Choices

Lifestyle choices are not made in isolation; people live within a range of different contexts
that also play a key role in influencing their unhealthy lifestyle choices. The reasons people
make unhealthy lifestyle choices are not straightforward and are influenced by factors at
many levels. This could include various government policies, the work patterns of
individuals, different local conditions, or what is available in the local community, as well as
the time and resources that individuals have and what is promoted through the media.
However, the social environment, including social, cultural, religious, family, and social class
inequalities, also plays a significant role in influencing lifestyle choices. As well as being
highly influential on the lifestyle choices that individuals make, many of these influencing
factors could be argued to be determinants of health. The term determinant of health refers to
those things that determine the health of individuals or are related to unequal health
outcomes.

It has been suggested that the economic concentration of a society, specifically the principles
of profit focus and untested food products, has dilapidating effects on humans. The
environment, as it is today, is detrimental to many aspects of human health. These factors are
depicted as influencing the so-called cause of the cause of ill health, as they operate to erode
the social fabric and consequently impact those who are less in control of their lives.
Therefore, risk behaviors may be seen as mechanisms through which societal norms and
problems manifest, and yet, in taking these actions, people are also continuously creating the
habitat that makes these responses understandable. Thus, even individuals with healthier
lifestyles will require regular exposure to medical diagnostic equipment and highly trained
staff to monitor their health as a result of increased risk associated with the environment.
Access to healthcare has been shown to be closely associated with social class, indicating
again a complex interrelationship between lifestyle and social class.

Empirical Literature Review

The literature surrounding the knowledge, attitudes, and practices of unhealthy lifestyle
habits among students in higher learning institutions reveals a concerning trend of poor health
behaviors, particularly in the context of non-communicable diseases (NCDs). (Alamri, 2018)
highlights a disconcerting lack of adherence to healthy dietary practices and physical activity
among undergraduate students in Edinburgh, suggesting that a significant portion of students
do not engage in any form of exercise and often consume unhealthy beverages. This
underscores the necessity for structured health education programs that could potentially
mitigate the early onset of cardiovascular diseases (CVDs) among young adults.

Building upon this foundation, (Anne Grace Malagamba Dorado & P Racca, 2019) explore
the disconnect between knowledge of healthy lifestyles and actual dietary practices and
physical activity among university students. Their findings reveal that despite high levels of
awareness regarding healthy choices, barriers such as time constraints hinder the
implementation of these practices. This suggests that mere knowledge is insufficient to
inspire behavioral change, indicating a need for more supportive university policies that
facilitate healthier lifestyle choices.

(Nasir et al., 2019) further emphasize the transitional phase of university life, where students
face challenges that influence their health behaviors. They note the critical need for students
to adapt to healthy lifestyles to prevent chronic diseases, especially given their future roles in
society. Their research points to the prevalence of unhealthy practices among medical
students, who are expected to model healthy behaviors as future healthcare providers.

contributes to this discourse by comparing health-promoting lifestyle behaviors among

female students in healthcare and non-healthcare fields. The study reveals significant
differences in health habits, suggesting that educational background may influence lifestyle
choices. This highlights the importance of tailored health promotion strategies that consider
demographic factors and academic disciplines.

(C. Menakaya & N. Menakaya, 2022) delve into the attitudes and practices of university
students towards healthy lifestyles, noting that adolescence is a critical period for establishing
health behaviors. Their qualitative study identifies environmental influences and personal
choices that contribute to unhealthy habits, which could have long-term implications for
health outcomes. This aligns with the growing concern over the rising rates of obesity and
associated health risks among young adults.
(J. Hutchesson et al., 2022) conduct a scoping review on health behavior interventions aimed
at university students, emphasizing the link between health risk behaviors and mental health
outcomes. The high prevalence of mental health disorders among students necessitates
targeted interventions that address both physical and psychological well-being, reinforcing
the interconnectedness of these aspects in promoting overall health.

(Batista et al., 2022) further discuss the significance of understanding student lifestyles
through the FANTASTIC Lifestyle Questionnaire. Their findings advocate for health
promotion strategies that enhance health literacy, suggesting that improved knowledge can
lead to healthier lifestyle choices. This is crucial for fostering future generations that
prioritize health and well-being.

Finally, (E Florence et al., 2023) provide a systematic review of health risk behaviors related
to NCDs among South African university students. Their analysis reveals alarming trends in
dietary inadequacies, physical inactivity, and substance use, calling for comprehensive health
campaigns and screening measures within universities to address these pervasive issues.

Overall, the literature indicates a pressing need for effective health interventions and policies
that not only educate but also support students in adopting healthier lifestyles, thereby
reducing the long-term risks associated with unhealthy habits.

The exploration of knowledge, attitudes, and practices surrounding unhealthy lifestyle habits
among university students is critical, particularly in the context of higher learning institutions
in Tanzania. This literature review synthesizes findings from various studies that investigate
the interplay between health knowledge, lifestyle choices, and the resulting health outcomes
among students.

Beginning with the work by (Anne Grace Malagamba Dorado & P Racca, 2019), the authors
highlight the paradox of high knowledge regarding healthy lifestyles among university
students juxtaposed with poor dietary practices and physical activity. Their research indicates
that barriers such as time constraints significantly hinder the application of this knowledge,
suggesting a disconnect between awareness and practice that warrants further investigation
into the health policies at universities.
Following this, (Nasir et al., 2019) delve into the lifestyle choices of medical students,
emphasizing the responsibility that comes with this transitional phase of adulthood. They
note that despite the awareness of healthy practices, many students engage in detrimental
behaviors such as poor dietary habits and physical inactivity, which can lead to chronic
diseases. Their findings underscore the importance of promoting healthy behaviors among
future healthcare professionals, as their lifestyle choices could influence their future patients.

In a comparative study, investigates health-promoting lifestyle behaviors among female

students in healthcare and non-healthcare fields. This research reveals that demographic
factors significantly influence health behaviors, indicating the necessity for tailored health
promotion strategies that address specific student populations and their unique challenges.

(C. Menakaya & N. Menakaya, 2022) further explore the perceptions, attitudes, and practices
of university students in Nigeria, highlighting the formative nature of adolescent years in
shaping lifestyle choices. Their findings reveal a concerning trend of increasing obesity and
related health risks among adolescents, emphasizing the urgent need for effective health
promotion strategies that target this vulnerable demographic.

(J. Hutchesson et al., 2022) contribute to the discourse by examining health behavior
interventions aimed at improving mental health outcomes among university students. Their
scoping review identifies a significant overlap between health risk behaviors and mental
health issues, suggesting that interventions targeting lifestyle changes could have a dual
benefit of enhancing both physical and mental well-being.

Building on this, (Batista et al., 2022) discuss the relevance of understanding student
lifestyles in the academic context. They argue for the necessity of health promotion
interventions that not only focus on academic success but also prioritize the overall well-
being of students, indicating a holistic approach to education.

(E Florence et al., 2023) conduct a systematic review on health risk behaviors related to non-
communicable diseases among South African university students, providing a comprehensive
overview of dietary patterns, alcohol use, and smoking behaviors. Their findings reveal
significant health risks prevalent in this demographic, further emphasizing the need for
targeted health interventions.
Finally, (F. Alves, 2024) examines the relationship between health-related knowledge,
attitudes, and risk behaviors among Portuguese university students. The study demonstrates a
concerning trend where students engage in risky behaviors despite having some level of
health knowledge. This highlights the necessity for ongoing health education programs aimed
at improving students' understanding of the consequences of their lifestyle choices.

Through the synthesis of these studies, it becomes evident that while knowledge of healthy
lifestyles exists among university students, the application of such knowledge is often
hindered by various factors, leading to unhealthy practices. The critical evaluation of these
articles reveals a pressing need for comprehensive health promotion strategies tailored to the
unique challenges faced by students in higher learning institutions.

The exploration of unhealthy lifestyle habits and their associated risks among students in
higher learning institutions is a critical area of research, particularly in the context of
developing countries like Tanzania. The literature on this topic reveals a concerning trend of
unhealthy eating habits and physical inactivity among university students, which are
significant risk factors for non-communicable diseases (NCDs). (R. Waweru & T. Marete,
2016) highlight the alarming rise in overweight and obesity among students, linking these
conditions to an increased risk of cardiovascular diseases, diabetes, and various cancers.
Their findings underscore that many students are unaware of the health risks they face due to
poor dietary choices, emphasizing the need for educational interventions within university
settings to promote healthier lifestyles.

In a complementary study, (Anne Grace Malagamba Dorado & P Racca, 2019) delve into the
relationship between knowledge of healthy lifestyles and actual dietary practices and physical
activity among university students. Their research suggests that despite a high level of
awareness regarding healthy practices, many students struggle to implement these behaviors
due to barriers such as time constraints. This disconnect between knowledge and practice is
concerning, especially in light of the World Health Organization's statistics indicating that
NCDs account for a significant proportion of global mortality. The authors advocate for a
reassessment of health policies within universities to better support students in translating
their knowledge into healthier lifestyle choices.

Furthering this discussion, (M Gosadi et al., 2024) provide insights into lifestyle satisfaction
among university employees, revealing a high prevalence of unhealthy lifestyles
characterized by low physical activity and poor dietary selections. Interestingly, some
individuals express satisfaction with their lifestyles despite these unhealthy choices,
suggesting a complex relationship between lifestyle habits and perceived well-being. This
finding calls for targeted interventions that consider the stages of health behavior change
among university affiliates, highlighting the necessity of tailored approaches to effectively
promote healthier lifestyle choices.

Together, these studies elucidate the multifaceted nature of unhealthy lifestyle habits among
university students and affiliates, pointing to the urgent need for comprehensive strategies
that not only educate but also facilitate the adoption of healthier practices in higher learning
institutions.

Unhealthy lifestyle habits are typically seen among the youth and young adults, especially
those in higher learning institutions. The issues could quickly be swept under the carpet if
nothing is done while students are in higher learning institutions. Education at this stage
should be seen as holistic and include educating students not only to fit into professional life
once they graduate from formal education but also to continue to thrive in the future. Health
education is an important tool in facilitating behavior change in line with a healthy lifestyle.

Unhealthy lifestyles consist of physical inactivity, an unhealthy diet, especially the

consumption of fast foods, unhealthy eating, increased body weight, and the associated risks
of non-communicable diseases. The study evaluates the knowledge, attitude, and
practice/physical activity levels of university students in higher learning institutions regarding
physical activities, which are very important as they have many health benefits compared to
inactivity. The presented findings will add new and important information regarding students'
lifestyle habits and associated risks.

Unhealthy Lifestyle Habits Among University Students Globally

Dietary Habits

Poor dietary choices are a major issue among university students worldwide. Research
suggests that students often consume diets high in processed foods, sugars, and unhealthy
fats, while neglecting essential nutrients such as fiber, vitamins, and minerals (Alghamdi et
al., 2022). A cross-sectional study in Saudi Arabia found that over 70% of university students
reported consuming fast food at least once per week, contributing to high levels of obesity
and metabolic syndrome within this demographic (Alghamdi et al., 2022). Inadequate
nutrition not only affects physical health but can also impair academic performance by
reducing cognitive function and increasing susceptibility to illness (Bain et al., 2021).

In Tanzania, the adoption of processed and convenience foods is growing, particularly among
urban populations. A study by Mboya et al. (2021) indicated that Tanzanian university
students often skip breakfast and consume fast foods, which negatively affects their
nutritional intake. This dietary shift is linked to the wider trend of urbanization and
Westernization, which has impacted traditional food practices (Mboya et al., 2021).
Addressing poor dietary habits through awareness and education could potentially mitigate
these risks among young adults.

Physical Inactivity

Physical inactivity is another prevalent issue, with numerous studies linking sedentary
lifestyles among students to health risks like obesity, cardiovascular disease, and mental
health disorders. According to the WHO (2020), physical inactivity is a major risk factor for
chronic diseases, and university students are particularly vulnerable due to academic
pressures and a lack of access to recreational facilities. A study conducted in the United
States revealed that over 60% of college students did not meet the recommended levels of
physical activity, which can lead to long-term health complications (Huang et al., 2019).

In Tanzania, the situation is similar, with research indicating that physical inactivity among
students is increasing due to the shift from rural to urban lifestyles (Shayo & Mugusi, 2021).
Many students lack access to fitness facilities and safe spaces for exercise on campus,
contributing to low levels of physical activity. Shayo and Mugusi (2021) argue that
integrating structured physical activity programs into university life could help address this
issue.

Substance Use

Substance use, including smoking and alcohol consumption, is another major concern among
university students globally. Substance use behaviors are often influenced by social
environments, peer pressure, and stress management practices. A study in South Africa found
that alcohol use among university students was associated with social gatherings and stress
relief, with a significant percentage of students reporting binge drinking behaviors (Mokwena
& Morwe, 2021). This trend is seen globally, with students often engaging in risky drinking
patterns that could lead to alcohol dependence and related health problems (Nayak et al.,
2020).

In Tanzania, alcohol and tobacco use among university students is increasing, especially in
urban centers where these substances are more readily available. According to a study by
Mosha et al. (2020), about 30% of university students in Dar es Salaam reported regular
alcohol consumption, often influenced by social settings and stress. Mosha et al. (2020)
suggest that addressing these behaviors requires a focus on mental health resources and stress
management programs, which could reduce the tendency toward substance abuse among
students.

4 Specific Studies on Tanzanian University Students

There is limited research focusing specifically on Tanzanian university students' health

habits, but a few studies provide valuable insights into the prevalence and impact of
unhealthy lifestyle practices. A study by Mboya et al. (2021) examined dietary patterns,
physical activity, and alcohol consumption among students at the University of Dar es
Salaam, revealing that many students struggle to maintain healthy diets and regular exercise
routines due to academic pressures and limited resources. This research highlights the need
for institutional support and policy changes that encourage healthy behaviors.

Another study by Shayo and Mugusi (2021) investigated physical inactivity and sedentary
behavior among Tanzanian students, finding that limited access to recreational facilities and
high academic demands were key barriers to physical activity. Shayo and Mugusi (2021)
concluded that universities need to prioritize student health by creating accessible fitness
facilities and integrating physical activity into the academic schedule.

A previous study conducted in two public universities aimed to assess dietary habits and
environmental factors among undergraduate students and found some of the risky eating
behaviors to be a common pattern. In their study, they depicted that suboptimal eating
behaviors were prevalent among students. They also pinpointed that irregular food
consumption and the high consumption of fast food, packed foods, and sugar-sweetened
beverages can contribute to increased non-communicable diseases prevalence and highlight
the need for policy intervention to rectify poor dietary patterns at the universities.

Other studies suggested a higher prevalence of various risky food habits that encompass high
intake of fast food, sugar-sweetened canned beverages, snacks, low fruit and vegetable
intake, accompanying lunch with heavy drinkers, higher dining out frequencies, eating out of
home, wrong dietary pattern creations, increasing acceptance of canned food, too frequent
eating, very large meals, and rarely food combinations.

Several published studies have shown that unhealthy lifestyle behaviors are very common
among students in higher learning institutions. This means that students are spending much
time on their studies and engaging in unhealthy habits for the rest of the time, which can
cause ill health and affect their performance during their academic careers. Unhealthy habits
in this study include characteristics such as consuming high amounts of sugar and fat, failing
to perform regular physical activity, sleeping less than 8 hours, smoking cigarettes, and
consuming alcohol. A study on risk and protective factors associated with tobacco use among
students aged 13-15 years in Uganda showed that they had only nine substance use risk
factors, among which the first was a very high use of alcohol.

According to another study to assess the nutritional behaviors and physical activity among
students, the unhealthy lifestyle behaviors associated with students were very high, including
overweight, obesity, and inactivity. The evidence also showed that the risk factors for non-
communicable diseases (NCDs) are prevalent in young people, and university or higher
education is a critical stage during which adolescents make the transition from high school to
adulthood. Another study on obesity among students in higher education in Accra analyzed
data from 61 obese participants, and the results showed that 94% were females. The study
concluded that obesity is prevalent among students in higher institutions, and their
predicament may be merging with earlier concerns about undernutrition and ineffective diet-
related health problems on campuses. This indicates that unhealthy behaviors are common
among students in higher institutions and provides a clue to carry out this study on the
knowledge, attitudes, and practices regarding unhealthy lifestyle habits and associated risks.

Empirical Studies on Unhealthy Lifestyle Habits Among Students

Studies on lifestyle habits and associated risks are very important to society as they contribute
to solving problems and help in achieving a sound solution to the problem of addictions. In
the field of healthcare, several studies were conducted to measure various aspects that link to
issues of unhealthy behaviors; however, very few have focused on investigating the
knowledge, attitude, and practice of unhealthy behaviors among students in higher learning
institutions. This chapter reviews previously conducted research that is related to this study.
Specifically, nine studies were reviewed, and they generated differing findings. Many of
these reviewed studies focused on risky sexual behavior; however, only a few studies on
unhealthy lifestyle habits indicated that students are aware of and influence their unhealthy
behavior participation. In general, the findings of this study were consistent with many views
and questions about the number of behaviors in the reviewed studies. However, there are
some questions that were not addressed in the reviewed studies. Concerning knowledge of
unhealthy behaviors, for instance, none of the reviewed studies asked about the effect of
education and gender. Such specific questions are warranted and need to be addressed in
subsequent studies to expand the empirical coverage in this area. Thus, a careful review of
empirical findings observed in the reviewed studies stands in contrast to studies carried out in
developed countries. Perhaps more importantly, the range of poor knowledge of unhealthy
behaviors is much wider than that detected in the existing empirical evidence to date. Merely
analyzing knowledge of unhealthy behaviors across different countries or students is also
insufficient. Thus, research should move into other domains. That is why the study through
the analytical approach aims to address these issues.

The Knowledge, Attitude, and Practice (KAP) Model

The KAP model is widely used in health research to understand how individuals’ knowledge
about health risks influences their attitudes and, ultimately, their health-related behaviors.
The model suggests that accurate knowledge can shape positive attitudes toward health,
which in turn can encourage healthy practices (Kumar et al., 2019). According to Kumar et
al. (2019), studies employing the KAP model have shown that gaps in knowledge often lead
to misconceptions and poor health choices. In the context of unhealthy lifestyle habits,
research indicates that university students who lack knowledge about the risks associated
with poor diet, lack of exercise, and substance use may be more likely to adopt such
behaviors (Zhang et al., 2020).
Using the KAP model in the Tanzanian context could reveal critical insights into students’
knowledge gaps, attitudes, and behaviors around lifestyle choices. For example, a study
conducted by Zhang et al. (2020) found that while students in China were aware of certain
health risks, many had misconceptions about the impact of diet and physical activity on long-
term health, leading to inconsistent practice. This finding underscores the importance of
understanding not only what students know but also their perceptions and behaviors to inform
effective health education interventions.

Gaps in the Literature

Amid the existing evidence, several gaps in the literature render our knowledge of the
problem of risky behaviors among college students limited. While conducting a thorough
review, we found that the majority of studies in this area utilized a small sample of students
only in one college or even the whole of certain countries; this implies that evidence in
understanding the problem of behavior related to health practices is limited. Owing to the
acceptance of alcohol consumption patterns as the norm and social act, there is also unequal
knowledge of adolescents' unhealthy drinking patterns, especially in developed countries.
Using a randomly selected sample of developing countries will allow for a quicker
accumulation of this knowledge. The only factor influencing a student becoming an alcoholic
was insufficient parental funds to obtain premium educational financing.

Moreover, there is a paucity of both qualitative and quantitative studies on sexual and
reproductive health that specifically concentrate on student groups in higher learning
institutions. While some research has addressed homelessness as a general youth problem,
very little has concentrated specifically on college students, despite recognition that
homelessness may exist among them. Previous work, however, has not focused on variables
at the collective or macro level. That is, previous research has focused on individual variables
such as demographic and personality characteristics while excluding the significant
influences of the institutional context. Lastly, longitudinal research is needed to track
development, particularly in population groups that have been overlooked by current
investigations. The aim of the current investigation was to empirically examine the typical
drinking behaviors in minor students at a university and, as a societal health predicament,
immoral drinking habits.

Sampling Techniques and Sample Size

The study adopted stratified random sampling to select the sample. Stratified random
sampling is a method of sampling that involves dividing the population into subpopulations
or groups known as strata. From each strata, a certain number of elements (students) were
selected systematically based on a predetermined selection rate. The sampling unit in this
research was a student of Mzumbe University. The stratification was based on the level of
study. There were particular levels of study, namely year 1, year 2, year 3, . It is important to
mention that the study adopted levels of study as it was possible to get all these years from
the students' department in a given session. For instance, year 1 students were composed of
one group, and this applied to students from year 2 to year 3.

Sample Size

The study used a formula for the estimation of the minimum sample size to obtain reliable
information about the population. The sample size was calculated using the formula for a
cross-sectional study. The assumption made in this sample size calculation approach was that
the proportion of students who have unhealthy lifestyle habits was 50%. The calculation of
the sample size is as follows:

n = Z² * p (1 - p) / d²

Where: n = Minimum sample size required, assuming the proportion of students with
unhealthy lifestyle habits equals 50%; Z = Standard normal deviate, which is equal to 1.96 at
the 95% confidence level; p = Proportion of the population with the characteristic being
measured and having unhealthy lifestyle habits, which is assumed to be 0.50 for this
calculation; and d = Absolute precision or margin of error at the 5% level of significance,
which was set at 0.05.

n = (1.96² * 0.50 * (1 - 0.50)) / (0.05²)

n = (3.8416 * 0.25) / 0.0025

n = 1536

Therefore, the minimum required sample size for the study was 1536 students. However, the
response rate was assumed to be 90%, hence for this calculation we took 10% as the
possibility of not participating in the research due to reasons such as declining to participate
due to busy schedules, failure to contact the students at the time they attended lectures, or
being absent for any other varying circumstance. When the 10% of the required sample size
was subtracted from the calculated sample size, the new figure of the sample size became
1382 students. Hence, the number of selected students (sample size) was 1382 students, with
691 students from Mzumbe University and 691 from Sokoine University.

Data Collection Methods

A self-administered structured questionnaire was the primary tool for data collection on
knowledge, attitudes, and practices (KAP) of unhealthy lifestyle habits, including associated
risks, dietary habits, physical activities, and stress management. Anthropometric
measurements of body mass index (BMI) were also collected. Data were collected once from
a test group of 400 students from two municipal universities, one public university, and one
private university located in two different regions. Data on dietary habits were assessed using
a non-validated structured questionnaire that collected information related to likes and
dislikes of preferred eating and cooking habits, fruit and vegetable intakes, food that was
usually eaten, and their drinking behaviors. Physical activities and stress were collected from
yes-no questions.

For quality assurance, the standard instrument and relevant literature were reviewed to
ascertain the comprehensiveness of the major concepts. This created the main structure of our
instrument used in the study. In order to maintain the reliability of the data, all data were
collected through a single mode after the concept and measurement dimensions were agreed
upon, were pilot-tested, and further calibrated prior to the formal data collection. The data
were then analyzed using statistical software. Even though the reliability was good, we did
not validate the survey tool in the present study but rather used content validity, which was
based on the relevance of the included questions and tested for reliability using a pilot test.
This is accepted as a major limitation in this study, and the tool could be validated and
improved in the future.

CHAPTER THREE

RESEARCH METHODOLOGY

Introduction

This chapter provides research methodologies and research designs such as, area of study,
target population, sample size and sampling techniques, source of data collection and data
collection tools or instruments.

Study Design

This study involved cross-sectional research aimed at investigating students’ knowledge,

attitude, and practice of unhealthy lifestyle habits and associated risks with a sample of
students from Mzumbe and Sokoine Universities in Tanzania. The study involved pre-testing,
development, and validation of the research tools. Subsequently, data were collected using a
pre-tested self-administered questionnaire with a Cronbach’s alpha coefficient of 0.707.

This study employed a cross-sectional design. The major aim of selecting this design was to
describe and assess the students’ knowledge, attitude, and practice of unhealthy lifestyle
habits at a specific point in time. The design is one of the most common and efficient
methods applied in quantitative research, including health-related research such as disabilities
or diseases. It is a rigorous way to establish relationships between phenomena and not
between differences. Data were collected at a single point during the study period. As health
educators, we aimed at better understanding and improving health behaviors by identifying
the prevalence of knowledge, attitude, and practice of the students towards a healthy lifestyle.

Study Area

The study was conducted in Tanzania at higher learning institutions, namely Sokoine
University of Agriculture and Mzumbe University. Both Sokoine University of Agriculture
and Mzumbe University offer different courses in various fields, such as health, law,
medicine, education, environmental studies, entrepreneurship, religion, social welfare,
informatics, and management. The universities were chosen in this study due to the fact that
they offer a diverse range of courses attracting students with different backgrounds.

This study was carried out among Mzumbe University, consisting of 27,000 students, and
Sokoine University of Agriculture, which has 5,778 undergraduate students and 775
postgraduate In the academic year 2023/2024, Mzumbe University had a total student number
of 1,840, and Sokoine University of Agriculture had a total student number of 44,300. The
general population of a university maintains a consistent academic pattern; thus, it is quite
easy to identify which group meets the study’s participant eligibility criteria. The participants
of the study were students in their first, second, and third years of study at Mzumbe
University, Tanzania, and students in their first-year study at Sokoine University of
Agriculture, Tanzania.

Study Population

The study involved a cross-sectional study design to collect data on knowledge, attitude, and
practice of unhealthy lifestyle habits and associated risks among students at Mzumbe and
Sokoine Universities. The study was conducted in Morogoro District. This district is divided
into two: Morogoro Municipal Council and Morogoro District Council. The selection of the
site was based on the fact that the district has many higher learning institutions. The district is
located between latitude 6.5-7.0 degrees south of the equator and longitude 37.0-38.4 degrees
east of Greenwich. The district shares Morogoro Regional Referral Hospital, the only referral
hospital in the region. This increases the chances of being chosen as it is expected for the
areas that show greater population sizes. Furthermore, Morogoro is located in an area
selected for the two main communication routes linking Dar es Salaam city with the Great
Lakes region and Zambia, and as such, it is likely to be selected in terms of its strategic
importance.

At Mzumbe University, the faculties involved in the study were the Faculty of Business
Administration and Mathematics, Faculty of Public Administration, Faculty of Development
Studies, Faculty of Education, Faculty of Law, Faculty of Social Sciences, and Faculty of
Science and Technology. At Sokoine University of Agriculture, students from the College of
Agriculture, College of Business Law, College of Veterinary Medicine, and Faculty of
Education were involved in the study. According to the registration books obtained from the
offices of the Deans of Students, there were 3,750 students and 3,240 at Mzumbe and
Sokoine Universities, respectively. Therefore, a list of students' names provided by the
aforementioned faculties was obtained. A systematic probability sampling technique at a
sampling interval of 5 was then used to select study respondents from each faculty.
Afterward, the first respondents to be included in the study were identified, and a team of 16
university Internal Social Workers and 8 Community Development Officers who were
involved in the field data collection process accompanied by trained community members
who also worked for the municipality to supervise the process. Categorized households in
selected localities were also visited. The help of several social welfare department officers
and the municipality community development officers was sought in locating adult
respondents who were absent.

Data Collection Methods and Tools

Connect form for knowledge, attitude, and practice about non-communicable and
communicable diseases, including lifestyle habits. Overall, the study will assess the status of
healthy versus unhealthy choices in addressing these diseases among students in higher
learning institutions. Through the achievement of this data, the study will be in a position to
generate baseline data that can offer evidence for youth interventions and campaigns aimed at
addressing lifestyle diseases significantly to reduce the economic burden of these diseases.
Face-to-face interviews will be used to collect primary data from students of each gender for
predesigned questions. The university health clinic situated in each participating university
will be of great help in explaining the purpose of the study, and guidance for the sample and
participants will be offered after coordinating with other offices in the university.
Alternatively, guidance and support for other key areas that might hinder the successful
implementation of the study will be resolved in the fieldwork together in case they arise
during the study's specific period. Guidelines for data collection techniques will be drawn
from the study questions and their arrangement. The strategies that will support data
collection include well-trained data collectors, supervision of data collection, questionnaire
pretesting, and modifications. Additionally, data quality will be safeguarded via standard
procedures while data will continuously be summarized to generate periodical reports, such
as daily, weekly, or monthly, in order to allow for early detection of inconsistencies and
omissions in the collected data. Participant motivation, which is closely related to ethical
conduct and data collection success, will be addressed by sharing information regarding
sustaining participants, which can be provided during and after participation.

Data Analysis Procedures

We had a sample of students from two higher learning institutions in Tanzania, which are
considered the major universities in the country. The universities are Mzumbe University and
Sokoine University of Agriculture. Mzumbe University is known to specialize mainly in
offering programs for business studies, which include: Business Administration,
Accountancy, Marketing, Banking and Finance, Public Administration, Human Resource
Management, etc., while other programs are offered as an initiative faculty. Sokoine
University of Agriculture is currently specialized in offering programs that are mainly related
to agricultural studies. These include, but are not limited to: Agricultural Economics and
Agribusiness, Horticulture, Veterinary Medicine, Irrigation and Water Resources
Engineering, Crop Science, Wildlife Management, and Human Nutrition. Major unhealthy
lifestyle habits associated with students' health were investigated; these include smoking,
substance use, overweight and obesity, poor eating habits, sedentary behaviors, poor sleeping
habits, alcohol consumption, stress, and depression, along with other mental complexities.

The data collection methods used were questionnaires and interviews. Each question was a
close-ended measure of pupils' behaviors on topic-related variables. After completely filling
in the forms, data was then extracted for analysis using statistical software

Research Approaches

Morgan D (2013) research approach helps to structure collection, analysis and interpretation
of data. The researcher will use mixed methods both qualitative and quantitative methods in
data collection and analysis. The researcher is opted for mixed methods because the methods
will help in integrating knowledge from both qualitative and quantitative data as well as
overcoming each method’s weaknesses and limitations.

Study Design
Kothari, (2013) stated that, research design is the method used in collection and analysis of
data in a manner that aims to combine relevance to the research objectives with economy in
the procedures. In this study descriptive design will used to examine the researcher will
collect raw data from the field and analyzed them by using both quantitative and qualitative
approaches.

Sampling Techniques
Prathapan (2014) asserts that the major reason for sampling is to reduce the expenses in
terms of time, money and effort.

Data Source

The nature of this study influences the use of primary data source by collecting information
from and and then secondary data source by reading other articles and

Data Collection Methods and Tools

This study will involve three data collection methods which are FGD, and questionnaires for
primary data and documentary review for secondary data the use of different methods aimed
to complement the strengths of each data collection tool to overcome weaknesses of one
another. These methods will help in increasing validity and reliability of study results.

focused group discussion

The focused group discussion involves discussion with the respondents to obtain ideas from
them about the phenomenon under investigation (Punziano & Paoli ,2019) The focused
group discussion involves the people who share the same and common interest in the issue
that need different opinions, beliefs , attitudes , perception as well as experiences. Therefore,
in this study, the researcher will form FGD with in the area of the study to examine

Questionnaires

Kumar (2019) defines questionnaires as set of stimuli to which literate people are exposed in
order to observe their verbal behavior, under these stimuli within method there are questions
the researcher seeks from respondent in order to gain knowledge about certain matters.

The researcher used open-ended questions due to the fact that it helps to get more reliable and
valid data about. Also, the method will be useful because the questions will be answered even
if the researcher is absent and it is less time consuming. The questionnaires will comprise of
both open-ended and closed ended items. The open –ended items enable the respondents to
look critically on the problem and thus give diverged views and responses. Closed-ended
items will be expected to elicit specific information from the respondents. Questionnaires will
be distributed

Data Analysis Procedures

The process of data collection was not an end in itself. Likewise, data analysis procedures
maintain the culminating activities of quantitative and qualitative inquiries are analysis,
interpretation and presentation of findings. This indicates that the researcher does not end
with the collection of data but the collected data should be analyzed by using the statistical
package for data analysis. Kothari (2004) asserts that, analysis procedures may help
researcher to summarize information collected from the field.

Therefore in the process data collected will be categorized, computed and arranged into the
evidence for answering the research questions. For quantitative data the study will have
frequency and percentages through the use of tables and bar graphs applied which are in
simple descriptive analysis for the aim of having wheel organized presentation of the results
based on the research objectives.

Ethical Considerations

The study will observe the respondent rights, respondent should be willingly to participate in
order to provide information but also the issue of respondent privacy and confidentiality will
be observed.

1. Ethical clearance will be obtained from relevant institutional review boards.

2. Informed consent will be secured from all participants.

3. Data confidentiality and anonymity will be strictly maintained.

Questionnaire: Structured questionnaires will capture data on KAP related to unhealthy

habits.

Anthropometric Measurements: Body Mass Index (BMI) will be measured to assess physical
health.
Focus Group Discussions: Small groups will discuss perceptions and barriers to healthy
lifestyles.

REFERENCES
Alamri, N. (2018). Risk factors for cardiovascular disease among undergraduate students in
Edinburgh, Scotland. Unpublished Manuscript.

Alves, F. R. (2024). The relationship between health-related knowledge and attitudes and
health risk behaviors among Portuguese university students. Journal of Global Health.
Retrieved from https://ncbi.nlm.nih.gov

Awwad, M. S., & Al-Aseer, R. M. N. (2021). Big five personality traits impact on
entrepreneurial intention: The mediating role of entrepreneurial alertness. Asia Pacific
Journal of Innovation and Entrepreneurship. Retrieved from https://emerald.com

Batista, P., Neves-Amado, J., Pereira, A., & Amado, J. (2022). Application of the
FANTASTIC Lifestyle Questionnaire in the academic context. Pakistan Journal of Medical
Sciences. Retrieved from https://ncbi.nlm.nih.gov

Boutayeb, A., & Boutayeb, S. (2005). The burden of non-communicable diseases in

developing countries. International Journal for Equity in Health, 4, 2.
https://doi.org/10.1186/1475-9276-4-2

Brandén, M., Aradhya, S., Kolk, M., Härkönen, J., & others. (2020). Residential context and
COVID-19 mortality among adults aged 70 years and older in Stockholm: A population-
based, observational study using individual-level data. The Lancet Healthy. Retrieved from
https://thelancet.com

Cockerham, W. C. (2021). Health lifestyles: Bringing structure back. In The Wiley Blackwell
Companion to Medical Sociology. Retrieved from https://mysocialbliss.com

Dorado, A. G. M., & Racca, P. (2019). Relationship of knowledge on healthy lifestyle to

dietary practices and physical activity as moderated by age. Unpublished Manuscript.

Florence, E. G., Derman, W., Popperwell, M., & others. (2023). Prevalence of health risk
behaviors related to non-communicable diseases amongst South African university students:
A systematic review. Journal of Global Health. Retrieved from https://ncbi.nlm.nih.gov
Goncalves, A., Le Vigouroux, S., & others. (2021). University students' lifestyle behaviors
during the COVID-19 pandemic: A four-wave longitudinal survey. International Journal of
Environmental Research and Public Health. Retrieved from https://mdpi.com

Gooding, H. C., Gidding, S. S., Moran, A. E., & others. (2020). Challenges and opportunities
for the prevention and treatment of cardiovascular disease among young adults. Journal of
the American Heart Association. Retrieved from https://ahajournals.org

Health Study Consortium and European Association for Predictive, Preventive and
Personalised Medicine. (2021). All around suboptimal health: A joint position paper. EPMA
Journal. Retrieved from https://springer.com

Hutchesson, J. M., Whatnall, C. M., Yazin, N., & others. (2022). Health behavior
interventions for university students measuring mental health outcomes: A scoping review.
Pakistan Journal of Medical Sciences. Retrieved from https://ncbi.nlm.nih.gov

I. Ilo, Cajetan, Nwimo, Ignatius O., Onwunaka, Chinagorom (2015). Personal Health Risks
Behaviour Profile among University Students in the South East Nigeria: Implication for
Health Education. https://core.ac.uk/download/234637386.pdf

Ibrahim, N. K., Mahnashi, M., Al-Dhaheri, A., & others. (2014). Risk factors of coronary
heart disease among medical students in King Abdulaziz University, Jeddah, Saudi Arabia.
BMC Public Health, 14, 411. https://doi.org/10.1186/1471-2458-14-411

Jardim, S. R., de Souza, L. M. P., & de Souza, H. S. P. (2023). The rise of gastrointestinal
cancers as a global phenomenon: Unhealthy behavior or progress? International Journal of
Environmental Research and Public Health. Retrieved from https://mdpi.com

Kebede, T., Taddese, Z., & Girma, A. (2022). Knowledge, attitude, and practices of lifestyle
modification and associated factors among hypertensive patients on-treatment follow-up at
Yekatit 12 General Hospital. PLOS ONE. Retrieved from https://journals.plos.org

Kothari C R (2013) Research Methodology: Methods and Techniques .New Age

International (P) Limited, Publishers,

Kothari, C.R. (2004) Research Methodology.2nd Ed. New Age International Publishers-
Kumar R (2019) Research Methodology: A Step-by-Step Guide for Beginners, SAGE
Publications.

Laar, R. A., Shi, S., Ashraf, M. A., Khan, M. N., Bibi, J., & others. (2020). Impact of
physical activity on challenging obesity in Pakistan: A knowledge, attitude, and practice
(KAP) study. International Journal of … Retrieved from https://mdpi.com

Mamurov, B., Mamanazarov, A., & others. (2020). Acmeological approach to the formation
of healthy lifestyle among university students. Proceedings of the International Congress
Society of Acmeology. Retrieved from https://atlantis-press.com

Martinez, J. E., Kahana, D. D., & Ghuman, S. (2021). Unhealthy lifestyle and gut dysbiosis:
A better understanding of the effects of poor diet and nicotine on the intestinal microbiome.
Frontiers in Nutrition. Retrieved from https://frontiersin.org

Memish, Z. A., El Bcheraoui, C., Tuffaha, M., & others. (2014). Obesity and associated
factors in the Kingdom of Saudi Arabia. Preventing Chronic Disease, 11, E174.
https://doi.org/10.5888/pcd11.140236

Menakaya, C. N., & Menakaya, N. I. (2022). Perceptions, attitudes, and practices of

adolescent university students in Lagos, Nigeria, towards a healthy lifestyle: A qualitative
study. Pakistan Journal of Medical Sciences. Retrieved from https://ncbi.nlm.nih.gov

Morgan D (2013) Integrating Qualitative and Quantitative Methods: Pragmatic Approach.

SAGE Publication Inc.

Msambichaka, Beverly (2018). The Epidemiology of Non-Communicable Diseases Lifestyle

Risk Factors in Tanzanian Population Groups. https://core.ac.uk/download/491345967.pdf

Muhanga, Mikidadi Idd (2020). Health literacy and health behaviour in the context of one
health approach in Morogoro, Tanzania: perceptions, attitudes, connections, and
realities.. https://core.ac.uk/download/618069116.pdf

Nasir, U., Butt, A. F., & Choudry, S. (2019). A study to evaluate the lifestyle of medical
students in Lahore, Pakistan. Pakistan Journal of Medical Sciences. Retrieved from
https://ncbi.nlm.nih.gov
Ndumwa, H. P., Amani, D. E., Ngowi, J. E., & others. (2023). Mitigating the rising burden of
non-communicable diseases through locally generated evidence: Lessons from Tanzania.
Journal of Global Health. Retrieved from https://pmc.ncbi.nlm.nih.gov

Owopetu, O. F., Adebayo, A. M., & others. (2021). Behavioral risk factors for non-
communicable diseases among undergraduates in South-West Nigeria: Knowledge,
prevalence, and correlates: A comparative cross-study. Journal of Preventive Medicine.
Retrieved from https://pmc.ncbi.nlm.nih.gov

Pallangyo, P., Mkojera, Z. S., Hemed, N. R., Swai, H. J., & others. (2020). Obesity epidemic
in urban Tanzania: A public health calamity in an already overwhelmed and fragmented
health system. Endocrine Disorders. Retrieved from https://springer.com

Parmenter, T. R. (2021). Quality of life for handicapped people: An analysis of the

dimensions of quality of life for people with physical disabilities. Taylor & Francis.
Retrieved from https://taylorfrancis.com

Pengpid, S., & Peltzer, K. (2021). Prevalence and correlates of multiple behavioral risk
factors of non-communicable diseases among university students from 24 countries. Journal
of Public Health. Retrieved from https://academic.oup.com

Prathapan K (2014) Research Methodology for Scientific Research: International

Publishing House Pvt. Limited.

Rahamathulla, M. P. (2020). Frequency and awareness of risk factors of non-communicable

diseases among university students in Saudi Arabia. Pakistan Journal of Medical Sciences.
Retrieved from https://ncbi.nlm.nih.gov

Sharma, S. K., Telles, S., & Gandharva, K. (2022). Yoga instructors' reported benefits and
disadvantages associated with functioning online: A convenience sampling survey. …
Therapies in Clinical Practice. Retrieved from https://elsevier.com

Tran, D. M. Y., Silvestri-Elmore, A., & others. (2022). Lifestyle choices and risk of
developing cardiovascular disease in college students. International Journal of Preventive
Medicine. Retrieved from https://pmc.ncbi.nlm.nih.gov
United Nations Children’s Fund, (UNICEF) (2012). Cities and Children: the challenge of
urbanisation in Tanzania. https://core.ac.uk/download/pdf/11307088.pdf

Waweru, R., & Marete, T. (2016). Estimation of relationship between eating habits and body
mass index of students in Mount Kenya University, Rwanda. Unpublished Manuscript.

Weigold, A., & Weigold, I. K. (2022). Traditional and modern convenience samples: An
investigation of college student, Mechanical Turk, and Mechanical Turk college student
samples. Social Science Computer Review. Retrieved from https://journals.sagepub.com

Whatnall, M. C., Patterson, A. J., Brookman, S., & others. (2020). Lifestyle behaviors and
related health risk factors in a sample of Australian university students. Journal of American
College Health. Retrieved from https://tandfonline.com

Xue, B., Zhang, X., Li, T., Gu, Y., Wang, R., & others. (2021). Knowledge, attitude, and
practice of obesity among university students. Annals of Palliative Medicine. Retrieved from
https://apm.amegroups.org

Zemrani, B., Gehri, M., Masserey, E., Knob, C., & others. (2021). A hidden side of the
COVID-19 pandemic in children: The double burden of undernutrition and overnutrition.
International Journal for Equity in Health. Retrieved from https://springer.com

Zubery, D., Kimiywe, J., & Martin, H. D. (2021). Prevalence of overweight and obesity, and
its associated factors among healthcare workers, teachers, and bankers in Arusha City,
Tanzania. Diabetes, Metabolic Syndrome and Obesity. Retrieved from
https://tandfonline.com