Project – Health Education Intervention and Prevention of Lifestyle-Related Health Risks among University Students: A Study of Students of Lagos State University, Ojo

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Health is an essential component of human development and an important foundation for educational, social and economic productivity. The World Health Organization (WHO) conceptualises health broadly as a state of physical, mental and social well-being rather than merely the absence of disease. This understanding implies that promoting health requires more than treating illness after it occurs; it also requires equipping individuals with the knowledge, attitudes, skills and environmental support needed to prevent disease and maintain healthy lifestyles. Within the university environment, this perspective is particularly important because students are undergoing a transition from adolescence to adulthood during which many personal behaviours and lifestyle patterns become established.

University education provides young people with greater independence in decision-making than they may have experienced during their secondary school years. Students increasingly make independent decisions about what they eat, how physically active they are, how they manage stress and sleep, whether they consume alcohol or tobacco, how much time they spend using digital devices and whether they seek preventive healthcare. Consequently, the university period can constitute both an opportunity for positive health behaviour formation and a period of increased exposure to lifestyle-related health risks. The systematic umbrella review by Dodd et al. (2020) identified university students as an important population for health promotion because modifiable behaviours involving physical activity, diet, mental health, substance use, sleep and media consumption occur during this stage of life.

Lifestyle-related health risks refer to behaviours and conditions that increase an individual’s likelihood of developing disease or experiencing poor health. Major examples include physical inactivity, unhealthy dietary practices, tobacco use, harmful alcohol consumption, inadequate sleep, excessive sedentary behaviour and poor stress-management practices. These behaviours may occur independently, but they can also cluster together. The WHO identifies tobacco use, physical inactivity, unhealthy diet and harmful alcohol use as major modifiable behavioural risk factors for non-communicable diseases (NCDs). These behaviours contribute to metabolic risk factors such as overweight and obesity, raised blood pressure, elevated blood glucose and abnormal blood lipids, which subsequently increase the risk of cardiovascular diseases, cancers, diabetes and chronic respiratory diseases.

Non-communicable diseases are increasingly recognised as a major public health concern globally and in low- and middle-income countries. According to the WHO (2025), NCDs accounted for at least 43 million deaths globally in 2021, representing approximately 75% of non-pandemic-related deaths. The burden disproportionately affects low- and middle-income countries, where most premature NCD deaths occur. Importantly, many of the behavioural risk factors associated with NCDs are preventable. Consequently, interventions that encourage healthier diets, regular physical activity, avoidance of tobacco, responsible alcohol use and other healthy behaviours have an important role in reducing future disease burden.

The importance of prevention is particularly relevant among university students because exposure to lifestyle-related risk factors may begin or intensify during early adulthood. WHO notes that exposure to major NCD risk factors often begins during childhood or early adulthood. This makes health promotion among young people an important strategy for preventing the development of unhealthy patterns that may persist throughout adulthood. Prevention at this stage can therefore produce benefits beyond the individual student by potentially reducing future healthcare needs and improving the productivity and well-being of the population.

Health education is one of the important approaches through which healthy behaviour can be promoted. Health education involves planned learning experiences designed to improve individuals’ knowledge, attitudes, skills and capacity to make informed decisions concerning their health. It goes beyond simply giving information. Effective health education seeks to influence understanding, attitudes, self-efficacy, motivation and practical skills that can support healthier choices. In the university environment, health education may involve classroom instruction, seminars, workshops, peer education, counselling, health campaigns, digital learning, screening programmes and other forms of behaviour-change communication.

Health education is particularly valuable because awareness of health risks does not always translate into healthy behaviour. Individuals may know that fruits and vegetables are beneficial but still consume them infrequently; they may understand the importance of exercise but remain physically inactive; and they may recognise the risks of alcohol or tobacco but continue using these substances. This distinction between knowledge and behaviour is important when designing health interventions. A recent study at Lagos State University found that although health awareness regarding good nutrition was relatively high, a substantial knowledge-behaviour gap persisted, with socioeconomic and environmental circumstances influencing students’ actual food choices.

The university therefore represents more than an educational institution; it is also a setting in which health behaviours can be shaped. The WHO’s health-promoting university approach emphasises the importance of institutional policies, healthy environments, supportive social environments and health-related services in creating conditions that enable students and staff to make healthier choices. A health-promoting university does not rely exclusively on individual responsibility but combines health education with supportive institutional structures and environments.

Nutrition is one of the major areas in which health education can contribute to prevention. University students may experience changes in eating habits because of financial limitations, busy academic schedules, independence, peer influence, availability of fast foods and campus food environments. Poor dietary patterns may include meal skipping, excessive consumption of energy-dense foods, frequent intake of processed foods and inadequate consumption of fruits and vegetables. These behaviours can contribute to overweight, obesity and other metabolic risk factors when sustained over time.

Evidence from Lagos State University illustrates the relevance of this issue. Arisa, Anaemene and Mekwunye (2020), in a study of 150 LASU undergraduate students, examined dietary habits, physical activity and nutritional status. The researchers reported that 75.3% of the participants skipped breakfast, while snacks and processed foods were commonly consumed. The study also identified central obesity as an important concern and recommended promotion of healthy lifestyles among LASU students.

Similarly, a study of undergraduate students across three universities in Lagos State found considerable concerns regarding dietary behaviour and metabolic risk factors. Among 506 students, fewer than one-third reported eating three meals daily, only 23% ate breakfast regularly and approximately 2% consumed the recommended daily amount of fruits and vegetables. The study demonstrates that unhealthy dietary patterns among university students can coexist with metabolic risk factors, reinforcing the importance of preventive health education within university settings.

Physical activity is another major component of a healthy lifestyle. Regular physical activity contributes to cardiovascular fitness, healthy body weight, muscular strength, psychological well-being and prevention of chronic diseases. Conversely, physical inactivity is associated with increased risks of cardiovascular disease, diabetes, obesity and other health conditions. WHO identifies insufficient physical activity as one of the major modifiable risk factors for NCDs.

University students may experience reduced physical activity because of academic schedules, prolonged sitting, transportation patterns, extensive computer use and recreational screen time. A study involving adolescent university students in Lagos found that computer and Internet activity constituted a major sedentary activity. Participants also identified academic schedules and aspects of the campus environment as factors influencing their lifestyle practices.

Sedentary behaviour is closely associated with the increasing use of digital technologies. Smartphones, computers and the Internet provide substantial educational and social benefits to university students, but prolonged screen-based activity can contribute to sedentary lifestyles when not balanced with physical activity. Health education can help students understand the importance of movement, active breaks, exercise and balanced use of technology. However, institutional measures such as access to sports facilities, recreational spaces and health-promoting programmes may also be necessary.

Substance use represents another important lifestyle-related health risk among university students. Alcohol consumption, tobacco use and other psychoactive substance use may be influenced by peer relationships, social environments, stress, perceived norms, accessibility and individual attitudes. A Nigerian study involving university students reported lifetime alcohol use of 43.5% and current alcohol use of 31.1%, demonstrating the relevance of alcohol-related risk among young adults in Nigerian university settings. The researchers recommended interventions to address unhealthy alcohol-use norms among students.

Evidence from South-West Nigeria further demonstrates the need for preventive health education among university students. A comparative cross-sectional study of undergraduates examining behavioural risk factors for NCDs reported that 68.3% of respondents had unhealthy diets, 70.6% were classified as physically inactive, 51.3% reported alcohol use and only a small proportion were current smokers. Of particular relevance to health education, only 23.9% of respondents in the public university had ever attended a seminar or programme on NCD prevention or management. This finding suggests that opportunities for formal health education may not adequately match the level of lifestyle-related risk among university students.

Mental health is also an important component of lifestyle and health promotion among university students. Students may encounter academic pressure, financial challenges, relationship difficulties, social adjustment, uncertainty about employment and other stressors. Poor sleep, unhealthy diets, physical inactivity, excessive substance use and inadequate coping mechanisms can interact with psychological well-being. Therefore, a comprehensive health education intervention should not focus narrowly on physical diseases but should also address stress management, sleep hygiene, emotional well-being, help-seeking and healthy coping strategies.

The COVID-19 pandemic further demonstrated the relationship between lifestyle, mental health, physical activity and digital behaviour among young adults. Although universities have returned to conventional academic activities, the increased reliance on digital technologies has continued to influence how students study, communicate and spend their leisure time. This reinforces the need for contemporary health education interventions that address both traditional health risks and changing patterns of student behaviour.

Another important consideration is health literacy. Health literacy involves the capacity to access, understand, evaluate and use health information to make appropriate health decisions. University students are exposed to large volumes of health information through social media, websites, peers and other informal sources. However, access to information does not necessarily guarantee that the information is accurate or that students will apply it appropriately. Health education can strengthen students’ capacity to distinguish reliable health information from misinformation and apply evidence-based recommendations to their daily lives.

The intervention component of health education is therefore critical. Effective health interventions may combine information provision with behaviour-change techniques such as goal setting, self-monitoring, social support, motivational communication and environmental modification. Evidence from a recent Lagos-based intervention demonstrates the feasibility of structured lifestyle education among university students. A 12-week online nutrition and lifestyle education programme for female university undergraduates in Lagos addressed diet, physical activity, sedentary behaviour, sleep, body image and weight-management practices using digital platforms and behaviour-change strategies.

Digital health interventions may be particularly relevant to university students because smartphones and Internet-based platforms are already integrated into their daily lives. A recent systematic review of digital health interventions for college students examined interventions targeting physical activity, sedentary behaviour, diet and sleep and concluded that digital approaches represent a promising strategy for improving lifestyle behaviours among students. However, digital interventions should complement rather than replace face-to-face health education, counselling and supportive institutional environments.

The Nigerian situation makes health education especially important because the country is experiencing an epidemiological transition characterised by the coexistence of communicable diseases and a growing burden of non-communicable diseases. The Nigerian National Policy and Strategic Plan of Action on NCDs identifies physical inactivity, unhealthy diets, tobacco use and harmful alcohol consumption as major modifiable risk factors. The policy also recognises the clustering of these behaviours within individuals and communities.

For university students, prevention is preferable to waiting until lifestyle-related conditions become clinically established. Students who acquire healthy habits concerning diet, physical activity, sleep, stress management and substance use may be better positioned to maintain these behaviours after graduation. Conversely, unhealthy habits developed during university may continue into employment, family life and later adulthood. Universities therefore have an opportunity to influence not only students’ immediate health but also their long-term health trajectories.

Lagos State University, Ojo, provides an appropriate setting for examining these issues. LASU is a large public university located in Lagos State and serves students from diverse social, cultural and economic backgrounds. The university environment exposes students to academic responsibilities, digital technologies, campus food environments, peer interactions and varying degrees of access to health and recreational resources. Importantly, previous research has already documented lifestyle concerns among LASU students, including dietary practices, physical activity and sedentary behaviour.

The presence of previous studies, however, does not eliminate the need for intervention-focused research. Existing studies have often concentrated on describing health behaviours or identifying risk factors. There remains a need to examine whether structured health education can improve students’ knowledge and attitudes and contribute to the prevention or reduction of lifestyle-related health risks. This is particularly important because awareness alone may not result in behavioural change, as demonstrated by recent LASU research showing that relatively high nutritional awareness coexisted with meal skipping and other unhealthy dietary practices.

The present study therefore focuses on Health Education Intervention and Prevention of Lifestyle-Related Health Risks among University Students: A Study of Students of Lagos State University, Ojo. The study seeks to examine students’ exposure to health education, their knowledge of lifestyle-related health risks, their health-related attitudes and practices, and the extent to which health education intervention may contribute to prevention. The ultimate concern is to determine whether appropriately designed health education can help university students adopt healthier behaviours and reduce exposure to preventable health risks.

1.2 Statement of the Problem

Lifestyle-related health risks constitute an important public health concern because many of the behaviours that contribute to chronic diseases are preventable. Physical inactivity, unhealthy diets, harmful alcohol consumption and tobacco use are among the major modifiable behavioural risk factors identified by the WHO. These behaviours can contribute to obesity, hypertension, diabetes, cardiovascular diseases and other chronic conditions. Although such diseases are often associated with older adults, the behavioural patterns that contribute to them frequently begin much earlier in life.

University students represent an important population in this regard because they are at a transitional stage where they acquire greater independence over their daily decisions. Students may determine what foods to consume, how frequently to exercise, how much time to spend on screens, how to manage academic stress and whether to engage in potentially harmful behaviours. Without adequate health knowledge, supportive environments and appropriate interventions, unhealthy behaviours may become established and persist into adulthood.

Evidence suggests that Nigerian university students are exposed to several lifestyle-related health risks. A South-West Nigerian study reported high levels of unhealthy diet and physical inactivity among undergraduates, alongside substantial alcohol use. Of particular concern was the relatively limited exposure of students in the public university to seminars or programmes addressing NCD prevention and management. This raises questions about whether existing university health education efforts are sufficiently comprehensive and accessible.

Dietary behaviour is another significant concern. Evidence from Lagos universities has identified inadequate meal patterns, low consumption of fruits and vegetables and other unhealthy dietary practices among undergraduates. In a study of students from three Lagos universities, only 23% reported regularly eating breakfast and approximately 2% consumed the recommended daily amount of fruits and vegetables. These findings suggest that nutritional knowledge and healthy food choices cannot be taken for granted among university students.

The problem is particularly relevant to Lagos State University. Research among LASU undergraduate students found that 75.3% of participants skipped breakfast, while snacks and processed foods were commonly consumed. The same study reported central obesity as a concern and recommended stronger promotion of healthy lifestyles among students. More recent LASU research similarly found that although many students recognised the importance of good nutrition, financial and environmental constraints contributed to meal skipping, fast-food consumption and inadequate fruit and vegetable intake.

These findings reveal a potential knowledge-behaviour gap. Students may possess information about healthy lifestyles but still engage in unhealthy practices because of financial limitations, convenience, campus food environments, peer influence, academic schedules, personal preferences or lack of sustained motivation. Therefore, simply providing health information may not be sufficient. Health education interventions need to address the practical, psychological and environmental factors that influence students’ health decisions.

Physical inactivity and sedentary behaviour also constitute important concerns. Students increasingly depend on computers, smartphones and Internet platforms for academic work, communication and recreation. Research among adolescent university students in Lagos identified computer and Internet activity as a major sedentary behaviour and reported academic schedules as one of the factors influencing students’ healthy-lifestyle practices. If prolonged sedentary behaviour is combined with unhealthy dietary practices, inadequate sleep and stress, students may face multiple overlapping health risks.

Substance use represents another dimension of the problem. Alcohol use, tobacco use and other substances can have physical, psychological, academic and social consequences. Nigerian research has documented substantial levels of alcohol consumption among university students and recommended targeted interventions to reduce unhealthy drinking norms. The clustering of different lifestyle risk factors means that interventions should ideally address multiple behaviours rather than treating each risk factor in isolation.

Mental health and stress further complicate the situation. University students often face academic demands, financial pressures, social adjustment and uncertainty concerning future employment. Poor coping mechanisms may encourage unhealthy eating, sleep disruption, inactivity or substance use. Consequently, a health education programme that focuses only on physical disease without addressing stress management, sleep, emotional well-being and healthy coping may have limited effectiveness.

A further problem is that university health education may be uneven in its reach and content. While students may encounter health information through orientation programmes, lectures, social media, health centres or occasional campaigns, there may be insufficient continuity, behavioural follow-up or evaluation of the effectiveness of such interventions. The South-West Nigerian evidence that fewer than one-quarter of public-university respondents had ever attended an NCD prevention or management seminar illustrates the potential gap between the existence of health risks and students’ exposure to organised preventive education.

There is also a need to recognise that health education operates within a broader institutional environment. The WHO health-promoting university framework emphasises that effective health promotion requires supportive policies, environments, services and organisational commitment rather than information alone. If healthy food options are unavailable or unaffordable, if opportunities for physical activity are limited, or if students cannot easily access health services, knowledge alone may not translate into healthy behaviour.

The problem, therefore, is not simply whether LASU students know about lifestyle-related health risks. The more important issue is whether structured health education can improve knowledge, attitudes and practices in ways that contribute to the prevention of such risks. There is a need for empirical evidence concerning students’ existing level of health knowledge, exposure to health education, lifestyle practices and willingness to adopt preventive behaviours.

Furthermore, although previous studies have examined dietary habits, physical activity, metabolic risk factors and healthy-lifestyle perceptions among university students in Lagos, fewer studies have specifically focused on a comprehensive health education intervention designed around multiple lifestyle-related risks among students of Lagos State University, Ojo. Previous evidence has identified important risks, but the intervention gap remains relevant.

The central problem addressed by this study is therefore the persistence of lifestyle-related health risks among university students despite the availability of health information and increasing awareness of healthy living. The study seeks to determine whether a structured health education intervention can improve students’ knowledge and attitudes and contribute to preventive health practices.

Accordingly, the study will examine Health Education Intervention and Prevention of Lifestyle-Related Health Risks among University Students, with particular reference to students of Lagos State University, Ojo. The findings are expected to provide evidence that can assist university administrators, health educators, healthcare providers, counsellors and policymakers in designing more effective health-promotion programmes for university students.

1.3 Purpose of the Study

The main purpose of this study is to examine the effectiveness of health education intervention in the prevention of lifestyle-related health risks among students of Lagos State University, Ojo.

Specifically, the study seeks to:

1. assess the level of knowledge of lifestyle-related health risks among students of Lagos State University, Ojo;
2. identify the major lifestyle-related health risks experienced or practised by students;
3. determine students’ sources and level of exposure to health education concerning lifestyle-related health risks;
4. examine the effect of health education intervention on students’ knowledge and attitudes towards healthy lifestyle practices

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of knowledge of lifestyle-related health risks among students of Lagos State University, Ojo?
2. What are the major lifestyle-related health risks experienced or practised by students?
3. What are the major sources and levels of students’ exposure to health education concerning lifestyle-related health risks?
4. What effect does health education intervention have on students’ knowledge and attitudes towards healthy lifestyle practices?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between health education intervention and the prevention of lifestyle-related health risks among students of Lagos State University, Ojo.

1.6 Significance of the Study

The study will be significant to students of Lagos State University because it will increase awareness of lifestyle-related health risks and provide practical knowledge concerning healthy eating, physical activity, substance-use prevention, stress management, adequate sleep and appropriate health-seeking behaviour. The intervention may encourage students to make healthier decisions and take greater responsibility for their health.

The study will also be beneficial to health educators and health education lecturers. Findings from the study may provide information that can guide the development of health education content that responds directly to the lifestyle challenges experienced by university students. It may also help health educators adopt intervention strategies that go beyond information provision to include behaviour change, self-monitoring, goal setting and peer support.

For Lagos State University management, the findings may provide evidence for strengthening university-wide health promotion programmes. The results may assist the institution in developing policies and services relating to healthy food environments, physical activity, mental health, substance-use prevention, health screening and student counselling.

The study will also be useful to university healthcare providers, including medical practitioners, nurses, nutritionists, counsellors and public health personnel. The findings may assist them in identifying common lifestyle-related risk behaviours and developing preventive programmes that target students before health problems become more serious.

The study will benefit parents and guardians by improving understanding of the health challenges that may affect students during university education. It may encourage parents to support healthy dietary choices, physical activity, responsible decision-making and appropriate health-seeking behaviours among their children.

The findings may also be useful to government and public health policymakers, particularly agencies responsible for health promotion, disease prevention and higher education. Evidence from the study may support the development of preventive health policies and health-promotion interventions targeted at young adults in Nigerian universities.

Finally, the study will contribute to the academic literature on health education, health promotion and lifestyle-related health risks among university students. It may provide a basis for future studies examining intervention strategies, health behaviour change and prevention of non-communicable diseases among Nigerian young adults.

1.7 Scope of the Study

The study focuses on Health Education Intervention and Prevention of Lifestyle-Related Health Risks among University Students, using students of Lagos State University, Ojo as the study population.

The study will examine students’ knowledge of lifestyle-related health risks, their exposure to health education, common health-risk behaviours, attitudes towards healthy lifestyles and adoption of preventive practices. The intervention component will focus on health education relating to major modifiable lifestyle risks, including unhealthy dietary practices, physical inactivity, sedentary behaviour, harmful alcohol use, tobacco use, inadequate sleep, poor stress management and related preventive health practices.

Geographically, the study will be restricted to Lagos State University, Ojo. The study will focus on undergraduate students selected from relevant faculties or departments according to the sampling procedure adopted for the research.

1.8 Limitations of the Study

One anticipated limitation is self-reporting bias. Students may underreport behaviours such as alcohol consumption, tobacco use, unhealthy eating or inadequate physical activity because of the sensitive nature of some questions.

Another limitation may be time constraints. University students have varying academic schedules, and their availability for participation in health education sessions and research activities may differ.

The study may also be affected by environmental and socioeconomic factors. Students may understand recommended healthy behaviours but lack adequate financial resources, healthy food options, recreational facilities or supportive environments needed to practise them consistently. Evidence from LASU indicates that socioeconomic circumstances can influence students’ food choices and contribute to a gap between health awareness and actual behaviour.

Another limitation is that lifestyle behaviours may change over time. Students’ dietary practices, physical activity, sleep and other behaviours may differ during examination periods, holidays and regular academic sessions. Consequently, findings obtained during the study period may not capture every variation in students’ behaviour.

Finally, the study will be limited to students of Lagos State University, Ojo. Therefore, the findings may not be generalised automatically to all university students in Lagos State or Nigeria because institutions differ in their student populations, resources, policies and health-promotion environments.

1.9 Operational Definition of Terms

Health Education: A planned process of providing individuals with knowledge, skills, attitudes and motivation that enable them to make informed decisions and adopt behaviours that promote and protect health.

Health Education Intervention: A structured programme of health education activities designed to improve students’ knowledge, attitudes, skills and behaviours concerning the prevention of lifestyle-related health risks.

Lifestyle: The pattern of behaviours, habits and choices through which an individual conducts everyday life, including eating, physical activity, sleep, substance use, stress management and health-seeking behaviour.

Lifestyle-Related Health Risks: Behaviours or conditions associated with an increased likelihood of disease or poor health, including unhealthy diet, physical inactivity, harmful alcohol use, tobacco use, excessive sedentary behaviour, inadequate sleep and poor stress-management practices.

Health Risk Prevention: Actions taken to reduce or eliminate exposure to factors that may cause disease or poor health.

Health Behaviour: An individual’s actions or practices that influence health, including dietary practices, physical activity, substance use, sleep and health-seeking behaviour.

University Students: Individuals formally enrolled in undergraduate programmes at Lagos State University, Ojo, who constitute the population of the study.

Health Promotion: The process of enabling individuals and communities to increase control over and improve their health through education, supportive environments, policies and other interventions.

Non-Communicable Diseases: Long-term diseases that are not primarily transmitted from person to person, including cardiovascular diseases, cancers, diabetes and chronic respiratory diseases.

Lagos State University, Ojo: A public university owned by the Lagos State Government and located in Ojo, Lagos State, Nigeria, which serves as the study setting.

1.10 Organisation of the Study

The study will be organised into five chapters.

Chapter One presents the introduction, background to the study, statement of the problem, purpose of the study, research questions, research hypothesis, significance of the study, scope, limitations and operational definitions of terms.

Chapter Two will review relevant literature on health education, health promotion, lifestyle-related health risks, health behaviour, non-communicable disease prevention and health education interventions among university students. The chapter will include the conceptual review, theoretical framework, empirical review, identified gap in literature and summary.

Chapter Three will present the methodology adopted for the study. It will discuss the research design, study area, population of the study, sample size, sampling technique, research instrument, validity and reliability of the instrument, procedure for data collection and method of data analysis.

Chapter Four will present, analyse and interpret the data collected from the respondents. The analysis will be organised according to the research questions and the research hypothesis.

Chapter Five will present the summary of the findings, conclusion and recommendations. Suggestions for further studies will also be provided.

Project – Health Education Intervention and Prevention of Lifestyle-Related Health Risks among University Students: A Study of Students of Lagos State University, Ojo