Priority Health Behaviors among South African Undergraduate Students.

Introduction The global prevalence of chronic diseases has increased dramatically over recent years, causing approximately 60% of the 56.5 million reported deaths globally each year. (1) The total number of people dying from chronic diseases worldwide is double that of all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined. (2) An estimated 80% of all chronic disease-related deaths occurs in low or middle income countries and chronic diseases associated with unhealthy behaviors (i.e., unhealthy diets, caloric excess, inactivity, and obesity) are now the greatest public health problem in most countries of the world. (3) Without research and prevention efforts to address risk behaviors, global deaths caused by chronic diseases are expected to rise to 73% by 2020. (4) Numerous studies conducted in the United States have demonstrated that the leading causes of death, such as heart disease and cancer, are largely caused by a relatively small number of preventable behaviors. These behaviors (such as smoking cigarettes, drinking alcohol and sedentary lifestyle) identified by the Centers for Disease Control and Prevention (CDC) are often interconnected, started during adolescence, and continued into adulthood. (5,6,7) While AIDS continues to be the leading cause of death in South Africa, deaths from chronic diseases, such as stroke and heart disease, remain a major public health issue. (8) It is believed that the chronic disease epidemic is emerging in developing countries. (9) Similar patterns of risk behaviors that contribute to chronic diseases, such as diet and physical inactivity, have also been observed in developing countries. Choi, Bonita, and McQueen (10) suggested that chronic diseases are sometimes communicable at risk factor levels because the patterns of risk behavior practices travel across countries, resulting in transmission from one population to another and affecting disease patterns worldwide. (11) This phenomenon is a result of globalization which is marked by increased migration of populations, particularly to urban communities, as well as a significant increase in the transportation of goods and services. The result is an exposure to new risk factors and changes in behavior which may lead to chronic disease. WHO has claimed that chronic diseases associated with unhealthy behaviors (i.e., unhealthy diets, caloric excess, inactivity, and obesity) are now the greatest public health problem in most developed as well as developing countries. (3) In South Africa, diseases that are primarily caused by unhealthy behaviors such as cardiovascular disease, injuries (unintentional and intentional), cancers, chronic obstructive lung diseases, and diabetes are the primary causes of mortality after HIV/AIDS. (8) Surveys revealed that, among South African adults aged 18 to 69 years, nearly half (44.9%) are physically inactive and over two-thirds (70.6%) consume fewer than five servings of fruits and vegetables everyday. (11) The high rates of physical inactivity and low rates of adequate fruit and vegetable consumption, together with poor environmental conditions (e.g., lack of facilities, high crime rates) and the belief that a heavier body weight is a sign of well-being (12,13,14) have contributed to the high rates of obesity and overweight (45%), especially among female adults (56.2%),15 rural adults (51.7%) and rural female adults (58.7%). 16 It is often the case that thin women are the subject of ridicule and gossip, further perpetuating poor dietary practices and lack of adequate physical activity among this population. As a result, chronic diseases associated with obesity such as diabetes, high blood pressure, and coronary heart disease are increasingly more prevalent among all population groups in South Africa. (17,18) Recent studies have revealed serious problems of alcohol, tobacco, and other drug use among various groups of South Africans with varying results. …