ABSTRACT Health risk behaviour contributes markedly to today’s major killers. A descriptive cross- sectional study was conducted to assess current awareness and practice of health risk behaviour among Egyptian university students. Only 121 students (18%) were practising risky behaviour. Tobacco use, alcohol and drugs use and risky sexual behaviour were positively correlated. Multiple regression analysis revealed that the main determinants of risky behaviour were being a male, of older age, having a high allowance and having no attention to danger. About 30% of students lacked adequate knowledge on AIDS. Most of those who had sexual relationships did not use contraceptives or any method of protection from sexually transmitted infection. Main sources of knowledge were the media (38%) then peers (30%).

RESUME Les comportements à risque pour la santé contribuent sensiblement aux causes principales de décès actuelles. Une étude transversale descriptive a été réalisée pour évaluer la connaissance et la pratique actuelles des comportements à risque pour la santé chez les étudiants égyptiens. Seuls 121 étudiants (18 %) avaient un comportement à risque. La consommation de tabac, d’alcool et de drogues et le comportement sexuel à risque étaient corrélés positivement. L’analyse de régression multiple a révélé que les principaux déterminants des comportements à risque étaient le fait d’être un garçon, d’être plus âgé, d’avoir une allocation d’études élevée et de ne porter aucune attention au danger. Environ 30 % des étudiants n’avaient pas les connaissances suffisantes sur le SIDA. La plupart de ceux qui avaient des relations sexuelles n’utilisaient pas de contraceptifs ou d’autres moyens de protection contre les infections sexuellement transmissibles. Les médias (38 %) et les pairs (30 %) constituaient les principales sources de connaissances.

Today, the health of young people—and the adults they will become—is critically linked to the health-related behaviour they choose to adopt.

Young adults aged 15–24 constituted about 20% of the Egyptian population in 2000 [1], and university students, whose health and productivity are determined by their current behaviour, are the future highly educated work force. This study aims to evaluate the awareness and practice of health risk behaviour among Egyptian university students, focusing on the use of tobacco, alcohol and drugs and unsafe sexual practices.

Surveys among youth and young adults (10–24 years) in the United States of America during 1991–1999 show the trends for health risk behaviour. The improved behaviour types included sexual practices. On the other hand, tobacco, alcohol and drug use worsened [2].

Kann et al. showed that 35% of high school students in the United States of America had smoked cigarettes during the 30 days preceding the survey [3].

In the Middle East region, however, studies have given a different picture. In Egypt, a study done on students at Suez Canal University found that prevalence of current smoking was much lower, 12.7% in general, and commoner in males and those of older age. Most smokers lived in urban areas, lived with smokers, and used their pocket money to buy cigarettes [4]. About one third smoked the water pipe too. A study done in Syria reported the prevalence of current smoking among high school adolescents to be 16% for boys and 7% for girls. Smoking was strongly associated with parental and sibling smoking; high school students from families with parents and/or siblings who smoked were 4.4 times more likely to be current smokers than those from non-smoking families [5]. In a Turkish study there was evidence for the effects of school type, a smoking- related attitude, presence of a stepmother, father’s use of alcohol, sister and brother who smoke, student’s alcohol use, and participation in art activities as determinants of smoking among middle and high school students in Ankara [6].

A descriptive cross-sectional study was carried out on students at Suez Canal University main campus in Ismailia. The schools were stratified according to type of study: health, mathematical, scientific and human studies. One school was randomly selected from each study type. For the purposes of future intervention, students were randomly allocated from student lists of the first and second years of the 4 selected schools: medicine, computer and informatics, agriculture and education.

A questionnaire was designed, adapted from the questionnaire of the Centers for Disease Control and Prevention 1999 risk behaviour survey [7] with cultural modifications. Questions were added regarding source of knowledge and awareness of the danger of any of the types of risky behaviour. Awareness of the dangers of each practice was indicated on a 5-point scale (0–4), where 0 indicated not at all and 4 indicated strongly aware.

The questionnaire was tested on 87 volunteer students to check its validity and to estimate the sample size. Necessary changes were made after testing.

There were 30 063 students enrolled for the academic year. The sample size at 95% CI, was estimated using Epi-Info (version 6.4d) to be 655 students (721 students adjusting for drop-out of 10%). Questionnaires were printed, enveloped and distributed via the junior faculty and students’ affairs staff of the selected schools according to their weighting: 180 for medicine, 240 for agriculture, 250 for education and 51 for computers and informatics.

Epi-Info was used primarily for data entry. Data was analysed using SPSS, version 9.0. Sociodemographic characteristics were described. Risky behaviour in each domain was identified as the following:

The different types of behaviour were analysed in relation to the students’ sociodemographic characteristics, attention to risky behaviour and source of information using test of significance and odds ratio. A new variable was computed from practice of risky behaviour and examined by multiple regression analysis to identify its determinants.

As the study deals with young adults, certain ethical steps were implemented:

Of the 721 questionnaires sent out, 687 were returned (95% response rate), 172 (25.0%) from the school of medicine, 48 (7.0%) from informatics, 237 (34.5%) from education and 230 (33.9%) from agriculture.

The median age of the students was 18 years; 59.0% were female, 71.0% urban residents and 98.8% never married. There were 3 formally married female students, while 5 male students stated that they were orfi married (not officially registered). Many of the students’ parents were educated up to university degree level (50.6 % of fathers and 34.5% of mothers) while only 12.1% of fathers and 25.7% of mothers were uneducated. The median monthly allowance was 90 Egyptian pounds (mode 100 Egyptian pounds) and 121 students (17.7%) were working in addition to their study (Table 1).

The majority (58.0%) of students had a moderate awareness of the dangers of risky health behaviour while 25.9% had no awareness at all. The main source of information was the media (37.5%) followed by friends (29.8%).

Alcohol was ever tried by 14.4% of students questioned, median age 17 years for first use. Currently only 4.1% were drinking alcohol, mode 1 time in the previous month. Awareness of the dangers was very high.

Health risk behaviour, which can be a contributing factor in the leading causes of mortality and morbidity among youth and adults [3], is often established during youth and extends into adulthood. The different types of behaviour are interrelated and are preventable. These include tobacco use, alcohol and other drug use, and risky sexual behaviour that can result in unintended pregnancy and STI, including HIV.

Two thirds of all deaths among persons aged > 25 years result from only 2 causes—cardiovascular disease and cancer. The commonest type of risk behaviour associated with these 2 causes of death is linked to tobacco use, which is initiated during adolescence [3]. The results of the present study confirm the results of a previous study [4] and show that tobacco users were mostly male, older in age, working or with high allowance, paying no attention to risks and highly influenced by peers and the media. The cigarette smoking rate has been stable since that study over all years, however, prevalence of smoking of water pipes increased dramatically (72% of smokers in the current study compared with 30% in the previous one). This is probably a reflection of the new trend among the youth in Egypt for smoking water pipes in cafés. Despite the banning of cigarette advertising in the Egyptian media, the depiction of water pipe smokers is widespread in TV serials and movies and is associated with pleasure. In addition, advertisements for water pipe tobacco products are common on Arab satellite channels. The effect of this habit on pulmonary function in comparison to cigarette smokers and non-smokers was investigated [8] and the results showed that the detrimental effects of water pipe smoking are not as great as those of cigarette smoking; lung function parameters were higher in water pipe smokers, especially the parameters for small airways. Water pipe smoking, however, has adverse effects on general health; it may predispose to oral cancer and is associated with a statistically increased incidence of squamous cell carcinoma and keratoacanthoma of the lips. [9]

Intensive and sustained efforts to counter-market tobacco among youth are necessary to negate the “friendly familiarity” created by tobacco advertising and to communicate the true health and social costs of tobacco use [10].

Although the main risky behaviour of the students in this study was tobacco use, 4% of them practise unsafe sex risky behaviour and 5% practise substance use. As they get their knowledge mainly from media that project drug use and extra-marital sex as not culturally accepted, they were highly aware of their risks and minimally practising them.

In addition, 18.2% of the students in the study had ever sniffed substances such as petrol products, paints and sprays. Petrol sniffing as a specific form of substance abuse is associated with dysfunctions that range in severity from subtle cognitive impairment to encephalopathy and death. Petrol sniffing causes a progressive decline of cognitive function that eventually leads to permanent neurological changes 11].

Only 70% of the subjects had enough knowledge on AIDS. Most of those who had sexual relationships did not use any method for protection from STI nor did they use contraceptives. Friends, the social culture at university, and the interaction of the two with the developmental characteristics of the period between adolescence and adulthood are more important influences on sexual relationships than parents or high-school sex education classes. How and whether friends talked about sex and practised safe sex were strong normative influences in predicting safer sex among individuals [12]. Adolescents have not changed their behaviour in response to the pandemic, despite being well informed about HIV/AIDS and having positive attitudes toward HIV/AIDS prevention [13]. Those AIDS-prevention programmes which, rather than merely providing information, focus on helping youths perceive HIV as a problem, motivating them to act safely and implement safe acts have successfully reduced adolescents’ risk acts.

The majority of the students in this study got their information on AIDS and sex from friends and the media. The mass media in Egypt does not offer enough information on AIDS. In a previous study it was found that only 7% of female and 62% of male medical students approved doing tests for the detection of AIDS, reflecting cultural sensitivity (A. Refaat. Knowledge and attitude of medical students towards premarital examination program. Paper presented at the 1st international conference of behavioural medicine, Cairo, Egypt, November 1994).

The present study showed the 3 types of risky behaviour were correlated and that students started them before university age and in sequence: smoking at age 15, sex at 16 then alcohol and drugs at age 17. In the United States of America also, it was found that adolescents engage in multiple health-risk behaviour according to age and that many adolescents engage in these kinds of behaviour serially rather than at the same time [14].

Less than one fifth of the students in this study practise risky behaviour, mainly as tobacco use. They paid moderate attention to risky behaviour, and got their information from the media and peers. The study revealed certain types of risky health behaviour that are not usually stressed in health communication programmes, such as smoking of water pipes, sniffing of petroleum products and lack of information on AIDS.

Based on the results of this study, it is recommended that a health communication programme be designed targeting Egyptian youth and adolescents that addresses all the types of risky behaviour identified. Counter-marketing campaigns should highlight a tobacco-free lifestyle as the majority lifestyle of diverse and interesting individuals.

I would like to thank Suez Canal University Vice President for Education and the deans and vice deans of the faculties included in this study for their kind support. I appreciate the help of the junior faculty, employees of students’ affairs and all the students who shared in the study.

14. Brener ND, Collins JL. Co-occurrence of health-risk behaviour among adolescents in the United States. Journal of adolescent health, 1998, 22(3):209–13.