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The transition from high school to college is known to be associated with changes in lifestyle and dietary habits. These changes are often negative and characterized by poor dietary choices, increased alcohol consumption, and decreased physical activity. These phenomena led us to study the dietary habits and lifestyle factors that can impact the health of freshmen students at Emory university. A questionnaire regarding lifestyle and dietary habits was created and administered to first year students (n=125). Our findings suggest that Emory freshmen appear to be largely healthy based upon their Body Mass Index (BMI) and dietary habits. However, from our questionnaire we found several factors that may impact the future health of Emory freshmen. In the transition from high school to college, athletic participation decreased dramatically across most demographic groups. In addition, alcohol consumption among caucasian college students was remarkably high. These trends may be a result of the high school to college transition. In addition to the initial transition, students will continue to experience new challenges and environments through each of their college years and may adopt different lifestyle and dietary habits later on. The habits developed in college can carry on into adulthood and will influence their health. Future studies are recommended to confirm our findings and to further investigate the change in students’ lifestyle and dietary choices in their following years at Emory.

The Health of Emory college Freshmen: Lifestyle Factors and Dietary Habits

Akhil Sood, Roger Tieu, chiu Kenny Tsui

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IntroductionObesity has been and is a growing problem in the United States. Ac cording to the National Health and Nutrition Examination Survey (NHANES), about two-thirds of all Americans are overweight or obese (Ogden 2012). Ac cording to the Behavioral Risk Factor Surveillance System, approximately 42% of young adults aged 18-24 years, including those who are college-educated, were overweight or obese (Gropper 2009). From 1991 to 1998, individuals with a college degree experienced the greatest increase in the prevalence of obesity which was 62% (Mokdad 1999). The prevalence of obesity throughout the entire population is a troubling development. Obesity is a chronic disease that increases the risk for many other diseases including diabetes and cardiovascular disease. Thus, failure to address the issue of obesity often leads to negative health outcomes, including lower quality of life and premature death. Obesity has been shown to lower life expectancy by 5 to 20 years (Olshansky 2005).

Popular media has suggested that the average college student gains around 15 pounds in their first year (Freedman 2010). This is more commonly known as the “Freshman Fifteen”. However, recent studies suggest that the freshman fifteen is a misconception. A study conducted by Dr. Jay Zagorsky used statistical analysis of a nationally representative random sample of college freshmen to test the validity of the “Freshman Fifteen” (Zagorsky 2011). The authors found that most students gain only 2.5 to 3.5 pounds on average during their first year of college. Despite this, the slightest weight gain beginning in early college years can lead to future health problems (Freedman 2010).

For most students the freshman year of college is a year of transition. First year students have to cope with a new environment and many new challenges (Freeman 2007). These changes have the potential to impact a student’s lifestyle choices and dietary habits. There are three significant characteristics found at most college campuses that could potentially lead to weight gain: buffet style cafeterias, readily available alcohol, and time-consuming academic work. In addition, there are also other factors that include athletic participation, meal frequency, and metabolic rate.An increase in body fat can result from excessive caloric intake, alcohol consumption, and lack of exercise. A pound of fat contains approximately 3500 Calories (Leischow 1991). An additional 100 Calories a day over 35 days can lead to gaining one pound of weight. As long as this intake of Calories is maintained an individual will gain about ten pounds every year. The cumulative effect of this weight gain can lead to obesity and other negative health outcomes. Going from home-style meals to buffet style meals allows college freshmen ac cess to unlimited portion sizes. A substantial increase of calories combined with poor food choices will result in weight gain.

Alcohol consumption is another critical factor for weight gain. Not only does alcohol offer little nutritional benefit, but it is also energy dense for a liquid at 7 calories per gram (Lieber 1991). A 12 ounce can of regular beer has approximately 150 calories, while a 1.5 ounce “shot” of distilled liquor has 100 calories (Bui 2008). Alcohol also affects fat metabolism due to the fact that the liver metabolizes fats and alcohol (Maher 1997). Under normal

circumstances, the liver metabolizes fats. However, when alcohol is ingested, the liver significantly slows down its fat metabolism to eliminate alcohol and its toxic byproducts from the blood (Zakhari 2006). As a result, the decrease in fat metabolism and increase in liquid calories can lead to ac cumulation of fat.

Lack of exercise may also lead to weight gain. Exercise stimulates metabolism because energy is needed to fuel the intentional movement of muscles. Energy is obtained by metabolizing stored carbohydrates and fats (Ricquier 2006). Energy is utilized during the exercise and post-exercise period. The post-exercise period is when the body repairs micro-tears in the muscle that are a result of physical activity (Kumar 2009). Regular exercise coupled with proper dieting is essential in maintaining a healthy weight and reducing the risk of obesity and cardiovascular disease (Haberman 1998).These three primary factors for weight gain tend to oc cur together in times of stress such as the transition from high school to college (Anderson 2003). The transition results in dietary and lifestyle changes which have significant influence on health and weight later on in life. Therefore it is critical to study the dietary habits and lifestyle changes in college freshmen and to assess if these choices are healthy or unhealthy. It was hypothesized that Emory University freshman are unhealthy due to poor lifestyle and dietary habits as a result of this transition. Various factors including nutrient intake, meal size and frequency, physical activity, and lifestyles were examined.

Method

The research study began in the fall of 2011 as part of the freshman research seminar ORDER (On Recent Discoveries by Emory Researchers). Over the course of three days, 125 participants filled out a survey voluntarily. All participants were college freshmen randomly selected from six residential complexes and four health classes. The first dataset was collected on Saturday, October 22nd at Longstreet Means Hall from 28 participants. The second set of data, consisting of 97 participants, was collected from four Health 100 classes at Emory University on Monday, October 24th, and Tuesday, October 25th with permission from the Emory University Center for the Study of Human Health and the peer health partners of the respective classes.

For the first set of data, we went door to door at the Longstreet Means Residence Hall on Saturday, October 22nd. We asked freshman residents if they were interested in completing our survey. The participants were notified that we were part of the freshman research seminar ORDER and that we were conducting a research project on the dietary habits and lifestyle changes of college freshman. The completed surveys were collected at the end of the day.

For the second set of data, we were given permission from the Emory University Center for the Study of Human Health and peer health partners to distribute surveys in our respective Health 100 classes and one additional Health 100 class of our choosing. We informed the class that the survey was for our seminar and that it was completely voluntary. Participant anonymity was strictly maintained in all cases.

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Some of the questions we used in our survey were derived from two surveys conducted prior to our own (Levitsky 2003, Silliman 2004). The survey used in our research can be found in the Appendix.

We calculated the BMI (Body Mass Index) of each participant based on his or her self-reported height and weight. The CDC standard formula (seen below) was used to calculate BMI (“About BMI for Adults”).

Furthermore, each individual was then categorized into one of four weight status categories based on his or her calculated BMI. As defined by CDC standards, an individual was: Underweight (BMI<18.5), Normal (18.5<BMI<24.9), Overweight (25.0<BMI<29.9), or Obese (BMI>30.0).

The research study continued into the spring of 2012. Over the course of two weeks, we recorded the food selection of freshman at the DUC (Dobbs University Center). With only two exits leaving the DUC serving area, we had two teams of two individuals sitting at a table near each exit. One individual served as the observer and the other as the data collector. Data was collected using Microsoft Excel Spreadsheets. Each observation session lasted for one hour during dinner (approximately 5:30-6:30PM). Dinner time was chosen because it had the highest frequency of participation (Figure 8). The information collected from these sessions was then compiled into a data chart illustrating the general eating habits of freshman.

ResultsFIGURE 1. Weight status breakdown among participating Emory freshmen ac cording to CDC classifications.

Figure 1 illustrates the weight status of 121 participants who had a valid calculated BMI as based on Center for Disease Control and Prevention classifications (“About BMI for Adults.”). The majority of participants had a “normal” BMI.

FIGURE 2. Vegetable and fruit intake frequency of Emory freshmen.

Figure 2 depicts the vegetable and fruit intake frequency of participating college freshmen. Approximately 81% of participants reported to “usually” eat fruits or vegetables.

FIGURE 3. Past high school sports activity and current sports activity level of Emory freshmen based on sex.

Figure 3 depicts the proportion of college freshmen who used to play high school sports and those who currently play Emory sports based on sex. Within each sex, there was a decrease in athletic participation in the transition from high school to college. However, female participants experienced a greater decline in athletic participation than their male counterparts after the transition.

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FIGURE 4. Past high school sports activity and current sports activity level of Emory freshmen based on ethnicity.

Figure 4 depicts the proportion of college freshmen who used to play high school sports and who currently play Emory sports (club, novice, and varsity sports) based on ethnicity. Within each ethnicity, there was a decrease in athletic participation in the transition from high school to college. However, Asian/Pacific Islander participants experienced a greater decline in athletic participation than their Caucasian counterparts after the transition. Black/African-American and Hispanic/Latino participants were surveyed. However, the number of participants for Blacks/African-Americans and Hispanics/Latinos were extremely low in comparison to the number of participants for Caucasians and Asians.

FIGURE 5. Exercise frequency of Emory freshmen based on ethnicity with respect to the number of sessions per week.

Figure 5 depicts the proportion of Emory freshmen who exercised based on ethnicity. Caucasians had a higher proportion of participants who exercise 5 or more times a week than Asians/Pacific Islanders.

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FIGURE 6. Alcohol consumption of Emory freshmen based on ethnicity with respect to the average number of servings per week.

Figure 6 depicts the proportion of college freshmen who consume alcohol based on ethnicity. A significantly higher proportion of Caucasian respondents consumed 8 or more drinks per week than their Asian classmates.

FIGURE 7. The BMI distribution of Emory freshmen who played high school sports and who currently play Emory sports.

Figure 7 depicts the BMI distribution of college freshmen who used to play high school sports and who currently play Emory sports. Those currently playing sports or who used to play sports had a higher overall average BMI than those currently not playing sports or who used to not play sports.

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FIGURE 8. Meal frequency of Emory freshmen.

Figure 8 depicts the meal frequency of participating college freshmen. There was variance in frequency of breakfast consumption. A majority of the participants reported usually or always eating lunch and dinner.

DiscussionThere are many challenges for first year college students when entering a new environment. Coping with these challenges is of great concern for college students (Freeman 2007). These new challenges can lead to changes in dietary habits. This can in turn put individuals at risk of weight gain and may lead to obesity or other chronic diseases in the future (Racette 2005).

Our research examined the lifestyles and dietary habits of freshmen at Emory University. This population has faced significant changes in lifestyle as a result of their transition from high school to college. We had hypothesized that as a result of their transition into a new environment, the respondents would overall be unhealthy with a set of poor lifestyle choices and dietary habits. However, upon completion of data analysis, we found that this was not the case. Analysis of the data suggests that Emory University freshmen are largely healthy based on their normal BMI classification and adequate vegetable and fruit intake. However, a number of freshmen do engage in unhealthy behaviors such as frequent alcohol consumption and infrequent exercise.

The majority of the participating Emory University freshmen have a normal BMI. Out of the 125 participants, 95 have a normal BMI (Figure 1). Only 2 of the 125 participants were obese. Ac cording to Nelson’s study, 23% of freshmen in the US were overweight compared to the 11% of freshmen representing Emory (Nelson 2007). An explanation for this observation is that Emory is known to be healthier than other college campuses due to the availability of healthy low fat food in the DUC, exercise facilities, and the nutrition awareness initiative. These three factors may contribute to the lower than national average BMI observed for Emory freshmen.

The socioeconomic status of incoming freshmen is also a factor likely to affect the normal BMI status among Emory freshman. Research has suggested that there is an inverse relationship between socioeconomic status and weight gain in adulthood (Ball 2005). This may be due to better ac cess to medical care, exercise facilities, healthy foods, and early education in healthy lifestyles (Kawachi 1997). Thus it is possible that many of the incoming freshmen are from families of high socioeconomic status and have established healthy behaviors in the transition to college. However, not enough time has elapsed for the negative effects of poor lifestyle and dietary habits to become physically apparent.

Self-reported food intake frequencies suggest Emory University freshmen usually eat vegetables and fruit. Out of the 125 participants, 101 usually eat vegetables and/or fruit (Figure 2). Research shows daily consumption of vegetables and fruit are a source of antioxidants and fiber, which reduce the risk of chronic diseases such as obesity and cardiovascular disease (Van Duyn 2000). Vegetables and fruit also play a role in weight management by being low-energy nutrient-dense foods (Ledikwe 2006). Based on these properties, vegetables and fruit may help Emory freshmen maintain a healthy diet and body weight.

With regards to sex and athletic participation, a decrease in participation was seen in both sexes after transitioning from high school to college (Figure 3). However, there was a greater decline in the athletic participation of females than males. For males, there was a 28% decrease in athletic participation after transitioning from high school to college, whereas for females, there was a 52% decrease. The result was 60% of males and 32% of females participate in athletics at Emory. However, females also

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had less athletic participation in high school than males. Of the females, 30% did not participate in high school athletics compared to 16% of males. Krane previously noted that western culture places an emphasis on feminine qualities in females (passiveness and slenderness) that typically contrast with athletic qualities (aggressiveness and bulk) (Krane 2004). Therefore, sportswomen face the challenge of dealing with two conflicting values and this conflict may discourage potential female athletes. This conflict may become even more evident as females transition from high school to college since they are now given the opportunity to opt out of athletics. This observation may also be explained by the growing female desire for academic achievement (Buchmann 2006). Some may engage in athletics in order to be admitted into college, and then cease athletic participation.

There was also a decrease in athletic participation among ethnic groups (Figure 4). Asians/Pacific Islanders experienced a 36% decline, while Caucasians experienced a 51% decline. With respect to ethnicity, Asians/Pacific Islanders have a higher proportion of individuals who are not involved in athletic participation both in high school and at Emory, when compared to Caucasians. Of the Caucasian participants, 19% did not participate in high school athletics and 50% did not participate in Emory athletics. Of the Asian/Pacific Islander participants, 30% did not participate in high school athletics and 66% did not participate in Emory athletics. Also, Caucasians exercise more frequently than Asians/Pacific Islanders (Figure 5). Among Caucasians, 34% reported exercising 5 or more times a week compared to 9% of Asians/Pacific Islanders. These observations may be explained by research suggesting that moving from a rural region to an urban region increases sedentary behavior (Kandula 2005). Kandula previously noted that Asians experience decreased levels of physical activity as a result of this transition. As the duration of residence for Asian American immigrants in the US increases, physical activity tends to decrease.

It was found that Asians/Pacific Islanders had lower alcohol consumption than Caucasians (Figure 6). Among Asians/Pacific Islanders, there were no individuals who consumed 15 or more drinks on a weekly basis. This supports research that Asian-Americans consume less alcohol (Caetano 1998). The emphasis on harmony and responsibility in Chinese and Japanese cultures may help reinforce alcohol abstention. Differences in upbringing among Caucasians and Asian/Pacific families are also likely reasons for differences in alcohol consumption between the two ethnic groups (Inman 2007). Additionally, many of the Muslim students in Emory’s freshmen class, who typically abstain from alcohol for religious reasons, may have self-reported as being “Asian/Pacific Islander”.

The data suggest that short-term significant alcohol consumption has minor weight gain consequences as shown by the majority of freshmen having a normal BMI. However, the same cannot be said for the long-term. Research has shown that excessive alcohol consumption over a long period of time can significantly damage nearly every organ in the body (Cook 1998). Moreover, excessive alcohol consumption increases the likelihood of weight gain and can lead to poor decisions (Schroder 2007, Wechsler 2006).

It was also observed that those who used to play high school sports or currently play Emory sports generally have a higher BMI (Figure 7). This correlates with Kumar’s study showing that exercise can promote muscle growth therefore increasing muscle mass (Kumar 2009). Since athletes exercise, they should have increased amounts of muscle mass compared to their non-athlete counterparts, which should result in a higher BMI among athletes than that of non-athletes.

conclusionIt was hypothesized that Emory University freshmen are unhealthy due to poor lifestyle and dietary habits as a result of the transition into a new environment. However, based on their normal BMI classification and adequate vegetable and fruit intake, the analysis of the data suggests Emory freshmen appear to be healthy.

There were several limitations in our study that need to be addressed. There was the possibility the participants did not answer the survey truthfully. We also noted that not all participants answered their surveys completely. Blacks/African-Americans and Hispanics/Latinos were underrepresented in our study, thus no conclusions can be drawn for those groups.

For future studies, we suggest a larger number of surveyed participants. This would increase the ac curacy of the data patterns by having a more representative portion of the Emory freshmen population. Future studies should also consider measuring height and weight of each participant instead of using self-reported height and weight. Furthermore, additional factors such as body fat measurements should be used to provide an additional view on the participants’ health. As we have shown with athletes having a higher average BMI than non-athletes, BMI is not the best indicator of health (Figure 7). BMI does not fully ac count for differences in muscle mass among those who exercise regularly and those who do not (Rothman 2008). Number of servings per food group, including vegetables and fruit, need to be examined. Previous studies have also found that less sleep was associated with obesity (Capuc cio 2008). Amount of sleep among the participants should be measured in future studies. Socioeconomic status should also be measured as it has been shown to play a role in weight gain (Ball 2005).

A dynamic and transforming atmosphere characterizes the Emory University community. The student lifestyle undergoes a transformation as a result of the transition of a structured environment in high school to one of freedom and independence in college. It would be interesting to assess the changes in student lifestyles over all four years of college. We plan to conduct future studies on what factors have an influence on student lifestyles and dietary habits. We are also interested in finding ways to quantify nutrient intake among college students. Preliminary research has already been carried out in preparation for upcoming studies. We carried out a preliminary analysis of the food choices of freshmen at the Emory University Dobbs University Center (DUC). The data collected from the DUC suggest Emory freshmen have healthy eating habits based on vegetable and fruit intake frequency. We believe the DUC may play a role in keeping freshmen eating

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habits healthy since it provides easy ac cess to prepared healthy food. If this is so, students who begin to live off campus and not eat at the DUC may change to unhealthy eating habits by consuming processed foods. Processed foods are cheaper and more readily available than whole foods, but processed foods are also less nutritious (Monsivais 2010, Shahidi 2009). The DUC may be one of the major factors that impact student health. Future studies would provide valuable insight on factors that influence student lifestyles, as there is little research on upperclassmen.

AcknowledgementsWe would like to thank Professor David Lynn, our supervisor in the freshman research seminar ORDER (On Recent Discoveries by Emory Researchers). Also, we would like to thank Dr. Michelle Lampl and Dr. Jill Welkley at the Emory University Center for the Study of Human Health for giving us permission to give out surveys to the Health 100 classes. We would like to thank our friends, Sakib Alam, Adam Chan, Janelle Elysee, Bernard Scott, and Tony Xu for giving us helpful feedback and assisting in data collection. Finally, we would like to give a special thanks to Dr. Dennis Mishler, a postdoctoral fellow in the Chemistry department, for serving as our mentor for the research project and guiding us since the beginning of our project.

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Appendix

Akhil Sood is a sophomore at Emory College from Houston, Texas. He plans to major in Biology with a minor in Predictive Health. After college, Akhil plans to attend medical school and pursue a career as a physician-scientist. He plans to do both clinical work and research

Roger Tieu is a sophomore at Emory College majoring in biology and chemistry. After graduation, he plans on pursuing an MD and Ph.D, and carry out biomedical research in experimental immunology. His hometown is Rochester, New York.

Kenny Tsui is a sophomore in the college from Philadelphia, PA. Currently majoring in Applied Mathematics, he also plans to participate in the dual degree program at the Georgia Institute of Technology for a degree in Biomedical Engineering after his time at Emory. After undergraduate at Emory and GA Tech, he plans to apply to a MD-PhD program and pursue a career researching biotechnology.