Roslinda Isa*, Noor Adni Mohd Adam , Siti Anissha Ahmad Subari, Siti Suraya Nordin, Rosuzeita Fauzi
Universiti Teknologi MARA, Selangor, Shah Alam 40450, Malaysia
*Corresponding Author’s Email: roslindaisa@uitm.edu.my
Keywords: Fast Food; Food Access; Consumption Behavior; Body Mass Index
Malaysia is undergoing a rapid process of modernisation. Through the 9th Malaysia plan, the government has taken the initiative to promote and encourage Western fast-food franchises, as one of many efforts to boost the country's economy (Abdullah et al., 2017). Ali & Abdullah (2012), state that the new living environment and changes of lifestyles have resulted in a new arrangement in eating, which was not the case two decades ago. As a result of lifestyle changes in metropolitan cities, the habit of fast food consumption has developed (Abdullah et al., 2017).
Habib et al. (2011) reported that 84% of Malaysian students' consumed fast food. Gan et al., 2011), found that university students are often unable to meet the recommended nutrient intakes. Snacking habits of high fat and calorie foods, tending to skip breakfast and they consume lots of fast food regularly. Bipasha & Goon (2014) also reported that university students, in particular tend to have a high frequency of eating out and were likely to pick fast food when they eat out.
Alizadeh & Ghabili (2008), showed students tended to skip their meals, especially breakfast and frequently consumed fast food. Gan et al., (2011), reported that many students frequently skipped breakfast skipped at least one meal daily. Javaid & Munir (2018) found that students who skip breakfast showed disruptive and distracting behaviour in the classroom.
Driskell et al., (2006) and Gan et al., (2011) reported that university students tend to eat fast food at least once weekly. Living in college also restrict students from cooking, thus increase the frequency of them ordering food online given the fact that fast foods usually quick and always ready-to-go, many students opted for fast food rather than nutritious food. Student dietary intake changed during college years resulting in increased consumption of fast food (Alfawaz, 2012; Fraser et al.,2010).
Excessive consumption of fast food is often associated with increased risk of non- communicable diseases, including diabetes and hypertension. Fast food is typically high in fat, sodium, and sugar but low in fibre and deficient in essential micronutrients (Cheong et al., 2019). Moreover, fast food tends to be consumed in large amounts and accompanied by carbonated beverages that may result in excessive calorie intake and afterwards increase the risk of overweight and obesity (Cheong et al., 2019). Radzi et al., (2019) found that obesity is associated with a higher risk of developing cardiovascular disease, metabolic syndrome and type II diabetes. The high amount of fat in fast food and lack of physical activities can rise to unhealthy and excessive weight (Abdullah et al., 2015).
Over-nutrition can lead to overweight and obesity (WHO, 2012). Based on the National Health and Morbidity Survey, (2015) classifications, the national prevalence of overweight was 33.4%, and the prevalence of obesity was 30.6%. Thus, this study was done to identify food access and fast-food consumption behaviour among Health Sciences students at UiTM Puncak Alam.
Study Design
A cross-sectional design was use in this study.
Study Location
This study was conducted at the Faculty of Health Sciences in UiTM Selangor Puncak Alam Campus at BandarPuncak Alam, Selangor.
Sample
Non-random probability sampling design which is used in this study is purposive convenience sampling. The inclusion criteria were Year 2 and Year 3 full-time degree students from Faculty of Health Sciences. Exclusion criteria students who were among first and fourth-year full time and part time degree, diploma and non-health science students and in medical or study leave.
Sample Size Calculation
A sample size was calculated from the population of 868 Year 2 and Year 3 full-time degree students by using formula (Krejcie & Morgan, 1970) and considered adequate based on “rule of thumb” with 5% margin of error, 95% confidence interval (CI), 50% population proportion and 868 of the population size. Finally, the sample required for this study was 267.
Instrument
The questionnaire was adapted from the research of Fast Food Consumption and Obesity (Abdullah et al., 2015). The questionnaires consisted of three parts, which were part A on demographic data, part B on food access and part C on fast food consumption. Part A consisted of seven items which were gender, year of study, course programs, weight, height, Body Mass Index (BMI) and transportation problems of respondents. Part B was food access questionnaire which consists of 7 questions. Question 1, 2, 4 and 5 used multiple-choice questions by choosing only one answer appropriately. For question 3, respondents need to answer all questions by ticking in the provided table. Question 6 and 7 were using Likert scale questions. Part C was on fast food consumption behavior, consists of 14 questions regarding fast food consumption and the reason why students visit fast food restaurants. Question 1 to 13 were using dichotomous questions (Yes/No) while question 14 using Likert scale (usually, sometimes, never/rarely). Pilot study was done, and the Cronbach’s alpha was found to highly reliable (a: 0.754).
Data Collection
Data was collected once ethical approval from UiTM ethic committee, from December 2019 until February 2020. The researchers approached second and third-year health sciences students to answer questionnaires during their learning and lectures in faculty. The information about the objectives of the study was given. Then, informed consent and questionnaires had been given to respondents once they agree to participate. The time allocated for respondents to answer the questionnaires was around 15 to 20 minutes. Questionnaires were collected immediately after respondents finished answering.
Data Analysis
Statistical Packages the Social Sciences (SPSS) version 25 was used to analyse the data. Descriptive statistical analysis was used for determining results of demographic data. Descriptive analysis also used to identify food access and fast food consumption behaviour among Health Sciences students at UiTM Puncak Alam. Pearson Chi-Square was used to find the relationship between transportation problem with fast food consumption behaviour and relationship between fast food consumption behaviour with BMI.
Approval from the UiTM Ethic Committee was obtained on 3 Sept 2019 before the study started. Respondents were given written consent prior to the commencement of the study.
Demographic Data
Table 1 show that majority of the respondents were female students, 220 (82.5%). In term year of study, 167 (62.5%) students from third year and 100 (37.5%) students from second year. Majority of students 167 (62.5%) were having normal weight.
Characteristic Demographic | Frequencies | Percent (%) |
Gender | ||
Male Female | 47 220 | 17.6 82.4 |
Year of Study | ||
Year 2 Year 3 | 100 167 | 37.5 62.5 |
BMI | ||
Underweight Normal Overweight Obese | 38 167 53 9 | 14.2 62.5 19.9 3.4 |
Do you have Transportation Problems? | ||
Has problem No problems | 159 108 | 59.6 40.4 |
This study found that 115 (43.1%) of respondents were “taking 2 serves of vegetables every day”. However, 19 (7.1%) respondents who “don’t eat vegetables”. Second question was on “Serves of fruits you usually eat every day”, majority of respondents 172 (64.4%) reported that take “Less than 1 serve”. Question three was on “Choose places to shop for fresh fruits and vegetables” 115 (43.1%) of the respondents preferred to shop for fresh fruits and vegetables within their community. While 28 (10.5%) of the respondents “did not buy fresh fruits and vegetables”. Question four was on “Main reason does not buy fresh fruits and vegetables within community or neighbourhood” 49 (18.4%) of the respondents reported that those stores had poor quality fruits and vegetables. Meanwhile, 8(3%) of the respondents reported that “stores having poor quality service” and 8(3%) also reported that “students do not eat fruits and vegetables”.
Question five was “It is easy to find fresh fruits and vegetables within community or neighbourhood.” 120 (44.9%) agreed to the statement while 54 (20.0%) students were strongly agreed. For the last question “Often is transportation become a problem in getting fresh fruits and vegetables”, 79 (29.6%) of the respondents reported it happened “sometimes” while 37 (13.9%) of the respondents reported that transportation “always” become a problem.
First question was on “Frequency eating fast food”, majority of the respondents 148(55.4%) consumed fast food multiple times per month. Question two was on “Main reason why respondents prefer fast food”, 99 (37.1%) of respondents chose fast foods because it was convenient and 80 (31.0%) picked taste of the food as reason. Other than that, cost of the food 29 (10.9%), sociability 37 (13.9%) and fast food outlets conveniently located 22 (8.2%). Question three was on “Usual time eat fast food”, 83 (31.1%) respondents eat during dinner, while 76 (28.5%) respondents eat during lunch.
Question four was on “type of fast food preference”, majority of the respondents 148 (55.4%) preferred to have meal package that sold in fast food outlets. The rest of respondents picked individual item or ‘a la carte’ 60 (22.5%), different item from the various menu 56 (21.0%) and other type of order 3 (1.1%). Question five was on “order super-size” with majority of respondents 194 (72.7%) did not order the super-size menu, meanwhile 57 (21.3%) of the respondents would have super-size. Question six was question on “eat in the restaurant or take out” 133 (49.8%) of the respondents preferred to take-outs and 115 (43.1%) of the respondents prefer to dine-in. Question seven was on “Where do you usually eat your take-out” 100 (37.5%) eat at home, 23 (8.6%) of the respondents eat in the car and 10 (3.7%) choose other places. Question eight was “Go to fast food restaurant with?”, 95 (35.6%) of the respondents go with friends (10.5%) and 4 (1.5%) go alone. Question nine was on “Is the type of nutritional information available at the fast-food restaurants you usually go to?” majority of the respondents 147 (55.1%) reported present, while 64 (24.0%) of the respondents reported never noticed. Question ten was on “Ever read nutritional information” only 107 (40.1%) of the respondents read. Question 11 was on “Nutritional information help to decide” only 47 (17.6%) of the respondents’ reported “sometimes”. Question 12 was on “Likely to order healthy meals” majority of the respondents 143 (53.6%) reported “Somewhat likely”. Last question “Distance resident from fast food restaurant” majority of the respondents 186 (69.7%) reported that 0- 5km.
Table 2 showed the relationship between transportation problem and fast food consumption. The result showed that there was no significant relationship between transportation problems and frequency of fast food consumption as p-value >0.05 which p=0.080.
Variables | Transportation problem, N (%) | X²(df) | p value | |
Has problem | No problem | |||
Frequency of fast-food consumption | 5.050 (2) | *0.080 | ||
Per week | 25 (9.4%) | 29 (10.9%) | ||
Per month | 92 (34.5%) | 56 (21.0%) | ||
Less than once per month | 42 (15.7%) | 23 (8.6%) | ||
Total | 159 (59.6%) | 108 (40.4%) | ||
*chi square test
Table 3 showed there was no significant association between fast food consumption behaviour among Health Sciences students with BMI as p-value >0.05 which p=0.715.
Characteristics | BMI, N (%) | X2(df) | p-value | ||
Underweight | Normal | Overweight | |||
Frequency of visiting fast food restaurant: Per week Per month Less once than per month | 9 (3.4) 20 (7.5) 9 (3.4) | 34 (12.7) 96 (36.0) 37 (13.9) | 11 (4.1) 32 (12.0) 19 (7.1) | 2.106 (4) | *0.716 |
Total | 38 (14.2) | 167 (62.5) | 62 (23.2) | ||
*chi square test
The finding from this study showed that most of the respondents 115 (43.1%), consumed two servings of vegetables followed by 106 (39.7%) respondents who eat less than one serving every day. This showed that more than half of the respondents consumed less vegetables per day. This trend also could be seen in fruits consumption where 172 (64.4%) of respondents eat less than one serving per day. Similar with Gan et al., (2011), who reported that 143 (47.7%) universities students in Malaysia consumed only one serving of vegetable every day. Bernardo et al., (2017) also reported that the intake of vegetables and fruits among university students were rather low than the recommended serving per day. The World Health Organisation (WHO, 2005) recommended adults to consume at least 400 gm or equivalent to five servings of vegetables and fruits daily to reduce the risk of chronic diseases.
The main reason for not buying fresh fruits and vegetables for 49 (18.4%) respondents in this study were due to the poor quality of fruits and vegetables. On top of that, 39 (14.6%) respondents reported a high price as the second reason not to buy fresh vegetables and fruits. Since respondents in this study were university students, money problems can be the reason for respondents to not buy fruits. Similar with Pulz et al., (2017), statement that healthy food was expensive, and the access was difficult, making it hard for live a healthy lifestyle.
Access to sources of food, students may need a medium of transportation such as public bus, cars, and motorbike. Among 267 respondents, 79 (29.6%) of them reported that sometimes it was difficult to find transportations. Living in college require respondents to follow the bus schedule, so they cannot go out to find fresh fruits.
The results of this study revealed that more than half of the respondents 148 (55.4%) eat fast foods every month. Similar with previous study in Malaysia, where most of the respondents aged 24 or younger consumed fast food monthly (Abdullah et al., 2015; Mat et al., 2016). Moreover, Gan et al., (2011), stated that 52.4% and 38.4% of female and male students respectively eat at a fast food restaurant at least one to three times monthly.
There were a lot of reasons that affected fast food consumption. In this study, about 99 (37.1%) of respondents chose convenience as the main reason to eat fast food. Dunn et al., (2011), reported that convenience influenced the respondents the most. Similar with Prabhu and Narayan (2015), students choose fast food because of quick service and convenience. This may be because of students’ busy lifestyles and the prohibition to cook in the residential college areas. Thus, food delivery was the most convenient way to sort out the issue. Habib et al., (2011) stated that the convenience of the restaurants and easily accessibility were prime criteria for students to choose fast foods outlets. Onurlubaş & Yilmaz (2013), found a similar outcome that accessibility, service speed, menu variety and availability of special products play a significant role towards youngsters.
The second common reason was the taste of food. Habib et al. (2011) also reported that taste of food, safety and the rapidity of preparation were the main factors for choosing a certain fast food restaurant. Anderson et al. (2012), also found that among 64% of the respondents who eat fast food at least once per month agree that fast food outlet was quick and convenient, 16% chose taste of the food.
In this study setting Faculty Health Sciences, Puncak Alam was surround with fast food restaurants such as McDonald's, Kentucky Fried Chicken (KFC) and Pizza Hut which were available nearby within 0-5 kilometre (km) from the campus and residential college. According to Abraham et al., (2018), the place of study was located in an area with a variety of fast food options making it easier or more likely for them to consume fast food. Bernsdorf et al., (2017) stated that there was relation between fast food accessibility and intake. The possibility increased when fast food outlet was near to the accommodation area because it was easier to access. Likewise, the consumption decreased when the distance increased (up to four km). However, this was not a problem for people who have transportations (Bernsdorf et al., 2017). An increasing number of fast food outlets also made them easy to access within a short distance (Habib et al., 2011).
This study reported that for majority of the respondents transportations become problem since students who stayed in hostel were not allowed to bring their own transport. Dhillon et al., (2019), reported that limited transportation options for out-of-campus grocery stores and food joints were also perceived as barrier to food access. Bernsdorf et al., (2017), reported that accessibility to fast food outlet also depends on the mobility factors such as car and other public transport services. Caspi et al. (2012) stated that though accessibility was a component, the availability of public services has been legally recognised as part of food access.
In this study there was no relationship between transportation problems with fast food consumption behaviour among Health science students at UiTM Puncak Alam. The reason can be as most of the fast food restaurant provides delivery services. Abdullah et al. (2015), reported that most of the fast food franchise provides delivery services to the accommodation area of the students; thus, this kind of facilities made fast food easy to access. Since majority of respondents in this study have internet access so it is easier for them to make online order. Even though they don’t have transport but still can ask for delivery services through apps like grab food, food panda and others.
The result showed that majority of Health Science students in Year 2 and 3 have an average normal BMI. Moreover, in this study, 36.0% of the respondents with normal BMI went to a fast food restaurant every month. Besides, respondents were among the group who frequently consume fast foods compared to other groups such as obese. From that, it indicates that there was no relation (p=0.715) between upper BMI and fast food consumption.
A study by Fournier et al. (2016) which was done in Malaysia, also showed a similar result, where 9.8% and 9.5% of the participants are underweight and obese respectively, and another 58.7% have normal weight. Similarly, the results reported no relationship between BMI and frequency of eating out (p=0.5037).
These results seem to be contradicted by a study by Al-Otaibi & Basuny (2015), among female university students in Saudi Arabia. There was a relationship between BMI and the frequency of students visiting fast food franchises (p=0.05). About 56% of the students visit fast food twice or more per week are overweight/obese.
Another thing to consider is the sample population in both studies study. This study population is from Health and Sciences Faculty, which made them conscious of their own BMI and food
consumption.
Availability of transportation influences respondents accesses to fresh foods. Fast food consumption behaviour of the students was influenced by several factors such as the taste of the food, and location of fast food restaurant. There was no relationship between transportation problem and fast food consumption behaviour, due to advance in technology food can be ordered online and can be delivered by the restaurant. Lastly, there was no significant relationship between fast food consumption behaviour and BMI since health science students were much aware about the effect of obesity. Future research should focus more on the long- term effect of fast food consumption behaviour on students’ academic performance and health related quality of life.
The authors declare that there is no conflict of interests.
The authors would like to thank all participating students, lecturers, and faculty administrators involved.
Abdullah, N. N., Mohamad Mokhtar, M., Abu Bakar, M. H., & Al-Kubaisy, W. (2017). Fast Food Consumption and Obesity. Asian Journal of Quality of Life, 2(6), 11. https://doi.org/10.21834/ajqol.v2i6.42
Abdullah, N. N., Mokhtar, M. M., Harriszamani, M., Bakar, A., & Al-kubaisy, W. (2015). Trend on Fast Food Consumption in Relation to Obesity among Selangor Urban Community. Procedia - Social and Behavioral Sciences, 202(December 2014), 505–513. https://doi.org/10.1016/j.sbspro.2015.08.189
Abraham, S., Martinez, M., Salas, G., & Smith, J. (2018). College student’s perception of risk factors related to fast food consumption and their eating habits. Journal of Nutrition and Human Health, 02(01). https://doi.org/10.35841/nutrition-human-health.2.1.18-21
Al-Otaibi, H. H., & Basuny, A. M. (2015). Fast food consumption associated with obesity/overweight risk among university female student in Saudi Arabia. Pakistan Journal of Nutrition, 14(8), 511–516. https://doi.org/10.3923/pjn.2015.511.516
Alfawaz, H. A. (2012). The Relationship Between Fast Food Consumption and BMI among University Female Students the Relationship Between Fast Food Consumption and BMI among University Female Students. (May 2012), 3–8. https://doi.org/10.3923/pjn.2012.406.410
Ali, Noraziah Abdullah, M. (2012). The food consumption and eating behavior of Malaysian urbanites. issues and concerns. Malaysian Journal of Society and Space, 3(1), 44–53.
Alizadeh, M., & Ghabili, K. (2008). Health related lifestyle among the Iranian medical students. Res Biol Sci, 3(1), 4-9.
Anderson, B., Rafferty, A. P., Lyon-Callo, S., Fussman, C., & Imes, G. (2011). Fast-food consumption and obesity among michigan adults. Preventing Chronic Disease, 8(4).
Bernsdorf, K. A., Lau, C. J., Andreasen, A. H., Toft, U., Lykke, M., & Glümer, C. (2017). Accessibility of fast-food outlets is associated with fast food intake. A study in the Capital Region of Denmark. Health and Place, 48(October), 102–110. https://doi.org/10.1016/j.healthplace.2017.10.003
Bipasha, M. S., & Goon, S. (2014). Fast food preferences and food habits among students of private universities in Bangladesh. Southeast Asia Journal of Public Health, 3(1), 61–64. https://doi.org/10.3329/seajph.v3i1.17713
Caspi, C. E., Sorensen, G., Subramanian, S. V., & Kawachi, I. (2012). The local food environment and diet: A systematic review. Health and Place, 18(5), 1172–1187.https://doi.org/10.1016/j.healthplace.2012.05.006
Cheong, K. C., Ling, C. Y., Hock, L. K., Ghazali, S. M., Huey, T. C., Ibrahim, M. K. C., … Yusoff, A. F. (2019). Association between availability of neighborhood fast food outlets and overweight among 5–18-year- old children in peninsular Malaysia: A cross-sectional study. International Journal of Environmental Research and Public Health, 16(4), 593. https://doi.org/10.3390/ijerph16040593
Dhillon, J., Diaz Rios, L. K., Aldaz, K. J., De La Cruz, N., Vu, E., Asad Asghar, S., … Ortiz, R. M. (2019). We don’t have a lot of healthy options: Food environment perceptions of first-year, minority college students attending a food desert campus. Nutrients, 11(4). https://doi.org/10.3390/nu11040816
Driskell, J., Meckna, B., & Scales, N. (2006). Differences exist in the eating habits of university men and women at fast-food restaurants. Nutrition Research - NUTR RES, 26, 524–530. https://doi.org/10.1016/j.nutres.2006.09.003
Dunn, K. I., Mohr, P., Wilson, C. J., & Wittert, G. A. (2011). Determinants of fast-food consumption. An application of the Theory of Planned Behaviour. Appetite, 57(2), 349–357. https://doi.org/10.1016/j.appet.2011.06.004
Fournier, T., Tibère, L., Laporte, C., Mognard, E., Ismail, M. N., Sharif, S. P., & Poulain, J. P. (2016). Eating patterns and prevalence of obesity. Lessons learned from the Malaysian Food Barometer. Appetite, 107, 362–371. https://doi.org/10.1016/j.appet.2016.08.009
Fraser, L. K., Edwards, K. L., Cade, J., & Clarke, G. P. (2010). The geography of fast food outlets: A review. International Journal of Environmental Research and Public Health, 7(5), 2290–2308. https://doi.org/10.3390/ijerph7052290
Gan, W. Y., Mohd Nasir, M. T., Zalilah, M. S., & Hazizi, A. S. (2011). Differences in eating behaviours, dietary intake and body weight status between male and female Malaysian university students. Malaysian Journal of Nutrition, 17(2), 213–228.
Habib, F. Q., Dardak, R. A., & Zakaria, S. (2011). Consumers’ preference and consumption towards fast food : Evidences from Malaysia.Business and Management Quarterly Review (BMQR), 2(1), 14-27.
Javaid, A., & Munir, I. (2018). Journal of Nutrition & Food Sciences Breakfast Skipping and its Effects on Emotional and Academic Behaviour of a Group of Saudi Medical Students. 8(6), 8–11. https://doi.org/10.4172/2155-9600.1000735
Krejcie, R. V, & Morgan, D. W. (1970). Determining Sample Size for Research Activities. 38, 607–610.
Mat, R. C., Zulqernain, N. S., & Mohd Zaid, N. A. (2016). Profiling of Malaysian Young Consumers Towards Fast Food Consumptions. Journal of Applied Environmental and Biological Sciences, 6(7S), 20–27.
National Health and Morbidity Survey. (2015). Non-Communicable Diseases, Risk Factors & Other Health Problems. Retrieved March 27, 2020, from Institute for Public Health website: http://iku.moh.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol2.pdf
Onurlubaş, E., & Yilmaz, N. (2013). Fast food consumption habits of university students. Journal of Food, Agriculture and Environment, 11(3–4), 12–14.
Prabhu, N. B. (2015). Examining fast-food consumption behaviour of students in Manipal University, India. African Journal of Hospitality, Tourism and Leisure, 4(2), 621-630. https://www.ajhtl.com uploads/7/1/6/3/7163688/article62vol4_2_july-nov2015.pdf
Pulz, I. S., Martins, P. A., Feldman, C., & Veiros, M. B. (2017). Are campus food environments healthy? A novel perspective for qualitatively evaluating the nutritional quality of food sold at foodservice facilities at a Brazilian university. Perspectives in Public Health, 137(2), 122–135. https://doi.org/10.1177/1757913916636414
Radzi, C. W. J. M., Jenatabadi, H. S., Alanzi, A. R. A., Mokhtar, M. I., Mamat, M. Z., & Abdullah, N. A. (2019). Analysis of obesity among malaysian university students: A combination study with the application of Bayesian structural equation modelling and pearson correlation. International Journal of Environmental Research and Public Health, 16(3). https://doi.org/10.3390/ijerph16030492
World Health Organisation (WHO). (2005). Fruit and Vegetables for Health. (September), 1–3.
World Health Organisation (WHO). (2012). 10 Facts on Nutrition. Retrieved March 25, 2020, https://www.who.int/features/factfiles/nutrition/en/