Nutrition Knowledge, Attitudes, and Practice towards Breast Cancer Prevention among University Female Students in Lebanon

Abstract

Background: According to the International Agency for Research on Cancer (IARC), breast cancer (BC) became the most diagnosed cancer type in 2020 worldwide, in general, and in Lebanon in specific. The median age at diagnosis of patients with BC in Lebanon is 10 years earlier than that in the United States (U.S.). Early preventive measures in the Lebanese young female population could mitigate the increased incidence of the disease. Accumulating evidence is showing that adopting adequate dietary practices could reduce the burden of BC. Objectives: The objective of this study is to assess nutrition-related BC prevention knowledge, attitudes, and practice (KAP) of female university students, and to examine the relationship between sociodemographic, anthropometric, behavioral, and general characteristics of students and their KAP. Methods: A cross-sectional study was carried out between February and March 2023 on a convenient sample of 356 American University of Beirut (AUB) female students aged between 18 and 25 years old, with no previous or current diagnosis of BC from all 7 faculties at AUB. A self-administered questionnaire was used to obtain information on nutrition KAP towards BC prevention as well as information on the sociodemographic, anthropometric, behavioral, and general characteristics of the students. The knowledge part of the questionnaire addressed the students’ knowledge of the relationship between diet and BC, and impact of other non-modifiable and modifiable nutrition-related BC risk factors, and the relationship between certain food items with BC. The attitude part of the questionnaire collected information on whether the students believe that nutrition or food selection can decrease the risk of BC, and that adherence to a healthy diet can reduce the risk of developing BC in the next generation. The practice questionnaire collected information on the students’ usual intake of specific foods reported to be associated with BC. Descriptive and analytical statistics were used to assess nutrition- related BC prevention knowledge, attitudes, and practice (KAP) of female university students, and to examine the association between sociodemographic, anthropometric, behavioral, and general characteristics of students and their KAP. The final scores of each of the KAP were summed up for every student. The ranges of answers varied between 0-18 for knowledge, 0-28 for attitude, and 0-30 for practice. Knowledge and practice scores were considered poor (scores < median score) and good (scores ≥ median score). Good knowledge scores were noted for those who received a score of ≥ 12.00, and good practice scores were given for those with scores ≥ 10.00. Attitudes were categorized as negative (scores < median of 20.00) and positive (scores ≥ median score of 20.00). All analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: The mean and median scores of knowledge, attitude, and practice of the total sample were similar with 11.68 ± 3.30, 19.62 ± 2.84, and 9.40 ± 5.59, for the mean and 12.00, 20.00, and 10.00, for the median respectively. The ranges of scores obtained for KAP were 2-18, 9-27, and 0-30, respectively. A significantly higher percentage of students had good knowledge and positive attitude scores if they were majoring in a health-related major as compared to those in non- health-related majors (73.2% vs 45.5%, and 62.7% vs 41.1%,, respectively). The mean GPA of students having good knowledge scores was significantly greater than that of students having poor knowledge scores (3.54 ± 0.40 vs 3.43 ± 0.48, respectively). Students having positive attitude or good practice scores were more likely to have a GPA ≥3.63 compared to those having a negative attitude or poor practice (51.6% vs 37.8%, and 50.9% vs 37.8%, respectively). Those having a positive attitude score were also significantly less likely to report their “amount of perceived stress” as ≥3 compared to those having negative attitude (93.3% vs 97.7%). The mean knowledge and attitude scores of the health-related majors’ students were significantly higher than that of non-health-related majors’ students (12.67 ± 2.97 vs 10.9 ± 3.35, and 20.46 ± 2.69 vs 19.00 ± 2.80, respectively). There was a statistically significant positive correlation between the overall knowledge and the overall attitude (r=0.41). However, there was no statistically significant correlation between practice and each of the knowledge or attitudes’ scores. Both health-related majors and GPA (capped at 4.0) were significant predictors of both total knowledge and total attitude scores, while only GPA was a significant predictor of total practice score. Conclusion: This study showed that pursuing a health-related major positively influenced the students’ nutrition knowledge and attitude scores of BC prevention, and that having a higher GPA predicted better nutrition KAP toward BC prevention. The amount of perceived stress negatively influenced nutrition attitude scores. These findings provide evidence for a relationship between health education and KAP and encourage further expansion in the Lebanese female population to develop evidence- based culture-specific awareness campaigns to mitigate the increasing trend of BC in the Lebanese female population. Future studies are needed, on a larger scale, to unravel the predictors of nutrition-related BC prevention practices, in the Lebanese population.