Exploring the Knowledge, Attitudes, and Practices of College Students Toward Sustainable Diets in Lebanon: A Cross-Sectional Study

Abstract

Background: Global and local food systems are currently challenged by various factors that compromise their ability to protect environmental resources and planetary health while failing to provide nutritious, accessible, and safe food equitably to all populations. Sustainable diets are critically needed to address some of these challenges. Sustainable diets are defined as dietary patterns that promote all dimensions of individuals’ health and wellbeing; have low environmental pressure and impact; are accessible, affordable, safe, and equitable; and are culturally acceptable. Such diets are particularly needed among college students, a key consumer group that is overall characterized by increased environmental awareness and a transitional age of independence, where dietary choices can evolve into lifelong habits. While much research has focused on the knowledge, attitudes and practices (KAP) towards healthy eating as well as the relationship between healthy diets and food insecurity among this population group, the present study aims to broaden our understanding to encompass not only healthy, but sustainable diets, particularly in the regional context undergoing climate stressors, environmental degradation, public health challenges and high rates of food insecurity.

Objective: The present study aims to explore the KAP of college students towards sustainable diets and to examine the relationship between their demographic, socioeconomic, and food security status with the KAP of sustainable diets.

Methods: A cross-sectional study was conducted among college students enrolled in different public and private universities across Lebanon. Participants were recruited through a convenience sampling approach, using email invitations and social media platforms (e.g., Facebook, Instagram, LinkedIn), as well as sharing the survey link within WhatsApp groups. Interested participants completed an online survey on LimeSurvey after providing their informed consent. The study was approved by the Institutional Review Board (IRB) at the American University of Beirut (AUB) and data collection took place between the months of March and April 2024. The online survey included questions related to demographic, socioeconomic and university characteristics, and food security status of college students measured using the previously validated and used food insecurity experience scale (FIES). In addition, previously validated scales were used to assess the KAP of sustainable diets among college students. These assessments provided numerical scores, with higher scores indicating greater knowledge, more positive attitudes, and more favorable practices. The possible score ranges for knowledge, attitudes, and practices were [0,52], [0,40] and [0,76], respectively. Descriptive statistics were presented as means and standard deviations (mean ± SD) and as frequencies and proportions n (%) for continuous and categorical variables, respectively. Simple and multiple linear regression analyses were conducted to explore the relationships between KAP, as dependent variables, with food security status and other demographic and socioeconomic correlates in the models. Results were presented as beta-coefficients (β) with 95% confidence intervals (CI).

Results: A total of 701 university students were recruited from 16 universities across Lebanon. The study sample was comprised of 58% females and 41% males with less than 1% identifying as other gender identities. The average age of participants was 20.6 years (± 2.15). Most students were Lebanese (96.4%) and attending private universities (80.6%). Approximately 61.6% pursued majors unrelated to health, while 38.4% were majoring in health-related fields. As for food insecurity levels, 60% were food secure while 40 % were food insecure, with 28% being mildly food insecure and 12% being moderately to severely food insecure. Knowledge and attitudes scores overall, showed good and positive results (36.24 ± 8.15; 30.33 ± 5.30). When individual items from each of the knowledge and attitude scales were evaluated, most participants responded strongly agree/agree on the following statements: “distinguishing between healthy and unhealthy foods” (92.2%) and “believing that sustainable diets should be affordable” (94%). However, students showed lower understanding of other dimensions related to “understanding the cultural and social dimensions of sustainable diets” (52%) and the least favorable attitudes were reported towards the impact of government policies and regulations to encourage and improve sustainability (53%). Lower scores on the sustainable practices were observed among study participants. These findings reflected less engagement in sustainable practices, such as willingness to pay more for environmentally friendly choices (10.8%), composting food at home (10.9%) or reducing meat consumption (12.1%). On the other hand, participants reported higher engagement in practices such as limiting food waste (79.4%), encouraging others to reduce food waste (66.7%), and preferring local products over imported food products (69%). Results from the simple linear regression models showed significant associations between food security level and KAP scores (all p-values <0.05). Other significant variables were also identified and included in the multiple linear regression models such as gender, age, major, university category and personal income. Multiple linear regression analyses showed that food security status was no longer statistically significant with KAP of sustainable diets among college students in the study sample, after adjusting for other demographic and socioeconomic covariates. Results indicated that female participants had better scores across all KAP models compared to male participants (β =2.811, 95% CI 1.671, 3.952] ; β = 3.029 , 95% CI [2.278, 3.779] ; β= 3.254 , 95% CI [1.757 , 4.750]). Students enrolled in non-health majors had lower knowledge scores (β =-4.200 , 95% CI [-5.405, 2.995 ]) and less favorable attitudes (β =-2.027, 95% CI [-2.819 , -1.236]) compared to students from health majors. Similarly, those having personal monthly incomes in the medium range ($90 to $170) had lower knowledge ( β =-2.808, 95% CI [-4.210 , 1.405]) and attitudes score( β =-1.815, 95% CI [-2.735 , -0.894]). Older students and those enrolled in a higher tuition fees university had higher attitudes scores (β =1.885, 95% CI [0.775 , 2.995] ; β =0.956, 95% CI [0.040 , 1.872] ). With respect to practices, results from the multiple linear regression showed that students with higher knowledge and attitudes scores had significantly higher sustainable practices scores (β =0.320, 95% CI [0.199 , 0.440] and β =0. 401, 95% CI [0.218 , 0.585], respectively). Being a female and students enrolled in the public university also remained statistically significant with higher practices scores compared to males and students enrolled in the private universities. Students overall expressed willingness to learn more about sustainable dietary practices through short social media posts and other online platforms. Several perceived challenges were identified among college students to adopt sustainable practices including such as the high prices of sustainable food options.

Conclusion: College students in Lebanon demonstrated overall good knowledge and positive attitudes towards sustainable diets yet adopting sustainable dietary practices remain challenging for students in our study sample. Findings from the present study also showed that higher knowledge and favorable attitudes towards dietary sustainability to be significant predictors for more sustainable practices and thus efforts should focus on enhancing education and awareness programs among this population group. Given the critical role of young adults as future parents and consumers of the next decades, promoting student engagement in the adoption of sustainable dietary habits is crucial, particularly in contexts facing growing challenges with food and nutrition insecurity. The collaborative efforts of the public and private sectors are essential in promoting sustainable food choices that are healthy, affordable and culturally acceptable. Also, educational institutions can play a key role in fostering sustainability among the student population through integrated curricula, research opportunities, practical campus initiatives and better food environments. Further research is still needed to examine the interlinkages between food security and the different dimensions of sustainability, in regions with numerous public health, environmental and political stressors, particularly LMICs such as Lebanon.