Time to change! Using the transition from school to university to promote healthy lifestyle habits in young people

Eating healthily, exercising, drinking sensibly and not smoking are known to reduce the risk of developing serious diseases and conditions such as cancer, heart and circulatory disease, obesity and type 2 diabetes. However, few young people engage in these health behaviours to a level that reduces their risk of developing such health problems. Unfortunately, the habits acquired in early adulthood can often persist and have a detrimental effect on health in middle and later adulthood. Moreover, some of the risky behaviours displayed by young people, such as binge drinking, can have immediate negative health and social problems, including accidents, injuries, physical violence and sexual risk taking. Consequently, interventions targeted at this age group may be particularly beneficial in producing both short-term and long-term benefits to health. Researchers, practitioners, and policy makers alike seek ways of encouraging young people to adopt healthier lifestyle habits. The current research proposes a new intervention, combining three behaviour change techniques from health psychology, that is delivered during the transition from school to university using the latest digital technologies to produce changes in the health behaviours of young people.

The intervention is novel in three ways. (1) The intervention combines three techniques from health psychology to (i) ensure that the health messages are not dismissed without being considered (through a self-affirmation task), (ii) develop health messages that target the most important predictors (e.g., beliefs) of each behaviour (based on a widely-used model of health behaviour, the theory of planned behaviour), and (iii) ensure that people's good intentions are translated into behaviour (through the use of planning tasks). (2) The intervention will be delivered during the transition from school to university (i.e., from one month before to one month after starting university). Many young people make this move each year. Such life transitions are critical (or "teachable") moments to intervene as people's beliefs and behaviour are in a state of flux (and are therefore easier to influence) due to the major changes to their social environments. (3) The latest digital technologies (e.g., internet, smartphones), that are part of students' social worlds, will be used to deliver the intervention. This will ensure that the intervention is interactive and engaging to students.

All new students (approximately 4,000) to a large city university will be invited to take part in the research. Half will be allocated to the intervention group and half to a control group. All participants will complete online questionnaires assessing their health beliefs and behaviour one month before starting university as well as one and six months after being at university. We will conduct analyses to see whether those in the intervention group adopt more health behaviours (e.g., eat more fruit and vegetables, exercise more, drink less, smoke less) as a result of the intervention.

If successful the project will enhance our knowledge of how to promote healthy lifestyle habits in young people. It will therefore create a lasting legacy in terms of best practices to help students develop healthy lifestyle habits when they start university and the technological means to deliver the intervention to all new students in the future.

Eating healthily, exercising, drinking sensibly and not smoking are known to reduce the risk of developing serious diseases and conditions in later life. However, few young people engage in these health behaviours. The research will develop and test a theory-based intervention that targets several health behaviours (i.e., fruit and vegetable intake, exercise, alcohol consumption, smoking) among young people, that will be delivered using the latest digital technologies during the transition from school to university. The potential impact of the trial is substantial because the intervention (a) combines three techniques from health psychology, each with a strong theory- and evidence-base, to promote healthy lifestyle habits in young people; namely, self-affirmation to reduce resistance to health messages, theory-based health messages to increase people's motivation to change, and implementation intentions to ensure that good intentions are translated into behaviour, (b) targets a large proportion of young people (up to 40% of all school leavers start university each year) who do not meet current health behaviour recommendations, (c) during a critical period when changes in health behaviour are likely to be easier to promote due to changes in the environmental context, (c) using methods that are part of students' social worlds (i.e., digital technologies) that ensure that the intervention is interactive, sustained, contextualised and personalised. A randomised controlled trial with 2 arms is proposed (intervention vs. control) with all new incoming students to the University of Sheffield. The intervention will last from one month before to one month after starting university. Online measures of health beliefs and behaviour will be taken at baseline (one month pre-university) and after one and six months after starting university to assess the effectiveness of the intervention and to inform the health economic analyses.

Non-academic beneficiaries of the research comprise 6 groups:
(1) Intervention participants will obtain immediate and potentially lifelong improvements in their physical health and well-being. In the longer term, this group also comprises students entering university in the future who will obtain similar advantages from taking part in the intervention.
(2) Professionals concerned with student welfare (university, health service, and student union personnel) will be able to access intervention materials and advice from researchers that will support and facilitate their role. This benefit should accrue towards the end of the project (when information about the research is disseminated to this group) and last into the long term (when KT funding will be sought to roll out the intervention at institutions wishing to use, and gain from, the research).
(3) Schools (local authority officials, head teachers, and boards of governors) are also likely to be engaged by findings that point to leaving school as a critical moment for intervening to break 'bad' health habits and adopt healthier lifestyle habits. The fact that the intervention is online, free, and easy to access means that in the longer term (one to five years in the wake of the project), the intervention could be delivered routinely to all school leavers whose institutions wish to take up this opportunity.
(4) Health education/promotion professionals will have access to project website during the course of the research and into the longer term (the project team will maintain the website at our own expense for a period of at least five years after the research has been completed). This will mean that these professionals can access materials that can effectively bolster their work of promoting the public health, i.e., materials that tackle, in sequence, the issues of enhancing open-mindedness/reducing defensiveness, persuading recipients to abandon unhealthy behaviours and set new, healthy goals, and facilitating successful enactment of these goals.
(5) Similarly, members of the public who are considering quitting smoking, improving their diet, moderating their alcohol consumption, or increasing levels of physical activity will be able to use the materials either during or in the wake of the project, and will be able to feed back their experiences via the project website.
(6) Finally, the research findings will be a boon to policy makers concerned with public health in at least two respects. First, the research will demonstrate that education/persuasive messages can be effective in promoting health behaviour change provided those messages are bolstered by techniques that (a) enable people both to process the message as non-threatening (as the self-affirmation induction will ensure), and (b) give people the tools to help them act upon their 'good' intentions (as the implementation intention induction will ensure). Second, the findings will afford new insights not only in relation to the content of interventions, but also how the timing of such interventions can be crucial for breaking unwanted habits and installing new ones. The conceptual analysis underpinning the present research - that changes in people's physical and social settings are crucial junctures when new healthier lifestyle habits can be promoted - could form basis for new ideas about when it is best to introduce policies geared at changing the behaviour of members of the public. Finally, the findings will speak to the delivery of such interventions given the potential of new digital technologies to deliver interventions that are engaging, interactive, sustained and tailored to large sections of the population.