University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA COLLEGE OF HEALTH SCIENCES PERSONALITY TRAITS AND DIETARY HABITS AMONG STUDENTS OF THE UNIVERSITY OF GHANA, LEGON BY EMEFA GIFTY ODDAM (10443580) A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF DEGREE OF MASTER OF SCIENCE IN DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS JULY, 2015 University of Ghana http://ugspace.ug.edu.gh DECLARATION This is to certify that this dissertation is the result of research undertaken by Emefa Gifty Oddam under the supervision of Dr. Joana Ainuson Quampah, Mrs Freda Intiful and Dr. Irene Kretchy towards the award of a Master of Science (MSc) degree in Dietetics in the Department of Nutrition and Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana. This dissertation has never been presented in part or whole to any Institution for the award of any degree or diploma. Signature---------------------------------------- Date---------------------------------- Emefa Gifty Oddam (Candidate) Signature------------------------------------------ Date---------------------------------- Dr. Joana Ainuson-Quampah (Supervisor) Signature---------------------------------------- Date---------------------------------- Mrs. Freda Intiful (Supervisor) Signature---------------------------------------- Date---------------------------------- Dr. Irene Kretchy (Supervisor) ii University of Ghana http://ugspace.ug.edu.gh ABSTRACT Background: For an effective behaviour modification in dietary habits, an understanding of the association between an individual’s personality traits and food habits are of much significance. Aim: The aim of this study was to determine the relationship between personality traits and dietary habits among undergraduate students of the University of Ghana. Methodology: A cross-sectional study was conducted and students were recruited by systematic sampling. A questionnaire was used to collect data. Anthropometric measurements (height, weight, waist and hip circumference), dietary intake (semi- quantitative food frequency questionnaire) and dietary habits were assessed. The Big 5 personality traits (extraversion, conscientiousness, neuroticism, agreeableness and openness) were assessed using the International Personality Item Pool (IPIP). Associations between dietary habits and BMI, WHR and personality traits were analyzed. Results: The mean BMI of the participants was 22±3.63 kg/m2. The Waist-to-Hip Ratios were 0.76±0.04 and 0.81±0.04 for females and males respectively. Except for neuroticism, all the personality traits had a significant association with at least one of the dietary habits. Waist-to-Hip Ratio was associated with pickiness. Sugar intake moderation was significantly associated with BMI (p =0.05). Conclusion: The dietary habits of the undergraduate students of the University of Ghana did not show much effect on their BMI. Some associations were detected between personality traits of the students and the aspects of their dietary habits observed. Personality traits may have an influence on dietary habits but further studies are required for confirmation. iii University of Ghana http://ugspace.ug.edu.gh DEDICATION This dissertation is dedicated to my husband, children, parents and siblings. iv University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENTS I thank God Almighty for granting me the grace to carry through to a successful end. My heartfelt appreciation goes to my supervisors Dr. Joana Ainuson-Quampah, Mrs. Freda Intiful and Dr. Irene Kretchy for their guidance, encouragement and immense contribution towards the success of this work. I am also very grateful to Dr. Matilda Asante, Dr. Charles Brown and all the other lecturers for their diverse inputs. I am particularly indebted to Miss. Portia Dzivenu and Mr. Samuel Sacker, senior research assistants of the department of nutrition and dietetics for their invaluable assistance. I acknowledge every effort from my course mates and friends. You were awesome. v University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION .............................................................................................................. ii ABSTRACT ..................................................................................................................... iii DEDICATION ................................................................................................................. iv ACKNOWLEDGEMENTS .............................................................................................. v TABLE OF CONTENTS ................................................................................................. vi LIST OF FIGURES ....................................................................................................... viii LIST OF TABLES ........................................................................................................... ix LIST OF ABBREVIATIONS ........................................................................................... x CHAPTER ONE ............................................................................................................... 1 1.0 INTRODUCTION ...................................................................................................... 1 1.1 BACKGROUND ................................................................................................................ 1 1.2 PROBLEM STATEMENT ................................................................................................. 3 1.3 SIGNIFICANCE OF STUDY............................................................................................. 4 1.4 AIM ..................................................................................................................................... 5 1.5 SPECIFIC OBJECTIVES ................................................................................................... 5 CHAPTER TWO .............................................................................................................. 6 2.0 LITERATURE REVIEW ........................................................................................... 6 2.1 PERSONALITY TRAITS .................................................................................................. 6 2.2 DEVELOPMENTS IN PERSONALITY STUDIES .......................................................... 8 2.2.1 The Four Temperaments .............................................................................................. 8 2.2.2 Trait Theories ............................................................................................................. 11 2.2.3 Criticisms of the Big Five theory ................................................................................. 21 2.3 DIETARY HABITS .......................................................................................................... 22 2.3.1 Tool for Assessing Dietary Habits ............................................................................... 23 2.4 DIET AND WELL-BEING .............................................................................................. 24 2.5 PERSONALITY TRAITS AND EATING DISORDERS ................................................ 26 2.6 RELATIONSHIP BETWEEN PERSONALITY TRAITS AND DIETARY HABITS ... 28 2.7. BMI AND DIETARY HABITS ....................................................................................... 29 CHAPTER THREE ........................................................................................................ 30 3.0 METHODS ............................................................................................................... 30 3.1 STUDY DESIGN .............................................................................................................. 30 vi University of Ghana http://ugspace.ug.edu.gh 3.2 STUDY SITE .................................................................................................................... 30 3.3 STUDY PARTICIPANTS ................................................................................................ 30 3.3.1 Inclusion Criteria ........................................................................................................ 30 3.3.2 Exclusion Criteria ........................................................................................................ 30 3.4 SAMPLE SIZE ................................................................................................................. 31 3.5 SAMPLING PROCEDURE.............................................................................................. 32 3.6 ETHICAL CLEARANCE ................................................................................................. 32 3.7 PRE-TESTING OF QUESTIONNAIRES ........................................................................ 33 3.8 DATA COLLECTION...................................................................................................... 33 3.8.1 Socio-demographic variables ..................................................................................... 33 3.8.2 Anthropometric Measurements ................................................................................ 33 3.8.3 Assessment of Personality Traits ............................................................................... 34 3.8.4 Assessment of Dietary Habits .................................................................................... 34 3.9 STATISTICAL ANALYSIS ............................................................................................. 35 CHAPTER FOUR ........................................................................................................... 37 4.0 RESULTS ................................................................................................................. 37 4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS........................ 37 4.2 ANTHROPOMETRIC INDICES OF THE STUDENTS ................................................. 38 4.3 PERSONALITY TRAITS OF THE STUDENTS ............................................................ 40 4.4 DIETARY HABITS OF STUDENTS .............................................................................. 42 CHAPTER FIVE ............................................................................................................ 50 5.0 DISCUSSION AND CONCLUSION ...................................................................... 50 5.1 CONCLUSION ................................................................................................................. 55 vii University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Figure 1: Body mass index of students 38 Figure 2: Waist-to-Hip Ratio of students 38 Figure 3: Personality traits of students 39 Figure 3a: Personality traits of males 40 Figure 3b: Personality traits of females 40 Figure 4: Frequency of consumption of the various food groups 44 viii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 1: Socio-demographic characteristics of the students 36 Table 2: Anthropometric Indices of the students 37 Table 3: Table showing the dietary habits of the students according to gender 42 Table 4a: Association between body mass index and dietary habits of the students 46 Table 4b: Association between body mass index and dietary habits (fat, sugar and salt moderation) 47 Table 5: Association between Waist-to-hip ratio and dietary habits of the students 48 Table 6: Relationship between personality traits and dietary habits of the students 49 ix University of Ghana http://ugspace.ug.edu.gh LIST OF ABBREVIATIONS ADA American Dietetic Association BMI Body Mass Index BPI Big 5 Personality Inventory CDC Center for Disease Control EPIC European Prospective Investigation of Cancer FAO Food and Agriculture Organization of the United Nations FFQ Food Frequency Questionnaire IPIP International Personality Item Pool TFEQ Three Factor Eating Questionnaire UG University of Ghana USDA United States Department of Agriculture USDHHS United States Department of Health and Human Services WHO World Health Organization WHR Waist-To-Hip Ratio x University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE 1.0 INTRODUCTION 1.1 BACKGROUND Efforts have been made to promote healthy eating over the years. However, there still remains a major need for improvement given the high prevalence of diet-related diseases such as heart disease, diabetes and hypertension (WHO, 2015). Sickness is costly in terms of loss of lives, pain, debilitations, loss of revenue or income and medical care expenditures. In spite of these challenges, people still find it difficult to change old negative eating habits even when they are aware of the poor health consequences (Marianne et al., 2006). There is therefore an urgent need to focus attention on behavioural strategies in dietary modification to prevent and manage diet- related diseases. For an effective behaviour modification in eating habits, an understanding of the association between an individual’s personality traits or character attributes and his/her food habits is of much significance (Fassino et al., 2002). Various factors affect an individual’s food habits. These include one’s geographical location, available foods, socio-economic status, education and the state of health (Wade et al, 2006). Considering the fact that different individuals tend to show variations in choices even under similar conditions, psychological factors may be playing an important role in dietary habits (Provencher et al., 2008; Hays et al, 2002; Goldberg & Strycker, 2002). For instance, differences in preferences and attitude towards food exist even among individual members in one family living together with the same food resources. Some members may practice more dietary diversity, balance and moderation than others (Bere 1 University of Ghana http://ugspace.ug.edu.gh et al., 2007). Another example is the adherence to dietary advice versus non-compliance among patients/clients counseled by dietitians. Some people would not follow dietary recommendations even when all resources are available for them to do so and they are much aware that eating unhealthily affects them negatively (Marianne et al., 2006). Personality traits are behavioural characteristics that are consistently expressed by an individual or the distinct patterns exhibited in behaviour (Schacter, 2011). Many trait theories have evolved over the years. Contemporary personality psychologists widely agree that there are five core domains or dimensions of traits that interact to form personality and shape social landscape (Matthews et al., 2003). They are referred to as the ‘Five Factor Model’ or the ‘Big 5’ personality traits (Digman, 1990). The ‘Five Factor Model’ has been shown to account for different traits in personality without overlapping with other traits and has demonstrated consistency in interviews, self-descriptions and physical observations (McCrae & Terracciano, 2005). The traits are broadly categorized as extraversion, agreeableness, conscientiousness, neuroticism and openness (McCrae & Terracciano, 2005). Since personality traits affect many choices an individual makes in life such as what to do for a living, how he/she interacts with family and the choices of friends and marriage partners, they could also be a factor in influencing dietary habits. Dietary habits refer to the set of choices or decisions one makes with regards to foods eaten. They involve what to eat, when to eat, how much to eat and where to eat (MacNicol et al., 2003). These include the taste preferences, variety in foods selected, frequency of meal consumption, portion sizes, snacking behaviour and skipping or not 2 University of Ghana http://ugspace.ug.edu.gh skipping of meals. Others are orientation towards junk foods, craving for sweets, binge eating, vegetarianism, ‘dieting’ or restraint of certain foods especially ‘fattening’ foods and eating to satisfy emotional needs (Whitney & Rolfes, 2015). Knowing how these dietary habits are influenced by personality traits is of relevance in health promotion as it can serve as a guide in individualized care (Provencher et al., 2008). 1.2 PROBLEM STATEMENT There has been a major transition from infectious diseases to non-communicable ones with degenerative diseases such as coronary heart disease, hypertension and diabetes being among the major causes of death worldwide (WHO, 2014; CDC, 2007). Other diet related conditions such as obesity and disordered eating practices like anorexia nervosa, bulimia nervosa and binge eating disorder are also big problems. Top risk factors for the development of degenerative diseases include behavioural or lifestyle practices such as poor food choices and a sedentary life. These are categorized under modifiable risk factors which can be worked on by the individual. On the other hand, there are non-modifiable risk factors like heredity and age, which the individual cannot change. Therefore, behaviour or lifestyle change is very crucial in dealing with non-communicable diseases (Wade et al., 2006). Among the lifestyle practices, diet is a key factor. Within the range set by one’s inheritance, the likelihood that one develops degenerative diseases is strongly influenced by food choices (Bere et al., 2007). Poor food habits accelerate the development of these conditions and these include practices such as consumption of excesses of calories especially from saturated fats and excess salt consumption (Nelms et al., 2011). Good dietary practices such as adequate and moderate intake of macro and micro-nutrients as well as fibre, through the consumption 3 University of Ghana http://ugspace.ug.edu.gh of whole grains, fruits and vegetables prevent or delay disease onset and help in their management (Mahan et al., 2011). The right control over one’s diet is indispensable to the attainment of good health and in that regard, much interest and consideration must be given to the role of psychological factors in dietary choices (Sullivan et al., 2007, Elfhag & Rossner, 2005; Lewis, 2001; Faith et al., 2001). Various studies have been conducted to find the relationship between personality traits and eating habits but there is still no clear picture on the subject (Lee & Chang, 2003). There is paucity of information on such studies in the Ghanaian population, as there is no published data on any of such studies in the Ghanaian setting. Knowledge of the association that exists between traits and food habits in the Ghanaian setting is of utmost importance. More studies of this nature are needed to add to clarity on the subject. 1.3 SIGNIFICANCE OF STUDY Quite a number of people do not follow dietary recommendations or counsel. Psychological factors may be contributing to that (Provencher et al., 2008). A good knowledge of the relationship between personality traits and attitude towards food can guide dieticians and other health professionals in the development of more effective interventions. Dietary interventions tailored to suit individual character styles may have a higher success rate than those presented in a ‘one size fits all’ fashion. Thus, findings from this study aside providing requisite knowledge on the relationship between personality traits and dietary habits will also serve as baseline information for future studies and efforts aimed at changing less-than-optimal eating habits. 4 University of Ghana http://ugspace.ug.edu.gh 1.4 AIM To determine the relationship between personality traits and dietary habits among students of The University of Ghana. 1.5 SPECIFIC OBJECTIVES The specific objectives were to: 1. Determine the personality traits of students of the University of Ghana. 2. Evaluate their anthropometric indices. 3. Assess their dietary habits. 4. Relate their personality traits to their dietary habits. 5. Relate their anthropometric variables to their dietary habits. 5 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO 2.0 LITERATURE REVIEW 2.1 PERSONALITY TRAITS In describing the character of an individual, we often use words such as outgoing, reserved, understanding, hardworking, quick-tempered, wicked, smart, responsible or kind. Such words describe the personality traits or attributes of the individual (Thompson, 2008). Human personality is composed of a number of traits or dispositions that shape conduct. These traits differ from one individual to another and influence behaviour. Each individual has a unique personality which differentiates that person from others, and understanding someone’s personality gives clues about how that person is likely to act and feel in a variety of situations (Harris, 2006; Klimstra et al., 2012; Lucas & Donnellan, 2009). According to Kassin (2003), personality traits are habitual patterns of behaviour, thought and emotion. They refer to all the aspects of a person’s character and attitudes that make up that person’s personality. Even characters in fictions have personality traits. Traits can be good or bad, positive or negative. Some traits are attributes a person either has or does not have while others, for example, extraversion versus introversion, are dimensions with each person rating somewhere along the spectrum. Personality traits can also be thought of as relatively stable characteristics that cause individuals to behave in certain ways. They are what rule passions and obsessions. Fiske and his colleagues (2009) put it this way, ‘personality is a pattern of relatively permanent traits and unique characteristics that give both consistency and individuality to a person’s behaviour’. 6 University of Ghana http://ugspace.ug.edu.gh Allport (1937) a pioneer psychologist classified personality traits into three groups based on the extent to which they control a person’s behavior. “Cardinal” traits are those that dominate an individual’s whole life often to the extent that the person becomes so known specifically for these traits such that others can always predict rightly how they would act or react (Mathews et al, 2003). The terms ‘Christ-like’ and ‘Freudian’, for example, came about because the characters were so known for certain qualities that their names were used synonymously with those qualities. "Central" traits on the other hand are general characteristics that form the basic foundations of personality. They are characteristics found to some degree in every person. Although they are not as dominating as cardinal traits, central traits are the major characteristics usually used to describe people. These include terms such as honest, intelligent, assertive, responsible and lazy. Finally, "secondary" traits are those related to attitude or preferences and appear only in certain specific situations or circumstances (such as particular likes or dislikes that a very close friend may know). They contribute to provide a more complete picture of human complexity (Mathews et al, 2003). Personality traits differ from personality states. Traits, unlike states, are relatively stable over time while states are more transitory dispositions. For example, anger, anxiety, depression are all regarded as states of personality (Tamir et al., 2002). The personality trait known as neuroticism makes individuals susceptible to these states (Demick & Garrity, 2001). Thus, particular traits predispose individuals to distinctive states. 7 University of Ghana http://ugspace.ug.edu.gh 2.2 DEVELOPMENTS IN PERSONALITY STUDIES 2.2.1 The Four Temperaments The study of personality started with Hippocrates' theory of the four humours which he postulated are responsible for four basic temperaments (Steiner, 2008). The "Four Humours" theory held that a person's personality was based on the balance of these bodily fluids; yellow bile, black bile, phlegm and blood. Choleric people were characterized as having an excess of yellow bile, making them irritable or hot-tempered. High levels of black bile were thought to induce melancholy, signified by a solemn, gloomy, pessimistic outlook. Phlegmatic people were thought to have an excess of phlegm, leading to their sluggish, calm temperament. Those thought to have high levels of blood were said to be sanguine and were characterized by their cheerful, passionate dispositions. Mixtures of the temperaments also exist (Cobb-Clark & Schurer, 2012). Later discoveries in biochemistry have led modern medical science to reject the theory of the four humours (Lutz, 2002). However, use of the four personality types or temperaments are still very popular especially in non-academic domains. 2.2.1.1 Choleric The Choleric is an extroverted, hot tempered, quick thinking, active, practical and strong-willed person (Childs, 2009). They are fundamentally ambitious and leader-like. They have a lot of aggression, energy and passion which they try to instill in others. Cholerics are self-confident, self-sufficient and very independent minded. They are very decisive and dominating, easily making decisions for themselves and others and so tend to leave little room for negotiating (Childs, 2009; Steiner, 2008). Cholerics are visionaries and seem to never run out of practical ideas, goals and plans. They think big and love to occupy positions of authority. Their activity seems endless and almost 8 University of Ghana http://ugspace.ug.edu.gh always has a purpose because they are result-oriented. They usually do not give in to the pressure of what others think and are both direct and firm when responding to others. Cholerics love to fight for a cause and so are usually crusaders against social injustice. Many great charismatic, military and political figures were choleric. Since to them, results are more important than people, they are slow to build relationships and do not easily empathize with the feelings of others or show compassion. In spite of being leader-like and assertive, they are prone to mood swings and easily suffer deep and sudden depression (Childs, 2009; Steiner, 2008). 2.2.1.2 Melancholic The Melancholic is an introverted, thoughtful, logical, analytical, factual, private, lets- do-it-right person (Childs, 2009). They are perceived as overly pondering and considerate. They respond to others in a slow, cautious and indirect manner. Melancholics are reserved and suspicious until sure of your intentions. They probe for the ‘hidden meaning’ behind other’s words, are timid and may appear unsure. Melancholics are self-sacrificing, gifted and tend to be perfectionists and are very sensitive to what others think about their performance (Childs, 2009; Steiner, 2008). They are determined to make the right and best decision and would ask specific questions, sometimes, again and again. They need reassurance, feedback and reasons why something should be done. They also need information, time to think and a plan. Melancholics are very creative and capable people but fear taking a risk, making a wrong decision and being viewed as incompetent. They are also skeptical and tend to have a negative attitude towards something new until they think it over but get bored once they have it figured out (Childs, 2009; Steiner, 2008). 9 University of Ghana http://ugspace.ug.edu.gh 2.2.1.3 Phlegmatic The Phlegmatic is an introverted, calm, unemotional, easy-going, never-get-upset person (Steiner, 2008). They are relaxed, passive and quiet and sometimes, lazily sluggish. They are slow and indirect when responding to others. They are also slow to warm up but are accommodating in the process and the easiest person to get along with. Phlegmatics avoid getting too involved with others and life in general and live a quiet, routine life free of normal anxieties and stresses people of other temperaments experience (Childs, 2009; Steiner, 2008). They also avoid conflicts and making decisions and are generally kind and content with themselves. They rarely exert themselves in their careers and other areas and just let things happen. They prefer a few close friends who they are loyal to, finding it difficult to break long standing friendships irrespective of what the other does but prone to holding grudges. They are traditional thinkers and tend to resist change, preferring stability to uncertainty. They can be very persistent, consistent, rational, curious, patient and observant which make them good administrators (Childs, 2009). 2.2.1.4 Sanguine The Sanguine is an extroverted, fun-loving, activity-prone, impulsive, entertaining, persuasive, easily amused and optimistic person (Childs, 2009; Steiner, 2008). People and events are their priority. They are fundamentally impulsive, pleasure seeking, talkative, sociable, boisterous and charismatic. Sanguines are receptive and open to others and build friendships easily and fast. They talk and smile frequently and are animated, excited and accepting of others. Even after meeting them for just a few minutes, it is not unusual for one to feel they have been known for years (Steiner, 2008). Sanguines are so people oriented that they often forget about time and other important 10 University of Ghana http://ugspace.ug.edu.gh matters. They generally struggle with following tasks all the way through, are chronically late and tend to be forgetful. The Sanguine never lacks friends. They dislike solitude and get bored easily when there is no fun and social involvement. They are also competitive, tend to be disorganized and can change their focus in an instant. Unless very disciplined, they usually have difficulty controlling their emotions. They tend to like sports and other activities involving lots of people (De Fruyt et al., 2004). Their voice depicts excitement and friendliness and usually dress according to current fashion or styles in vogue. Having an almost shameless nature, they are seldom shy and often seem confident and certain that what they are doing is right. The Sanguine is very effective working with people and hates rejection and not making a favourable impression on others or being viewed as unsuccessful (Childs, 2009). 2.2.2 Trait Theories Following Hippocrates’ four humours theory, later personality theories focused on describing the individual traits, attributes or characteristics that make up a person’s personality. Some of these traits are perfectionism, disinhibition, obsessionality, impulsivity, pessimism, optimism, extraversion and introversion (Widiger & Simonsen, 2005). The trait approach primarily identifies and measures these various personality characteristics, the combination and interaction of which form a personality that is unique to each individual. Trait measurements are more suitable for academic research and clinical purposes because trait theory has objectivity, which some personality theories lack. The earliest theories actually attempted describing every possible trait. Allport (1937) identified more than four thousand (4,000) words in the English language that could be used to describe personality traits. These words were later 11 University of Ghana http://ugspace.ug.edu.gh downsized to introversion/extraversion, neuroticism/emotional stability and psychoticism (Eysenck, 1982). Trait theories have undergone many transformations over the years. A new trait theory popularly referred to as the Five Factor Model or the “Big 5” personality theory was developed based on empirical data-driven research by several independent sets of researchers (Atkinson et al., 2000; McCrae & John, 1992). It is the most scientifically validated and reliable psychological model to test personality. Currently, the majority of contemporary psychologists widely accept that five factors representing five core trait groupings that interact to form human personality are sufficient for trait studies (Cheung et al., 2011). These are Openness to experience, Extraversion, Agreeableness, Conscientiousness and Neuroticism (Schacter et al., 2011; Grucza & Goldberg, 2007) Openness to experience is connected to Intellect. Behavioural aspects include having a wide range of interests and being imaginative and insightful. It involves an appreciation for adventure and sensitivity to beauty, art and emotion (Luo et al., 2007). Extraversion means gregarious, outgoing, sociable, projecting one's personality outward. The opposite of extraversion is introversion. Agreeableness measures the degree to which an individual relates to others with acceptance and tolerance. It describes a compliant, trusting, empathic, sympathetic, friendly and cooperative nature. Conscientiousness refers to being scrupulous, meticulous and having principled behaviour guided by or conforming to one's own conscience. Conscientious people are efficient and organized as opposed to easy-going and disorderly. Neuroticism refers to the tendency to experience negative emotions such as anxiety, depression, anger and mood swings 12 University of Ghana http://ugspace.ug.edu.gh (Cattell & Mead, 2007; DeYoung et al., 2007; DeYoung et al., 2010; Carnivez & Allen, 2005; O’Connor, 2002; Paunonen & Ashton, 2001). Personality is complex and varied but groupings of characteristics tend to occur together in many people. In reality, most people lie somewhere in between the two polar ends of each domain. So trait factors are measured as a continuum between two extremes. Extraversion, for instance, represents a range between extreme extraversion and extreme introversion. Although situational variables play a major role in how people react, more often than not, reactions are consistent with one’s underlying personality traits (McCrae & Terracciano, 2005; Mathews et al., 2003). The Big five model is suitable for both academic and clinical purposes and is able to account for different traits in personality without overlap. It has also been demonstrated to show consistency in interviews, self- descriptions and observations and is found across a wide range of participants from different ages and cultures (Cobb-Clark & Schurer, 2012; Grucza & Goldberg, 2007). 2.2.2.1 Openness to experience Each of the Big Five personality traits is made up of six facets or dimensions which can be assessed independently of the trait to which they belong. Those of openness are active imagination (fantasy), aesthetic sensitivity, attentiveness to inner feelings, preference for variety and intellectual curiosity (Komarraju et al, 2011). These facets or qualities are significantly correlated. 13 University of Ghana http://ugspace.ug.edu.gh Openness to experience points to high levels of imagination and insight and having a broad range of interests (Cheung et al, 2011). People who are open to experience are intellectually curious, creative, sensitive to beauty and willing to try new things. They like adventure, unusual ideas and a diversity of new experiences. They tend to be more aware of their feelings and are also less likely to hold conventional and traditional beliefs. They are flexible and enjoy having their minds and senses stimulated through activities such as complex problem solving, reasoning out issues, reading literature and poetry, viewing art, listening to new music and sampling exotic cuisine (De Fruyt et al, 2004). Open people like to have variety in their day-to-day lives and crave novelty. However, a particular individual may have a high overall openness score and have great interest in wildlife, for instance, but little interest in literature. People rating low on openness are described as closed to experience. Compared to open people, closed people are conservative and resistant to change, portraying a conventional outlook. They prefer familiarity over new experiences and like the plain, straightforward, and obvious over the complex, ambiguous and abstract (Costa & McCrae, 1992). A closed individual enjoys following routines, likes predictability and structure and tends not to engage his imagination on regular bases. They tend to have a narrow range of interests. Such people have their standard beliefs near the status quo. Their choices in occupation, apparel and other areas also often go along with mainstream values (Thompson, 2008). Openness tends to be normally distributed with a small number of people scoring extremely high or low on the trait and the majority in the midline. Highly open people tend to perform significantly more creatively at work as opposed to closed people who 14 University of Ghana http://ugspace.ug.edu.gh have less creative performance (Boileau, 2008). People scoring high on openness also have more liberal political views in contrast to closed people who are more likely to endorse authoritarian, ethnocentric and prejudiced political views. Religious fundamentalism and, to a lesser extent, general traditional religiosity tend to be associated with low openness, while open, mature religiosity and spirituality tend to be associated with high openness (Boileau, 2008). 2.2.2.2 Extraversion Extraversion is characterized by attributes such as excitability, sociability, talkativeness, assertiveness and high amounts of emotional expressiveness (Cobb-Clark & Schurer, 2012). Extraverts enjoy interacting with people, and are often perceived as being full of life, energy and positivity. They are also seen as out-going, gregarious, enthusiastic, expressive, accessible or easy-to approach, action-oriented and possessing high group visibility. They tend to seek out social stimulation and opportunities to engage with others. They are simply excited when around people, feel very much at home and like to energize others (Lucas & Fujita, 2000). They are themselves energized by interaction. In a group, an extravert feels very comfortable and would talk more often and assert himself. They have a wide range of friends and know lots of people. They smile a lot and believe that most people like or will like them (Lucas & Diener, 2001). They are also bold, confident, like to lead, like achievement, compete for the spotlight, like to be popular and would rather be a participant than an observer. They want to change the world, not try to understand it. They tend to like night life activities, like to amuse and frequently touch people. They like moving into action and making things happen. Sometimes, they jump too quickly into an activity forgetting to stop and think it 15 University of Ghana http://ugspace.ug.edu.gh over and get clear on what they want or why they should do it (Schultz & Schultz, 2005). As such, they talk quickly without pausing much to think. Usually, they feel better about a problem when they can talk loud about it and hear what others have to say. They are easy to get to know and would easily volunteer information about themselves. They prefer work that has variety, action and breadth rather than depth and may be seen as shallow. They take words at face value, talk without definite conclusions and do not assume commitment on decisions made (Schultz & Schultz, 2005). Introverts are those who score low on extraversion (Schultz & Schultz, 2005). They tend to be less involved in social situations or have less social engagement than extraverts. They appear quiet, reflective, low-key, private, independent, deliberate and solitary not because they are shy, depressed or unfriendly but are just reserved in social situations. When feeling down, chances are they will not go to anyone for help. Others will have to check out on them. They often hold on to information about themselves and take a while to get to know people and trust them. Introverts get their energy from dealing with the ideas, memories, pictures and reactions from their inner self (Schultz & Schultz, 2005). To them, ideas are almost solid things. Introverts need little external stimulation. They think deeply about things and rather than trying to change the world, they just want to understand it. They like engagements they can carry out on their own as they prefer doing things alone or with one or two people with whom they feel comfortable. To an introvert, having a few friends whom he/she knows very well is worth more than a lot of superficial friends. They prefer work that has depth than breadth and seek out quiet places where they can concentrate (Schultz & Schultz, 2005). They may be seen by others as impenetrable, passive, questioning, subtle and 16 University of Ghana http://ugspace.ug.edu.gh egocentric. They would take time to reflect and decide on what exactly to do before taking action. They think before they speak. Sometimes, they are too hesitant and do not move into action quickly enough (Rothman & Coetzer, 2003; Laney, 2002). Extraversion and introversion are about where people get their energy from - other people or within themselves. Extraversion is also described as an attitude-type characterized by orientation in life through focus on the external world of people and things, and introversion as concentration of interest on one’s inner psychic contents, ideas, concepts and images. Everyone exhibits some amount of extraversion and introversion and would spend some time extroverting and other times introverting (Mendez et al., 2006). What brings the difference is the extent to which we practice one or the other. An extravert would often make a good Persuader, Entertainer or Performer, Advocate, Supporter, Overseer and the like while an introvert would make a good Examiner, Craftsman, Engineer, Confidant or Artist. Extraversion has been shown to share certain genetic markers with substance abuse (Wright et al., 2006). The six facets of extraversion are warmth, gregariousness, assertiveness, activity, excitement seeking and positive emotions. 2.2.2.3 Agreeableness Agreeableness measures the tendency to have faith in other people and be eager to help them or the degree to which one gets along with others. Agreeable people value getting along with others and are generally perceived as warm, sympathetic, considerate, kind, altruistic, affectionate, understanding, tactful, generous, trusting and trustworthy. They 17 University of Ghana http://ugspace.ug.edu.gh are generally helpful and willing to compromise their interests with others. They have positive social interactions showing affection readily and often, are pleasant to be around, work to help others and cooperate well in teams. A person with an agreeable disposition tends to have an optimistic view of human nature, believing that most people are honest, decent and trustworthy. They are likeable by the majority of people (Schacter et al., 2011; Judge et al., 2012). Disagreeable individuals place self-interest above getting along with others. They are generally less empathic or unconcerned with others' well-being so they are less likely to go out of their way to help others (Schacter et al., 2011). They are usually distant, difficult, manipulative, easily offended and demanding in their social relationships. A person scoring low on agreeableness has a high tendency of being suspicious, skeptical and untrusting of others’ intentions and motives. Such a person is generally seen as unfriendly, uncooperative and lacking in social skills. As with the other traits, most people fall somewhere between the two extremes. The facets that are grouped under agreeableness are trust, straightforwardness or morality, altruism, compliance or cooperation, modesty and tender-mindedness or sympathy (Judge & Bono, 2000). Agreeableness is a big advantage for team work and harmony at work and so it is very useful in many working environments (Rothman & Coetzer, 2003). However, this trait is not useful in occupations requiring difficult and objective decisions. Disagreeable people make good military leaders, critics or scientists. Human resource managers and career counselors often include agreeableness in personality job tests (Atkinson et al., 2000). 18 University of Ghana http://ugspace.ug.edu.gh 2.2.2.4 Conscientiousness The sub-traits or facets of conscientiousness are competence or self-efficacy, orderliness, dutifulness, achievement striving, self-discipline and deliberation or cautiousness (Lim & Ployhart, 2004). Conscientiousness describes the extent to which one works towards goals in an industrious, dutiful, disciplined and dependable fashion. It is being thorough, careful or vigilant. It is how a person controls, regulates and directs their impulses. High scores on conscientiousness indicate a preference for planned, rather than spontaneous behaviour. Highly conscientious people are organized, mindful of details, thoughtful, goal directed and have good impulse control (Atkinson et al., 2000). They deliberate on matters or think carefully before acting and prefer to follow a methodical plan rather than act spontaneously. They are disciplined, hard-working and aim for achievement. They possess the desire to do a task well. They are perceived by others as reliable and responsible. They are usually neat, orderly and systematic. Individuals who score high on conscientiousness in a career test are good at formulating long-range goals, organizing and planning routes to these goals and working consistently to achieve them. Due to these attributes, conscientious people are highly successful in their chosen careers or occupation (Cavallera et al, 2013). At the extreme, conscientious people may be conformists, workaholics, perfectionists and compulsive in character. They are also seen as being boring and inflexible. Those who score low on conscientiousness tend to be less goal-oriented, laid back and less driven by success. Such people are also more likely to engage in criminal behaviour (Cavallera et al, 2013). 19 University of Ghana http://ugspace.ug.edu.gh 2.2.2.5 Neuroticism Neuroticism refers to the degree to which a person is vulnerable to stress or how easily one experiences negative emotions such as anxiety, fear, moodiness, worry, irritability, envy, sadness, anger, guilt and depression (Cobb-Clark & Schurer, 2012). It is also defined as a mental or personality disturbance not attributable to any known neurological or organ dysfunction. People who score high in neuroticism are very emotionally reactive and would respond poorly to events that would not bother most people as they are more likely to interpret ordinary situations as threatening and minor frustrations as hopelessly difficult and are often in a bad mood even under normal conditions. They yield easily to stressors and are often self-conscious and shy. Most may find it difficult to think clearly due to the inability to cope with stress. They also tend to have difficulty controlling urges and delaying gratification (Matthews et al, 2003; Jeronimus et al., 2013). The six sub traits of neuroticism are Anxiety, Angry hostility, Depression, Self- consciousness, Immoderation or Impulsivity and Vulnerability. According to Takano et al., (2007) and Miller et al., (2006), neuroticism predicts the occurrence of more negative life experiences. It is also a prospective risk factor for mental conditions such as phobia, panic disorder and substance use disorder. Individuals who score low in neuroticism are more stable emotionally and tend to be calm and free from persistent negative feelings. They are less easily upset, angered, frightened, anxious, stressed or worried. They do not often react negatively or pessimistically to situations and tend to be more optimistic. This does not necessarily mean that emotionally stable people constantly experience lots of positive and exciting 20 University of Ghana http://ugspace.ug.edu.gh emotions, they may remain rather neutral. Exciting emotions are more characteristic of extraverts (Schultz & Schultz, 2005). Generally, people who are highly neurotic are not preferred at the workplace because they may be more easily distracted from their work by deadlines, personal situations, attitudes from colleagues or bosses and pressure (Fiske et al., 2009). Emotionally stable people have more control over their emotions at work and can relate better with others and more likely to deliver results even under unfavourable conditions (Jeronimus et al., 2014). 2.2.3 Criticisms of the Big Five theory This theory is however not without criticisms. The most common criticisms center on the fact that an individual may score high on assessments of a specific trait but may not always behave that way in every situation (Klimstra et al., 2012). Another is that, trait theories do not address how or why individual differences in personality develop or emerge. Some also claim the Big 5 traits do not quite cover all the characteristic traits of humanity. It neglects other domains of personality such as religiosity, honesty, manipulativeness, seductiveness, thriftiness, snobbishness, egotism, masculinity or femininity, sense of humour, risk-taking and thrill-seeking (Komarraju et al, 2011). The Big Five was also described as a ‘psychology of the stranger’ because only traits that are relatively easy to observe in a stranger are considered, excluding traits that are more privately held or more context-dependent (De Fruyt et al., 2004; Harms, 2012). 21 University of Ghana http://ugspace.ug.edu.gh 2.3 DIETARY HABITS Dietary habits refer to the way a person or group eats, considered in terms of what types of food are eaten, in what quantities, and when (MacNicol et al., 2003). Dietary habits include practices such as skipping of meals (some people skip breakfast and other meals due to time pressures, economic reasons, stress and other priorities), vegetarianism (exclusion of meat, fish and other animal products from the diet for religious, health, economic and other reasons) and disordered eating habits such as anorexia nervosa, bulimia nervosa and binge eating disorder. They also involve whether one eats a variety of foods across the food groups or sticks to the same foods all the time. People limiting food intake or avoiding certain foods because ‘it makes them fat’, being unable to control the types and amounts of foods one eats, being a picky eater, eating at short and frequent intervals, not spreading meals but taking one large meal for the day, substituting snacks for main meals, being able or unable to eat foods other than those one is used to, having a sweet tooth or craving for sweets, having a strong liking for fatty foods and always taking large portion sizes are all examples of dietary habits. Making efforts to moderate the intake of fats, sugar, salt or sodium and alcohol are also part (MacLaren & Best, 2009). Individual physical, psychological and philosophical factors as well as social, cultural, religious, geographical, economic, health, environmental, educational and political factors constitute the framework within which foods are chosen to eat and thus influence people's eating habits (Lynam et al., 2005). Considerations and factors people often cite to explain daily food choices include availability, convenience, economy, 22 University of Ghana http://ugspace.ug.edu.gh emotional comfort (they make one feel better for a while), habit (they are familiar, one always eats them), ethnic heritage, personal preference (one likes them) and positive associations (eaten by people one admires, indicate status or reminds one of fun). Others are social pressure (they are offered and one feels one cannot refuse them), region or country where one comes from, values or beliefs (fits one religious traditions, honour environmental ethic, political views) and nutritional value or importance (Wardlaw et al., 2004). Nutritional value, which assigns a high priority to health is most crucial and is of utmost concern to dietitians and should rightly be so to all others but decisions on what to eat are often based on needs other than nutrition judgment. University students may choose to eat at fast-food joints and restaurants to save time or socialize, rather than a consciousness of the need to obtain healthy food (Wade et al., 2006; Henningsen, 2011). 2.3.1 Tool for Assessing Dietary Habits 2.3.1.1 The three factor eating questionnaire The Three-Factor Eating Questionnaire (TFEQ) is one dietary assessment tool frequently used in the determination of dietary behaviour. It is a validated self-report questionnaire developed by Stunkard and Messick (1985) and valuable in evaluating three behavioural characteristics associated with food intake. These are cognitive restraint of eating, disinhibition of control of eating and hunger or emotional eating. Cognitive restraint of eating refers to the monitoring and control of food intake out of the desire to control body weight and shape. Disinhibition of control of eating measures the tendency to continue eating even when satiated (Bryant et al., 2008). The Hunger 23 University of Ghana http://ugspace.ug.edu.gh scale regards subjective feelings of hunger and food cravings both habitual (at certain hours of the day) and in reaction to external cues (Elfhag, 2005; Heaven et al., 2001). According to Appleton & McGowan (2006), one of the most widely used measures in the field of eating behaviour research is the Three Factor Eating Questionnaire. The structural validity of this self-assessment questionnaire is very good. Stunkard and Messick (1985) asserted that the TFEQ has demonstrated relevance in studies of problem eating behaviour and obesity, has good test/retest reliability, and predicts responses to experimental manipulations as well as life events. Costa and his colleagues (2001) also confirmed that the TFEQ is an easily self-administered questionnaire able to distinguish among varied eating behaviours in the population especially in adults and teenagers. The original TFEQ is composed of 51 questions. A short, revised 18-item version was later formulated to boost both the internal consistency and discriminant capacity of scales while still maintaining the three factor structure. This short form is particularly suitable in large-scale studies where participant fatigue and administrative costs should be limited (Klimstra et al., 2012). 2.4 DIET AND WELL-BEING Dietary choices profoundly influence long-term health prospects. The incidence of obesity and debilitating conditions such as cardiovascular diseases, diabetes, osteoporosis, dyslipidaemia and cancer are highly correlated with diet although genetics and some other environmental factors also play a role. Even when individuals are 24 University of Ghana http://ugspace.ug.edu.gh genetically predisposed to the development of negative health conditions, eating right can help subdue or delay their onset (Brown et al., 2014; Mahan et al., 2011). Aside long term health problems, poor eating habits also have short-term effects which compromise daily living standards. Some of these effects are sub-optimal brain function, poor exercise capabilities, indigestion and heartburns, deprived sleep, mood problems and hypo/hyperglycemia in those with diabetes (Williams et al, 2012). Short term rewards for eating right include improved immunity, enhanced memory and concentration, energized body, a more restful or sound sleep, reduced vulnerability to stressors, better mood and stabilized blood sugar for people with diabetes (Mahan et al., 2011). To obtain the best of health from the diet, certain goals must be met. These are adequacy, balance, calorie-control, moderation and variety. Adequacy means that the foods provide enough of each essential nutrient, fibre and energy. Balance means food choices do not overemphasize one nutrient or food type over another. With regards to calorie control, foods should supply the right amounts of calories required to meet energy needs and maintain an appropriate body weight. Moderation is the dietary characteristic of consuming nutrients within set limits and not in excess. The foods should not provide more than the necessary amounts of fat, sugar, salt, and other constituents even if they are desirable. Variety means selecting foods from a very wide and differing range. Rather than repeating the same foods from time to time, diverse types should be sought or chosen and consumed (Whitney & Rolfes, 2015). 25 University of Ghana http://ugspace.ug.edu.gh Dietary guidelines are designed to help in the attainment of these goals. These are plans that recommend specific amounts of food of each type, focusing on whole grains, vegetables, fruits and lean proteins with little room for junk food (Mahan et al., 2011). Good dietary habits such as eating the right portion sizes and appropriate timing of meals and snacks can help in the attainment of these objectives while poor dietary practices such as binging or eating oversized portions, excessive consumption of fatty foods, regularly eating at night, taking lots of sugary beverages, restricted diet and skipping of breakfast and other meals make achievement difficult. Not meeting these goals can have negative consequences on health from under-nutrition or over-nutrition. Insufficiencies and excesses of nutrients can both detract from health (Brown et al., 2014). 2.5 PERSONALITY TRAITS AND EATING DISORDERS Some evidence support an association between personality traits and disordered eating habits such as anorexia nervosa and bulimia nervosa (Clark, 2007; Ball et al, 2009; Hautala et al., 2008; Haycraft et al., 2011; MacLaren & Best, 2009). Certain traits may predispose to or increase the risk of an eating disorder. Both anorexia nervosa and bulimia nervosa have been consistently associated with perfectionism, obsessive- compulsiveness, impulsivity, negative emotionality, sensation seeking, low self- directedness, low cooperativeness, sociotropy, autonomy, narcissism and some other traits as revealed by self-report measures of specific traits (Bollen et al., 2004; Bornstein, 2001). 26 University of Ghana http://ugspace.ug.edu.gh Perfectionism is characterized by the tendency to set and pursue unrealistically high standards in spite of adverse consequences such as persistent hunger (Shafran et al., 2002). Perfectionists tend to be over concerned with mistakes and anxious over performance, which translates into their food and weight preoccupation (Bulik et al., 2003). Impulsivity is characterized by lack of forethought and failure to contemplate risks and consequences before acting, such as a sudden decision to binge and purge, without considering the associated risks (Claes et al., 2006; Chamberlain & Sahakian, 2007). Sociotropy is a personality style characterized by concern with acceptance and approval from others, whereas autonomy is a personality style oriented towards independence, control, and achievement. Cross-sectional studies suggest that disordered eating is associated with both sociotropy and autonomy in clinical samples (Narduzzi & Jackson, 2000). Narcissism reflects pathological concern with physical appearance and presentation, need for external validation from the social environment, intense interpersonal sensitivity, and proneness to deflation of self-esteem (Steiger & Bruce, 2004). Using the Big 5 model which measures Neuroticism, Extraversion, Openness to experience Agreeableness and Conscientiousness, to examine relationship between traits and eating disorders, Neuroticism was found to be the most consistently associated with eating disorders (Diaz-Marza et al., 2000; Ghaderi & Scott, 2000) and correlates with symptoms even in non-clinical subjects (Miller et al., 2006; Wade et al., 2006). Miller et al. (2006) also observed that a combination of high Neuroticism and Low Extraversion has been reported to be a risk factor for eating disorders while Ghaderi & 27 University of Ghana http://ugspace.ug.edu.gh Scott (2000) found low Conscientiousness, low Agreeableness and high Openness to be predictive of the development of an eating disorder. Among the various forms of disordered eating habits, anorexics were noted to have higher levels of conscientiousness (Luo et al., 2007). 2.6 RELATIONSHIP BETWEEN PERSONALITY TRAITS AND DIETARY HABITS Personality traits affect many aspects of life such as career choice, job performance, psychological resilience, negotiation, decision making, physical health, academic achievement, sports/exercise habits and other lifestyle parameters and much likely affect eating habits (Gibson, 2006). Some of the studies conducted pertaining to the link between personality traits and dietary habits revealed some correlations between the two. Huang and his colleagues (2010) found that personality was related to dietary habits and health attitude and concluded that effective health education methods must take the personality of the targeted individuals into consideration. In another study, Marianne et al. (2005) observed that associations exist between personality and diet, even though the strength of this association is influenced by socio- demographic factors such as income and education. Studies by Provencher et al. (2008) also suggested that some personality dimensions are related to some food choices. They found out that a higher score of neuroticism was positively related to disinhibition and susceptibility to hunger. While a higher score of conscientiousness was associated with an increased level of cognitive dietary restraint, it was negatively related to disinhibition 28 University of Ghana http://ugspace.ug.edu.gh and susceptibility of hunger. Negative associations were also observed between extraversion and disinhibition as well as between extraversion or agreeableness and susceptibility to hunger. In another study, Goldberg & Strycker (2002), indicated conscientiousness was linked to low fat intake as opposed to extraversion. Openness was found to be linked to high fiber intake. MacNicol et al. (2003) also came up with reports that Neuroticism was associated with Pickiness and ‘Neophobia’ (dislike for new and unusual foods). Findings from MacLaren & Best (2009) were consistent with previous research results by Miller et al. (2006) that associations exist between disordered eating and high levels of neuroticism as compared to low levels of extraversion. 2.7. BMI AND DIETARY HABITS An individual’s BMI is dependent on the height and weight, thus, at a constant height, the larger the weight, the bigger the BMI of the person. Dietary practices and attitudes that lead to increases in weight thus result in higher BMIs. Generally, binging, or the intake of large portion sizes have the potential to cause weight gains. Immoderation in the intake of the dietary components fat and sugar which are high in calories are also highly predictive of weight gain. On the other hand, insufficient food intake (due to unavailability of enough food, or the habit of dietary restraint) can lead to weight losses. For an ideal weight, calorie control, moderation in the intake of fats and simple carbohydrates such as sugar, adequate fibre intake and other healthy dietary habits are encouraged (Mahan et al., 2011). However, other factors such as genetics and physical activity levels tremendously influence body weight and BMI (Gropper et al., 2009). 29 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE 3.0 METHODS 3.1 STUDY DESIGN This was a cross-sectional study. 3.2 STUDY SITE The study was conducted at the University of Ghana main campus (Legon) and Korle- Bu campus. The University of Ghana is the nation’s premier University, located in Accra, Ghana. Aside its main campus at Legon, in Accra, it has campuses at Korle-Bu, Atomic Energy Commission and Accra Teachers College. The Korle-Bu campus, situated at the Korle-Bu Teaching Hospital which is the country’s largest referral centre serving patients in the Accra Metropolitan area and beyond. 3.3 STUDY PARTICIPANTS The study recruited consenting male and female undergraduate students from the University of Ghana pursuing various courses. 3.3.1 Inclusion Criteria The study included undergraduate students of the University of Ghana who consented to be part of the study. They were either residents or non-residents on campus. 3.3.2 Exclusion Criteria Pregnant or international students and those whose anthropometric measurements could not be taken easily were excluded from the study. 30 University of Ghana http://ugspace.ug.edu.gh 3.4 SAMPLE SIZE Sample size was calculated using the formula: N = Z2 (p) (q) / (E) 2 (Bartlett et al., 2001) Where N is the required sample size Z is the normal distribution value at a chosen confidence interval, α. For this study, a 95% confidence interval was chosen. At α = 95%, Z = 1.96. p = probability that personality traits influence dietary habits q = probability that personality traits do not influence dietary habits. Since there was no published data on the association between traits and eating habits in Ghana at the time of the study, a 50% probability of there being a relationship was chosen. E is the allowable margin of error (5%). N = (1.96)2 (0.5) (0.5) / (0.05)2 N = 384 students To make room for any shortfalls in participants’ answering of questionnaires, 400 respondents were assessed. The current student population of the University of Ghana is about twenty nine thousand, seven hundred and fifty-four (29754) out of which twenty six thousand, one hundred and fifty four (26154) are undergraduates. The male to female ratio is about 2:1. (www.ug.edu.gh, 2015) 31 University of Ghana http://ugspace.ug.edu.gh 3.5 SAMPLING PROCEDURE The 400 students were selected using systematic sampling. The University of Ghana has four colleges, each of which has a number of schools under it. Under each school are departments. From each college, two schools were chosen at random by asking someone to pick two out of a number of folded pieces of papers each having the name of a school. After the selection of the schools, a department was chosen from each school using the same random procedure. Lists of the total number of students were obtained from each of the eight departments chosen. This total number of students was divided by 50 and the result (without the decimals) was used as a factor in selecting the students. For example, if there were a total of 300 students in a department, 300/50 = 6. This forms the sampling interval. Beginning with the first on the list, every 6th student was chosen and these were solicited to take part in the study. Departments that did not have up to fifty (50) students were excluded and another department selected. 3.6 ETHICAL CONSIDERATIONS Permission to conduct the study was sought from the School of Biomedical and Allied Health Sciences Ethics and Protocol Review Committee, College of Health Sciences of the University of Ghana, Korle-Bu. Students were provided with Participant Information Sheet in which the purpose of the study was carefully explained and their liberty to go ahead or withdraw from the study made known to them. A signed written consent was obtained from each student before being allowed to participate. Information obtained pertaining to individuals were kept confidential. 32 University of Ghana http://ugspace.ug.edu.gh 3.7 PRE-TESTING OF QUESTIONNAIRES All the questionnaires were pretested on 20 students to confirm their appropriateness in the Ghanaian setting. A little modification was made before the questionnaires were finally used for data collection e.g. the word blue in the statement ‘I seldom/often feel blue’ was changed to sad to read ‘I seldom/often feel sad’. 3.8 DATA COLLECTION 3.8.1 Socio-demographic Variables Data on socio-demographic variables was obtained using a self-reported questionnaire. Information on their age, gender and level or year of study (100, 200, 300 or 400) was taken. 3.8.2 Anthropometric Measurements Anthropometric measurements were taken according to standardized procedure (CDC, 2007). Body weight was taken to the nearest 0.1 kg on a floor weighing scale (Seca; Humburg) with participant lightly dressed without shoes and any heavy objects. Height was measured to the nearest 0.1cm using a stadiometer (Seca; Humburg). Waist circumference and hip circumference were taken for calculation of Waist/Hip ratio (WHR). Body mass index was calculated as weight divided by height squared (kg/m2). A simple range of values defined as underweight < 18.5 (kg/m2), normal weight 18.5- 24.5 (kg/ m2), overweight 25-29.9 (kg/ m2), obese ≥ 30 (kg/ m2) was used in this study based on the World Health Organization criteria for adults (WHO, 2011). Waist-to-hip ratio was categorized as low, moderate and high risk for disease. These were males (≤ 0.95 as low risk, 0.96-1.0 as moderate risk, 1.0+ as high risk) and females (≤ 0.80 as 33 University of Ghana http://ugspace.ug.edu.gh low risk, 0.81-0.85 as moderate risk, 0.85+ as high risk) (www.bmi-calculator.net/waist- to-hip-ratio-chart.php). 3.8.3 Assessment of Personality Traits Personality traits were assessed using the International Personality Item Pool –IPIP- (Appendix 2), a validated tool for assessing the personality domains of conscientiousness, openness, neuroticism, extraversion and agreeableness (Goldberg & Strycker, 2002). This comprehensive self-assessment personality test instrument measures the strength of these five fundamental dimensions of personality. Respondents were given a list of statements concerning their perception of themselves in a variety of situations and were to choose from a scale, answers that most closely reflected their attitude by indicating the strength of their agreement with each statement. These answers were scored using the scoring instructions given. An individual at or above the fiftieth percentile in a particular trait was considered to be high in that trait. Scores below the fiftieth percentile were considered low. 3.8.4 Assessment of Dietary Habits The "Three-Factor Eating Questionnaire" (TFEQ) (Appendix 1) was used to assess three aspects of the dietary habits which are behavioural. These are cognitive restraint of food intake i.e. monitoring and control of food intake and body weight, disinhibition of control of eating i.e. tendency to continue eating even when satiated and hunger or emotional eating i.e. finding solace in food when stressed or reaction to external cues. The revised 18-item version was used and scoring was carried out according to the scoring instructions provided on the questionnaire. 34 University of Ghana http://ugspace.ug.edu.gh Additional dietary information was taken using a structured questionnaire which assessed pickiness (being fussy, choosy or selective with regards to food), ‘neophagia’ (acceptance of new and unusual foods such as foods from other cultures) food interest (having strong liking for food as compared to one who finds having to eat as a bother and would only eat because he/she has to eat), variety seeking, skipping of meals, consumption of fibre, consumption of fruits and vegetables as well as moderation in the intake of fats, sugar and salt. Students were asked to indicate the strength of their agreement with specific statements pertaining to the dietary habits on a true or false scale which was expanded to definitely true, mostly true, mostly false and definitely false. False for a reversed question was taken as true (compare ‘I like to stick to the foods that I know’ to ‘I enjoy trying new foods’). A number of statements were analyzed (based on this true or false scale) to determine whether or not the respondent was prone to the dietary habit in question. A Food Frequency Questionnaire, which was adapted from the validated EPIC-Norfolk nutritional methods food frequency questionnaire (www.srl.cam.ac.uk/epic/nutmethod/FFQ.shtml) and modified to suit the food categories in consideration, was used to further assess the intake of fibre, fruits and vegetables in addition to foods rich in fats and sugar (Appendix 1). Rather than using individual food items, some foods were grouped together under a common name (such as fruits, legumes, vegetables) and foods commonly consumed in Ghana were listed in the examples given. 3.9 STATISTICAL ANALYSIS Data collected was analyzed using the Statistical Package for Social Sciences (SPSS) software version 20.0. Descriptive variables like means with standard deviations, modes, medians and frequencies were used. Chi-square analysis was used to test for 35 University of Ghana http://ugspace.ug.edu.gh association between measured dietary habits and BMI, dietary habits and WHR as well as between personality traits and dietary habits. The level of significance was set at p ≤ 0.05. 36 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR 4.0 RESULTS 4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS Table 1 shows the socio-demographic characteristics of the undergraduate students. A total of 400 students, 100 students from each of the four colleges were recruited into the study. The 400 students consisted of 230 (57.5%) males and 170 (42.5%) females. Majority (74%) of the students were in the age range of 20-24 years. The mean age of the students was 21.0 ± 2.0 years. Students’ levels spanned from first year to fourth year. Table 1: Socio-demographic characteristics of the students Variables Category Frequency Percentage (%) (n = 400) Age (years) 17-19 82 20.5 20-24 296 74 25-29 22 5.5 Gender Male 230 57.5 Female 170 42.5 Level of study 100 88 22.0 200 110 27.5 300 108 27.0 400 94 23.5 37 University of Ghana http://ugspace.ug.edu.gh 4.2 ANTHROPOMETRIC INDICES OF THE STUDENTS Table 2 shows the anthropometric indices of the students. Statistically significant differences (p< 0.05) were observed between gender and all the indices. The majority of the students had normal BMI (68%) with a few obese (3.8%) (Fig.1). When WHRs were compared in terms of gender (Figure 2), more males (99.14%) were in the low risk category than females (84.12%). TABLE 2: Anthropometric indices of the students Anthropometric Mean ±Standard Deviation indices p-value Males Females All (n=230) (n=170) (n=400) Weight (kg) 63.67 ± 8.62 59.46±10.52 61.89 ± 9.69 0.000* Height (cm) 170.49 ± 17.19 163.17±6.22 167.38 ± 14.11 0.000* BMI (kg/m²) 21.87 ± 3.63 22.37±3.63 22.0 ± 3.6 0.000* WHR 0.81 ± 0.04 0.76±0.04 0.000* Significance set at p-value ≤ 0.05 chi-square test 38 University of Ghana http://ugspace.ug.edu.gh Figure 1: Body mass index of students Figure 2: Waist-to-Hip Ratio of students 39 University of Ghana http://ugspace.ug.edu.gh 4.3 PERSONALITY TRAITS OF THE STUDENTS Assessment of the personality traits revealed that 73.2% and 51.5% scored high on conscientiousness and agreeableness respectively, and scored low (20.7%) on openness to experience (figure 3). Figure 3: Personality traits of students Males (figure 3a) and females (figure 3b) showed similar trends. High scores were observed for conscientiousness and agreeableness whereas low scores were observed for extraversion, neuroticism and openness. 40 University of Ghana http://ugspace.ug.edu.gh Figure 3a: Personality traits of males Figure 3b: Personality traits of females 41 University of Ghana http://ugspace.ug.edu.gh 4.4 DIETARY HABITS OF STUDENTS The dietary habits of the students are presented in Table 3. Significant differences (p<0.05) were observed between the males and females in the areas of emotional eating, pickiness, neophagia, fibre consumption, sugar and salt moderation. A significantly higher percentage of females than males reported being emotional eaters (p = 0.024), picky eaters (p = 0.031), practicing neophagia (p = 0.013) and consuming fiber-rich foods (p = 0.023). Comparatively, a significantly larger percentage of males than females described themselves as moderating sugar intake (p = 0.029) and salt intake (p = 0.058). 42 University of Ghana http://ugspace.ug.edu.gh Table 3: Table showing the dietary habits of students according to gender Males Females All p-value (n=230) (n=170) (N=400) Yes No Yes No Yes No % % % % % % Disinhibition 20.9 79.1 16.5 78.3 19.0 81.0 0.635 Cognitive 21.7 78.3 30 70 25.2 74.8 0.060 Restraint Emotional eating 15.7 84.3 24.7 75.3 19.5 80.5 0.024* Pickiness 24.8 75.2 34.7 65.3 29.0 71.0 0.031* Neophagia 28.7 71.3 40.6 59.4 33.8 66.2 0.013* Food interest 47.4 52.6 47.6 52.4 47.5 52.5 0.960 Variety 42.6 57.4 45.3 54.7 43.8 56.2 0.593 Skipped meals 43 57 45.3 54.7 44.0 56.0 0.654 Fiber 19.1 80.9 28.8 71.2 23.2 76.8 0.023* consumption Fruits and 56.5 43.5 60.5 39.4 58.2 41.8 0.415 vegetables Fats moderation 44.3 55.7 47.6 52.4 45.8 54.2 0.513 Sugar moderation 42.4 57.6 31.7 68.3 36.2 63.8 0.029* Salt moderation 49.6 50.4 40 60 45.5 54.5 0.058* Significance set at p-value ≤ 0.05 Chi-Square test 43 University of Ghana http://ugspace.ug.edu.gh The students ate from all the selected food groups in the study (Figure 4). The majority of the students consumed unpolished whole grain cereals, legumes and fruits about 1-3 times a month. Vegetables were consumed 2-4 times a week. More males consumed fruits than females and this was significant (p=0.023). For sugar, more females consumed sugar once a day than males and this was significant (p=0.029). Equal numbers of males and females consumed carbonated drinks once a day. 44 University of Ghana http://ugspace.ug.edu.gh Figure 4: Frequency in consumption of the various food groups 44 University of Ghana http://ugspace.ug.edu.gh Table 4a and 4b show the association betw een BMI and dietary habits of the students. With the exception of sugar moderation (p=0.05), no significant associations were observed between the dietary habits of the students and their BMI. 45 University of Ghana http://ugspace.ug.edu.gh TABLE 4a: Association between Body Mass Index and Dietary Habits of the students N = 400 Disinhibition Cognitive Emotional Pickiness Neophagia Food Variety Skipping Fiber intake Fruits & Restraint Eating interest meals veggies Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N % % % % % % % % % % % % % % % % % % % % Underweight 17.3 82.7 19.2 80.8 21.2 78.8 26.9 73.1 30.8 69.2 42.3 57.7 38.5 61.5 38.5 61.5 84.6 15.4 51.9 48.1 Normal weight 19.9 80.1 25.0 75.0 18.0 82.0 28.7 71.3 33.1 66.9 46.4 52.6 44.9 55.1 45.2 54.8 75.0 25.0 59.2 40.8 Overweight 16.4 83.6 32.8 67.2 24.6 75.4 31.1 68.9 36.1 63.9 45.9 54.1 42.6 57.4 42.6 57.4 77.0 23.0 57.4 42.6 Obese 20.0 80.0 20.0 80.0 20.0 80.0 33.3 66.7 46.7 53.3 73.3 26.7 46.7 53.9 46.7 53.3 80.0 20.0 66.7 33.3 P-value 0.918 0.382 0.686 0.941 0.676 0.200 0.847 0.825 0.501 0.703 Y = yes, N = no. P-value ≤ 0.05 is significant chi-square test 46 University of Ghana http://ugspace.ug.edu.gh Table 4b: Association between Body mass index and dietary habits (fat, sugar and salt moderation) of students N = 400 Variables Fat moderation Sugar Salt moderation moderation Y N Y N Y N % % % % % % Underweight 42.3 57.7 25.0 75.0 50.0 50.0 Normal weight 44.1 55.9 38.2 61.8 46.7 53.3 Overweight 57.4 42.6 42.6 57.4 32.8 67.2 Obese 40.0 60.0 13.3 86.7 60.0 40.0 P-value 0.255 0.050* 0.120 Significance set at p-value ≤ 0.05 chi-square test 47 University of Ghana http://ugspace.ug.edu.gh Table 5 shows the association between waist-to-hip ratio and dietary habits of the students. There was no significant difference between the WHR of males and females and their dietary habits with the exception of pickiness (p=0.043 and p=0.017 respectively). Table 5: Association between Waist-to-Hip Ratio and Dietary Habits of students Dietary Habits Males Females Disinhibition 0.519 0.615 Cognitive restraint 0.130 0.257 Emotional eating 0.057 0.144 Pickiness 0.043* 0.017* Neophagia 0.080 0.074 Food Interest 0.660 0.570 Variety 0.309 0.620 Skipping Meals 0.319 0.633 Fibre Intake 0.122 0.135 Fruits and Vegetables 0.240 0.525 Fat moderation 0.581 0.481 Sugar moderation 0.109 0.130 Salt moderation 0.122 0.132 Significance set at p-value ≤ 0.05. chi-square 48 University of Ghana http://ugspace.ug.edu.gh Table 6 shows the relationship between personality traits and dietary habits. Extraversion, agreeableness and openness were significantly related to neophagia (p<0.05). Only extraversion was significantly related to food interest (p=0.008). Both conscientiousness and agreeableness were significantly related to variety seeking (p=0.045 and p=0.005 respectively). Agreeableness and conscientiousness were significantly related to skipping meals (p=0.007) and sugar moderation (p=0.006) respectively. Table 6: Relationship between personality traits and dietary habits of students Extraversion Conscientiousness Neuroticism Agreeableness Openness Disinhibition 0.198 0.702 0.541 0.135 0.699 Cognitive 0.531 0.996 0.353 0.359 0.579 Restraint Emotional 0.455 0.805 0.205 0.768 0.800 eating Pickiness 0.177 0.323 0.665 0.870 0.985 Neophagia 0.028* 0.243 0.908 0.045* 0.009* Food 0.008* 0.968 0.827 0.528 0.887 Interest Variety 0.273 0.045* 0.582 0.005* 0.675 Skipping 0.220 0.066 0.629 0.007* 0.713 meals Fiber 0.171 0.764 0.588 0.092 0.780 Fruits 0.965 0.126 0.177 0.310 0.679 Fat 0.634 0.642 0.196 0.310 0.213 moderation Sugar 0.249 0.006* 0.734 0.248 0.780 moderation Salt 0.367 0.197 0.148 0.957 0.850 moderation p-value ≤ 0.05 is significant chi-square test 49 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE 5.0 DISCUSSION AND CONCLUSION 5.1 DISCUSSION This study provides information on the anthropometry of students of University of Ghana, their personality traits and the dietary habits or behaviours. It went further to find whether the various dietary habits or patterns were significantly reflected on their BMI and whether personality traits were predictive of dietary habits. The sample size and the structural design were consistent with methods used in related studies (Provencher et al, 2008; Marrianne et al, 2005; MacNicol et al, 2003). In this study, the mean weight, height and WHR of the males were significantly higher than that of the females (p < 0.05). However, the mean BMI of the females was significantly higher than that of the males. Except for a few obese students and others who were either underweight or overweight, the BMI and WHR were within the normal or ideal range as categorized by the WHO (2011). The results agree with a study conducted among freshman University students in a Turkish population, where most of them (85.7%) had normal BMI (Gunes et al., 2012). In addition, more males were within the normal range for WHR than females. This is similar to the results from some studies carried out among young adults where average BMI values were consistently lower in males than in their female counterparts (Dugas et al, 2009; BeLue et al, 2009). Studies among South-African and Cameroonian Universities also, reported similar findings (Smith & Essop, 2009). However, their values were slightly higher than the findings in this study. 50 University of Ghana http://ugspace.ug.edu.gh About three quarters of the students had high scores on conscientiousness describing themselves in ways that portray self-discipline, dutifulness and planned behaviour as compared to disorderliness. Conscientiousness is a highly desirable character trait and thus it is commendable to have a great number of students exhibiting this trait. It shows that they are generally concerned about accomplishing tasks correctly. They can therefore be described as dependable, responsible, vigilant, careful, thorough, organized, highly efficient and aiming for achievement (Takano, 2007). Agreeableness is another trait in which a lot of the students (51.5%) had high scores. The students could be described as cooperative, considerate, kind, warm and affectionate. (Takano, 2007). Less than half (37%) of the students can be described as being highly sociable, warm, talkative and emotionally expressive (high extraversion) while about the same number (30%) were emotionally unstable and highly susceptible to stress, anxiety, depression and other negative emotions (high neuroticism). Openness, which describes intellectual pursuits, seeking new experiences, imagination and creativity, had the least occurrence (20.7%). Openness tells how readily an individual accepts change, whether he/she is conservative, always holding on to the old ways of doing things or seeks out new ways (Luo et al, 2007). The result for openness contradicts the report by Wen et al. (2015), who found openness to be a dominant trait in a group of Chinese young adults. Cultural differences may be a factor for the variations in the levels of openness. In this study, both males and females scored highest on conscientiousness and lowest on openness. More males than females scored high on neuroticism but it was not statistically significant (p=0.07). This also contradicts the findings from other studies which suggest that women generally score higher on neuroticism than males (Wen et al, 2015; Marianne et al, 2005). Fischer et al. (2004) also revealed that women tend to report more negative emotionality than men. 51 University of Ghana http://ugspace.ug.edu.gh Overall, the dietary pattern of the students cannot be described as healthy as general dietary recommendations were not met by the majority. Whether an individual practiced disinhibition in the control of food intake, cognitively restraint the diet, was susceptible to emotional hunger, was picky, “neophagic” or had high interest in food, the most important aspect is to meet goals for balance, variety, adequacy of nutrients, calorie control and moderation in the intake of constituents such as fat, sodium (salt) sugar and alcohol. However, these attitudes may influence the individual’s ability or inability in meeting nutrition goals. More than half the population studied indicated they skipped meals, which is not a good practice. Aside reports by the greater number of students of consuming varied foods from day to day and not always repeating the same food types, reports for the consumption of fruits and vegetables on daily basis and adequate intake of fibre-rich foods as well as moderation in the intake of fat, sugar and salt were not favourable. Only 24.3% of the students consumed enough fibre. This may be detrimental to their health since adequate intake of fibre, fruits and vegetables is important for optimum health and can help reduce the risk of many disease conditions (WHO, 2015). The number who moderated the intake of fats, sugar and salt were also few. Over-consumption of fats and sugar can lead to obesity with consequent health problems (WHO, 2015, FAO, 2010). Immoderation in the intake of salts has been found to be associated with hypertension (WHO, 2012; Mahan et al, 2011). Not a large percentage of the students recounted having a lack of control over eating (disinhibition) or intentionally avoiding food for fear of weight gain ( cognitive dietary restraint) or even seeking comfort in food when sad, depressed, anxious or stressed (emotional eating). A significantly higher proportion of females scored higher on emotional eating compared to the males. A plausible explanation could be that females tend to be more emotional than men (Fischer et al., 2004). 52 University of Ghana http://ugspace.ug.edu.gh The findings in this study also revealed significantly higher differences in pickiness and ‘neophagia’ in females compared to males. No significant difference was seen in food interest between genders which is in conformity with reports from MacNicol et al. (2003). A significantly higher proportion of males reported consuming more fibre than the females. Overall, the intake of fruits and vegetables, skipping of meals and seeking variety was not significantly different between genders. In a study by Cassin and Von-Ranson (2005), they found out that gender differences may exist between males and females in their eating habits. From the results of the collation of frequencies of consumption of various food items, the moderation of fat intake and sugar intake was not significantly different between males and females. No associations were found between the BMI of respondents and the dietary habits observed except for moderation of sugar consumption. Sugar is high in calories which can lead to weight gains when consumed in excess and higher weights results in higher BMI. It was anticipated that disinhibition control of eating, emotional hunger and high food interest would be linked with higher BMI as a result of binging or intake of large portion sizes while cognitive restraint connects with lower BMI from inadequate intake. Adequate consumption of fruits, vegetables and fibre as well as moderation in the intake of fat and sugar were also expected to be significantly associated with BMI as dietary guidelines generally recommend these practices for normal weight and optimum health (Whitney & Rolfes, 2015). A study by Liu and his colleagues (2003) revealed that weight gain and thus BMI was inversely associated with high-fiber, whole grain foods but positively related to the intake of refined foods. A study by Al-Muammar et al, (2014) to find the association between dietary habits and BMI of students in a Saudi Arabian school found no significant differences between BMI category and dietary pattern and lifestyle. Thus, BMI may be influenced by other factors such as physical activity levels, genetics and age. Higher physical activity levels are linked to ideal 53 University of Ghana http://ugspace.ug.edu.gh or closer-to-the-normal BMI values. With regards to age, younger adults generally tend to have lower BMI than older adults. According to Villareal et al, (2005) data from population studies showed that mean body weight and BMI gradually increase during most of adult life and reach peak values at 50-59 years of age in both males and females. The students observed in this study were young adults with the majority between ages 20 – 24 years. This study indicates that differences in personality styles are reflected in some attitudes towards food and eating behaviour or dietary habits in general. No significant association was found between any of the five traits and disinhibition of control of food intake, cognitive dietary restraint and emotional eating. In a similar study (Marianne et al, 2005), neuroticism and low agreeableness were associated with continued eating even when satiated (disinhibition). They also found extraversion and low openness to be associated with greater cognitive control of food intake. In addition, they found low conscientiousness; low extraversion and low agreeableness were associated with greater susceptibility to hunger. In this study, pickiness was also not associated with any of the five traits. However in Scotland, MacNicol et al., (2003) found some relationship between neuroticism and pickiness as well as neophobia (neophobia is dislike or rejection of new and unusual foods in contrast to neophagia which is the acceptance of such foods). Most of the associations observed were the expected linkages. Extraversion was associated with neophagia meaning that individuals who are warm and sociable would not only stick to the foods they know but like to try new foods from other cultures. Extraverts also have high food interest. They do not find having to eat to be a bother or only eat because they have to eat (MacNicol et al., 2003). This does not necessarily mean that the individual overeats but that he/she expresses much interest or liking for food. 54 University of Ghana http://ugspace.ug.edu.gh Conscientiousness was associated with variety seeking and moderation in salt intake. This shows the students who were disciplined, industrious and dutiful also sought variety in their diet and moderated salt intake. Reports from other studies (Goldberg & Strycker, 2002) suggest that conscientiousness is connected to fat moderation as opposed to extraversion. Openness was linked to high fibre intake. In this study, neuroticism was not found to be associated with any of the dietary habits observed. Agreeableness was associated with neophagia, variety seeking and skipping of meals. This suggests those who like to modify their character to suit others also like to try new foods but skip meals which is not a good habit. Openness was associated with only neophagia and this also demonstrates that people who embrace change and like to try new experiences readily accept even unfamiliar foods. The study had the following limitations: i. Respondents might have under- or over- reported (Donaldson & Grant-Vallone, 2012). ii. The study was cross-sectional, so that causality between variables could not be determined. 5.2 CONCLUSION Almost all the students scored high on conscientiousness and agreeableness but low on openness implying Ghanaian students are less open compared to most others in the world. The majority of the students did not practice healthy dietary habits with regards to adequate fibre consumption, moderation in the intake of sugar, salt and fats as well as seeking variety in meals. The dietary habits of the undergraduate students of the University of Ghana did not 55 University of Ghana http://ugspace.ug.edu.gh reflect on their BMI except for sugar intake. Other factors that influence BMI might be at play. Personality traits may have an influence on dietary habits but generalizations cannot be made based on this study alone. It is recommended that: 1. Similar studies are carried out in different populations differing in age, education and other socio-demographic variables. 2. Future studies could take a look at some of the dietary habits not covered in this work – adequacy of intake, calorie control, intake of supplements, alcohol etc. 3. Future studies could also benefit from inclusion of more accurate methods for assessing dietary habits, such as weighed food record. Other aspects of personality such as impulsivity, sociotropy and autonomy could also be observed. 4. Further studies to unearth ways in which knowledge obtained on relationship between personality and dietary habits can be used to enhance dietary counselling. 5. Increasing nutrition and health education programmes may help improve students’ attitudes and dietary habits. 6. The majority of students had low scores on openness to experience. This trait is essential for the growth and development of a nation or people. Activities that challenge or stimulate the students to reasoning out of issues and solving of complex problems should be encouraged. 7. 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APPENDIX Appendix 1: Questionnaires 67 University of Ghana http://ugspace.ug.edu.gh PERSONALITY TRAITS AND DIETARY HABITS AMONG UNDERGRADUATE STUDENTS OF THE UNIVERSITY OF GHANA College of Health Sciences, School of Biomedical and Allied Health Sciences, Department of Nutrition and Dietetics. ID No……… Participant Information Sheet This is in conjunction with a study being conducted by the department of Nutrition and Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, Korle-Bu. The goal of this study is to establish/determine the relationship between personality traits and dietary habits among students of the University of Ghana. You will be requested to answer questions on your age, gender and other socio-demographic factors as well as questions pertaining to your character attributes or personality type. This will be followed by questions on your dietary habits. Your permission will also be sought for your weight, height and your waist and hip circumference to be taken. These questions and procedures are purely for academic purposes. They are usually asked or carried out in studies of this sort. Information gathered will be kept strictly confidential. For a true reflection of personality traits on eating habits, it is very important that we get as accurate an answer as possible from you. We trust that you will give us your best support. Thank you very much. 68 University of Ghana http://ugspace.ug.edu.gh Informed Consent Form I …………………………………………… willingly agree to partake in this research study being conducted by Emefa Gifty Oddam, Mrs Freda Intiful and Dr. Joana Ainuson-Quampah all of the department of Dietetics, School of Biomedical and Allied Health Sciences, Korle- Bu and Dr. Irene Kretchy of the Department of Practice and Clinical Pharmacy, University of Ghana School of Pharmacy. I understand that I do not have to go ahead if I do not want to do so. There are no harms or benefits that I will get by taking part in this study. Findings will be kept confidential and would be made available to me if I make a request. I may also ask any questions I have now or later. I have been informed that this proposal is reviewed, approved and granted ethical clearance by the School of Biomedical and Allied Health Sciences Ethics and Protocol Review Committee, Korle-Bu. They are responsible for protecting research participants from harm. By signing this form, I am agreeing to take part in this research study. ……………………………………. ………………… ………………….. Name of Principal Investigator Signature Date ………………………………......... …………………… …………………. Name of Participant Signature Date 64 University of Ghana http://ugspace.ug.edu.gh Questions can be addressed to the Principal Investigator (0573786678, emefatoddam@yahoo.com). Additional questions or problems concerning your rights as a research participant should be addressed to: The Chairperson, Ethics and Protocol Review Committee, School of Biomedical and Allied Health Sciences, Korle-Bu, Accra, Ghana. Socio-demographics and Anthropometry ID No…............... Age …..... Gender: 1. Male 2. Female Level 1). 100 2). 200 3). 300 4). 400 Are you Resident on campus? 1). Yes 2). No (indicate where you live)……........... Weight ………… Height……….. BMI……….. Waist circumference…………cm Hip circumference……..cm W/H ratio …………… 65 University of Ghana http://ugspace.ug.edu.gh The ‘Big 5’ personality traits or the Five Factor Model questionnaire Tick in the corresponding box: 1 - Strongly disagree 2 - Somehow disagree 3 – Neutral 4 – Somehow agree 5 - Strongly agree Disagree Neutral Agree Behaviour 1 2 3 4 5 I am the life of the party ( I make gatherings lively/exciting) I feel little concern for others. I am always prepared. I get stressed out easily. I have a rich vocabulary. I don't talk a lot. I am interested in people. I leave my belongings around. I am relaxed most of the time. I have difficulty understanding abstract ideas. I feel comfortable around people. I insult people. I pay attention to details. I worry about things. I have a vivid imagination. I keep in the background. I sympathize with others' feelings. I make a mess of things. I seldom feel sad. I am not interested in abstract ideas. I start conversations. I am not interested in other people's problems. I get chores done right away. 66 University of Ghana http://ugspace.ug.edu.gh Disagree Neutral Agree Behaviour 1 2 3 4 5 I am easily disturbed. I have excellent ideas. I have little to say. I have a soft heart. I often forget to put things back in their proper place. I get upset easily. I do not have a good imagination. I talk to a lot of different people at parties. I am not really interested in others. I like order. I change my mood a lot. I am quick to understand things. I don't like to draw attention to myself. I take time out for others. I shirk my duties. I have frequent mood swings. I use difficult words. I don't mind being the center of attention. I feel others' emotions. I follow a schedule. I get irritated easily. I spend time reflecting on things. I am quiet around strangers. I make people feel at ease. I am exacting in my work. I often feel sad. I am full of ideas. 67 University of Ghana http://ugspace.ug.edu.gh The Three-Factor Eating Questionnaire Please tick the description that most appropriately applies to you Definitely Mostly Mostly Definitely This is how I feel or behave true true false false 1 2 3 4 1 When I smell a sizzling steak or juicy piece of meat, I find it very difficult to keep from eating, even if I have just finished a meal. 2 I deliberately take small helpings as a means of controlling my weight. 3 When I feel anxious, I find myself eating 4 Sometimes when I start eating, I just can’t seem to stop. 5 Being with someone who is eating often makes me hungry enough to eat also 6 When I feel sad, I often overeat 7 When I see a real delicacy, I often get so hungry that I have to eat right away 8 I get so hungry that my stomach often seems like a bottomless pit. 9 I am always hungry so it is hard for me to stop eating before I finish the food on my plate. 10 When I feel lonely, I console myself by eating 11 I consciously hold back at meals in order not to weight gain. 12 I do not eat some foods because they make me fat 13 I am always hungry enough to eat at any time 68 University of Ghana http://ugspace.ug.edu.gh 14 How often do you feel hungry? Only at meal times Sometimes between meals Often between meals Almost always 15 How frequently do you avoid "stocking up" on tempting foods? Almost never Seldom Usually Almost always 16 How likely are you to consciously eat less than you want? Unlikely Slightly likely Moderately likely Very likely 17 Do you go on eating binges though you are not hungry? Never Rarely Sometimes At least once a week 18 On a scale of 1 to 8, where 1 means no restraint in eating (eating whatever you want, whenever you want it) and 8 means total restraint (constantly limiting food intake and never "giving in"), what number would you give yourself? Definitely Mostly Mostly Definitely true true false false I have been called / consider myself a picky eater I find many foods distasteful I won’t try a food if I don’t like one of its ingredients A bad experience would keep me from trying a food again I enjoy trying new, sometimes unusual foods I like different cultural foods I like to stick to the foods that I know I make a deliberate effort to take enough fiber I love to eat 69 University of Ghana http://ugspace.ug.edu.gh Having to eat is a bother I like very sweet foods and take much sugar I only eat because I have to eat I always have breakfast I take three meals a day with snacks I take small meals at frequent intervals I sometimes binge eat I stop eating as soon as I feel full I eat fruits and/or raw vegetables everyday I sometimes skip meals I avoid meat fats (I trim off all visible fats) I sometimes substitute snacks for meals I avoid animal foods especially red meats (write 5 in the first box if you are a vegetarian) I eat the same kinds of foods very often I eat a wide variety of foods I take one bulky meal a day rather than smaller amounts spread through the day I often choose fried and oily foods I avoid eating even when I am hungry because I am terrified about being overweight I add salt to my food at the table I have been called / consider myself a picky eater I find many foods distasteful I won’t try a food if I don’t like one of its ingredients A bad experience would keep me from trying a food again I enjoy trying new, sometimes unusual foods I like different cultural foods 70 University of Ghana http://ugspace.ug.edu.gh I like to stick to the foods that I know I make a deliberate effort to take enough fiber I love to eat Having to eat is a bother I like very sweet foods and take much sugar I only eat because I have to eat I always have breakfast I take three meals a day with snacks I take small meals at frequent intervals I sometimes binge eat I stop eating as soon as I feel full I eat fruits and/or raw vegetables everyday I sometimes skip meals I avoid meat fats (I trim off all visible fats) I sometimes substitute snacks for meals I avoid animal foods especially red meats (write 5 in the first box if you are a vegetarian) I eat the same kinds of foods very often I eat a wide variety of foods I take one bulky meal a day rather than smaller amounts spread through the day I often choose fried and oily foods I avoid eating even when I am hungry because I am terrified about being overweight I add salt to my food at the table 71 University of Ghana http://ugspace.ug.edu.gh Appendix 2: INTERNATIONAL PERSONALITY ITEM POOL DEVELOPED BY GOLDBERG (1999) Please answer this survey as honestly as possible. Any questions you may object to can be left blank. After completing this survey, determine your absolute and relative scores on this survey and store those scores in a safe place. Please describe yourself as you generally are now, not as you wish to be in the future. Describe yourself as you honestly see yourself, in relation to other people you know of the same sex as you are, and roughly your same age Below are phrases describing people's behaviours. Please read each statement carefully, and then indicate how accurately each statement describes you by marking the appropriate number on the scale beside each question. Use the following format: 1 2 3 4 5 Very Moderately Neither Inaccurate Moderately Very Inaccurate Inaccurate nor Accurate Accurate Accurate 72 University of Ghana http://ugspace.ug.edu.gh 1. … I am the life of the party. 1 2 3 4 5 2. … I feel little concern for others. 1 2 3 4 5 3. … I am always prepared. 1 2 3 4 5 4. … I get stressed out easily. 1 2 3 4 5 5. … I have a rich vocabulary. 1 2 3 4 5 6. … I don't talk a lot. 1 2 3 4 5 7. … I am interested in people. 1 2 3 4 5 8. ... I leave my belongings around. 1 2 3 4 5 9. … I am relaxed most of the time. 1 2 3 4 5 10. … I have difficulty understanding abstract ideas. 1 2 3 4 5 11. … I feel comfortable around people. 1 2 3 4 5 12. … I insult people. 1 2 3 4 5 13. … I pay attention to details. 1 2 3 4 5 14. … I worry about things. 1 2 3 4 5 15. … I have a vivid imagination. 1 2 3 4 5 16. … I keep in the background. 1 2 3 4 5 17. … I sympathize with others' feelings. 1 2 3 4 5 18. … I make a mess of things. 1 2 3 4 5 19. … I seldom feel blue. 1 2 3 4 5 20. … I am not interested in abstract ideas. 1 2 3 4 5 21. … I start conversations. 1 2 3 4 5 22. … I am not interested in other people's problems. 1 2 3 4 5 23. … I get chores done right away. 1 2 3 4 5 24. … I am easily disturbed. 1 2 3 4 5 25. … I have excellent ideas. 1 2 3 4 5 26. … I have little to say. 1 2 3 4 5 27. … I have a soft heart. 1 2 3 4 5 28. … I often forget to put things back in their proper place. 1 2 3 4 5 29. … I get upset easily. 1 2 3 4 5 30. … I do not have a good imagination. 1 2 3 4 5 31. … I talk to a lot of different people at parties. 1 2 3 4 5 32. … I am not really interested in others. 1 2 3 4 5 33. … I like order. 1 2 3 4 5 34. … I change my mood a lot. 1 2 3 4 5 73 University of Ghana http://ugspace.ug.edu.gh 35. … I am quick to understand things. 1 2 3 4 5 36. … I don't like to draw attention to myself. 1 2 3 4 5 37. … I take time out for others. 1 2 3 4 5 38. … I shirk my duties. 1 2 3 4 5 39. … I have frequent mood swings. 1 2 3 4 5 40. … I use difficult words. 1 2 3 4 5 41. … I don't mind being the center of attention. 1 2 3 4 5 42. … I feel other’s emotions. 1 2 3 4 5 43. … I follow a schedule. 1 2 3 4 5 44. … I get irritated easily. 1 2 3 4 5 45. … I spend time reflecting on things. 1 2 3 4 5 46. … I am quiet around strangers. 1 2 3 4 5 47. … I make people feel at ease. 1 2 3 4 5 48. … I am exacting in my work. 1 2 3 4 5 49. … I often feel blue. 1 2 3 4 5 50. … I am full of ideas. 1 2 3 4 5 Scoring Instructions This test measures your level of extroversion, agreeableness, conscientiousness, emotional stability, and openness to experience. Reverse Scoring: For questions 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 29, 30, 32, 34, 36, 38, 39, 44, 46, 49, give yourself 1 point if you circled 5, 2 points if you circled 4, 3 points if you circled 3, 4 points if you circled 2, and 5 points if you circled 1. For all the other questions, give yourself 5 points if you circled 5, 4 points if you 4, 3 points if you circled 3, 2 points if you circled 2, and 1 point if you circled 1. 74 University of Ghana http://ugspace.ug.edu.gh Extraversion Item Your Score 1 _________ (hint…if you gave yourself a 5, then put 5 in ‘your score’) Reverse Scored 6 _________ (hint…if you gave yourself a 5, then put a 1 in ‘your score’) 11 _________ (hint…if you gave yourself a 4, then put a 4 in ‘your score’) Reverse Scored 16 _________ (hint…if you gave yourself a 4, then put a 2 in ‘your score’) 21 _________ (hint…if you gave yourself a 3, then put a 3 in ‘your score’) Reverse Scored 26 _________ (hint…if you gave yourself a 3, then put a 3 in ‘your score’) 31 _________ (hint…if you gave yourself a 2, then put a 2 in ‘your score’) Reverse Scored 36 _________ (hint…if you gave yourself a 2, then put a 4 in ‘your score’) 41 _________ (hint…if you gave yourself a 1, then put a 1 in ‘your score’) Reverse Scored 46 _________ (hint…if you gave yourself a 1, then put a 5 in ‘your score’) Total Extraversion _________ Agreeableness Item Your Score Reverse Scored 2 _________ 7 _________ Reverse Scored 12 _________ 17 _________ Reverse Scored 22 _________ 27 _________ 75 University of Ghana http://ugspace.ug.edu.gh Reverse Scored 32 _________ 37 _________ 42 _________ 47 __________ Total Agreeableness __________ Conscientiousness Item Your Score 3 _________ Reverse Scored 8 _________ 13 _________ Reverse Scored 18 _________ 23 _________ Reverse Scored 28 _________ 33 _________ Reverse Scored 38 _________ 43 _________ 48 __________ Total Conscientiousness __________ Emotional Stability Item Your Score Reverse Scored 4 _________ 9 _________ Reverse Scored 14 _________ 19 _________ Reverse Scored 24 _________ 29 _________ 76 University of Ghana http://ugspace.ug.edu.gh Extroversion Agreeableness Conscientiousness Stability Openness Reverse Scored 34 _________ Reverse Scored 39 _________ Reverse Scored 44 _________ Reverse Scored 49 __________ Total Emotional Stability __________ Openness Item Your Score 5 _________ Reverse Scored 10 _________ 15 _________ Reverse Scored 20 _________ 25 _________ Reverse Scored 30 _________ 35 _________ 40 _________ 45 _________ 50 _________ Total Openness to Experience __________ Locate your relative scores on the personality dimensions based on the scores obtained by other MGTC24 students like yourself in previous years by using the following percentile information. Circle the percentile you fall in. 77 University of Ghana http://ugspace.ug.edu.gh Average 31.7 38.9 36.0 30.0 35.1 Percentiles 20th 25 34.8 31.8 25 30 40 29.6 38 35 28 34 60 34 40 37.4 31 36.4 80 39 43 41 35 39 Food Frequency Questionnaire Study ID No……….. Please tick how often you consume these foods: Food Type Never or 1-3/ Once 2-4/ 5-6 Once 2-3/ 6+ Quantity less than month /week week /week /day day /day /time once/ month Unpolished cereals Legumes (cowpea/soya/Bambara...) Sugar/honey/sweets Vegetables Fruits Oils (Palm/soybean, sunflower etc) Carbonated drinks 78