Opportunities for improving health and well-being of university students in Bulgaria

Introduction

Universities are key settings for promoting health and wellbeing through policies, supportive environments, curricula and student-centered services. This study aims to assess health-related behavior among students at a Bulgarian medical university, with the goal of informing the development of an institutional health strategy.

Methods

A cross-sectional online survey was conducted in 2021. A quota-sample of students from three faculties and one health science college was recruited. An anonymous, self-administered questionnaire assessed smoking, alcohol and drug use, diet, physical activity, and mental health. Associations with demographics and academic performance were analyzed with non-parametric tests.

Results

A total of 570 students (88.6% female, mean age 24.0 ± 7.6 years) represented a range of programs, medicine, dentistry, nursing, and midwifery. The majority (68.2%) rated their health as very good or excellent. Smoking was reported by 35.5%, with 46.3% initiating the habit after university enrolment. Significant association was observed between smoking status and academic major (lowest prevalence among medical students, p = 0.002), as well as between smoking and academic performance (non-smokers reported better academic results, p = 0.028). Alcohol use was reported by 53.2%, more frequently by men (p < 0.001), students in later years of study (p < 0.001), and smokers (p = 0.033). Unhealthy diet (43.7%), low physical activity (68.9%), and high stress (25.4%) were prevalent. Despite these challenges, the majority of students expressed interest in participating in health-promoting initiatives: 78.6% were open to stress management programs, and 78.4% to healthy eating initiatives.

Conclusions

These findings underscore the need for targeted institutional strategies that promote healthy lifestyles and support student well-being. Tailored interventions can enhance both academic success and long-term health outcomes for future health professionals.

Key messages

• Risky health behaviors (smoking, alcohol and drug use) often begin after university enrolment and early institutional action is crucial.

• The strong student willingness to engage in health-improving initiatives present a valuable opportunity for targeted, evidence-based interventions. Universities must seize the opportunity.