Assessment of Dietary Supplement Usage, Motivations, and Information Sources Among University Students

Assessment of Dietary Supplement Usage, Motivations, and Information Sources Among University Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Dietary Supplement Usage, Motivations, and Information Sources Among University Students Iyad Ali, Aseel AbuHasan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6803978/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Introduction: Dietary supplements (DS) play a significant role in health promotion and chronic disease management by providing vitamins, minerals, herbs, and other bioactive compounds. Their use has surged globally, especially amid the COVID-19 pandemic, with varying consumption patterns across populations and regions. College students represent a key demographic with distinctive usage motivations and knowledge gaps regarding DS. This study aimed to assess the demographic profile, prevalence, types, motivations, information sources, spending habits, and perceptions of dietary supplement use among college students at An-Najah National University. Methods: A quantitative cross-sectional design was employed using an online and paper-based questionnaire administered to 380 randomly sampled students. The instrument assessed demographics, DS use patterns, knowledge, perceptions, and adverse effects. Data were analyzed using descriptive statistics and comparative tests via SPSS. Ethical approval and informed consent were obtained. Results: Among participants (54.1% female, majority aged >22 years), 43.4% reported DS use, predominantly multivitamins/minerals (37%) and herbal products (21.8%). Primary motivations included boosting energy (33.6%) and immunity (31.4%). The internet (48.4%) and nutritionists (43.9%) were the main information sources. DS users had significantly lower knowledge scores than non-users (p=0.001). Adverse effects were reported by 14.2%, mainly nausea and stomach pain, prompting 42.3% to consult healthcare providers. Non-users expressed concerns about DS effectiveness and cost. Conclusion: DS use among college students is common, driven by health enhancement motives but accompanied by knowledge deficits and occasional side effects. Targeted education and professional guidance are essential to optimize safe and informed DS use in this population. Dietary supplements College students Usage patterns Knowledge gaps Health motivations Introduction Nutrition plays a foundational role in promoting overall health, with dietary supplements (DS) increasingly recognized as supportive agents in the prevention and management of chronic illnesses such as cardiovascular disease and cancer ( 1 ). These supplements—typically consumed as capsules, tablets, powders, or liquids—contain vitamins, minerals, amino acids, herbs, or other botanicals and are designed to complement the diet ( 2 ). DS are commonly used to correct nutritional deficiencies, support immune function, enhance physical performance, and improve general well-being ( 3 , 4 ). The field of nutritional science gained momentum in the late 19th century with pivotal discoveries linking diet to disease, such as Eijkman’s work on polished rice and beriberi, and Hopkins and Funk's early identification of essential nutrients like vitamins ( 5 ). The COVID-19 pandemic further amplified global interest in supplements, especially those aimed at boosting immunity—vitamin C, vitamin D, and zinc being among the most consumed ( 6 ). Patterns of DS use vary across regions: in the European Union, vitamins and minerals comprise half the market ( 7 ), while in the United States and parts of the Middle East, multivitamins and herbal preparations are more prevalent ( 8 , 9 ). Among certain groups, college students exhibit particularly high rates of use, with reported prevalence varying widely across countries, from relatively low levels in Japan to significantly higher levels in Saudi Arabia. ( 10 , 11 ). Motivations for use often include improving general health, boosting energy, and strengthening the immune system ( 12 ). However, a significant proportion of students rely on non-professional sources such as social media and coaches for guidance, indicating persistent knowledge gaps ( 13 ). Regulatory frameworks differ widely by country. In the U.S., the Dietary Supplement Health and Education Act (DSHEA) of 1994 categorizes DS as food products, thereby exempting them from pre-market approval but requiring accurate labeling ( 14 ). The FDA monitors post-market safety through adverse event reporting, while the Federal Trade Commission oversees marketing claims ( 15 ). Nonetheless, regulatory inconsistencies and limited global oversight present ongoing challenges. Among adults in the United States who are in early adulthood and older, the use of dietary supplements is widespread, with women more likely to use them than men. The prevalence of supplement use increases with age, reaching its highest levels among women in later adulthood. Older adults were more likely to use multiple supplements, while non-use declined with age. Multivitamin-mineral supplements, vitamin D, and omega-3s were the most commonly used, and the prevalence of dietary supplement use increased steadily in all age groups from 2007–2008 through 2017–2018 ( 16 ). Among adults in the United States aged from early adulthood onward, the use of dietary supplements is widespread. Women tend to use these supplements more frequently than men, and usage generally increases with age, reaching its highest levels among older women. ( 17 ). Among older adults, a significant portion report using dietary supplements as part of their approach to managing chronic health conditions ( 18 ). Athletes, particularly in regions like Algeria, demonstrate near-universal DS use, often without sufficient awareness of associated health risks ( 19 ). Despite their perceived advantages, dietary supplements can pose health risks. A considerable number of emergency department visits in the U.S. are attributed to adverse effects associated with these products, with weight-loss supplements being a leading cause of cardiovascular issues ( 20 ). Commonly reported side effects include gastrointestinal and cardiovascular symptoms. To ensure safe and effective use, individuals are advised to consult healthcare professionals before initiating any supplement regimen ( 21 ), critically evaluate product claims via trusted resources such as the NIH and FDA, prioritize nutrient-dense foods over supplements ( 22 ), and report any adverse reactions through systems like FDA MedWatch. Given that college students often share similar lifestyles and characteristics, their usage patterns of dietary supplements may differ from those of the general public. The primary objective of this study is to evaluate the demographic profile of college students and assess the prevalence, types, and motivations for using dietary supplements. Additionally, the study will explore the sources of information students rely on, the impact of supplement use on academic performance and lifestyle behaviors, the amount of money spent on supplements, and students’ knowledge and perceptions regarding their use. Methods To achieve the objectives of the study, explore the relationships between key variables, provide meaningful suggestions, and develop a clear understanding of the phenomenon and its population characteristics, a quantitative research design was employed. Numerical data were collected through online and paper surveys developed based on existing literature. Two different scales were standardized relative to the study variables, and descriptive analysis was applied with results presented in tables using an analytical descriptive approach. The study population included all individuals relevant to the research problem to enhance the accuracy and applicability of the results. Based on the study’s focus and goals, the target population comprised students enrolled at An-Najah National University. Data were gathered from a sample of 380 students from various colleges within the university. Because students share similar lifestyles and characteristics, their dietary supplement usage may differ from the general population. Random sampling was used to select participants. Initially, 450 online survey responses were collected, but 70 were excluded due to incomplete or suspicious data, resulting in 380 valid responses. The data sources included primary data obtained directly through organized observations or data collection tools, where a questionnaire was the main instrument administered to the sample. Secondary sources comprised existing materials such as books, prior studies, and academic articles that provided background and context for the research. To test the hypotheses and analyze the data, the questionnaire was used as the main tool within a descriptive-analytical method framework. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) to examine relationships between independent and dependent variables and to test the study hypotheses. The questionnaire titled “Discovering Differences in Knowledge and Perception Between Users and Non-Users and the Degree of Use Among College Students at An-Najah University” was designed to include Likert scale items, multiple-choice questions, and yes/no questions. Participants responded by indicating the degree of agreement or disagreement with statements. The questionnaire consisted of two main sections: demographic variables such as gender, age, marital status, nature of residence, college name, and education level, as well as study variables related to dietary supplement use. Ethical approval for this study was obtained from the Institutional Review Board (IRB) at An-Najah National University. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Participants provided informed consent by ticking a consent box before completing the online questionnaire, ensuring voluntary participation and confidentiality. Inclusion criteria consisted of male and female college students from various disciplines who were willing to participate in the study, while those who declined or refused to participate were excluded. Results The study included a total of 380 participants. The demographic analysis (Table 1) revealed that 54.1% of the participants were female and 45.9% were male, with missing gender data for five individuals. Age distribution showed that the largest proportion (39.8%) were older than 22 years, followed by 36.1% in the 20–22 age group and 24.0% aged 17–19 years. The majority of participants (78.0%) were unmarried. Most lived with their families (68.8%), while 31.2% resided in university housing. Regarding academic year, 42.4% were in their fourth year or higher, while the rest were distributed across first to third years. Missing data across variables were minimal, ranging between 1 and 5 responses. Table 1. Demographic Characteristics of the Study Participants (N = 380) Variable Category Frequency Missing Gender Male 172 (45.9%) 5 Female 203 (54.1%) Age Group 17–19 91 (24.0%) 1 20–22 137 (36.1%) Over 22 151 (39.8%) Marital Status Unmarried 295 (78.0%) 2 Married 33 (8.7%) Engaged 38 (10.1%) Separated 12 (3.2%) Housing University housing 117 (31.2%) 5 With family 258 (68.8%) School Year First year 54 (14.3%) 3 Second year 85 (22.5%) Third year 78 (20.7%) Fourth year or more 160 (42.4%) Reliability testing of the 40-item questionnaire showed excellent internal consistency, with a Cronbach’s alpha of 0.892. The knowledge scores followed a normal distribution as indicated by a non-significant Kolmogorov–Smirnov test result (p = 0.200), justifying the use of parametric analyses (Table 2). Table 2. Reliability and Normality Test Results for the Questionnaire Test Value Interpretation Cronbach’s Alpha (40 items) 0.892 Excellent internal consistency Kolmogorov-Smirnov (Knowledge) p = 0.200 Data follows normal distribution When comparing knowledge and perception scores between dietary supplement users and non-users (Table 3), non-users had significantly higher knowledge scores (2.74 ± 0.45) than users (1.94 ± 0.31; p = 0.001). Although non-users also had slightly higher perception scores (2.75 ± 0.48) than users (2.32 ± 0.52), the difference was not statistically significant (p = 0.243). Table 3. Comparison Between Dietary Supplement Users and Non-Users Regarding Knowledge and Perception Scores Group N Knowledge Mean (SD) Perception Mean (SD) Users 165 1.94 (0.31) 2.32 (0.52) Non-Users 236 2.74 (0.45) 2.75 (0.48) p-value 0.001 0.243 Patterns of dietary supplement use among the 165 users are presented in Table 4. The most frequently consumed supplements were multivitamins and minerals (37.0%), followed by herbal products (21.8%) and vitamins alone (20.0%). Key motivations included boosting energy (33.6%), enhancing immunity (31.4%), and improving hair and nail health (24.3%). The internet (48.4%) and nutritionists (43.9%) were the predominant sources of information. Monthly expenditures varied, with 42.7% spending 14-28 US$, 34.2% spending more than, and 23.2% spending under 14 US$. Table 4. Patterns of Dietary Supplement Use Among Users (n = 165) Aspect Category Users Type Used Vitamins & minerals 37.0% Herbs 21.8% Vitamins-only 20.0% Reason for Use Boosting energy 33.6% Strengthening immunity 31.4% Hair/nail improvement 24.3% Info Source Internet 48.4% Nutritionists 43.9% Social media 23.6% Monthly Spending < 14 $ 23.2% 14-28 $ 42.7% ≥ 28 $ 34.2% Adverse effects were reported by 14.2% of supplement users (Table 5), with nausea (14.1%) and stomach pain (10.9%) being the most common. In response, 42.3% consulted a healthcare provider, while 34.2% discontinued use. Table 5. Adverse Effects Experienced and Actions Taken by Supplement Users Metric Result Details Experienced side effects 14.2% 10.9%) Nausea Stomach pain Actions taken after side effects 34.2% 42.3% Stopped DS Consulted doctor Among the 231 non-users, attitudes toward dietary supplements were mixed (Table 6). While 38.0% slightly agreed that supplements are ineffective (mean score: 3.37 ± 0.99), 38.6% disagreed with having had negative past experiences (mean: 3.62 ± 0.89). Cost concerns were also evident, with a mean score of 2.77 ± 1.06 for the belief that supplements are expensive. Table 6. Beliefs and Attitudes of Non-Users Towards Dietary Supplements Reason Mean (SD) Top Response DS are ineffective 3.37 (0.99) 38.0% slightly agree DS cost too much 2.77 (1.06) 34.5% slightly agree Had prior negative effects 3.62 (0.89) 38.6% disagree My diet is balanced 2.99 (1.11) 28.8% slightly agree Correlation and regression analyses (Table 7) revealed a significant positive association between knowledge and lifestyle practices (r = 0.144, p = 0.005), and a stronger association between lifestyle and supplement use (r = 0.271, p < 0.001). Notably, an inverse correlation was observed between knowledge and supplement use (r = –0.377, p = 0.030), indicating that users had lower knowledge scores. Regression analysis confirmed that knowledge significantly predicted supplement use behavior (β = 0.265, p = 0.001). Table 7. Correlation and Regression Analysis Between Knowledge, Lifestyle, and Supplement Use Relationship Correlation (r) p-value Interpretation Knowledge ↔ lifestyle 0.144 0.005 Significant positive Users ↔ lifestyle 0.271 <0.001 Significant positive Users ↔ non-users –0.377 0.030 Significant inverse Knowledge → usage (Regression) β = 0.265 0.001 Knowledge predicts usage Discussion This study provides a comprehensive analysis of dietary supplement (DS) usage patterns among Palestinian university students, revealing nuanced relationships between demographic factors, knowledge, attitudes, and behaviors. The largely youthful, unmarried, and family-living nature of the cohort reflects trends commonly observed in student populations worldwide ( 23 , 24 ). However, the higher proportion of females in this group surpasses the levels typically reported in Jordanian populations ( 25 ) and Saudi student populations ( 26 ). The strong presence of advanced-year students may indicate greater health awareness during key academic transitions, aligning with patterns of stress-related supplement use observed in Turkish student groups ( 27 ). An unexpected pattern emerged in the findings, as non-users showed significantly greater knowledge levels compared to users. This contrasts with previous studies that have associated dietary supplement use with higher health literacy ( 28 ) but aligns with more recent findings suggesting that non-users often possess greater critical awareness of DS limitations. Researchers observed that skepticism regarding supplement efficacy frequently correlates with evidence-based health decision-making ( 29 ). In line with this, non-users in our study identified perceived lack of effectiveness and financial constraints as key reasons for not using supplements. These findings align with Andersen’s Behavioral Model, which highlights that economic accessibility can outweigh the intention to seek health-related services ( 30 ). Despite the difference in knowledge levels, users and non-users exhibited comparable perception scores, indicating that underlying attitudes toward dietary supplements may be shaped by cultural norms and remain consistent regardless of actual usage. The reasons for using dietary supplements seem to reflect cultural nuances; however, goals such as boosting immunity and enhancing energy remain consistent with patterns observed among student populations worldwide ( 31 ), The comparatively lower use of herbal supplements in this group, relative to rates reported in Lebanon, may be influenced by regional differences in product availability or varying consumer preferences and practices ( 32 ). The strong dependence on internet-based sources for information, which is nearly twice as prevalent as that reported among U.S. cohorts, highlights a distinct preference for digital platforms in health-related decision-making ( 33 ), underscores vulnerabilities to misinformation, especially in contexts with limited institutional health literacy support. Spending habits reflect the financial limitations common in developing economies, where discretionary items such as dietary supplements often compete with essential needs for limited household resources. The reported rate of adverse events may underestimate the true incidence due to potential underreporting of mild or gradual symptoms. However, it is encouraging that a substantial portion of those affected sought medical advice, indicating proactive health-seeking behavior. Interestingly, non-users were less inclined to cite negative experiences as a reason for avoiding supplements, which contrasts with typical pharmacovigilance findings where adverse effects often lead to discontinuation ( 34 ). This discrepancy could be due to recall bias or the acceptance of mild side effects as normal. Correlation analyses revealed two main insights. First, there is a positive relationship between knowledge of dietary supplements and engagement in healthy lifestyle behaviors, supporting Spronk et al.'s theory ( 35 ), that supplement use is often part of a broader wellness routine. Second, the significant negative correlation between supplement use and knowledge suggests distinct behavioral patterns: informed non-users tend to exercise economic and health-related caution, whereas users, despite having less knowledge, are likely motivated more by lifestyle and wellness goals. Limitations of the study include its cross-sectional design, which prevents causal inferences, and its focus on a single institution, which limits generalizability. Self-reported data on expenditure and adverse events are vulnerable to recall bias. Moreover, the cultural specificity of the Palestinian student context warrants further comparative studies to validate these findings in broader populations. Conclusion : This study reframes DS utilization through a knowledge-behavior paradox: users demonstrate lower critical awareness yet higher wellness engagement, while non-users employ their knowledge to navigate concerns about cost and efficacy. Universities should address misinformation by incorporating nutritionist-led digital literacy initiatives and consider subsidized DS programs to alleviate financial barriers. Future research should investigate cultural mediators influencing DS decision-making and assess the long-term academic and health outcomes of supplement use. Declarations Ethics approval and consent to participate Ethical approval for the study was secured from the Institutional Review Board (IRB) of An-Najah National University, Nablus, Palestine, and informed consent was obtained implicitly through a mandatory checkbox at the beginning of the survey. Consent for publication Participants provided consent for publication by selecting a mandatory checkbox at the start of the survey Availability of data and materials The data supporting the findings of this study are available in the tables and figures included in the manuscript. Competing interests The author declares no conflicts of interest. Funding NA Authors' contributions I.A & AMA: contributed to conceptualization, methodology, data collection, writing, review and editing. Acknowledgements This research was made possible thanks to the dedication of the students at An-Najah National University. We also acknowledge the use of AI tools for support in paraphrasing and language editing during the preparation of this manuscript Authors' information Iyad Ali is a Professor of Biochemistry at the Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. He is the corresponding author for this manuscript and can be contacted at the Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. Aseel Mazin Abu Hasan is a graduate from Department of Public Health, Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine. References Anders S, Schroeter C. The impact of nutritional supplement intake on diet behavior and obesity outcomes. PloS one. 2017;12(10):e0185258. Dear O. PUBLIC COMMENTS SUBMITTED TO THE NIH OFFICE OF DIETARY SUPPLEMENTS (ODS) ON THE ODS DRAFT STRATEGIC PLAN 2022-2026. Bekker JL, Flores A, Sinha MSJJFL, Pol'y. Re-Regulating Dietary Supplements. 2023;19:1. Noorwali EA, Aljaadi AM, Al-Otaibi HH, editors. Change in growth status and obesity rates among Saudi children and adolescents is partially attributed to discrepancies in definitions used: a review of anthropometric measurements. Healthcare; 2023: MDPI. McDowell L. Vitamin history, the early years: First Edition Design Pub.; 2013. Corrao S, Bocchio RM, Monaco ML, Natoli G, Cavezzi A, Troiani E, et al. Does evidence exist to blunt inflammatory response by nutraceutical supplementation during COVID-19 pandemic? An overview of systematic reviews of vitamin D, vitamin C, melatonin, and zinc. 2021;13(4):1261. Spiro A, Buttriss JJNb. Vitamin D: an overview of vitamin D status and intake in E urope. 2014;39(4):322-50. Alhaqbani AN. Level of Awareness and Impact of Using Multivitamins During COVID-19 Among Adults in Riyadh, Saudi Arabia: Alfaisal University (Saudi Arabia); 2024. Hassen G, Belete G, Carrera KG, Iriowen RO, Araya H, Alemu T, et al. Clinical implications of herbal supplements in conventional medical practice: a US perspective. 2022;14(7). Okabe Y, Takahashi F, Ito DJFiP. Problematic pornography use in Japan: A preliminary study among university students. 2021;12:638354. Aljerian K, Alamri R, Althomali A, Aljamili L, Alkhalaf L, Alsultan Z, et al. Prevalence of Substance Use Among Students in Health Colleges in Saudi Arabia: A Cross-Sectional Study. 2024;16(10). Islam MA, Haque MA, Rahman MA, Hossen F, Reza M, Barua A, et al. A review on measures to rejuvenate immune system: natural mode of protection against coronavirus infection. 2022;13:837290. Čaušević D, Alexe CI, Čović N, Panaet EA, Abazović E, Todor RM, et al. Supplement Use Among Athletes: Insights from Gyms in Sarajevo. 2025;15(9):4747. Karle AA, Waghchaure PS, Rane BR, Kalamkar RV, Keservani RK, Shirode PR. Regulatory guidance on food supplement and dietary fiber. Food Supplements and Dietary Fiber in Health and Disease: Apple Academic Press; 2023. p. 425-53. Alghamdi MH, Alotaibi GM, Almutairi AR, Alharbi FFJSJoCP. Post-Marketing Drug Safety Sources: An Evaluation of the FDA’s Drug Safety Communications in the Past 10 Years. 2025;4(1):3-7. Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary supplement use among adults: United States, 2017–2018. 2021. Chen S, Binns CW, Maycock B, Liu Y, Zhang YJN. Prevalence of dietary supplement use in healthy pre-school Chinese children in Australia and China. 2014;6(2):815-28. Armstrong AR, Thiébaut SP, Brown LJ, Nepal BJA, health NZjop. Australian adults use complementary and alternative medicine in the treatment of chronic illness: a national study. 2011;35(4):384-90. Mansour F, Kadi H, Messaadia A, Lisciani S, Rezkallah C, Lakehal AJNCeM. Dietary supplement consumption and associated factors among Algerian population residing in Tebessa: Cross-sectional survey. 2024;38(4):271-9. Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, et al. Emergency department visits for adverse events related to dietary supplements. 2015;373(16):1531-40. Maughan RJ, Shirreffs SM, Vernec AJIjosn, metabolism e. Making decisions about supplement use. 2018;28(2):212-9. Salameh P, Jomaa L, Issa C, Farhat G, Salamé J, Zeidan N, et al. Assessment of dietary intake patterns and their correlates among university students in Lebanon. 2014;2:185. Lieberman HR, Marriott BP, Williams C, Judelson DA, Glickman EL, Geiselman PJ, et al. Patterns of dietary supplement use among college students. 2015;34(5):976-85. Myszkowska-Ryciak J, Harton A. Implementation of Dietary Reference Intake Standards in Preschool Menus in Poland. 2018;10(5):592. Elsahoryi NA, Odeh MM, Jadayil SA, McGrattan AM, Hammad FJ, Al-Maseimi OD, et al. Prevalence of dietary supplement use and knowledge, attitudes, practice (KAP) and associated factors in student population: A cross-sectional study. 2023;9(4). Syed NK, Syed MH, Meraya AM, Albarraq AA, Al-Kasim MA, Alqahtani S, et al. The association of dietary behaviors and practices with overweight and obesity parameters among Saudi university students. 2020;15(9):e0238458. Delikanlı Akbay G, Karakullukçu EJMJoN, Metabolism. Nutritional health, supplement and herbal product use, and Mediterranean diet evaluation among Turkish university students. 2024;17(4):335-47. Kofoed CL, Christensen J, Dragsted LO, Tjønneland A, Roswall NJBJoN. Determinants of dietary supplement use–healthy individuals use dietary supplements. 2015;113(12):1993-2000. Hurst P, Schiphof-Godart L, Kavussanu M, Barkoukis V, Petróczi A, Ring CJIJoDP. Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis. 2023;117:104077. Andersen RMJJoh, behavior s. Revisiting the behavioral model and access to medical care: does it matter? 1995:1-10. Djaoudene O, Romano A, Bradai YD, Zebiri F, Ouchene A, Yousfi Y, et al. A global overview of dietary supplements: regulation, market trends, usage during the COVID-19 pandemic, and health effects. 2023;15(15):3320. Saad B, Azaizeh H, Said OJEbC, Medicine A. Tradition and perspectives of Arab herbal medicine: a review. 2005;2(4):475-9. Austin KG, Price LL, McGraw SM, Lieberman HRJPO. Predictors of dietary supplement use by US Coast Guard personnel. 2015;10(7):e0133006. Palmer ME, Haller C, McKinney PE, Klein-Schwartz W, Tschirgi A, Smolinske SC, et al. Adverse events associated with dietary supplements: an observational study. 2003;361(9352):101-6. Spronk I, Kullen C, Burdon C, O'Connor HJBjon. Relationship between nutrition knowledge and dietary intake. 2014;111(10):1713-26. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviews received at journal 17 Jul, 2025 Reviews received at journal 11 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers invited by journal 09 Jul, 2025 Editor invited by journal 09 Jun, 2025 Editor assigned by journal 08 Jun, 2025 Submission checks completed at journal 08 Jun, 2025 First submitted to journal 02 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6803978","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485045346,"identity":"72fc2ae6-d656-42de-8e05-b69dcc1927ab","order_by":0,"name":"Iyad Ali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACNiCWYCiQkAPSCcxAgrGBOC0GEsbEa2GAaGFIBKkkTgufRPLDGz8MLNK3sx94+LmAwUZ2wwFCDpNIM7bsMZDI3dmTkCw9gyHNmAgtCWYSPEAtGw4kJEjzMBxOJEJL+jfJPwYS6QbnHyT/5mH4T4yWHDNpoC0JBjcS0oC2HCBCC8+bYmsZAwnDDTcepFnzGCQbzySkRb49fePNNxV18gbnc5Jv81TYyfYR0sIgkABj8QBZBoSUgwA/3FB2gsaPglEwCkbBCAUAD7E+xgyMC30AAAAASUVORK5CYII=","orcid":"","institution":"An-Najah National University","correspondingAuthor":true,"prefix":"","firstName":"Iyad","middleName":"","lastName":"Ali","suffix":""},{"id":485045347,"identity":"4e59e795-166d-4018-83c0-eb4bc11f9be1","order_by":1,"name":"Aseel AbuHasan","email":"","orcid":"","institution":"An- Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Aseel","middleName":"","lastName":"AbuHasan","suffix":""}],"badges":[],"createdAt":"2025-06-02 16:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6803978/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6803978/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86766549,"identity":"8cb6f575-806e-47c4-a4d5-0ca9dbe0c461","added_by":"auto","created_at":"2025-07-15 11:08:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":972769,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6803978/v1/d371b768-5847-481e-89e7-804b7e251fed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Dietary Supplement Usage, Motivations, and Information Sources Among University Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNutrition plays a foundational role in promoting overall health, with dietary supplements (DS) increasingly recognized as supportive agents in the prevention and management of chronic illnesses such as cardiovascular disease and cancer (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These supplements\u0026mdash;typically consumed as capsules, tablets, powders, or liquids\u0026mdash;contain vitamins, minerals, amino acids, herbs, or other botanicals and are designed to complement the diet (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). DS are commonly used to correct nutritional deficiencies, support immune function, enhance physical performance, and improve general well-being (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe field of nutritional science gained momentum in the late 19th century with pivotal discoveries linking diet to disease, such as Eijkman\u0026rsquo;s work on polished rice and beriberi, and Hopkins and Funk's early identification of essential nutrients like vitamins (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The COVID-19 pandemic further amplified global interest in supplements, especially those aimed at boosting immunity\u0026mdash;vitamin C, vitamin D, and zinc being among the most consumed (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Patterns of DS use vary across regions: in the European Union, vitamins and minerals comprise half the market (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), while in the United States and parts of the Middle East, multivitamins and herbal preparations are more prevalent (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong certain groups, college students exhibit particularly high rates of use, with reported prevalence varying widely across countries, from relatively low levels in Japan to significantly higher levels in Saudi Arabia. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Motivations for use often include improving general health, boosting energy, and strengthening the immune system (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, a significant proportion of students rely on non-professional sources such as social media and coaches for guidance, indicating persistent knowledge gaps (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegulatory frameworks differ widely by country. In the U.S., the Dietary Supplement Health and Education Act (DSHEA) of 1994 categorizes DS as food products, thereby exempting them from pre-market approval but requiring accurate labeling (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The FDA monitors post-market safety through adverse event reporting, while the Federal Trade Commission oversees marketing claims (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Nonetheless, regulatory inconsistencies and limited global oversight present ongoing challenges.\u003c/p\u003e\u003cp\u003eAmong adults in the United States who are in early adulthood and older, the use of dietary supplements is widespread, with women more likely to use them than men. The prevalence of supplement use increases with age, reaching its highest levels among women in later adulthood. Older adults were more likely to use multiple supplements, while non-use declined with age. Multivitamin-mineral supplements, vitamin D, and omega-3s were the most commonly used, and the prevalence of dietary supplement use increased steadily in all age groups from 2007\u0026ndash;2008 through 2017\u0026ndash;2018 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong adults in the United States aged from early adulthood onward, the use of dietary supplements is widespread. Women tend to use these supplements more frequently than men, and usage generally increases with age, reaching its highest levels among older women. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Among older adults, a significant portion report using dietary supplements as part of their approach to managing chronic health conditions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Athletes, particularly in regions like Algeria, demonstrate near-universal DS use, often without sufficient awareness of associated health risks (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite their perceived advantages, dietary supplements can pose health risks. A considerable number of emergency department visits in the U.S. are attributed to adverse effects associated with these products, with weight-loss supplements being a leading cause of cardiovascular issues (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Commonly reported side effects include gastrointestinal and cardiovascular symptoms.\u003c/p\u003e\u003cp\u003eTo ensure safe and effective use, individuals are advised to consult healthcare professionals before initiating any supplement regimen (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), critically evaluate product claims via trusted resources such as the NIH and FDA, prioritize nutrient-dense foods over supplements (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and report any adverse reactions through systems like FDA MedWatch.\u003c/p\u003e\u003cp\u003eGiven that college students often share similar lifestyles and characteristics, their usage patterns of dietary supplements may differ from those of the general public. The primary objective of this study is to evaluate the demographic profile of college students and assess the prevalence, types, and motivations for using dietary supplements. Additionally, the study will explore the sources of information students rely on, the impact of supplement use on academic performance and lifestyle behaviors, the amount of money spent on supplements, and students\u0026rsquo; knowledge and perceptions regarding their use.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo achieve the objectives of the study, explore the relationships between key variables, provide meaningful suggestions, and develop a clear understanding of the phenomenon and its population characteristics, a quantitative research design was employed. Numerical data were collected through online and paper surveys developed based on existing literature. Two different scales were standardized relative to the study variables, and descriptive analysis was applied with results presented in tables using an analytical descriptive approach.\u003c/p\u003e\n\u003cp\u003eThe study population included all individuals relevant to the research problem to enhance the accuracy and applicability of the results. Based on the study\u0026rsquo;s focus and goals, the target population comprised students enrolled at An-Najah National University. Data were gathered from a sample of 380 students from various colleges within the university. Because students share similar lifestyles and characteristics, their dietary supplement usage may differ from the general population. Random sampling was used to select participants. Initially, 450 online survey responses were collected, but 70 were excluded due to incomplete or suspicious data, resulting in 380 valid responses.\u003c/p\u003e\n\u003cp\u003eThe data sources included primary data obtained directly through organized observations or data collection tools, where a questionnaire was the main instrument administered to the sample. Secondary sources comprised existing materials such as books, prior studies, and academic articles that provided background and context for the research.\u003c/p\u003e\n\u003cp\u003eTo test the hypotheses and analyze the data, the questionnaire was used as the main tool within a descriptive-analytical method framework. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) to examine relationships between independent and dependent variables and to test the study hypotheses.\u003c/p\u003e\n\u003cp\u003eThe questionnaire titled \u0026ldquo;Discovering Differences in Knowledge and Perception Between Users and Non-Users and the Degree of Use Among College Students at An-Najah University\u0026rdquo; was designed to include Likert scale items, multiple-choice questions, and yes/no questions. Participants responded by indicating the degree of agreement or disagreement with statements. The questionnaire consisted of two main sections: demographic variables such as gender, age, marital status, nature of residence, college name, and education level, as well as study variables related to dietary supplement use.\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Board (IRB) at An-Najah National University. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Participants provided informed consent by ticking a consent box before completing the online questionnaire, ensuring voluntary participation and confidentiality.\u003c/p\u003e\n\u003cp\u003eInclusion criteria consisted of male and female college students from various disciplines who were willing to participate in the study, while those who declined or refused to participate were excluded.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included a total of 380 participants. The demographic analysis (Table 1) revealed that 54.1% of the participants were female and 45.9% were male, with missing gender data for five individuals. Age distribution showed that the largest proportion (39.8%) were older than 22 years, followed by 36.1% in the 20\u0026ndash;22 age group and 24.0% aged 17\u0026ndash;19 years. The majority of participants (78.0%) were unmarried. Most lived with their families (68.8%), while 31.2% resided in university housing. Regarding academic year, 42.4% were in their fourth year or higher, while the rest were distributed across first to third years. Missing data across variables were minimal, ranging between 1 and 5 responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic Characteristics of the Study Participants (N = 380)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMissing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e172 (45.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e203 (54.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e17\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e91 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e20\u0026ndash;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e137 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eOver 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e151 (39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e295 (78.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e33 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eEngaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e38 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e12 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eUniversity housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e117 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eWith family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e258 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool Year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eFirst year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e54 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eSecond year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e85 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eThird year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e78 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eFourth year or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e160 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eReliability testing of the 40-item questionnaire showed excellent internal consistency, with a Cronbach\u0026rsquo;s alpha of 0.892. The knowledge scores followed a normal distribution as indicated by a non-significant Kolmogorov\u0026ndash;Smirnov test result (p = 0.200), justifying the use of parametric analyses (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Reliability and Normality Test Results for the Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026rsquo;s Alpha (40 items)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eExcellent internal consistency\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKolmogorov-Smirnov (Knowledge)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003ep = 0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 232px;\"\u003e\n \u003cp\u003eData follows normal distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhen comparing knowledge and perception scores between dietary supplement users and non-users (Table 3), non-users had significantly higher knowledge scores (2.74 \u0026plusmn; 0.45) than users (1.94 \u0026plusmn; 0.31; p = 0.001). Although non-users also had slightly higher perception scores (2.75 \u0026plusmn; 0.48) than users (2.32 \u0026plusmn; 0.52), the difference was not statistically significant (p = 0.243).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Comparison Between Dietary Supplement Users and Non-Users Regarding Knowledge and Perception Scores\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"337\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1.94 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e2.32 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Users\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e2.74 (0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e2.75 (0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePatterns of dietary supplement use among the 165 users are presented in Table 4. The most frequently consumed supplements were multivitamins and minerals (37.0%), followed by herbal products (21.8%) and vitamins alone (20.0%). Key motivations included boosting energy (33.6%), enhancing immunity (31.4%), and improving hair and nail health (24.3%). The internet (48.4%) and nutritionists (43.9%) were the predominant sources of information. Monthly expenditures varied, with 42.7% spending 14-28 US$, 34.2% spending more than, and 23.2% spending under 14 US$.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Patterns of Dietary Supplement Use Among Users (n = 165)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAspect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType Used\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eVitamins \u0026amp; minerals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e37.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eHerbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e21.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eVitamins-only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e20.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for Use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eBoosting energy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e33.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eStrengthening immunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e31.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eHair/nail improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e24.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfo Source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eInternet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e48.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eNutritionists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e43.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e23.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly Spending\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026lt; 14 $\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e23.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e14-28 $\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e42.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026ge; 28 $\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e34.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAdverse effects were reported by 14.2% of supplement users (Table 5), with nausea (14.1%) and stomach pain (10.9%) being the most common. In response, 42.3% consulted a healthcare provider, while 34.2% discontinued use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Adverse Effects Experienced and Actions Taken by Supplement Users\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMetric\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDetails\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced side effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e14.2%\u003c/p\u003e\n \u003cp\u003e10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eNausea\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eStomach pain\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActions taken after side effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e34.2%\u003c/p\u003e\n \u003cp\u003e42.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eStopped DS\u003c/p\u003e\n \u003cp\u003eConsulted doctor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAmong the 231 non-users, attitudes toward dietary supplements were mixed (Table 6). While 38.0% slightly agreed that supplements are ineffective (mean score: 3.37 \u0026plusmn; 0.99), 38.6% disagreed with having had negative past experiences (mean: 3.62 \u0026plusmn; 0.89). Cost concerns were also evident, with a mean score of 2.77 \u0026plusmn; 1.06 for the belief that supplements are expensive.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Beliefs and Attitudes of Non-Users Towards Dietary Supplements\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTop Response\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDS are ineffective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e3.37 (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e38.0% slightly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDS cost too much\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e2.77 (1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e34.5% slightly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHad prior negative effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e3.62 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e38.6% disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMy diet is balanced\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e2.99 (1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e28.8% slightly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCorrelation and regression analyses (Table 7) revealed a significant positive association between knowledge and lifestyle practices (r = 0.144, p = 0.005), and a stronger association between lifestyle and supplement use (r = 0.271, p \u0026lt; 0.001). Notably, an inverse correlation was observed between knowledge and supplement use (r = \u0026ndash;0.377, p = 0.030), indicating that users had lower knowledge scores. Regression analysis confirmed that knowledge significantly predicted supplement use behavior (\u0026beta; = 0.265, p = 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Correlation and Regression Analysis Between Knowledge, Lifestyle, and Supplement Use\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"498\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation (r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge \u0026harr; lifestyle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSignificant positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsers \u0026harr; lifestyle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSignificant positive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsers \u0026harr; non-users\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026ndash;0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSignificant inverse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge \u0026rarr; usage (Regression)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026beta; = 0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eKnowledge predicts usage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a comprehensive analysis of dietary supplement (DS) usage patterns among Palestinian university students, revealing nuanced relationships between demographic factors, knowledge, attitudes, and behaviors. The largely youthful, unmarried, and family-living nature of the cohort reflects trends commonly observed in student populations worldwide (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, the higher proportion of females in this group surpasses the levels typically reported in Jordanian populations (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and Saudi student populations (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The strong presence of advanced-year students may indicate greater health awareness during key academic transitions, aligning with patterns of stress-related supplement use observed in Turkish student groups (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAn unexpected pattern emerged in the findings, as non-users showed significantly greater knowledge levels compared to users. This contrasts with previous studies that have associated dietary supplement use with higher health literacy (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) but aligns with more recent findings suggesting that non-users often possess greater critical awareness of DS limitations. Researchers observed that skepticism regarding supplement efficacy frequently correlates with evidence-based health decision-making (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In line with this, non-users in our study identified perceived lack of effectiveness and financial constraints as key reasons for not using supplements. These findings align with Andersen\u0026rsquo;s Behavioral Model, which highlights that economic accessibility can outweigh the intention to seek health-related services (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Despite the difference in knowledge levels, users and non-users exhibited comparable perception scores, indicating that underlying attitudes toward dietary supplements may be shaped by cultural norms and remain consistent regardless of actual usage.\u003c/p\u003e\u003cp\u003eThe reasons for using dietary supplements seem to reflect cultural nuances; however, goals such as boosting immunity and enhancing energy remain consistent with patterns observed among student populations worldwide (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), The comparatively lower use of herbal supplements in this group, relative to rates reported in Lebanon, may be influenced by regional differences in product availability or varying consumer preferences and practices (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The strong dependence on internet-based sources for information, which is nearly twice as prevalent as that reported among U.S. cohorts, highlights a distinct preference for digital platforms in health-related decision-making (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), underscores vulnerabilities to misinformation, especially in contexts with limited institutional health literacy support. Spending habits reflect the financial limitations common in developing economies, where discretionary items such as dietary supplements often compete with essential needs for limited household resources.\u003c/p\u003e\u003cp\u003eThe reported rate of adverse events may underestimate the true incidence due to potential underreporting of mild or gradual symptoms. However, it is encouraging that a substantial portion of those affected sought medical advice, indicating proactive health-seeking behavior. Interestingly, non-users were less inclined to cite negative experiences as a reason for avoiding supplements, which contrasts with typical pharmacovigilance findings where adverse effects often lead to discontinuation (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This discrepancy could be due to recall bias or the acceptance of mild side effects as normal.\u003c/p\u003e\u003cp\u003eCorrelation analyses revealed two main insights. First, there is a positive relationship between knowledge of dietary supplements and engagement in healthy lifestyle behaviors, supporting Spronk et al.'s theory (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), that supplement use is often part of a broader wellness routine. Second, the significant negative correlation between supplement use and knowledge suggests distinct behavioral patterns: informed non-users tend to exercise economic and health-related caution, whereas users, despite having less knowledge, are likely motivated more by lifestyle and wellness goals.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e of the study include its cross-sectional design, which prevents causal inferences, and its focus on a single institution, which limits generalizability. Self-reported data on expenditure and adverse events are vulnerable to recall bias. Moreover, the cultural specificity of the Palestinian student context warrants further comparative studies to validate these findings in broader populations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e: This study reframes DS utilization through a knowledge-behavior paradox: users demonstrate lower critical awareness yet higher wellness engagement, while non-users employ their knowledge to navigate concerns about cost and efficacy. Universities should address misinformation by incorporating nutritionist-led digital literacy initiatives and consider subsidized DS programs to alleviate financial barriers. Future research should investigate cultural mediators influencing DS decision-making and assess the long-term academic and health outcomes of supplement use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was secured from the Institutional Review Board (IRB) of An-Najah National University, Nablus, Palestine, and informed consent was obtained implicitly through a mandatory checkbox at the beginning of the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided consent for publication by selecting a mandatory checkbox at the start of the survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available in the tables and figures included in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.A \u0026amp; AMA: contributed to conceptualization, methodology, data collection, writing, review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was made possible thanks to the dedication of the students at An-Najah National University. We also acknowledge the use of AI tools for support in paraphrasing and language editing during the preparation of this manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIyad Ali is a Professor of Biochemistry at the Department of Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. He is the corresponding author for this manuscript and can be contacted at the Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine. Aseel Mazin Abu Hasan is a graduate from Department of Public Health, Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAnders S, Schroeter C. The impact of nutritional supplement intake on diet behavior and obesity outcomes. PloS one. 2017;12(10):e0185258.\u003c/li\u003e\n\u003cli\u003eDear O. PUBLIC COMMENTS SUBMITTED TO THE NIH OFFICE OF DIETARY SUPPLEMENTS (ODS) ON THE ODS DRAFT STRATEGIC PLAN 2022-2026.\u003c/li\u003e\n\u003cli\u003eBekker JL, Flores A, Sinha MSJJFL, Pol\u0026apos;y. Re-Regulating Dietary Supplements. 2023;19:1.\u003c/li\u003e\n\u003cli\u003eNoorwali EA, Aljaadi AM, Al-Otaibi HH, editors. Change in growth status and obesity rates among Saudi children and adolescents is partially attributed to discrepancies in definitions used: a review of anthropometric measurements. Healthcare; 2023: MDPI.\u003c/li\u003e\n\u003cli\u003eMcDowell L. Vitamin history, the early years: First Edition Design Pub.; 2013.\u003c/li\u003e\n\u003cli\u003eCorrao S, Bocchio RM, Monaco ML, Natoli G, Cavezzi A, Troiani E, et al. Does evidence exist to blunt inflammatory response by nutraceutical supplementation during COVID-19 pandemic? An overview of systematic reviews of vitamin D, vitamin C, melatonin, and zinc. 2021;13(4):1261.\u003c/li\u003e\n\u003cli\u003eSpiro A, Buttriss JJNb. Vitamin D: an overview of vitamin D status and intake in E urope. 2014;39(4):322-50.\u003c/li\u003e\n\u003cli\u003eAlhaqbani AN. Level of Awareness and Impact of Using Multivitamins During COVID-19 Among Adults in Riyadh, Saudi Arabia: Alfaisal University (Saudi Arabia); 2024.\u003c/li\u003e\n\u003cli\u003eHassen G, Belete G, Carrera KG, Iriowen RO, Araya H, Alemu T, et al. Clinical implications of herbal supplements in conventional medical practice: a US perspective. 2022;14(7).\u003c/li\u003e\n\u003cli\u003eOkabe Y, Takahashi F, Ito DJFiP. Problematic pornography use in Japan: A preliminary study among university students. 2021;12:638354.\u003c/li\u003e\n\u003cli\u003eAljerian K, Alamri R, Althomali A, Aljamili L, Alkhalaf L, Alsultan Z, et al. Prevalence of Substance Use Among Students in Health Colleges in Saudi Arabia: A Cross-Sectional Study. 2024;16(10).\u003c/li\u003e\n\u003cli\u003eIslam MA, Haque MA, Rahman MA, Hossen F, Reza M, Barua A, et al. A review on measures to rejuvenate immune system: natural mode of protection against coronavirus infection. 2022;13:837290.\u003c/li\u003e\n\u003cli\u003eČau\u0026scaron;ević D, Alexe CI, Čović N, Panaet EA, Abazović E, Todor RM, et al. Supplement Use Among Athletes: Insights from Gyms in Sarajevo. 2025;15(9):4747.\u003c/li\u003e\n\u003cli\u003eKarle AA, Waghchaure PS, Rane BR, Kalamkar RV, Keservani RK, Shirode PR. Regulatory guidance on food supplement and dietary fiber. Food Supplements and Dietary Fiber in Health and Disease: Apple Academic Press; 2023. p. 425-53.\u003c/li\u003e\n\u003cli\u003eAlghamdi MH, Alotaibi GM, Almutairi AR, Alharbi FFJSJoCP. Post-Marketing Drug Safety Sources: An Evaluation of the FDA\u0026rsquo;s Drug Safety Communications in the Past 10 Years. 2025;4(1):3-7.\u003c/li\u003e\n\u003cli\u003eMishra S, Stierman B, Gahche JJ, Potischman N. Dietary supplement use among adults: United States, 2017\u0026ndash;2018. 2021.\u003c/li\u003e\n\u003cli\u003eChen S, Binns CW, Maycock B, Liu Y, Zhang YJN. Prevalence of dietary supplement use in healthy pre-school Chinese children in Australia and China. 2014;6(2):815-28.\u003c/li\u003e\n\u003cli\u003eArmstrong AR, Thi\u0026eacute;baut SP, Brown LJ, Nepal BJA, health NZjop. Australian adults use complementary and alternative medicine in the treatment of chronic illness: a national study. 2011;35(4):384-90.\u003c/li\u003e\n\u003cli\u003eMansour F, Kadi H, Messaadia A, Lisciani S, Rezkallah C, Lakehal AJNCeM. Dietary supplement consumption and associated factors among Algerian population residing in Tebessa: Cross-sectional survey. 2024;38(4):271-9.\u003c/li\u003e\n\u003cli\u003eGeller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, et al. Emergency department visits for adverse events related to dietary supplements. 2015;373(16):1531-40.\u003c/li\u003e\n\u003cli\u003eMaughan RJ, Shirreffs SM, Vernec AJIjosn, metabolism e. Making decisions about supplement use. 2018;28(2):212-9.\u003c/li\u003e\n\u003cli\u003eSalameh P, Jomaa L, Issa C, Farhat G, Salam\u0026eacute; J, Zeidan N, et al. Assessment of dietary intake patterns and their correlates among university students in Lebanon. 2014;2:185.\u003c/li\u003e\n\u003cli\u003eLieberman HR, Marriott BP, Williams C, Judelson DA, Glickman EL, Geiselman PJ, et al. Patterns of dietary supplement use among college students. 2015;34(5):976-85.\u003c/li\u003e\n\u003cli\u003eMyszkowska-Ryciak J, Harton A. Implementation of Dietary Reference Intake Standards in Preschool Menus in Poland. 2018;10(5):592.\u003c/li\u003e\n\u003cli\u003eElsahoryi NA, Odeh MM, Jadayil SA, McGrattan AM, Hammad FJ, Al-Maseimi OD, et al. Prevalence of dietary supplement use and knowledge, attitudes, practice (KAP) and associated factors in student population: A cross-sectional study. 2023;9(4).\u003c/li\u003e\n\u003cli\u003eSyed NK, Syed MH, Meraya AM, Albarraq AA, Al-Kasim MA, Alqahtani S, et al. The association of dietary behaviors and practices with overweight and obesity parameters among Saudi university students. 2020;15(9):e0238458.\u003c/li\u003e\n\u003cli\u003eDelikanlı Akbay G, Karakulluk\u0026ccedil;u EJMJoN, Metabolism. Nutritional health, supplement and herbal product use, and Mediterranean diet evaluation among Turkish university students. 2024;17(4):335-47.\u003c/li\u003e\n\u003cli\u003eKofoed CL, Christensen J, Dragsted LO, Tj\u0026oslash;nneland A, Roswall NJBJoN. Determinants of dietary supplement use\u0026ndash;healthy individuals use dietary supplements. 2015;113(12):1993-2000.\u003c/li\u003e\n\u003cli\u003eHurst P, Schiphof-Godart L, Kavussanu M, Barkoukis V, Petr\u0026oacute;czi A, Ring CJIJoDP. Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis. 2023;117:104077.\u003c/li\u003e\n\u003cli\u003eAndersen RMJJoh, behavior s. Revisiting the behavioral model and access to medical care: does it matter? 1995:1-10.\u003c/li\u003e\n\u003cli\u003eDjaoudene O, Romano A, Bradai YD, Zebiri F, Ouchene A, Yousfi Y, et al. A global overview of dietary supplements: regulation, market trends, usage during the COVID-19 pandemic, and health effects. 2023;15(15):3320.\u003c/li\u003e\n\u003cli\u003eSaad B, Azaizeh H, Said OJEbC, Medicine A. Tradition and perspectives of Arab herbal medicine: a review. 2005;2(4):475-9.\u003c/li\u003e\n\u003cli\u003eAustin KG, Price LL, McGraw SM, Lieberman HRJPO. Predictors of dietary supplement use by US Coast Guard personnel. 2015;10(7):e0133006.\u003c/li\u003e\n\u003cli\u003ePalmer ME, Haller C, McKinney PE, Klein-Schwartz W, Tschirgi A, Smolinske SC, et al. Adverse events associated with dietary supplements: an observational study. 2003;361(9352):101-6.\u003c/li\u003e\n\u003cli\u003eSpronk I, Kullen C, Burdon C, O\u0026apos;Connor HJBjon. Relationship between nutrition knowledge and dietary intake. 2014;111(10):1713-26.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dietary supplements, College students, Usage patterns, Knowledge gaps, Health motivations","lastPublishedDoi":"10.21203/rs.3.rs-6803978/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6803978/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e\u003cbr\u003e\nDietary supplements (DS) play a significant role in health promotion and chronic disease management by providing vitamins, minerals, herbs, and other bioactive compounds. Their use has surged globally, especially amid the COVID-19 pandemic, with varying consumption patterns across populations and regions. College students represent a key demographic with distinctive usage motivations and knowledge gaps regarding DS. This study aimed to assess the demographic profile, prevalence, types, motivations, information sources, spending habits, and perceptions of dietary supplement use among college students at An-Najah National University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nA quantitative cross-sectional design was employed using an online and paper-based questionnaire administered to 380 randomly sampled students. The instrument assessed demographics, DS use patterns, knowledge, perceptions, and adverse effects. Data were analyzed using descriptive statistics and comparative tests via SPSS. Ethical approval and informed consent were obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nAmong participants (54.1% female, majority aged \u0026gt;22 years), 43.4% reported DS use, predominantly multivitamins/minerals (37%) and herbal products (21.8%). Primary motivations included boosting energy (33.6%) and immunity (31.4%). The internet (48.4%) and nutritionists (43.9%) were the main information sources. DS users had significantly lower knowledge scores than non-users (p=0.001). Adverse effects were reported by 14.2%, mainly nausea and stomach pain, prompting 42.3% to consult healthcare providers. Non-users expressed concerns about DS effectiveness and cost.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nDS use among college students is common, driven by health enhancement motives but accompanied by knowledge deficits and occasional side effects. Targeted education and professional guidance are essential to optimize safe and informed DS use in this population.\u003c/p\u003e","manuscriptTitle":"Assessment of Dietary Supplement Usage, Motivations, and Information Sources Among University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 10:52:49","doi":"10.21203/rs.3.rs-6803978/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-18T19:29:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124673705289098745833841614171902198056","date":"2025-07-18T19:27:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316569361558507910751128883559608201977","date":"2025-07-18T09:45:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-17T20:16:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-11T08:38:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293713095319692128265368240506621784041","date":"2025-07-11T08:35:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85402935139573638969910403103429720480","date":"2025-07-09T09:30:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13497811431990761279175452261768970831","date":"2025-07-09T08:34:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-09T08:19:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-09T11:45:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-08T23:31:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-08T23:31:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-02T16:13:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"988a5fa9-7e93-40c1-9e78-4e86fa10cb39","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T10:52:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 10:52:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6803978","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6803978","identity":"rs-6803978","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}