Association Between Nursing Education and Risk of Eating Behavior Disorders Among Undergraduate Students

Background/Objectives: Eating behavior disorders (EBDs) are a public health concern among undergraduate students. Evidence suggests that certain health-related academic environments may be associated with heightened psychological vulnerability. Hence, we aimed to evaluate the association between nursing education and the risk of EBDs and to assess whether self-esteem and anxiety mediate this relationship. Methods: A cross-sectional analytical study was conducted between July and August 2023 among 433 undergraduate students from two public universities in Hidalgo, Mexico. The sample included 209 nursing students and 224 peers from non-health-related programs. Self-esteem, anxiety, and EBD risk were assessed using the Rosenberg Self-Esteem Scale, Hamilton Anxiety Rating Scale, and Eating Attitudes Test-26, respectively. Logistic regression and counterfactual mediation analyses were performed, adjusting for age, sex, family income, and year of study. Results: Nursing students showed higher odds of low self-esteem (aOR = 1.64; 95% CI: 1.06-2.53), anxiety (aOR = 2.06; 95% CI: 1.25-3.37), and EBDs risk (aOR = 2.37; 95% CI: 1.37-4.09) compared with non-health peers. Mediation analyses revealed significant indirect effects through self-esteem (aOR = 1.20; 95% CI: 1.03-1.38) and anxiety (aOR = 1.14; 95% CI: 1.01-1.29). Conclusions: Nursing education was independently associated with a higher risk of EBDs, with statistical mediation analyses indicating that differences in self-esteem and anxiety may help characterize this association. Self-esteem exerted a slightly stronger indirect effect, suggesting that negative self-evaluation may represent a more proximal psychological process rather than a causal determinant.