Academic and institutional determinants of artificial sweetener use among undergraduates in Southeast Nigeria: a structural equation modeling study

Artificial sweeteners (AS) are increasingly consumed by young adults, yet the factors influencing their use in low- and middle-income settings remain poorly understood. This study examined the determinants and structural pathways of AS consumption among Nigerian undergraduates. A cross-sectional survey was conducted among 1,473 undergraduate students from two public universities in Southeast Nigeria. Knowledge, attitudes, and practices (KAP) were assessed using a structured questionnaire and food frequency questionnaires. Multivariable logistic regression was used to identify predictors of AS consumption, while structural equation modeling (SEM) was used to examine the direct and indirect relationships among KAP domains. Mediation analysis was performed using bias-corrected bootstrapping with 5,000 resamples. Federal university students demonstrated significantly higher knowledge, attitudes, and consumption practices compared to State university students ( p < 0.001). Students from federal universities had higher odds of good knowledge (AOR = 1.86, 95% CI: 1.39–2.49; p < 0.001), positive attitudes (AOR = 0.62, 95% CI: 0.46–0.83; p < 0.001), and higher practice scores (AOR = 5.15, 95% CI: 3.75–7.07; p < 0.001). SEM indicated that knowledge was associated with attitude (β = 0.783, p < 0.001) and practice (β = 0.685, p < 0.001), while the attitude-practice pathway was not significant. Attitude partially mediated the relationship between knowledge and practice (β = 0.097; 95% CI: 0.050–0.167). AS consumption among undergraduates may be influenced by both institutional factors and knowledge-driven behavioral pathways. These findings suggest that the university environment and information exposure may play a more significant role in shaping consumption patterns than attitude.