08242017Headline:

Healthy Lifestyles of University Students in China and Influential Factors

3.3.2. Exercise BehaviorMale students were more active than female students ( ). Exercise behavior was also significantly related to grade, location of institution, type of institution, parents’ educational level, residence before being enrolled in school, and family monthly income. In particular, freshmen students ( ) whose institution is located in West China ( ), whose university is medical university ( ), Whose parents had university education ( ; , resp.), those who had the highest family monthly income ( ), and those who came from urban areas before being enrolled in school ( ) reported more exercise behavior than the other groups. The variables included in the multivariate stepwise regression equation were gender, grade, type of institution, and family monthly income ( ; ), and these variables explained 41.73% of the total variance for exercise behavior (Table 4).

3.3.3. Regular BehaviorFemale students were more regular than male students ( ). Grade, location of institution, type of institution, and father’s educational level also were significantly related with regular behavior in the univariate analyses. Specifically, the highest scores were found among freshmen students ( ), whose institution is located in West China ( ), whose university is medical university ( ), and whose fathers ( ) had completed university education. The multiple regression model included type of institution, grade, family monthly income, gender, and father’s educational level as predicting variables ( ; ) and explained 21.04% of the total variance of the predicted variable (Table 4).

3.3.4. Nutrition BehaviorIn the univariate analysis with nutrition behavior as the dependent variable, differences were found for grade, location of institution, type of institution, parents’ educational level, residence before being enrolled in school, and family monthly income. The highest scores were found among junior students and above ( ), those students whose institution located in East China ( ), those students whose university is medical university ( ), highest family monthly income ( ), those who came from urban areas before being enrolled in school ( ), and those whose parents ( ; , resp.) had completed university education. Multiple regression presented that type of institution, family monthly income, and father’s educational level were included in the final equation and those accounted for 22.47% of the total variance ( ; ) (Table 4).

3.3.5. Health Risk BehaviorIn the univariate analysis, the score of health risk behavior was significantly related to gender, grade, location of institution, both parents’ educational level, residence before being enrolled in school, and family monthly income. Female students were less engaged in health risk behaviors than male students ( ). Little health risk behaviors were observed in sophomores ( ), institution located in midland China ( ), and low family monthly income ( ). Little health risk behaviors were also found in those students whose parents had primary educational level ( ; , resp.) and who came from rural areas before being enrolled in school ( ). In the multiple regression analyses, gender, mother’s level of education, and family monthly income were the significant variables in the adjusted model, explaining 19.36% of the variance ( ; ) (Table 4).

3.3.6. Health ResponsibilityIn the univariate analysis with health responsibility behavior as the dependent variable, differences were found for gender, grade, type of institution, parents’ educational level, and residence before being enrolled in school. The healthier health responsibility behaviors were observed in female students ( ). The highest scores were found among junior students and above ( ), those students whose university is medical university ( ), those who came from urban before enrolled in school ( ), and those whose father ( ) and mothers ( ) had completed university education. Multiple regression presented that gender, grade, type of institution, and father’s educational level were included in the final equation, and those accounted for 9.22% of the total variance ( ; ) (Table 4).

3.3.7. Social SupportIn the univariate analysis, the score of social support behavior was significantly related to gender, grade, type of institution, both parents’ educational level, residence before being enrolled in school, and family monthly income. Female students had better social support behavior than male students ( ). Best support behaviors were observed in freshmen ( ), medical university ( ), higher family monthly income ( ), those students whose parents had completed university education ( ; , resp.), and those who came from urban areas before being enrolled in school ( ). In the multiple regression analyses, gender, father’s level of education, and grade were the significant variables in the adjusted model, explaining 20.13% of the variance ( ; ) (Table 4).

3.3.8. Stress ManagementIn the univariate analyses, stress management was significantly related to all of the assessed socio-demographic characteristics. Better stress management strategies were found among male students ( ). Furthermore, freshmen ( ), those students whose institution located in East China ( ), those students whose university is medical university ( ), higher family monthly income ( ), those who came from urban before being enrolled in school ( ), and those whose fathers ( ) and mothers ( ) with higher educational levels presented better stress management strategies than the other groups. The multiple regression model included gender, grade type of institution, and mother’s education in the final equation ( ; ), and these variables explained 21.81% of the final variance of stress management (Table 4).

3.3.9. Life AppreciationGender, grade, location of institution, type of institution, both parents’ educational level, and residence before being enrolled in school were the variables that were significantly related to spiritual growth in the univariate analyses. Male students had higher levels than female students ( ) on this variable, and higher levels were also observed in freshmen ( ), those students whose institution located in West China ( ), those students whose university is medical university ( ), those who came from urban areas before being enrolled in school ( ), and those whose fathers ( ) and mothers ( ) had completed university education ( ) compared with the other groups. The multiple regression model included three variables (type of institution, grade, and mother’s educational level) as predicting dimensions ( ; ), explaining 16.2% of the total variance (Table 4).

4. DiscussionThe main findings provide insight into two main directions. First, it was determined that the mean scores from all dimensions of healthy lifestyle behaviors, except for the exercise behavior, were at a medium level. Second, healthy lifestyles are modulated by gender, grade, father’s level of education, and type of institution when controlling for other social and demographical variables.

A sedentary lifestyle is a common and serious problem among university students. Compared to young adults in general, the pressure of work is so severe for university students that much of their time and energy is likely to be occupied with their studies. On the other hand, the popularization of computers and the Internet may provide more choices of entertainment and reduce interest in exercise. Lack of exercise facilities is also a major reason why university students do not participate actively in exercise. This result is similar to those obtained in other studies [24, 33, 34]. The previous investigations in Taiwan [35, 36] and Hong Kong [14] found that the mean scores on the health-responsibility and exercise behavior dimensions were lower than the average level; other dimensions were at a medium level. In an educational study carried out with university students, it was established that the mean scores obtained from all domains at baseline, excluding the health responsibility, were also at a medium level [37]. This difference on the score of health-responsibility dimension is considered to arise possibly from the dissimilarity between sociocultural structures and enhancement of health consciousness with time.

We found that female students display an overall healthier profile, whereas it was reported in Hacıhasanoğlu et al.’s and Peltzer’s study [24, 38]. It was determined in this study that female students were more likely to take a regular behavior, nutrition behavior and health responsibility, and showed more confidence than male students in the social support dimension. Male students exercise more frequently and manage their stress better than female students but more likely to take a health risk behavior than female students. This result shows similarity with those obtained from some studies conducted in university students [39, 40], although it differs from the results of some studies [34, 41]. It was also reported in some studies [24, 40, 42] that score average of female students was higher than that of male students in the subscales of self-actualization, health responsibility and nutrition, and interpersonal relations, and physical activity score average was higher in male students compared with female students [14, 23, 43]. Unlike the current research, it was determined in the study that 44 female students were more willing to practice healthy life activities compared with male students and their nutrition habits were better, but they were more stressful. In addition, no significant difference was determined between gender and self-actualization, and interpersonal relations and stress management in Hacıhasanoğlu et al.’s study [24]. Ünalan et al. [39] also reported no significant difference between gender and health responsibility, and interpersonal relations and stress management. These results demonstrate that gender is not always determinant in adopting or maintaining better healthy lifestyle behaviors; yet, female students are better in nutrition, health responsibility and interpersonal relations, whereas male students are better in performing physical activities.

Alpar et al. [44] reported a significant difference between the university students’ score averages except nutrition over the time period from their first year at university to their graduation year. In our study, it was detected that total HLSUS scores were better among freshmen than other groups, probably because there is no much workload and stress in the freshmen stage. In terms of exercise behavior, regular behavior, health responsibility, social support, stress management, and life appreciation, this study revealed that junior students were far more capable than senior students, which may be because the senior students are engaged in coping with increasing workload and employment stress and had less enthusiasm for university life owing to a longer time of sensitization. There is no difference among grades in nutrition behavior, probably because almost all students have dinner in the canteen. Previous studies on Turkey university students [23, 24] reported that health promoting behaviors score averages of students increased in direct proportion to the increase in their grade levels but not to the analysis of the mutual interference factors of healthy lifestyles by using multivariate analyses.

In all aspects of healthy lifestyle, the university students in the medical university are better than students in the three-year college and comprehensive university, which may be because training of medical curriculums make the medical students pay more attention to adopt healthy lifestyle. It also was reported in the study by Can et al. [45] that the nursing students had more positive health-promoting lifestyles than those of the nonnursing students. The result also suggests the importance of health education for university students which aims to promote healthy lifestyle.

Exercise behavior and nutrition behavior score averages of students and their families were observed to have increased as their level of high income, while regular behaviour and health risk behaviour score averages of students and their families were observed to have decreased as their level of high income. No statistically significant difference was found between family monthly income and the total score average of HLSUS. Can et al. [45] reported those students’ total score average of healthy lifestyle behaviours and score averages of subscales of physical activity, nutrition, and interpersonal relations increased with the increase in their level of income. It was also detected in other studies that students’ healthy lifestyle behaviour score average increased together with the increase in their family income [34, 40].

In addition, it was found that students’ total score averages of healthy lifestyle behaviors and score averages of dimensions of regular behavior, nutrition behavior, health responsibility, and social support increased with the increase in fathers’ education level, and score average of stress management and life appreciation increased with the increase in mothers’ education level. Ayaz et al. [33] reported that total score average of students’ healthy lifestyle behavior scale and score average of health responsibility subscale increased with the increase in mothers’ education level. Students’ total score average of healthy lifestyle behaviors and score averages of subscales were detected to have increased with the increase in fathers’ education level, and this increase was found to be significant in all areas except interpersonal relations. Ulla Díez and Pérez-Fortis[23] found that total score average of students’ healthy lifestyle behavior scale and score average of nutrition, physical activity, stress management, and interpersonal relations subscale increased with the increase in mothers’ education level. Students’ total score average of healthy lifestyle behaviors and score averages of subscales were detected to have increased with the increase in fathers’ education level, except nutrition, physical activity, and health responsibility. Tuğut and Bekar [46] also reported a statistically significant difference between fathers’ education level and health perception score averages. These different results demonstrate an effect of maternal education over healthy lifestyles of university students, and the difference is considered to arise possibly from the dissimilarity between sociocultural structures.

Nevertheless, some limitations of this study include the following aspects. First, no detailed information about nonresponders was collected. However, the high response rate limited the effect of any bias due to missing information on nonrespondents. Second, although the interviewers received uniform training, their explanations of questionnaire items may have influenced the results. Third, as shown in the tables, even though the regression models are statistically significant, the explained amount of variance is considerably low. Thus, further studies should be conducted in multiple global settings to evaluate university students’ healthy lifestyles and associated factors more fully, before the findings are applied widely to the establishment of health-promoting interventions.

5. ConclusionThe main findings of this study revealed that a high percentage of university students do not exhibit healthy lifestyles, and these can be predicted to some extent by social characteristics. These results obtained here provide relevant information for future actions. To more effectively reduce chronic illnesses and improve population health, health education programs should be planned to stimulate the interests of different students according to their socio-demographic characteristics.

Conflict of InterestsThe authors declare that they have no conflict of interests.

AcknowledgmentsThe authors would like to thank the National Natural Science Foundation of China (81102199) and the Guangdong Natural Science Foundation (S2011040003676) for financial support. They would also like to thank all participants who gave their time to make this project a reality.

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