Cluster Analysis of Health-Related Lifestyles in University Students

Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study

BACKGROUND

Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults.

OBJECTIVE

This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition.

METHODS

University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points.

RESULTS

Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%).

CONCLUSIONS

The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56749.

Healthy Lifestyle Related to Executive Functions in Chilean University Students: A Pilot Study

BACKGROUND

A negative lifestyle is reported to be related to cognitive problems. However, there is little information about this in relation to university students. The objective of the present study was to investigate the association between executive functions (EFs) and lifestyle parameters (i.e., physical activity (PA), sleep duration, screen time (ST), and food habits) among Chilean university students.

METHODS

This cross-sectional study included a total of 150 university students (94 females and 56 males, aged 21.28 ± 3.15 and 22.18 ± 2.90 years, respectively). Cognitive outcomes were measured using the CogniFit assessment battery. Lifestyle was measured through validated questionnaires.

RESULTS

Across the total sample, attention exhibited a positive association with PA h/week (β: 24.34 95% CI: 12.46 to 36.22, p = 0.001). Additionally, coordination was positively associated with PA h/week (β: 15.06 95% CI: 0.62 to 29.50, p < 0.041). PA h/week was positively linked with reasoning (β: 20.34 95% CI: 4.52 to 36.17, p = 0.012) and perception (β: 13.81 95% CI: 4.14 to 23.49, p = 0.005). Moreover, PA h/week was significantly linked to memory (β: 23.01 95% CI: 7.62 to 38.40, p = 0.004). In terms of the EFs, PA h/week showed a positive association with cognitive flexibility (β: 45.60 95% CI: 23.22 to 67.69, p = 0.001).

CONCLUSIONS

In conclusion, lifestyle (PA h/week) was positively associated with EFs. Therefore, an increase in PA levels among these students should be a target for community- and university-based interventions in order to promote cognitive development such as attention, coordination, reasoning, perception, memory, and cognitive flexibility.

The influence of diet quality on health-related quality of life in undergraduates

Objective: Explore the relationship between fruit and vegetable (FV) intake and health-related quality of life (HRQOL) in undergraduates. Participants: Undergraduates (N = 655). Methods: Using the Centers for Disease Control's Healthy Days Core Module and National Cancer Institute's (NCI) FV screener, differences in HRQOL between students who had consumed above the sample's average FV intake and their counterparts were evaluated. Multiple regression analyses assessed behaviors that predicted HRQOL. Results: Differences existed between HRQOL of students who consumed above average FV (M = 2.2 1.3) and peers, F(9,602) = 509, p < 0.001, Wilk's Δ = 0.116, partial n2 = 0.884. Predictors explained 30.0% of the variance in days per month feeling healthy (r2 = 0.29, F(4, 549) = 58.6, p < 0.001): perceived stress (β = 0.46, p < 0.001), body mass index (BMI) (β = 0.11, p < 0.01), FV intake (β = 0.16, p < 0.001), and sleep duration (β = 0.08, p < 0.05). Conclusions: FV intake and modifiable behaviors influenced HRQOL, suggesting that multifaceted interventions could improve HRQOL in this population.

Abusive Consumption of Alcoholic Beverages and Associated Factors in Brazilian University Students

The university is considered an environment that favors the initiation and use of substances, especially those that are legal, such as alcohol. This consumption can be differentiated in university students, which makes it necessary to better understand this behavior. Taking into account these aspects, we analyzed the abusive consumption of alcoholic beverages in university students and its association with socioeconomic and behavioral factors. We conducted a cross-sectional study with regularly enrolled students. We assessed the abusive consumption of alcoholic beverages using the binge drinking pattern. We collected socioeconomic and behavioral data using a questionnaire. The association between the variables was verified using logistic regression. Abusive consumption of alcoholic beverages was high, with a high weekly frequency. The association with sociodemographic and behavioral factors can increase the health risk. Education campaigns within institutions with students in the classroom and with all those who can influence these students are important. As there are few studies that consider other health risk factors that have not been analyzed yet, such as those treated in our study, with the abusive consumption of alcoholic beverages, this study seeks to contribute to the knowledge of the relationships between these variables and in the elaboration of actions aimed at improving the lifestyle and health of university students.

Association between Anxiety Status and Hydration Status in Spanish University Students

Anxiety disorders are a very common psychiatric pathology among young university students, and the strategies for its mitigation are limited to the consumption of anxiolytic substances. Adequate hydration is essential for staying healthy, as water is the main component of the human body and of several physiological processes. A state of dehydration, in addition to a negative water balance, has serious consequences on health status. We aimed to determine the association between the degree of anxiety and the level of hydration in Spanish university students. A cross-sectional, observational research study with a sample of 65 female university students was conducted. Over 90% of the study population shows anxiety levels above the 95th percentile. The individuals with anxiety above the 95th percentile showed a negative water balance. The consumption of coffee and herbal teas shows correlations with state anxiety and trait anxiety.

Physical Activity Time, Alcohol Consumption, Mediterranean Diet, and Anxiety in Education Science Students

Student lifestyles change during university. This research aimed to classify university students according to their levels of physical activity, alcohol consumption, adherence to the Mediterranean diet, and anxiety and studied the relationships between the variables using a multigroup equation model according to gender. The sample was composed of 549 participants (M = 23.06; S.D. = 6.22), of whom 409 were women and 140 were men. Validated and adapted instruments such as the Beck Anxiety Inventory, the PREDIMED Questionnaire, and the Alcohol Use Disorder Identification Test were used. The data revealed four clusters through Ward's method and the k-means method. Regarding the exploratory model, differences were found in the effects of the variables according to sex. In conclusion, alcohol consumption was positively associated with the Mediterranean diet, and physical activity was negatively associated with the Mediterranean diet and anxiety.

Screening of hepatitis B and C viral infection, recognition of risk factors, and immunization of patients against hepatitis B virus: a module developed for effective hepatitis control

Introduction

The continually increasing incidence of hepatitis, a worldwide health issue, in Pakistan, has highlighted the need to investigate the epidemiology factors and implement preventive measures accordingly. The purpose of this study was to scrutinize the prevalent and significantly associated risk factors of hepatitis in students and employees, screening them for hepatitis B and C virus and vaccinating them against HBV to make IUB hepatitis free.

Methodology

A total of 12,912 participants including students (n = 10,948) and employees (n = 1964) were screened for HBV and HCV via immunochromatographic test. Hepatitis- positive participants' blood samples were further tested and viral load was estimated by quantitative PCR. All the hepatitis-negative participants were vaccinated against HBV. The demographic and risk factors-related data were collected using the questionnaire. Statistical analysis (Chi-square test and bivariate regression analysis) was performed using SPSS software to explore any association between risk factors and hepatitis.

Results

Results indicated that 662/12912 participants (students = 478/10,948, employees = 184/1,964) tested positive for hepatitis. Among them, HCV was observed to be more prevalent than HBV among the study participants, employees, and students, and viral count was low in both HBV and HCV-infected participants. However, men were more affected than women. The studied risk factors represented higher frequency among hepatitis-positive participants relative to the hepatitis-negative participants. The Chi-square test revealed that students' gender, history of hepatitis in the family and relatives, dental treatment, sharing cosmetics and shaving blades were significant (p > 0.005) risk factors of hepatitis while in the employees group surgery and age were significant. Moreover, the reused of syringes was found to be associated with hepatitis in both groups. The bivariate analysis helped to identify various new risk factors which were independently, either positively or negatively, associated with hepatitis.

Discussion

Our study enabled us to recognize different risk factors of hepatitis among the target population. The information thus generated can be usefully applied in planning hepatitis awareness, targeted screening, and effective control programs for other target populations. In general, this module can be further utilized for any other disease.

Prevalence and clustering of health behaviours and the association with socio-demographics and mental well-being in Dutch university students

The college years represent a vulnerable period for developing health-risk behaviours (e.g., physical inactivity/unhealthy eating habits/substance use/problematic internet use/insufficient sleep). This study examined current health behaviour levels (RQ1), health behaviour classes (RQ2) and between-class differences in socio-demographics (RQ3) and mental well-being (RQ4) among Dutch university students (n = 3771). Participants (Mage = 22.7 (SD = 4.3); 71.2% female/27.3% male/1.5% other) completed an online survey (Oct-Nov 2021). Descriptive statistics (RQ1), Latent Class Analysis (RQ2), and Kruskal-Wallis/Chi-square tests (RQ3-4) were used. RQ1: Prevalence rates suggest that a subsequent proportion of the student sample engages in health-risk behaviours. RQ2: Four classes were identified: class 1 (n = 862) "Licit substance use health-risk group", class 2 (n = 435) "Illicit and licit substance use health-risk group", class 3 (n = 1876) "Health-protective group" and class 4 (n = 598) "Non-substance use health-risk group". RQ3: Class 1 represents relatively more international students and students in a steady relationship. Class 2 represents relatively more older/male/(pre-)master students and students living with roommates/in a steady relationship/with more financial difficulty. Class 3 represents relatively more younger/female students and students living with family/with lower Body Mass Index (BMI)/less financial difficulty. Class 4 represents relatively more younger/non-Western/international/bachelor students and students living with children/single/part of LGBTIQ+ community/with higher BMI. RQ4: Class 3 has significantly higher mental well-being while class 4 has significantly lower mental well-being, relative to the other classes. Above findings provide new insights which can help educational institutes and governments better understand the clustering of students' health behaviours and between-class differences in socio-demographics and mental well-being.

Health-related behavioral changes during the COVID-19 pandemic. A comparison between cohorts of French and Italian university students

This cross-sectional observational study compares the health behaviors of university students in France and Italy, examining how their choices and lifestyles were affected by the COVID-19 pandemic with the aim of contributing to the development of adequate public health and higher education institutions interventions. The French cohort was investigated between January and February 2022, while the Italian cohort was examined between March and April 2022. In both contexts, data were collected through web surveys using institutional directories of university degree programs. Data were collected using standardized tools, validated and recovered in full or partial form. The tool used consisted of three specific sections (general experience, eating habits, physical activity), to which a fourth, dedicated to describing the sociographic picture of the respondents, was added. It was found that the pandemic mainly affected the mental health and sense of well-being of young people in both countries. The pandemic altered dietary habits (41.8% of the French subjects and 38.3% of the Italians declared an increasing of their food intake), alcohol consumption (9.0% of the Italian respondents and 4.0% of the French respondents reported an increased alcohol consumption), propensity to smoke (among the French 85.3% subjects remained non-smokers versus 65.3% of the Italian subjects), sleep quality (25.7% of Italian students 16.6% of French students experienced a decline in the quality of their sleep), and physical activity levels (the percentage of physically active French subjects rose to 72.4%, whereas among Italian students, it dropped to 68,4%). The results emphasize the need for the implementation of relational and psychological interventions, even digital, to face the consequences of social isolation and negative changes in everyday behaviors due to the restrictions during the COVID-19 pandemic.

The Associations of Body Mass Index, Body Image, Perceived Stress, and Mental Health among Female Nursing Students: A Cross-Sectional Study in Taiwan

Maintaining a healthy caloric intake and expenditure balance is challenging. The preliminary study examined (a) the associations of Body Mass Index (BMI), body image, perceived stress, mental health, dietary habits, and exercise participation among 310 female college nursing students and (b) the differences in these factors among BMI subgroups. The cutoffs for underweight, normal weight, overweight, and obesity were <18.5 kg/m2, ≥18.5 but <23 kg/m2, ≥23 but <25 kg/m2, and ≥25 kg/m2, respectively. The survey used Multidimensional Body-Self Relations Questionnaire-Appearance Scale, Perceived Stress Scale, and Chinese Health Questionnaire (CHQ). Because of a non-normal distribution, non-parametric statistics were used. The study found that BMI correlated with body image. The lower the BMI, the higher the satisfactory score the participants rated. BMI was irrelated to diet, exercise, stress, and mental health. The participants were unlikely to eat under stress and negative moods. The underweight group (17.1%) had the highest satisfactory score on their appearance evaluation. There was no difference between the overweight (14.2%) and obese (11.0%) groups. Meanwhile, the median of perceived stress was 18 and the prevalence of mental disturbance was 45.2% based on the CHQ. Underweight, overweight, obesity, high perceived stress, and poor mental health among nursing students warrant attention. Nurse educators should strengthen their coping strategies and provide support. A longitudinal study may consider incorporating coping strategies into the study design.

FANTASTIC lifestyle questionnaire from 1983 until 2022: A review

Background

Studying lifestyles has always been important; quantifying them has become more complex. However, a questionnaire produced in 1983 has shown that its simple form of evaluation can be an added value in understanding lifestyles. Our aim is a systematic review of the scientific literature about the use of the FANTASTIC Lifestyle questionnaire (FLQ).

Methods

The reflective systematic literature review on PubMed, Medline, Science Direct, and SCIELO databases with the descriptors "FANTASTIC Lifestyle questionnaire" OR "FANTASTICO questionnaire" OR "FANTASTIC questionnaire" OR "FANTASTIC survey" OR "FANTASTIC checklist". PRISMA criteria reporting of systematic reviews and meta-analyses were applied. The inclusion criteria were the use of FLQ instrument to measure lifestyles, presenting quantitative or qualitative results, and psychometric studies. It excluded other lifestyle instruments, incomplete articles, and non-English, Brazilian, Spanish, and Portuguese language articles.

Results

Findings reveal 41 scientific articles included in the study. It analyzed the results and most studies use the instrument to assess all dimensions. However, some studies reported assessing specific dimensions such as nutrition, sleep, stress, tobacco, alcohol, and drugs. The questionnaire has been applied to a wide range of ages and literacy levels.

Conclusion

This literature review allowed us to conclude that this questionnaire is still in use today and is applied in several contexts and populations. It is also possible to verify the relevance of its use and to design intervention strategies and programs for a healthy society. It is essential to draw attention to this issue and promote health literacy (HL) on this topic.

Association Between Comorbid Anxiety and Depression and Health Risk Behaviors Among Chinese Adolescents: Cross-Sectional Questionnaire Study

BACKGROUND

Comorbidity of psychiatric disorders such as depression and anxiety is very common among children and adolescents. Few studies have examined how comorbid anxiety and depression are associated with health risk behaviors (HRBs) in adolescents, which could inform preventative approaches for mental health.

OBJECTIVE

We evaluated the association between HRBs and comorbid anxiety and depression in a large adolescent cohort.

METHODS

We used data from 22,868 adolescents in the National Youth Cohort (China). Anxiety and depression symptoms were assessed using the 9-item Patient Health Questionnaire scale and the 7-item Generalized Anxiety Disorder scale, respectively. Comorbidity was determined by the coexistence of anxiety and depression. HRBs including poor diet, smoking, physical inactivity, and poor sleep, as well as the above HRB scores, were added to obtain the total HRB score (HRB risk index). Based on single and total HRB scores, we divided participants into low-, medium-, and high-risk groups. Potential confounders included gender, presence of siblings, regional economic level, educational status, self-rated health, parental education level, self-reported family income, number of friends, learning burden, and family history of psychosis. Correlation analysis was used to explore associations between single risk behaviors. Binary logistic regression estimated the association between HRBs and anxiety-depression comorbidity before and after adjusting for potential confounders.

RESULTS

The comorbidity rate of anxiety and depression among Chinese adolescents was 31.6% (7236/22,868). There was a statistically significant association between each HRB (P<.05), and HRBs were positively associated with comorbid anxiety and depression in the above population. For single HRBs, adolescents with poor diet, smoking, and poor sleep (medium-risk) were more prone to anxiety-depression comorbidity after adjusting for confounders compared to low-risk adolescents. However, adolescents with all high-risk HRBs were more likely to have comorbid anxiety and depression after adjusting for confounders (poor diet odds ratio [OR] 1.50, 95% CI 1.39-1.62; smoking OR 2.17, 95% CI 1.67-2.81; physical inactivity OR 1.16, 95% CI 1.06-1.28; poor sleep OR 1.84, 95% CI 1.70-2.01). Moreover, in both unadjusted (medium risk OR 1.79, 95% CI 1.56-2.05; high risk OR 3.09, 95% CI 2.72-3.52) and adjusted (medium risk OR 1.57, 95% CI 1.37-1.80; high risk OR 2.33, 95% CI 2.03-2.68) models, HRB risk index, like clustered HRBs, was positively associated with anxiety-depression comorbidity, and the strength of the association was stronger than for any single HRB. In addition, we found that compared to girls, the association between clustered HRBs and anxiety-depression comorbidity was stronger in boys after adjustment.

CONCLUSIONS

We provide evidence that HRBs are related to comorbid anxiety and depression. Interventions that decrease HRBs may support mental health development in adolescence, with the potential to improve health and well-being through to adulthood.

Physical Activity Levels, Eating Habits, and Well-Being Measures in Students of Healthcare Degrees in the Second Year of the COVID-19 Pandemic

BACKGROUND

When the first cases of COVID-19 (caused by SARS-CoV-2 virus infection) were discovered, exceptional norms to fight the spread of the virus were established by applying movement restrictions (lockdown) in many countries. These unprecedented norms led to sedentary behaviours and less healthy diets which could persist for much longer after lockdown. The aim of this study was to analyse the physical activity, eating habits, self-perceived well-being, and toxic habits, as well as the perceived changes of these habits with respect to the pre-pandemic period, in a population of university students in the second year of the COVID-19 pandemic.

METHODS

A single-centre, cross-sectional study was conducted in a population of university students of healthcare degrees. A total of 961 students (639 (66.5%) women and 322 (33.5%) men) signed the informed consent and completed the questionnaire. The study was conducted through an anonymous survey, which was voluntarily self-completed by the students on an online platform. The questionnaire was based on the Spanish Health Survey and it was divided into six main parts: demographic and anthropometric characteristics, physical activity, eating habits, well-being measures (sleeping habits, health state, and stress), toxic habits, and perception of the influence of the COVID-19 pandemic on the variables described.

RESULTS AND CONCLUSIONS

The results showed that, during the second year of the pandemic, statistically significant dependence was identified for those students that showed higher levels of physical activity with greater perceived physical activity (p < 0.05), healthier eating habits (p < 0.05), and a better self-perceived health state (p < 0.05), with respect to the 12 months before the COVID-19 pandemic. On the other hand, there was a negative correlation between the sedentary students and greater perceived physical activity (p < 0.05). With regard to toxic habits and physical activity, a significant correlation was only detected between sedentary behaviour and cocaine consumption (p < 0.05). Analysing eating habits, it was observed that the students who smoked, consumed alcohol, and binge drank had low adherence to the Mediterranean diet (p < 0.05). In addition, those students with high stress levels slept less than 7 h (p < 0.05).

Changes in physical activity, diet, sleep, and mental well-being when starting university: A qualitative exploration of Australian student experiences

Objective: To explore young adult's experiences of how starting university influenced their physical activity, diet, sleep, and mental well-being, and barriers and enablers to health behavior change. Participants: University students aged 18-25 years. Methods: Three focus groups were conducted in November 2019. Inductive thematic approach was utilized to identify themes. Results: Students (female: n = 13, male: n = 2, other gender identity: n = 1, 21.2 (1.6) years) reported mental well-being, physical activity levels, diet quality and sleep health were negatively affected. Stress, study demands, university timetabling, not prioritizing physical activity, cost and availability of healthy foods, and difficulty falling asleep were key barriers. Health behavior change interventions aiming to support mental well-being need to include both information and support features. Conclusions: There is a significant opportunity to improve the transition to university for young adults. Findings highlight areas to target in future interventions to improve physical activity, diet, and sleep of university students.

An Exploratory Research to Assess Total Nutritional Knowledge of Students at the University of Lahore, Pakistan

Background: Good nutrition is imperative to achieve a better health status. The rate of obesity and related comorbidities is increasing all over the world. The main reasons behind this worse situation are the overconsumption of food groups or exceeding the recommended portion sizes. University life is a period when students are independent in making their food choices. The chances of adopting unhealthy eating behaviors are increased during this tenure. Nutritional knowledge is an important tool in assessing the nutritional status of an individual, group, and community. Objectives: The main objective of the current study was to assess the nutritional knowledge of university-going students. Methods: The pre-tested questionnaire was used to collect the data from the students of the University of Lahore, Pakistan. A total of 300 students participated in this study (150 from the Nutrition Department and 150 from the non-nutrition departments). Demographic data, anthropometric measurements, and total nutritional knowledge (TNK) scores were measured during the 4-month study duration. Additionally, gender-and department-based comparisons of various parameters were performed. The mean TNK of the Nutrition Department students was higher (34.89 ± 0.95/58) than non-nutrition departments (24.05 ± 1.00/58) (P = 0.01). Additionally, the mean TNK of female students was higher (28.53 ± 1.28/58) than male students (27.05 ± 1.27/58) (P = 0.03). Moreover, 61% and 63% of nutrition students were familiar with the relationship between high intake of salt and fats with chronic diseases, respectively. Results: A statistically significant relationship was not observed between gender (P = 0.78) and departments (P = 0.10) with body mass index (BMI). This finding shows that nutritional knowledge alone is not a predictor of the nutritional status (BMI) of an individual. Students, even from the Nutrition Department, failed to transform their knowledge about nutrition into healthy food choices and eating practices. Conclusions: It is necessary to initiate nutrition education programs emphasizing making healthy food choices. Moreover, nutritional knowledge related to dietary guidelines should be incorporated into daily life to remove the disease burden associated with obesity.

Clustering of Health and Oral Health-Compromising Behaviours in Army Personnel in Central Peninsular Malaysia

Health- and oral health-compromising behaviours (HOHCBs) impact the health readiness of military personnel, resulting in decreased fitness performance, thus affecting combat readiness. This study aimed to identify the clustering patterns and number of HOHCBs in army personnel in Central Peninsular Malaysia. Thus, a cross-sectional study using a multistage sampling technique and a validated 42-item online questionnaire was conducted to assess ten health (medical screening, physical activity, sedentary lifestyle, smoking status, alcohol consumption, substance abuse, aggressive behaviours, sleep, and road safety habits) and five oral health behaviour domains (tooth brushing, fluoridated toothpaste use, flossing, dental visits, and bruxism). Each HOHCB was dichotomised into healthy and health-compromising behaviour and analysed using hierarchical agglomerative cluster analysis (HACA). With the majority being males (92.5%), of other ranks (96.8%), and healthy (83.9%), 2435 army members of a mean age of 30.3 years (SD = 5.9) participated, with a response rate of 100%. HACA identified two clustering patterns: (i) 'high-risk behaviours' (30 HOHCBs) and (ii) 'most common risk behaviours' (12 HOHCBs) with a mean clustering number of 14.1 (SD = 4.1). In conclusion, army personnel in Central Peninsular Malaysia displayed 2 broad HOHCB clustering patterns, 'high-risk' and 'most common risk', with an average of 14 HOHCB clusters per person.

Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences

PURPOSE

Adolescents exposed to adverse childhood experiences (ACEs) are at increased risk for health-compromising behaviors. However, few studies have investigated how ACEs correlate with patterns of health risk behaviors (HRBs) during adolescence, a crucial developmental period. The aim was to extend the current knowledge about the relationship between ACEs and HRB patterns among adolescents, and to explore gender differences.

METHODS

A multi-centered population-based survey was conducted in 24 middle schools in three provinces across China between 2020 and 2021. A total of 16,853 adolescents effectively completed anonymous questionnaires covering exposure to eight ACE categories and 11 HRBs. Clusters were identified using latent class analysis. Logistic regression models were utilized to test the association between them.

RESULTS

There were four classes of HRB patterns: "Low all" (58.35%), "Unhealthy lifestyle" (18.23%), "Self-harm" (18.42%), and "High all" (5.0%). There were significant differences between HRB patterns in terms of the different numbers and types of ACEs in three logistic regression models. Specifically, compared to "Low all," different types of ACEs were positively associated with the three other HRB patterns, and there were significant trends toward increase in the three latent classes of HRBs with higher ACEs. In general, females with ACEs had a higher risk of "High all" except sexual abuse than males.

CONCLUSION

Our study comprehensively considers the association between ACEs and aggregation categories of HRBs. The results support efforts to improve clinical healthcare, and future work may explore protective factors based on individual, family, and peer education to mitigate the negative trajectory of ACEs.

Application of the FANTASTIC Lifestyle Questionnaire in the Academic Context

Studying citizens' lifestyles is extremely important for understanding society and the social conditions of the personal lifestyle. Understanding the lifestyles of university students is especially important because they will be the future citizens and professionals who will shape society's future. The aim of this study was a systematic review of the scientific literature about the use of the FANTASTIC Lifestyle questionnaire in an academic context. The reflective systematic literature review was carried out on PubMed, MEDLINE, Science Direct, and SCIELO databases with the keywords ("FANTASTIC Lifestyle questionnaire" OR "FANTASTICO questionnaire" OR "FANTASTIC questionnaire" OR "FANTASTIC survey" OR "FANTASTIC checklist") AND ("university students"). The PRISMA criteria for reporting systematic reviews and meta-analyses were applied. The inclusion criteria were the use of the "FANTASTIC Lifestyle questionnaire" instrument for measuring lifestyles, the presentation of quantitative or qualitative results, and psychometric studies. The exclusion criteria were no use of FANTASTIC Lifestyle Questionnaire; other population, no quantitative or qualitative analysis, incomplete articles. The 15 scientific articles included in the study were analyzed. This literature review allowed us to conclude the importance and usefulness/actuality of this questionnaire. Furthermore, the importance of diagnosis should be emphasized, as should the development of strategies and intervention programs for the maintenance or creation of healthy societies.

Health behavior interventions for university students measuring mental health outcomes: A scoping review

Introduction

Many university students have poor mental health, and co-occurring health risk behaviors. Targeting health behavior change in this population may improve mental health outcomes. This scoping review describes the extent and range of randomized controlled trials (RCT) evaluating interventions targeting health risk behaviors and measuring a mental health outcome, among university students.

Methods

Six electronic databases were searched for RCTs published until the 18^th May 2021. Eligible RCTs included university students, evaluated interventions that promoted health behavior change (i.e., dietary intake, physical activity, sedentary behavior, alcohol and drug use, smoking, and sleep), and measured a mental health-related outcome.

Results

Fifty-nine RCTs met the inclusion criteria that were published from 2000 to 2021, and over half (n = 33) were conducted in the United States. Interventions evaluated within the RCTs (n = 92) predominantly targeted changes to dietary intake (n = 41 interventions), physical activity (n = 39), or alcohol intake (n = 35). Most interventions targeted one (n = 51) or two (n = 27) health behaviors only. Included RCTs considered mental ill health outcomes (n = 24), psychological wellbeing outcomes (n = 20), or both (n = 15).

Discussion

This scoping review identified a moderate volume of experimental research investigating the impact of health behavior interventions on university students' mental health. There is scope for further research examining health behavior interventions targeting university students, particularly interventions taking a multi-behavioral approach.

Toxic Habits and Well-Being Measures in Spanish Healthcare University Students during the COVID-19 Pandemic

BACKGROUND

Unhealthy lifestyles are strongly entrenched in healthcare universities and have sometimes been linked to stress or lack of sleep. This study investigated the prevalence of toxic habits (smoking, patterns of harmful alcohol use, and illicit drug use), stress levels, perceived health status, and sleep duration and assessed the connections between toxic habits and said well-being measures, as well as healthcare students' perception of the influence of the COVID-19 pandemic on these health-related behaviors.

METHODS

In a cross-sectional study, healthcare students from Alfonso X University (Spain) completed a health survey composed of Alcohol Use Disorders Identification Test (AUDIT-C), Perceived Stress Scale (PSS-10), self-perceived health status, and the number of hours of sleep.

RESULTS

A total of 997 healthcare students completed the survey, of which 982 were analyzed. Being a smoker (32.2%) was associated with worse health status and insufficient sleep. Risk drinkers (33.2%) were associated with being female, and the consumption of cannabinoids (6.7%), with being male. These three toxic habits were related to each other. High levels of stress (28.2%) were correlated with worse ratings in the perception of health status (29.2%) and with insufficient sleep (45.8%), and all of them were associated with the female sex. Respectively, 49.3% and 44.2% of students recognized a worsening in their perception of stress and their sleep habits during the pandemic.

CONCLUSION

Healthcare universities must carry out health promotion programs for stress management, sleep habits, and unhealthy lifestyles.

Mediterranean Diet, a Posteriori Dietary Patterns, Time-Related Meal Patterns and Adiposity: Results from a Cross-Sectional Study in University Students

The transition to university is connected to potentially obesogenic dietary changes. Our aim was to assess the relation of Mediterranean diet adherence, and a posteriori dietary and meal patterns with adiposity in Greek students at the University of the Peloponnese. A total of 346 students (269 women) participated. Anthropometry was performed, and a food frequency questionnaire was administered. The MedDietScore was higher in women and was not linearly related to adiposity. Principal component analysis revealed six patterns: (1) legumes/vegetables/fruits/tea/dairy/whole grains, (2) juice/sodas/liquid calories, (3) olive oil/fats, (4) meat/poultry/fish, (5) alcohol/eggs/dairy and (6) fast foods/sweets. Patterns 4 and 6 were related to overweight/obesity probability (OR = 1.5, 95% CI: 0.995-2.538 and OR = 2.5, 95% CI: 1.07-6.06, respectively) and higher waist circumference (men). Men "early eaters" (breakfast/morning/afternoon snack) had a higher MedDietScore and lower overweight probability (OR = 0.47, 95% CI: 0.220-1.020). Poor meal and dietary patterns relate to overweight and central obesity, which is important for targeted health promotion programs.

Impact of COVID-19 on Physical Activity and Lifestyles in Post-Confinement Sports Science Undergraduates

The aim of this study was to assess whether the infection by SARS-CoV-2 has significantly influenced physical activity, diet, alcohol, and drug consumption habits, as well as the quality of life of students of the bachelor's degree in Physical Activity and Sports Sciences. For this purpose, an online survey was conducted, which included socio-demographic questions related to the COVID-19 disease. Physical activity was analyzed using the International Physical Activity Questionnaire (IPAQ), adherence to the Mediterranean diet using the PREDIMED questionnaire, alcohol consumption using the AUDIT questionnaire, and drug consumption using the DAST-10 questionnaire. Health-related quality of life was analyzed with the SF-12 questionnaire. Our results reveal that those who engaged in either vigorous physical activity or, on the contrary, very low-intensity physical activity, were affected by the SARS-CoV-2 disease, which reduced the average weekly time they spent on their type of activity. However, those who previously performed moderate activities have managed to stay on the same fitness level despite having suffered from SARS-CoV-2 disease (p = 0.433). In conclusion, general health is affected by suffering from the COVID-19 disease, inadequate eating habits, substance use, and the performance of vigorous or very low-intensity of physical activity.

The relationship between mental and physical health: a longitudinal analysis with British student

Purpose

Previous studies in the field have highlighted a bidirectional link between mental health and physical health. Students may be at a higher risk of both mental and physical health problems because of unhealthy lifestyle behaviours and the commencement of university occurring at the same mean age of onset for many psychiatric disorders. This study aims to examine how physical health variables influence changes in mental health symptoms, and vice versa, over time, in a sample of British undergraduate students.

Design/methodology/approach

A longitudinal design over a one-year time period. A national sample of 430 British undergraduate students completed measures of mental health and physical health online at up to four time-points across their first two years of university.

Findings

General physical health and energy and fatigue predicted more severe depression, anxiety, stress and poorer general mental health over time. Depression and stress predicted poorer physical functioning over time. Greater anxiety predicted poorer general health and more severe pain over time. General mental health was not predictive of general physical health. Overall, poor general physical health appears to exacerbate mental health symptoms in students to a greater extent than mental health problems lead to a deterioration in physical health.

Originality/value

This study adds a longitudinal design to a field that is usually cross-sectional, as well as a lack of consideration of how this relationship may differ within student samples. Early interventions should integrate physical and mental well-being rather than focus on any single health-related behaviour.

Health-promoting factors among students in higher education within health care and social work: a cross-sectional analysis of baseline data in a multicentre longitudinal study

Background

Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.

Methods

This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).

Results

Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.

Conclusions

Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

Clinical Application of the Food Compass Score: Positive Association to Mediterranean Diet Score, Health Star Rating System and an Early Eating Pattern in University Students

Nutrient profiling systems (NPS) assist consumers in food choices. Several scores based on NPS have been proposed, but data on their clinical application are lacking. The food compass score (FCS) is a newly developed NPS per 100 kcal (from 1 “least healthy” to 100 “most healthy”). We examined the correlations of FCS with other indices, food groups, and meal patterns. A total of 346 students of the University of the Peloponnese (269 women and 77 men) participated. Dietary habits were evaluated with a food frequency questionnaire, and FCS, health star rating score (HSR), and MedDietScore were computed. Meal and snack frequency consumption was reported. Principal component analysis revealed three meal patterns: “early eater” (breakfast, morning snack and afternoon snack), “medium eater” (lunch and dinner), and “late eater” (bedtime snack). Pearson partial correlations between ranked variables were used to test the correlation coefficients between FCS, other scores, and meal patterns, after adjustment for age, sex, BMI, and underreporting. FCS was positively correlated to HSR (rho = 0.761, p ≤ 0.001) in a multi-adjusted analysis. In the highest tertile of MedDietScore FCS was also positively correlated to MedDietScore (rho = 0.379, p < 0.001). The FCS was positively correlated with juices, high-fat dairy, vegetables, legumes, fruits, and olive oil and negatively correlated with sodas, alcoholic drinks, red meat, refined grains, sweets, fats other than olive oil, fast foods, and coffee. In addition, it related positively to the “early eater” pattern (rho = 0.207, p < 0.001). The FCS was associated with other quality indices and better nutritional habits, such as being an early eater.

Atrial fibrillation, quality of life and distress: a cluster analysis of cognitive and behavioural responses

PURPOSE

Few studies have examined specific cognitive and behavioural responses to symptoms, which may impact health-related outcomes, in conjunction with illness representations, as outlined by the Common-Sense-Model. Patients with atrial fibrillation (AF) report poor quality-of-life (QoL) and high distress. This cross-sectional study investigated patterns/clusters of cognitive and behavioural responses to illness, and illness perceptions, and relationships with QoL, depression and anxiety.

METHODS

AF patients (N = 198) recruited at cardiology clinics completed the AF-Revised Illness Perception Questionnaire, Atrial-Fibrillation-Effect-on-Quality-of-Life Questionnaire, Patient Health Questionnaire-8 and Generalized Anxiety Disorder Questionnaire. Cluster analysis used Ward's and K-means methods. Hierarchical regressions examined relationships between clusters with QoL, depression and anxiety.

RESULTS

Two clusters of cognitive and behavioural responses to symptoms were outlined; (1) 'high avoidance'; (2) 'low symptom-focussing'. Patients in Cluster 1 had lower QoL (M = 40.36, SD = 18.40), greater symptoms of depression (M = 7.20, SD = 5.71) and greater symptoms of anxiety (M = 5.70, SD = 5.90) compared to patients in Cluster 2 who had higher QoL (M = 59.03, SD = 20.12), fewer symptoms of depression (M = 3.53, SD = 3.56) and fewer symptoms of anxiety (M = 2.56, SD = 3.56). Two illness representation clusters were outlined; (1) 'high coherence and treatment control', (2) 'negative illness and emotional representations'. Patients in Cluster 2 had significantly lower QoL (M = 46.57, SD = 19.94), greater symptoms of depression (M = 6.12, SD = 5.31) and greater symptoms of anxiety (M = 4.70, SD = 5.27), compared with patients in Cluster 1 who had higher QoL (M = 61.52, SD = 21.38), fewer symptoms of depression (M = 2.85, SD = 2.97) and fewer symptoms of anxiety (M = 2.16, SD = 3.63). Overall, clusters of cognitive and behavioural responses to symptoms, and illness perceptions significantly explained between 14 and 29% of the variance in QoL, depression and anxiety.

CONCLUSION

Patterns of cognitive and behavioural responses to symptoms, and illness perceptions are important correlates of health-related outcomes in AF patients.

Intention to Screen for Hepatitis C Among University Students: Influence of Different Communicative Scenarios

This study aimed to evaluate the influence of different narrative scenarios regarding students' intentions to undergo diagnostic screening for hepatitis C, and whether gender identification with the characters of the scenario could influence the students' intentions to undergo a medical test. A sample of 600 participants was administered three narrative scenarios with different frames (positive, negative, and ambivalent), including two gender options (male and female) for the main character of the story. A statistically significant three-way interaction between scenario, gender identification, and time resulted. There were significant simple main effects on the intention to have a diagnostic test for hepatitis C for the scenarios with the protagonist of the same gender as the participant and after the administration of the negative scenario. The use of a negative scenario with the same gender character was always more effective than the use of a positive framed scenario, even though there was a high level of knowledge regarding the disease. Personal diagnostic testing was not directly associated with knowledge regarding the infection. The findings of this study can ultimately help policymakers develop communication campaigns adapted to target populations such as college students, in order to raise awareness of the risk, promote prevention and behavioral change, and encourage medical screening.

Correlates of Lifetime and Past Month Vape Use in a Sample of Canadian University Students

Introduction

This study examines correlates of lifetime (ie, ever vaped) and past month vape use among students aged 17 to 19 years, 20 to 25 years, and 26+ years from Western University in London, Ontario. The secondary objective is to assess lifetime and past month vape use among students not of legal age to purchase vaping products in Ontario (ie, those 17 to 18 years only).

Methods

Using Qualtrics, a cross-sectional survey was sent via email to all students at Western University (N = 38 442), assessing their current and past risk-taking behaviors, mental health, sociodemographic characteristics, as well as questions pertaining to their family structure and socioeconomic background during childhood. Students were asked if they had ever vaped in their lifetime and about past month vape use. Logistic regression models were used to assess correlates of lifetime and past month vape use.

Results

The sample consisted of 2626 university students. Compared to those ages 26+ years, teenage university students were 10 times more likely to have vaped in the past month and males were twice as likely as females to have vaped. Alcohol use doubled the odds of vaping in the past month, whereas cigarette, cannabis, or cocaine use approximately tripled the odds. Students who reported many sexual partners were far more likely to have vaped in the past month.

Conclusion

Vape use is more common among teenage university students, males, those who drink alcohol, smoke, use cannabis or cocaine, and who report many sexual partners.

Factors Related to Diet Quality: A Cross-Sectional Study of 1055 University Students

Given that there is only a limited body of evidence available concerning the dietary habits of Spanish university students, the present study assesses the quality of this group's diet, their adherence to the National Food-Based Dietary Guidelines, and the predictive factors of their diet quality. To do so, a cross-sectional study was performed on a sample of 1055 students. The quality of the participants' diets was then analysed by using the Spanish Healthy Eating Index, and then their level of compliance was assessed in light of the dietary recommendations put forth by the Spanish Society for Community Nutrition. According to these standards, only 17.4% of the participants had a healthy diet. The level of compliance with the recommendations was poor, highlighting especially the low levels of "fruit" and "vegetables" that they consumed as well as high levels of "cold meats and cuts" and "sweets". The factors that predicted a worse diet are being male, living alone, low levels of physical activity, smoking, high alcohol intake, leading a sedentary lifestyle, psychological distress, and insomnia (p < 0.005). Furthermore, participants with low or high body weights showed signs of a higher quality diet (p < 0.001). The present findings suggest that a significant proportion of university students ought to change their dietary habits; these also attest to the importance of developing strategies that are directly targeted at university students in order to promote a healthy diet.

Pattern analysis of vegan eating reveals healthy and unhealthy patterns within the vegan diet

OBJECTIVE

This study aimed to identify the types of foods that constitute a vegan diet and establish patterns within the diet. Dietary pattern analysis, a key instrument for exploring the correlation between health and disease, was used to identify patterns within the vegan diet.

DESIGN

A modified version of the EPIC-Norfolk FFQ was created and validated to include vegan foods and launched on social media.

SETTING

UK participants, recruited online.

PARTICIPANTS

A convenience sample of 129 vegans voluntarily completed the FFQ. Collected data were converted to reflect weekly consumption to enable factor and cluster analyses.

RESULTS

Factor analysis identified four distinct dietary patterns including: (1) convenience (22 %); (2) health conscious (12 %); (3) unhealthy (9 %) and (4) traditional vegan (7 %). Whilst two healthy patterns were defined, the convenience pattern was the most identifiable pattern with a prominence of vegan convenience meals and snacks, vegan sweets and desserts, sauces, condiments and fats. Cluster analysis identified three clusters, cluster 1 'convenience' (26·8 %), cluster 2 'traditional' (22 %) and cluster 3 'health conscious' (51·2 %). Clusters 1 and 2 consisted of an array of ultraprocessed vegan food items. Together, both clusters represent almost half of the participants and yielding similar results to the predominant dietary pattern, strengthens the factor analysis.

CONCLUSIONS

These novel results highlight the need for further dietary pattern studies with full nutrition and blood metabolite analysis in larger samples of vegans to enhance and ratify these results.

Risk factors of overweight/obesity-related lifestyles in university students: Results from the EHU12/24 study

This paper investigates the prevalence and interaction of overweight/obesity-related lifestyles (specifically, examining whether subjects meet the recommended criteria), in a representative sample of university students. This study is part of the project EHU12/24, an observational cross-sectional study, designed to assess the prevalence of excess body fat (BF) and major risk of developing overweight/obesity, according to a standardised protocol. In a cohort of 603 students, aged between 18 and 28 years, of the University of the Basque Country, information about meal patterns, diet quality, physical activity, sitting time, sleeping time, toxic habits and anthropometric measurements were collected. Sampling took place from February 2014 to May 2017. Binary logistic regression models adjusted for the covariates were utilised to test the association between lifestyles and risk of excess adiposity. The prevalence of overweight/obesity, according to BF percentage, was 14·4 %. The variables analysed related to meal pattern were associated with diet quality, and less healthy food habits were associated with other less health-related behaviours. Among men, moderate/low physical activity, breakfast skipping, non-adequate breakfast duration, number of eating occasions and eating breakfast alone/depending on the occasion were associated with excess BF, while among women, low MedDietScore, moderate/high alcohol consumption, non-adequate sleep duration, eating breakfast and lunch alone/depending on the occasion. Results suggest that certain unhealthy lifestyle behaviours coexist, interact with one another and increase the risk of overweight/obesity in this population. Sex-specific differences in risk factors of obesity have implications for interventions for primary prevention of obesity within this environment.

Prevalence and predictors of smoking, quit attempts and total smoking ban at the University of Turku, Finland

OBJECTIVES

The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university.

METHODS

Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables.

RESULTS

Slightly < 80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across > 1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined.

CONCLUSION

Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with > 1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.

Engagement in Health Risk Behaviours before and during the COVID-19 Pandemic in German University Students: Results of a Cross-Sectional Study

Tobacco and cannabis use, alcohol consumption and inactivity are health risk behaviors (HRB) of crucial importance for health and wellbeing. The impact of the COVID-19 pandemic on university students' engagement in HRB has yet received limited attention. We investigated whether HRB changed during the COVID-19 pandemic, assessed factors associated with change and profiles of HRB changes in university students. A web-based survey was conducted in May 2020, including 5021 students of four German universities (69% female, the mean age of 24.4 years (SD = 5.1)). Sixty-one percent of students reported consuming alcohol, 45.8% binge drinking, 44% inactivity, 19.4% smoking and 10.8% cannabis use. While smoking and cannabis use remained unchanged during the COVID-19 pandemic, 24.4% reported a decrease in binge drinking while 5.4% reported an increase. Changes to physical activity were most frequently reported, with 30.6% reporting an increase and 19.3% reporting a decrease in vigorous physical activity. Being female, younger age, being bored, not having a trusted person and depressive symptoms were factors associated with a change in HRB. Five substance use behavior profiles were identified, which also remained fairly unchanged. Efforts to promote student health and wellbeing continue to be required, also in times of the COVID-19 pandemic.

Latent Class Analysis of Multiple Health Risk Behaviors among Australian University Students and Associations with Psychological Distress

University students have high rates of health risk behaviors and psychological distress. This study explores patterns of health behaviors among a sample of Australian university students, and determines whether patterns of health behaviors are associated with psychological distress and demographic characteristics. Cross-sectional data from the University of Newcastle Student Healthy Lifestyle Survey 2019 were analyzed. Fruit and vegetable intake, sugar-sweetened beverage intake, physical activity, sitting time, smoking, alcohol intake, drug use, sleep and psychological distress were assessed. Latent class analysis (LCA) was used to identify patterns of health risk behaviors, and latent class regression to explore associations between psychological distress and demographic characteristics with health behavior classes. Analysis included 1965 students (mean age 25.8 ± 8.6 years, 70.7% female). Three patterns of health behaviors were identified: healthier (48.6%), moderate (40.2%) and unhealthy (11.2%) lifestyle classes. Students in the moderate and unhealthy lifestyle classes had higher odds of moderate (OR 1.43 and 2.37) and high/very high psychological distress risk (OR 2.71 and 11.69). Students in the unhealthy and moderate lifestyle classes had a higher odds of being male, younger, enrolled in transition to university and English language courses, Aboriginal or Torres Strait Islander descent and to report some financial difficulty. Study findings may be used to inform the design of mental health interventions for university students that target key health risk behaviors.

Psychometric Properties of the Healthy Lifestyle Questionnaire for Ecuadorian University Students (EVS-EUE)

University students are considered a key population in promoting and establishing healthy lifestyles that will ensure a full life for the next generations. The purpose of this study was to do a cultural and linguistic adaptation of the healthy lifestyle questionnaire for Ecuadorian university students (EVS-EUE). Two thousand, one hundred and eight (2108) students from 17 to 19 years old (27%), 20 to 24 years old (57%), and over 24 years old (16%) participated (M = 21.81 years; SD = 3.04). A confirmatory factor analysis, internal consistency analysis, and concurrent validity were conducted. The results of the EVS-EUE Questionnaire presented adequate values (χ2/d.f = 9.02, Comparative Fit Index (CFI) = 0.96, Incremental Fit Index (IFI) = 0.96, McDonald Fit Index (MFI) = 0.91, Adjusted Goodness of Fit Index (AGFI) = 0.94, Root Mean Square Error of Approximation (RMSEA) = 0.06, Standardized Root Mean Square Residual (SRMR) = 0.03). The internal consistency showed values above 0.70, and analyzed its concurrent validity, reaching adequate values. This study has provided a valid and reliable questionnaire to evaluate healthy lifestyles in the Ecuadorian population.

Multiple Health Risk Factors in Vocational Education Students: A Systematic Review

Health risk factors such as tobacco smoking, inadequate fruit intake, inadequate vegetable intake, risky alcohol consumption, physical inactivity, obesity, anxiety and depression often commence during adolescence and young adulthood. Vocational education institutions enrol many students in these age groups making them an important setting for addressing multiple health risk factors. This systematic review examined (i) co-occurrence of health risk factors, (ii) clustering of health risk factors, and (iii) socio-demographic characteristics associated with co-occurrence and/or clusters of health risks among vocational education students. MEDLINE, PsycINFO, EMBASE, CINAHL and Scopus were searched to identify eligible studies published by 30 June 2020. Two reviewers independently extracted data and assessed methodological quality using the National Heart, Lung and Blood Institute Quality Assessment Tool. Five studies assessed co-occurrence and three studies clustering of health risks. Co-occurrence of health risk factors ranged from 29–98% and clustering of alcohol use and tobacco smoking was commonly reported. The findings were mixed about whether gender and age were associated with co-occurrence or clustering of health risks. There is limited evidence examining co-occurrence and clustering of health risk factors in vocational education students. Comprehensive assessment of how all these health risks co-occur or cluster in vocational education students is required.

Maternal Education Level and Excessive Recreational Screen Time in Children: A Mediation Analysis

There is increasing recognition of the adverse health consequences of excessive recreational screen time (RST) in children and adolescents. Early interventions that aim to reduce RST are crucial, but there are some controversies about which individual and parental variables affect RST in children. The aim of this study was to determine the relationship of parental education level with RST in children and early adolescents and to identify mediators of these relationships. This cross-sectional study examined a sample of children (2–14 year-old) who attended routine childcare visits in primary health care centers in Spain (n = 402; 53.7% males; mean age: 7 ± 4 year-old). A self-reported questionnaire was given to the parents to assess sociodemographic data, parental education, the home media environment, and RST in children. Separate analysis was performed for two age groups (2–6 year-old and 6–14 year-old). Path analysis, an application of structural equation modeling, was used to analyze the data. Fitty three percent of the children had excessive RST (≥2 h/day). The maternal education level, eating lunch/dinner in front of a TV, presence of a background TV, and the amount of parental TV viewing had significant associations with excessive RST in both age groups. For the younger group, the maternal education level had direct and indirect effects on RST (total effect: β = −0.29, p < 0.01). For the older group, maternal education level only had a significant indirect effect on RST, and this was mediated by the presence of a background TV and the time of parental TV viewing (total indirect effect: β = −0.11, p < 0.01). A higher maternal education level appears to be associated with certain environmental factors or habits that prevent excessive RST.

Physical Activity and Sedentary Lifestyle in University Students: Changes during Confinement Due to the COVID-19 Pandemic

Regular physical activity is related to many factors in a university student’s environment. The coronavirus pandemic and the resulting lockdown have restricted many elements of our environment. The aim of this study was to evaluate students’ physical activity and sedentary behaviour at two points in time: before and during the coronavirus lockdown. As a secondary aim, we also wanted to look at changes resulting from other factors (alcohol, tobacco, diet, stages of change, symptoms of anxiety/depression and sociodemographic characteristics). We conducted an observational, cross-sectional, pre-post study with two cut-off points. Two hundred and thirteen students took part in the study. The main dependent variables were physical activity and sitting time, measured using the International Physical Activity Questionnaire—Short Form (IPAQ-SF). Parametric and non-parametric tests were used for paired and unpaired data, as well as group-stratified analysis. During lockdown, both weekly physical activity (MD: −159.87; CI: −100.44, −219.31) and weekly sitting time increased (MD: −106.76; CI: −71.85, −141.67). In the group analysis, differences were observed in relation to gender, year of study, BMI, alcohol consumption, tobacco use, symptoms of anxiety/depression, Mediterranean diet, living situation and stage of change. The results showed an increase in both physical activity and sitting time globally and by group.

Prevalence and Socio-Demographic, Academic, Health and Lifestyle Predictors of Illicit Drug/s Use among University Undergraduate Students in Finland

Illicit drug/s use (IDU) among university students is a public health concern. We assessed the associations between socio-demographic, academic, and health and lifestyle characteristics (independent variables) and regular, occasional or never IDU (dependent variables). Data were collected across seven faculties (1177 students) at the University of Turku (Finland) via an online questionnaire. About 1.5% of the sample had regular IDU, 19% occasional IDU, and 79% never IDU. Independent predictors of ever (lifetime) IDU included males [adjusted odds ratio (AOR) 1.82, P = 0.001], not living with parents (AOR 2.59, P < 0.001), singles (AOR 0.51, P < 0.001), lower religiosity (AOR 1.49, P = 0.022), better self-rated general health (AOR 0.41, P = 0.003), higher health awareness (AOR 1.93, P = 0.014), more depressive symptoms (AOR 1.82, P = 0.004), daily smokers (AOR 3.69, P < 0.001), heavy episodic drinking (AOR 2.38, P < 0.001) and possible alcohol dependency (AOR 2.55, P < 0.001). We observed no independent associations between ever IDU with age, study discipline, perceived stress or academic performance. The 20.5% ever IDU is concerning. The compelling independent predictors of ever IDU included not living with parents, lower religiosity, daily smokers, heavy episodic drinking and possible alcohol dependency (AOR range 2.38-3.69). Education and prevention need to emphasize the negative consequences to reinforce abstinence from IDU. Health promotion could focus on beliefs and expectations about IDU and target students at risk for successful efforts.

Implications of personality and parental education on healthy lifestyles among adolescents

Several studies have shown an association between personality and health status. The aim of this study was to evaluate the association between personality traits, parental education and health-related lifestyles in a cohort of Spanish adolescents. This is a longitudinal study with a source population of 1,123 third-year students (aged 14-15) in secondary schools in Spain. At the baseline evaluation sociodemographic variables, parental education and personality (Big Five Questionnaire for Children) were collected. At 18 months of follow-up health related lifestyles, including adherence to a healthy diet (KidMed index), tobacco and alcohol consumption, physical exercise, sleep problems and recreative screen and social network time were collected. A total of 824 adolescents (73.4%) completed the 18 months assessment and 695 (84.3%) presented valid data. Higher conscientiousness was associated to a lower risk for non-adherence to Mediterranean diet (OR = 0.7, 95% CIs=0.5-0.9), tobacco (OR = 0.5, 95% CIs=0.3-0.7) and alcohol consumption (OR = 0.6, 95% CIs=0.5-0.8), excessive use of screens (OR = 0.7, 95% CIs=0.5-0.9) and social network sites (OR = 0.7, 95% CIs=0.5-0.8). Higher levels of extraversion was significantly related to a lower risk of physical inactivity (OR = 0.7, 95% CIs=0.6-0.9), but they are at a higher risk of low adherence to Mediterranean diet (OR = 1.3, 95% CIs=1.0-1.7), tobacco (OR = 2.7, 95% CIs=1.7-4.3) and alcohol consumption (OR = 1.9, 95% CIs=1.5-2.4) and excessive use of social network sites (OR = 1.6, 95% CIs=1.3-1.9). High levels of emotional instability were associated with tobacco consumption (OR = 1.5, 95% CIs=1.0-2.2) and sleep problems (OR = 2.0, 95% CIs=1.5-2.7). Finally, we found an association with lower parental education and adolescents' low adherence to Mediterranean diet (OR = 1.6, 95% CIs=1.0-2.4) and sleep problems (OR = 1.8, 95% CIs=1.0-3.0). Cluster analysis of health-related behaviours indicated the presence of two different clusters (unhealthy and healthy adolescents) that were associated with personality traits. Conscientiousness, extraversion, emotional instability and parental education are independent factors associated with the acquisition of adolescent healthy lifestyles.