Patterns of Risky Health Behaviors and Associations With Chronic Diseases Among Young Adult Nursing Students: A Latent Class Analysis

10.1097/jnr.0000000000000521

Chaoqun DONG；Hua CHEN；Yeqin YANG；Yi LI；Yumei SUN；Hongyu SUN

latent class analysis ； young adults ； nursing students ； chronic disease ； health behavior

The Journal of Nursing Research

30卷6期（2022 / 12 / 01）

1 - 10

英文

Background: Little is known about how health behaviors cluster to form meaningful patterns that influence health outcomes in young adult nursing students. Purpose: The purpose of this study was to identify the unique health behavior patterns among young adult nursing students in China and examine the associations between health behaviors and chronic diseases. Methods: Using an electronic app, the achievements of an exercise target, sedentary behavior, smoking and drinking, and dietary patterns were assessed in 1,480 nursing student participants aged 18-24 years from two medical universities in Eastern China. Results: A four-class model was developed using latent class analysis that included the ＂failure to achieve exercise target, alcohol-drinking, and insufficient fruit and vegetable group＂ (Group 1, n = 187, 12.6%), the ＂alcohol-drinking and sedentary behavior group＂ (Group 2, n = 290, 19.6%), the ＂sedentary behavior only group＂ (Group 3, n = 721, 48.7%), and the ＂failure to achieve exercise target only group＂ (Group 4, n = 282, 19.1%). Logistic regressions indicated that nursing students in Group 2 (odds ratio [OR] = 0.42), Group 3 (OR = 0.51), and Group 4 (OR = 0.30) were less likely to have chronic diseases than those in Group 1 after adjusting for sociodemographic variables. Conclusions: The health behaviors were clustered in different patterns among young adult nursing students. Tailoring interventions to specific groups is suggested to improve health outcomes.

1. Agaba, E. I.,Akanbi, M. O.,Agaba, P. A.,Ocheke, A. N.,Gimba, Z. M.,Daniyam, S.,Okeke, E. N.(2017).A survey of non-communicable diseases and their risk factors among university employees: A single institutional study.Cardiovascular Journal of Africa,28(6),377-384.
2. Ahmadi-Montecalvo, H.,Lilly, C. L.,Zullig, K. J.,Jarrett, T.,Cottrell, L. A.,Dino, G. A.(2019).A latent class analysis of the co-occurrence of risk behaviors among adolescents.American Journal of Health Behavior,43(3),449-463.
3. Akbari, F.,Azadbakht, L.(2014).A systematic review on diet quality among Iranian youth: Focusing on reports from Tehran and Isfahan.Archives of Iranian Medicine,17(8),574-584.
4. Alamian, A.,Paradis, G.(2009).Correlates of multiple chronic disease behavioral risk factors in Canadian children and adolescents.American Journal of Epidemiology,170(10),1279-1289.
5. Almutairi, K. M.,Alonazi, W. B.,Vinluan, J. M.,Almigbal, T. H.,Batais, M. A.,Alodhayani, A. A.,Alsadhan, N.,Tumala, R. B.,Moussa, M.,Aboshaiqah, A. E.,Alhoqail, R. I.(2018).Health promoting lifestyle of university students in Saudi Arabia: A cross-sectional assessment.BMC Public Health,18(1),Article No. 1093.
6. Alzamil, H. A.,Alhakbany, M. A.,Alfadda, N. A.,Almusallam, S. M.,Al-Hazzaa, H. M.(2019).A profile of physical activity, sedentary behaviors, sleep, and dietary habits of Saudi college female students.Journal of Family and Community Medicine,26(1),1-8.
7. Assanangkornchai, S.,Li, J.,McNeil, E.(2018).Clusters of alcohol and drug use and other health-risk behaviors among Thai secondary school students: A latent class analysis.BMC Public Health,18(1),Article No. 1272.
8. Atorkey, P.,Byaruhanga, J.,Paul, C.,Wiggers, J.,Bonevski, B.,Tzelepis, F.(2021).Multiple health risk factors in vocational education students: A systematic review.International Journal of Environmental Research and Public Health,18(2),Article 637.
9. Bauer, D. J.,Curran, P. J.(2003).Distributional assumptions of growth mixture models: Implications for overextraction of latent trajectory classes.Psychological Methods,8(3),338-363.
10. Binns, C. W.,Lee, M. K.,Kagawa, M.,Low, W. Y.,Liqian, Q.,Guldan, G. S.,Hokama, T.,Nanishi, K.,Oy, S.,Tang, L.,Zerfas, A.(2017).Dietary guidelines for the Asia Pacific region.Asia-Pacific Journal of Public Health,29(2),98-101.
11. Biswas, A.,Oh, P. I.,Faulkner, G. E.,Bajaj, R. R.,Silver, M. A.,Mitchell, M. S.,Alter, D. A.(2015).Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis.Annals of Internal Medicine,162(2),123-132.
12. Blake, H.,Stanulewicz, N.,McGill, F.(2017).Predictors of physical activity and barriers to exercise in nursing and medical students.Journal of Advanced Nursing,73(4),917-929.
13. Bryer, J.,Cherkis, F.,Raman, J.(2013).Health-promotion behaviors of undergraduate nursing students: A survey analysis.Nursing Education Perspectives,34(6),410-415.
14. Caprara, G.(2021).Mediterranean-type dietary pattern and physical activity: The winning combination to counteract the rising burden of non-communicable diseases (NCDs).Nutrients,13(2),Article 429.
15. Champion, K. E.,Mather, M.,Spring, B.,Kay-Lambkin, F.,Teesson, M.,Newton, N. C.(2018).Clustering of multiple risk behaviors among a sample of 18-year-old Australians and associations with mental health outcomes: A latent class analysis.Frontiers in Public Health,6,Article 135.
16. Cockerham, W. C.(2005).Health lifestyle theory and the convergence of agency and structure.Journal of Health and Social Behavior,46(1),51-67.
17. Darch, J.,Baillie, L.,Gillison, F.(2019).Preparing student nurses to be healthy role models: A qualitative study.Nurse Education in Practice,40,Article 102630.
18. Daw, J.,Margolis, R.,Wright, L.(2017).Emerging adulthood, emergent health lifestyles: Sociodemographic determinants of trajectories of smoking, binge drinking, obesity, and sedentary behavior.Journal of Health and Social Behavior,58(2),181-197.
19. de Vries, H.,van’t Riet, J.,Spigt, M.,Metsemakers, J.,van den Akker, M.,Vermunt, J. K.,Kremers, S.(2008).Clusters of lifestyle behaviors: Results from the Dutch SMILE study.Preventive Medicine,46(3),203-208.
20. Ekelund, U.,Steene-Johannessen, J.,Brown, W. J.,Fagerland, M. W.,Owen, N.,Powell, K. E.,Bauman, A.,Lee, I. M.(2016).Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.The Lancet,388(10051),1302-1310.
21. Garcia, L. M.,da Silva, K. S.,Del Duca, G. F.,da Costa, F. F.,Nahas, M. V.(2014).Sedentary behaviors, leisure-time physical inactivity, and chronic diseases in Brazilian workers: A cross sectional study.Journal of Physical Activity and Health,11(8),1622-1634.
22. Hagenaars, J. A.(Ed.),McCutcheons, A. L.(Ed.)(2002).Applied latent class analysis.Cambridge University Press.
23. Hamilton, M. T.,Healy, G. N.,Dunstan, D. W.,Zderic, T. W.,Owen, N.(2008).Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on sedentary behavior.Current Cardiovascular Risk Reports,2(4),292-298.
24. He, W.,Li, Q.,Yang, M.,Jiao, J.,Ma, X.,Zhou, Y.,Song, A.,Heymsfield, S. B.,Zhang, S.,Zhu, S.(2015).Lower BMI cutoffs to define overweight and obesity in China.Obesity,23(3),684-691.
25. Hobbs, M.,Duncan, M. J.,Collins, P.,Mckenna, J.,Schoeppe, S.,Rebar, A. L.,Alley, S.,Short, C.,Vandelanotte, C.(2018).Clusters of health behaviours in Queensland adults are associated with different socio-demographic characteristics.Journal of Public Health,41(2),268-277.
26. Hutchesson, M. J.,Duncan, M. J.,Oftedal, S.,Ashton, L. M.,Oldmeadow, C.,Kay-Lambkin, F.,Whatnall, M. C.(2021).Latent class analysis of multiple health risk behaviors among Australian university students and associations with psychological distress.Nutrients,13(2),Article 425.
27. Jaakkola, J. J. K.,Hernberg, S.,Lajunen, T. K.,Sripaijboonkij, P.,Malmberg, L. P.,Jaakkola, M. S.(2019).Smoking and lung function among adults with newly onset asthma.BMJ Open Respiratory Research,6(1),Article e000377.
28. James, E.,Freund, M.,Booth, A.,Duncan, M. J.,Johnson, N.,Short, C. E.,Wolfenden, L.,Stacey, F. G.,Kay-Lambkin, F.,Vandelanotte, C.(2016).Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: A systematic review of randomised trials.Preventive Medicine,89,211-223.
29. Jao, N. C.,Robinson, L. D.,Kelly, P. J.,Ciecierski, C. C.,Hitsman, B.(2019).Unhealthy behavior clustering and mental health status in United States college students.Journal of American College Health,67(8),790-800.
30. Kritsotakis, G.,Psarrou, M.,Vassilaki, M.,Androulaki, Z.,Philalithis, A. E.(2016).Gender differences in the prevalence and clustering of multiple health risk behaviours in young adults.Journal of Advanced Nursing,72(9),2098-2113.
31. Lanza, S. T.,Rhoades, B. L.(2013).Latent class analysis: An alternative perspective on subgroup analysis in prevention and treatment.Prevention Science,14(2),157-168.
32. Ma, D.,Sakai, H.,Wakabayashi, C.,Kwon, J.-S.,Lee, Y.,Liu, S.,Wan, Q.,Sasao, K.,Ito, K.,Nishihara, K.,Wang, P.(2017).The prevalence and risk factor control associated with noncommunicable diseases in China, Japan, and Korea.Journal of Epidemiology,27(12),568-573.
33. Macedo, T. T. S.,Mussi, F. C.,Sheets, D.,Campos, A. C. P.,Patrão, A. L.,Freitas, C. L. M.,Paim, M. A. S.(2020).Lifestyle behaviors among undergraduate nursing students: A latent class analysis.Research in Nursing and Health,43(5),520-528.
34. Meader, N.,King, K.,Moe-Byrne, T.,Wright, K.,Graham, H.,Petticrew, M.,Power, C.,White, M.,Sowden, A. J.(2016).A systematic review on the clustering and co-occurrence of multiple risk behaviours.BMC Public Health,16,657-657.
35. Meeusen, C.,Meuleman, B.,Abts, K.,Bergh, R.(2017).Comparing a variable-centered and a person-centered approach to the structure of prejudice.Social Psychological and Personality Science,9(6),645-655.
36. Miranda, V. P. N.,dos Santos Amorim, P. R.,Bastos, R. R.,Souza, V. G. B.,de Faria, E. R.,do Carmo Castro Franceschini, S.,Priore, S. E.(2019).Evaluation of lifestyle of female adolescents through latent class analysis approach.BMC Public Health,19(1),Article 184.
37. Nazar, G.,Stiepovic, J.,Bustos, C.(2019).Latent class analysis of lifestyle behavior among Chilean university students.International Journal of Health Promotion & Education,57(2),98-111.
38. Noble, N. E.,Paul, C. L.,Turner, N.,Blunden, S. V.,Oldmeadow, C.,Turon, H. E.(2015).A cross-sectional survey and latent class analysis of the prevalence and clustering of health risk factors among people attending an aboriginal community controlled health service.BMC Public Health,15(1),Article 666.
39. Nour, M.,Sui, Z.,Grech, A.,Rangan, A.,McGeechan, K.,Allman-Farinelli, M.(2017).The fruit and vegetable intake of young Australian adults: A population perspective.Public Health Nutrition,20(14),2499-2512.
40. Nylund, K. L.,Asparouhov, T.,Muthén, B. O.(2007).Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study.Structural Equation Modeling: A Multidisciplinary Journal,14(4),535-569.
41. O'Donovan, G.,Lee, I. M.,Hamer, M.,Stamatakis, E.(2017).Association of “weekend warrior” and other leisure time physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality.JAMA Internal Medicine,177(3),335-342.
42. Park, D. I.,Choi-Kwon, S.,Han, K.(2015).Health behaviors of Korean female nursing students in relation to obesity and osteoporosis.Nursing Outlook,63(4),504-511.
43. Ren, J.,Li, H.(2022)。Trends and population differences of chronic disease prevalence among Chinese residents from 1998 to 2018。Health Economics Research，39(6)，30-33。
44. Rodriguez-Gazquez, M.,Chaparro-Hernandez, S.,González-López, J. R.(2017).Are first-year nursing students' lifestyles coherent with their future career?.International Journal of Nursing Practice,23(2),Article e12511.
45. Silva, D. A.,Rinaldi, A. E. M.,Azeredo, C. M.(2019).Clusters of risk behaviors for noncommunicable diseases in the Brazilian adult population.International Journal of Public Health,64(6),821-830.
46. Tabacchi, G.,Faigenbaum, A.,Jemni, M.,Thomas, E.,Capranica, L.,Palma, A.,Breda, J.,Bianco, A.(2018).Profiles of physical fitness risk behaviours in school adolescents from the ASSO project: A latent class analysis.International Journal of Environmental Research and Public Health,15(9),Article 1933.
47. Thwaite, T. L.,Heidke, P.,Williams, S. L.,Vandelanotte, C.,Rebar, A. L.,Khalesi, S.(2020).Barriers to healthy lifestyle behaviors in Australian nursing students: A qualitative study.Nursing & Health Sciences,22(4),921-928.
48. Tomlinson, M.,Ross, D. A.,Bahl, R.,Rollins, N.,Daelmans, B.,Simon, J.,Costello, A.(2019).What will it take for children and adolescents to thrive? The global strategy for women's, children's, and adolescents' health.The Lancet: Child & Adolescent Health,3(4),208-209.
49. Vermeulen-Smit, E.,Ten Have, M.,Van Laar, M.,De Graaf, R.(2015).Clustering of health risk behaviours and the relationship with mental disorders.Journal of Affective Disorders,171,111-119.
50. Wattick, R. A.,Hagedorn, R. L.,Olfert, M. D.(2018).Relationship between diet and mental health in a young adult Appalachian college population.Nutrients,10(8),Article 957.
51. Williams, J.,Allen, L.,Wickramasinghe, K.,Mikkelsen, B.,Roberts, N.,Townsend, N.(2018).A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries.Journal of Global Health,8(2),Article 020409.
52. World Health Organization(2017).Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation—Summary.Author.
53. Wu, X. Y.,Han, L. H.,Zhang, J. H.,Luo, S.,Hu, J. W.,Sun, K.(2017).The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review.PLOS ONE,12(11),Article e0187668.
54. Zhang, Y.,Wang, Q.,Jiang, T.,Wang, J.(2018).Equity and efficiency of primary health care resource allocation in mainland China.International Journal for Equity in Health,17(1),Article 140.
55. Zhou, M.,Wang, H.,Zeng, X.,Yin, P.,Zhu, J.,Chen, W.,Li, X.,Wang, L.,Wang, L.,Liu, Y.,Liu, J.,Zhang, M.,Qi, J.,Yu, S.,Afshin, A.,Gakidou, E.,Glenn, S.,Krish, V. S.,Miller-Petrie, M. K.,Liang, X.(2019).Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017.The Lancet,394(10204),1145-1158.