| Background:During recent decades, lifestyle is an important determinant of health status, which has become a focus that attracted increasing interests around the world. The World Health Organization pointed out that 60 percent of the quality of an individual's health and life depends on his behavior and lifestyles. A good health-promoting behavior depends on the living habits adopted in the early years of one's life. It is far more difficult for adults to change unhealthy habits adopted in their youth, so the young people are the major population whose healthy lifestyles should be attached great importance to.College student life is an important stage when individual independence and healthy behavior are to be established, and also a golden period when knowledge is absorbed and personality is shaped. Meanwhile, during this stage, unhealthy practices and behaviors will also continue into adulthood and thus jeopardize their health status in later life. At present, In China Mainland, the research on the life styles of college students is mostly focused on the health risk behavior and remains at research phase on the relationship between behavior and health, namely, the research only addresses the life styles as factors that affect health. So far the relevant research approach aiming at the measurement of the college students' healthy lifestyles have not been reported; few studies on the factors that affect healthy lifestyles of college students have been carried out, and almost no empirical study thereof has been considered. Therefore, based on this, the present research attempts to focus mainly on the quantification regarding college students' healthy behaviors so as to explore the influential factors on their healthy life style-forming.Objectives:1. To provide the objective, effective and standard tools to evaluate the healthy lifestyles of college students, this research fully considers, by adopting the tools on evaluating life styles in Taiwan region and abroad, the cultural background, social structure and values of young people in China Mainland. Besides, the research used the systematic technology of developing scale to generate the healthy lifestyle questionnaire (HLQ) for the college students.2. Through HLQ, the current situation of the college students' lifestyles will be understood, and the relevant influence factors from many aspects will be explored. Apart from this, the strategies to promote healthy lifestyles of college students will be proposed to serve as the reference for the departments of educational administration to promote the college students' lifestyles.Methods:1. An item pool of HLQ for College Students is to be complied based on literature reviews, brain storm, focus subject (undergraduates) interview, and expert consultation and interview.2. Totally 33 experts based on their professional reputation and research domain were selected to form a panel and the 3 round Delphi method was adopted to form the first draft of HLQ.3. Totally 500 college students from 5 universities located separately in the eastern, western, southern, northern, and middle China were chosen as subjects to investigate via questionnaire, disperse trend, factor analysis, response rate, principal component analysis, correlation coefficient among and between item and domain were adopted to further screen the items for HLQ.4. The validity, the reliability and the responsiveness of the test version of HLQ were worked out from the data of totally 2000 college students selected from four universities.5. The method of expert consultation was adopted to update the test version of HLQ.6. Totally 5400 students from nine universities were selected by a two-stage stratified cluster sampling method. These subjects were also surveyed with the HLQ and self-designed questionnaire containing demographic variables and the other factors by the method of univariate analysis and multivariate analysis.Results:1. The item pool of HLQ for College studentsThe item pool of HLQ consists of 117 items and was classified into 2 sub-scales concerning the extrinsic healthy lifestyles and implicit healthy lifestyles and 13 domains.2. The first draft HLQ for College students2.1 Result of the first round consultationThe positive coefficient of experts is 84.60%. The means concerning authority coefficient of each item evaluated by 33 experts range from 0.517 to 0.818, and the average is 0.737. The total coordination coefficient (Kendall'W coefficient) of each item evaluated by 33 experts is 0.212, and the coordination coefficient of each domain goes between 0.083 and 0.360, The 70 items falling into 8 domains were obtained according to the mean of transformed importance value and experts' updated suggestion on the items.2.2 Result of the second round consultationThe positive coefficient of experts is 93.94%. The means of authority coefficient of each item evaluated by 31 experts go between 0.730 and 0.945, and the average is 0.834. The relative importance of the extrinsic healthy lifestyles and implicit healthy lifestyles is 0.58:0.42, and the Kendall's Wcoefficient is 0.742. The total coordination coefficient of each item evaluated by 31 experts is 0.317, and the coordination coefficient of each domain is found between 0.217 and 0.402. The 44 items are observed to belong to 8 domains. Two aspects were obtained according to the mean of transformed importance value and experts' updated suggestion on the items. 2.3 Result of the third round consultationThe positive coefficient of experts is 96.77%. The means of authority coefficient of each item evaluated by 30 experts are found between 0.778 and 0.903, and the average is 0.850. The relative importance of the extrinsic healthy lifestyles and implicit healthy lifestyles is 0.583:0.417. The total coordination coefficient of each item evaluated by 30 experts is 0.401, and the coordination coefficient of each domain is between 0.298 and 0.526. The 42 items are categorized into 7 domains. Two aspects were obtained according to the mean of transformed importance value and experts' updated suggestion on the items.3. The test version of HLQ for College studentsTotally 472, accounting for 94.4%, valid questionnaires were used for data analyses in this study, and the test version of HLQ is composed of 7 domains and 40 items obtained from further screen by six methods.4. The HLQ for College students4.1 The appraisal result of reliabilityCronbach a of total score was 0.898 and that of 7 domains were observed to range from 0.607 to 0.910 except for health risky behavior. Retest reliability of total score is 0.708 and that of 7 domains is 0.501～0.842 (p<0.001). The correlation coefficient of Spearman-brown split-half was 0.865 and hat of 7 domains goes from 0.422 to 0.746 (p<0.001).4.2 The appraisal result of validityThe content validity was supported by prophase research, and the items of the HLQ can reflect the real present situation of healthy lifestyles of college students. The Pearson's correlation coefficient between the total score of the HLQ test version and the total score of WHOQOL—BREF is 0.571; therefore, the criterion validity was accepted. The construct validity in factor analysis did not go well with the structure of the HLQ. The KMO statistic of 0.932 and Bartlett's test of sphericity with x~2=20883.975 (p=0.000) suggested that the factor analysis could be performed appropriately. Both convergent validity and discriminating validity were strongly supported by the correlations within the factors which were stronger than that between the factors.4.3 The appraisal result of responsivenessThe correlation coefficient of the total score of the HLQ test version obtained between the first test and the test two weeks later is 0.582～0.843(p<0.05), suggesting higher correlation, and two test results have no significant differences except for nutritional behavior. The correlation coefficient of the total score of the HLQ test version obtained between the first test and the test four weeks later is 0.526～0.853(p<0.05), suggesting higher correlation, and the two test results indicate no significant differences except for exercise behavior. This shows good responsiveness.4.4 The appraisal result of Demographic variablesThe total score of the HLQ test version show significant differences in type characteristic of the university, family's monthly earning, parental educational level, residence before being enrolled into university and family with one-child or not. The total score has no significant differences in terms of gender and grade.4.5 The HLQ for College studentsThe HLQ for College students is composed of 8 domains and 38 items and involvesin the extrinsic healthy lifestyles and implicit healthy lifestyles.5. The preliminary application study of HLQ for College students5.1 Appraisal of the HLQ for College students5.1.1 The appraisal result of reliabilityCorrected in accordance with Spearman-Brown, the total split-half correlationcoefficient became 0.840; two aspects split-half correlation coefficients were0.710,0.808, and that of 8 domains were 0.372～0.737. Cronbach a coefficient oftotal score was 0.892; two aspects of coefficient were 0.770 and 0.891, that of 8domains were 0.418～0.830 (p<0.001). 5.1.2 The appraisal result of validityFactor analysis used to evaluate construct validity, KMO statistic was 0.929; Bartlett's test results of spherical x~2=54913.124 (p=0.000), suggested that the factor analysis could be performed appropriately. Through factor analysis, the nine common factors were worked out, and the cumulative contribution rate was 55.02%. In addition, health risk behavior is divided into two factors, the remaining entries in the load factors found in line with the scale structure, supporting the structural validity. At the 38 convergent validity tests, the success rate was 97.37%. At the 259 discriminating validity calibration trials, the success rate was 97.30%. The Spearman correlation coefficient between the domains was smaller than that of the Cronbach'α. The scores between the domain scores and total scores were greater than those of the domains. Comparatively speaking, the correlation coefficients of every dimension and its sub- scale were large, and other sub-scale correlation coefficient smaller. All this supports convergent validity and discriminate validity.5.1.3 The appraisal result of responsivenessThe HLQ is able to distinguish students who are healthy, students who sutler fromchronic diseases, students who are often ill and students who are physicallydiscomfort. Therefore, it demonstrates reliable responsiveness.5.2 A preliminary explorative study of influential factors on college students' healthylifestyles5.2.1 The standard total score of college students' healthy lifestyles is 67, near the middle level. In every domain, the maximal one is health responsibility behavior, the next one is life appreciation behavior. The rest goes in the order of significance: interpersonal supporting behavior, law of life behavior, stress management behavior, health risk behavior and nutrition behavior, the minimal one is exercise behavior.5.2.2 Some factors affect the healthy lifestyles of college students, such as gender, temperament, self-rated health, self-rated achievement, place of colleges, type of college, grade, residential peer, birth region, educational levels of parents and family's monthly-earning. Conclusions:1. The HLQ for college students includes exercise behavior, law of life behavior, nutrition behavior, health risk behavior, health responsibility behavior, interpersonal support behavior, stress management behavior and life appreciation behavior.2. The HLQ for college students has high reliability and validity by further statistical verification to indicate that it could serve as a measuring tool for evaluating college student' healthy lifestyles.3. The college students healthy lifestyles is close to the middle level, and have a good health responsibility behavior, but they are less engaged in exercise.4. The factors including physiological, psychological and cognitive, school and family affect the college student healthy lifestyles, and the factors are very complex, and all mutually affect the healthy lifestyles of college students. It is strongly suggested that the colleges should take different measures to stimulate student interest in taking health-promoting lifestyles based on their characteristics so as to develop healthy lifestyles during their college student life.
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