| Objective:Health promoting lifestyle,as a major factor affecting personal health,which is closely related to the formation of health-related habits.The unbalanced diet and nutrition,frequent staying up late,irregular work and rest time,etc.,lead to the health problems in the lifestyle of college students,and their overall health promotion behavior is in the middle and low level.Medical students,as the core workers and pioneers of health promotion in the future national medical and health undertakings,have a health promoting lifestyle,which is not only conducive to maintaining their own health,but also helps them lead patients to form a health promoting lifestyle,and ultimately achieve everyone's health.In this study,prospective cohort study was carried out among the students enrolled in China Medical University in 2015,followed for 3 years,to analyze the dynamic changes of health promoting lifestyle under the influence of dual opposite factors with the continuous improvement of medical knowledge and the increase of academic pressure,and to explore many influencing factors accompanying the changes of health promoting lifestyle to clarify the relationship between them.In order to effectively explore the impact of different grades,we conducted a cross-sectional survey of students in four grades from the first year to the fourth year of University in 2018,and compared with the results of the cohort study,in order to obtain more powerful evidence.Finally,we can master the situation of health promoting life style of medical students,know the influencing factors of health promoting life style of medical students,provide basis for the prediction and intervention of health promoting life style of medical students.Methods:A questionnaire survey was conducted among students from grade one to grade four in China medical university in 2016,2017 and 2018.The investigators were trained,the whole process was supervised,and the questionnaires were conducted using the health promotion lifestyle scale,the Pittsburgh sleep quality scale and the general condition questionnaire.A prospective cohort study was conducted on1,166 medical students enrolled in China medical university in 2015,who were followed up for 3 consecutive years from 2016 to 2018.A cross-sectional survey was conducted among 7,020 college students of China medical university in 2018.In 2016,a total of 4,800 questionnaires were issued,and 4,452 questionnaires were recovered,with a recovery rate of 92.75%.A total of 137 questionnaires were excluded for those who did not complete the questionnaire and those who did not pass the questionnaire.Finally,4,315 effective questionnaires were obtained,with an overall effective rate of89.90%.In 2017,a total of 6,105 questionnaires were issued,with a recovery rate of96.02%and an overall effective rate of 90.04%.A total of 7,500 questionnaires were issued in the 2018 survey,with a recovery rate of 95.08%and an overall effective rate of 98.44%.Use EpiData 3.1,SPSS 26.0 and mplus7.4 software to input and analyze data.Cross section analysis of health promoting lifestyle of college students in 2018:single factor analysis of influencing factors of health promoting lifestyle,difference test of scores of health promoting lifestyle and scores of all dimensions by t test or variance analysis,and comparison between two by LSD-t test.Using stepwise regression analysis,the total score of health promoting lifestyle and the scores of each dimension were analyzed,and the regression equation was established.Correlation analysis was used to understand the correlation between sleep quality,health promoting lifestyle and scores of various dimensions of medical students.The data of2015 level for three consecutive years were studied in a cohort study.The influencing factors were analyzed by repeated measurement analysis of variance.The change track of health promoting lifestyle of medical students was understood through the growth model of unconditional latent variables.The development trend differences among individuals were included in the influencing factors,and the growth curve model of conditional latent variables was established.Results:(1)The average score of health promoting lifestyle of medical students is143.12±5.25,and the average score of single item is 2.75±0.49;the score of subscale is the highest,the score of interpersonal relationship is the highest,and the score of the rest is the lowest in order of spiritual growth,nutrition,health responsibility,stress management and sports.(2)Single factor analysis of cross-sectional survey showed that:different grades(F=11.623,P<0.001),professional schooling(t=-2.752,P=0.006),major(F=4.203,P<0.001),father's education(F=17.912,P<0.001),mother's education(F=26.098,P<0.001),living expenses(F=14.696,P=0.012),breakfast(F=175.554,P=0.004),eating too late at night(t=25.663,P=0.01),anxiety(F=136.642,P=0.004),depression(F=133.607,P=0.004),life optimism(F=435.602,P=0.004),control(F=125.823,P=0.004)were statistically significant differences in the scores of health promoting lifestyle of medical students.(3)The results of cross-sectional survey showed that there was a significant negative correlation between the dimensions of sleep quality and the total score of health promoting lifestyle(r=-0.025-0.257,P<0.001).(4)The results of multiple linear regression analysis of cross-sectional survey showed that:the two dimensions of sleep quality,life optimism,breakfast situation,control,mother's education level,anxiety,cost of living,grade,eating too late at night entered the multiple regression equation,which accounted for 28.1%of the total variation of health promoting lifestyle.(5)The results of repeated measurement analysis of variance showed that there were significant differences in the total score of health promoting lifestyle and the scores of all dimensions of medical students at different time points(P<0.05).(6)The analysis results of the unconditional LGCM model in the cohort study showed that:the factor load of the time point after the unconditional LGCM was estimated to be 0.797;the fitting data of the model(?~2=0.000,DF=0,P<0.001,CFI=1.000,TLI=1.000,RMSEA=0.000,SRMR=0.000,AIC r=31707.103,BIC=31752.655);the correlation coefficient between intercept and slope(r=0.413,P>0.05),the initial health promoting lifestyle of medical students was 140.043(P<0.001),from 2016 to 2018,the change rate of health promoting lifestyle of medical students(slope=3.448,P<0.001);the variance of intercept and slope were212.891(P<0.05)and 33.914(P>0.05),respectively.(7)The results of LGCM model analysis showed that:the variables included in the intercept equation included gender(b=3.526,P<0.05),breakfast frequency(b=4.421,P<0.01),anxiety(b=-2.543,P<0.05),depression(b=-4.850,P<0.001),control(B=-3.109,P<0.01);subjective sleep quality on health promoting lifestyle of medical students,2016 prediction coefficient b=-2.697,P<0.01 prediction coefficient b=-5.080 in 2017,P<0.01prediction coefficient b=-3.134 in 2018,P<0.01,hypnotic drug use on medical students'health promoting lifestyle,prediction coefficient b=-5.115 in 2018,P<0.05,daytime dysfunction on medical students'health promoting lifestyle,prediction coefficient b=-2.487 in 2017,P<0.05.Conclusion:The health promoting life style of medical students is in the middle and higher level.Gender,grade,cost of living,mother's education level,breakfast frequency,eating too late at night are the influencing factors of health promoting life style of medical students;anxiety,depression and control are the risk factors of health promoting life style of medical students;life optimism is the protection factor of health promoting life style of medical students.The change track of health promoting lifestyle of medical students is a free estimation curve of time parameters;the initial health promoting lifestyle level of medical students is different;the change speed of first rising and then falling is different;the change speed has nothing to do with the initial level of health promoting lifestyle;there are individual differences in health promoting lifestyle of medical students.Medical students'sleep quality and the total score of health promoting lifestyle and all dimensions have a significant negative correlation.Medical students with poor sleep quality have a low level of health promoting lifestyle,and the impact of sleep quality on health promoting lifestyle changes with time. |
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