Associations between health promotion behaviors and multidimensional health among Chinese middle-school students—a study focusing on gender differences

Adolescence is a crucial period for establishing lifelong healthy behaviors, and unhealthy habits developed during adolescence can increase the risk of chronic diseases in adulthood. However, few is on the relationships between health promotion behaviors and multidimensional health in Chinese middle-school students, focusing on identifying gender-specific differences. This study employed a non-experimental, correlational design using online surveys to collect data from 179 middle-school students and 103 teachers. Data analysis was conducted using SPSS v20, including ordinal logistic regression analysis, Chi-square tests and t-tests. The results indicate that approximately 43.7% of middle-school teachers perceive that rural students as having effective health promotion behaviors. Female students demonstrated higher levels of health promotion behaviors than males, with significant gender differences observed in health responsibility behavior (p = 0.011) and interpersonal relationships (p = 0.025). However, no gender differences were found in the multidimensional health of rural middle-school students. Both male and female students showed concerning levels of physical health, with only 38.2% of males and 37.78% of females rated as good or excellent. Notably, life appreciation behavior was identified as the only significant predictor of multidimensional health among these students, indicating that higher scores in this domain correlate with better health. Health educators and policymakers are advised to account for gender differences in the development and delivery of health promotion initiatives aimed at adolescents, with a particular emphasis on fostering life appreciation. Interventions focused on these aspects may offer substantial potential in diminishing health risks in adulthood and enhancing overall lifelong well-being.

Health promotion behaviors; Multidimensional health; Rural middle-school students; Middle-school teachers

[1] World Health Organization. Health promotion. 2023. Available at: https://www.who.int/health-topics/health-promotion#tab=tab_1 (Accessed: 02 January 2024).

[2] Patrao AL, Almeida MDC, Matos SMA, Chor D, Aquino EML. Gender and psychosocial factors associated with healthy lifestyle in the Brazilian longitudinal study of Adult Health (ELSA-Brasil) cohort: a cross-sectional study. BMJ open. 2017; 7: e015705.

[3] Guedes DP, Zuppa MA, Yamaji BHS. Health-promoting domains and lifestyle of a sample of Brazilian adolescents. Journal of Education and Health Promotion. 2023; 12: 83.

[4] Kim S, Oh J. The relationship between e-health literacy and health-promoting behaviors in nursing students: a multiple mediation model. International Journal of Environmental Research and Public Health. 2021; 18: 5804.

[5] Park JM, Han AK, Cho YH. Construct equivalence and latent means analysis of health behaviors between male and female middle school students. Asian Nursing Research. 2011; 5: 216–221.

[6] Honer O, Demetriou Y. Effects of a health-promotion programme in sixth grade German students’ physical education. European Journal of Sport Science. 2014; 14: S341–S351.

[7] Lazzeri MFL, Mastorci F, Piaggi P, Doveri C, Marinaro I, Trivellini G, et al. A close association between body weight, health-related quality of life, and risk behaviors in a sample of Italian high school students. Nutrients. 2023; 15: 5107.

[8] Takacs J, Katona ZB, Ihasz FA. Large sample cross-sectional study on mental health challenges among adolescents and young adults during the COVID-19 pandemic at risk group for lonelyness and hopelessness during the COVID-19 pandemic. Journal of Affective Disorders. 2023; 325: 770–777.

[9] Tao K, Liu WX, Xiong SY, Ken L, Zeng N, Peng QW, et al. Associations between self-determined motivation, accelerometer determined physical activity, and quality of life in Chinese college students. International Journal of Environmental Research and Public Health. 2019; 16: 2941.

[10] Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: development and psychometric characteristics. Nursing Research. 1987; 36: 76–81.

[11] Noel R. ‘The “buck” stops with me’—reconciling men’s lay conceptualizations of responsibility for health with men’s health policy. Health Sociology Review. 2010; 19: 419–436.

[12] August KJ, Malik D, Markey CH, Woods K, Gerwitz GC. Additive and interactive associations among body appreciation, self-compassion, and gender in understanding college students’ health behaviors. Body Image. 2023; 47: 101634.

[13] Zhang S, Xiao T, He J. The influence of a school social network intervention on adolescent’s health behaviors: a gender-specific agent-based model. Frontiers in Public Health. 2022; 10: 861743.

[14] Vakili M, Mirzadeh M, Mirzaei M, Modarresi M, Raei R, Karimi R, et al. Sex differences in high-risk health behaviors among school-going adolescents in Yazd, Iran; a cross-sectional study. Heliyon. 2023; 9: e16404.

[15] Thunfors P, Collins BN, Hanlon AL. Health behavior interests of adolescents with unhealthy diet and exercise: implications for weight management. Health Education Research. 2009; 24: 634–645.

[16] Eyimaya AO, Ozdemir F, Tezel A, Apay SE. Determining the healthy lifestyle behaviors and e-health literacy levels in adolescentes. Journal of School of Nursing. 2021; 55: e03742.

[17] Tian H, Chen J. The association and intervention effect between eHealth literacy and lifestyle behaviors among Chinese university students. Journal of School of Nursing. 2022; 56: e20220147.

[18] Tian H, Chen J. The relationship between the eHealth literacy and computer skills of university students. Education and Information Technologies. 2023; 28: 10691–10707.

[19] Tabrizi JS, Doshmangir L, Khoshmaram N, Shakibazadeh E, Abdolahi HM, Khabiri R. Key factors affecting health promoting behaviors among adolescents: a scoping review. BMC health services research. 2024; 24: 58.

[20] Bergier J, Bergier B, Tsos A. Variations in physical activity of male and female students from the Ukraine in health-promoting life style. Annals of Agricultural and Environmental Medicine. 2017; 24: 217–221.

[21] Baceviciene M, Jankauskiene R, Emeljanovas A. Self-perception of physical activity and fitness is related to lower psychosomatic health symptoms in adolescents with unhealthy lifestyles. BMC Public Health. 2019; 19: 980.

[22] Tian H, Chen J. Health of widowed elderly and related factors in China. Journal of Men’s Health. 2022, 18: 163.

[23] Wang D, Ou C, Chen M, Duan N. Health-promoting lifestyles of university students in Mainland China. BMC Public Health. 2009; 9: 379.

[24] World Health Organization. Adolescent and young adult health. 2023. Available at: https://www.who.int/zh/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions (Accessed: 25 February 2024).

[25] Díaz Y, Hessel P, Avendano M, Evans-Lacko S. Multidimensional poverty and adolescent mental health: unpacking the relationship. Social Science & Medicine. 2022; 311: 115324.

[26] Curtis AC, Waters CM, Brindis C. Rural adolescent health: the importance of prevention services in the rural community. The Journal of Rural Health. 2011; 27: 60–71.

[27] Chauhan SK, Dhar M. Prevalence and predictors of mental health disorder among the adolescent living in the slums of Lucknow, India: a cross-sectional study. Community Mental Health Journal. 2020; 56: 383–392.

[28] Ayaz-Alkaya S, Kulakçi-Altintas H. Predisposing factors of health promotion behaviors and health literacy in adolescents: a cross-sectional design. To be published in Public Health Nursing. 2024. [Preprint].

[29] Ma Y, Ma C, Lan X. A person-centered analysis of emotional-behavioral functioning profiles in adolescents: associations with teacher autonomy support and growth mindset. Current Psychology. 2023; 42: 20591–20605.

[30] Becker BE, Luthar SS. Peer‐perceived admiration and social preference: contextual correlates of positive peer regard among suburban and urban adolescents. Journal of Research on Adolescence. 2007; 17: 117–144.

[31] Rojas-Barahona CA, Gaete J, Olivares E, Förster CE, Chandia E, Chen M. Psychometric evaluation of the adolescent health promotion scale in Chile: differences by socioeconomic status and gender. Journal of Nursing Research. 2017; 25: 471–480.

[32] Musavian AS, Pasha A, Rahebi SM, Roushan ZA, Ghanbari A. Health promoting behaviors among adolescents: a cross-sectional study. Nursing and Midwifery Studies. 2014; 3: e14560.

[33] Ortabag T, Ozdemir S, Bakir B, Tosun N. Health promotion and risk behaviors among adolescents in Turkey. The Journal of School Nursing. 2011; 27: 304–315.

[34] Piko B, Kiss H, Graczer A. Relationship of young women’s body appreciation with eating disorders and psychological variables. Orvosi Hetilap. 2022; 163: 1082–1088.

[35] Piko BF, Obal A, Mellor D. Body appreciation in light of psychological, health-and weight-related variables among female adolescents. Europe’s Journal of Psychology. 2021; 16: 676–687.

[36] Lemoine JE, Konradsen H, Lunde Jensen A, Roland-Lévy C, Ny P, Khalaf A, et al. Factor structure and psychometric properties of the body appreciation Scale-2 among adolescents and young adults in Danish, Portuguese, and Swedish. Body Image. 2018; 26: 1–9.

[37] Alruwaili TAM, Alshehri SAK, Thirunavukkarasu A, Elfarargy MS, Alanazi TK, Muharib R. Assessment of health promotion behavior and associated factors among the northern Saudi adolescent population: a cross-sectional study. PeerJ. 2023; 11: e15567.