Psychosocial Factors Predict Healthy Lifestyle Behaviors among University Students with Differences by Sex and Age

Psychosocial Factors Predict Healthy Lifestyle Behaviors among University Students with Differences by Sex and Age | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychosocial Factors Predict Healthy Lifestyle Behaviors among University Students with Differences by Sex and Age Wanich Suksatan, Hisako Matsuo, Tanyathorn Hauwadhanasuk, Gurusai Sujitha Peramsetty This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9411028/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Healthy lifestyle behaviors play an essential role in preventing chronic diseases among university students, yet the psychosocial factors that shape these behaviors may differ across demographic groups. This study examined whether health awareness, self-esteem, and social support predicted healthy lifestyle behaviors among university students and explored whether these associations varied by sex and age. Methods A cross-sectional secondary data analysis was conducted using survey data from 1,169 undergraduate students in China. Validated instruments measured health awareness, healthy lifestyle behaviors, self-esteem, and social support. Multiple regression analyses were performed separately for males and females, and for younger (18–20 years) and older (21–23 years) students. Group differences were assessed using independent-samples t-tests. Results Self-esteem and social support were the strongest predictors of healthy lifestyle behaviors across all groups, although their relative influence varied slightly by sex and age. Among males and younger students, self-esteem demonstrated the largest effect, whereas social support was more influential among females and older students. Health awareness showed smaller but statistically significant associations. The models explained a moderate proportion of variance in healthy lifestyle behaviors (adjusted R² ≈ 0.29–0.30). Conclusion Psychosocial factors, particularly self-esteem and social support, play a central role in shaping healthy lifestyle behaviors among university students. These findings highlight the importance of interventions that enhance psychological well-being and strengthen social support systems within university settings. Health Behavior Health Knowledge Attitudes Practice Social Support Students’ Attitudes Figures Figure 1 Figure 2 Figure 3 1. Background Healthy lifestyle behaviors, including balanced nutrition, regular physical activity, adequate sleep, and stress management, are essential for preventing chronic noncommunicable diseases and supporting long-term physical and mental well-being among university students. Yet, unhealthy lifestyle patterns remain common during the university years, a period often characterized by academic pressure, irregular schedules, and major developmental transitions [1]. These challenges may lead to inadequate dietary habits, low physical activity, and increased stress, which can have lasting effects on health trajectories into adulthood [2]. Psychosocial factors play a central role in shaping students’ health behaviors. Health awareness, defined as individuals’ knowledge of and attention to personal health, has been positively linked to healthier dietary and exercise habits [3, 4]. Self-esteem, reflecting one’s sense of self-worth, is another determinant associated with positive health behaviors; students with higher self-esteem often demonstrate healthier eating patterns and lower engagement in risky behaviors such as disordered eating [5, 6]. Social support, including emotional and practical assistance from family, peers, and significant others, has also been shown to promote healthier behaviors, with strong evidence that supportive networks encourage better diet, higher physical activity, and improved well-being [7, 8]. Despite growing evidence, less is known about whether these psychosocial predictors operate similarly across demographic groups. Prior research suggests potential sex differences in lifestyle habits; for example, females often exhibit healthier eating patterns, while males tend to engage in more physical activity [9]. Age-related variation may also occur as students transition from early to later university years [10]. However, findings remain inconsistent, and few studies have examined how sex and age may influence the relative importance of health awareness, self-esteem, and social support, particularly within the Chinese higher education context. Given these gaps, further investigation is needed to understand how these psychosocial factors predict healthy lifestyle behaviors among university students and whether these relationships differ across demographic subgroups. This study is guided by Social Cognitive Theory (SCT), which posits that health behaviors are shaped through reciprocal interactions between personal factors, behavior, and the social environment [11]. Within this framework, health awareness reflects cognitive influences on behavior, self-esteem represents intrapersonal motivational factors, and social support captures environmental reinforcement. Applying SCT provides a coherent theoretical basis for examining how these psychosocial factors jointly shape students’ health behaviors and whether these relationships differ by sex and age. 2. Objectives The objective of this study was to examine the extent to which health awareness, self-esteem, and social support predict healthy lifestyle behaviors among university students and to determine whether these associations differ by sex and age group. Specifically, the study aimed to evaluate the independent contributions of these psychosocial factors and to compare their predictive strength between male and female students and between younger (18–20 years) and older (21–23 years) students. 3. Methods Design and Setting This study utilized a cross-sectional design and analyzed secondary data originally collected from a university in Guangdong Province, China. The dataset was accessed through the Inter-university Consortium for Political and Social Research (ICPSR) and included undergraduate students who completed an online survey assessing health awareness, lifestyle behaviors, self-esteem, and social support [12]. Sample and Sampling Technique The original data collection used simple random sampling [12]. A complete list of enrolled students was obtained from the university, and a computer-generated random number table was used to select potential participants. Invitation emails were sent between March 23 and April 12, 2024, and included study details, confidentiality assurances, and an online consent form. Only students who provided informed consent were able to proceed to the survey. Of the 1,297 students who accessed the questionnaire, 1,169 met the inclusion criteria after data screening for completeness and response validity. Research Instruments Health Awareness was measured using the Health Awareness Scale (HAS), a six-item instrument rated on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). Higher scores represent greater awareness of personal health status and engagement with health-related information. In the original dataset, internal consistency was excellent (Cronbach’s α = 0.991) [13]. Healthy Lifestyle Behaviors scale was assessed using the Diet and Healthy Lifestyle Scale (DEVS), a 14-item instrument with three response options per item (1 = low frequency/intake to 3 = high frequency/intake). Scores reflect the extent to which students engage in various healthy habits. Cronbach’s α for this scale was 0.932 in the original study [14]. Self-Esteem was measured using the Rosenberg Self-Esteem Scale (RSES), which contains 10 items scored from 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate greater global self-worth. Reliability in the dataset was high (Cronbach’s α = 0.996) [15]. Social Support was assessed using the Oslo Social Support Scale (OSSS-3), consisting of three items assessing number of close contacts, interest shown by others, and perceived practical support. Scores range across 4- and 5-point Likert-type options, with higher totals indicating stronger perceived support. The original dataset demonstrated strong internal consistency (Cronbach’s α = 0.981) [15]. Data Screening and Preparation All data underwent quality screening to remove inconsistent, incomplete, or patterned responses in the original dataset. For the present analysis, variables were assessed for missing values, normality, and outliers, with no additional exclusions required. Demographic variables were recoded for analysis, with sex coded as male = 0 and female = 1, and age group categorized as 18–20 years = 0 and 21–23 years = 1. Statistical Analysis All analyses were performed using SPSS Version 28. Descriptive statistics were used to summarize participant characteristics and key study variables, and independent-samples t-tests were conducted to assess group differences by sex and age. To examine whether health awareness, self-esteem, and social support predicted healthy lifestyle behaviors, and to determine whether these associations differed across demographic groups, hierarchical multiple regression models were conducted separately for males and females, as well as for younger (18–20 years) and older (21–23 years) students. For each model, standardized beta coefficients (β), confidence intervals, R², adjusted R², F-statistics, and p-values were reported, and effect sizes were interpreted using established guidelines. All statistical tests were two-tailed with a significance level of p < .05. 4. Results Participant Characteristics and Gender Comparisons A total of 1,169 university students participated in the study, comprising 554 males (47.4%) and 615 females (52.6%). The mean age of the sample was 20.56 years (SD = 1.73), ranging from 18 to 23 years. Descriptive statistics and gender differences for the study variables, including health awareness, healthy lifestyle behaviors, self-esteem, and social support, are presented in Table 1 . Comparisons by age group, students aged 18–20 years (n = 573) and 21–23 years (n = 596) did not differ significantly in health awareness, healthy lifestyle behaviors, or self-esteem. A marginal difference was observed in social support (t(1,164.73) = − 1.80, p = .073), with older students reporting slightly higher levels of support. Table 1 Descriptive statistics of study variables by sex and age group Variable Group n Mean (SD) Test statistic p-value Health Awareness Male 554 20.19 (7.65) t(1167) = − 0.05 .964 Female 615 20.21 (7.77) 18–20 years 573 20.26 (7.62) t(1167) = 0.25 .807 21–23 years 596 20.15 (7.81) Healthy Lifestyles Male 554 22.89 (7.08) t(1167) = 0.18 .855 Female 615 22.81 (6.95) 18–20 years 573 22.67 (7.00) t(1167) = − 0.82 .412 21–23 years 596 23.01 (7.05) Self-Esteem Male 554 24.48 (10.95) t(1167) = − 0.07 .948 Female 615 24.52 (11.05) 18–20 years 573 23.72 (10.94) t(1167) = − 0.64 .523 21–23 years 596 24.30 (11.06) Social Support Male 554 6.86 (3.86) t(1148) = − 0.13 .898 Female 615 6.84 (3.77) 18–20 years 573 6.62 (3.82) t(1164.73) = − 1.80 .073 21–23 years 596 7.02 (3.80) Note. Values are presented as mean (SD). Independent samples t-tests were conducted to compare groups. Pearson Correlations among key study Variables Pearson correlation analysis showed that all variables were positively associated, with weak to moderate correlations. Healthy lifestyle behaviors were moderately correlated with social support (r = 0.41) and self-esteem (r = 0.38), whereas health awareness showed weaker associations with all variables (r = 0.10–0.21). Overall, psychosocial factors appeared to have stronger relationships with healthy lifestyle behaviors than health awareness. All correlations were below 0.80, indicating no multicollinearity concerns (see Fig. 1 ). Multiple Regression Analyses Multiple regression analyses indicated that self-esteem and social support were the strongest predictors of healthy lifestyle behaviors across all groups. Among males, self-esteem demonstrated the largest effect (β = 0.34), followed closely by social support (β = 0.33), whereas among females, social support emerged as the most influential predictor (β = 0.37), with self-esteem also showing a strong association (β = 0.31). In contrast, health awareness demonstrated smaller but statistically significant effects (β = 0.08) (see Fig. 2 ). Age-stratified analyses showed a similar pattern, with self-esteem being the strongest predictor among individuals aged 18–20 years (β = 0.35), while social support had the greatest influence among those aged 21–23 years (β = 0.38). Overall, the models explained a moderate proportion of variance in healthy lifestyle behaviors (Adjusted R² ≈ 0.29–0.30), indicating consistent and robust effects of psychosocial factors across sex and age groups (see Fig. 3). Complete regression coefficients for gender and age groups are summarized in Table 2 . Table 2 Multiple regression models predicting healthy lifestyle behaviors by sex and age group (standardized coefficients with 95% confidence intervals) Predictor Male (n = 554) Female (n = 615) Aged 18–20 (n = 573) Aged 21–23 (n = 596) β (95%CI) β (95%CI) β (95%CI) β (95%CI) Health Awareness 0.19*** (0.118, 0.259) 0.08* (0.013, 0.149) 0.18*** (0.111, 0.250) 0.09** (0.026, 0.163) Self-esteem 0.34*** (0.274, 0.414) 0.31*** (0.246, 0.382) 0.35*** (0.285, 0.423) 0.30*** (0.234, 0.373) Social Support 0.33*** (0.263, 0.404) 0.37*** (0.298, 0.435) 0.31*** (0.236, 0.376) 0.38*** (0.313, 0.450) Adjusted R² 0.30 0.26 0.30 0.29 F-statistic 81.7*** 82.6*** 84.0*** 80.3*** Notes. Values are standardized regression coefficients (β) with 95% confidence intervals. The final model (Model 3) is presented. *p < .05, **p < .01, ***p < .001 5. Discussion This study identified health awareness, self-esteem, and social support as significant predictors of healthy lifestyle behaviors among Chinese university students. The strong influence of health awareness, reflected in students’ knowledge and attitudes about nutrition, exercise, and health risks, is consistent with international evidence showing that greater health consciousness predicts better dietary patterns and greater engagement in physical activity [ 2 , 6 ]. Likewise, the association between self-esteem and healthy behaviors in our study aligns with prior work indicating that students with higher self-worth tend to maintain balanced diets and regular physical activity, whereas lower self-esteem is linked to maladaptive behaviors such as disordered eating [ 16 ]. These findings reinforce the central role of psychological factors in shaping health-related behaviors during late adolescence and early adulthood. The importance of social support observed in this study also mirrors patterns reported across countries and cultural settings. Adolescents and university students who receive consistent encouragement, emotional support, or modeling from family and peers are more likely to engage in physical activity and consume fruits and vegetables [ 1 , 17 ]. Similarly, research involving international undergraduates found that friend support plays a critical role in motivating participation in physical activity [ 7 ]. A recent systematic review further confirms that social support enhances young adults’ health behaviors and well-being by providing emotional resources, accountability, and motivation [ 8 ]. Collectively, these findings demonstrate that health awareness, self-esteem, and social support operate as universal psychosocial determinants of healthy lifestyles, and our study extends this body of evidence to the Chinese higher education context. Notably, we found no significant differences in overall healthy lifestyle scores between male and female students, nor between younger (18–20) and older (21–23) students. This contrasts with international findings that often report gender-based differences—for example, female students typically demonstrate healthier eating patterns, while males participate more frequently in physical activity [ 9 ]. The absence of sex differences in our sample may indicate a convergence in lifestyle behaviors among young Chinese adults, possibly influenced by shared campus environments, access to similar resources, and comparable academic demands. Likewise, the lack of age-group differences within a relatively narrow developmental period suggests that undergraduate students, regardless of their year in university, tend to exhibit similar lifestyle habits. These findings are consistent with a Spanish study reporting uniformly poor dietary patterns and high sedentary behavior across university students of different ages [ 10 ]. However, subtle variations emerged in the predictive strength of key psychosocial determinants. Social support demonstrated a somewhat stronger positive influence on healthy lifestyle behaviors among female students and those in the older subgroup. This pattern aligns with evidence that women may benefit more from interpersonal support when engaging in health-promoting behaviors [ 18 ]. Female students often describe encouragement from peers and family as a primary motivator for exercising and maintaining healthy eating habits, whereas male students may be more influenced by individual goals, competitiveness, or self-directed interests [ 10 ]. Future cross-cultural research should investigate these moderating effects in greater depth to inform tailored and more effective health promotion strategies. The findings of this study highlight the critical need for nurses and health educators to integrate psychosocial assessment, specifically health awareness, self-esteem, and social support, into routine practice when working with university populations. Nursing professionals can play a pivotal role by developing targeted interventions such as wellness counseling, health education workshops, peer-support initiatives, and programs that build confidence and coping skills. Collaboration among universities, families, and community organizations can further strengthen supportive networks and extend health-promoting resources beyond the campus. Collectively, these multilevel, nurse-led strategies can create a supportive ecosystem that empowers students to adopt, strengthen, and sustain healthy lifestyle behaviors. This study has several limitations. First, its cross-sectional design limits causal inference, and bidirectional relationships between psychosocial factors and health behaviors cannot be ruled out. Second, reliance on self-reported measures may introduce recall and social desirability bias, despite the use of validated instruments. Third, the sample was drawn from a single province in China, which may limit generalizability to students in other regions or countries with different cultural norms, socioeconomic conditions, or university environments. Finally, although key psychosocial predictors were included, other potentially relevant factors, such as stress, self-efficacy, family socioeconomic status, or academic workload, were not assessed and may contribute to lifestyle behaviors. Conclusion This study demonstrates that health awareness, self-esteem, and social support are key psychosocial determinants of healthy lifestyle behaviors among Chinese university students. The multiple regression findings show that each factor uniquely contributes to healthier behaviors, with self-esteem and social support emerging as the most consistent predictors across groups, underscoring the importance of psychosocial and environmental factors in promoting healthy lifestyles among university students. Together, the results highlight the importance of fostering health knowledge, psychological well-being, and supportive social environments in university settings. Strengthening these areas may enhance students’ ability to adopt and sustain healthy lifestyles during a critical period of transition into adulthood. Future research should explore these relationships longitudinally and evaluate tailored interventions that address the specific needs of diverse student populations. Declarations Clinical Trial Number Not Applicable Author Contributions Conceptualization, W.S., H.M., and T.H.; methodology, W.S. and H.M.; soft-ware, W.S. and H.M.; validation, W.S. and H.M.; formal analysis, W.S.; writing—original draft preparation, W.S.; writing—review and editing, W.S., H.M., T.H., and G.S.P.; supervision, H.M. All authors have read and agreed to the published version of the manuscript. Ethical Considerations The original study protocol received approval from the Ethics Committee of Guangdong Business and Technology University (Approval No. 2024GS006). All responses were anonymous, and participants were informed about voluntary participation, confidentiality, and the right to withdraw at any time. Consent to Participate Informed consent was obtained from all participants included in the original study. Consent to Publish Not applicable. Conflict of Interest The authors declare that there is no conflict of interest. Funding Statement This research did not receive any grants from public, commercial, or nonprofit funding agencies. Data Availability The dataset analyzed in this study is publicly available through the Inter-university Consortium for Political and Social Research (ICPSR) at https://doi.org/10.3886/E207741V1. References Zhang Z, Abdullah H, Ghazali AHA, D’Silva JL, Ismail IA, Huang Z. The influence of health awareness on university students’ healthy lifestyles: The chain mediating role of self-esteem and social support. PLOS ONE. 2024;19(10):e0311886. doi: 10.1371/journal.pone.0311886. Benjanirat T, Ounprasertsuk J, Kawe S, Sillabutra J. Mental Health Status, Related Knowledge, and Its Influencing Factors Among First-Year University Students: A Cross-sectional Study in Thailand. Journal of Nursing and Midwifery Sciences. 2025;12(12):e163995. doi: 10.5812/jnms-160956. Wu Y, Wang S, Shi M, Wang X, Liu H, Guo S, et al. Awareness of nutrition and health knowledge and its influencing factors among Wuhan residents. Front Public Health. 2022;10:987755. doi: 10.3389/fpubh.2022.987755. Li H, Shi L, Xing YL. The mediating role of health awareness in the relationship between health information behavior and health outcomes among the older adults. Front Public Health. 2025;13:1492472. doi: 10.3389/fpubh.2025.1492472. Li H, Hao F. The influence of physical activity on the mental health of high school students: the chain mediating effects of social support and self-esteem. Sci Rep. 2025;15(1):27537. doi: 10.1038/s41598-025-11952-5. Cella S, Cipriano A, Aprea C, Cotrufo P. Self-Esteem and Binge Eating among Adolescent Boys and Girls: The Role of Body Disinvestment. Int J Environ Res Public Health. 2021;18(14). doi: 10.3390/ijerph18147496. Lisboa T, Silva WRD, Silva DAS, Felden É PG, Pelegrini A, Lopes JJD, et al. Social support from family and friends for physical activity in adolescence: analysis with structural equation modeling. Cad Saude Publica. 2021;37(1):e00196819. doi: 10.1590/0102-311x00196819. Ruihua L, Hassan NC, Qiuxia Z, Sha O, Jingyi D. A systematic review on the impact of social support on college students’ wellbeing and mental health. PLOS ONE. 2025;20(7):e0325212. doi: 10.1371/journal.pone.0325212. Lonati E, Cazzaniga E, Adorni R, Zanatta F, Belingheri M, Colleoni M, et al. Health-Related Lifestyles among University Students: Focusing on Eating Habits and Physical Activity. International Journal of Environmental Research and Public Health. 2024;21(5):626. doi: 10.3390/ijerph21050626. García-Pérez L, Villodres GC, Muros JJ. Differences in healthy lifestyle habits in university students as a function of academic area. J Public Health (Oxf). 2023;45(2):513-22. doi: 10.1093/pubmed/fdac120. Bandura A. Health promotion from the perspective of social cognitive theory. Understanding and changing health behaviour. Psychology Press; 2013. p. 299-339. Zhang Z: The Influence of Health Awareness on University Students’ Healthy Lifestyles in Guangdong. https://doi.org/10.3886/E207741V1 (2024). Accessed November 10, 2025. Michaelidou N, Hassan LM. The role of health consciousness, food safety concern and ethical identity on attitudes and intentions towards organic food. International Journal of Consumer Studies. 2008;32(2):163-70. doi: 10.1111/j.1470-6431.2007.00619.x. Calizaya-Milla YE, Saintila J, Morales-García WC, Ruiz Mamani PG, Huancahuire-Vega S. Evidence of Validity and Factorial Invariance of a Diet and Healthy Lifestyle Scale (DEVS) in University Students. Sustainability. 2022;14(19):12273. doi: 10.3390/su141912273. Rosenberg M, Rosenberg M. Society and the Adolescent Self-Image. Princeton: Princeton University Press; 2015. Hazzard VM, Telke SE, Simone M, Anderson LM, Larson NI, Neumark-Sztainer D. Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010-2018. Eat Weight Disord. 2021;26(1):287-94. doi: 10.1007/s40519-020-00852-4. Nabors L, Fiser-Gregory K, Olaniyan A, Stanton-Chapman T, Merianos A. College students' attitudes about ways family, friends, significant others and media affect their eating and exercise behaviors and weight perceptions. J Am Coll Health. 2024;72(4):1296-308. doi: 10.1080/07448481.2022.2076101. Jimenez-Morcillo J, Clemente-Suárez VJ. Gender Differences in Body Satisfaction Perception: The Role of Nutritional Habits, Psychological Traits, and Physical Activity in a Strength-Training Population. Nutrients. 2024;16(1):104. doi: 10.3390/nu16010104. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 May, 2026 Reviews received at journal 15 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviewers agreed at journal 10 May, 2026 Reviewers agreed at journal 08 May, 2026 Reviewers invited by journal 05 May, 2026 Editor assigned by journal 28 Apr, 2026 Submission checks completed at journal 27 Apr, 2026 First submitted to journal 27 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9411028","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639233141,"identity":"ef093882-5959-4527-9018-ffdb252bb484","order_by":0,"name":"Wanich Suksatan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYJCCA4wNQJIHwpFjYAdRbMRqOcDAYMzATIQWBmQtiQ2EtBgcP3vwwM8dDPYGZ44//Pyh5k76/GYeA4YPZYdxazmTl3Cw9wxD4oazPcYSB449y91wmMeAccY53FrMDuQYHGZsY0gwOM/DIHGA7XDuBmYeA2beNjxazr8Ba7E3OM/++MeBf4fT5YEOY/6LT8sNiC2MG842mEkcbDucwAB0GDMjHi32N94YHOxtk0iceeaMmcXZvsOGGw6zFRzsOZeOU4tkf47xh59tNvZ8Z9If36j4dlhevr1544MfZdY4tUCBBCr3ACH1o2AUjIJRMArwAwDMIF4E56K72wAAAABJRU5ErkJggg==","orcid":"","institution":"Saint Louis University","correspondingAuthor":true,"prefix":"","firstName":"Wanich","middleName":"","lastName":"Suksatan","suffix":""},{"id":639233142,"identity":"26cd127f-b2ef-4e63-a0fa-600036128376","order_by":1,"name":"Hisako Matsuo","email":"","orcid":"","institution":"Saint Louis University","correspondingAuthor":false,"prefix":"","firstName":"Hisako","middleName":"","lastName":"Matsuo","suffix":""},{"id":639233143,"identity":"1de01827-db6c-4ea9-bc7b-f79cdc0f3399","order_by":2,"name":"Tanyathorn Hauwadhanasuk","email":"","orcid":"","institution":"Saint Louis University","correspondingAuthor":false,"prefix":"","firstName":"Tanyathorn","middleName":"","lastName":"Hauwadhanasuk","suffix":""},{"id":639233144,"identity":"cadbce6e-aa3a-4a8b-9399-b89f41263e34","order_by":3,"name":"Gurusai Sujitha Peramsetty","email":"","orcid":"","institution":"Saint Louis University","correspondingAuthor":false,"prefix":"","firstName":"Gurusai","middleName":"Sujitha","lastName":"Peramsetty","suffix":""}],"badges":[],"createdAt":"2026-04-14 06:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9411028/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9411028/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109283624,"identity":"1b73546d-5e50-46a2-8962-fa053c87693d","added_by":"auto","created_at":"2026-05-14 19:51:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46245,"visible":true,"origin":"","legend":"\u003cp\u003ePearson correlation matrix among study variables. Color intensity represents the strength and direction of correlations. All variables were significantly correlated (p \u0026lt; .05), with no evidence of multicollinearity.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9411028/v1/738e1ce8f6a96b293b195c64.png"},{"id":109283625,"identity":"2353d857-7003-436a-97e8-c8ab7084c4c8","added_by":"auto","created_at":"2026-05-14 19:51:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41679,"visible":true,"origin":"","legend":"\u003cp\u003eSex differences in predictors of healthy lifestyle behaviors. Points represent standardized regression coefficients (β), and error bars indicate 95% confidence intervals.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9411028/v1/d984545b09cd09e2780d8ef0.png"},{"id":109283626,"identity":"bfd836c7-3586-4c60-bbe8-ff79da818fe4","added_by":"auto","created_at":"2026-05-14 19:51:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":43490,"visible":true,"origin":"","legend":"\u003cp\u003eAge differences in predictors of healthy lifestyle behaviors.Points represent standardized regression coefficients (β), and error bars indicate 95% confidence intervals.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9411028/v1/dd51730c501a8ae6f124b5f9.png"},{"id":109296639,"identity":"26b31d5d-b5ad-455a-8ead-65f368739bef","added_by":"auto","created_at":"2026-05-15 08:48:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":326707,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9411028/v1/af683518-6fcf-4205-b49b-4d7c371fd0ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychosocial Factors Predict Healthy Lifestyle Behaviors among University Students with Differences by Sex and Age","fulltext":[{"header":"1. Background","content":"\u003cp\u003eHealthy lifestyle behaviors, including balanced nutrition, regular physical activity, adequate sleep, and stress management, are essential for preventing chronic noncommunicable diseases and supporting long-term physical and mental well-being among university students. Yet, unhealthy lifestyle patterns remain common during the university years, a period often characterized by academic pressure, irregular schedules, and major developmental transitions [1]. These challenges may lead to inadequate dietary habits, low physical activity, and increased stress, which can have lasting effects on health trajectories into adulthood [2].\u003c/p\u003e\n\u003cp\u003ePsychosocial factors play a central role in shaping students’ health behaviors. Health awareness, defined as individuals’ knowledge of and attention to personal health, has been positively linked to healthier dietary and exercise habits [3, 4]. Self-esteem, reflecting one’s sense of self-worth, is another determinant associated with positive health behaviors; students with higher self-esteem often demonstrate healthier eating patterns and lower engagement in risky behaviors such as disordered eating [5, 6]. Social support, including emotional and practical assistance from family, peers, and significant others, has also been shown to promote healthier behaviors, with strong evidence that supportive networks encourage better diet, higher physical activity, and improved well-being [7, 8].\u003c/p\u003e\n\u003cp\u003eDespite growing evidence, less is known about whether these psychosocial predictors operate similarly across demographic groups. Prior research suggests potential sex differences in lifestyle habits; for example, females often exhibit healthier eating patterns, while males tend to engage in more physical activity [9]. Age-related variation may also occur as students transition from early to later university years [10]. However, findings remain inconsistent, and few studies have examined how sex and age may influence the relative importance of health awareness, self-esteem, and social support, particularly within the Chinese higher education context.\u003c/p\u003e\n\u003cp\u003eGiven these gaps, further investigation is needed to understand how these psychosocial factors predict healthy lifestyle behaviors among university students and whether these relationships differ across demographic subgroups. This study is guided by Social Cognitive Theory (SCT), which posits that health behaviors are shaped through reciprocal interactions between personal factors, behavior, and the social environment [11]. Within this framework, health awareness reflects cognitive influences on behavior, self-esteem represents intrapersonal motivational factors, and social support captures environmental reinforcement. Applying SCT provides a coherent theoretical basis for examining how these psychosocial factors jointly shape students’ health behaviors and whether these relationships differ by sex and age.\u003c/p\u003e\n\n"},{"header":"2. Objectives","content":"\u003cp\u003eThe objective of this study was to examine the extent to which health awareness, self-esteem, and social support predict healthy lifestyle behaviors among university students and to determine whether these associations differ by sex and age group. Specifically, the study aimed to evaluate the independent contributions of these psychosocial factors and to compare their predictive strength between male and female students and between younger (18–20 years) and older (21–23 years) students.\u003c/p\u003e"},{"header":"3. Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDesign and Setting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized a cross-sectional design and analyzed secondary data originally collected from a university in Guangdong Province, China. The dataset was accessed through the Inter-university Consortium for Political and Social Research (ICPSR) and included undergraduate students who completed an online survey assessing health awareness, lifestyle behaviors, self-esteem, and social support [12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample and Sampling Technique\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original data collection used simple random sampling [12]. A complete list of enrolled students was obtained from the university, and a computer-generated random number table was used to select potential participants. Invitation emails were sent between March 23 and April 12, 2024, and included study details, confidentiality assurances, and an online consent form. Only students who provided informed consent were able to proceed to the survey. Of the 1,297 students who accessed the questionnaire, 1,169 met the inclusion criteria after data screening for completeness and response validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e \u003cem\u003eResearch Instruments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Health Awareness \u003c/strong\u003ewas measured using the Health Awareness Scale (HAS), a six-item instrument rated on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). Higher scores represent greater awareness of personal health status and engagement with health-related information. In the original dataset, internal consistency was excellent (Cronbach’s α = 0.991) [13].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Healthy Lifestyle Behaviors\u003c/strong\u003e scale was assessed using the Diet and Healthy Lifestyle Scale (DEVS), a 14-item instrument with three response options per item (1 = low frequency/intake to 3 = high frequency/intake). Scores reflect the extent to which students engage in various healthy habits. Cronbach’s α for this scale was 0.932 in the original study [14].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Self-Esteem\u003c/strong\u003e was measured using the Rosenberg Self-Esteem Scale (RSES), which contains 10 items scored from 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate greater global self-worth. Reliability in the dataset was high (Cronbach’s α = 0.996) [15].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Support\u003c/strong\u003e was assessed using the Oslo Social Support Scale (OSSS-3), consisting of three items assessing number of close contacts, interest shown by others, and perceived practical support. Scores range across 4- and 5-point Likert-type options, with higher totals indicating stronger perceived support. The original dataset demonstrated strong internal consistency (Cronbach’s α = 0.981) [15]. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e \u003cem\u003eData Screening and Preparation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data underwent quality screening to remove inconsistent, incomplete, or patterned responses in the original dataset. For the present analysis, variables were assessed for missing values, normality, and outliers, with no additional exclusions required. Demographic variables were recoded for analysis, with sex coded as male = 0 and female = 1, and age group categorized as 18–20 years = 0 and 21–23 years = 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll analyses were performed using SPSS Version 28. Descriptive statistics were used to summarize participant characteristics and key study variables, and independent-samples t-tests were conducted to assess group differences by sex and age. To examine whether health awareness, self-esteem, and social support predicted healthy lifestyle behaviors, and to determine whether these associations differed across demographic groups, hierarchical multiple regression models were conducted separately for males and females, as well as for younger (18–20 years) and older (21–23 years) students. For each model, standardized beta coefficients (β), confidence intervals, R², adjusted R², F-statistics, and p-values were reported, and effect sizes were interpreted using established guidelines. All statistical tests were two-tailed with a significance level of p \u0026lt; .05.\u003c/p\u003e"},{"header":"4. Results","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics and Gender Comparisons\u003c/h2\u003e \u003cp\u003eA total of 1,169 university students participated in the study, comprising 554 males (47.4%) and 615 females (52.6%). The mean age of the sample was 20.56 years (SD\u0026thinsp;=\u0026thinsp;1.73), ranging from 18 to 23 years. Descriptive statistics and gender differences for the study variables, including health awareness, healthy lifestyle behaviors, self-esteem, and social support, are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Comparisons by age group, students aged 18\u0026ndash;20 years (n\u0026thinsp;=\u0026thinsp;573) and 21\u0026ndash;23 years (n\u0026thinsp;=\u0026thinsp;596) did not differ significantly in health awareness, healthy lifestyle behaviors, or self-esteem. A marginal difference was observed in social support (t(1,164.73)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.80, p = .073), with older students reporting slightly higher levels of support.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of study variables by sex and age group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Awareness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.19 (7.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1167)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.21 (7.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.26 (7.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1167)\u0026thinsp;=\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.15 (7.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthy Lifestyles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.89 (7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1167)\u0026thinsp;=\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.81 (6.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.67 (7.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1167)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.01 (7.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-Esteem\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.48 (10.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1167)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.948\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.52 (11.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.72 (10.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1167)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.30 (11.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.86 (3.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1148)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.898\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.84 (3.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.62 (3.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003et(1164.73)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.02 (3.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote.\u003c/em\u003e Values are presented as mean (SD). Independent samples t-tests were conducted to compare groups.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePearson Correlations among key study Variables\u003c/h2\u003e \u003cp\u003ePearson correlation analysis showed that all variables were positively associated, with weak to moderate correlations. Healthy lifestyle behaviors were moderately correlated with social support (r\u0026thinsp;=\u0026thinsp;0.41) and self-esteem (r\u0026thinsp;=\u0026thinsp;0.38), whereas health awareness showed weaker associations with all variables (r\u0026thinsp;=\u0026thinsp;0.10\u0026ndash;0.21). Overall, psychosocial factors appeared to have stronger relationships with healthy lifestyle behaviors than health awareness. All correlations were below 0.80, indicating no multicollinearity concerns (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMultiple Regression Analyses\u003c/h3\u003e\n\u003cp\u003eMultiple regression analyses indicated that self-esteem and social support were the strongest predictors of healthy lifestyle behaviors across all groups. Among males, self-esteem demonstrated the largest effect (\u0026beta;\u0026thinsp;=\u0026thinsp;0.34), followed closely by social support (\u0026beta;\u0026thinsp;=\u0026thinsp;0.33), whereas among females, social support emerged as the most influential predictor (\u0026beta;\u0026thinsp;=\u0026thinsp;0.37), with self-esteem also showing a strong association (\u0026beta;\u0026thinsp;=\u0026thinsp;0.31). In contrast, health awareness demonstrated smaller but statistically significant effects (\u0026beta;\u0026thinsp;=\u0026thinsp;0.08) (see Fig. \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAge-stratified analyses showed a similar pattern, with self-esteem being the strongest predictor among individuals aged 18\u0026ndash;20 years (\u0026beta;\u0026thinsp;=\u0026thinsp;0.35), while social support had the greatest influence among those aged 21\u0026ndash;23 years (\u0026beta;\u0026thinsp;=\u0026thinsp;0.38). Overall, the models explained a moderate proportion of variance in healthy lifestyle behaviors (Adjusted R\u0026sup2; \u0026asymp; 0.29\u0026ndash;0.30), indicating consistent and robust effects of psychosocial factors across sex and age groups (see Fig. 3). Complete regression coefficients for gender and age groups are summarized in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple regression models predicting healthy lifestyle behaviors by sex and age group (standardized coefficients with 95% confidence intervals)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;554)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;615)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eAged 18\u0026ndash;20\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;573)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eAged 21\u0026ndash;23\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;596)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u0026beta; (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eHealth Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e0.19*** (0.118, 0.259)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e0.08* (0.013, 0.149)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.18*** (0.111, 0.250)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.09** (0.026, 0.163)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSelf-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e0.34*** (0.274, 0.414)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e0.31*** (0.246, 0.382)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.35*** (0.285, 0.423)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.30*** (0.234, 0.373)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eSocial Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e0.33*** (0.263, 0.404)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e0.37*** (0.298, 0.435)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.31*** (0.236, 0.376)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.38*** (0.313, 0.450)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAdjusted R\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eF-statistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e81.7***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cp\u003e82.6***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e84.0***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e80.3***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eNotes.\u003c/strong\u003e Values are standardized regression coefficients (\u0026beta;) with 95% confidence intervals. The final model (Model 3) is presented.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e*p \u0026lt; .05, **p \u0026lt; .01, ***p \u0026lt; .001\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eThis study identified health awareness, self-esteem, and social support as significant predictors of healthy lifestyle behaviors among Chinese university students. The strong influence of health awareness, reflected in students\u0026rsquo; knowledge and attitudes about nutrition, exercise, and health risks, is consistent with international evidence showing that greater health consciousness predicts better dietary patterns and greater engagement in physical activity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Likewise, the association between self-esteem and healthy behaviors in our study aligns with prior work indicating that students with higher self-worth tend to maintain balanced diets and regular physical activity, whereas lower self-esteem is linked to maladaptive behaviors such as disordered eating [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These findings reinforce the central role of psychological factors in shaping health-related behaviors during late adolescence and early adulthood.\u003c/p\u003e \u003cp\u003eThe importance of social support observed in this study also mirrors patterns reported across countries and cultural settings. Adolescents and university students who receive consistent encouragement, emotional support, or modeling from family and peers are more likely to engage in physical activity and consume fruits and vegetables [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Similarly, research involving international undergraduates found that friend support plays a critical role in motivating participation in physical activity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A recent systematic review further confirms that social support enhances young adults\u0026rsquo; health behaviors and well-being by providing emotional resources, accountability, and motivation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Collectively, these findings demonstrate that health awareness, self-esteem, and social support operate as universal psychosocial determinants of healthy lifestyles, and our study extends this body of evidence to the Chinese higher education context.\u003c/p\u003e \u003cp\u003eNotably, we found no significant differences in overall healthy lifestyle scores between male and female students, nor between younger (18\u0026ndash;20) and older (21\u0026ndash;23) students. This contrasts with international findings that often report gender-based differences\u0026mdash;for example, female students typically demonstrate healthier eating patterns, while males participate more frequently in physical activity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The absence of sex differences in our sample may indicate a convergence in lifestyle behaviors among young Chinese adults, possibly influenced by shared campus environments, access to similar resources, and comparable academic demands. Likewise, the lack of age-group differences within a relatively narrow developmental period suggests that undergraduate students, regardless of their year in university, tend to exhibit similar lifestyle habits. These findings are consistent with a Spanish study reporting uniformly poor dietary patterns and high sedentary behavior across university students of different ages [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, subtle variations emerged in the predictive strength of key psychosocial determinants. Social support demonstrated a somewhat stronger positive influence on healthy lifestyle behaviors among female students and those in the older subgroup. This pattern aligns with evidence that women may benefit more from interpersonal support when engaging in health-promoting behaviors [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Female students often describe encouragement from peers and family as a primary motivator for exercising and maintaining healthy eating habits, whereas male students may be more influenced by individual goals, competitiveness, or self-directed interests [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Future cross-cultural research should investigate these moderating effects in greater depth to inform tailored and more effective health promotion strategies.\u003c/p\u003e \u003cp\u003eThe findings of this study highlight the critical need for nurses and health educators to integrate psychosocial assessment, specifically health awareness, self-esteem, and social support, into routine practice when working with university populations. Nursing professionals can play a pivotal role by developing targeted interventions such as wellness counseling, health education workshops, peer-support initiatives, and programs that build confidence and coping skills. Collaboration among universities, families, and community organizations can further strengthen supportive networks and extend health-promoting resources beyond the campus. Collectively, these multilevel, nurse-led strategies can create a supportive ecosystem that empowers students to adopt, strengthen, and sustain healthy lifestyle behaviors.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, its cross-sectional design limits causal inference, and bidirectional relationships between psychosocial factors and health behaviors cannot be ruled out. Second, reliance on self-reported measures may introduce recall and social desirability bias, despite the use of validated instruments. Third, the sample was drawn from a single province in China, which may limit generalizability to students in other regions or countries with different cultural norms, socioeconomic conditions, or university environments. Finally, although key psychosocial predictors were included, other potentially relevant factors, such as stress, self-efficacy, family socioeconomic status, or academic workload, were not assessed and may contribute to lifestyle behaviors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that health awareness, self-esteem, and social support are key psychosocial determinants of healthy lifestyle behaviors among Chinese university students. The multiple regression findings show that each factor uniquely contributes to healthier behaviors, with self-esteem and social support emerging as the most consistent predictors across groups, underscoring the importance of psychosocial and environmental factors in promoting healthy lifestyles among university students. Together, the results highlight the importance of fostering health knowledge, psychological well-being, and supportive social environments in university settings. Strengthening these areas may enhance students\u0026rsquo; ability to adopt and sustain healthy lifestyles during a critical period of transition into adulthood. Future research should explore these relationships longitudinally and evaluate tailored interventions that address the specific needs of diverse student populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, W.S., H.M., and T.H.; methodology, W.S. and H.M.; soft-ware, W.S. and H.M.; validation, W.S. and H.M.; formal analysis, W.S.; writing—original draft preparation, W.S.; writing—review and editing, W.S., H.M., T.H., and G.S.P.; supervision, H.M. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original study protocol received approval from the Ethics Committee of Guangdong Business and Technology University (Approval No. 2024GS006). All responses were anonymous, and participants were informed about voluntary participation, confidentiality, and the right to withdraw at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants included in the original study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any grants from public, commercial, or nonprofit funding agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset analyzed in this study is publicly available through the Inter-university Consortium for Political and Social Research (ICPSR) at https://doi.org/10.3886/E207741V1.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhang Z, Abdullah H, Ghazali AHA, D\u0026rsquo;Silva JL, Ismail IA, Huang Z. The influence of health awareness on university students\u0026rsquo; healthy lifestyles: The chain mediating role of self-esteem and social support. PLOS ONE. 2024;19(10):e0311886. doi: 10.1371/journal.pone.0311886.\u003c/li\u003e\n\u003cli\u003eBenjanirat T, Ounprasertsuk J, Kawe S, Sillabutra J. Mental Health Status, Related Knowledge, and Its Influencing Factors Among First-Year University Students: A Cross-sectional Study in Thailand. Journal of Nursing and Midwifery Sciences. 2025;12(12):e163995. doi: 10.5812/jnms-160956.\u003c/li\u003e\n\u003cli\u003eWu Y, Wang S, Shi M, Wang X, Liu H, Guo S, et al. Awareness of nutrition and health knowledge and its influencing factors among Wuhan residents. Front Public Health. 2022;10:987755. doi: 10.3389/fpubh.2022.987755.\u003c/li\u003e\n\u003cli\u003eLi H, Shi L, Xing YL. The mediating role of health awareness in the relationship between health information behavior and health outcomes among the older adults. Front Public Health. 2025;13:1492472. doi: 10.3389/fpubh.2025.1492472.\u003c/li\u003e\n\u003cli\u003eLi H, Hao F. The influence of physical activity on the mental health of high school students: the chain mediating effects of social support and self-esteem. Sci Rep. 2025;15(1):27537. doi: 10.1038/s41598-025-11952-5.\u003c/li\u003e\n\u003cli\u003eCella S, Cipriano A, Aprea C, Cotrufo P. Self-Esteem and Binge Eating among Adolescent Boys and Girls: The Role of Body Disinvestment. Int J Environ Res Public Health. 2021;18(14). doi: 10.3390/ijerph18147496.\u003c/li\u003e\n\u003cli\u003eLisboa T, Silva WRD, Silva DAS, Felden \u0026Eacute; PG, Pelegrini A, Lopes JJD, et al. Social support from family and friends for physical activity in adolescence: analysis with structural equation modeling. Cad Saude Publica. 2021;37(1):e00196819. doi: 10.1590/0102-311x00196819.\u003c/li\u003e\n\u003cli\u003eRuihua L, Hassan NC, Qiuxia Z, Sha O, Jingyi D. A systematic review on the impact of social support on college students\u0026rsquo; wellbeing and mental health. PLOS ONE. 2025;20(7):e0325212. doi: 10.1371/journal.pone.0325212.\u003c/li\u003e\n\u003cli\u003eLonati E, Cazzaniga E, Adorni R, Zanatta F, Belingheri M, Colleoni M, et al. Health-Related Lifestyles among University Students: Focusing on Eating Habits and Physical Activity. International Journal of Environmental Research and Public Health. 2024;21(5):626. doi: 10.3390/ijerph21050626.\u003c/li\u003e\n\u003cli\u003eGarc\u0026iacute;a-P\u0026eacute;rez L, Villodres GC, Muros JJ. Differences in healthy lifestyle habits in university students as a function of academic area. J Public Health (Oxf). 2023;45(2):513-22. doi: 10.1093/pubmed/fdac120.\u003c/li\u003e\n\u003cli\u003eBandura A. Health promotion from the perspective of social cognitive theory. Understanding and changing health behaviour. Psychology Press; 2013. p. 299-339.\u003c/li\u003e\n\u003cli\u003eZhang Z: The Influence of Health Awareness on University Students\u0026rsquo; Healthy Lifestyles in Guangdong. https://doi.org/10.3886/E207741V1 (2024). Accessed November 10, 2025.\u003c/li\u003e\n\u003cli\u003eMichaelidou N, Hassan LM. The role of health consciousness, food safety concern and ethical identity on attitudes and intentions towards organic food. International Journal of Consumer Studies. 2008;32(2):163-70. doi: 10.1111/j.1470-6431.2007.00619.x.\u003c/li\u003e\n\u003cli\u003eCalizaya-Milla YE, Saintila J, Morales-Garc\u0026iacute;a WC, Ruiz Mamani PG, Huancahuire-Vega S. Evidence of Validity and Factorial Invariance of a Diet and Healthy Lifestyle Scale (DEVS) in University Students. Sustainability. 2022;14(19):12273. doi: 10.3390/su141912273.\u003c/li\u003e\n\u003cli\u003eRosenberg M, Rosenberg M. Society and the Adolescent Self-Image. Princeton: Princeton University Press; 2015.\u003c/li\u003e\n\u003cli\u003eHazzard VM, Telke SE, Simone M, Anderson LM, Larson NI, Neumark-Sztainer D. Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010-2018. Eat Weight Disord. 2021;26(1):287-94. doi: 10.1007/s40519-020-00852-4.\u003c/li\u003e\n\u003cli\u003eNabors L, Fiser-Gregory K, Olaniyan A, Stanton-Chapman T, Merianos A. College students\u0026apos; attitudes about ways family, friends, significant others and media affect their eating and exercise behaviors and weight perceptions. J Am Coll Health. 2024;72(4):1296-308. doi: 10.1080/07448481.2022.2076101.\u003c/li\u003e\n\u003cli\u003eJimenez-Morcillo J, Clemente-Su\u0026aacute;rez VJ. Gender Differences in Body Satisfaction Perception: The Role of Nutritional Habits, Psychological Traits, and Physical Activity in a Strength-Training Population. Nutrients. 2024;16(1):104. doi: 10.3390/nu16010104.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Behavior, Health Knowledge, Attitudes, Practice, Social Support, Students’ Attitudes","lastPublishedDoi":"10.21203/rs.3.rs-9411028/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9411028/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealthy lifestyle behaviors play an essential role in preventing chronic diseases among university students, yet the psychosocial factors that shape these behaviors may differ across demographic groups. This study examined whether health awareness, self-esteem, and social support predicted healthy lifestyle behaviors among university students and explored whether these associations varied by sex and age.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional secondary data analysis was conducted using survey data from 1,169 undergraduate students in China. Validated instruments measured health awareness, healthy lifestyle behaviors, self-esteem, and social support. Multiple regression analyses were performed separately for males and females, and for younger (18\u0026ndash;20 years) and older (21\u0026ndash;23 years) students. Group differences were assessed using independent-samples t-tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSelf-esteem and social support were the strongest predictors of healthy lifestyle behaviors across all groups, although their relative influence varied slightly by sex and age. Among males and younger students, self-esteem demonstrated the largest effect, whereas social support was more influential among females and older students. Health awareness showed smaller but statistically significant associations. The models explained a moderate proportion of variance in healthy lifestyle behaviors (adjusted R\u0026sup2; \u0026asymp; 0.29\u0026ndash;0.30).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePsychosocial factors, particularly self-esteem and social support, play a central role in shaping healthy lifestyle behaviors among university students. These findings highlight the importance of interventions that enhance psychological well-being and strengthen social support systems within university settings.\u003c/p\u003e","manuscriptTitle":"Psychosocial Factors Predict Healthy Lifestyle Behaviors among University Students with Differences by Sex and Age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 19:51:04","doi":"10.21203/rs.3.rs-9411028/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-15T16:07:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T05:09:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288587828637085073048192465684354474866","date":"2026-05-10T14:07:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205623318239895885254380648110003613044","date":"2026-05-10T12:10:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185495743839782124284930040405643214589","date":"2026-05-08T12:21:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-05T12:09:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-28T11:03:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-27T05:34:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-04-27T05:30:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eba4e889-e3bd-4a85-9e6a-011261a0d3f3","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T16:07:07+00:00","index":56,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T05:09:50+00:00","index":55,"fulltext":""},{"type":"reviewerAgreed","content":"288587828637085073048192465684354474866","date":"2026-05-10T14:07:17+00:00","index":49,"fulltext":""},{"type":"reviewerAgreed","content":"205623318239895885254380648110003613044","date":"2026-05-10T12:10:58+00:00","index":48,"fulltext":""},{"type":"reviewerAgreed","content":"185495743839782124284930040405643214589","date":"2026-05-08T12:21:51+00:00","index":45,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-05T12:09:44+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T19:51:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 19:51:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9411028","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9411028","identity":"rs-9411028","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}