Internet Use and Self-Rated Health: The Mediating Role of Physical Exercise
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data and Sample
2.2. Variables
3. Results
3.1. Descriptive Analysis
3.2. Correlation Analysis of Key Variables
3.3. Multicollinearity Analysis
3.4. Analysis of Regression Results
3.4.1. Baseline Regression Results
3.4.2. Robustness Test
3.4.3. Heterogeneity Analysis
3.4.4. Mediating Effect Test
4. Discussion
4.1. Summary of Findings
4.2. Policy Implications
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- The 53rd Statistical Report on China’s Internet Development. Available online: https://www.cnnic.com.cn/IDR/ReportDownloads/202405/P020240509518443205347.pdf (accessed on 9 May 2024).
- He, D.; Gu, Y.; Shi, Y.; Wang, M.; Lou, Z.; Jin, C. COVID-19 in China: The role and activities of Internet-based healthcare platforms. Glob. Health Med. 2020, 2, 89–95. [Google Scholar]
- Yang, F.; Shu, H.; Zhang, X. Understanding “internet plus healthcare” in china: Policy text analysis. J. Med. Internet Res. 2021, 23, e23779. [Google Scholar]
- Zhou, D.S.; Zhan, Q.Q.; Wen, X. How does digital life influence the health service use among rural residents? Evidence from China. Technol. Health Care 2023, 31, 2091–2106. [Google Scholar] [PubMed]
- Ghahramani, F.; Wang, J. Impact of Smartphones on Quality of Life: A Health Information Behavior Perspective. Inf. Syst. Front. 2020, 22, 1275–1290. [Google Scholar]
- Wang, J.L.; Wu, H.T.; Liu, Y.; Wang, W.L. Health welfare in the digital era: Exploring the impact of digital trade on residents’ health. Econ. Hum. Biol. 2024, 54, 101414. [Google Scholar]
- Wen, W.; Zhang, Y.; Shi, W.; Li, J. Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China. J. Med. Internet Res. 2023, 25, e40956. [Google Scholar]
- Li, L.; Ding, H. The Relationship between Internet Use and Population Health: A Cross-Sectional Survey in China. Int. J. Environ. Res. Public Health 2022, 19, 1322. [Google Scholar] [CrossRef]
- Frison, E.; Eggermont, S. Exploring the Relationships Between Different Types of Facebook Use, Perceived Online Social Support, and Adolescents’ Depressed Mood. Soc. Sci. Comput. Rev. 2015, 34, 153–171. [Google Scholar]
- Lee, H.Y.; Kim, J.; Sharratt, M. Technology use and its association with health and depressive symptoms in older cancer survivors. Qual. Life Res. 2018, 27, 467–477. [Google Scholar] [CrossRef]
- Liu, Y.; Ni, X.; Niu, G. The influence of active social networking services use and social capital on flourishing in Chinese adolescents. Child. Youth Serv. Rev. 2020, 119, 105689. [Google Scholar]
- Bevilacqua, R.; Strano, S.; Di Rosa, M.; Giammarchi, C.; Cerna, K.K.; Mueller, C.; Maranesi, E. eHealth Literacy: From Theory to Clinical Application for Digital Health Improvement. Results from the ACCESS Training Experience. Int. J. Environ. Res. Public Health 2021, 18, 11800. [Google Scholar] [CrossRef] [PubMed]
- Liu, N.; He, Y.; Li, Z. The Relationship between Internet Use and Self-Rated Health among Older Adults in China: The Mediating Role of Social Support. Int. J. Environ. Res. Public Health 2022, 19, 14785. [Google Scholar] [CrossRef]
- Rosenthal, S.R.; Buka, S.L.; Marshall, B.D.L.; Carey, K.B.; Clark, M.A. Negative Experiences on Facebook and Depressive Symptoms Among Young Adults. J. Adolesc. Health 2016, 59, 510–516. [Google Scholar]
- Lee, S.Y. How do people compare themselves with others on social network sites?: The case of Facebook. Comput. Hum. Behav. 2014, 32, 253–260. [Google Scholar]
- Zhang, L.; Li, S.; Ren, Y. Does internet use benefit the mental health of older adults? Empirical evidence from the China health and retirement longitudinal study. Heliyon 2024, 10, e25397. [Google Scholar]
- Lewandowski, J.; Rosenberg, B.D.; Jordan Parks, M.; Siegel, J.T. The effect of informal social support: Face-to-face versus computer-mediated communication. Comput. Hum. Behav. 2011, 27, 1806–1814. [Google Scholar]
- Tang, D.; Jin, Y.; Zhang, K.; Wang, D. Internet Use, Social Networks, and Loneliness Among the Older Population in China. Front. Psychol. 2022, 13, 895141. [Google Scholar]
- Bull, F.C.; Al-Ansari, S.S.; Biddle, S.; Borodulin, K.; Buman, M.P.; Cardon, G.; Carty, C.; Chaput, J.P.; Chastin, S.; Chou, R.G.; et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br. J. Sports Med. 2020, 54, 1451–1462. [Google Scholar]
- Zhang, S.; Zhang, Y.J. The Relationship Between Internet Use and Mental Health Among Older Adults in China: The Mediating Role of Physical Exercise. Risk Manag. Healthc. Policy 2021, 14, 4697–4708. [Google Scholar]
- Hansen, A.W.; Beyer, N.; Flensborg-Madsen, T.; Gronbæk, M.; Helge, J.W. Muscle strength and physical activity are associated with self-rated health in an adult Danish population. Prev. Med. 2013, 57, 792–798. [Google Scholar]
- Engberg, E.; Liira, H.; Kukkonen-Harjula, K.; From, S.; Kautiainen, H.; Pitkälä, K.; Tikkanen, H. Associations of physical activity with self-rated health and well-being in middle-aged Finnish men. Scand. J. Public Health 2015, 43, 190–196. [Google Scholar] [CrossRef]
- Ibsen, B.; Elmose-Osterlund, K.; Hoyer-Kruse, J. Associations of types of physical activity with self-rated physical and mental health in Denmark. Prev. Med. Rep. 2024, 37, 9. [Google Scholar] [CrossRef]
- Guo, B.; Zhang, X.D.; Zhang, R.; Chen, G. The Association between Internet Use and Physical Exercise among Middle-Aged and Older Adults-Evidence from China. Int. J. Environ. Res. Public Health 2022, 19, 16401. [Google Scholar] [CrossRef]
- Li, L.; Ding, H. Internet Use, Leisure Time and Physical Exercise of Rural Residents—Empirical Analysis Based on 2018 CFPS Data. Lanzhou Acad. J. 2022, 4, 108–122. [Google Scholar]
- Chen, N.; Shen, Y.; Liang, H.; Guo, R. Housing and Adult Health: Evidence from Chinese General Social Survey (CGSS). Int. J. Environ. Res. Public Health 2021, 18, 916. [Google Scholar] [CrossRef]
- Ding, H.; Zhang, C.; Xiong, W. Associations between Mobile Internet Use and Self-Rated and Mental Health of the Chinese Population: Evidence from China Family Panel Studies 2020. Behav. Sci. 2022, 12, 221. [Google Scholar] [CrossRef]
- Li, Z.; Wang, Y.; Li, X.; Luo, Y. Research on the Correlation between Digital Health Literacy and Physical Health Status in Middle-Aged and Elderly Adults: Based on the Mediating Effect of Physical Exercise Behavior. China Sport Sci. Technol. 2023, 59, 44–51. [Google Scholar]
- Lu, J.; Wang, B. The Mechanism of the Impact of Internet Use on Residents’ Self-rated Health: Based on the 2016 China Family Panel Studies. J. Sun Yat-Sen Univ. (Soc. Sci. Ed.) 2020, 60, 117–127. [Google Scholar]
- Zhang, X.; Wang, D.; Li, F. Physical Exercise, Social Capital, Hope, and Subjective Well-Being in China: A Parallel Mediation Analysis. Int. J. Environ. Res. Public Health 2023, 20, 303. [Google Scholar] [CrossRef] [PubMed]
- Sui, M.; Ding, H.; Xu, B.; Zhou, M. The Impact of Internet Use on the Happiness of Chinese Civil Servants: A Mediation Analysis Based on Self-Rated Health. Int. J. Environ. Res. Public Health 2022, 19, 13142. [Google Scholar] [CrossRef] [PubMed]
- Wen, Z.; Ye, B. Analyses of Mediating Effects: The Development of Methods and Models. Adv. Psychol. Sci. 2014, 22, 731–745. [Google Scholar] [CrossRef]
- Kohler, U.; Karlson, K.B.; Holm, A. Comparing coefficients of nested nonlinear probability models. Stata J. 2011, 11, 420–438. [Google Scholar] [CrossRef]
- Ahn, J.-H.; Lim, K.-C.; Lee, Y.-J.; Kim, K.-S. Effects of computer/internet game play on depression and life satisfaction among the elderly: Mediating effects of perceived self-control. J. Korea Contents Assoc. 2011, 11, 406–417. [Google Scholar] [CrossRef]
- Hartanto, A.; Yong, J.C.; Toh, W.X.; Lee, S.T.; Tng, G.Y.; Tov, W. Cognitive, social, emotional, and subjective health benefits of computer use in adults: A 9-year longitudinal study from the Midlife in the United States (MIDUS). Comput. Hum. Behav. 2020, 104, 106179. [Google Scholar] [CrossRef]
- Luo, X.; Pu, H.; Wang, S.; Zhong, D.; Liu, F.; Li, Z. Influence of Internet use on Chinese residents’ health: The mediating role of health knowledge. Technol. Soc. 2024, 76, 102413. [Google Scholar] [CrossRef]
- Nevado-Peña, D.; López-Ruiz, V.-R.; Alfaro-Navarro, J.-L. Improving quality of life perception with ICT use and technological capacity in Europe. Technol. Forecast. Soc. Change 2019, 148, 119734. [Google Scholar] [CrossRef]
- Peng, Y.-I.; Chan, Y.-S. Do internet users lead a healthier lifestyle? J. Appl. Gerontol. 2020, 39, 277–284. [Google Scholar] [CrossRef]
- Kobayashi, L.C.; Wardle, J.; von Wagner, C. Internet use, social engagement and health literacy decline during ageing in a longitudinal cohort of older English adults. J. Epidemiol. Community Health 2015, 69, 278–283. [Google Scholar] [CrossRef]
- Chen, H.; Zhang, T.P.M.; Li, Y.H.; Zhao, W.F.; Xu, W. Relationship and mechanisms between internet use and physical exercise among middle- and younger-aged groups. PLoS ONE 2024, 19, e0305131. [Google Scholar] [CrossRef] [PubMed]
- Wang, S.; Guo, K.; Lu, W. Will internet use promote physical exercise for the elderly in China? An empirical analysis based on CGSS. J. Sports Res. 2021, 35, 62–70. [Google Scholar]
- Kearns, A.; Whitley, E. Associations of internet access with social integration, wellbeing and physical activity among adults in deprived communities: Evidence from a household survey. BMC Public Health 2019, 19, 860. [Google Scholar]
- Chen, W.-C.; Yang, L.; Wang, X.-Y. Internet Use, Cultural Engagement, and Multi-Dimensional Health of Older Adults: A Cross-Sectional Study in China. Front. Public Health 2022, 10, 887840. [Google Scholar] [CrossRef]
- Li, S.J.; Cui, G.H.; Yin, Y.T.; Xu, H.L. Associations between health literacy, digital skill, and eHealth literacy among older Chinese adults: A cross-sectional study. Digit. Health 2023, 9, 20552076231178431. [Google Scholar]
- Xie, B. Multimodal computer-mediated communication and social support among older Chinese internet users. J. Comput. Mediat. Commun. 2008, 13, 728–750. [Google Scholar]
- Yong, W.; Zhanhong, Z.; Xingyu, S.; Jianfang, Z.; Xiaoming, S.; Xiaomei, R. Health status, health needs and provision of health services among the middle-aged and elderly people. Popul. Res. 2014, 38, 72. [Google Scholar]
- Saleh, J.; Robinson, B.S.; Kugler, N.W.; Illingworth, K.D.; Patel, P.; Saleh, K.J. Effect of social media in health care and orthopedic surgery. Orthopedics 2012, 35, 294–297. [Google Scholar]
- Hong, Y.A.; Zhou, Z.; Fang, Y.; Shi, L. The digital divide and health disparities in China: Evidence from a national survey and policy implications. J. Med. Internet Res. 2017, 19, e317. [Google Scholar]
- Grossman, M. The Demand for Health: A Theoretical and Empirical Investigation; Columbia University Press: New York, NY, USA, 2017. [Google Scholar]
- Hanson, J. Empowerment and online social networking. In The Handbook of Media and Mass Communication Theory; Wiley Online Library: Hoboken, NJ, USA, 2014; pp. 572–590. [Google Scholar]
- Zheng, X. Rodríguez-Monroy C: The development of intelligent healthcare in China. Telemed. e-Health 2015, 21, 443–448. [Google Scholar] [CrossRef]
- Hvistendahl, M. China Pushes the ‘Internet of Things’; American Association for the Advancement of Science: New York, NY, USA, 2012. [Google Scholar]
- Liao, Y.; Wu, Q.; Tang, J.; Zhang, F.; Wang, X.; Qi, C.; He, H.; Long, J.; Kelly, B.C.; Cohen, J. The efficacy of mobile phone-based text message interventions (‘Happy Quit’) for smoking cessation in China. BMC Public Health 2016, 16, 833. [Google Scholar]
Variables (Percent) | Mean | SD |
---|---|---|
Dependent variable | ||
SRH
| 3.480 | 1.090 |
Independent variable INT
| 0.720 | 0.450 |
Leisure
| 3.540 | 1.810 |
Mediating Variables Physical exercise
| 1.290 | 1.180 |
Control variables | ||
Age
| 1.020 | 0.830 |
Gender
| 0.450 | 0.500 |
Hukou
| 0.600 | 0.490 |
Marital status
| 0.720 | 0.450 |
Work
| 1.790 | 1.010 |
Health
| 3.930 | 1.230 |
Education
| 0.870 | 0.720 |
SRH | INT | Leisure | Exercise | |
---|---|---|---|---|
SRH | 1 | |||
INT | 0.272 *** | 1 | ||
Leisure | 0.298 *** | 0.802 *** | 1 | |
Exercise | 0.137 *** | 0.184 *** | 0.224 *** | 1 |
Variables | VIF |
---|---|
INT | 1.61 |
Exercise | 1.12 |
Age | 1.93 |
Education | 1.77 |
Hukou | 1.25 |
Work | 1.23 |
Health | 1.18 |
Marital | 1.08 |
Gender | 1.05 |
Variable | Model1 | Model2 | Model3 | Model4 |
---|---|---|---|---|
SRH | SRH | Exercise | SRH | |
INT | 0.656 *** (0.0280) | 0.119 *** (0.0359) | 0.269 *** (0.0381) | 0.0319 ** (0.0112) |
Exercise | 0.111 ** (0.0359) | |||
Age (ref:18–44) | ||||
45–59 | −0.325 *** (0.0362) | 0.181 *** (0.0366) | −0.332 *** (0.0363) | |
60 and above | −0.366 *** (0.0443) | 0.295 *** (0.0457) | −0.376 *** (0.0444) | |
Rural (ref: Urban) | 0.0659 * (0.0304) | −0.250 *** (0.0307) | 0.0745 * (0.0305) | |
Male (ref: Female) | 0.0351 (0.0262) | 0.0709 ** (0.0266) | 0.0409 (0.0260) | |
Married (ref: Otherwise) | −0.0437 (0.0301) | −0.0630 (0.0390) | −0.0439 (0.0301) | |
Work (ref: Never worked) | ||||
Unemployment | −0.224 *** (0.0558) | −0.110 (0.0748) | −0.221 *** (0.0559) | |
Agricultural work | −0.165 ** (0.0626) | −0.259 ** (0.0816) | −0.155 * (0.0627) | |
Non-agricultural work | −0.0790 (0.0541) | −0.107 (0.0751) | −0.0715 (0.0542) | |
Health (ref: Poor) | ||||
Fairly poor | 0.675 *** (0.0694) | 0.219 ** (0.0741) | 0.670 *** (0.0694) | |
Average | 1.511 *** (0.0694) | 0.341 *** (0.0715) | 1.505 *** (0.0694) | |
Fairly good | 2.129 *** (0.0693) | 0.430 *** (0.0698) | 2.120 *** (0.0694) | |
Good | 2.538 *** (0.0677) | 0.505 *** (0.0676) | 2.526 *** (0.0678) | |
Education (ref: Primary and below) | ||||
Junior/Senior high school | 0.0828 * (0.0327) | 0.359 *** (0.0342) | 0.0724 * (0.0329) | |
College and above | 0.129 ** (0.0480) | 0.568 *** (0.0488) | 0.112 * (0.0484) | |
Provinces | Yes | Yes | Yes | Yes |
Observations | 7582 | 7582 | 7582 | 7582 |
Variable | Model5 | Model6 | Model7 | Model8 |
---|---|---|---|---|
SRH | SRH | SRH | SRH | |
INT | 1.152 *** (0.0495) | 0.215 *** (0.0629) | ||
Leisure | 0.177 *** (0.00701) | 0.0351 *** (0.00924) | ||
Age (ref:18–44) | ||||
45–59 | −0.561 *** (0.0623) | −0.314 *** (0.0365) | ||
60 and above | −0.623 *** (0.0770) | −0.352 *** (0.0449) | ||
Rural (ref: Urban) | 0.106 * (0.0523) | 0.0663 * (0.0304) | ||
Male (ref: Female) | 0.0647 (0.0448) | 0.0419 (0.0260) | ||
Married (ref: Otherwise) | −0.102 * (0.0521) | −0.0101 * (0.0532) | ||
Work (ref: Never worked) | ||||
Unemployment | −0.387 *** (0.0962) | −0.226 *** (0.0559) | ||
Agricultural work | −0.281 ** (0.108) | −0.164 ** (0.0626) | ||
Non-agricultural work | −0.145 (0.0924) | −0.0826 (0.0541) | ||
Health (ref: Poor) | ||||
Fairly poor | 1.324 *** (0.124) | 0.680 *** (0.0694) | ||
Average | 2.886 *** (0.128) | 1.514 *** (0.0693) | ||
Fairly good | 3.996 *** (0.130) | 2.134 *** (0.0692) | ||
Good | 4.694 *** (0.128) | 2.540 *** (0.0676) | ||
Education (ref: Primary and below) | ||||
Junior/Senior high school | 0.147 ** (0.0572) | 0.0782 * (0.0327) | ||
College and above | 0.195 * (0.0829) | 0.119 * (0.0483) | ||
Provinces | Yes | Yes | Yes | Yes |
Observations | 7582 | 7582 | 7582 | 7582 |
Variables | Age | Hukou | |||
---|---|---|---|---|---|
18–45 | 46–59 | Age ≥ 60 | Urben | Rural | |
INT | 0.221 (0.187) | 0.0792 (0.0609) | 0.105 * (0.0475) | 0.173 ** (0.0631) | 0.0834 (0.0444) |
Provinces | Yes | Yes | Yes | Yes | Yes |
Control variables | Yes | Yes | Yes | Yes | Yes |
Observations | 2576 | 2576 | 2294 | 3022 | 4560 |
Coeff | SE | P | Amount of Effect (%) | |
---|---|---|---|---|
Total Effect | 0.092 ** | 0.029 | 0.008 | |
Direct Effect | 0.084 * | 0.035 | 0.015 | 91.3% |
Indirect Effect | 0.008 ** | 0.031 | 0.008 | 8.7% |
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Zhu, F.; Tan, B.; Jang, Y. Internet Use and Self-Rated Health: The Mediating Role of Physical Exercise. Healthcare 2025, 13, 714. https://doi.org/10.3390/healthcare13070714
Zhu F, Tan B, Jang Y. Internet Use and Self-Rated Health: The Mediating Role of Physical Exercise. Healthcare. 2025; 13(7):714. https://doi.org/10.3390/healthcare13070714
Chicago/Turabian StyleZhu, Fangmei, Bowen Tan, and Yi Jang. 2025. "Internet Use and Self-Rated Health: The Mediating Role of Physical Exercise" Healthcare 13, no. 7: 714. https://doi.org/10.3390/healthcare13070714
APA StyleZhu, F., Tan, B., & Jang, Y. (2025). Internet Use and Self-Rated Health: The Mediating Role of Physical Exercise. Healthcare, 13(7), 714. https://doi.org/10.3390/healthcare13070714