Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk
Abstract
:1. Introduction
2. Results
2.1. Demographic and Anthropometric Information
2.2. Differences in Health Behaviors by Country
2.3. Differences in COVID-19 Pandemic-Influenced Health Behaviors by Country
2.4. Examination of Relationships between Sleep Quality and Duration Changes and Health Behaviors
3. Discussion
3.1. Differences in the Overall Influence of the COVID-19 Pandemic by Country
3.2. Health Behaviors among Students in Higher Education during the COVID-19 Pandemic
3.3. Health Behavior Analysis
3.4. Public Health Message
3.5. Strengths and Limitations
4. Materials and Methods
4.1. Study Design
4.2. Demographics
4.3. Assessment of Dietary Risk and Alcohol Misuse
4.4. Assessment of Sleep Quality and Duration
4.5. Assessment of Physical Activity and Sitting Time
4.6. Assessment of the Influence of the COVID-19 Pandemic on the Factors Described Above
4.7. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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China | Ireland | Malaysia | South Korea | Taiwan | The Netherlands | USA | Total | Adjusted Total | |
---|---|---|---|---|---|---|---|---|---|
N | 111 | 192 | 91 | 89 | 377 | 114 | 1280 | 2254 | - |
Female (%) | 67.6 a | 71.9 a | 79.1 a | 39.3 b | 41.1 b | 80.7 a | 73.0 a | 66.6 † | 74.5 |
Male (%) | 32.4 a | 27.6 a | 20.9 a | 60.7 b | 53.6 b | 19.3 a | 24.1 a | 30.8 † | 33.7 |
Age (year) (Mean ± SD) | 20.4 ± 2.5 c | 24.7 ± 7.6 a | 22.2 ± 4.1 b,c | 25.5 ± 4.6 a | 20.8 ± 3.1 c | 20.1 ± 1.3 c | 22.9 ± 5.9 b | 22.5 ± 5.5 | 22.4 |
BMI (kg/m2) (Mean ± SD) | 20.2 ± 2.9 d | 24.1 ± 6.3 b | 22.2 ± 4.6 b,c,d | 22.7 ± 3.4 b,c | 22.5 ± 3.2 c | 22.0 ± 3.6 c,d | 26.0 ± 6.4 a | 24.4 ± 5.6 | 22.8 |
Undergraduate (%) | 84.7 a,b,c | 80.2 c | 96.7 b,d | 46.1 e | 95.5 d | 100.0 d | 74.3 a,c | 79.9 | 88.6 |
Domestic student (%) | 95.5 a,b | 93.2 a,b | 81.3 c | 94.4 a,b,c | 95.5 b | 40.4 d | 87.0 a,c | 87.0 | 91.2 |
China | Ireland | Malaysia | South Korea | Taiwan | The Netherlands | USA | Total * | Adjusted Total | |
---|---|---|---|---|---|---|---|---|---|
N | 111 | 190 | 91 | 89 | 375 | 114 | 1272 | 2242 | - |
PSQI (Mean ± SD) | 5.5 ± 2.6 b,c | 7.4 ± 3.6 a | 5.9 ± 3.1 b,c | 6.4 ± 3.1 a,b,c | 5.5 ± 3.1 c | 6.8 ± 3.4 a,b | 7.4 ± 3.6 a | 6.8 ± 3.5 | 6.4 |
Average sleep (h/d) (Mean ± SD) | 7.7 ± 0.8 a,b | 7.5 ± 1.2 a,b,c | 7.2 ± 1.2 b,c,d | 7.1 ± 1.1 c,d | 7.0 ± 1.1 d | 7.7 ± 1.0 a | 7.6 ± 1.3 a | 7.5 ± 1.2 | 7.5 |
Weekday sleep (h/d) (Mean ± SD) | 7.5 ± 0.9 a,b | 7.3 ± 1.2 a,b | 7.0 ± 1.2 a,b | 6.7 ± 1.3 b | 7.0 ± 1.3 b | 8.2 ± 4.6 a | 7.6 ± 2.5 a,b | 7.5 ± 3.5 | 7.4 |
Weekend sleep (h/d) (Mean ± SD) | 8.2 ± 1.1 | 8.0 ± 1.4 | 7.8 ± 1.5 | 8.3 ± 1.5 | 8.2 ± 3.4 | 8.2 ± 1.1 | 8.2 ± 1.6 | 8.1 ± 1.9 | 8.1 |
Poor sleep quality (%) | 46.8 a,b,c,d | 64.7 c,d,e | 49.5 a,b,c,d | 60.7 b,d,e | 42.7 a | 55.3 a,b,c,d,e | 67.2 e | 60.3 | 55.3 |
Short sleep duration (%) | 14.4 a | 26.6 a,b | 34.1 b,c | 46.1 c | 43.2 c | 12.3 a | 24.2 a,b | 27.8 | 28.7 |
China | Ireland | Malaysia | South Korea | Taiwan | The Netherlands | USA | Total * | Adjusted Total | |
---|---|---|---|---|---|---|---|---|---|
N | 111 | 192 | 91 | 89 | - | 114 | 1280 | 1877 | - |
Dietary risk (Mean ± SD) | 6.6 ± 2.3 b | 6.9 ± 3.1 b | 7.1 ± 2.4 b | 7.4 ± 2.9 a,b | - | 7.0 ± 2.5 b | 8.2 ± 2.7 a | 7.9 ± 2.8 | 7.3 |
n (provided alcohol use data) | 107 | 190 | 91 | 86 | 377 | 114 | 796 | 1761 | - |
Alcohol misuse score (Mean ± SD) (male †) | 2.3 ± 2.5 c | 4.4 ± 2.5 a | 1.2 ± 1.6 c | 4.2 ± 3.3 a,b | 4.0 ± 3.3 a,b | 4.4 ± 2.3 a,b | 3.3 ± 3.0 b | 3.6 ± 3.1 | 3.4 |
Alcohol misuse score (Mean ± SD) (female ††) | 1.2 ± 1.7 a | 3.6 ± 2.1 b | 0.9 ± 1.4 a | 3.1 ± 2.8 b,c | 2.7 ± 2.4 c | 3.7 ± 2.3 b | 3.1 ± 2.4 b,c | 2.9 ± 2.4 | 2.6 |
Classified as misuser (%) (male †) | 25.0% a,b,c,d | 49.1% d | 5.3% c | 48.1% b,d | 42.6% b,d | 45.5% a,b,c,d | 23.7% a,c | 33.3% | 34.2% |
Classified as misuser (%) (female ††) | 8.0% a | 50.7% b | 6.9% a | 42.9% b,c | 36.8% b | 53.3% b | 23.3% c | 28.0% | 31.7% |
China | Ireland | Malaysia | South Korea | Taiwan | The Netherlands | USA | Total * | Adjusted Total | |
---|---|---|---|---|---|---|---|---|---|
N | 105 | 177 | 88 | 87 | - | 109 | 1174 | 1742 | - |
Total METs (min/wk) (Mean ± SD) | 1966.5 ± 2710.9 b,c | 3748.1 ± 3772.3 a | 1639.2 ± 2502.9 c | 2842.6 ± 3317.9 a,b,c | - | 2849.7 ± 2442.6 a,b,c | 2892.9 ± 3549.5 b | 2859.8 ± 3441.0 | 2656.5 |
Sitting time (min/d) (Mean ± SD) | 285.7 ± 204.4 a | 389.7 ± 189.7 b | 492.8 ± 255.5 c | 368.5 ± 200.2 a,b | - | 427.1 ± 165.5 b,c | 423.8 ± 204.3 b | 413.0 ± 206.7 | 397.9 |
China (%) | Ireland (%) | Malaysia (%) | South Korea (%) | Taiwan (%) | The Netherlands (%) | USA (%) | Total | Adjusted Total | ||
---|---|---|---|---|---|---|---|---|---|---|
N | 111 | 192 | 91 | 89 | 377 | 114 | 1280 | 2254 | - | |
Diet | Less healthy | 22.5 a | 35.8 a,b | 36.3 a,b | 24.7 a | 6.1 c | 33.3 a,b | 45.6 b | 35.2 | 30.5 |
Alcohol consumption * | Drinking more | 5.6 a,b,c | 16.3 c,d | 2.2 b | 5.8 a,b,c | 6.1 b | 17.5 a,b,d | 26.1 d | 16.8 | 8.9 |
Sleep quality | Sleeping worse | 16.2 a,b | 41.6 c | 29.7 b,c | 19.1 b | 8.0 a | 48.2 c | 38.8 c | 32.1 | 21.7 |
Sleep duration | Sleeping less | 12.6 a,b,c,d,e | 27.4 d,e | 22.0 c,e | 10.1 a,b,c | 8.2 b | 20.2 a,c,d,e | 18.5 a,c,d,e | 17.1 | 17.0 |
Exercise frequency * | Exercising less | 56.8 a | 37.0 b | 50.5 a,b | 44.9 a,b | - | 50.0 a,b | 51.5 a | 49.9 | 48.5 |
Exercise intensity * | Less intense | 49.5 a | 39.7 a | 42.9 a | 38.2 a | - | 43.0 a | 46.4 a | 45.2 a | 43.3 |
Groups | n (%) | PSQI (Mean ± SD) | Average Sleep Duration (h/day) (Mean ± SD) |
---|---|---|---|
Sleep quality change | |||
Worse | 719 (32.1) | 9.2 ± 3.4 a | 7.3 ± 1.3 a |
Better | 348 (15.5) | 5.5 ± 2.9 b | 7.8 ± 1.1 b |
Did not change | 1175 (52.4) | 5.8 ± 2.9 b | 7.5 ± 1.1 c |
Sleep duration change | |||
Less | 383 (17.1) | 9.4 ± 3.8 a | 6.7 ± 1.2 a |
More | 1002 (44.7) | 6.6 ± 3.2 b | 8.0 ± 1.1 b |
Did not change | 857 (38.2) | 6.0 ± 3.2 c | 7.3 ± 1.0 c |
Predictors | Dietary Risk B (p-Value) | Alcohol Misuse Scores B (p-Value) | Physical Activity (METs/wk) B (p-Value) | Sitting Time (min/d) B (p-Value) |
---|---|---|---|---|
(Constant) | 6.756 (<0.001) | 2.005 (<0.001) | 2517.932 (<0.001) | 368.664 (<0.001) |
Sleep quality change | ||||
Worse | 0.486 (0.001) | 0.310 (0.051) | −272.907 (0.123) | 19.909 (0.082) |
Better | −0.323 (0.081) | 10.162 (0.413) | 18.737 (0.934) | −36.064 (0.010) |
Did not change (reference) | - | - | - | - |
Sleep duration change | ||||
Less | 0.409 (0.040) | 0.473 (0.019) | −128.772 (0.582) | 4.436 (0.770) |
More | 0.408 (0.008) | 0.459 (0.004) | −568.192 (0.002) | 22.841 (0.050 *) |
Did not change (reference) | - | - | - | - |
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Du, C.; Zan, M.C.H.; Cho, M.J.; Fenton, J.I.; Hsiao, P.Y.; Hsiao, R.; Keaver, L.; Lai, C.-C.; Lee, H.; Ludy, M.-J.; et al. Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk. Clocks & Sleep 2021, 3, 12-30. https://doi.org/10.3390/clockssleep3010002
Du C, Zan MCH, Cho MJ, Fenton JI, Hsiao PY, Hsiao R, Keaver L, Lai C-C, Lee H, Ludy M-J, et al. Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk. Clocks & Sleep. 2021; 3(1):12-30. https://doi.org/10.3390/clockssleep3010002
Chicago/Turabian StyleDu, Chen, Megan Chong Hueh Zan, Min Jung Cho, Jenifer I. Fenton, Pao Ying Hsiao, Richard Hsiao, Laura Keaver, Chang-Chi Lai, HeeSoon Lee, Mary-Jon Ludy, and et al. 2021. "Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk" Clocks & Sleep 3, no. 1: 12-30. https://doi.org/10.3390/clockssleep3010002