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Article(id=1240375270679572484, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202310345, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1698681600000, receivedDateStr=2023-10-31, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658109588, onlineDateStr=2026-03-16, pubDate=1713974400000, pubDateStr=2024-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658109588, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658109588, creator=13701087609, updateTime=1773658109588, updator=13701087609, issue=Issue{id=1240375270163673092, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658109465, creator=13701087609, updateTime=1773658579758, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377242795176417, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377242795176418, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1479, endPage=1485, ext={EN=ArticleExt(id=1240375270922842117, articleId=1240375270679572484, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analyses of the structural equation model with affecting lifestyle behaviors for the physiological sub-health status of medical students, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the impact and pathways of lifestyle behaviors on physiological sub-health of medical students, and to provide a basis for health management and health education in universities.

Methods

Under the use of stratified whole cluster random sampling method, 3 100 medical students from a medical university were selected as the study subjects, general situation questionnaire, lifestyle factor questionnaire and Sub-Health Measurement Scale Version 1.0 (SHMS V1.0) were used for questionnaire survey. Chi-square test, exploratory factor analysis and structural equation model were used for statistical analysis and path construction.

Results

The total detection rate of medical students’ sub-health status was 62.2%. There were significant differences in the distribution of drinking (χ2=12.245,P<0.001), activity(Frequency of exercise(χ2=46.115, P<0.001);Frequency of activities between classes(χ2=7.179,P=0.028);Leisure promotes health(χ2=60.789,P<0.001)), dietary habits (Frequency of takeout orders(χ2=8.912, P=0.012);Frequency of consumption of sugar-sweetened beverages(χ2=23.437,P<0.001);Bad eating habits(χ2=82.863,P<0.001))and mobile phone and computer usage(Time spent on mobile phones and computers(χ2=12.350, P=0.002); Short video viewing time(χ2=9.291,P=0.026)) among medical students with different physiological health states. The direct effect of activity on physiological sub-health of medical students was 0.26(95% CI:0.137-0.366). The direct effect of dietary habits on physiological sub-health of medical students was -0.171 (95% CI:-0.233--0.035), and the indirect effect was -0.04(95% CI:-0.085--0.015). The indirect effect of mobile phone and computer usage on physiological sub-health of medical students was -0.043 (95% CI: -0.087--0.017).

Conclusion

The overall detection rate of sub-health status among medical students is relatively high. Physical activity is a significant influencing factor in the physiological sub-health status of medical students and serves as a mediator between dietary habits and mobile phone and computer usage with respect to the physiological sub-health status of medical students.

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目的

了解生活行为方式对医学生生理亚健康的影响及其路径，为高校开展健康管理和健康教育提供依据。

方法

采用分层整群随机抽样方法，选取某医科大学3 100名医学生为研究对象，使用一般情况调查表、生活方式因素调查表和亚健康评定量表（SHMS V1.0)进行问卷调查，应用χ2检验、探索性因子分析和结构方程模型进行统计分析和路径构建。

结果

医学生亚健康状态总检出率为62.2%；饮酒（χ2=12.245,P<0.001）、活动情况(锻炼频率（χ2=46.115,P<0.001）；课间活动频率（χ2=7.179，P=0.028）；休闲方式促健康情况（χ2=60.789，P<0.001））、饮食习惯（点外卖频率（χ2=8.912,P=0.012）；饮用含糖饮料频率（χ2=23.437,P<0.001）；不良饮食习惯（χ2=82.863,P<0.001））、手机电脑使用情况（手机电脑使用时长（χ2=12.350，P=0.002）；短视频浏览时长（χ2=9.291,P=0.026））在不同生理健康状态的医学生中的分布差异具有统计学意义；模型显示，活动情况对医学生生理亚健康的直接效应值为0.26（95% CI:0.137~0.366）；饮食习惯对医学生生理亚健康的直接效应值为-0.171（95% CI:-0.233~-0.035），间接效应值为-0.04（95% CI:-0.085~-0.015）；手机电脑使用情况对医学生生理亚健康的间接效应值为-0.043（95% CI：-0.087~-0.017）。

结论

医学生亚健康状况总检出率较高，活动情况是医学生生理亚健康重要的影响因素，并在饮食习惯和手机电脑使用情况对医学生生理亚健康的影响中具有中介作用。

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郭斌, E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=HsQ/cnRnhkj2HSZsJ8p9VQ==, magXml=luMoCmc9wL+OmN/cZMHyOA==, pdfUrl=null, pdf=jghRUbTFTeUj9C4Rz65pTQ==, pdfFileSize=943042, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=x75c1y5y8i+5uxNGyt5WsA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Jmm+5M7AU7TqsODz4WTM4A==, mapNumber=null, authorCompany=null, fund=null, authors=

商杰森（1993—）,男,硕士在读,研究方向：健康教育、卫生政策

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商杰森（1993—）,男,硕士在读,研究方向：健康教育、卫生政策

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Cyberpsychology, Behavior and Social Networking, 2020, 23(9): 619-626., articleTitle=Impact of problematic smartphone use on mental health of adolescent students: association with mood, symptoms of depression, and physical activity, refAbstract=null), Reference(id=1240748868942483861, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, doi=null, pmid=null, pmcid=null, year=2023, volume=31, issue=5, pageStart=716, pageEnd=722, url=null, language=null, rfNumber=[19], rfOrder=30, authorNames=张晓州, 彭婷, journalName=中国健康心理学杂志, refType=null, unstructuredReference=张晓州，彭婷．大学新生正念对手机成瘾倾向的影响:社交焦虑的中介作用[J]．中国健康心理学杂志，2023，31（5）：716-722．, articleTitle=大学新生正念对手机成瘾倾向的影响:社交焦虑的中介作用, refAbstract=null), Reference(id=1240748869017981338, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, doi=null, pmid=null, pmcid=null, year=2023, volume=31, issue=5, pageStart=716, pageEnd=722, url=null, language=null, rfNumber=[19], rfOrder=31, authorNames=Zhang XZ, Peng T, journalName=China Journal of Health Psychology, refType=null, unstructuredReference=Zhang XZ, Peng T. Impact of mindfulness on college freshmen Mobile phone addiction tendency: The mediating effect of social anxiety[J].China Journal of Health Psychology, 2023, 31(5): 716-722., articleTitle=Impact of mindfulness on college freshmen Mobile phone addiction tendency: The mediating effect of social anxiety, refAbstract=null)], funds=[Fund(id=1240748865788367067, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, awardId=21EDB073, language=CN, fundingSource=黑龙江省哲学社会科学研究规划项目(21EDB073), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240748860696482627, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, xref=null, ext=[AuthorCompanyExt(id=1240748860704871236, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, companyId=1240748860696482627, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Daqing Campus of Harbin Medical University, Daqing, Heilongjiang 163319, China), AuthorCompanyExt(id=1240748860713259846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, companyId=1240748860696482627, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=哈尔滨医科大学大庆校区，黑龙江 大庆 163319)])], figs=[ArticleFig(id=1240748864240668796, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=EN, label=Fig.1, caption=Standard structural equation model of the influence of lifestyle behaviors on physiological sub-health status of medical students after modification, figureFileSmall=JNFg3dhf0x9XvJCsCRo8dw==, figureFileBig=Ngkw6eES99hhWwUIR3zkQQ==, tableContent=null), ArticleFig(id=1240748864332943490, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=CN, label=图1, caption=修正后医学生生活行为方式对生理亚健康状况影响标准结构方程模型

注：X1为独立因子“是否饮酒”，P1～P14为SHMS V1.0问卷中生理维度14个条目，X1～X9详见表3变量赋值表，e1～e19为所对应残差项，*为P<0.05。

, figureFileSmall=JNFg3dhf0x9XvJCsCRo8dw==, figureFileBig=Ngkw6eES99hhWwUIR3zkQQ==, tableContent=null), ArticleFig(id=1240748864509104271, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=EN, label=Table 1, caption=

Detection of five states of medical students in a medical university

, figureFileSmall=null, figureFileBig=null, tableContent=
组别疾病
（例)		亚健康（人）健康
（人）
重度中度轻度合计（%）
生理7634961 0212851 802（62.9）300
心理6384151 0113481 774（61.9）453
社会3575189905322 040（71.2）468
总体6554319753771 783（62.2）427
), ArticleFig(id=1240748864597184661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=CN, label=表1, caption=

某医科大学医学生5种状态检出情况

, figureFileSmall=null, figureFileBig=null, tableContent=
组别疾病
（例)		亚健康（人）健康
（人）
重度中度轻度合计（%）
生理7634961 0212851 802（62.9）300
心理6384151 0113481 774（61.9）453
社会3575189905322 040（71.2）468
总体6554319753771 783（62.2）427
), ArticleFig(id=1240748864760762525, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=EN, label=Table 2, caption=

Influence of lifestyles behaviors on physiological sub-health of medical students [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别生理健康人数生理亚健康人数χ2P值
是否吸烟从不吸烟277(14.3)1 659(85.7)
已戒烟12(15.6)65(84.4)0.3760.828
有吸烟11(12.4)78(87.6)
是否饮酒是242(13.2)1 586(86.8)12.245<0.001
否58(21.2)216(78.8)
点外卖频率从不61(19.1)259(80.9)
少200(14.0)1 232(86.0)8.9120.012
多39(11.1)311(88.9)
饮用含糖饮料频率从不26(27.7)68(72.3)
少235(14.9)1 346(85.1)23.437<0.001
多39(9.1)388(90.9)
是否有不良饮食习惯是155(10.1)1 384(89.9)82.868<0.001
否145(25.8)418(74.2)
一周锻炼频率从不44(9.9)399(90.1)
少200(13.6)1 274(86.4)46.115<0.001
多56(30.3)129(69.7)
课间活动频率从不53(12.8)361(87.2)
少117(12.7)805(87.3)7.1790.028
多130(17.0)636(83.0)
休闲方式促健康情况几乎无效11(5.5)188(94.5)
有些效果176(12.1)1 276(87.9)60.789<0.001
非常有效113(25.1)338(74.9)
手机电脑使用时长(h)<229(22.0)103(78.0)
3～6213(14.9)1 217(85.1)12.3500.002
≥758(10.7)482(89.3)
短视频浏览时长(min)无20(23.3)66(76.7)
≤60141(15.1)794(84.9)9.2910.026
61～9067(11.7)506(88.3)
>9072(14.2)436(85.8)
), ArticleFig(id=1240748864844648610, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=CN, label=表2, caption=

生活行为方式对医学生生理亚健康的影响[n（%）]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别生理健康人数生理亚健康人数χ2P值
是否吸烟从不吸烟277(14.3)1 659(85.7)
已戒烟12(15.6)65(84.4)0.3760.828
有吸烟11(12.4)78(87.6)
是否饮酒是242(13.2)1 586(86.8)12.245<0.001
否58(21.2)216(78.8)
点外卖频率从不61(19.1)259(80.9)
少200(14.0)1 232(86.0)8.9120.012
多39(11.1)311(88.9)
饮用含糖饮料频率从不26(27.7)68(72.3)
少235(14.9)1 346(85.1)23.437<0.001
多39(9.1)388(90.9)
是否有不良饮食习惯是155(10.1)1 384(89.9)82.868<0.001
否145(25.8)418(74.2)
一周锻炼频率从不44(9.9)399(90.1)
少200(13.6)1 274(86.4)46.115<0.001
多56(30.3)129(69.7)
课间活动频率从不53(12.8)361(87.2)
少117(12.7)805(87.3)7.1790.028
多130(17.0)636(83.0)
休闲方式促健康情况几乎无效11(5.5)188(94.5)
有些效果176(12.1)1 276(87.9)60.789<0.001
非常有效113(25.1)338(74.9)
手机电脑使用时长(h)<229(22.0)103(78.0)
3～6213(14.9)1 217(85.1)12.3500.002
≥758(10.7)482(89.3)
短视频浏览时长(min)无20(23.3)66(76.7)
≤60141(15.1)794(84.9)9.2910.026
61～9067(11.7)506(88.3)
>9072(14.2)436(85.8)
), ArticleFig(id=1240748864966283437, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=EN, label=Table 3, caption=

Variable assignment table

, figureFileSmall=null, figureFileBig=null, tableContent=
潜变量变量简称赋值方式
饮食习惯点外卖频率X2无=1，少=2，多=3
饮用含糖饮料频率X3无=1，少=2，多=3
是否有不良饮食习惯X4否=1，是=2
活动情况锻炼频率X5无=1，少=2，多=3
课间活动频率X6无=1，少=2，多=3
休闲促健康情况X7几乎无效=1，有些效果=2，非常有效=3
手机电脑使用情况手机电脑使用时长X8<2h=1，3~6h=2，≥7h=3
短视频浏览时长X9无=1，≤60min=2，61~90min=3，>90min=4
), ArticleFig(id=1240748865071141043, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=CN, label=表3, caption=

变量赋值表

, figureFileSmall=null, figureFileBig=null, tableContent=
潜变量变量简称赋值方式
饮食习惯点外卖频率X2无=1，少=2，多=3
饮用含糖饮料频率X3无=1，少=2，多=3
是否有不良饮食习惯X4否=1，是=2
活动情况锻炼频率X5无=1，少=2，多=3
课间活动频率X6无=1，少=2，多=3
休闲促健康情况X7几乎无效=1，有些效果=2，非常有效=3
手机电脑使用情况手机电脑使用时长X8<2h=1，3~6h=2，≥7h=3
短视频浏览时长X9无=1，≤60min=2，61~90min=3，>90min=4
), ArticleFig(id=1240748865192775871, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=EN, label=Table 4, caption=

Model path coefficients

, figureFileSmall=null, figureFileBig=null, tableContent=
路径路径系数标准误标准化路径系数临界比值P值
手机、电脑使用情况→活动情况-0.2910.049-0.367-5.998<0.001
饮食习惯→活动情况-0.2640.058-0.253-4.523<0.001
饮食习惯↔手机、电脑使用情况0.0360.0070.3095.095<0.001
活动情况→生理亚健康0.1580.0350.2604.570<0.001
饮食习惯→生理亚健康-0.1080.031-0.171-3.485<0.001
是否饮酒→生理亚健康-0.0810.017-0.149-4.904<0.001
), ArticleFig(id=1240748865301827783, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=CN, label=表4, caption=

模型路径系数

, figureFileSmall=null, figureFileBig=null, tableContent=
路径路径系数标准误标准化路径系数临界比值P值
手机、电脑使用情况→活动情况-0.2910.049-0.367-5.998<0.001
饮食习惯→活动情况-0.2640.058-0.253-4.523<0.001
饮食习惯↔手机、电脑使用情况0.0360.0070.3095.095<0.001
活动情况→生理亚健康0.1580.0350.2604.570<0.001
饮食习惯→生理亚健康-0.1080.031-0.171-3.485<0.001
是否饮酒→生理亚健康-0.0810.017-0.149-4.904<0.001
), ArticleFig(id=1240748865419268299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=EN, label=Table 5, caption=

Test of the mediating effect of lifestyle behaviors on the influencing of physiological sub-health of medical students

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型效应路径效应值（95% CI）SE
直接效应手机、电脑使用情况→活动情况-0.367（-0.484～-0.253）0.064
饮食习惯→活动情况-0.253（-0.379～-0.364）0.088
手机、电脑使用情况→生理亚健康-0.007（-0.061～0.045）0.049
饮食习惯→生理亚健康-0.171（-0.233～-0.035）0.049
活动情况→生理亚健康0.260（0.137～0.366）0.054
间接效应饮食习惯→活动情况→生理亚健康-0.040（-0.085～-0.015）0.017
手机、电脑使用情况→活动情况→生理亚健康-0.043（-0.087～-0.017）0.018
总效应饮食习惯→活动情况→生理亚健康-0.211（-0.281～-0.068）0.054
手机、电脑使用情况→活动情况→生理亚健康-0.050（-0.102～-0.004）0.025
), ArticleFig(id=1240748865557680336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375270679572484, language=CN, label=表5, caption=

生活行为方式对医学生生理亚健康影响作用路径中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型效应路径效应值（95% CI）SE
直接效应手机、电脑使用情况→活动情况-0.367（-0.484～-0.253）0.064
饮食习惯→活动情况-0.253（-0.379～-0.364）0.088
手机、电脑使用情况→生理亚健康-0.007（-0.061～0.045）0.049
饮食习惯→生理亚健康-0.171（-0.233～-0.035）0.049
活动情况→生理亚健康0.260（0.137～0.366）0.054
间接效应饮食习惯→活动情况→生理亚健康-0.040（-0.085～-0.015）0.017
手机、电脑使用情况→活动情况→生理亚健康-0.043（-0.087～-0.017）0.018
总效应饮食习惯→活动情况→生理亚健康-0.211（-0.281～-0.068）0.054
手机、电脑使用情况→活动情况→生理亚健康-0.050（-0.102～-0.004）0.025
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医学生生活行为方式对生理亚健康状况影响的结构方程分析
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商杰森 , 程怀志 , 陈东权 , 田若童 , 高凌霄 , 郭斌
现代预防医学 | 健康与社会行为 2024,51(8): 1479-1485
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现代预防医学 | 健康与社会行为 2024, 51(8): 1479-1485
医学生生活行为方式对生理亚健康状况影响的结构方程分析
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商杰森, 程怀志, 陈东权, 田若童, 高凌霄, 郭斌
作者信息
  • 哈尔滨医科大学大庆校区，黑龙江 大庆 163319

    • 商杰森（1993—）,男,硕士在读,研究方向：健康教育、卫生政策

通讯作者:

郭斌, E-mail：
Analyses of the structural equation model with affecting lifestyle behaviors for the physiological sub-health status of medical students
Jie-sen SHANG, Huai-zhi CHENG, Dong-quan CHEN, Ruo-tong TIAN, Ling-xiao GAO, Bin GUO
Affiliations
  • Daqing Campus of Harbin Medical University, Daqing, Heilongjiang 163319, China
出版时间: 2024-04-25 doi: 10.20043/j.cnki.MPM.202310345
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摘要
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目的

了解生活行为方式对医学生生理亚健康的影响及其路径，为高校开展健康管理和健康教育提供依据。

方法

采用分层整群随机抽样方法，选取某医科大学3 100名医学生为研究对象，使用一般情况调查表、生活方式因素调查表和亚健康评定量表（SHMS V1.0)进行问卷调查，应用χ2检验、探索性因子分析和结构方程模型进行统计分析和路径构建。

结果

医学生亚健康状态总检出率为62.2%；饮酒（χ2=12.245,P<0.001）、活动情况(锻炼频率（χ2=46.115,P<0.001）；课间活动频率（χ2=7.179，P=0.028）；休闲方式促健康情况（χ2=60.789，P<0.001））、饮食习惯（点外卖频率（χ2=8.912,P=0.012）；饮用含糖饮料频率（χ2=23.437,P<0.001）；不良饮食习惯（χ2=82.863,P<0.001））、手机电脑使用情况（手机电脑使用时长（χ2=12.350，P=0.002）；短视频浏览时长（χ2=9.291,P=0.026））在不同生理健康状态的医学生中的分布差异具有统计学意义；模型显示，活动情况对医学生生理亚健康的直接效应值为0.26（95% CI:0.137~0.366）；饮食习惯对医学生生理亚健康的直接效应值为-0.171（95% CI:-0.233~-0.035），间接效应值为-0.04（95% CI:-0.085~-0.015）；手机电脑使用情况对医学生生理亚健康的间接效应值为-0.043（95% CI：-0.087~-0.017）。

结论

医学生亚健康状况总检出率较高，活动情况是医学生生理亚健康重要的影响因素，并在饮食习惯和手机电脑使用情况对医学生生理亚健康的影响中具有中介作用。

医学生  /  生活行为方式  /  生理亚健康  /  影响  /  结构方程
Objective

To understand the impact and pathways of lifestyle behaviors on physiological sub-health of medical students, and to provide a basis for health management and health education in universities.

Methods

Under the use of stratified whole cluster random sampling method, 3 100 medical students from a medical university were selected as the study subjects, general situation questionnaire, lifestyle factor questionnaire and Sub-Health Measurement Scale Version 1.0 (SHMS V1.0) were used for questionnaire survey. Chi-square test, exploratory factor analysis and structural equation model were used for statistical analysis and path construction.

Results

The total detection rate of medical students’ sub-health status was 62.2%. There were significant differences in the distribution of drinking (χ2=12.245,P<0.001), activity(Frequency of exercise(χ2=46.115, P<0.001);Frequency of activities between classes(χ2=7.179,P=0.028);Leisure promotes health(χ2=60.789,P<0.001)), dietary habits (Frequency of takeout orders(χ2=8.912, P=0.012);Frequency of consumption of sugar-sweetened beverages(χ2=23.437,P<0.001);Bad eating habits(χ2=82.863,P<0.001))and mobile phone and computer usage(Time spent on mobile phones and computers(χ2=12.350, P=0.002); Short video viewing time(χ2=9.291,P=0.026)) among medical students with different physiological health states. The direct effect of activity on physiological sub-health of medical students was 0.26(95% CI:0.137-0.366). The direct effect of dietary habits on physiological sub-health of medical students was -0.171 (95% CI:-0.233--0.035), and the indirect effect was -0.04(95% CI:-0.085--0.015). The indirect effect of mobile phone and computer usage on physiological sub-health of medical students was -0.043 (95% CI: -0.087--0.017).

Conclusion

The overall detection rate of sub-health status among medical students is relatively high. Physical activity is a significant influencing factor in the physiological sub-health status of medical students and serves as a mediator between dietary habits and mobile phone and computer usage with respect to the physiological sub-health status of medical students.

Medical students  /  Lifestyle behaviors  /  Physiological sub-health  /  Influencing  /  Structural equation model
商杰森, 程怀志, 陈东权, 田若童, 高凌霄, 郭斌. 医学生生活行为方式对生理亚健康状况影响的结构方程分析. 现代预防医学, 2024 , 51 (8) : 1479 -1485 . DOI: 10.20043/j.cnki.MPM.202310345
Jie-sen SHANG, Huai-zhi CHENG, Dong-quan CHEN, Ruo-tong TIAN, Ling-xiao GAO, Bin GUO. Analyses of the structural equation model with affecting lifestyle behaviors for the physiological sub-health status of medical students[J]. Modern Preventive Medicine, 2024 , 51 (8) : 1479 -1485 . DOI: 10.20043/j.cnki.MPM.202310345
正文
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“健康中国2030”规划纲要指出，要在2030年实现人民健康水平持续提升，身体素质明显增强，全民健康素养大幅提高，健康生活方式得到全民普及。医护人员自身健康是全民健康的重要组成部分，也是守护全民健康的重要力量，应重视他们的健康。由于医疗卫生服务的特殊性，医护人员已经成为亚健康状态的高发人群,其发生率在52.4%～67.2%[1-2]。亚健康被定义为处于健康和疾病之间的中间状态，具有向健康或疾病双向转化的特征，采取积极措施可降低亚健康状态恶化为疾病状态的风险，促进向健康状态的转变[3]。2021年第八次全国学生体质与健康调研结果显示，大学生身体素质持续下滑，体质健康水平整体呈现下降趋势[4]，而生活行为方式如体育锻炼、饮食习惯和不良嗜好等是影响大学生身体素质水平及身体能力变化的重要因素[5]。医学生是未来医护人员的储备军，对医学生群体开展亚健康现状调查和生活方式对医学生生理亚健康的影响研究对推进健康中国战略的实现具有重要意义。现有研究较少从医学生生活行为方式对生理亚健康状况进行内部路径研究，无法准确得知影响因素的根源。因此，本文通过调查黑龙江省某医科大学医学生亚健康状况，并运用结构方程探究不同生活行为方式对医学生生理亚健康的影响，旨在促进医学生身体素质提升，为高校对医学生健康管理和健康教育提供科学参考。
1 对象与方法
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1.1 研究对象
采用分层整群随机抽样方法，选取黑龙江省某医科大学2019年至2022年入学的全日制在校学生，共计4个年级、13个专业、55个班级。发放问卷3 100份，有效问卷2 865份，有效率92.4%。该调查通过了哈尔滨医科大学大庆校区伦理委员会批准(HMUDQ20231115001),受访学生均签署了知情同意书。
1.2 方法
1.2.1 调查问卷
问卷包含自制一般情况调查表（包括性别、年龄、民族、家庭所在地、专业和家庭人均月收入等）和生活行为方式等因素调查表（包括是否吸烟、是否饮酒、点外卖频率、饮用含糖饮料频率、是否有不良饮食习惯、一周锻炼频率、课间活动频率、休闲方式促健康情况、手机电脑使用时长和短视频浏览时长），以及许军等研制的亚健康评定量表（SHMS V1.0)[6]。
1.2.2 亚健康及生理亚健康判定标准
SHMS V1.0量表由3个维度子量表（生理、心理和社会）以及总体自评健康状况构成。采用Likert五等级评分法，总量表最终得分为3个子量表得分之和，自评健康状况不参与评分。分值越高表示健康状况越好，分值越低则表示健康状况越差。该研究均采用转化分进行统计分析，转化分 =（原始分-理论最低分）/（理论最高分-理论最低分）×100。亚健康评判标准和生理亚健康划分标准采用许军等[6]构建的中国城镇居民亚健康评定量表常模，其中选取男、女14～19岁和20～29岁两个年龄组的常模数据为参照，根据亚健康评定量表转化分的常模标准将总体健康状态和生理健康状态划分成健康、轻度亚健康、中度亚健康、重度亚健康和疾病。
1.2.3 质量控制
参与本次问卷调查人员均为社会医学与卫生事业管理专业研究生，调查前统一培训调查人员；问卷回收后，检查问卷是否存在纰漏、误填或逻辑错误等；采用双人录入，同时进行一致性检验校正保证录入数据的准确性。
1.2.4 统计学方法
采用EpiData 3.1软件建立数据库，SPSS 25.0进行一般描述分析和χ2检验，使用探索性因子分析提取公因子构建潜变量。利用AMOS 26.0构建结构方程模型探讨各潜变量的关系，以验证生活方式影响医学生生理亚健康的重要因素及相关作用机制，所有P值均表示双侧概率，检验水平ɑ=0.05。中介分析采用偏差校正Bootstrap方法。
2 结果
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2.1 基本情况
2 865名调查对象中，男性954人(33.3%),女性1 911人(66.7%)，平均年龄（20.3±1.2）岁；汉族2 616人(91.3%),其他民族249人(8.7%)；城市1 621人（56.6%），农村1 244人（43.4%）；低年级（一年级）1 026人(35.8%)，中年级（二年级）761人(26.6%)，高年级（三、四年级）1 078人(37.6%)；临床医学专业（精神医学、护理学、助产学等）1 305人（45.5%），非临床医学专业（健康服务与管理、信息管理与信息系统、医学信息工程等）1 560人（54.5%）。
2.2 医学生亚健康状态检出情况
医学生SHMS V1.0量表总转化分为(66.07±12.76)分，其中生理维度亚健康转化分为(69.23±13.20)分，心理维度亚健康转化分为(63.73±15.56)分，社会维度亚健康转化分为(64.27±16.28)。根据SHMS V1.0量表的划分，将医学生健康状况划分为5种状态，见表1。
2.3 生活行为方式对医学生生理亚健康的影响
因疾病状态与亚健康、健康状态两者之间有较大差异[7]，为了使研究结果更为准确，采用生理亚健康状态组与生理健康状态组进行比较，剔除被SHMS V1.0量表生理维度常模得分划分为疾病状态的763例医学生，对剩下2 102名医学生亚健康状况进行影响因素分析。结果发现饮酒、点外卖频率、饮用含糖饮料频率、是否有不良饮食习惯、一周锻炼频率、课间活动频率、休闲方式促进健康情况、手机电脑使用时长和短视频浏览时长对医学生生理亚健康状况差异具有统计学意义，见表2。
2.4 影响因素结构方程模型构建
2.4.1 探索性因子分析
将生活方式在不同亚健康状况医学生中分布差异具有统计学意义的9个条目进行探索性因子分析。KMO值为0.632，Bartlett球形检验χ2= 934.708,P < 0.001,满足因子分析条件。采用最大方差法旋转后，根据特征值大于1，排除因子载荷小于0.40的条目，共提取出3个公因子和1个独立因子，即公因子1命名为饮食习惯，公因子2命名为活动情况，公因子3命名为手机、电脑使用情况，独立因子为是否饮酒。变量赋值见表3。
2.4.2 结构方程模型的构建及影响效应分析
将3个公因子与生理亚健康量表条目构建结构方程模型，采用极大似然法（Maximum Likelihood）进行参数估计。文献研究得出，饮食习惯、运动情况和手机电脑的使用均会对大学生健康状况产生影响[8]，且饮食习惯和手机电脑使用情况影响大学生活动情况[9]，基于此本研究将活动情况作为运动情况和手机电脑使用情况对医学生生理亚健康影响的中介变量。
原始模型结果中手机电脑使用情况对医学生生理亚健康的直接影响不显著，经删除该路径后根据结构方程模型适配度指标标准不断修正模型，该模型的适配度（拟合评价）指标：χ2/v=3.746>5、RMSEA=0.036<0.05、GFI=0.967>0.9、AGFI=0.958>0.9、CFI=0.903>0.9，模型拟合程度较好，达到相应判断标准[10]，拟合模型见图1。结果显示，饮食习惯、活动情况和是否饮酒对医学生生理亚健康的影响均有统计学意义（P<0.05），各路径系数见表4。活动情况对医学生生理亚健康影响的直接效应值为0.26（95% CI:0.137～0.366）。饮食习惯对医学生生理亚健康影响直接效应值为-0.171（95% CI:-0.233～-0.035）。手机、电脑使用情况对医学生生理亚健康影响效应值为-0.007（95% CI:-0.061～0.045），其95%可信区间包括0，则说明该路径不显著。Bootstrap中介效应检验结果显示饮食习惯通过活动情况影响医学生生理亚健康的中介效应，以及手机、电脑使用情况通过活动情况影响医学生生理亚健康的中介效应，其95%可信区间均不包括0,表明两个中介效应均成立,说明活动情况对饮食习惯影响医学生生理亚健康具有中介作用,活动情况是手机电脑使用情况影响医学生生理亚健康的完全中介，见表5。
3 讨论
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3.1 医学生亚健康状况总检出率较高，高校应充分发挥学科优势提升医学生健康素养
结果表明，医学生亚健康总检出率为62.2%，特别是生理亚健康情况为疾病状态和重度、中度亚健康状态的医学生较多，其健康状况仍不容乐观。高校应充分发挥自身专业发展和学科优势，积极采取措施提高医学生健康素养，促进医学生亚健康状态向健康状态发展。无论是医学基础课和专业课，还是健康教育等人文类课程，都应时刻强调健康的重要性，不能因医学生学业负担大压力重而忽视自身健康状况。通过课间见习和课堂实践，教师不但要以身作则影响医学生，还要利用典型案例讲解亚健康的危害，强化健康意识，树立正确的健康观。
3.2 活动情况是医学生生理亚健康重要的影响因素，可加强体育锻炼促强身健体魄
WHO身体活动和久坐行为指南建议每周至少进行150～300 min的中等至剧烈体育活动[11]，规律体育锻炼可以提高身体素质，降低近视、肥胖、糖尿病等疾病的发生[12]。结果显示，活动情况对医学生生理亚健康评分具有正向直接效应，即锻炼频率、课间活动频率越多，休闲方式促进健康效果越好，身体健康状况越好，且活动情况是生活行为方式影响医学生生理亚健康最大效应，反映体育锻炼对医学生生理亚健康具有保护因素。研究表明，课间活动可以改善身体健康状况，有效降低青少年肥胖和近视的发生率[13]。医学生未来要面对的是高风险、高强度、高压力的神圣职业，必须拥有健康的体魄，才能禁得住工作带来的各种不可能性。因此，高校应积极倡导和宣传医学生培养健康休闲方式，促进自身身体健康，提高生命质量。课间休息时，增设班级课间音乐操，促使学生有意识站起轻微活动，眺望远方缓解疲劳，以及降低久坐带来的身体不适感。有效利用体育课，督促医学生自觉加强锻炼。健康的休闲方式也能够促进健康，高校团委可适当的增加医学生户外活动，如球类比赛、健步走等，感受大自然的馈赠，真正实现劳逸结合。
3.3 不良饮食习惯影响医学生生理亚健康和活动情况，及时发现、积极干预有益健康
结果显示，饮食习惯对医学生生理亚健康具有直接影响，频繁点外卖、饮用含糖饮料及不规律饮食习惯等，生理健康则处在亚健康状态。究其原因，一方面外卖餐食多以高油高盐为主，频繁以外卖餐食为饮食来源容易造成身体摄入油脂和钠盐过量，增加心血管疾病和高血压患病风险[14]；而含糖饮料的消费，会增加肥胖及Ⅱ型糖尿病患病风险[15]。另一方面不良饮食习惯也会影响活动情况进而影响医学生生理亚健康，即活动情况在不良饮食习惯与医学生生理亚健康中具有中介作用。高盐、高糖及不规律饮食等对身体代谢产生压力，容易产生疲劳、乏力[16]，降低主动锻炼活动意愿，影响医学生生理健康状态。因此，高校可通过校园卡支付的大数据，定期追踪学生消费的饮食类型和偏好，及时发现学生不良饮食习惯，并进行精准干预，同时加强健康饮食的宣传，时刻警醒不良饮食所产生的后果。青少年的饮食习惯具有同伴属性[17]，高校也应该加强开展基于学生同伴之间的干预，注重学生伙伴的相互监督，有助于减少不健康的饮食行为，全方位的保障医学生饮食营养的健康情况。
3.4 手机电脑使用情况通过影响活动情况进而影响医学生生理亚健康，高校需创新课程形式降低手机电脑成瘾现象
智能手机和电脑使用与日常活动行为模式密切相关，易扰乱休闲时间的身体活动，导致久坐行为的发生[18]。结果显示，手机电脑使用情况对医学生活动情况影响效应为负值，且手机电脑使用情况通过影响活动情况进而影响医学生生理亚健康状况，即活动情况是手机电脑使用情况对医学生生理亚健康影响的完全中介，说明减少对手机电脑沉迷可促进医学生活动情况的提升，改善医学生生理亚健康状况。研究表明，正念与体育锻炼和大学生手机成瘾呈负相关关系[19]，并能够显著负向预测大学生手机成瘾问题，提示医学院校可依托护理学专业优势和优秀师资，开设正念心理课程，通过正念疗法使学生集中注意力去深刻地触摸自我的内心，增强自身专注力，倡导绿色课堂。并进一步推进医学教育的改革与发展，加强教师的课堂设计及授课方式的创新，提升学生听课兴趣。同时，将当下热门运动锻炼方式引入大学体育课程中，如飞盘、腰旗橄榄球等，确保学生安全的情况下，既丰富了大学体育课程形式，又增强学生之间的社交连接与自身体质健康，享受体育锻炼带来的乐趣，降低沉迷于手机电脑的情况。
基金
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  • 黑龙江省哲学社会科学研究规划项目(21EDB073)
文献
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2024年第51卷第8期
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doi: 10.20043/j.cnki.MPM.202310345
  • 接收时间：2023-10-31
  • 首发时间：2026-03-16
  • 出版时间：2024-04-25
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  • 收稿日期：2023-10-31
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黑龙江省哲学社会科学研究规划项目(21EDB073)
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    哈尔滨医科大学大庆校区，黑龙江 大庆 163319

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2种不同金属材料的力学参数
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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