How College Students Choose to Live

Health promoting lifestyle of university students in Saudi Arabia: a cross-sectional assessment
Abstract
Objective
This study was designed to assess the health-promoting lifestyle of students in health colleges and non-health colleges.in Saudi Arabia
Methods
A total of 1656 students participated in this descriptive cross-sectional study. Data gathering was conducted from November 2016 to February 2017 at King Saud University in Saudi Arabia. All participants answered a two-part questionnaire which includes demographic data and questions about determining the healthy lifestyle behaviors of students.
Results
The majority of the participants were females (70.4 %) and 20 % of the participants were overweight and 11.3%, were obese. Only 12.8% of the students were diagnosed with health problem. The analysis show that there was a significant difference between health colleges and non-health colleges with regards to the factors of health responsibility. Seventy percent of the students in both colleges never inspect their bodies at least monthly for physical changes and do not attend educational programs on health care.
Conclusion
Universities are ideal settings for implementing health promotion programs. For this reason, planning and implementing programs to motivate students to be more responsible for their own health, engage in regular physical activity, and practice healthy eating habits and other forms of wellness of paramount importance.
Keywords: Health promoting lifestyle, Students, Healthy behavior, Saudi Arabia,
Introduction
A health promoting lifestyle is an important determinant of health status and recognized as a major factor for maintenance and improvement of health (Mirghafourvand et al., 2015). Lifestyle factors such as diet, physical activity, and sleep are often perceived modifiable are issues that impact on a person’s health (Garcia-Toro et al., 2012). Lifestyle is a way used by people and during the transition from adolescence to adulthood, students particularly in the college level often experience some unhealthy change in lifestyles. A variety of lifestyle or health related habits such as poor diet leading to malnutrition or obesity, smoking and drinking alcohol, and being less physically active (Butler et al., 2004; Wengreen & Moncur 2009). Furthermore, these unhealthy lifestyles have become more popular among college students in recent years (Keating et al., 2005; Lund et al., 2010). The unfavorable changes in lifestyles have been shown to disturb and cause different health problems like cardio-vascular diseases, hypertension, overweight, metabolic diseases, joint and skeletal problems and even depression (Bourre 2006; Sarbadhikari & Saha 2006). However, the existing evidence on the associations of these lifestyle factors with depression is quite inconsistent (Averina et al., 2005; Demura & Sato 2003; Song et al., 2012).
Moreover, many college students are living away from home for the ?rst time either in student housing or in communities nearby. They are faced with the responsibility for their personal health, lifestyle, and behavior. Young adults develop behaviors that may remain part of their lifestyle into adulthood or that may jeopardize their health status in later life. These behaviors include activities such as assuming responsibility for personal health, participating in physical activities, and acquiring good nutritional habits (Polat et al., 2015). University students are in a dynamic transition period of growth and development that bridges adolescence (high school students) and adulthood (people in the community). This period sees many rapid changes in the body and mind, and in social relationships (WHO, 1977). At this stage, there are various dif?cult life conditions and different lifestyles in the university environment. With the changes in study style and unfamiliar life conditions, many students engage in a wide range of unhealthy habits, such as inadequate nutritional intake, rest, and exercise (Fujii et al., 1998; Hawks et al., 2003; Werch et al., 2007; Wei et al., Teiji et al 2008).
Several studies have reported the relationships among demographic variables and health-promoting behaviors. However, limited studies have found relationships between university year (?rst, second, etc.) and health-promoting behaviors. The purpose of this study is to determine whether or not there were any relationships between university students’ age, gender, whether or not they were living with family, as well as other factors such as body mass index (BMI), their year level, overall score on the Health Promoting Lifestyle Pro?le II (HPLP-II) instrument and three health promoting lifestyle subscales [health responsibility (HR), physical activity (PA) and nutrition (N)]. The study also aims to identify the difference between health promoting lifestyles of students in health colleges and non-health colleges. It is hoped that the results of this study will provide information to university administrators and teachers for general education program awareness and health literacy dissemination and help students to adopt a healthy lifestyle. Lastly, since King Saud University is considered the premiere university in the kingdom, results of this study can bring great impact in promoting the health of individuals and the young adult population of Saudi Arabia.
The study by Al-Kandari and Vidal (2007) examined the health-promoting lifestyle profile of 224 nursing students in Kuwait and correlated it with levels of enrollment in nursing courses as well as academic performance. The researchers used Walker’s Health-promoting Lifestyle Profile II instrument to measure the profile of the students’ lifestyle. The students’ academic performance was measured by focusing on grade point average of the individual students and the general grade point average of the whole group. The researchers found significant differences between male and female students regarding their health-promoting lifestyle, as well as regarding their level of physical activity, interpersonal relationships and techniques of managing stress. Age, nationality, and marital status also correlate with health-promoting profiles according to the study’s findings. However, one thing the researchers failed to find was an association between health-promoting lifestyles and academic performance. This lack of association may be superficial or authentic, and one of the aims of this present study is to follow up on the findings of Al-Kandari and Vidal (2007) and close any gaps left by their research.
The study by Farghaly, Ghazali, Al-Wabel et al. (2007) focused on the lifestyle habits of school students. Specifically, the researchers examined the role of life style and nutrition in impacting school students in Saudi Arabia. The researchers conducted a two-stage random sample to select 767 male and female students at a variety of levels of schooling. The participants completed a questionnaire: information about weight, height and body mass index was obtained. The findings showed that students suffering from poor health (typically obesity) were most commonly females of younger levels of education. The study indicated that poor health-promotion in lifestyles of students can begin at an early age and that schools should do more to understand the lifestyles of students. This present study aims to provide a better understanding of students’ lifestyles so that their health can be better addressed.
Results
A total of 1656 samples of students from different colleges were available for analysis. Demographics of the participants are presented in Table 1. The majority of the participants were females (70.4 %), 29.6 % were male, 57.4 % were 20 years of age or younger, 40.0 % were in the range of 21–30 years old, 2.4 % were 31– 40 years of age and only 0.2% were 41 or older. Regarding their health status, 50% were of normal weight, 11.1% were underweight, 11.3%, were obese and 20.8% were overweight. Almost all of the participants had a traditional type of family structure having 76.1%, while 13.5% consisted of an extended family structure, and 10.4% came from single parent homes. The majority of the participants (94.9 percent) lived with their families, 1.2% lived with friends, 0.9% with their relatives, 2.4% lived in university housing and 0.3% lived alone. Only 12.8% of the students were diagnosed with health problem.
The difference in health lifestyle among non-health colleges and health colleges is shown in Table 2. The analysis revealed that there was a significant differences across response waves among health colleges and non-health colleges with health responsibility. Only a small proportion of students both in health (11.5%) and non – health colleges (6%) reported any unusual signs or symptoms to a physician or other health professional. Mostly half of the students in both colleges were getting information and discussing health concerns with health professionals. Meanwhile, almost half of the students were sometimes reading or watching TV programs about improving their health. Nearly seventy percent of the students in both colleges never inspect their body at least monthly for physical changes. Furthermore, the majority of the students in both colleges do not attend educational programs on health care. There was a significant difference in students seeking guidance or counseling between non-health and health colleges (p =0.001).

With regards to physical activity and exercise of students in non-health and health colleges, a significant difference was found in following a planned exercise program (p=0.019) and taking part in leisure time and physical activities (p=0.013). A total of 35.3 % of students in non- health colleges and 37.8% students in health colleges indicated that they exercise vigorously for 20 or more minutes at least three times a week. Further, the Chi square analysis revealed that there were significant differences across response waves of doing stretching exercise at least 3 times per week among the students in non-health and health colleges (p =0.013). However, 37.7% of students in non-health colleges and 42.4% of students in health colleges indicated they exercise during their routine activities was not found to be significant (p = 0.899). Neither the analysis on students in taking part in light to moderate physical activity (such as sustained walking 30-40 minutes 5 or more times a week) shows no significance on their quit attempts (p = 0.591).
Health-promoting behaviors in relation to nutrition and diet management were also shown in Table 2. A significant difference were found in responses between non-health and health colleges in eating fruits and meat poultry and nuts each day (p=0.001). The majority of the students in both colleges do not choose diets low in fat, saturated fat and cholesterol. A small proportion of students in non-health (6.7%) and health colleges (7.5%) limit use of sugar and food containing sugar. Approximately 90% of the non-health college students consume 2-3 servings of milk, yogurt or cheese each day compared to 71.4% of those from health colleges (p=0.001). There were no significant difference between non-health and health colleges’ students who eat breakfast (p=0.254) and consume 3-5 servings of vegetables each day (p=0.231).

Table 3 presents the factors associated with the healthy lifestyle of students in Saudi Arabia. The socio-demographic variables, including age, gender, college, college level, family structure, and GPA of students were entered and analyzed. The model shows that gender, college, college level and family structure was significantly correlated with the health lifestyle of students in Saudi Arabia. The results show that males were more willing to engage in physical activity than females (p=0.001). The analysis also found that difference in colleges of students was significantly associated with increased likelihood of health responsibility of students. Furthermore, female students had more concern in their diet management and nutrition than male students (p=0.001). There were no significant association in age, place or residence and GPA based on health responsibility, physical activity and diet management or nutrition. There was significant correlation in the level of students and physical activity and exercise (p=0.001).

Discussion
The aim of this study was to explore health lifestyles among university students in Saudi Arabia. Considering the importance of this matter, the Kingdom’s policymakers and health care professionals should it make it a priority to provide community-based services aimed at helping students develop healthy lifestyles. The findings showed the importance of health promotion planning with an emphasis on empowerment to develop healthy lifestyles among university students.
The study’s findings supported the overall findings of Al?Kandari and Vidal (2007) and Farghaly et al. (2007) regarding male and female student differentiation. Male students showed a greater tendency to engage in physical activity and exercise than female students, which corroborates the conclusions made by Al-Kandari and Vidal (2007). The study also found that the college itself is responsible for cultivating an environment that will promote a healthy lifestyle. This finding is new to the literature and adds to the understanding of how students respond to lifestyle choices: in an environment where a college promotes healthy choices, the student body is more likely to be conscious of how they go about their lives and what sort of habits they adopt.
The study also builds on the findings of Farghaly et al. (2007) by showing that many female students do not choose low fat diets, though they do show more interest in knowing about nutritional diets than male students do. This shows an intuitive sense on the part of females to be informed about healthy eating habits. It also shows on the male student part an intuitive approach to knowing about healthy exercise habits. Together, the two—male and female students—complement one another’s choices and interests. The problem is that in spite of their knowledge about healthy eating, female students still will choose diets that are high in sugars and fats. This finding indicates that more needs to be done to understand what compels female students to make lifestyle choices that go against their better judgment. More research into how the university environment impacts the decision making of students may be helpful in closing that gap.
With regards to health responsibility, the results showed significant differences between responses of the participants among health colleges and non-health colleges. Only a small proportion of students in health and non–health colleges reported any unusual signs or symptoms to a physician or other health professional. This result was similar to another study by Chen et al., 2017, and reflected a suboptimal health responsibility among many university students which may be explained by the fact that they are relatively young and may not notice any unusual signs and symptoms or worry about their health status (Chen et al., 2017). Most of the students in both colleges got information and discussed health concerns with health professionals. Acknowledging the role of health professionals in providing health information and education as well as discussing health concerns showed students their health responsibility to adopt into a healthy lifestyle (Schmidt 2009). Meanwhile, almost half of the students sometimes read or watched television programs about improving their health. This was similar to a study where the personal responsibility model of health is reflected and reinforced in prominent entertainment texts of 536 episodes of American primetime television medical dramas which emphasized an individualistic understanding of health (West 2014). Nearly seventy percent of the students in both colleges never inspect their body at least monthly for physical changes. Furthermore, the majority of the student in both colleges did not attend educational programs on health care which was contrary to a previous study in which university students participated in educational programs and some sort of support activities on health care (Mehri et al., 2016). Furthermore, there was a significant difference in seeking guidance or counseling between students in non-health and health colleges. More students in health colleges reported seeking professional counseling or guidance when needed. These interpersonal health attributes were noted as definitive indicators of the health status of students which must be considered as part of the health education and promotion planning (Mahdipour et al., 2013). It showed that the weak health lifestyle of students in non-health colleges has a chance to improve if health promotion programs are implemented for these young people.
With regards to physical activity and exercise, a significant difference was found in which more students in health colleges followed a planned exercise program and took part in leisure time and physical activities than in non-health colleges. It indicated that they exercised vigorously for 20 or more minutes at least three times a week. This results was contrary to previous studies which reported insufficient levels of vigorous recreational physical activity and indicated increased suboptimal health status among participants (Leino-Arjas et al., 2004; Mustard et al., 2003; Hassmen et al., 2000; Wu et al., 2016). The findings suggested that frequent engagement with recreational activities may be associated with better reports of health, physical and psychological wellbeing. In similar studies, those who exercised regularly showed better physical fitness, and perceived physical and psychological health (Klainin-Yobas et al., 2015). Further, it revealed that there were significant differences across response waves of doing stretching exercise at least 3 times per week among the students in non-health and health colleges. This result is similar to a previous study where nursing students were tested for their body flexibility but not limited to stretching exercise (Klainin-Yobas et al., 2015). Meanwhile, no significance found between students of both colleges and their response towards exercising during usual activities. Neither the analysis on students who took part in light to moderate physical activity (such as sustained walking 30-40 minutes 5 or more times a week) showed no significance. This result was similar to a study in which female nursing students in Korea denied participating in regular exercise (Park et al., 2015). However, evidence showed that moderate-intensity and vigorous-intensity exercises are required to achieve cardiovascular fitness among university staff and students, and those who are physically active are more likely to pay attention to their health (Gormley et al., 2008; Yang et al., 2017).
Health lifestyle in relation to nutrition and diet management showed a significant difference in responses between students in non-health and health colleges in eating fruits and poultry and nuts each day. The majority of the students in both colleges did not choose diets low in fat, saturated fat and cholesterol. These results emerged at this period during the university stage of students as risky health and nutrition activities such as unhealthy diet practices (Park et al., 2015; Bonevski et al., 2013). More often, this health risk is primarily the result of transitioning from, and secondary to tertiary education secondary to increase poor dietary choices (Von Ah et al 2004; Plotnikoff et al., 2015). These unhealthy dietary deeds among participants raised a noteworthy health concern for being at risk for malnutrition and obesity. It was an unexpected result that even students in health colleges reported unhealthy diet practice. The reason behind this result was unclear because the researchers did not explore the justifications. Most of the students in both groups did not eat 2-4 servings of fruits each day. This eating concern is presumed that university students observe a typical diet which is high in fats and carbohydrates and low in fruits and vegetables, and usually do not follow a healthy eating style (Sakamaki et al., 2005; El-Ahmady & El-Wakeel 2017). With regards to the consumption of dairy products, more than half of the students in both colleges consume 2-3 servings of milk, yogurt or cheese each day.
In the present study, the model showed that gender, college, college level, and family structure were significantly correlated with the health lifestyle of university students in Saudi Arabia. The results also showed that males are more willing to engage in physical activity than females. This is similar to other studies in Japan and Portugal where male participants reported higher physical activity than their female counterparts (Wei et al., 2007; Sousa et al., 2015). This can be explained by cultural considerations such as the fact that Saudi females have more restrictions placed on them when it comes to doing physical activities than Saudi males. The analysis also found that differences in colleges was significantly associated with increased likelihood of health responsibility of students. Furthermore, female students were more concerned about diet and nutrition than male students. The findings were similar to previous studies indicating that females were more aware of health related concepts and acknowledged the connection between nutrition and health much more than males (Wei et al., 2007; El-Ahmady & El-Wakeel 2017). There was a significant correlation in college level of students for health lifestyle related to physical activity and exercise. Similar to a previous study in Japan, general education courses like physical education are offered in the preparatory year in Saudi Arabia and are no longer included in the higher college levels (Wei et al., 2007). This may be one of the reasons contributing to the increasingly sedentary lifestyle of university students in Saudi Arabia. It could be that physical inactivity is related to lower physical activities and unhealthy diet practices among participants in the current study. With regard to family structure, a significant association was established related to participants’ physical activity. This result was similar to previous studies signifying that a favorable health action is shown when having parents that have higher educational level together with seeking support from family (Mehri et al., 2016; Nacar et al., 2014)[24, 40]. However, there were no significant associations in age, place or residence and GPA based on health responsibility, physical activity, and nutrition and diet management.
Several limitations should be addressed in future researchers related to this study. The cross-sectional design of this current study did not explain causation and changes over time in health lifestyles among the participants which posed one limitation. In addition, as all information gathered in this study was based on self-reporting, it is possible that the university students gave answers they thought the researchers wanted to hear. Furthermore, the results cannot be generalized to university students across the kingdom because its sampling technique is limited to one university. A prospective study may be conducted with the aforementioned problems addressed.

Conclusion
The current study explored the health lifestyles of university students regarding their health responsibility, physical activity, and nutrition. As universities are ideal settings for implementing health promotion programs, planning and implementing those programs to motivate students to be more responsible for their own health, engage in regular physical activity, and practice healthy diet with the purpose of promoting health and preventing diseases are of paramount importance. Thus, it can be concluded that developing and implementing goal-oriented programs to promote health responsibility, physical activity and nutrition may promote healthy lifestyles among university students. Applications like ‘Healthy University’ and ‘Universities Humanizing Health’ are also suggested to enhance health lifestyle awareness of students.

Conflict of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.












Reference
Al?Kandari, F., & Vidal, V. L. (2007). Correlation of the health?promoting lifestyle, enrollment level, and academic performance of College of Nursing students in Kuwait. Nursing & Health Sciences, 9(2), 112-119.

Averina, M., Nilssen, O., Brenn, T.,  Brox. J., Arkhipovsky, V.L., Kalinin, A.G. (2005). Social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated quality of life in Russia--a population-based study in Arkhangelsk. Soc Psychiatry Psychiatr Epidemiol.  40(7):511-8.

Bonevski, B., Guillaumier, A., Paul, C., Walsh, R. (2013). The vocational education setting for health promotion: a survey of students’ health risk behaviours and preferences for help. Health Promotion Journal of Australia, 24(3), 185-191.

Bourre, J.M. (2006). Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging.  10(5):377-85.

Butler, S.M., Black, D.R., Blue, C.L., Gretebeck, R.J. (2004). Change in diet, physical activity, and body weight in female college freshman. Am J Health Behav. 28:24–32

Chen, J., Xiang, H., Jiang, P., Yu, L., Jing, Y., Li, F., et al. (2017). The role of healthy lifestyle in the implementation of regressing suboptimal health status among college students in China: a nested case-control study. International Journal of Environmental Research and Public Health, 14, 240.
Demura, S., Sato, S. (2003). Relationships between depression, lifestyle and quality of life in the community dwelling elderly: a comparison between gender and age groups. J Physiol Anthropol Appl Human Sci. 22(3):159-66.

El-Ahmady, S., El-Wakeel, L. (2017). The effects of nutrition awareness and knowledge on health habits and performance among Pharmacy students in Egypt. J Community Health, 42, 213-220.

Farghaly, N. F., Ghazali, B. M., Al-Wabel, H. M., Sadek, A. A., & Abbag, F. I. (2007). Life style and nutrition and their impact on health of Saudi school students in Abha, Southwestern region of Saudi Arabia. Saudi medical journal, 28(3), 415-421.
Fujii, T., Ohsawa, I., Nozawa, A., Mori, K., Kagaya, M., Kajioka, T., et al. (1998). The association of physical activity level characteristics and other lifestyle with obesity in Nagoya University alumni, Japan. Scand J Med Sci Sports. 8:57–62.
Garcia-Toro, M., Roca, M., Monzón, S., Vives M, Oliván, B., Vicens, E., Salva, J., Gili, M. (2012). Hygienic-dietary recommendations for major depression treatment: Study protocol of a randomized controlled trial. BMC Psychiatry. (12)201.
Hassmen, P., Koivula, N., Uutela, A. (2000). Physical exercise and psychological well-being: A population study in Finland. Prev Med, 30, 17–25.
Hawks SR, Madanat HN, Merrill RM, Goudy MB, Mitagawa T. A cross-cultural analysis of ‘motivation for eating’ as a potential factor in the emergence of global obesity: Japan and the United States. Health Promot Int. 2003;18:153–61.
Keatin,g X.D., Guan, J., Piñero, J.C., Bridges, D.M. (2005). A meta-analysis of college students' physical activity behaviors. J Am Coll Health. 54(2):116-25.

Klainin-Yobas, P., He, H.-G., Lau, Y. (2015). Physical fitness, health behavior and health among nursing students: a descriptive correlational study. Nurse Education today, 35, 1199-1205.

Leino-Arjas, P., Solovieva, S., Riihimaki, H., Kirjonen, J., Telama, R. (2004). Leisure time physical activity and strenuousness of work as predictors of physical functioning: A 28 year follow up of a cohort of industrial employees. Occup Environ Med, 61, 1032–1038.

Lund, H.G., Reider, B.D., Whiting, A.B., Prichard, J.R. (2010). Sleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health. 46(2):124-32.

Mahdipour, N., Shahnazi, H., Hassanzadeh, A., Tabaraie, Y., Sharifirad, G. (2013). Relationship between various aspects of life style in middle-aged women. Bull Environ Pharmacol Life Sci.  3:68–74.

Mehri, A., Solhi, M., Garmaroudi, G., Nadrian, H., Sighaldeh, S.S. (2016). Helath promoting lifestyle and its determinants among university students in Sabzevar, Iran. Int J Prev Med, 7, 65.

Mirghafourvand, M., Baheiraei, A., Nedjat, S., Mohammadi, E., & Charandabi, S. M.-A. (2015). A population-based study of health-promoting behaviors and their predictors in Iranian women of reproductive age. Health Promotion International, 30(3), 586–594. doi:10.1093/heapro/dat086

Mustard, C.A., Vermeulen, M., Lavis, J.N. (2003). Is position in the occupational hierarchy a determinant of decline in perceived health status? Soc Sci Med, 57, 2291–2303.
Nacar, M., Baykan, Z., Cetinkaya, F., Arslantas, D., Ozer, A., Coskun, O., et al. (2014). Health promoting lifestyle behavior in medical students: a multicenter study from Turkey. Asian pacific Journal of Cancer Prevention, 15, 8969-74.
Park, D.-I., Choi-Kwon, S., Han, K. (2015). Health behaviors of Korean female nursing students in relation to obesity and osteoporosis. Nursing Outlook, 63(4), 504–511.

Plotnikoff, R.C., Costigan, S.A., Williams, R.L., Hutchesson, M.J., Kennedy, S.G., Robards, S.L., et al. (2015). Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis. International Journal of Behavioral Nutrition, 12:45.

Polat, Ü., Özen, ?., Kahraman, B., & Bostano?lu, H. (2015). Factors affecting health-promoting behaviors in nursing students at a university in turkey. Journal of transcultural nursing : official journal of the Transcultural Nursing Society / Transcultural Nursing Society., 27(4), 413–9.

Sakamaki, R., Toyama, K., Amamoto, R., Liu, C.J., Shinfuku, N. (2005) Nutritional knowledge, food habits and health attitude of Chinese university students-a cross sectional study. Nutrition Journal, 4, 4.

Sarbadhikari, S.N., Saha, A.K. (2006). Moderate exercise and chronic stress produce counteractive effects on different areas of the brain by acting through various neurotransmitter receptor subtypes: A hypothesis. Theoretical Biology & Medical Modelling. 3:33.

Schmidt, S. (2009). Just health responsibility. J Med Ethics, 35, 21-26.
Song, M.R., Lee, Y.S., Baek,, J.D., Miller, M. (2012). Physical activity status in adults with depression in the National Health and Nutrition Examination Survey, 2005-2006. Public Health Nurs.  29(3):208-17.

Sousa, P., Gaspar, P., Fonseca, H., Hendricks, C. Murdaugh, C. (2015). Health promoting behaviors in adolescence: validation of the Portuguese version of the Adolescent Lifestyle Profile. Journalde Peditria, 91(4), 358-365.
Teiji, N. (2008). The integration of school nutrition program into health promotion and prevention of lifestyle-related diseases in Japan. Asia Pac J Clin Nutr. 17(S1):349–51.
Von Ah, D., Ebert, S., Ngamvitroj, A., Park, N., Kang, D.H. (2004). Predictors of health behaviours in college students. J Adv Nurs, 48, 463-74.

Walker, S.N., Sechrist, K.R., Pender, N.J. (1987). The Health-Promoting Lifestyle Profile: development and psychometric characteristics. Nurs Res.  36(2):76-81.

Walker, S.N., Hill-Polerecky, D.M. (1996). Psychometric evaluation of the health-promoting lifestyle profile II. Unpublished manuscript, University of Nebraska Medical Center.

Wei, C.N., Harada, K., Ueda, K., Fukumoto, K., Minamoto, K., Ueda, A. (2012). Assessment of health-promoting lifestyle in Japanese university students. Environ Health Prev Med, 17, 222-227.
Wengreen, H.J., Moncur, C. (2009). Change in diet, physical activity, and body weight among young-adults during the transition from high school to college. Nutr J. 8:32.

Werch, (Chad) C.E., Bian, H., Moore, M.J., Ames, S., DiClemente, C.C., Weiler, R.M. (2007). Brief multiple behavior interventions in a college student health care clinic. J Adolesc Health. 41:577–85.

West, E. (2014). Television and health responsibility in an age of individualism. Katherine A. Foss. Lanham, Maryland: Lexington Books. 132 pp. Journalism & Mass Communication Quarterly. 94(1), 382-383


World Health Organization. (1977). Coming of age: from facts to action for adolescent sexual and reproductive health. Geneva: WHO;

Wu, S., Xuan, Z., Li, F., Xiao, W., Fu, X., Jiang, P., et al. (2016). Work-recreation balance, health-promoting lifestyles and suboptimal health status in Southern China: a cross-sectional study. Int J Environ Res Public Health, 13:339.

Yang, S.-C., Lou, Y.-F., Chiang, C.-H. (2017). The associations among individual factors, eHealth literacy, and health-promoting lifestyles among college students. Journal of Medical Internet Research, 19(1), e15.