Association of adverse childhood experiences with cumulative health risk behaviors among college students
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摘要:
目的 了解大学生健康危险行为的聚集模式，探索童年不良经历与聚集性健康危险行为的关联，为大学生健康危险行为防控提供理论依据。 方法 2022年11—12月，采用方便抽样方法抽取上海市4所大学，再运用整群随机抽样方法选取3 039名学生开展问卷调查，调查内容包括一般基本信息、童年不良经历和健康危险行为。通过潜在类别分析探索大学生健康危险行为的潜在分类，并运用多元Logistic回归分析童年不良经历与聚集性健康危险行为的关联。 结果 大学生健康危险行为可分为低风险组、吸烟饮酒高危组和摄糖过度组3个类别，占比分别为84.60%，10.37%和5.03%。童年时期有无虐待忽视、家庭功能不良及其他逆境的大学生在健康危险行为3个潜在类别组的分布差异均有统计学意义(χ2值分别为210.67，106.55，104.41，P值均＜0.01)。多元Logistic回归分析结果显示，童年期虐待忽视、家庭功能不良、其他逆境均增加大学生吸烟饮酒高危组的发生风险(OR值分别为6.24，3.80，3.68)，童年期虐待忽视增加大学生摄糖过度组的发生风险(OR=2.18)(P值均＜0.01)。 结论 大学生童年不良经历与聚集性健康危险行为之间存在关联。采取积极措施预防童年不良经历的发生，有助于减少大学生健康危险行为的发生。 Abstract:Objective To understand cumulative health risk behaviors among college students and the association with adverse childhood experiences, so as to provide a theoretical basis for the prevention and control of health risk behaviors in this population. Methods From November to December 2022, four universities in Shanghai were selected using convenience sampling, and 3 039 students were selected for a questionnaire survey using random cluster sampling. The questionnaire covered general basic information, adverse childhood experiences and health risk behaviors. A latent class analysis was carried out to explore the latent classes of health risk behaviors among the college students and multivariate Logistic regression was performed to analyze the association between adverse childhood experiences and cumulative health risk behaviors. Results The health risk behaviors of college students were classified into three latent classes: a low-risk group (84.60%), a high-risk group for smoking and alcohol consumption (10.37%), and an excessive sugar intake group (5.03%). The proportion of three latent classes of health risk behaviors varied significantly by childhood neglect and abuse, family functioning and other adverse childhood experiences (χ2=210.67, 106.55, 104.41, P < 0.01). The results of the multiple Logistic regression analysis revealed that childhood neglect and abuse, poor family functioning, and other adversities increased the risk in the high-risk group for smoking and alcohol consumption among college students (OR=6.24, 3.80, 3.68), as well as an childhood neglect and abuse increased the risk of the excessive sugar intake group among college students (OR=2.18) (P < 0.01). Conclusions Adverse childhood experiences are associated with clustered health risk behaviors. Proactive measures should be taken to prevent the transmission of negative childhood experiences, which would contribute to reduce the occurrence of health risk behaviors among college students. -
Key words:
- Child abuse /
- Dangerous behavior /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。 -
图 1 大学生健康危险行为3分类条件概率分布
Figure 1. Conditional probability distribution of 3 latent classes of health risk behaviors among college students
表 1 不同性别大学生健康危险行为报告率比较
Table 1. Comparison of reported rates of health risk behaviors among college students of different genders
性别 人数 体力活动不足 过度使用视屏电子产品 每天喝含糖饮料 每天吃甜点 蔬菜摄入不足 不健康减肥 日常危险行为 自杀意念 遭受欺凌 吸烟 饮酒 男 1 217 711(58.42) 547(44.95) 133(10.93) 65(5.34) 464(38.13) 502(41.25) 190(15.61) 172(14.13) 129(10.60) 205(16.84) 411(33.77) 女 1 822 1 402(76.95) 998(54.77) 150(8.24) 129(7.08) 715(39.24) 970(53.24) 247(13.56) 344(18.88) 180(9.88) 105(5.76) 469(25.74) 合计 3 039 2 113(69.53) 1 545(50.84) 283(9.31) 194(6.38) 1 179(38.80) 1 472(48.44) 437(14.38) 516(16.98) 309(10.17) 310(10.20) 880(28.96) χ2值 118.20 28.20 6.28 3.69 0.38 41.99 2.50 11.67 0.42 97.82 22.87 P值 ＜0.01 ＜0.01 0.01 0.06 0.54 ＜0.01 0.11 ＜0.01 0.52 ＜0.01 ＜0.01 注：()内数字为报告率/%。 
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表 2 大学生健康危险行为潜在类别模型拟合指数(n=3 039)
Table 2. Latent class model fit index of health risk behaviors among college students(n=3 039)
类别 AIC值 BIC值 aBIC值 Entropy值 PLMR值 PBLRT值 条件概率 1 32 783.46 32 855.69 32 817.57 — — — — 2 32 029.40 32 179.88 32 100.45 0.69 ＜0.01 ＜0.01 0.15/0.85 3 31 774.48 32 003.22 31 882.48 0.83 ＜0.01 ＜0.01 0.05/0.85/0.10 4 31 635.91 31 942.89 31 780.84 0.74 ＜0.01 ＜0.01 0.08/0.74/0.15/0.03 5 31 529.47 31 914.70 31 711.35 0.64 ＜0.01 ＜0.01 0.08/0.03/0.14/0.30/0.45
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表 3 不同组别大学生健康危险行为潜在类别分布比较
Table 3. Comparison of latentclasses distribution of health risk behaviors among college students with different groups
组别 选项 人数 低风险组 吸烟饮酒高危组 摄糖过度组 χ2值 P值 性别 男 1 217 985(80.94) 185(15.20) 47(3.86) 54.57 ＜0.01 女 1 822 1 586(87.05) 130(7.13) 106(5.82) 年级 大一 942 827(87.79) 72(7.64) 43(4.56) 28.14 ＜0.01 大二 862 735(85.27) 75(8.70) 52(6.03) 大三 778 643(82.65) 99(12.72) 36(4.63) 大四 457 366(80.09) 69(15.10) 22(4.81) BMI/(kg·m-2) ＜18.5 607 528(86.99) 39(6.42) 40(6.59) 20.11 ＜0.01 18.5~23.9 1 772 1 493(84.26) 198(11.17) 81(4.57) 24.0~27.9 449 382(85.08) 50(11.14) 17(3.79) ≥28.0 211 168(79.62) 28(13.27) 15(7.11) 父亲文化程度 小学及以下 358 295(82.40) 55(15.36) 8(2.23) 23.75 ＜0.01 初中 637 547(85.87) 66(10.36) 24(3.77) 高中 815 680(83.44) 88(10.80) 47(5.77) 大专及以上 1 229 1 049(85.35) 106(8.62) 74(6.02) 母亲文化程度 小学及以下 512 406(79.30) 86(16.80) 20(3.91) 36.74 ＜0.01 初中 640 563(87.97) 52(8.13) 25(3.91) 高中 756 653(86.38) 69(9.13) 34(4.50) 大专及以上 1 131 949(83.91) 108(9.55) 74(6.54) 月生活费/元 ＜1 000 249 222(89.16) 19(7.63) 8(3.21) 82.84 ＜0.01 1 000~＜2 000 1 262 1 121(88.83) 84(5.66) 57(4.52) 2 000~＜3 000 1 059 889(83.95) 117(11.05) 53(5.00) ≥3 000 469 339(72.28) 95(20.26) 35(7.46) 至少存在一种童年不良经历 是 867 648(74.74) 176(20.30) 43(4.96) 129.46 ＜0.01 否 2 172 1 923(88.54) 139(6.40) 110(5.06) 童年期虐待忽视 有 450 287(63.78) 131(29.11) 32(7.11) 210.67 ＜0.01 无 2 589 2 284(88.22) 184(7.11) 21(1.21) 童年家庭功能不良 有 383 266(69.45) 97(25.33) 20(5.22) 106.55 ＜0.01 无 2 656 2 305(86.78) 218(8.21) 133(5.01) 童年其他逆境 有 558 405(72.58) 124(22.22) 29(5.20) 104.41 ＜0.01 无 2 481 2 166(87.30) 191(7.70) 124(5.00) 注：()内数字为构成比/%。
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表 4 童年不良经历与大学生聚集性健康危险行为的Logistic回归分析[OR值(95%CI)，n=3 039]
Table 4. Logistic regression analysis of adverse childhood experiences and aggregated health risk behaviors among college students [OR(95%CI), n=3 039]
自变量 吸烟饮酒高危健康危险行为 摄糖过度健康危险行为 模型1 模型2 模型1 模型2 至少存在一种童年不良经历 3.76(2.96~4.78)** 4.00(3.11~5.17)** 1.16(0.81~1.67) 1.25(0.87~1.80) 童年期虐待忽视 5.66(4.39~7.32)** 6.24(4.73~8.24)** 2.11(1.40~3.17)** 2.18(1.44~3.30)** 童年家庭功能不良 3.86(2.94~5.06)** 3.80(2.84~5.08)** 1.30(0.80~2.12) 1.31(0.80~2.14) 童年其他逆境 3.47(2.71~4.46)** 3.68(2.81~4.82)** 1.25(0.82~1.90) 1.42(0.93~2.17) 注：自变量分别以无童年不良经历、无童年期虐待忽视、无童年家庭功能不良和无童年其他逆境为参照组；模型1未调整变量，模型2调整性别、年级、BMI、父亲文化程度、母亲文化程度、月生活费；**P＜0.01。
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