Healthy Lifestyles and Attitudes Towards Preventive Counseling: a Survey of Chinese and US Medical Students

Abstract

BACKGROUND: Non-communicable diseases are currently the leading cause of death worldwide. Leading healthy lifestyles as a means of prevention is one of the most important aspects of preventing the occurrence of non-communicable diseases. Working from the premise that physicians globally serve as role models for patients and their health beliefs can influence how they interact and counsel patients, this international study ("MedLife") seeks to examine the self-report of health behaviors and clinical practice attitudes towards preventive counseling of medical students at institutions in China and the US, and identify any associations between these behaviors and students' clinical practice attitudes towards preventive counseling of future patients.METHODS: From 2012-2013, a total of 860/1,216 (response rate = 71%) medical students from Duke University in the US and Peking University Health Science Center and Xi'an Jiaotong University in China completed culturally-adapted web versions of the 33-item "MedLife" questionnaire. Items from the survey were pulled from previously validated survey tools and included questions on diet, exercise, smoking, and alcohol consumption. Alcohol consumption was divided into heavy drinking and binge drinking. Prevalence estimates of health behaviors and attitudes towards preventive counseling in the domains of diet, exercise, smoking, and alcohol consumption were obtained in addition to measures of association between health behaviors and clinical practice attitudes towards counseling future patients on these issues. Finally, multivariate logistic regression analyses were performed to assess the associations between personal habits and clinical practice attitudes towards preventive counseling while adjusting for gender.RESULTS: The median ages of students at Duke University in years 1, 2, 3, and 4 were 23 years, 24 years, 25 years, and 26 years, respectively. The median ages of students at both schools in China among second, fourth, and seventh year students were 19 years, 22 years, and 24 years, respectively. In addition, the percentage of total females at Duke University and in China who completed the survey was 51% and 54%, respectively. Prevalence estimates of a healthy lifestyle, defined as complying with widely recognized recommendations at Duke University in the domains of diet, exercise, smoking, non-binge drinking, and non-heavy drinking were 30%, 42%, 99%, 41%, and 97%, respectively. Prevalence estimates in China of a healthy lifestyle in diet, exercise, smoking, non-binge drinking, and non-heavy drinking were 17%, 33%, 97%, 94%, and 99%, respectively. Overall, approximately 30% of medical students at Duke and 25% of medical students in China had positive clinical practice attitudes towards preventive counseling in terms of diet, exercise, smoking, and alcohol consumption combined. No statistically significant associations between the self-report of health behaviors and clinical practice towards preventive counseling were found among Duke medical students. Second, fourth, and seventh year medical students in China together who complied with all lifestyle recommendations were two times more likely to have a positive clinical practice attitude towards preventive counseling on all healthy lifestyle domains (diet, exercise, smoking, and alcohol) combined (OR=2.03 95% CI=1.06-3.92; p=0.03). When adjusted for gender, this positive association among Chinese medical students was still statistically significant (OR=1.98 95% CI=1.02-3.83; p=0.04).CONCLUSION: Medical students self-reported that they led unhealthy lifestyles in the domains of diet, exercise, and alcohol binge drinking at Duke and in the domains of diet and exercise in China. However, there was little evidence of an association between self-report of health behaviors and clinical practice towards preventive counseling for Duke medical students. But there was evidence among Chinese medical students to support an association between an overall self-reported healthy lifestyle and positive clinical practice attitudes towards preventive counseling on diet, exercise, smoking, and alcohol consumption combined, even after adjusting for gender. If clinicians are going to serve as role models and have their behaviors and lifestyle choices influence patients, medical schools need to ensure students lead healthy lifestyles in these areas and improve positive clinical practice attitudes towards preventive counseling on diet, exercise, smoking, and alcohol consumption to help curb the global cardiovascular disease epidemic. Student health and positive clinical practice attitudes towards preventive counseling should be a top priority for all medical schools, and it seems that policies aimed at improving student health in China are likely to be associated with positive clinical practice attitudes towards preventive counseling.