This retrospective study showed that the distributions of health-related behaviors and dietary habits varied by gender, age and SES among governmental employees in China. Males in the meddle-aged group (41–60) were more likely to smoke, use alcohol and have short sleep duration, but males in the 31–40 age group had the highest rate of leisure-time physical inactivity (59.6%). Young females (age ≤ 30 y) were more likely to have leisure‐time physical inactivity, but females aged ≥ 51 y were more likely to have short sleep duration. Sedentary behavior, late sleeping, as well as all four risk eating behavior habits were more prevalent in youngest age group (age ≤ 30 y), regardless of gender. In addition, we found that people in the H-SES group were less likely to be current smoker and have physical inactivity, but were more likely to have late sleeping. We also identified four food consumption patterns, which varied by gender, age and SES.
We found gender and age differences in the occurrence of health-related behaviors. For instance, the rate of smoking and alcohol drinking were much lower in females than males, which may be explained by socio-cultural factors. The social gender role in culture consider it acceptable, appropriate, or even desirable to engage in certain behaviors such as smoking and drinking for males, but almost not for females [27–29]. In this study, a higher rate of smoking and alcohol drinking was found in middle-aged (41-60y) males than that in younger males (≤ 40 y). In recent years, the Chinese government has been gradually strengthening the policies against tobacco use, and the group intervention on smoking cessation based on social cognitive theory could be effective to reduce smoking[30, 31]. Male smokers in the high age group lacking health knowledgeable and ignoring the proper health behaviors, cannot sufficiently understand the need for preventive measures[32, 33], even reduce the stress of social isolation, economic hardship, prior trauma, and the loss of power and status by smoking [34]. In addition, we found young females and males had a high rate of leisure-time physical inactivity, late sleeping and sedentary behavior, which was consistent with previous research[35]. With the rapid socioeconomic development in China and changes in urbanization, work stress emerged in the urban population, especially among the working young population due to a rise in living costs, which may result in long working time and lacking leisure-time to participant in physical activity. Modern media use has also become intricately connected with our bedtime routine and sleep [36]. Additionally, individuals in the ≥ 51 y age group were more likely to have a high level of short sleep duration. These findings strongly suggest that planning of effective health promotion programs should target health-related behaviors that are modified by gender and age.
The association between SES and various health-related behaviors are multiple and complex[37]. Past studies have consistently shown SES as the strongest predictor of tobacco use [38–40]. In the current study, we found higher rate of smoking and leisure-time physical inactivity in the H-SES group than L-SES group, which were consistent with previous research[41, 42]. Our study, for the first time, found higher rate of late sleeping in H-SES group than L-SES group among governmental employees in China. Tobacco control policies, leisure‐time physical inactivity and late sleeping interventions in China should be increasingly focused on populations with low-SES in order to break the link between socioeconomic disadvantage and these unhealthy behaviors. Education, one of the components of SES, remained the strongest predictor of these unhealthy behaviors[38–40, 42], suggesting future intervention programs to take targeted measures to reduce unhealthy behaviors, according to education attainment status. Although no significant differences in short sleep duration and sedentary behaviors were observed by SES in this study, we found much higher rate of short sleep duration and sedentary behaviors in our study population than the general population in southeast of China in other studies [41, 43], drawing our attention to the impact of short sleep duration and sedentary behaviors on health among this special population [9].
We found differences in dietary habits including eating behavior habits and food consumption patterns by gender, age and SES. For eating behavior habits, both females and males in the younger age group (≤ 30 years) have the highest rate of these four unhealthy dietary habits. Younger individuals may get involved easily in unhealthy eating behaviors due to poor control awareness and health literacy [19, 20, 44]. Although there were absent differences in four eating behaviors among three SES groups, combination of some other studies, SES remained an important factor to impact unhealthy eating behaviors [45–47].
We also explored food consumption patterns by socio-demographics using CATCPA analysis, which is the first study of its kind among governmental employees in China. We found the ‘traditional foods’ and ‘cereals and dairy product’ patterns were mainly observed in the 41–50 age group with H-SES. In China, traditional foods such as vegetables, fruits, meats and eggs were considered as healthy food pattern in line with Chinese traditions. Research has consistently shown that high intake of vegetables and fruits, whole grains, and eggs may decrease the risk of chronic diseases, even cancer[48, 49]. In addition, we found ‘fish and nut’ and ‘smoked and pickled foods, and dessert’ patterns were mainly observed among the ≥ 51 y males in L-SES group. High intake of sugars, and pickled or smoked foods may increase such risk [9, 22, 50, 51], but fish consumption was associated with a reduced risk of all-cause mortality[52]. Available study has pointed out that males have a higher liking for sweets than females [53]. Younger age, low education, and low family income were associated with a poor health literacy status, which may result in a low nutrient food consumption[44]. The findings have implications for future intervention programs to take targeted measures to reduce unhealthy food consumption habits, according to specific sociodemographic characteristics.
To the best of our knowledge, this is the first study using a large sample from a representative urban governmental employee population. This is also the first study to use the CATPCA method to study health-related behaviors and dietary habits by socio-demographic characteristics such as gender, age and SES groups. However, some limitations should be considered when interpreting our results. First, many variables were self-reported and the findings may be subject to recall bias. Second, the study participants came from Hunan province and China, and the generalizability of the study findings may not be able to generalize to other parts of China despite its large sample size. Future multiprovince or multinational surveillance studies are needed to further test findings in our study. Third, the retrospective design of the current study may preclude any observation of behaviors and dietary habits changes over time. Future longitudinal studies may overcome such a limitation.