The impact of Internet use on the health status of Chinese women: the chain mediating effect of participation in cultural activities, physical exercise and social entertainment activities

doi:10.21203/rs.3.rs-4935758/v1

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The impact of Internet use on the health status of Chinese women: the chain mediating effect of participation in cultural activities, physical exercise and social entertainment activities

https://doi.org/10.21203/rs.3.rs-4935758/v1

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Objective：The purpose of this study is to explore the impact of Internet use on the health status of Chinese women, and to analyze the chain mediating role of participation in cultural activities, physical exercise and social entertainment activities.

Methods：Based on the data of China General Social Survey in 2021, a total of 4469 Chinese women were selected, and multiple linear regression model, structural equation model and Bootstrap mediating effect test method were used.

Results: (1) Internet use has a positive impact on women 's health; (2) Participation in cultural activities plays an intermediary role in the impact of Internet use on women 's health status; (3) Participation in physical exercise plays an intermediary role in the impact of Internet use on women 's health status; (4) Participation in social entertainment activities plays an intermediary role in the impact of Internet use on women 's health status; (5) Participation in cultural activities, physical exercise and social entertainment activities play a chain mediating role in the impact of Internet use on women 's health status.

Conclusion: Internet use has a positive impact on the health status of Chinese women, with an average increase of 0.153 points in health status, that is, higher frequency of Internet use has a more positive impact on women 's health status. In order to maintain women 's physical and mental health, women should reasonably arrange their online time, pay attention to the quality of information, cultivate healthy living habits, actively participate in offline social activities and improve their self-management ability. At the same time, relevant departments should also strengthen Internet supervision and governance to create a safe, healthy and positive network environment for women.

Internet use

women 's health

to participate in cultural activities

participate in physical exercise

participate in social entertainment activities

chain mediating role

In recent years, with the development of China 's economy and the progress of society, people pay more and more attention to health. As an important part of society, women 's health is directly related to the stability of the family and the harmonious development of society. The physical and psychological health of women is related to the health of the next generation and the sustainable development of the future society. In China, women 's lifestyle and health status are affected by many factors. According to the China Internet Network Information Center, the 53 rd ' China Internet Development Statistics Report ' shows that as of December 2023, the number of Chinese netizens reached 1.092 billion, and the Internet penetration rate reached 77.5%. Among them, the proportion of male and female Internet users is 51.2: 48.8, which is basically consistent with the proportion of male and female in the overall population [1]. With the popularization and development of the Internet, women 's way of life has undergone tremendous changes. The Internet has penetrated into all aspects of life, affecting people 's daily life and psychological state. Therefore, in-depth study and understanding of the influencing factors of women 's health status is of great significance for promoting women 's health and promoting social development.

Studies have shown that Internet use has a complex impact on women 's mental and physical health [2]. In terms of mental health, the Internet provides women with a platform for information acquisition, emotional communication, and social interaction, which helps to reduce stress, relieve emotions, and improve mental health [3]. However, information overload, social anxiety, Internet addiction and other problems on the Internet may also have a negative impact on women 's mental health [4–5]. According to research, long-term use of the Internet may lead to psychological problems such as information anxiety, social anxiety, and loneliness among women [6]. For example, overuse of social media can lead to social anxiety and lower life satisfaction and well-being [7]. In terms of physical health, the Internet provides women with convenient access to health information, which helps women better understand and manage their health status [8–9]. However, long-term use of the Internet may lead to physiological problems such as decreased vision, cervical pain, and sleep disorders in women [10]. For example, women are prone to occupational diseases such as ' computer eye ' and ' mouse hand ' when they use electronic devices such as computers and mobile phones for a long time. In addition, excessive use of the Internet may also affect women 's sleep quality, leading to insomnia, dreaminess and other problems [11].

Although previous studies have shown that Internet use has an impact on people 's health, few have explored the impact of Internet use on women 's health, especially the influencing factors and paths. Internet use can not only directly affect women 's health status, but also indirectly affect health status by participating in cultural activities, physical exercise and social entertainment activities. Previous studies have focused on the direct impact of social support and social participation on the health status of the elderly, and there are few studies on the remaining mediating factors [12–15]. Therefore, whether and how the remaining mediating factors, such as participation in cultural activities, participation in physical exercise and participation in social and recreational activities, regulate the relationship between Internet use and women 's health needs further verification.

The purpose of this study is to explore the impact of Internet use on the health status of Chinese women, focusing on the chain mediating role of participation in cultural activities, physical exercise and social entertainment activities. By using the national, comprehensive, continuous and authoritative survey data in China and multiple linear regression model and structural equation model, this study empirically tests whether participation in cultural activities, physical exercise and social entertainment activities has a chain mediating effect between Internet use and health status. Relevant research results will help government departments to take measures to encourage and improve women 's use of the Internet and create a safe, healthy and positive network environment for women.

2.1. Internet Use Affects Health

With the rapid development and popularization of Internet technology, the Internet has become an indispensable part of people 's lives. More and more women begin to use the Internet to work, study, socialize and entertain [16–18]. The impact of Internet use on women 's health, including psychological, physiological and social interaction, has attracted wide attention. Studies have shown that Internet use helps women reduce stress and relieve emotions [19]. Internet use has a significant effect on women 's subjective health (self-rated health and emotion) [20]. The Internet provides women with a wealth of emotional communication channels, which helps to enhance emotional diversity. Through social media, online forums and other platforms, women can share their feelings, seek support and suggestions with others, thereby enhancing emotional connection and satisfaction [21]. The Internet provides women with convenient access to health information management [22]. Women can record and manage their health status through online health platforms, applications, and other tools, such as weight, exercise data, and physiological cycles. This helps women better understand their physical condition and take corresponding health management measures. Health information and resources on the Internet can promote women to adopt positive health behaviors. For example, online fitness courses, healthy diet recommendations, etc. Can motivate women to participate in sports, improve eating habits, etc. The Internet provides a broader social space for women. Women can expand their social circle, make new friends and share their lives through social media, online dating platforms and other tools [23–24]. This helps to enhance women 's social support and sense of belonging.

However, we should also be concerned that Internet use may also have a negative impact on women 's health status [25]. For example, appearance comparison and perfect image on the Internet may trigger women 's appearance anxiety and lead to mental health problems (6). A considerable number of women are dissatisfied with their appearance, partly due to the appearance pressure on the Internet. There is also a large amount of inaccurate health information on the Internet, and women need to learn to identify and screen reliable sources of information [26]. Although Internet use may have some imperfections in health status, we still propose Hypothesis 1 of this study: Internet use has a positive impact on women 's health status.

2.2. Participation in cultural activities affects health

Participating in cultural activities has many effects on health status. Participating in cultural activities such as enjoying music, watching movies, reading books, etc., can help people reduce stress, relieve stressful emotions, and feel the vitality of life and the beauty of nature [27]. These activities can guide people into a state of relaxation and promote mental health. It helps people to better understand themselves, improve self-cultivation, and thus enhance mental health. Participating in cultural activities such as painting courses, drama performances, etc., allows people to express their thoughts and feelings, so as to cultivate their independent thinking ability. This ability not only helps people better understand themselves, but also improves their ability to solve problems and further promotes mental health.

Some cultural activities such as dance, drama, etc., need physical activity and coordination. These activities can promote the development of the body 's various systems, increase the body 's endurance and resistance, thus contributing to good health. Participating in cultural activities such as tourism, learning foreign languages, etc., can broaden their horizons, increase their knowledge, and improve the quality of life. This improvement in the quality of life helps people to enjoy life better and maintain a positive attitude, which is conducive to physical health. By participating in literary performances, volunteer activities and other activities, people can communicate, enhance understanding and build friendships [28]. This kind of social activity helps people to expand interpersonal relationships, enhance social adaptability, and further promote health. At the same time, Internet use is closely related to participation in cultural activities. Internet use can improve the skills of participating in cultural activities and make the experience of participating in cultural activities better. Therefore, Hypothesis 2 of this study is proposed: participation in cultural activities plays a mediating role in the impact of Internet use on women 's health status.

2.3. Taking part in physical exercise affects health

Participation in physical exercise has a significant positive impact on health status [29]. Exercise can reduce the risk of cardiovascular disease. For example, through regular exercise, people can reduce cholesterol levels and blood pressure, thereby improving cardiovascular health. Both obesity and underweight have a negative impact on health, and exercise is very important for weight management. For example, aerobic exercise can help people reduce body fat and increase muscle mass.

Physical exercise can stimulate the activity of the immune system and enhance the body 's defense against viruses and bacteria. Physical exercise helps to prevent common diseases such as colds and influenza. Physical exercise can help people release stress, improve their emotional state, and have a positive effect on alleviating mental diseases such as depression and anxiety [30]. Especially in the game success, can enhance the individual ' s self-confidence. Aerobic exercise such as running and swimming can help improve metabolic rate, consume more calories, and help control weight. Strength training such as weightlifting and push-ups can increase muscle mass and improve body shape. Physical exercise can reduce the risk of cardiovascular diseases, such as heart disease and stroke. Exercise can prevent and manage chronic diseases, such as diabetes and hypertension. After participating in physical exercise, have a better physical and mental state to use the Internet. The use of the Internet has also broadened the channels for acquiring scientific sports knowledge and increased the possibility of participating in various sports competitions [31]. Therefore, Hypothesis 3 of this study is proposed: participation in physical exercise plays a mediating role in the impact of Internet use on women 's health status.

2.4. Participating in social entertainment activities affects health status

Participation in social and recreational activities has a positive impact on health status. Studies have shown that participation in social activities can reduce the incidence of depression and anxiety [32]. For example, social activities such as partying with friends, participating in community activities, or volunteering can increase an individual 's sense of well-being and satisfaction, thereby reducing the risk of depression and anxiety disorders. In social interaction, people will come into contact with different views and cultures, and understand the advantages and disadvantages of themselves and others. By communicating and collaborating with others, people are able to demonstrate their values and abilities, thereby enhancing self-esteem and self-confidence [33–34]. Face-to-face communication with others can share happiness and troubles, gain understanding and support, and relieve psychological pressure. The joy people release in social interactions can help lower blood pressure and reduce the risk of cardiovascular problems. People who often participate in social activities usually have a better immune system and recover faster. Social activities aim to promote interpersonal communication and connection. By participating in social activities, people can establish and maintain various social relationships and reduce loneliness [35–36]. Social activities also help to promote social integration, enable people to better integrate into society, and enhance a sense of social belonging [37]. The use of the Internet makes it more possible to participate in social entertainment activities, especially online social networking makes people closer to each other. Participation in social and recreational activities, so that people are more willing to communicate, but also enhance the desire to understand the Internet. Therefore, hypothesis 4 of this study is proposed: participation in social entertainment activities plays an intermediary role in the impact of Internet use on women 's health status.

Health is one of the most important factors in human life, which has a crucial impact on individual happiness and social stability. In recent years, with the popularity of the Internet, as well as the improvement of living standards and medical conditions, people pay more and more attention to health problems [38–39]. Therefore, research on health status is also increasing, aiming at improving people 's health and quality of life. Although scholars mainly focus on the relationship between Internet use, social support, health status and subjective well-being, there are few studies on participating in cultural activities, participating in physical exercise and participating in social and recreational activities as influencing factors or mediating variables. Therefore, this study mainly explores the relationship between Internet use and health status, and explores the mediating role of participation in cultural activities, physical exercise and social entertainment activities between Internet use and health status. Based on this, Hypothesis 5 of this study is proposed: participating in cultural activities, participating in physical exercise and participating in social and recreational activities play a chain mediating role in the impact of Internet use on women 's health status.

3.1. Data sources

The data of this study are from China general social survey (CGSS). We selected the latest data released by CGSS in 2021 (CGSS (2021)) for analysis. The initial sample size of CGSS (2021) data is 8148, covering 28 provinces, autonomous regions and municipalities in China. CGSS (2021) data are investigated, collected and published by the China Survey and Data Center of Renmin University of China. The data quality is high and has the characteristics of authority, universality and continuity. According to the needs of the study, we removed and cleaned the samples of male, incomplete data and obvious errors, and finally got 4469 valid data.

3.2. Variables measurement

3.2.1. Dependent variable

This study mainly selects three questions, corresponding to self-rated health, physical health and mental health [40–41]. In CGSS (2021), select ' A15.What do you think of your current physical health? The question was used as a self-rated health status variable. The ' very unhealthy ' is assigned to 1, the ' relatively unhealthy ' is assigned to 2, the ' general ' is assigned to 3, the ' relatively healthy ' is assigned to 4, and the ' very healthy ' is assigned to 5. The larger the value, the better the self-rated health status. Select ' A16.In the past four weeks, have health problems affected the frequency of your work or other daily activities? The problem as a variable of physical health. The value of ' always ' was assigned to 1, the value of ' often ' was assigned to 2, the value of ' sometimes ' was assigned to 3, the value of ' seldom ' was assigned to 4, and the value of ' never ' was assigned to 5. The greater the value, the better the health status. A17.How often have you felt depressed or depressed over the past four weeks? Problem as a variable of mental health status. The ' always ' is assigned to 1, the ' often ' is assigned to 2, the ' sometimes ' is assigned to 3, the ' rarely ' is assigned to 4, and the ' never ' is assigned to 5. The larger the value, the better the mental health status. Using principal component analysis, we combine three questions to generate a new variable ' health status '.

3.2.2. Independent variable

Select ' A28-5. In the past year, your use of the Internet (including mobile Internet)? The problem as an independent variable. The ' never ' is assigned to 1, the ' rarely ' is assigned to 2, the ' sometimes ' is assigned to 3, the ' often ' is assigned to 4, and the ' very frequent ' is assigned to 5. The larger the value, the higher the frequency of Internet use.

3.2.3. Mediator variable

Select ' A30-5. In the past year, have you often participated in cultural activities (such as listening to concerts, watching shows and exhibitions) in your spare time? The problem as a mediating variable. The value of ' never ' is assigned to 1, ' several times a year or less ' is assigned to 2, ' several times a month ' is assigned to 3, ' several times a week ' is assigned to 4, and ' every day ' is assigned to 5. The larger the value is, the higher the frequency of participating in cultural activities is.

Select ' A30-9. In the past year, have you often participated in physical exercise in your free time ? The problem as a mediating variable. The ' never ' is assigned to 1, the ' several times a year or less ' is assigned to 2, the ' several times a month ' is assigned to 3, the ' several times a week ' is assigned to 4, and the ' daily ' is assigned to 5. The larger the value is, the higher the frequency of participating in physical exercise is.

Choose ' A31-1 '. During the past 1 year, have you often participated in social / networking activities in your free time? The problem as a mediating variable. The value of ' never ' is assigned to 1, the value of ' seldom ' is assigned to 2, the value of ' sometimes ' is assigned to 3, the value of ' often ' is assigned to 4, and the value of ' very frequently ' is assigned to 5. The greater the value, the higher the frequency of participating in social entertainment activities.

3.2.4. Control variable

Social demographic characteristics such as ethnicity, household registration, religious belief, education level, marital status, and job satisfaction were selected as control variables. Among them, the ethnic variable is selected as ' A4. Your ethnicity is? The option ' Han ' is assigned to 1, indicating that it is a Han resident. The options 'Mongol nationality ', ' Manchu nationality ', ' Hui nationality ', ' Tibetan nationality ', ' Zhuang nationality ', ' Uygur nationality ' and ' other nationalities ' are combined and assigned to 0, indicating that they are minority residents. The job satisfaction variable is selected as ' L17.In general, are you satisfied with your current job? The options ' very satisfied ' and ' relatively satisfied ' are combined and assigned to 1, indicating satisfaction with the job. The options ' general ', ' not very satisfied ' and ' very dissatisfied ' are combined and assigned to 0, indicating that they are not satisfied with the work.

3.3. Analysis method

3.3.1. Multiple linear regression model

This study uses a multiple linear regression model to analyze Hypothesis 1 to reveal that Internet use has a positive impact on women 's health. In the model construction, this study regards women 's health status as the dependent variable $\:\text{Y}$ and the frequency of Internet use as the independent variable $\:{\text{X}}_{1}$. In addition, in order to control other factors that may affect health status, this study will include a series of control variables, including socio-demographic characteristics $\:{\text{X}}_{2}$, participation in cultural activities $\:{\text{X}}_{3}$, participation in physical exercise $\:{\text{X}}_{4}$, participation in social and recreational activities $\:{\text{X}}_{5}$. These control variables help this study to exclude the interference of other potential factors, so as to accurately assess the relationship between Internet use and health status.

The mathematical equation of the multiple linear regression model can be expressed as Eq. (1):

$$\:\text{Y}={{\beta\:}}_{0}+{{\beta\:}}_{1}{\text{X}}_{1}+{{\beta\:}}_{2}{\text{X}}_{2}+{{\beta\:}}_{3}{\text{X}}_{3}+{{\beta\:}}_{4}{\text{X}}_{4}+{{\beta\:}}_{5}{\text{X}}_{5}+\text{ϵ}$$

In formula (1), $\:\text{Y}$ represents the score of women 's health status, $\:{\text{X}}_{1}$ represents Internet use, $\:{\text{X}}_{2}$ represents socio-demographic characteristics, $\:{\text{X}}_{3}$ represents participation in cultural activities, $\:{\text{X}}_{4}$ represents participation in physical exercise, and $\:{\text{X}}_{5}$ represents participation in social activities. $\:{{\beta\:}}_{0}$ is the intercept term, indicating the health status reference value predicted by the model when all independent variables are zero. $\:{{\beta\:}}_{1}$-$\:{{\beta\:}}_{5}$ are regression coefficients, which represent the strength of the influence of each variable on the dependent variable $\:\text{Y}$, respectively. Among them, $\:{{\beta\:}}_{1}$ is the focus of this study, indicating the direct impact of Internet use frequency on women 's health. $\:\text{ϵ}$ is the error term, which represents the influence of other factors that are not observed in the model on health status.

In the multivariate linear regression analysis, this study first examines the basic assumptions such as normality, multicollinearity, heteroscedasticity and independence of the data. In addition, this study will also evaluate the goodness of fit and potential outliers of the model through residual analysis.

3.3.2. Structural equation model

This study tests Hypothesis 2, Hypothesis 3 and Hypothesis 4 by constructing a structural equation model (SEM). The structural equation is constructed as shown in Formula (2):

$$\:\text{Y}=\text{B}\text{y}+{\Gamma\:}\text{x}+{\zeta\:}$$

In the formula (2), $\:\text{y}$ is the endogenous variable vector, $\:\text{x}$ is the exogenous variable vector, $\:\text{B}$ is the path coefficient matrix between endogenous variables, $\:{\Gamma\:}$ is the path coefficient matrix between exogenous variables and endogenous variables, and $\:{\zeta\:}$ is the residual term of the structural equation model. Then, through the constructed structural equation model, the Bootstrap method is used to estimate the mediating effect, to test the significant effect of the chain mediating effect, and finally to verify whether Hypothesis 5 is valid.

4.1. Descriptive statistical results

This study focuses on the relationship between Internet use and health status. According to the descriptive results of each variable in Table 1, the sample data of health status (dependent variable $\:Y$) is 4469, the score range of health status is from − 2.978 to 1.310, and the mean value is -0.071 (standard deviation SD = 1.029), indicating that most samples are in good health. The mean value of Internet use (the main independent variable $\:{X}_{1}$) is 3.320 (standard deviation SD = 1.662), the minimum value is 1 (' never '), and the maximum value is 5 (' very frequent '), which shows that Chinese women use the Internet more frequently. The descriptive statistical results of each variable are shown in Table 1.

Table 1

Descriptive result statistics of each variable
Variable	N	Minimum value	Maximum value	Mean value	Standard deviation
Nation	4469	0.000	1.000	0.924	0.265
Census register	4469	0.000	1.000	0.611	0.488
Religious belief	4469	0.000	1.000	0.912	0.283
Marital status	4469	0.000	1.000	0.136	0.343
Job satisfaction	4469	0.000	1.000	0.136	0.343
Education degree	4469	1.000	5.000	2.331	0.908
Internet use	4469	1.000	5.000	3.320	1.662
Take part in cultural activities	4469	1.000	5.000	1.467	0.760
Participating in the physical exercise	4469	1.000	5.000	2.758	1.619
Participate in social entertainment activities	4469	1.000	5.000	2.662	1.145
Health conditions	4469	-2.978	1.310	-0.071	1.029

Before the formal analysis, this study conducted a normality test on the five variables of Internet use, participation in cultural activities, participation in physical exercise, participation in social and recreational activities, and health status to ensure the validity of the subsequent analysis and the reliability of the results. This study uses IBM SPSS Statistics 26 software for normality test. The normality test results are shown in Table 2 and the normality test diagram is shown in Fig. 1.

Table 2

Normality test analysis results
Variable	Kolmogorov-Smirnov			Shapiro-Wilk
Variable	Statistic	Degree of freedom	Significance	Statistic	Degree of freedom	Significance
Internet use	0.231	4469	0.000**	0.787	4469	0.000**
Take part in cultural activities	0.384	4469	0.000**	0.644	4469	0.000**
Participating in the physical exercise	0.233	4469	0.000**	0.817	4469	0.000**
Participate in social entertainment activities	0.207	4469	0.000**	0.907	4469	0.000**
Health conditions	0.132	4469	0.000**	0.936	4469	0.000**
Note: p < 0.05, *p < 0.01

According to Table 2 and Fig. 1, although the sample data results are not absolutely normal, after combining the normal distribution histogram, the variables are basically acceptable normal distribution, and the next research and analysis can be carried out.

4.2. Multiple regression results

This study takes the health status of Chinese women as the dependent variable, the use of the Internet as the independent variable, participation in cultural activities, participation in physical exercise, participation in social and entertainment activities as the control variables, and selects the level of education, marital status, job satisfaction and other socio-demographic characteristics as the control variables to establish a multiple linear regression model. The construction and results of this model are shown in Table 3. In the model 1, only socio-demographic characteristics were included as control variables; on this basis, Model 2 adds the factor of participating in cultural activities; model 3 is also increased to participate in physical exercise factors; model 4 further increased participation in social entertainment activities; model 5 integrates all independent variables, mediating variables and control variables.

The results show that after incorporating Internet use into the model in Model 5, the regression coefficient is 0.153 (p = 0.000 < 0.01), and the results have a significant positive impact on health status. This result indicates that Hypothesis 1 of this study is valid, that is, Internet use has a positive impact on women 's health status. By comparing the adjusted R square values of Model 1 to Model 5, it can be seen that it gradually increases with the increase of variables. The adjusted R-square value of Model 5 is 0.157, which is significantly improved compared with 0.103 of Model 1. This shows that with the increase of variables, the model 's explanation of health status is more comprehensive and the explanatory power is enhanced. According to the results of model 5, under the action of control variables, Internet use has a positive and positive impact on the health status of Chinese women, with an average increase of 0.153 points in health status, that is, higher frequency of Internet use has a more positive impact on women 's health status.

According to Table 3, the regression coefficient value of participating in cultural activities is 0.068 (p = 0.001 < 0.01), the regression coefficient value of participating in physical exercise is 0.055 (p = 0.000 < 0.01), and the regression coefficient value of participating in social entertainment activities is 0.057 (p = 0.000 < 0.01). It shows that participation in cultural activities, participation in physical exercise, and participation in social and entertainment activities all have a significant positive impact on women 's health status, indicating that these three variables are important factors affecting women 's health status.

Table 3

Multiple linear regression results of influencing factors of health status
Variable	Model group 1	Model group 2	Model group 3	Model group 4	Model group 5
Nation	0.012(0.057)	0.013(0.057)	0.001(0.056)	-0.013(0.056)	-0.020(0.055)
Census register	-0.025(0.032)	-0.016(0.033)	0.014(0.033)	0.005 (0.033)	0.002 (0.032)
Religious belief	0.133*(0.053)	0.135*(0.053)	0.141**(0.053)	0.139**(0.053)	0.137**(0.051)
Education degree	0.254**(0.020)	0.243**(0.020)	0.225**(0.020)	0.223**(0.020)	0.090**(0.022)
Marital status	0.161**(0.048)	0.144**(0.048)	0.154**(0.048)	0.150**(0.047)	0.128**(0.046)
Job satisfaction	0.399**(0.044)	0.393**(0.044)	0.394**(0.044)	0.396**(0.044)	0.314**(0.043)
Take part in cultural activities	—	0.068**(0.020)	0.048*(0.021)	0.040 (0.021)	0.033 (0.020)
Participating in the physical exercise	—	—	0.055**(0.010)	0.052**(0.010)	0.043**(0.009)
Participate in social entertainment activities	—	—	—	0.057**(0.013)	0.046**(0.013)
Internet use	—	—	—	—	0.153**(0.010)
N	4469	4469	4469	4469	4469
Constant term	-0.857**(0.083)	-0.936**(0.086)	-1.030**(0.087)	-1.136**(0.090)	-1.245**(0.088)
Adjusted $\:{R}^{2}$	0.103	0.105	0.111	0.115	0.157
Note: p < 0.05, *p < 0.01, standard deviation in parentheses.

In summary, through multiple regression analysis, it is proved that Internet use has a significant positive impact on women 's health status. After joining the intermediary variables to participate in cultural activities, participate in physical exercise, and participate in social entertainment activities, it still shows that Internet use has a positive impact on women 's health. In the follow-up part, this study will use the structural equation model to further explore the results.

4.3. Structural Equation Model Results

According to the social demographic characteristics, Internet use, health status, participation in cultural activities, participation in physical exercise, participation in social entertainment activities, the structural equation model of this study was established. The structural equation model parameters were calculated as shown in Table 4.

Table 4

Model fitting degree table
Index	Fit index	Standard	Actual value	Result
Absolute index	χ2 /df	< 3	0.901	Excellent
	GFI	> 0.9	0.970	Excellent
	RMR	< 0.05	0.021	Excellent
Value-added indicators	RMSEA	< 0.10	0.011	Excellent
	CFI	> 0.9	0.996	Excellent
	NFI	> 0.9	0.908	Excellent
	NNFI	> 0.9	0.938	Excellent

It can be seen from Table 4 that the values fitted by the above models are within the standard range, indicating that the fitting degree of this model is very good, and the data of this study have a good fitting effect. Therefore, the results of this model are shown in Table 5.

Table 5

Results of structural equation model
Latent variable	→	Manifest variables	Standardized coefficient	Significant P value
Internet use	→	Take part in cultural activities	0.423	0.000
Internet use	→	Participating in the physical exercise	0.441	0.000
Internet use	→	Participate in social entertainment activities	0.109	0.002
Internet use	→	Health conditions	0.965	0.000
Take part in cultural activities	→	Participating in the physical exercise	0.352	0.000
Take part in cultural activities	→	Participate in social entertainment activities	0.108	0.003
Take part in cultural activities	→	Health conditions	0.094	0.000
Participating in the physical exercise	→	Participate in social entertainment activities	0.216	0.007
Participating in the physical exercise	→	Health conditions	0.112	0.002
Participate in social entertainment activities	→	Health conditions	0.045	0.000
Note: → denotes regression influence relation or measurement relation.

It can be seen from Table 5 that the measured variables of all factors are P < 0.05, indicating that these variables are statistically significant. The latent variable → explicit variable path of this model: ' Internet use → participation in cultural activities, Internet use → participation in physical exercise, Internet use → participation in social and recreational activities, Internet use → health status, participation in cultural activities → participation in physical exercise, participation in cultural activities → participation in social and recreational activities, participation in cultural activities → health status, participation in physical exercise → participation in social and recreational activities, participation in physical exercise → health status, participation in social and recreational activities → health status ', all paired items P < 0.05, indicating that all paths are significant, so all paths established by this model are valid. The influence coefficients of each path are: 0.423,0.441,0.109,0.965,0.352,0.108,0.094,0.216,0.112,0.045, indicating that these paths play a significant role in the model. In particular, Internet use has the greatest impact on health status (0.965), indicating that Internet use plays an important role in women 's health status. The path diagram of the structural equation model is shown in Fig. 2.

4.4. Mediation model results

In this study, Bootstrap method was used to test the mediating effect. Taking Internet use as the independent variable, health status as the dependent variable, participation in cultural activities, participation in physical exercise and participation in social entertainment activities as the mediating variables, a mediating model was established. The results of Bootstrap analysis of mediating effect are shown in Table 6.

Table 6

Bootstrap analysis of mediating effect
Category	Effect	Boot SE	BootLLCI	BootULCI
Internet Use ⇒ Participation in Cultural Activities ⇒ Health Status	0.001	0.001	0.001	0.004
Internet use ⇒ Participating in physical exercise ⇒ Health status	0.003	0.001	0.002	0.009
Internet Use ⇒ Participation in Social Entertainment ⇒ Health Status	0.002	0.001	0.001	0.008
Internet use ⇒ Participating in cultural activities ⇒ Participating in physical exercise ⇒ Health status	0.001	0.001	0.001	0.005
Internet use ⇒ Participate in cultural activities ⇒ Participate in social entertainment ⇒ Health status	0.002	0.001	0.001	0.010
Internet use ⇒ Participate in physical exercise ⇒ Participate in social entertainment ⇒ Health status	0.003	0.002	0.004	0.011
Internet use ⇒ Participate in cultural activities ⇒ Participate in physical exercise ⇒ Participate in social entertainment ⇒ Health status	0.002	0.001	0.001	0.007
Note: BootLLCI refers to the lower limit of 95% interval of Bootstrap sampling, and BootULCI refers to the upper limit of 95% interval of Bootstrap sampling.

Internet use not only directly affects health status, but also indirectly affects health status by participating in cultural activities, physical exercise and social entertainment activities. As shown in Table 6, the mediating effect of Internet use on participation in cultural activities is 0.001, and the 95% confidence interval (CI) is [0.001,0.004]. The path interval does not include the number 0, indicating that this mediating effect path exists, indicating that Internet use can have a significant indirect positive impact on health status through participation in cultural activities, supporting hypothesis 2 of this study. The mediating effect of Internet use on participation in physical exercise is 0.003, and the 95% confidence interval (CI) is [0.002,0.009]. The path interval does not include the number 0, indicating the existence of this mediating effect path. It shows that Internet use can have a significant indirect positive impact on health status by participating in physical exercise, which supports the hypothesis 3 of this study. The mediating effect of Internet use on participation in social entertainment activities is 0.002, and the 95% confidence interval (CI) is [0.001,0.008]. The path interval does not include the number 0, indicating that this mediating effect path exists. It shows that Internet use can have a significant indirect positive impact on health status by participating in social entertainment activities, which supports hypothesis 4 of this study.

According to the analysis of the chain mediating effect path, the mediating effect of ' Internet use ⇒ participation in cultural activities ⇒ participation in physical exercise ⇒ health status ' is 0.001, and the 95% interval does not include the number 0 [0.001,0.005], indicating that this mediating effect path exists. According to the mediating path of ' Internet use ⇒ cultural activities ⇒ social and recreational activities ⇒ health status ', the mediating effect is 0.002, and the 95% interval does not include the number 0 [0.001,0.010], which indicates that this mediating effect path exists. According to the mediating path of ' Internet use ⇒ physical exercise ⇒ social entertainment ⇒ health status ', the mediating effect is 0.003, and the 95% interval does not include the number 0 [0.004,0.011], thus indicating the existence of this mediating effect path. According to the mediating path of ' Internet use ⇒ participation in cultural activities ⇒ participation in physical exercise ⇒ participation in social and recreational activities ⇒ health status ', the mediating effect is 0.002, and the 95% interval does not include the number 0 [0.001,0.007].Therefore, this mediating effect path exists. The existence of four chain mediating effect paths shows that participation in cultural activities, participation in physical exercise and participation in social and recreational activities play a chain mediating role in the impact of Internet use on women 's health status, which supports hypothesis 5 of this study.

This study uses CGSS (2021) as sample data to explore the relationship between Internet use and the health status of Chinese women. There are many studies on the relationship between Internet use and health status, but the influencing factors between the two still need to be further explored. Therefore, we use multiple regression model, structural equation model and mediation model to test the relationship between Internet use, participation in cultural activities, participation in physical exercise, participation in social and entertainment activities and the health status of Chinese women. Through research, we can draw the following conclusions.

First, Internet use has a positive impact on women 's health, which is consistent with previous research results [42–44]. Health status mainly includes self-rated health, physical health and mental health. Internet use has a positive effect on self-rated health [45–47]. The use of the Internet makes women happy physically and mentally, and is satisfied in learning knowledge, entertainment, online shopping, online social interaction, live delivery and so on. Internet use has a positive effect on physical health [48–49]. Through the use of the Internet, more health information can be found, network communication between each other can be increased, sports fitness can be learned and used for reference, so that women can be more effective in body management, and the truth of ' love of beauty is universal ' can be verified. Internet use has a positive effect on mental health [50–52], which is contrary to the view that Internet use increases mental health problems [53]. Using the Internet can alleviate our loneliness and reduce the probability of anxiety and depression [54–55]. Especially introverted women are more likely to have these symptoms.

Second, participation in cultural activities plays an intermediary role in the impact of Internet use on women 's health. Participating in elegant art and cultural activities can make our body and mind happy, be washed in mind and spirit, improve the quality of life, and greatly improve the health status. By participating in cultural activities, we can bridge the gap between regions and ages, and protect women 's physical and mental health [56]. The use of the Internet has made women more willing to accept diversified cultures, from the Internet to practice, and more exciting for everyone to participate in cultural activities offline [27]. Therefore, it is credible to participate in cultural activities to play a mediating role in the impact of Internet use on women 's health status.

Thirdly, participation in physical exercise plays a mediating role in the impact of Internet use on women 's health status, which is consistent with previous research results [57]. As a positive way of life, physical exercise can not only exercise to increase vitality, but also release pressure to enhance perseverance and verify the truth that ' life lies in exercise '. In the use of the Internet environment, enhance women 's physical exercise, through the internal adjustment of the body, to improve physical health and mental health purposes. Therefore, it is credible to participate in physical exercise to mediate the impact of Internet use on women 's health status.

Fourth, participation in social entertainment activities plays an intermediary role in the impact of Internet use on women 's health status. Social entertainment activities are divided into online and offline. Online social entertainment activities through the Internet avoid the mismatch of time and space, avoid the tension of some people when they meet offline, and even avoid women 's inferiority because of their looks, which is conducive to physical and mental health, especially mental health. Online social entertainment activities can reduce the level of depression, loneliness and anxiety, and significantly improve mental health [58–60]. Therefore, it is credible to participate in social entertainment activities to play a mediating role in the impact of Internet use on women 's health status.

Fifth, participation in cultural activities, physical exercise and social entertainment activities play a chain mediating role in the impact of Internet use on women 's health status. We found a total of ' Internet use-participating in cultural activities ⇒ participating in physical exercise ⇒ health status, Internet use ⇒ participating in cultural activities ⇒ participating in social entertainment activities ⇒ health status, Internet use ⇒ participating in physical exercise ⇒ participating in social entertainment activities ⇒ health status, Internet use ⇒ participating in cultural activities ⇒ participating in physical exercise ⇒ participating in social entertainment activities ⇒ health status ' 4 chain intermediary paths, we discuss the most complex chain intermediary path ' Internet use ⇒ participating in cultural activities ⇒ participating in physical exercise ⇒ participating in social entertainment activities ⇒ health status '. The popularization and use of the Internet allows us to open our horizons, accept more diversified cultural activities, and stimulate our willingness to participate in cultural activities, participate in physical exercise, and participate in social and entertainment activities online and offline. The choice of time and space is more convenient, the content form is more colorful, and the group object is more extensive. Reduce the levels of depression, loneliness, anxiety, mental disorders, etc., form a healthy lifestyle, and ultimately positively affect physical and mental health. This is a gradual chain process. Participating in cultural activities broadens our horizons and recognizes the importance of health. Physical exercise itself is also one of the cultures and arts. Having a good body is conducive to our participation in social and recreational activities. The improvement of social ability promotes the pursuit of physical and mental health and culture and art, and ultimately forms a virtuous circle.

There are also some limitations in this study. First, there are many factors affecting women 's health status, and it is a dynamic impact. We use the data of 2021, is it suitable for women now? This is a question worth thinking about. Second, about the intermediary role, only to participate in cultural activities, to participate in physical exercise, to participate in social and recreational activities, did not involve other discussions. For example, family economic status, peer neighborhood relationship status and other factors. Thirdly, although we use regression model, structural equation model and mediation model, can other models also test such results? In the future research, we can make and distribute questionnaires by hand, and grasp the first-hand information in time. In the course of the discussion, the factors such as the influence of economic status and the influence of classmates and friends are discussed to supplement the research results. The selection and testing of multiple models, such as the use of system dynamics models to explore the synergy between female Internet use and health status.

The results of this study also have some policy implications. Improve network speed, purify network content, especially extremely negative and vulgar network content. After all, women 's self-control needs to be improved, the curiosity is serious, and it is easy to be misled by network content with a little carelessness, which has a negative impact on body and mind. In China, the network cost is more expensive, as far as possible to reduce the network cost, so that the network welfare spread to every citizen. Promote a healthy way of life and entertainment. Encourage women to participate in cultural activities, participate in physical exercise and participate in social and recreational activities, and integrate into the social collective. For example, more participation in school concerts, painting and calligraphy exhibitions, musicals, etc., the surrounding elegant art with the history, with the network to compare, improve their spiritual realm. Moderate exercise, through the Internet to understand the nearest marathon, basketball football, swimming, etc., lead the family or invite friends to participate in, not only increase the friendship, but also exercise the body. The above measures are beneficial to women 's health.

In summary, this study explores the impact of Internet use on the health status of Chinese women through the mediating role of participating in cultural activities, participating in physical exercise and participating in social and recreational activities. The use of the Internet can enable women to meet the needs of online shopping, live broadcasting, social entertainment, etc., enhance communication, and make up for deficiencies in precision learning, which is conducive to women 's health. Due to the numerous influencing factors of health status, this study selects Internet use as an independent variable, and selects participation in cultural activities, participation in physical exercise and participation in social entertainment activities as mediating variables. Through empirical research, it is concluded that Internet use has a positive impact on women 's health status. Participation in cultural activities, participation in physical exercise and participation in social entertainment activities play a chain mediating role in the impact of Internet use on women 's health status. These findings will help government departments to take measures to encourage and improve women 's use of the Internet and improve their health by participating in cultural activities, physical exercise and social entertainment.

CGSS: China general social survey; CGSS (2021): China general social survey in 2021.

Acknowledgments

The authors thank the China General Social Survey (CGSS), designed by the National Survey Research Center at Renmin University of China (NSRC).

Author contributions

PW and TQ conceived the concept and design of the study. PW contributed to data cleaning and analysis. PW, TQ and YX contributed to the writing assistance and proof reading the article. All authors approved the final version of the manuscript.

Funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Availability of data and materials

Publicly available datasets were analyzed in this study. This data can be found here: http://cgss.ruc.edu.cn. The opinions in this paper are those of the authors.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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No competing interests reported.

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The impact of Internet use on the health status of Chinese women: the chain mediating effect of participation in cultural activities, physical exercise and social entertainment activities

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Abstract

Figures

1. Introduction

2. Literature Review and Research Hypothesis

2.1. Internet Use Affects Health

2.2. Participation in cultural activities affects health

2.3. Taking part in physical exercise affects health

2.4. Participating in social entertainment activities affects health status

3. Materials and methods

3.1. Data sources

3.2. Variables measurement

3.2.1. Dependent variable

3.2.2. Independent variable

3.2.3. Mediator variable

3.2.4. Control variable

3.3. Analysis method

3.3.1. Multiple linear regression model

3.3.2. Structural equation model

4. Results

4.1. Descriptive statistical results

4.2. Multiple regression results

4.3. Structural Equation Model Results

4.4. Mediation model results

5. Discussion

6. Conclusion

Abbreviations

Declarations

References

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