Psychosocial factors associated with healthy lifestyle behaviors among Chinese university students across sex and age groups

Background Healthy lifestyle behaviors play an essential role in preventing chronic diseases among university students, yet the psychosocial factors that shape these behaviors may differ across demographic groups. This study examined whether health awareness, self-esteem, and social support predicted healthy lifestyle behaviors among university students and explored whether these associations varied by sex and age. Methods A cross-sectional secondary data analysis was conducted using survey data from 1,169 undergraduate students in China. Validated instruments measured health awareness, healthy lifestyle behaviors, self-esteem, and social support. Multiple regression analyses were performed separately for males and females, and for younger (18–20 years) and older (21–23 years) students. Group differences were assessed using independent-samples t-tests. Results Self-esteem and social support were the strongest predictors of healthy lifestyle behaviors across all groups, although their relative influence varied slightly by sex and age. Among males and younger students, self-esteem demonstrated the largest effect, whereas social support was more influential among females and older students. Health awareness showed smaller but statistically significant associations. The models explained a moderate proportion of variance in healthy lifestyle behaviors (adjusted R² ≈ 0.29–0.30). Conclusion Psychosocial factors, particularly self-esteem and social support, play a central role in shaping healthy lifestyle behaviors among university students. These findings highlight the importance of interventions that enhance psychological well-being and strengthen social support systems within university settings.