Healthy Lifestyles of Italian and Latvian university students, according to demographics, nationality, and study specialty with special reference to sport studies

: This study compares lifestyle behaviour of Italian and Latvian university students, with special reference to sport students, to assess if there are differences for gender, age, university or studies specialties. An online questionnaire investigating healthy lifestyle habits and 8 wellness dimensions has been compiled by 155 (43,9 % females) respondents from Italy (all having Italian nationality) and 132 from Latvia (76,5 % females, all having Latvian nationality) The responses were collected between April and December 2020. Presence of smokers in our sample is negligible. The questionnaire showed a good internal consistency (Cronbach α =.933). On the total group, statistically significant differences in all the dimensions regarding age, gender, study specialty and university. Physical activity was associated with healthier lifestyle choices. Geographical differences were found (eating and sleeping behaviours, alcohol awareness) as well as socio-economic differences. Female students showed being more stressed than males. Occupational wellness increased by age. Sport students showed more health awareness. Many of the differences found between males and females in the total group disappeared when comparing only sport students of the two universities.


Introduction.
Quality of life of University students is a major concern for public health, and has been studied extensively, referring to mental health [1,2], physical activity and nutrition [2,3], health related lifestyles [3,4] such as alcohol, drug abuse and sleeping habits. Selfperception of healthy lifestyle determinants of university students have been studied less [5,6,7]. The results of these studies are linked to the specificity of the social environment, and the interpretation of the results is also influenced by the cultural context, for example, religion [8]. Family conditions and social participation (friendships) had been associated to healthy lifestyle choices [9]. There is an evidence that lifestyles acquired during youth years, continue to persist even in adulthood [10], thus making it important to know how these lifestyles develop. The university life brings major changes in lifestyles, including reduced parental control and increased individual autonomy. Stress and freedom are sometimes associated with alcohol and tobacco consumption, less physical activity, and low consumption of fruit and vegetables [10,11,12]. Socio -economic factors have been hypothesized to be the determinants of certain lifestyle choices [13], and it is also known that geographical location influences the mood and thus life habits, sleeping and eating [14]. Gender also influences lifestyle perceptions, as shown in a Swedish study of university students. Males reported to be less stressed, and their health, fitness and mental health level was rated higher than females [15]. The same study shows how self-rated health can be predicted by gender and ethnicity [15]. Another study of Spanish university students that there were less differences between the genders in lifestyle behaviours in sport students compared to non-sport group, thus a comparison of Italian and Latvian sport student subgroupswas also performed.

Methods.
The students participating in this research come from two different universities: one belonging to south Europe (Bologna), the other to north Europe (Liepaja). Bologna city (geographical coordinates:44°29′38″N 11°20′34″E) is a middle size North Italian university town of 395.000 habitants with a student population of 70.000. Liepaja is a middle size university town of Latvia (geographical coordinates: 56°30′42″N 21°00′50″E) of 80.000 habitants with a student population of 1400. Environmental mean temperature (8,2° Celsius in Latvia vs 14,3C in Italy) and economic conditions (pro-capita income 29.901$ in Latvia -vs 39.637$ in Italy) are quite different between the two countries.
Recruiting of respondents was done by word-of-mouth, email messages, andon social networks, and during lessons. In Latvia, due to the smaller numbers, the recruiting was done directly during the lessons. In addition, a total of 1600 emails were sent to themail list of Bologna University, Bologna and Rimini Campus, sport studies. All the students of Bologna were Italian and all the students from Liepaja were Latvian. All students were natives of their country. The students compiled an online questionnaire [36], previously validated [37]. The questionnaire was anonymous, and both Ethical Committees of Liepaja and Bologna Universities approved the study protocol. Informed consent was requested of the participants prior to the survey. The questionnaire aimed at investigating the Overall Healthy Lifestyle and 8 wellness dimensions: Physical, Intellectual, Emotional, Social, Spiritual, Environmental, Occupational, Financial. Each dimension is assessed by 10 items. Each item can be answered in a 3-grade scale: Almost always = 4 points; Sometimes/occasionally = 2 points; Very seldom = 1 points. Answers were collected between April and December 2020. This period is in the beginning of Covid19 pandemic, and this fact could have impacted the responses. However, we do not have any previous data to assess this point. The recruiting in Latvia were made in classes taught in person, because at that time Latvia was at the beginning of pandemic and there were not yet restrictions on classroom teaching. Thus, the results can be useful for a further study to compare with post-covid19 conditions.
Statistical analysis was performed with SPSS v.25. At first, Cronbach's alpha test was performed to determine the internal consistency of the survey which gave an α =.933. The answers were assessed for normality with the Kolmogorov-Smirnov (p < .05), which suggested using the nonparametric tests. Then, Kruskal-Wallis and Mann-Whitney tests were performed. The first comparison was performed between universities (country), gender, age and study programmes in the whole sample of students, then a comparison between Italian and Latvian students was performed on the same variables but 0 for sport students.

Results.
In the whole sample, there were 155 (43,9 % females) respondents from Italy (all having Italian nationality) and 132 from Latvia (76,5 % females, all having Latvian nationality). The female percent was higher for Latvian students. This difference can be explained by the high percentage of females in Latvia population, compared to Italy (84,8 males/100 females in Latvia vs 94,6 in Italy), and with a presence of primary school teachers in Liepaja sample. Age of the students is reported in Table 1. The students belong to different study programmes (Table 2). Smokers' % in the sample was negligible (12,9%, for Italians and 12,9 % for Latvian). Distribution for age shows that a significant % of the sample is over 30. This is due to the students enrolled in the teacher education programmes. One respondent (0.4 %) did not indicate his/her age. Distribution for age shows that a significant % of the Latvian sample is over 30. This is due to the subjects enrolled in the schoolteacher's study course. This is due to the students enrolled in the teacher education programmes. Using the Kruskal-Wallis and Mann-Whitney test, it was determined whether there are statistically significant differences in the evaluations according to the respondents profile. Results are summarized in Table 3. Several statistically significant differences were found between respondent's speciality of study. Statistically most significant differences (p=.000) were found in the evaluation of the Overall Healthy Lifestyle: the highest score was obtained in Sport students Several statistically significant differences were found according to the respondent's age (see Mean Rank in Graph 1) Graph 1. Ranks of the different wellness dimensions by age.
All dimensions decline with age with some exception for the +35 group. The older age is explained with the presence of a group of school teachers following an education curriculum. Intellectual, Environmental, Occupational and Financial wellness, increase in the +35 group. This result can be explained by the fact that the older subjects have a job and can afford better lifes conditions. Results for gender are reported as Mean Rank in Graph 2. Males perceived to be better in all considered dimensions. This result confirms the findings of other studies, which indicate a need for the improvement of the condition of female students in the university [6,8,12]. Bologna students perceived themselves better in all the considered dimensions of wellness in comparison to Latvian students (Graph 3). These results probably reflect the different socio-economic and the geographic/environment, and is accord with the results a previous study comparing a Northern and a Southern Europe cohort of students [22].   Comparison of Latvian and Italian Sport students.
The respondents belonging to sport studies were 140 (in a total population of 1000) from Bologna and 61 from Liepaja (on a total population of 60). Age distribution is mostly in the range 18-28 years old. Liepaja students are of older age, because of the presence of a continuum education courses for elementary school teachers in the sample. Age distribution in sport students is reported in Table 4. Age distributions for sport students are like the total sample distribution. Italian students are younger than Latvian. Cronbach's alpha test was performed to determine the internal consistency of the survey which gave an α =.926. In Table 5, significant differences by country/university and are reported for sport students and Cronbach's alpha for each dimension. Overall, Italian's sports students are more aware of their food consumption. Alcohol and drugs awareness is higher in Latvian students. Higher consumption of fruit in Italian students are probably linked to geographical reasons as well awareness of sun exposure [ 38]. However, differences that can be explained with the geographical location has been evidenced also in other studies comparing European northern and southern countries [22]. Again, it is interesting to observe that eating habits reflect the geographical location, as well as habits about sun exposure. Italians eat more fruits and whole grain. Also, they are more aware of the risk of saturated fat and alcohol eating and drinking and of sleep and healthy weight to maintain health. This result is in accord with previous findings about the association between sleep and moderate to intense physical activity in university students [39]. Diet is also a major concern for Italian students, and it is known that diet is related to stress [40], sleep [41] and overall mental health [42].
In Italian students show higher rankings in social wellness. In a comparative study on mental health of German and Chinese students, more regular social rhythm and physical activity was associated with better mental health [43].
. We didn't find significant differences between males and females sport students. . A masculinization of sport studies has been observed before [44,45] and attributed to social reasons, such as a less female culture in sport studies [44]. Also, cultural conduits in the construction and transmission of male gender orientations and practices in the profession has been observed in PE teachers [46,47]. This result is different from previous findings in Swedish university students (general curriculum), which found the females more stressed than males [15], a similar result was found in female medical students [48].

Conclusions.
Overall, it appears there are not substantial (significant) differences between males and females, between universities, between ages, and between degrees in all the dimensions of healthy lifestyles. Environmental factors, as well as socio-demographic factors can explain the differences between Italian and Latvian students. Geographical latitude seems to influence the eating habits. Despite the politics to improve the females' conditions in the society, not much has been done in the university to empower female students, which still show worse scores than males in many positions. The overall health perception improves significantly with age, and this can be explained by better economic conditions. From the answers, it arises that sport students are more aware of their health, in comparison to the other groups. In our sample, the presence of smokers is negligible, while alcohol seems to be an important health concern in all samples, and more in sport students. Female/male differences are present in the sport students, albeit these differences are few if compared to the gender's differences found in the total sample. We can hypothesize this to be an effect of sport practice, which has a 'masculinization' effect, but this hypothesis must be researched to draw firm conclusions. A limit of our study is the limited number of students tested in sport, especially in the Latvian sample, albeit they represent a large percent of the respective populations. Also, we did not consider any physiologic parameters, for example heart rate variability at rest who has been shown to relate to the lifestyles or body weight, which could have been useful to better interpret some associations we found. These data can be useful for better understanding of the influence of sport studies on healthy lifestyles and design intervention program to improve healthy lifestyle targeting university students involved in different disciplines, to reduce some disparities between males and female' students, and for designing double degree university courses between Latvia and Italy. Further, the study can be useful for a post-pandemic comparison.