This cross-sectional study of nationally representative urban Chinese residents found that lifestyle behaviors and living environmental factors were significantly associated with SHS. The association strengths between lifestyle behaviors and GS, lifestyle behaviors and PS were bigger than those of living environmental factors. The association of lifestyle behaviors and MS, lifestyle behaviors and SS were almost the same with those of living environmental factors.
To the best of our knowledge, this was the first study on the association strengths of lifestyle behaviors and living environmental factors with SHS. The findings concluded in this study were generally in line with previous studies on the relationship between lifestyle and PS[24, 25]. Innovative findings in this study were the significant associations between living environmental factors and MS, living environmental factors and SS. Although, the association between living environmental factors and mental health has been elucidated before.
This study used the 39-item SHMS V.1.0 questionnaire to analyze SHS. It included physical, mental, and social dimensions. Our previous research indicated that SHMS V.1.0 had good internal consistency among both a population of southern Chinese medical staff members and urban residents in three Chinese districts; Detective rate of GS in Chinese urban residents was 66.7%, slightly higher than southern China (65.1%)  and Tianjin (66.37%) .
This study found that bad lifestyle habits such as smoking, alcohol consumption, second-hand smoking influences, poor dietary habits, and surfing the internet were associated with low SHS scores. On the other hand, good lifestyle habits such as taking daily breakfast, sufficient sun exposure, daily physical exercise, consistently going to bed before 11 pm, and daily sleep durations between 7–9 hours were associated with non-SHS. A study among Chinese university students similarly indicated that sleep durations of less than six hours per day were independently and significantly associated with poor self-reported health. Skipping breakfast has also been found in association with a significantly increased risk of mortality from cardiovascular disease. Further, an English study pointed out that poor health outcomes were more common among ex-smokers and current smokers than those who had never smoked. Finally, alcohol use and short sleep durations are likely related to poor health among black men living in the United States.
Many studies have indicated that exercise, physical activity, and physical-activity interventions are beneficial for several physical and mental-health outcomes. Sufficient fresh air and sun exposure are also good for promoting public health. Taken together, these studies and our findings underscore the importance of maintaining good lifestyle habits while abandoning bad choices as a simple way to prevent SHS and increase overall health.
This study further found that living environmental factors such as sufficient greenery, fresh air, pleasant housing, less spacious rooms, harmonious neighborhoods, the presence of many fitness facilities, and convenient living conditions were associated with high SHS scores. It is well-known that positive environments (especially natural outdoor areas) are good for human health. Contrary to our general expectations, however, we found that people who lived in spacious rooms had a greater probability of developing both mental and GS. This may be due to feelings of emptiness in one’s surroundings. For example, a systematic review indicated that living alone may be associated with low levels of positive mental health.
This population-based study examined a sample of urban residents (5,881 respondents), thus facilitating overall generalizability to the entire urban population in China. Further, we illustrated the relative strengths of lifestyle behaviors and living environmental factors on the associations with SHS. We firstly illustrated the important association of living environmental factors and MS, living environmental factors and SS, which almost the same with lifestyle behaviors. What’s more, association factors were comprehensive, including 10 lifestyle behaviors and eight living environmental factors, which can be intervened and was helpful for preventing of SHS and chronic noncommunicable diseases.
First, because of the cross-sectional design, it was not possible to confirm causal relationships of SHS with lifestyle behaviors and living environmental factors. Second, lifestyle factors were self-reported in this study, which reduced the precision of measurement of lifestyle behaviors and living environmental factors. Third, although we have considered as many factors as possible, bias may happen inevitably due to some factors not being included.