{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:57:52Z","timestamp":1791568672047,"version":"4.3.4"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2023ZD0510104, 2023ZD0510100"],"award-info":[{"award-number":["2023ZD0510104, 2023ZD0510100"]}]},{"DOI":"10.13039\/501100017594","name":"Medical Science and Technology Project of Zhejiang Province","doi-asserted-by":"publisher","award":["2024KY913"],"award-info":[{"award-number":["2024KY913"]}],"id":[{"id":"10.13039\/501100017594","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Smoking, alcohol drinking, dietary habits, physical activity, screen time, and sleep duration have been examined separately in relation to suicidality. Based on these behaviors, this study aimed to develop a composite measure of a healthy lifestyle, and to explore its associations with suicidal behaviors among Chinese young people aged 10\u201324 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from 2022 Zhejiang Youth Risk Behavior Survey, in which 27,059 students aged 10\u201324 years completed an anonymous questionnaire designed to assess the health behaviors. A healthy lifestyle score was calculated and categorized into favorable, intermediate, and unfavorable lifestyle categories. Multivariate logistic regression models were employed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for suicidal behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 21.12% of students followed a favorable lifestyle, 56.67% followed an intermediate lifestyle, and 22.21% followed an unfavorable lifestyle. Compared to unfavorable lifestyle, students with intermediate and favorable lifestyle had lower odds of suicidal ideation, with the OR was 0.67 (95% CI: 0.62\u20130.72) and 0.40 (0.36\u20130.45); for suicidal plans, the corresponding OR was 0.61 (0.55\u20130.67) and 0.37 (0.31\u20130.44); for suicidal attempts, the corresponding OR was 0.53 (0.45\u20130.62) and 0.27 (0.20\u20130.37).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study suggested that adherence to healthy lifestyles combining seven modifiable lifestyle factors were significantly associated with the lower odds of suicidal behaviors engagement in Chinese young people.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349662","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:43:34Z","timestamp":1791567814000},"page":"e0349662","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A composite measure of healthy lifestyle and the association with suicidal behaviors in Chinese young people aged 10\u201324 years: Results from a school-based survey in Zhejiang Province"],"prefix":"10.1371","volume":"21","author":[{"given":"Meng","family":"Wang","sequence":"first","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Xiao","family":"Xu","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Qi","family":"Guan","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Fan","family":"Xu","sequence":"additional","affiliation":[{"name":"University of Manchester","place":["Manchester, England"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Yu","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Min","family":"Ma","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4686-5843","authenticated-orcid":true,"given":"Jie-Ming","family":"Zhong","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Center for Disease Control and Prevention","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"pone.0349662.ref001","unstructured":"World Health Organization. Suicide. 2025. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/suicide Accessed 2025 August 15."},{"issue":"3","key":"pone.0349662.ref002","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1177\/0004867420931161","article-title":"Is suicidal behaviour a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis","volume":"55","author":"M Large","year":"2021","journal-title":"Aust N Z J Psychiatry"},{"key":"pone.0349662.ref003","doi-asserted-by":"crossref","first-page":"100253","DOI":"10.1016\/j.eclinm.2019.100253","article-title":"Global risks of suicidal behaviours and being bullied and their association in adolescents: School-based health survey in 83 countries","volume":"19","author":"JJ Tang","year":"2020","journal-title":"EClinicalMedicine"},{"issue":"6","key":"pone.0349662.ref004","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1007\/s10964-024-01969-w","article-title":"Risk and Protective factors of self-harm and suicidality in adolescents: An umbrella review with meta-analysis","volume":"53","author":"R Richardson","year":"2024","journal-title":"J Youth Adolesc"},{"key":"pone.0349662.ref005","doi-asserted-by":"crossref","first-page":"1044354","DOI":"10.3389\/fpsyt.2022.1044354","article-title":"Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention","volume":"13","author":"J Renaud","year":"2022","journal-title":"Front Psychiatry"},{"issue":"4","key":"pone.0349662.ref006","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/S2215-0366(20)30049-3","article-title":"Risk and protective factors for childhood suicidality: A US population-based study","volume":"7","author":"D Janiri","year":"2020","journal-title":"Lancet Psychiatry"},{"issue":"8","key":"pone.0349662.ref007","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1136\/jech-2014-205300","article-title":"Life course epidemiology: Recognising the importance of adolescence","volume":"69","author":"RM Viner","year":"2015","journal-title":"J Epidemiol Community Health"},{"key":"pone.0349662.ref008","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.jad.2023.02.044","article-title":"Lifestyle factors and suicide risk: A nationwide population-based study","volume":"328","author":"H Kim","year":"2023","journal-title":"J Affect Disord"},{"issue":"6","key":"pone.0349662.ref009","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1111\/apa.15079","article-title":"Low physical activity and high sedentary behaviour are associated with adolescents\u2019 suicidal vulnerability: Evidence from 52 low- and middle-income countries","volume":"109","author":"R Uddin","year":"2020","journal-title":"Acta Paediatr"},{"key":"pone.0349662.ref010","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jad.2024.07.099","article-title":"Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents","volume":"363","author":"H Duan","year":"2024","journal-title":"J Affect Disord"},{"issue":"5","key":"pone.0349662.ref011","article-title":"Breakfast habits, sedentary behavior, and suicide among Korean adolescents: A cross-sectional national study","volume":"18","author":"J-S Kim","year":"2023","journal-title":"PLoS One"},{"issue":"17","key":"pone.0349662.ref012","doi-asserted-by":"crossref","first-page":"6660","DOI":"10.3390\/ijerph20176660","article-title":"Lifestyle risk behaviours and nutritional status associated with mental health problems among Myanmar adolescents: secondary analysis of a nationwide 2016 school survey","volume":"20","author":"TZ Win","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0349662.ref013","doi-asserted-by":"crossref","first-page":"105955","DOI":"10.1016\/j.ypmed.2019.105955","article-title":"Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective","volume":"131","author":"R Uddin","year":"2020","journal-title":"Prev Med"},{"issue":"1","key":"pone.0349662.ref014","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s12887-025-05567-y","article-title":"Clustering unhealthy lifestyle factors in Chinese children and adolescents with overweight or obesity","volume":"25","author":"Q Wang","year":"2025","journal-title":"BMC Pediatr"},{"issue":"2","key":"pone.0349662.ref015","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jped.2018.09.002","article-title":"Adolescents\u2019 healthy lifestyle","volume":"96","author":"A Marques","year":"2020","journal-title":"J Pediatr (Rio J)"},{"issue":"1","key":"pone.0349662.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010379","article-title":"Prevalence and associated factors of smoking in middle and high school students: A school-based cross-sectional study in Zhejiang Province, China","volume":"6","author":"M Wang","year":"2016","journal-title":"BMJ Open"},{"issue":"9","key":"pone.0349662.ref017","doi-asserted-by":"crossref","DOI":"10.1016\/j.amjmed.2015.03.027","article-title":"American Heart Association\u2019s life\u2019s simple 7: Avoiding heart failure and preserving cardiac structure and function","volume":"128","author":"AR Folsom","year":"2015","journal-title":"Am J Med"},{"issue":"3","key":"pone.0349662.ref018","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ypmed.2012.06.017","article-title":"The combined effects of healthy lifestyle behaviors on all cause mortality: A systematic review and meta-analysis","volume":"55","author":"M Loef","year":"2012","journal-title":"Prev Med"},{"issue":"4","key":"pone.0349662.ref019","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1161\/CIRCULATIONAHA.117.032047","article-title":"Impact of healthy lifestyle factors on life expectancies in the US population","volume":"138","author":"Y Li","year":"2018","journal-title":"Circulation"},{"key":"pone.0349662.ref020","volume-title":"The health consequences of smoking-50 years of progress: a report of the surgeon general","author":"US Department of Health and Human Services","year":"2014"},{"key":"pone.0349662.ref021","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.nicl.2014.06.011","article-title":"The effect of alcohol consumption on the adolescent brain: A systematic review of MRI and fMRI studies of alcohol-using youth","volume":"5","author":"SWF Ewing","year":"2014","journal-title":"Neuroimage Clin"},{"key":"pone.0349662.ref022","unstructured":"World Health Organization. Global Recommendations on Physical Activity for Health. 2010. Available from https:\/\/www.who.int\/publications\/i\/item\/9789241599979 (Access date: 8\/15\/2025)."},{"issue":"2","key":"pone.0349662.ref023","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1542\/peds.107.2.423","article-title":"American Academy of Pediatrics: Children, adolescents, and television","volume":"107","author":"American Academy of Pediatrics, Committee on Public Education","year":"2001","journal-title":"Pediatrics"},{"issue":"3","key":"pone.0349662.ref024","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/josh.12481","article-title":"Combined patterns of risk for problem and obesogenic behaviors in adolescents: A latent class analysis approach","volume":"87","author":"SA Fleary","year":"2017","journal-title":"J Sch Health"},{"key":"pone.0349662.ref025","unstructured":"World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. 2013. Available from https:\/\/www.who.int\/publications\/i\/item\/9789241506236 (Access date: 8\/15\/2025)."},{"issue":"2","key":"pone.0349662.ref026","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.sleep.2010.11.008","article-title":"Recent worldwide sleep patterns and problems during adolescence: A review and meta-analysis of age, region, and sleep","volume":"12","author":"M Gradisar","year":"2011","journal-title":"Sleep Med"},{"issue":"1","key":"pone.0349662.ref027","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s44263-024-00055-4","article-title":"Clustering of lifestyle risk factors in relation to suicidal thoughts and behaviors in young adolescents: A cross-national study of 45 low- and middle-income countries","volume":"2","author":"Y Zhan","year":"2024","journal-title":"BMC Glob Public Health"},{"issue":"1","key":"pone.0349662.ref028","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1186\/s12888-025-07009-6","article-title":"Association of unhealthy lifestyles and suicidal behaviors among Chinese middle school students: A latent class analysis","volume":"25","author":"C Wang","year":"2025","journal-title":"BMC Psychiatry"},{"key":"pone.0349662.ref029","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jad.2019.05.031","article-title":"A latent class analysis of health lifestyles and suicidal behaviors among US adolescents","volume":"255","author":"Y Xiao","year":"2019","journal-title":"J Affect Disord"},{"key":"pone.0349662.ref030","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jad.2017.08.070","article-title":"Physical activity and suicidal ideation: A systematic review and meta-analysis","volume":"225","author":"D Vancampfort","year":"2018","journal-title":"J Affect Disord"},{"issue":"12","key":"pone.0349662.ref031","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.1249\/mss.0b013e31815793a3","article-title":"Psychobiology and behavioral strategies. Physical activity, sport participation, and suicidal behavior: U.S. high school students","volume":"39","author":"DR Brown","year":"2007","journal-title":"Med Sci Sports Exerc"},{"key":"pone.0349662.ref032","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.jad.2024.08.234","article-title":"Physical activity and suicidal behavior in medical students from the United States","volume":"367","author":"H Oh","year":"2024","journal-title":"J Affect Disord"},{"issue":"4","key":"pone.0349662.ref033","first-page":"888","article-title":"Physical Activity and suicide attempt of South Korean Adolescents - Evidence from the eight korea youth risk behaviors web-based survey","volume":"13","author":"K-O Cho","year":"2014","journal-title":"J Sports Sci Med"},{"issue":"7","key":"pone.0349662.ref034","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1097\/00005768-200207000-00006","article-title":"Physical activity, sports participation, and suicidal behavior among college students","volume":"34","author":"DR Brown","year":"2002","journal-title":"Med Sci Sports Exerc"},{"key":"pone.0349662.ref035","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jad.2020.01.147","article-title":"Sex difference in the association between physical activity and suicide attempts among adolescents from 48 countries: A global perspective","volume":"266","author":"M Felez-Nobrega","year":"2020","journal-title":"J Affect Disord"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349662","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:43:42Z","timestamp":1791567822000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349662"}},"subtitle":[],"editor":[{"given":"Paul","family":"Obeng","sequence":"first","affiliation":[{"name":"Robert Gordon University","place":["UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349662","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}