Cent Eur J Public Health 2025, 33(3):216-224 | DOI: 10.21101/cejph.a8620

Behavioural risk factors clusters and their associations with self-reported burdens among university students in Finland

Walid El Ansari1, Kareem El-Ansari2, René Šebeňa3
1 College of Medicine, Ajman University, Ajman, United Arab Emirates
2 Faculty of Medicine, St. George's University, Saint George's, Grenada
3 Department of Psychology, Faculty of Arts, Pavol Josef Šafárik University in Košice, Košice, Slovak Republic

Objectives: No research among Finnish universities grouped students into clusters, based on their lifestyle behavioural risk factors (BRFs), and appraised relationships of the clusters with self-reported burdens, adjusting for confounders. The aim of the study was to undertake this task.

Methods: Students (N = 1,169) at Turku University completed online questionnaire comprising socio-demographic variables (age, sex, income, social support), 18 burdens, and 4 BRFs (smoking, alcohol, drug use, food habits). Factor analysis reduced burdens into factors; cluster analysis of BRFs categorized students into clusters. Regression models appraised associations between socio-demographics and clusters with burdens.

Results: Mean age was 23 ± 5 years, with 70.4% females, 23.4% smokers, 28.8% problematic drinkers, 21.1% illicit drug/s users, and mean dietary guideline adherence 4.84 ± 1.57 (maximum score of 8 points). Factor analysis of burdens generated four factors: 'Studies' - 3 items; 'Future' - 3 items; 'Relationships' - 7 items; and 'Needs' - 5 items. Cluster analysis produced four BRFs clusters with significantly different BRFs and socio-demographics. Cluster 1 exhibited less risk-taking behaviours, cluster 4 comprised more risk-taking, and the other two clusters fell in between. Regression showed that females were more likely to report all four burdens; higher social support was associated with less burdens generally; older age was associated with less 'Studies' + 'Future' + 'Relationships' burdens; and sufficient income was associated with less 'Studies' + 'Future' burdens. Compared to cluster 1, cluster 3 and 4 membership was more likely to feel 'Needs' burdens; cluster 2 and 3 was more likely to report 'Relationships' burdens (p-range: < 0.05 to < 0.001 for all).

Conclusion: Controlling for socio-demographics, cluster membership was more influenced by students' perceptions of 'Relationships' + 'Needs', rather than academic difficulties of 'Studies' or unsecure 'Future'. Risk taking was more likely with relationship difficulties, isolation, and day-to-day problems (housing, financial situation, health) rather than academic load or concerns for future prospects. Preventive and intervention efforts tackling students' lifestyle behaviours need to consider programmes aimed at better relationship building/maintenance to prevent isolation, while mitigating 'on-the-ground' everyday challenges that students face.

Keywords: behavioural risk factors, burdens, university students, cluster analysis, social support

Received: April 6, 2025; Revised: June 18, 2025; Accepted: June 18, 2025; Published: September 30, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
El Ansari W, El-Ansari K, Šebeňa R. Behavioural risk factors clusters and their associations with self-reported burdens among university students in Finland. Cent Eur J Public Health. 2025;33(3):216-224. doi: 10.21101/cejph.a8620.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • PDF will be unlocked 31.3.2026

    References

    1. Islam A, Low WY, Tong WT, Choo C, Yuen W. Factors associated with depression among university students in Malaysia: a cross-sectional study. KnE Life Sci 2018;415-27. Go to original source...
    2. Müller C, El-Ansari K, El Ansari W. Health-promoting behavior and lifestyle characteristics of students as a function of sex and academic level. Int J Environ Res Public Health. 2022 Jun 20;19(12):7539. doi: 10.3390/ijerph19127539. Go to original source... Go to PubMed...
    3. Wirnitzer KC, Motevalli M, Cocca A, Tanous DR, Wirnitzer G, Wagner KH, et al. Health behavior of Austrian tertiary students focusing on diet type linked to sports and exercise-first glimpse of results from the "sustainably healthy-from science 2 high school and university" study. Front Public Health. 2023 Jul 18;11:1129004. doi: 10.3389/fpubh.2023.1129004. Go to original source... Go to PubMed...
    4. Mikolajczyk RT, Maxwell AE, Naydenova V, Meier S, El Ansari W. Depressive symptoms and perceived burdens related to being a student: survey in three European countries. Clin Pract Epidemiol Ment Health. 2008 Jul 3;4:19. doi: 10.1186/1745-0179-4-19. Go to original source... Go to PubMed...
    5. Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Med Educ Online. 2018 Dec;23(1):1530558. doi: 10.1080/10872981.2018.1530558. Go to original source... Go to PubMed...
    6. El Ansari W, Stock C. Explaining the gender difference in self-rated health among university students in Egypt. Women Health. 2016 Oct;56(7):731-44. Go to original source... Go to PubMed...
    7. El Ansari W, Sebena R, Stock C. Socio-demographic correlates of six indicators of alcohol consumption: survey findings of students across seven universities in England, Wales and Northern Ireland. Arch Public Health. 2013 Nov 6;71(1):29. doi: 10.1186/2049-3258-71-29. Go to original source... Go to PubMed...
    8. El Ansari W, Stock C; UK Student Health Group; Snelgrove S, Hu X, Parke S, et al. Feeling healthy? A survey of physical and psychological wellbeing of students from seven universities in the UK. Int J Environ Res Public Health. 2011 May;8(5):1308-23. Go to original source... Go to PubMed...
    9. Sinha GR, Larrison CR, Brooks I, Kursuncu U. Comparing naturalistic mental health expressions on student loan debts using Reddit and Twitter. J Evid Based Soc Work (2019). 2023 Sep 3;20(5):727-42. Go to original source... Go to PubMed...
    10. Hanson M. Average medical school debt [Internet]. Education Data Initiatives; 2021 Dec 9 [cited 2024 May 23]. Available from: https://educationdata.org/averagemedical-school-debt.
    11. Wunsch K, Fiedler J, Bachert P, Woll A. The tridirectional relationship among physical activity, stress, and academic performance in university students: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021 Jan 16;18(2):739. doi: 10.3390/ijerph18020739. Go to original source... Go to PubMed...
    12. Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C, Bezerra IM, et al. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Braz J Psychiatry. 2017 Oct-Dec;39(4):369-78. Go to original source... Go to PubMed...
    13. Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. J Affect Disord. 2015 Mar 1;173:90-6. Go to original source... Go to PubMed...
    14. Eskin M, Sun JM, Abuidhail J, Yoshimasu K, Kujan O, Janghorbani M, et al. Suicidal behavior and psychological distress in university students: a 12-nation study. Arch Suicide Res. 2016 Jul 2;20(3):369-88. Go to original source... Go to PubMed...
    15. Wilson CK, Matthews JI, Seabrook JA, Dworatzek PDN. Self-reported food skills of university students. Appetite. 2017 Jan 1;108:270-6. Go to original source...
    16. Abdel Sadek HA, Abu-Nazel MW, Shata ZN, Abd El-Fatah NK. The relationship between the BMI and the emotional status of Alexandria University students, Egypt. J Egypt Public Health Assoc. 2016 Sep;91(3):101-8. Go to original source... Go to PubMed...
    17. Al-Sayegh N, Al-Shuwai N, Ramadan S, Al-Qurba T, Al-Obaidi SM, Dean E. Benchmarking the health of health sciences students at Kuwait University: towards a culture of health. East Mediterr Health J. 2016 Nov 2;22(8):619-27. Go to original source... Go to PubMed...
    18. White HR, Labouvie EW, Papadaratsakis V. Changes in substance use during the transition to adulthood: a comparison of college students and their noncollege age peers. J Drug Iss. 2005;35(2):281-306. Go to original source...
    19. Wechsler H, Wuethrich B. Dying to drink: confronting binge drinking on college campuses. Emmaus: Rodale Books; 2002.
    20. Kypri K, Langley J, Stephenson S. Episode-centred analysis of drinking to intoxication in university students. Alcohol Alcohol. 2005 Sep-Oct;40(5):447-52. Go to original source... Go to PubMed...
    21. Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE, Miech RA. Monitoring the Future national survey results on drug use, 1975-2014: volume 2, college students and adults ages 19-55. Ann Arbor: Institute for Social Research; 2015.
    22. Jelagat J, Budambula NLM, Ngari M, Budambula V. Polydrug Use among students in a public university in a lower middle-income country. Biomed Res Int. 2023 Aug 1;2023:8085588. doi: 10.1155/2023/8085588. Go to original source... Go to PubMed...
    23. El Ansari W, Ssewanyana D, Stock C. Behavioral health risk profiles of undergraduate university students in England, Wales, and Northern Ireland: a cluster analysis. Front Public Health. 2018 May 7;6:120. doi: 10.3389/fpubh.2018.00120. Go to original source... Go to PubMed...
    24. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2197-223. Go to original source... Go to PubMed...
    25. Quintiliani L, Allen J, Marino M, Kelly-Weeder S, Li Y. Multiple health behavior clusters among female college students. Patient Educ Couns. 2010 Apr;79(1):134-7. Go to original source... Go to PubMed...
    26. Baskin-Sommers A, Sommers I. The co-occurrence of substance use and high-risk behaviors. J Adolesc Health. 2006 May;38(5):609-11. Go to original source... Go to PubMed...
    27. Willoughby T, Chalmers H, Busseri MA. Where is the syndrome? Examining co-occurrence among multiple problem behaviors in adolescence. J Consult Clin Psychol. 2004 Dec;72(6):1022-37. Go to original source... Go to PubMed...
    28. El Ansari W, Berg-Beckhoff G. Country and gender-specific achievement of healthy nutrition and physical activity guidelines: latent class analysis of 6266 university students in Egypt, Libya, and Palestine. Nutrients. 2017 Jul 11;9(7):738. doi: 10.3390/nu9070738. Go to original source... Go to PubMed...
    29. Costa E, Dias CM, Oliveira L, Gonçalves L. Clustering of behavioural risk factors in the Portuguese population: data from National Health Interview Survey. J Behav Health. 2014;3(4):205-11. Go to original source...
    30. Hudd S, Dumlao J, Erdmann-Sager D, Murray D, Phan E, Soukas N, et al. Stress at college: effects on health habits, health status and self-esteem. Coll Stude J. 2000;34(2):217-27.
    31. Cheung DK, Tam DKY, Tsang MH, Zhang DLW, Lit DSW. Depression, anxiety and stress in different subgroups of first-year university students from 4-year cohort data. J Affect Disord. 2020 Sep 1;274:305-14. Go to original source... Go to PubMed...
    32. Sebena R, Orosova O, Mikolajczyk RT, van Dijk JP. Selected sociodemographic factors and related differences in patterns of alcohol use among university students in Slovakia. BMC Public Health. 2011 Nov 9;11:849. doi: 10.1186/1471-2458-11-849. Go to original source... Go to PubMed...
    33. Goodman E, Huang B, Schafer-Kalkhoff T, Adler NE. Perceived socioeconomic status: a new type of identity that influences adolescents' self-rated health. J Adolesc Health. 2007;41(5):479-87. Go to original source... Go to PubMed...
    34. Dougall I, Vasiljevic M, Kutlaca M, Weick M. Socioeconomic inequalities in mental health and wellbeing among UK students during the COVID-19 pandemic: clarifying underlying mechanisms. PLoS One. 2023 Nov 1;18(11):e0292842. doi: 10.1371/journal.pone.0292842. Go to original source... Go to PubMed...
    35. Lakey B, Sheldon C. Social support theory and measurement. In: Sheldon C, Underwood LG, Gottlieb BH, editors. Social support measurement and intervention: a guide for health and social scientists. New York: Oxford University Press; 2000. p. 29-52. Go to original source...
    36. Baqutayan S. Stress and social support. Indian J Psychol Med. 2011;33(1):29-34. Go to original source... Go to PubMed...
    37. Litwic-Kaminska K, Błachnio A, Kapsa I, Brzeziński Ł, Kopowski J, Stojković M, et al. Resilience, positivity and social support as perceived stress predictors among university students. Int J Environ Res Public Health. 2023 Oct 7;20(19):6892. doi: 10.3390/ijerph20196892. Go to original source... Go to PubMed...
    38. Szkody E, McKinney C. Appraisal and social support as moderators between stress and physical and psychological quality of life. Stress Health. 2020 Dec;36(5):586-95. Go to original source... Go to PubMed...
    39. El Ansari W, Sebena R, El-Ansari K, Suominen S. Clusters of lifestyle behavioral risk factors and their associations with depressive symptoms and stress: evidence from students at a university in Finland. BMC Public Health. 2024 Apr 22;24(1):1103. doi: 10.1186/s12889-024-18421-0. Go to original source... Go to PubMed...
    40. El Ansari W, Suominen S, El-Ansari K, Šebeňa R. Are behavioural risk factors clusters associated with self-reported health complaints? University students in Finland. Cent Eur J Public Health. 2023 Dec;31(4):248-55. Go to original source... Go to PubMed...
    41. Scott AJ, Knott M. A cluster analysis method for grouping means in the analysis of variance. Biometrics. 1974;30(3):507-12. Go to original source...
    42. De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, Oppert JM, Rostami C, Brug J, et al. School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev. 2011 Mar;12(3):205-16. Go to original source... Go to PubMed...
    43. Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. 2000 May;55(5):469-80. Go to original source...
    44. Aceijas C, Waldhäusl S, Lambert N, Cassar S, Bello-Corassa R. Determinants of health-related lifestyles among university students. Perspect Public Health. 2017 Jul;137(4):227-36. Go to original source... Go to PubMed...
    45. Sebena R, El Ansari W, Stock C, Orosova O, Mikolajczyk RT. Are perceived stress, depressive symptoms and religiosity associated with alcohol consumption? A survey of freshmen university students across five European countries. Subst Abuse Treat Prev Policy. 2012 May 28;7:21. doi: 10.1186/1747-597X-7-21. Go to original source... Go to PubMed...
    46. Sarason IG, Levine HM, Basham RB, Sarason BR. Assessing social support: the social support questionnaire. J Pers Soc Psychol. 1983;44(1):127-30. Go to original source...
    47. Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905-7. Go to original source...
    48. El Ansari W, Salam A. Prevalence and predictors of smoking, quit attempts and total smoking ban at the University of Turku, Finland. Cent Eur J Public Health. 2021;29(1):45-55. Go to original source... Go to PubMed...
    49. El Ansari W, Vallentin-Holbech L, Stock C. Predictors of illicit drug/s use among university students in Northern Ireland, Wales and England. Glob J Health Sci. 2014 Dec 16;7(4):18-29. Go to original source... Go to PubMed...
    50. El Ansari W, Stock C, Mikolajczyk RT. Relationships between food consumption and living arrangements among university students in four European countries - a cross-sectional study. Nutr J. 2012;11:28. doi: 10.1186/1475-2891-11-28. Go to original source... Go to PubMed...
    51. World Health Organization. Food-based dietary guidelines in the WHO European Region. Copenhagen: WHO Regional Office for Europe; ‎2003.
    52. Knäuper B, Rabiau M, Cohen O, Patriciu N. Compensatory health beliefs: scale development and psychometric properties. Psychol Health. 2004 Nov;19(5):607-24. Go to original source...
    53. Cabé N, Lanièpce A, Pitel AL. Physical activity: a promising adjunctive treatment for severe alcohol use disorder. Addict Behav. 2021 Feb;113:106667. doi: 10.1016/j.addbeh.2020.106667. Go to original source... Go to PubMed...
    54. Hallett J, McManus A, Maycock B, Smith J, Howat P. Excessive drinking-an inescapable part of university life? A focus group study of Australian undergraduates. Open J Prev Med. 2014;4(7):616-29. Go to original source...
    55. Wicki M, Kuntsche E, Gmel G. Drinking at European universities? A review of students' alcohol use. Addict Behav 2010;35(11):913-24. Go to original source... Go to PubMed...
    56. Schulenberg J, Wadsworth KN, O'Malley PM, Bachman JG, Johnston LD. Adolescent risk factors for binge drinking during the transition to young adulthood: variable- and pattern-centered approaches to change. Dev Psychol. 1996;32(4):659-74. Go to original source...
    57. Williams A, Clark D. Alcohol consumption in university students: the role of reasons for drinking, coping strategies, expectancies, and personality traits. Addict Behav. 1998 May-Jun;23(3):371-8. Go to original source... Go to PubMed...
    58. Douglass MA, Colley ML, Tyskiewicz AJ, Prince MA. Drinking to cope and college grade point average. Drug Habit Soc Policy. 2023;24(4):342-50. Go to original source...
    59. Terlecki MA, Ecker AH, Buckner JD. College drinking problems and social anxiety: the importance of drinking context. Psychol Addict Behav. 2014;28(2):545-52. Go to original source... Go to PubMed...
    60. National Union of Students; Release. Taking the hit: student drug use and how institutions respond [Internet]. London: NUS; 2018 [cited 2024 May 22]. Available from: https://www.release.org.uk/publications/taking-hit-student-drug-use-and-how-institutions-respond.
    61. Schulenberg JE, Johnston LD, O'Malley PM, Bachman JG, Miech RA, Patrick ME. Monitoring the future national survey results on drug use, 1975-2019: volume II, college students and adults ages 19-60. Ann Arbor: Institute for Social Research; 2020. Go to original source...
    62. Parikka S, Holm N, Ikonen J, Koskela T, Kilpeläinen H, Lundqvist A. [KOTT 2021 baseline survey results 2021] [Internet]. Helsinki: Finnish Institute for Health and Welfare; 2021 [cited 2024 May 22]. Available from: https://www.terveytemme.fi/kott/. Finnish.
    63. Jones JM, Cigarette smoking rates down sharply among U.S. young adults.[Internet]. Washington D.C.: Gallup; 2022 [cited 2024 May 23]. Available from: https://news.gallup.com/poll/405884/cigarette-smoking-rates-down-sharply-among-young-adults.aspx.
    64. Hersh J, Curry JF, Becker SJ. The influence of comorbid depression and conduct disorder on MET/CBT treatment outcome for adolescent substance use disorders. Int J Cogn Ther. 2013;6(4):325-41. Go to original source... Go to PubMed...
    65. Scalco MD, Colder CR, Hawk LW, Read JP, Wieczorek WF, Lengua LJ. Internalizing and externalizing problem behavior and early adolescent substance use: a test of a latent variable interaction and conditional indirect effects. Psychol Addict Behav. 2014 Sep;28(3):828-40. Go to original source... Go to PubMed...
    66. Wu LT, Zhu H, Ghitza UE. Multicomorbidity of chronic diseases and substance use disorders and their association with hospitalization: Results from electronic health records data. Drug Alcohol Depend. 2018;192:316-23. Go to original source... Go to PubMed...
    67. National Institute on Drug Abuse. Co-occurring disorders and health conditions [Internet]. Bethesda: NIDA; 2024 [cited 2024 Apr 20]. Available from: https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions#health-conditions.
    68. Bugbee BA, Beck KH, Fryer CS, Arria AM. Substance use, academic performance, and academic engagement among high school seniors. J Sch Health. 2019 Feb;89(2):145-56. Go to original source... Go to PubMed...
    69. Copeland M, Fisher JC, Moody J, Feinberg ME. Different kinds of lonely: dimensions of isolation and substance use in adolescence. J Youth Adolesc. 2018 Aug;47(8):1755-70. Go to original source... Go to PubMed...
    70. Kim B, Jee S, Lee J, An S, Lee SM. Relationships between social support and student burnout: a meta-analytic approach. Stress Health. 2018 Feb;34(1):127-34. Go to original source... Go to PubMed...
    71. Szkody E, Stearns M, Stanhope L, McKinney C. Stress-buffering role of social support during COVID-19. Fam Process. 2021 Sep;60(3):1002-15. Go to original source... Go to PubMed...
    72. Frazier P, Gabriel A, Merians A, Lust K. Understanding stress as an impediment to academic performance. J Am Coll Health. 2019 Aug-Sep;67(6):562-70. Go to original source... Go to PubMed...
    73. Muirhead V, Locker D. Canadian dental students' perceptions of stress and social support. Eur J Dent Educ. 2008 Aug;12(3):144-8. Go to original source... Go to PubMed...
    74. Xin Z. Perceived social support and college student engagement: moderating effects of a grateful disposition on the satisfaction of basic psychological needs as a mediator. BMC Psychol. 2022 Dec 11;10(1):298. doi: 10.1186/s40359-022-01015-z. Go to original source... Go to PubMed...
    75. Backović DV, Živojinovic JI, Maksimović J, Maksimović M. Gender differences in academic stress and burnout among medical students in final years of education. Psychiatria Danubina. 2012;24(2):75-181.
    76. Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021 Aug 12;16(8):e0255634. doi: 10.1371/journal.pone.0255634. Go to original source... Go to PubMed...
    77. Dougall I, Vasiljevic M, Kutlaca M, Weick M. Socioeconomic inequalities in mental health and wellbeing among UK students during the COVID-19 pandemic: clarifying underlying mechanisms. PLoS One. 2023 Nov 1;18(11):e0292842. doi: 10.1371/journal.pone.0292842. Go to original source... Go to PubMed...

    Return to the content