In the recent years, there has been much discussion revolving around the diminishing share of young people among the population of Russia, increasing level of morbidity, poorer overall physical development of the people, disrupted morphofunctional capabilities of the body [1–6], while the background for all these issues is the society's urgent need for active, healthy, creative individuals who are ready to realize their potential in all spheres of life, with a focus on professional activities [7].

At the ages 18 through 25, the body becomes biologically mature and morphofunctional indicators reach their definitive values, which makes young people interesting research subjects; this is when they define their independent lifestyle that largely shapes the state of health of a human being [8, 9]. Apart from the working young people, this age group includes students that make up the majority of the country's young population [10].

This review aims to analyze and summurize the results of a number of scientific investigations of the relationship between behavioral risk factors and health indicators as registered in the working and studying youth;

Materials and methods

This is an analytical review of research investigating the relationship between behavioral risk factors and health status indicators in working and studying youth aged 18 to 25 years; the papers reviewed were published from 2013 to 2023. We searched for the papers in eLibrary, East View, PubMed, Google Scholar, Cyberleninka.

Top behavioral risk factors for health of young people

According to the World Health Organization (WHO), some of the key promoters of morbidity and mortality are addictive behavior, poor nutrition and insufficient physical activity [11]. The negative consequences of alcohol abuse, both at the level of individuals and population as a whole, make this habit a national security concern. Alcohol is a proven factor triggering development of diseases of various organs and systems of the body [12]. There is a review [13] that summarizes Russian medical and sociological studies of the causes and consequences of alcohol consumption. The researchers note that young people are particularly susceptible to the grave effects of alcohol.

A noteworthy indicator is the rather high alcohol- and drug-associated death rate among young people: in the last decade, it has climbed up to 4.3 persons per 100000 population [14]. Among people aged 20 through 39, alcohol is a factor in 13.5% of deaths [15]. Because of the social and economic crises, unexpected unemployment, deteriorating living conditions and quality of life, more young people began to consume alcohol regularly, although previously they never had the habit [13, 16].

According to another study, working population of Russia, young people included, saw no direct link between the frequency of alcohol consumption and their health status, although strong alcoholic beverages promote heart disease (RR = 1.426; 95% CI: 1.190–1.709), hypertension (RR = 1.378; 95% CI: 1.236-1.536) and liver disease (RR = 1.245; 95% CI: 1.008-1.538) [17]. In the cohort of higher school students, the number of those suffering from chronic diseases increased together with the frequency of consumption of alcohol. The researchers have established the average correlation between self-assessed health condition and alcohol abuse (r = 0.43), and the relative risk (RR) of poor health was 1.1 [16].

The problem of tobacco smoking remains very acute among the youth [18]. Smoking is an effective contributor to the development and progression of diseases and disorders of the cardiovascular system, such as atherosclerosis, vascular endothelial damage, reduced oxygen supply to the tissues and higher activity of the sympathetic nervous system. Moreover, smoking boosts platelet aggregation and decreases the level of high-density lipoproteins. According to a research paper [19], young people that smoke run a 3.33 times higher risk of myocardial infarction than their non-smoking counterparts, and the elderly have this risk only 2.44 times higher.

An analysis of how the working population perceives risks allowed identifying the difference between objective and subjective knowledge. A paper [20] highlights that while the participants of the respective study declared high danger of smoking for human health, subjectively they underestimated the significance of the risk in question. In terms of importance for health, workers involved in industrial production rated smoking fifth most important factor, while those in other professions — third. Responding to the question of link between smoking and health of the respondents, the respondents assessed the danger of smoking ambiguously: 22% of smokers surveyed considered smoking to be very dangerous (5 points out of 5), 45% of respondents from this group gave it 4 points, and 23% of the smoking respondents found it difficult to characterize the health hazard potential of smoking. The possible reason behind this ambiguity is the fact that only 46% of smokers felt the harmful effects of smoking on their health. The researchers revealed no significant age- or gender-related differences in the assessment of smoking. According to the published papers [17], smoking increased the likelihood of chronic respiratory diseases in the working population (RR = 1.39; 95% CI: 1.104–1.749). Another study discovered that smokers felt sick more often than non-smokers, and their sicknesses lasted longer [15]. Higher school students 17 through 20 years old already exhibited negative consequences of smoking: weakness (61%), sleep disorders (58%), headaches (43%), frequent sore throats (39%), acute respiratory diseases (33%), cough with sputum (31%), shortness of breath (15%), disorders of the digestive system (8%). There are results of medical examinations confirming complaints of the students [16].

Scientific circles in Russia and abroad have long been discussing the mass indulgence of young people in smoking hookahs, vaporizers and electronic cigarettes. The results of the analysis of study reports authored by Russian and foreign researchers lead to an unambiguous conclusion about the destructive effect of electronic cigarettes: the damage they do is comparable to smoking a classic cigarette and aggravated by inhalation of the electronic cigarette's smoking liquid [21, 22]. In the survey, young people mentioned stress, social unsettledness and lack of knowledge of effective ways of relaxation as the main causes of their addictive behavior [16].

Systematic violation of the daily routine, as confirmed by numerous studies in this area, puts an additional burden on the health of young people. Violation of the "sleep-wakefulness" rhythm brings desynchronosis, which breaks the harmony between the body's biological rhythms and those of the environment; this broken bond brings disorders of the immune [23], endocrine [24], cardiovascular, respiratory, digestive and other functional systems [25]. One of the first Russian studies [26] investigating the relationship between the sleep-wakefulness rhythm patterns (regularity, fragmentation) and cardiometabolic indicators revealed that a stable sleep pattern, high daytime and low nighttime activity are associated with a better condition of the circulatory system. The "social jetlag" (SJL) term suggested by T.Roenneberg et al. reflects the difference between the average nighttime sleep on workdays and weekends. Currently, SJL is known to be associated with several behavioral outcomes: less healthy eating patterns [27], poorer performance in high school and university [28], higher physical and verbal aggression exhibited by students [29]. Prolonged sleep restriction affects behavioral responses to food choices, especially hedonic food stimuli [24].

Workers, young people included, involved in industrial production and other professions did not consider sleep disturbance to be a highly significant factor of health deterioration [20]. In higher school students, there was established a strong link between a full night's sleep and how well they felt (r = 0.86); against the background of a broken daily routine, the RR of them self-assessing their health status as low was 1.8 [16]. A lifestyle peculiarity for young students was the longer gadget screen time [6, 30]. It was shown that the actual daily routine of students actively using information and communication technologies changed: they tended to sleep less at night, were less physically activity and consumed their meals within shorter periods of time [2]. Changed structure of the daily routine and use of various electronic devices for both educational and leisure purposes had a negative effect on the health and well-being of young people [31, 32]. Studies have also revealed the relative risks of hearing loss in young people that use headphones at the maximum volume every day (RR = 3.20; 95% CI: 2.40–5.21) [33] and the risk of development of eye and adnexa diseases as a result of non-compliance with the hygienic rules developed for users of electronic devices (RR = 1.21; 95% CI: 1.1–1.6) [6].

Throughout life, nutrition is a necessity for a human being, and it has specific features in every age period. The health of society depends on how well nutrition of a person and population in general fits the physiological needs [11, 34, 35].

Researchers often discuss the issues of faulty catering, imbalanced food sets and biological value of diets of children, adolescents, youth and adults in various regions of Russia [5, 17]. They conclude that the current pattern of nutrition practiced by the young people generally discourages adoption of a healthy food consumption culture and, on the contrary, causes development of alimentary-dependent diseases [4, 36]. Along with unfavorable environmental conditions, in some cases harmful working conditions exacerbate the deficiency of essential nutrients against the background of any disease, stress, antibiotics intake and widely followed dieting plans [37].

Unsound diets, faulty in nutritional value and food intake time alike, is a common problem for the working population [38]. Often, lacking time and awareness of the basics of healthy nutrition, working people did not focus on what kind of food and how much they ate, preferring deeply processed foodstuff [39]. In a study that assessed behavioral health risks faced by the working population of Russia, regression analysis showed that 55% of the examined "unhealthy eaters" were prone to developing chronic diseases, with the probability of endocrine system diseases being 1.6 times higher for them than for the control group [17]. An interesting fact [20]: only 19% of the respondents employed in the industrial sector regarded unhealthy nutrition as one of the top five strongest factors affecting health of an individual. Those working outside industrial production facilities expressed similar opinion in 33% of cases (p = 0.010). Among industrial workers who stated the absolute need to maintain a healthy diet, only 23% included nutrition in the system of important risk factors, while among the respondents from other walks of life this number was 34% (p = 0.020). According to the leading Russian scientists, malnutrition accounts for 30% to 50% of the causes of various chronic non-communicable diseases [5, 35].

It has been proven that a full value breakfast helps feel full throughout the day, reduces cravings for high-calorie foods and mitigates the risk of obesity [40]. Foreign researchers have shown that a snack-free diet that includes a mandatory breakfast and implies consumption of most of the daily calories in the morning and around noon [41], as well as a varied diet [42], reduce chronic inflammation, improve circadian regulation, stress tolerance and the state of the intestinal microbiome. People who ate a large amount of whole grains and vegetables had a healthy gut microflora [43]. However, the habits of young people indicated early formation of incorrect nutritional behavioral patterns: frequent dismissal of breakfast, high consumption of sugar, salt, fats, refined food and insufficient consumption of dishes from cereals, vegetables, fruits, fish and oils [2, 18, 44, 45]. The assessment of the effect poor nutrition has on the health of higher school students revealed a close relationship thereof with chronic diseases (r = 0.85), with the RR of health disorders at 4.9 [16].

It has been established that consumption of food high in added sugar and frequent snacking provoke growth of the level of cholesterol, triglycerides and low-density lipoproteins in blood, increases body mass index and reduces insulin sensitivity [46]. The situation is further aggravated by the high popularity of products with low biological value: consumed in excess, they contribute significantly to the development of metabolic syndrome [47]. A study [18] has shown that Russian higher school students, compared to their English peers, snack on hamburgers and hot dogs 3 times less often, do not prefer potato chips between meals (chosen by 2.9% of the former compared to 47.4% of the latter) and drink sweet carbonated drinks only occasionally (0.5% vs. 41.4% of students, respectively). The matter of significance of insufficient physical activity

is an urgent one for the healthcare systems all over the world, not only in Russia [48]. Physical activity is a broader concept than just sports. It includes any movement of the body powered by the skeletal muscles that results in expenditure of energy at the level exceeding that of state of rest. Sports activities make up only 5 through 15% of the daily energy expenditure generally in the population. Regardless of gender and age, regular physical activity has a positive effect: alleviates arterial hypertension, reduces severity of hyperglycemia and dyslipidemia, and helps control excessive body weight [11].

According to the research reports, workers that moved less self-assessed their health worse than those who purposefully practiced physical activity (RR = 1.208; 95% CI: 1.138–1.281), and the the former were 1.3 time more likely to have chronic lung diseases, hypertension and high blood pressure than the latter [17]. Another study has established that students whose level of physical activity was low felt worse in general, with the link between the level and the self-perceived health status being significant (r = 0.75), and the RR of health disorders for such students was at 1.5 [16].

Health risk analysis methodology

The health risk analysis methodology includes three interrelated elements: assessment of the risk, communication of the respective information/message and risk management.

In this sequence, communication is an element in its own right because there are two levels of risk interpretation: 1) expert knowledge, formed on the basis of scientific research on risk assessment, and 2) ordinary knowledge, formed by laypersons based on the subjective experience and data obtained directly through everyday communication and online. The perception of behavioral risk factors had a multilevel structure: firstly, risks to the health of the respondents themselves and health in general were perceived differently; secondly, awareness of the risk and self-preserving behavior were not interconnected directly; thirdly, respondents more often found important threats that they had less control of, e.g., workers involved in industrial production attached more importance to unfavorable environmental factors and not lifestyle factors [20]. Therefore, to match the "observed" and "perceived" risks and consequently improve control over them, it would help to correctly assess the risks and communicate results of the studies to laypersons in a timely manner. Development of understanding of the need for positive changes in the lifestyle and creation of the respective motivation in relation to a person's health are considered to be of great importance.

Researchers [1–6, 8, 35, 49] believe that preventive measures planting the healthy lifestyle among young people will lead to positive changes in their physical health and quality of life, including psychological well-being, social relationships and interaction with the environment.

CONCLUSION

The review showed that behavioral risk factors, to varying degrees, had a negative effect on both how young people self-assess their health and its objective condition confirmed clinically. The research papers pay much attention to evaluation of health of young students, prevalence of individual behavioral risk factors and their relationship with the development of non-communicable diseases. The data on the health status and lifestyle of the working youth more often cover either the entire working-age population or those over 25 years of age. There are very few publications that assess the risk factors peculiar to the lifestyle of young working people starting their professional careers. In order to develop health-preserving programs for deployment in work and higher school environments, it is necessary to investigate the modifiable risk factors in different age and social groups of young people.