The effects of sports nutrition diet, physical activity and sleep quality on health behavior in primary and secondary school students: A cross-sectional study based on the COM-B model

Reasonable diet, appropriate amount of exercise and sufficient sleep are the basic elements of human health, which are also the key elements to ensure the healthy growth of primary and secondary school students. This cross-sectional study, grounded in the COM-B behavior change framework, investigates the complex interplay between sports nutrition diet, physical activity, sleep quality, and health behavior among Chinese adolescents. Against the backdrop of global concerns over declining youth physical health and insufficient activity, this research addresses a critical gap by examining how nutritional practices influence health outcomes both directly and indirectly through behavioral and physiological pathways. Using a stratified multi-stage cluster sampling, 1270 valid questionnaires were collected from primary and secondary school students in China's rapidly developing Yangtze River Delta and Beijing-Tianjin-Hebei regions. The results confirm that sports nutrition diet, physical activity, and sleep quality collectively have a significant positive influence on adolescent health behavior (OR = 0.586, P < 0.05). The effect comprises a substantial direct impact (OR = 0.320, P < 0.05) and a significant indirect effect (OR = 0.266, P < 0.05) mediated through sleep quality, physical activity, and a chained pathway involving both (OR = 0.009, P < 0.05). Dietary behaviors exhibited the strongest direct effect. These findings underscore the synergistic relationship between nutrition, exercise, and sleep, advancing the COM-B model by delineating specific mediation pathways. The study provides a robust empirical basis for designing integrated, multi-component school-based health interventions targeting these interconnected pillars to effectively promote and sustain healthy lifestyles among adolescents.