The increasing prevalence of modifiable risk factors associated with irrational lifestyles, influenced by biological, social, and technogenic environmental factors, negatively affects the health of adults and children, representing a significant cause of chronic noncommunicable diseases (NCDs). One significant factor in the development of NCDs is irrational nutrition with excessive food consumption, fast carbohydrates, saturated and trans fats, and excess salt in the daily diet — in 49% of the population, including 53% among men and 46% among women — with insufficient consumption of fruits and vegetables in 41% (50% among men, 36% among women); insufficient fish and seafood consumption in 37% (34% among men, 39% among women). Low physical activity and insufficient exercise are identified in 40% of the population, including 37% among men and 42% among women [1]. Among children, significant indicators of lifestyle and dietary characteristics include: excessive meal frequency and portion sizes in 26%, late dinners 5-7 times per week in 17%, insufficient (less than 8 hours) nighttime sleep in 27%; infrequent visits to sports facilities — only 14.2% of children visit the pool 3-5 times weekly, only 12% of children engage in sports for more than 3 hours daily, prolonged daily computer use (more than 3 hours) — 34% [2].

On the other hand, the prevalence of bad habits continues in the Russian population: regular smoking in 24%, including 39% among men and 14% among women. Excessive alcohol consumption among men is 6% and 2% among women. All this leads to the spread of socially significant diseases: overweight and obesity are registered in 30%, including 27% among men and 31% among women. In 33% of the country's population, there is an epidemic increase in elevated blood pressure, including 40% among men and 28% among women [1]. In the pediatric population, the number of diseases previously characteristic only of adults is increasing: overweight and obesity (18% and 8%, respectively), arterial hypertension up to 10% in the population aged 0-17 years, fatty liver, metabolic syndrome, type 2 diabetes mellitus [3, 4, 5].

Mortality from major NCDs in Russia accounts for 68.5% of total population mortality. The contribution of population-based and personalized preventive measures accounts for at least half of the success in reducing NCD morbidity and mortality. It has been proven that modern effective prevention programs yield returns on tangible and intangible investments within 5-10 years [1].

In our opinion, residents of clinical specialties at medical universities should become advocates of HLS principles both for their own health and for their future patients across various age groups and spheres of activity. The young specialist's conviction in the effectiveness of adhering to work, rest, sleep, and nutrition regimens for the prevention and correction of disorders in NCDs will enable their active implementation in patient care. To be convinced of the effectiveness of HLS principles, it is necessary to incorporate these principles into one's own daily life. However, the increasing volume of responsibilities, as well as the numerous difficulties students (residents) face during university studies, directly affects their healthy lifestyle. Available sources indicate that during this period, university students encounter numerous changes, the number of which increases with each academic year. During this time, their habits deteriorate: they rarely maintain optimal nutrition, lead sedentary lifestyles, and experience high levels of stress, which particularly often leads to academic burnout [6].

To assess the prevalence of irrational lifestyle risk factors and the level of adherence to healthy lifestyle principles among residents at Yaroslavl State Medical University.

A survey and interviews were conducted with clinical residents across various medical specialties in their first and second years of study at Yaroslavl State Medical University during 2023-2024. For this work, we used the questionnaire "Structure of a Healthy Lifestyle for Students," developed by the Center for Methodological Support of Educational Work and Study of Student Orientations Toward Healthy Lifestyles at the Republican Institute of Professional Education (Belarus, 2016). The questionnaire contained sections on communication characteristics, physical and motor activity, attitudes toward bad habits and sexual life, hardening practices, vaccination, and dietary characteristics. The sample consisted of 82 individuals, including 72 females (88%) and 10 males (12%) aged 24 to 35 years. The specialty structure of the sample: 29% of residents studying in the specialty "Pediatrics" and 71%, collectively, in the specialties of neonatology, internal medicine, ophthalmology, otorhinolaryngology, surgery, and neurosurgery. Quantitative assessment of the level of adherence to HLS principles was conducted based on our developed assessment system considering clinical recommendations [7]. Statistical data processing was performed using STATISTICA version 10 (2011) and MedCalc Statistical Software version 15.8 (2015).

The socio-communicative relationships of residents were assessed based on six questions, which included: interest in life, leisure activities, the influence of positive emotions on health strengthening, satisfaction with the socio-psychological climate at the educational institution, vocation in the profession, and relationships with teachers. The importance of positive answers to these questions characterizes the student's interest in the profession and the desire to master it non-formally. For all six questions, more than half of the resident respondents (67.0-82.6%) gave positive affirmative answers, characterizing their positive attitude toward life, professional mastery, and university studies. Figure 1 presents residents' responses to key questions on socio-communicative relationships.

Fig. 1. Socio-communicative functions of medical university residents, %

Note: * — p <0.05 — significant difference from the number of respondents with negative answers

Physical activity is a universal factor in preventing most noncommunicable diseases and an integral part of a healthy lifestyle [8]. Ninety-six percent of residents are convinced that physical education and sports affect health status. However, only 19% of residents engage in physical education regularly. According to some literature data, one reason for insufficient physical activity should be considered inadequate conditions for organizing sports grounds, bicycle paths, and places for exercise equipment in residential areas — that is, accessibility to sports and physical education [9]. The survey showed that only 18% of respondents believe that conditions for sports at Yaroslavl State Medical University are sufficient, 26% consider these conditions insufficient, and 56% of residents believe there are no conditions or are unaware of their existence, despite the university having an excellent sports complex.

Strengthening the body or increasing its resistance is perceived as exposure to a natural stimulus (e.g., cold) that leads to increased resistance to stress and diseases such as acute cardiovascular diseases. Hardening, practiced by people in good general health, in a regular, gradual, and adaptive manner, beneficially affects the cardiovascular system and other organs; moreover, it increases resistance to infectious and noninfectious factors and optimizes mental and physical performance [10]. Unfortunately, among surveyed residents, attitudes toward hardening are even more passive than toward physical activity. Only 26% resort to periodic hardening of their bodies. However, from pathogenetic perspectives, all young physicians know that hardening is a powerful factor in increasing the body's adaptive capabilities for a long and active life.

The results of assessing medical residents' attitudes toward bad habits should be viewed from the perspective of their professional understanding of their adverse effects on the human body. The increase in alcohol and psychoactive substance use among students is a global public health problem. This is associated with the risk of developing health disorders from their use among students themselves, as well as public health problems affecting their families and society. Furthermore, students face an increased risk of poor academic performance, extended study periods, or university dropout [11]. Among surveyed residents, 100% know about the dangers of psychoactive substance use, but only 53.66% are fully aware of the problem, 41.46% are aware to some extent, and 5% have never been interested in these issues. This distribution indicates that an insufficient number of young physicians possess professional and in-depth information on the problem of drug addiction, meaning they will not be able to identify it at an early stage and provide prevention in their professional activities. According to our study, a quarter of respondents smoke regularly or occasionally. The high percentage of nonsmoking residents is associated with the high percentage of female pediatric residents in the sample.

Adolescent childbirth is not only a risk factor for adverse pregnancy outcomes but also negatively affects the future well-being of both mother and infant [12]. A physician must understand the risks of early pregnancy. Most often, early pregnancy is unplanned and associated with many risks for both the expectant mother and the child. According to the questionnaire, about 60% consider early pregnancy a personal matter or are not concerned about it. This attitude does not correspond to understanding the biological and social risks of early pregnancy.

Important for disseminating HLS principles among the population is how regularly the physician implements them in daily life (Fig. 2). The most frequent factors residents implement in daily life are giving up bad habits and annual vaccination. At the same time, only 34.8% maintain a daily routine, and 26.0% practice periodic hardening. Among surveyed residents, 19.0% regularly engage in sports, and 26.10% perform morning exercises.

Fig. 2. Healthy lifestyle factors present in the daily routine of medical residents, %

It is important to determine not only the prevalence of basic behavioral patterns among young medical residents but also to assess the individual level of adherence to HLS principles based on consideration of several factors [7]. Quantitative assessment of adherence is viewed as a research method in which adherence is assessed quantitatively on a nominal scale and expressed as a percentage of the maximum possible calculated value. Adherence to lifestyle modification refers to the measured ability of an individual to follow recommendations regarding diet and physical activity regimens, to limit or abandon undesirable habits for an indefinitely long time [7]. For quantitative assessment, we selected six questions from the questionnaire and assigned points according to the degree of adherence to HLS principles. Full adherence was scored as 2 points, partial as 1, and absence of adherence as 0. A total of 15 responses to 6 questions were selected for the overall assessment. The arithmetic sum of all points was calculated, with a maximum value of 14 (Table 1).

Table 1. Quantitative assessment of adherence to healthy lifestyle principles (Maskova G.S., Ganuzin V.M., Korobkina E.A., 2023)

No.QuestionsResponse scoring1.How actively do you engage in physical education and sports?Regularly — 2 points, occasionally — 1 point, do not engage — 0 points2.Do you practice hardening your body?Regularly — 2 points, occasionally — 1 point, do not practice — 0 points3.Do you smoke?No — 2 points, rarely — 1 point, yes — 0 points4.Do you consume alcoholic beverages?No — 2 points, yes — 0 points5.Which of the HLS factors listed in the questionnaire are present in your lifestyle?*Presence — 0.5 points, absence — 0 points6.What measures do you take to maintain your health?Implementation — 0.5 points, absence — 0 points

Note: * — The following factors are considered: giving up bad habits, high physical activity, balanced nutrition, daily outdoor exposure, regular balanced nutrition, regular exercise, aerobics/fitness, diet adherence, vaccination (against influenza, etc.), adherence to daily routine, daily morning exercises.

The criteria for quantitative assessment of treatment adherence were based on the above recommendations of the All-Russian Society of Internists, according to which a value above 75% corresponds to a high level of adherence, 50-75% to a medium level, and less than 50% to a low level, which corresponded to values in points in our study of 12-14, 7-11, and less than 7 points, respectively (Table 2).

Table 2. Criteria for quantitative assessment of adherence to healthy lifestyle principles (Maskova G.S., Ganuzin V.M., Korobkina E.A., 2023)

Adherence LevelPercentage of Maximum PossibleExpression in Points in the Presented WorkHigh76-100%12-14 pointsMedium50-75%7-11 pointsLow0-49%less than 7 points

According to the study results, the majority of residents (56%) had a medium level of adherence (Fig. 3). The group of residents with a low level of adherence, comprising 29% of the sample, raises concerns and questions. In our view, there are several reasons for low adherence to HLS principles. First, the lack of sufficient free time due to heavy academic workload; second, most residents combine study with work in medical institutions. Additionally, failure to follow HLS principles may be associated with insufficient conviction in the importance of preventive measures for maintaining health.

Fig. 3. Distribution of resident respondents by level of adherence to healthy lifestyle principles, %

Low adherence (29.4%) can also be associated with the fact that 41.46% of respondents do not consider information on HLS relevant for their future medical practice and for themselves. However, the information sources residents use to enhance their knowledge about HLS characterize their professional approach to acquiring knowledge on the issue: 52% rely on specialized courses and 39% on journal articles in their specialty.

The importance of adhering to basic healthy lifestyle principles is recognized by the majority of medical residents, comprising 96%. However, young people's awareness of this issue is insufficient for specialists who have graduated from a medical university. The number of residents regularly implementing basic HLS principles is only 31%. Approximately the same percentage (29.4%) have a low level of adherence to HLS principles. The obtained results dictate the need for active implementation of existing HLS programs into daily life and the training of medical residents, using available developments from leading scientists on this issue.