Research Article Lifestyle and Violence among Dating in University Students

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Introduction
In 1998, the World Health Organization (WHO) defned lifestyle as the number of habitual reactions of a person and the patterns of behaviour developed during socialization processes [1].Habits such as regular exercise, adequate nutrition and sleep, good management and enjoyment of leisure, healthy social relationships, and mental health care are keys to leading a healthy lifestyle.It should also be noted that there are factors such as smoking, drug and alcohol consumption, negative infuences in the social environment, and little education received about sexual relations or emotional intelligence that negatively afect an individual's lifestyle and can prompt violent behaviour.All these causes are variable since they are subject to social and personal factors that can positively or negatively infuence the life of each human being [2].
A healthy lifestyle has a positive impact on the physical and mental health of individuals.Some habits are very important to lead a healthy lifestyle.Nevertheless, there are factors that may negatively infuence an individual's social environment; a clear example is the lack of education on sexual relations and emotional intelligence [3].
Adolescence is a stage in which physical, psychological, and social changes occur [4].It is important to establish equal relationships between men and women at this stage since there is a high risk of developing sexist or traditional attitudes that may follow a stereotyped gender model [5].
Young people start to show their feelings, attitudes, and sexual interests at this stage of their life.However, considering the problematic behaviours of some teenagers, their parents and teachers are the ones who must educate them in the afective-sexual sphere.Tis will allow young people to lead with future problems and avoid violent relationships [6].
Several studies have analysed situations of gender violence at universities, in which participants claimed to have been involved in situations of both physical and psychological or sexual violence [7][8][9][10][11][12][13].
Diferent studies show that women of university age are more likely to sufer physical or sexual violence, while men tend to sufer mostly surveillance and cyberbullying by their partners [7,9,10,13,14].
In recent years, studies related to gender violence in universities [15][16][17][18] have shown that lessons in the classroom about how to avoid situations of intimate partner violence are necessary, but have they related lifestyles related to the consumption of psychoactive substances and/or alcohol with gender violence?[19,20].Some universities [16,[21][22][23] have proposed programs or other options to combat gender-based violence.So, their purpose is to reduce cases of violence in college-age couples by promoting awareness and knowledge.
It should be noted that in Spain, an innovative project was promoted in 2018 with a duration of three academic courses, it is called "PRO-Move healthy relationships: prevention of gender violence in adolescents."Te aim of this programme is to provide young people with information about gender violence, sexist attitudes, myths of romantic love, and healthy relationships through collaborative learning and active participation based on practical and dynamic exercises, play activities, and discussion groups [23].
Tese questions raise the following ones: what elements of university students' lifestyles are related to the violence they exercise or receive?And, what are the diferences depending on the sex of the person?
Te objective of the present study is to analyse the relationship between the lifestyle of students at diferent university degrees in relation to the violence they exert or receive, taking into account the training acquired in this feld, disaggregating the analysis by sex.
Te manuscript hypothesis states that a healthy lifestyle is a protective factor against violence, both exercised and received, in university students' relationships.Te variables that we will deal with not only include the study of risk factors but also the study of protective factors.

Methods
A cross-sectional descriptive study was conducted through a self-administered online survey provided to a university for distribution among its students on all campuses.
2.1.Participants.Te students who participated did so completely voluntarily and anonymously and gave their consent to use the data.Te inclusion criteria were as follows: students enrolled in a degree program of the Universidad Rey Juan Carlos and having had a couple.Tere were no exclusion criteria.

Instruments.
Data collection was performed using the Survey Monkey platform.Te statistical programs SPSS 21.0 and STATA 14 were used.
Te sent survey included the following variables: sex, age, grade and year of university enrolment, regular physical activity (150-300 minutes per week of moderate physical activity), daily use of tobacco, weekly consumption of alcohol, consumption of some other type of drug (cannabis or derivatives, cocaine, heroin, amphetamines, and ecstasy), sexual relations without the use of a condom, daily hours of sleep (average number of hours per week), work (working hours of less than or more than 20 hours per week), number of sexual relations with a partner (understood as the average number of hours per week), number of relationships with a partner (understanding a relationship as that agreed between two people that includes companionship in social and leisure activities together with expression of feelings through speech and body contact), duration of the current relationship in months, training in gender violence (if it has not been received, or if it has been received either in preuniversity or university training), and the Multidimensional Scale of Dating Violence (MSDV), validated by García-Carpintero et al. [7]; was applied.
Tis scale consists of 32 items and is composed of two subscales that measure the violence exerted and sufered.It is easy to apply and interpret and allows the detection and verifcation of attitudes of violence and abuse towards the partner.Te reliability of the scale is demonstrated by Cronbach's α values above 0.9 points, both in the subscale of violence exerted and in the subscale of violence sufered.When analysing the construct validity and discriminated validity of the scale, the scale shows that in the subscale of violence exerted, the items are grouped into six factors (physical and sexual abuse, harassment, surveillance, cyberbullying, domination, and denigration) and ofer information on three dimensions of violence (physical, control, and psycho-emotional).In the subscale of violence sufered, fve factors are addressed (physical abuse, harassment, surveillance, domination, and denigration) on the same dimensions of violence mentioned above.

Access to the Sample.
Students were invited to participate via institutional e-mail and given access to the questionnaire.In addition, the coordinators of the diferent degree programs of the university were asked to post this information through the collaborative space for each program in the virtual classrooms.
Te calculation of the sample size was performed considering the total number of students enrolled in the entire university: 46.450, with a margin of error of 5% and a confdence level of 95%.Adjusting for a 10% loss, a total of 420 responses were proposed.Once the favourable report of the ethics committee was received, the survey was distributed from April to August, 2021.Two reminders were made during the time of data collection: in May and June.

Data Analysis.
In the statistical analysis, the qualitative variables were described by absolute and relative frequencies, and the quantitative data were described by means and standard deviations (SDs) or medians and interquartile ranges (p 25-p 75), according to the distribution of the data.Te nonparametric Mann-Whitney U test was used to analyse the diferences in the total scores of violence exerted and sufered and by components according to sex and lifestyle.As a measure of efect size, the statistic is presented as U of the Mann-Whitney test, which measures the probability that, given two random observations of each group, the value of the quantitative variable will be higher in one group than in another [24].

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Ethical Aspects. Te Research Ethics Committee of the
University of Rey Juan Carlos issued a favourable opinion on 17th December, 2020, for the conduct of this project with internal registration number 0909202016920.

Results
Data from 382 complete surveys were analysed.A total of 72.3% of the sample (n � 276) were women.Te average age of the students was 21.9 years (SD 2.8) and 38% had worked at a job.Te students who participated the most, according to the feld of study, were health sciences majors with 32% (n � 119), followed by social and legal sciences with 25.3% (n � 94), science with 22.3% (n � 83), engineering and architecture with 15.6% (n � 58) and art and humanities with 4.8% (n � 18).Regarding the university year (from frst to fourth year), students in 4th grade participated to a greater extent than 1st-year students (31.5% versus 19%).
Regarding lifestyle habits (see Table 1), we found that 62.1% performed weekly physical activity, with a higher frequency among men (59.4% compared to 69.2%, p � 0.079).Of these participants, 21.4% reported having varied the frequency of physical activity since they acquired a partner.Participants reported sleeping a median of 7 hours (7)(8).A total of 12.9% smoked daily and 34.7% drank alcohol weekly, with a higher frequency in men (31.5% versus 43.3%, p � 0.032).A total of 7.1% consumed some other type of drug, with a higher frequency also in men (4.7% versus 13.6%, p < 0.003).Sixteen percent report having varied the frequency of consumption since they acquired a partner.A total of 47.9% reported having sex without a condom, and the number of partners was a median of 2 (1-2, 25) in relationships with a median duration of 26 months (11.5-48).Tirty-six percent of the sample had never received training on gender violence, with no differences between men and women.
Regarding the results of the MSDV shown in Table 2, it is worth highlighting the control dimension, which contributes the highest score to the total score and covers the aspects of surveillance and cyberbullying, is more relevant in terms of violence and surveillance.
Statistically signifcant diferences were observed in the overall score of violence perpetrated (see Figure 1), with 3 points more than the median in the group of women (p < 0.001) and in the overall score of violence sufered (p < 0.001), with 4 points more than the median in the group of women; both had a similar efect size, approximately 0.63, which indicates that the probability that a woman scores more than a man is 63%.Regarding the components, statistically signifcant diferences are shown in the factors of harassment, surveillance, and domination in the violence exerted, which have a probability of approximately 60%.Women scored higher as perpetrators of harassment and surveillance and as victims of physical and sexual abuse, vigilance, domination, and denigration.
When analysing the association between lifestyles and the subscale of violence perpetrated (Table 3), we found that those who vary their frequency of regular physical activity have a statistically signifcant higher overall score (p � 0.002), as do those who vary their consumption of tobacco, alcohol, or other drugs (p � 0.008), those who do not use a condom (p < 0.001), and those who work (p � 0.022).
In addition, those who consume alcohol or other drugs have higher scores for harassment (p � 0.034) and cyberbullying (p � 0.009).Tose who have had more than three partners also had a higher score for harassment (p � 0.034).In all cases, the efect size is approximately 60%.Tere are no diferences with respect to whether the individuals received training in gender violence.

Discussion
When analysing the lifestyle of university students in relation to the violence they receive, it is worth highlighting elements such as cyberbullying and surveillance as the most relevant of the violence sufered by them.Women obtain a signifcantly higher overall score than men when completing the Multidimensional Dating Violence Scale (EMVN), both in violence exercised and sufered.Te factors of harassment, surveillance, and domination are the most exercised by women towards men.Physical and sexual abuse, surveillance, domination, and denigration are the factors most exercised by men towards women.When we are referring to lifestyle and training in violence, one-third of these young people have no knowledge about it.Tis increases the probability of falling into it.When talking about the subdimension of domination and submission, the patterns learned in childhood were traditionally accepted, although today they are considered violent and negative.
Taking into account the previous information, Alp Yilmaz and S ¸ener Taplak [25] used the Dating Violence Attitude Scale (DVAS) in a study that obtained the highest scores for physical and emotional violence, and in the economic and sexual violence dimensions and were most frequently detected in dating relationships among university students.Tese relationships were characterized as challenging and stressful, with partners complaining predominantly of physical and psychological abuse.In this sense, this research and ours are very similar, although the economic sphere is not considered.In relation to physical violence, it continues to stand out and is the one subcomponent is most widely studied among the dating relationships of university students according to research conducted by a university in Spain and another in South Korea led by Arenas-Carbellido et al. [26].Similarly, in the study of Medina-Maldonado et al. [27]; the most common violent relationships among adolescents are psychological, mild, and severe.
When disaggregating the data regarding lifestyle, we fnd that one-third of youth drink alcohol on a weekly basis, and a lower percentage consume some other type of drug, with the percentage being higher in men than in women.Tis factor increases the possibilities of exercising violence in the subdimensions of harassment and cyberbullying, resulting in negative pressures on both lifestyle and healthy relationships.In our study, factors such as the variation of weekly physical activity (greater in men than in women), Perspectives in Psychiatric Care tobacco consumption, or an active work situation negatively infuence the MSDV, increasing the percentages of both perpetrated and sufered violence.Tis is also refected in other similar studies, such as that of Sánchez Villegas et al. [28] and Rubio-Laborda et al. [29], in which it is shown how the consumption of alcohol, tobacco, and other drugs can lead to violence.In this way, in our study, violent patterns related to unhealthy lifestyles can be identifed, considering all their factors and how they can afect young people.Similarly, the work carried out by Barroso-Corroto et al. [30] found a high prevalence of dating violence among students in this case, nursing students, with signifcant factors such as coexistence, alcohol consumption, socioeconomic status, and history of confict.

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Likewise, the lack of training is intrinsically related to the percentage of young people surveyed who have sex without a condom.Tis is a question that implies a greater possibility of catching or transmitting a sexually transmitted infection, showing hidden violence behind it.Aspects such as domination or physical and sexual abuse can cause men to refuse to wear a condom, with the victim being denied participation in the decision or negotiation.Studies by Anicama Queneche [31], Boira et al. [32], and Casique [33] show that women who are victims of intimate partner violence are forced to have sex without a condom or do not have a say in the fnal decision of whether to use a condom or not, which is intrinsically related to our data.Llano-Suárez et al. [34] used the Dating Violence Questionnaire-R (DVQ-R) aimed at university students in Spain and found that most of them were passive, submissive, coerced, and detached; they sufered humiliation and experienced sexual and physical violence by a dominant and aggressive partner.Te studies of Anitha and Lewis [15], Díaz Martínez [16], Diéguez Méndez et al. [35], López Francés and Tapía [17], and Sharoni and Klocke [18] like ours established that training and education regarding dating violence is essential for both men and women.Without this type of training, the essential pillars that cement a healthy relationship begin to crumble because individuals do not know how healthy relationships should be and why some behaviours are classifed as violent and should not be normalized.According to Dalouh and Soriano [6], this training should be basic so that youth learn how to build healthy relationships from adolescence until they are adults, become aware of how certain factors infuence lifestyles and learn to discern whether a relationship is healthy or not.Studies are fundamental for planning prevention and intervention programs against dating violence in university environments, according to Alp Yilmaz and S ¸ener Taplak [25].Llano-Suárez et al. [34] also stated that universities should adopt policies about gender equality and raise awareness about dating violence.
In relation to lifestyle, the study carried out by Aceijas et al. [36] highlighted that 60% of university students did not do enough physical exercise.Tese data are similar to the one obtained in this study.Similarly, Aceijas et al. [36] and Griban et al. [37] afrmed that alcohol consumption is elevated throughout students.Tey both claim that physical activity, active leisure, rest, and couple relationships (attending to both the love aspect, as well as the sexual aspect of the couple relationship) are the most important factors for preserving health.Perspectives in Psychiatric Care Perspectives in Psychiatric Care 4.1.Limitations.Tis study is limited because it was based on the students of a single Spanish university and because the response rate in some degree programs does not keep a proportion with the total number of students.Te higher response rate is in health sciences students (54.3%); this may change the overall picture of the lifestyle of all students.Tus, results may not be generalized to other contexts or communities.
Future studies should be extended to include multiple universities in diferent parts of Spain to obtain a more accurate analysis, in addition to modifying the data collection of some variables (alcohol consumption: healthy and unhealthy (alcohol abuse and addiction) and use of condoms during sexual contacts (not using condoms at all, inconsistent use of condoms, and one-time episodes of not using condoms during sexual contacts).

Conclusions
Te students in this study point out the main factors of violence surveillance and cyberbullying when it is exercised and surveillance when it is sufered.Likewise, women exert violence against men, with harassment and surveillance predominating.Physical and sexual abuse, surveillance, domination, and denigration in the case of being the man who assaults.
Tere is a relationship between the lifestyle of young university students and the violence they exert or receive, with drug use (tobacco, alcohol, and others) being the main association for their exercise in greater number and intensity, along with the avoidance of violence and condoms during sexual intercourse.

Implications for Nursing Practice.
It is essential to develop training programs that educate young people about equality and healthy lifestyles to create healthy relationships and prevent violence in them.Terefore, universities should provide policies for gender equality and raise awareness about dating violence.

Table 1 :
Living habits of the sample were disaggregated by sex.perform regular physical activity (150-300 minutes per week) every week?your pattern of consumption of tobacco, alcohol, or other drugs changed since you acquired a partner?How many relationships have you had?A couple relationship is defned as a relationship agreed between two people that includes companionship in social and leisure activities along with the expression of feelings through speech and body contact Median.you currently have a partner, what is the duration of the relationship in months?

Table 3 :RICM:
Scores in the subdimension of violence perpetrated according to lifestyle habits.Do you perform regular physical activity (150-300 minutes per week) every week?Has your pattern of consumption of tobacco, alcohol, or other drugs changed since you acquired a partner?Have you ever had sex without using a condom?Median; IQR: p 25-p 75; efect size: probability that the "Yes" response score is higher.

Table 2 :
Total scores and dimensions of the MSDV were disaggregated by sex.Median; IQR.p 25 -p 75.Efect size: probability that a woman's score is higher than that of a man. M: