# An unhealthy lifestyle and incident activity-limiting neck and back problems in university students: the Sustainable UNiversity Life (SUN) study

## TL;DR

University students with unhealthy lifestyles are more likely to develop neck and back pain that limits their daily activities.

## Contribution

This study identifies a link between an unhealthy lifestyle and new-onset activity-limiting neck/back problems in university students.

## Key findings

- Students with three or more unhealthy behaviors had a 35% higher risk of developing activity-limiting neck/back problems.
- Unhealthy lifestyle behaviors included physical inactivity, high sitting time, and risky substance use.
- The study followed participants for one year to assess the development of musculoskeletal issues.

## Abstract

Neck and back pain are common musculoskeletal conditions in university students and associated with unhealthy lifestyle behaviors such as physical inactivity, unhealthy dietary habits, smoking and risky alcohol use. Cohort studies have investigated the effect of a healthy lifestyle including several lifestyle behaviors on the risk and prognosis for neck and back pain. Studies of an association between an unhealthy lifestyle and musculoskeletal conditions in university students are lacking. This study aimed to assess the association between an unhealthy lifestyle and incident activity-limiting neck/back problems (ALNBP) in university students.

Participants enrolled in the Sustainable UNiversity Life (SUN) study who did not report baseline ALNBP in the past three months were included (n = 3492). The baseline web-survey assessed unhealthy lifestyle behaviors (physical inactivity, high sitting time, meal skipping and risky use of alcohol, tobacco, and illicit drugs) with valid instruments and single-item questions. Participants with ≥ 3 unhealthy lifestyle behaviors were categorized as exposed to an unhealthy lifestyle. Responses to web-based follow-up surveys every third month until first reporting ALNBP or to the end of the one-year follow-up were used. The outcome ALNBP was defined as reporting limitations in daily activities due to a neck, low back and/or midback problem the past three months, assessed with a modified version of the Nordic Musculoskeletal Questionnaire. Crude and adjusted Cox regression models were built to assess the association between an unhealthy lifestyle and incident ALNBP, reported as a hazard rate ratio (HRR) with a 95% confidence interval (CI).

Sixty percent of the participants were women, and the mean age was 24.5 ± 6.0 years. A total of 574 participants (16%) were exposed to an unhealthy lifestyle at baseline. Having an unhealthy lifestyle generated an adjusted HRR of 1.35 (95% CI 1.12, 1.63) for incident ALNBP, compared to not having an unhealthy lifestyle.

An unhealthy lifestyle, categorized as ≥ 3 unhealthy lifestyle behaviors, is associated with incident ALNBP in university students.

The online version contains supplementary material available at 10.1186/s12889-025-25478-y.