Adherence to the 24-hour movement guidelines and its correlates among Spanish university students: UNILIFE-M study

Adherence to the 24-hour movement guidelines and its correlates among Spanish university students: UNILIFE-M study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adherence to the 24-hour movement guidelines and its correlates among Spanish university students: UNILIFE-M study José Francisco López-Gil, Samuel Manzano-Carrasco, José Adrián Montenegro-Espinosa, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7521428/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: University students are at a critical stage for establishing healthy lifestyle habits, yet little is known about their adherence to integrated 24-hour movement guidelines that include physical activity, sedentary behavior, and sleep. The aim of this study was to examine the prevalence of adherence to the 24-hour movement guidelines and identify sociodemographic, anthropometric and mental or physical health conditions correlates among Spanish university students. Methods: This cross-sectional analysis included first-year students from Universidad Loyola Andalucía (Spain) participating in the UNIversity student’s LIFEstyle behaviors and Mental health (UNILIFE-M) study. Data were self-reported using validated questionnaires. Adherence was defined according to international recommendations for moderate-to-vigorous physical activity (≥150 min/week), screen time (≤3 h/day), and sleep duration (7–9 hour/night). Descriptive statistics, Venn diagrams, and robust logistic regression models were used to assess prevalence and correlates. Results: A total of 671 students (median age = 18 years; interquartile range [IQR] 18-19); 50.1% females) were included. Only 25.9% of students met all three 24-hour movement guidelines, while 7.0% met none. Adherence was significantly higher among males (odds ratio [OR] = 1.77; 95% confidence interval [95% CI] 1.21 to 2.59), and lower in older students (≥18 years old; OR = 0.58; 95% CI 0.37 to 0.90), those enrolled in non-health sciences programs (OR = 0.68; 95% CI 0.47 to 1.00); and those with mental health problems (OR = 0.27; 95% CI 0.09 to 0.65). Conclusions: Adherence to 24-hour movement guidelines is low among Spanish university students, particularly among females, older students, non-health sciences academic disciplines and mental health problems. Personalized interventions targeting high-risk groups are warranted to promote healthy lifestyle behaviors in this population. young adults behavior patterns university education public health promotion lifestyle risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The university stage typically coincides with emerging adulthood (approximately 18–25 years), a developmental period marked by significant biological, psychological, and social transformations 1 , 2 . Neurodevelopmentally, the prefrontal cortex, responsible for impulse control, planning, and emotion regulation, continues to mature during this stage, increasing vulnerability to external stressors and influencing decision-making processes 1 , 3 . Simultaneously, emerging adults face increased autonomy, academic demands, identity exploration, and changes in social networks, all of which can disrupt established routines and challenge self-regulation 4 . Maintaining a healthy lifestyle is particularly important during this life stage, as it contributes to both immediate psychological well-being and long-term disease prevention 5 . Evidence suggests that health-related behaviors formed during emerging adulthood tend to track into later adulthood 6 , 7 , underscoring the importance of promoting sustainable habits early on. However, the transition to university life is often associated with deteriorating health routines 8 , 9 , highlighting the need for targeted efforts to foster healthier lifestyle patterns during this vulnerable period. Traditionally, physical activity, sedentary behavior, and sleep have been studied as independent lifestyle components. However, examining these behaviors separately overlooks how they interact in daily time use. For this reason, research has adopted the concept of “24-hour movement behaviors” 10 . This encompasses all movement-related activities, ranging from physical activity and sleep duration to sedentary behavior (including screen time), on a 24-hour continuum 11 . According to these guidelines, a healthy routine for adults aged 18–64 years should include at least 150 minutes per week of moderate- to vigorous-intensity physical activity (MVPA), ensure 7–9 hours of restful sleep, and limit time spent in sedentary behaviors to no more than 8 hours per day, also restricting leisure screen time to no more than 3 hours 12 . On this basis, studies have established an association between adherence to the 24-hour movement guidelines and various health indicators across the lifespan 13 – 16 . A meta-analysis encompassing 387,437 participants aged 3 to 18 years across 23 countries revealed that a mere 2.68% adhered to the 24-hour movement guidelines 17 . Compliance with these guidelines was notably lower among adolescents, particularly females. In Europe, only 9.62% of the sample adhered to all three recommendations, while 13.48% did not adhere to any, underscoring the low compliance with these guidelines. However, there is a paucity of literature concerning adults, particularly university students. A multi-center cross-sectional survey conducted by Pengpid and Peltzer 18 involving 3223 university students from Indonesia, Malaysia, Myanmar, Thailand, and Vietnam reported that 11.7% met all three 24-hour movement guidelines. Another study by Zhang et al. 19 conducted among 1,793 Chinese university students, found that 27.8% adhered to the 24-hour movement guidelines, but there is a scarcity of studies in European students. Regarding correlates of adherence to the 24-hour movement guidelines, the systematic review by Rollo et al. 13 reported that, among adults, adherence was more likely among individuals who were younger, male, had a lower body mass index (BMI), higher educational attainment, were employed, had higher income, and did not have children. In more specific samples, Pengpid and Peltzer 18 found greater adherence among males (15.6%), individuals aged 22–30 years (17.0%), and those from lower-income countries such as Indonesia, Myanmar, and Vietnam (14.6%). Similarly, Bu et al. 20 observed that male university students, and those whose mothers held a master’s degree or above, were more likely to meet all three movement behavior recommendations, which was associated with lower anxiety symptoms compared with meeting fewer guidelines. Although studies on adherence to 24-hour movement guidelines have been conducted in countries such as Indonesia, Malaysia, Myanmar, Thailand, Vietnam, China, and Canada, none have specifically targeted the Spanish university population. This group, due to its transitional developmental stage and the physical, psychological, and social changes it undergoes, is particularly vulnerable to symptoms of depression and anxiety, which tend to increase throughout the university years. Moreover, cultural norms, academic pressures, and lifestyle patterns in Spain may influence movement behaviors and mental health outcomes differently compared to other countries, highlighting the need for context-specific research. Therefore, the aim of the present study was two-fold: first, to determine the adherence to the 24-hour movement guidelines in a sample of college students from Spain; second, to identify the correlates associated with that adherence. Methods Population and study design The UNIversity student’s LIFEstyle behaviors and Mental health (UNILIFE-M) 21 is a global prospective cohort study aimed at investigating the links between university student’s lifestyle choices and mental health symptoms throughout their academic careers. The study's research framework was previously detailed in the UNILIFE-M study 21 . UNILIFE-M collects self-reported data through an online survey that assesses mental health symptoms such as depression, anxiety, mania, sleep disturbances, substance abuse, inattention-hyperactivity disorder, and obsessive-compulsive thoughts or behaviors, alongside lifestyle factors like diet, physical activity, substance use, stress management, social support, restorative sleep, the environment, and sedentary behavior over a period of 3.5 years. Participants from 84 universities in 27 countries were assessed upon entry in the 2023 and/or 2024 academic year and will be followed up at 1, 2, and 3.5-year intervals. In this study, data was collected from Universidad Loyola Andalucia during the 2024 academic year, involving 923 participants, of whom 671 completed all the questionnaires. Participants who did not meet the inclusion criteria (130), those who left the questionnaire entirely blank (114), and those with one or more unanswered questions (8) were excluded. The study's inclusion criteria required participants to be between 18 and 35 years old and to be enrolled as first-year students, specifically in their first semester, during the 2024 academic year. Students from various faculties and disciplines were eligible to participate. Those not meeting these criteria were excluded from the analysis. A team of trained psychologists administered the questionnaires to students during the initial weeks of classes using convenience sampling. Students from different faculties and specializations were recruited through online platforms (such as university websites, virtual classroom messages, and online reminders), mass emails, and visits to classrooms where first-semester courses were held to inform them about the study and seek their participation in completing the questionnaires, all in compliance with relevant data privacy laws and policies. This study was reviewed and approved by the Research Ethics Committee of Universidad Loyola Andalucía (Approval ID: 240605/CE24544). All procedures involving human participants will be conducted in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to their inclusion in the study. Variables The questionnaire used in this study was specifically developed for the UNILIFE-M project. The full protocol is currently under peer review, and a preprint version is already available 21 . An English version of the questionnaire has been uploaded as Supplementary File 1. Lifestyle Twenty-four-hour Movement Behaviors Twenty-four-hour Movement Behaviors were evaluated using the validated Spanish version of the Physical Activity Scale 2.1 (PAS-2.1S) 22 , which measures physical activity across work/school, transportation, and leisure domains. The PAS-2.1S was not originally conceived within the UNILIFE-M protocol. However, in the present study, we included it as an additional instrument in the sample from Universidad Loyola Andalucía. This instrument consists of nine items: six focus on daily activities such as sleep duration, sedentary time, leisure activities, and commuting, while three assess weekly physical activity at light (LPA), moderate (MPA), and vigorous (VPA) intensity levels. The total moderate-to-vigorous physical activity (MVPA) was determined by adding the minutes of MPA and VPA per week. Meeting the MVPA guidelines was defined as achieving ≥ 150 minutes per week 12 . Sleep duration was considered adequate when participants reported 7–8 hours per night (420–540 minutes/day) 12 . Sedentary behavior was deemed within the recommended limits if participants reported ≤ 640 minutes/day of total sedentary time and ≤ 180 minutes/day of recreational screen time 12 . Participants were categorized based on the number of 24-hour movement guidelines they met, ranging from 0 to 3, and were grouped into four categories: “none of the guidelines”, “one guideline”, “two guidelines”, and “all three guidelines”. Sociodemographic information Self-reported data were collected on age (in years), sex (male/female), sexual orientation (originally including heterosexual, homosexual, bisexual, pansexual, and other), marital status (original categories ranging from single to married, separated, divorced, or widowed), student accommodation (yes/no), employment status (yes/no), race/ethnicity (originally categorized into multiple groups), and university degree (based on academic program enrollment). For analytical purposes, the following dichotomous variables were created: age was grouped as “≤18 years old” or “>18 years old” (based on the sample median); sexual orientation was dichotomized as “LGTBQ+” (including homosexual, bisexual, pansexual, and other identities) or “heterosexual”; marital status was recoded into “single” or “non-single”; student accommodation and employment status were recoded as “yes” or “no”; and ethnic group was categorized as “Caucasian” or “non-Caucasian”. Degree programs were grouped into academic areas and further dichotomized as “health sciences” or “non-health sciences”. Anthropometric information Anthropometric data were self-reports and included weight (kg) and height (cm), from which body mass index (BMI, kg/m²) was calculated. BMI categories followed World Health Organization (WHO) cut-offs: underweight, normal weight, overweight, and obesity 23 . For analysis, BMI was dichotomized into “no overweight/obesity” (underweight or normal weight) or “overweight/obesity” (overweight or obesity). Mental and physical health information Participants were asked whether they had ever been diagnosed with a mental health problem or developmental disorder by a psychiatrist or psychologist. Responses were dichotomized into “yes” or “no” to create a binary variable representing mental health diagnosis status. In addition, participants were asked to report whether they had ever been diagnosed with specific mental disorders (e.g., depression, anxiety, eating disorders) and physical conditions (e.g., asthma, diabetes, epilepsy, coeliac disease). These conditions were grouped into two broad categories: a) mental health disorders: defined as having received a diagnosis of any of the following conditions: depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), eating disorders, or other related mental health diagnoses; b) physical health conditions: defined as having received a diagnosis of any chronic somatic disease, including cardiovascular, respiratory, metabolic, neurological, or gastrointestinal disorders Statistical analyses Descriptive statistics were computed for all study variables. The distribution of continuous variables (e.g., age, BMI, MVPA, sitting time, and sleep duration) was assessed using the Shapiro–Wilk test, density plots, and quantile-quantile (Q–Q) plots. All variables showed non-normal distributions ( p < 0.05) and visual deviation from normality). Therefore, continuous variables are presented as medians with interquartile ranges (IQR), while categorical variables are summarized using frequencies and percentages. To examine the association between sociodemographic characteristics and adherence to all three 24-hour movement guidelines, a robust logistic regression model was fitted. Results are reported as odds ratios (ORs) with 95% confidence intervals (95% CIs). Additionally, Venn diagrams were generated to visually illustrate the overlap between adherence to physical activity, sleep, and screen time recommendations, facilitating the interpretation of behavioral combinations. All analyses were conducted using R (version 4.3.2) and RStudio (version 2023.12.1 + 402), with statistical significance set at p ≤ 0.05. Results Table 1 presents the descriptive characteristics of the participants (N = 671). The age sample consisted of adolescents of ≤ 18 years (n = 472; 70.3%). The distribution by sex was nearly equal, with 336 females (50.1%) and 335 males (49.9%). Most participants identified as heterosexual (n = 614; 91.5%), and the majority were Caucasian (n = 629; 93.7%). A large proportion were single (n = 483; 72.0%). Student accommodation was reported by 140 participants (20.9%), and current employment was reported by 93 participants (13.9%). Regarding the academic program, 264 participants (39.3%) were enrolled in health sciences. Overweight or obesity was recorded in 609 participants (91.0%). Mental health problems were reported by 67 participants (10.0%), and physical health problems were reported by 176 participants (26.2%). Table 1 Descriptive data of the covariates of the study participants. Variable N = 671 Age group ≤ 18 472 (70.3%) > 18 199 (29.7%) Sex Female 336 (50.1%) Male 335 (49.9%) Sexual orientation LGTBQ+ 57 (8.5%) Heterosexual 614 (91.5%) Race/ethnicity Caucasian 629 (93.7%) Non-Caucasian 42 (6.3%) Marital status Non-single 188 (28.0%) Single 483 (72.0%) Student accommodation 140 (20.9%) Work status 93 (13.9%) Degree program Health sciences 264 (39.3%) Non-health sciences 407 (60.7%) Overweight/obesity status No overweight/obesity 60 (9.0%) Overweight/obesity 609 (91.0%) Missing 2 Mental health No mental health problem 604 (90.0%) Mental health problem 67 (10.0%) Physical health No physical health problem 495 (73.8%) Physical health problem 176 (26.2%) Data expressed as median (interquartile range) or number (percentage). BMI, body mass index; CI, confidence interval; LGBTQ+, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and other sexual orientations including pansexual and other non-heterosexual identities. Table 2 shows the descriptive data of the 24-hour movement behaviors among the university students examined. The median time spent in moderate-to-vigorous physical activity (MVPA) was 240.0 minutes per week (IQR 120.0 to 660.0). Median screen time was 180.0 minutes per day (IQR 120.0 to 300.0), and median sleep duration was 420.0 minutes per night (IQR 390.0 to 480.0). In terms of adherence to individual recommendations, 68.5% of participants met the physical activity guideline, 49.9% met the screen time guideline, and 66.6% met the sleep duration guideline. When analyzed jointly, only 25.9% of the sample met all three 24-hour movement guidelines. A total of 40.1% met two guidelines, 27.1% met one, and 7.0% did not meet any of the recommendations (Fig. 1 ). Table 2 Descriptive data of the 24-hour movement behaviors study participants. Variable N = 671 LPA (min) 150.0 (90.0, 300.0) Missing 19 MPA (min) 90.0 (30.0, 240.0) Missing 15 VPA (min) 120.0 (0.0, 360.0) Missing 16 MVPA (min) 240.0 (120.0, 660.0) Missing 18 PA (min) 480.0 (240.0, 907.5) Missing 23 PA guideline Meeting 447 (68.5%) Non-meeting 206 (31.5%) Missing 18 Sitting time (min) 420.0 (300.0, 480.0) Missing 11 Sitting (min) 180.0 (120.0, 300.0) Missing 18 SB guideline Meeting 326 (49.9%) Non-meeting 327 (50.1%) Missing 18 SD (min) 420.0 (390.0, 480.0) Missing 9 SD guideline Meeting 441 (66.6%) Non-meeting 221 (33.4%) Missing 9 Twenty-four-hour guidelines None of the guidelines 45 (7.0%) One guideline 175 (27.1%) Two guidelines 259 (40.1%) All three guidelines 167 (25.9%) Missing 25 Median (interquartile range) or number (percentage). LPA, light physical activity; MPA, moderate physical activity; MVPA, moderate-to-vigorous physical activity; PA, physical activity; SB, sedentary behavior; SD, sleep duration; VPA, vigorous physical activity. Note: The number of information may vary due to lack of data" and not presenting the number for each variable. Table 2 Robust generalized linear model examining the association of several correlates and adherence to the 24-hour movement guidelines among Spanish university students. Predictor OR 95% CI p value Age group ≤ 18 years old Ref. > 18 years old 0.58 0.37 to 0.90 0.016 Sex Female Ref. Male 1.77 1.21 to 2.59 0.003 Sexual orientation LGTBQ+ Ref. Heterosexual 1.41 0.68 to 3.21 0.380 Race/ethnicity Caucasian Ref. Non-Caucasian 0.61 0.24 to 1.38 0.267 Marital status Non-single Ref. Single 0.87 0.58 to 1.31 0.502 Living in a student accommodation Yes Ref. No 1.22 0.77 to 1.97 0.407 Work status Yes Ref. No 1.02 0.59 to 1.82 0.940 Degree program Health sciences Ref. Non-health sciences 0.68 0.47 to 1.00 0.050 Overweight/obesity status No overweight/obesity Ref. Overweight/obesity 1.25 0.65 to 2.59 0.523 Mental health No mental health problem Ref. Mental health problem 0.27 0.09 to 0.65 0.008 Physical health No physical health problem Ref. Physical health problem 0.89 0.58 to 1.36 0.600 CI, confidence interval; LGBTQ+, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and other sexual orientations including pansexual and other non-heterosexual identities; Ref., reference. Figure 2 presents the proportion of participants meeting all three 24-hour movement guidelines, disaggregated by sociodemographic. Overall adherence was higher among participants older than 18 years (19.8%) compared with those aged 18 or younger (16.1%). When stratified by sex, females reported greater adherence (20.7%) than males (11.0%). In addition, students who identified as heterosexual showed a higher adherence (26.8%) than LGTBQ + students (5.9%). Regarding marital status, single students showed slightly higher adherence (26.4%) than their non-single counterparts (23.7%). Finally, in terms of race/ethnicity, a higher proportion of non-Caucasian participants (26.3%) met all three recommendations compared with their Caucasian peers (17.1%). Figure 3 presents the proportion of participants meeting all three 24-hour movement guidelines, disaggregated by academic and labor characteristics. Adherence was slightly higher among students enrolled in health sciences (28.9%) compared with those in non-health sciences (23.8%). When stratified by type of accommodation, participants living in student accommodation showed a higher adherence (23.7%) than those not living in such arrangements (14.5%). Regarding labor status, students who were not working reported greater adherence (26.4%) than those who were working (5.0%). Figure 4 presents the proportion of participants meeting all three 24-hour movement guidelines, disaggregated by physical and psychological characteristics. Compliance was slightly higher among participants who were overweight/obesity (26.3%) compared to those who were no overweight/obesity (20.3%). When stratified by mental health, participants with no mental health problems showed higher compliance (27.8%) than those with mental health problems (7.8%). In terms of physical health, students with no physical health problems showed slightly higher adherence (26.6%) than those with physical health problems (23.8%). According to the GLM (Table 2 ), male students were significantly more likely to meet all three 24-hour movement guidelines compared to female students (OR = 1.77; 95% CI 1.21 to 2.59; p = 0.003). In contrast, students older than 18 years showed significantly lower odds of adherence compared to their younger peers (OR = 0.54; 95% CI 0.35 to 0.84; p = 0.007). Additionally, those enrolled in non-health sciences programs were less likely to meet the guidelines compared to students in health sciences (OR = 0.68; 95% CI 0.47 to 1.00; p = 0.050). Lasty, students with mental health problems were less likely of adhering to all the three guidelines (OR = 0.27; 95% CI 0.09 to 0.65; p = 0.008). Discussion Our findings suggest that only approximately one in four university students met the 24-hour movement guidelines, highlighting a concerningly low adherence in this population. This prevalence is consistent with previous studies conducted in similar settings. For instance, Bu et al. 20 reported a 27.0% adherence rate among 1,846 Chinese university students, while Pengpid and Peltzer 18 found that only 11.7% of students across five countries met all three recommendations. These figures reinforce the idea that integrated movement behaviors remain suboptimal among young adults globally. Conversely, our results contrast sharply with those of Contini et al. 24 , who found that just 0.2% of a sample of Canadian undergraduate students met the 24-hour movement guidelines. However, their study applied a more stringent set of criteria, incorporating additional components such as muscle-strengthening activities and specific sleep and screen-time subdomains, which may partially explain the stark discrepancy. In fact, had our study used similarly detailed and demanding metrics, the proportion of adherent participants might have been even lower, further underscoring the seriousness of the situation. These findings collectively suggest that, regardless of the country or methodological differences, a substantial proportion of university students are failing to meet integrated recommendations for physical activity, sedentary behavior, and sleep, behaviors that are essential for their overall health and well-being 13 – 16 , 25 , 26 . Additionally, our findings indicate that male students are more likely to meet the 24-hour movement guidelines, which aligns with previous research conducted among both adolescent and university populations. Previous literature has consistently shown that males tend to report greater adherence to physical activity, sleep and screen time recommendations 13 , 18 , 20 . Although studies in younger populations have not always found sex-based differences in overall adherence 27 , such disparities appear to become more pronounced during young adulthood, particularly in relation to physical activity levels 28 . Theoretically, this association may be explained by sociocultural and gender-related factors. Males are often exposed to encouragement for engaging in vigorous physical activity from early ages, while females may face stronger social norms and greater barriers, such as lower perceived safety, reduced self-efficacy, or time constraints linked to traditional roles 29 . Moreover, sedentary behaviors patterns tend to differ by sex, with females engaging more frequently in recreational screen time 30 , which may negatively affect adherence to the integrated movement guidelines. Younger students were more likely to meet the 24-hour movement guidelines, a finding consistent with previous research showing age-related declines in movement behaviors 17 , even within university populations 18 . Several studies have highlighted that health-related behaviors tend to deteriorate as students’ progress through their academic careers 31 , 32 . One possible explanation is that younger students are more engaged in a campus culture that promotes social interaction, group exercise, and peer support 33 , which can facilitate healthier routines, including regular physical activity and reduced sedentary time. In contrast, older students may feel less connected to this environment and, in some cases, experience social disengagement or stigma 33 , potentially decreasing their participation in health-promoting group activities. Moreover, they often face additional responsibilities, such as employment, caregiving, or financial stress, that may constrain their time and energy, contributing to more sedentary behavior and irregular sleep patterns 34 . This deterioration may also be exacerbated by increased academic stress and a decline in perceived self-efficacy to maintain healthy routines, as students’ progress through their university careers 35 . However, it is important to note that, despite the age difference, all students are at the same stage in their academic careers (first year). Therefore, older students may have other responsibilities in addition to their academic studies, while younger students still have greater support from their parents. Students enrolled in health sciences programs were more likely to meet the 24-hour movement guidelines compared to their peers from other academic disciplines. However, the literature on this association remains inconclusive and, to some extent, contradictory 36 – 38 . For instance, studies in Spain and Croatia have shown that health sciences students report higher levels of physical activity, better dietary habits, and less screen time compared to those from other fields 36 , 37 . In contrast, a large study across 17 low- and middle-income countries found no significant differences in health risk behaviors between Health and non-health science students 38 . These discrepancies may reflect contextual variations across countries. Although no consistent trend is observed across income groups, with adherence rates of 16.6% in low- and lower-middle–income countries, 11.9% in upper-middle–income countries, and 14.4% in high-income countries (among children under five years) 39 , differences between studies suggest that national context plays a role. Supporting this, a meta-regression analysis showed that overall adherence to the 24-hour movement guidelines was positively associated with a country’s Human Development Index (HDI). This suggests that students in more developed countries, such as Spain, may be more likely to engage in healthier movement behaviors. Similarly, greater ability to access and understand health information has been linked to healthier lifestyles among health sciences students³⁰. Moreover, health sciences programs often include practical components (e.g., physical activity or nutrition workshops) and promote higher health literacy 40 , which may encourage healthier behaviors compared to students in non-health disciplines, who may have less exposure to such content and weaker health beliefs 38 . Importantly, our findings revealed that students with a diagnosed mental health problem were significantly less likely to adhere to all three 24-hour movement guidelines. While most of the existing literature has traditionally focused on the beneficial impact of meeting these guidelines on mental health, showing that greater adherence is associated with lower levels of depression, anxiety, and psychological distress 13 , 25 – 27 , our results also support the plausibility of the reverse relationship. This inverse association may be explained by several interrelated mechanisms. First, common symptoms of mental disorders, such as anhedonia, low motivation, fatigue, and executive dysfunction, can impair an individual’s ability to initiate and sustain health-promoting behaviors, including physical activity 41 and sleep hygiene 42 . Second, sleep disturbances are highly prevalent across a range of mental health conditions 43 , including depression, anxiety, and ADHD, and can directly interfere with both sleep duration and physical recovery 44 . Finally, mental health conditions are associated with higher perceived barriers to physical activity (e.g., fear of injury, low self-efficacy, lack of social support), which further reduce the likelihood of meeting activity guidelines 45 . This study has several limitations that must be acknowledged. First, its cross-sectional design prevents the establishment of causal relationships between adherence to movement behaviors and potential determinants. Second, all data were self-reported, which may introduce recall bias and social desirability bias, particularly in behaviors such as screen use, physical activity, or sleep duration. Furthermore, the lack of objective measurements, such as accelerometry for physical activity and sleep, may limit the accuracy of the estimates. Thirdly, the sample was selected for convenience, requiring caution in extrapolating the findings. Despite these limitations, the findings have important practical implications. Rather than promoting these behaviors in isolation, health professionals and public health authorities should advocate for personalized, integrated 24-hour movement behavior interventions, especially targeting high-risk groups identified in this study, such as female students, older students, non-health sciences students and individuals with mental health problems. Conclusion Our results indicate that only a small proportion of Spanish university students adhered to all three 24-hour movement guidelines, with significant disparities observed by sex, age, academic discipline and mental health problems. These findings highlight the urgent need to address integrated movement behaviors in this population, particularly among high-risk subgroups. Promoting a holistic approach that combines physical activity, limited screen time, and adequate sleep may offer a promising, nonpharmacological strategy to support overall health and well-being in university students. Future interventions should be personalized and context-specific, targeting those least likely to meet the guidelines. Furthermore, should also consider the possible plausibility of an inverse relationship between 24-hour movement guidelines and diagnosed mental health problems. Abbreviations MVPA moderate- to vigorous-intensity physical activity BMI body mass index UNILIFE-M UNIversity student’s LIFEstyle behaviors and Mental health PAS-2.1S Physical Activity Scale 2.1 Spanish version LPA light physical activity MPA moderate physical activity VPA vigorous physical activity WHO World Health Organization ADHD attention-deficit/hyperactivity ASD autism spectrum disorder Q–Q quantile-quantile plots IQR interquartile ranges ORs odds ratios 95% CIs 95% confidence intervals HDI Human Development Index Declarations Ethics approval and consent to participate This study was reviewed and approved by the Research Ethics Committee of Universidad Loyola Andalucía (Approval ID: 240605/CE24544). All procedures involving human participants will be conducted in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to their inclusion in the study. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests Funding This research received no external funding. Author Contribution J.F.L.-G. and J.A.M.-E. contributed to the conceptualization. J.F.L.-G. contributed to the methodology, formal analysis and data curation. J.F.L.-G. contributed to the writing original draft preparation. F.Q.-C., J.A.M.-E., S.C.-M., M.M.-M., A.L.-B., A.J. W., D.T., A. C. D., R.Y.-S., F.B. S. and P. G.-L. contributed to the writing review and editing. All authors have read and agreed to the published version of the manuscript. J.F.L.-G. is the guarantor of this article, and he accepts full responsibility for the work, had access to the data and controlled the decision to publish. Acknowledgement The authors wish to extend their gratitude to Universidad Loyola Andalucía and all the students, teachers, and staff members who participated. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Arnett JJ. Emerging adulthood: A theory of development from the late teens through the twenties. Am Psychol. 2000;55(5):469–80. 10.1037/0003-066X.55.5.469 . Silvers JA. Adolescence as a pivotal period for emotion regulation development. Curr Opin Psychol. 2022;44:258–63. 10.1016/j.copsyc.2021.09.023 . Casey BJ, Jones RM, Hare TA. The Adolescent Brain. Ann N Y Acad Sci. 2008;1124(1):111–26. 10.1196/annals.1440.010 . Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223–8. 10.1016/s2352-4642(18)30022-1 . Patton GC, Sawyer SM, Santelli JS, et al. Our future: a Lancet commission on adolescent health and wellbeing. 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Nutrients. 2024;16(5):620. 10.3390/nu16050620 . Peltzer K, Pengpid S, Yung TKC, Aounallah-Skhiri H, Rehman R. Comparison of health risk behavior, awareness, and health benefit beliefs of health science and non‐health science students: An international study. Nurs Health Sci. 2016;18(2):180–7. 10.1111/nhs.12242 . Chong KH, Suesse T, Cross PL, et al. Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries. JAMA Pediatr. 2024;178(11):1199. 10.1001/jamapediatrics.2024.3330 . Çakır F, Ozturk S, Gerçek H, Eryildiz E, Kartal G, Polat MG. Relationship between E-health literacy and healthy lifestyle behaviours of Turkish health sciences students. Health Educ. 2025;125(3):333–44. 10.1108/he-07-2024-0089 . Schuch F, Vancampfort D, Firth J, et al. Physical activity and sedentary behavior in people with major depressive disorder: A systematic review and meta-analysis. J Affect Disord. 2017;210:139–50. 10.1016/j.jad.2016.10.050 . Baglioni C, Nanovska S, Regen W, et al. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull. 2016;142(9):969–90. 10.1037/bul0000053 . Freeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. Lancet Psychiatry. 2020;7(7):628–37. 10.1016/S2215-0366(20)30136-X . Mougin F, Simon-Rigaud ML, Davenne D, et al. Effects of sleep disturbances on subsequent physical performance. Eur J Appl Physiol. 1991;63(2):77–82. 10.1007/BF00235173 . Soundy A, Freeman P, Stubbs B, Probst M, Vancampfort D. The value of social support to encourage people with schizophrenia to engage in physical activity: an international insight from specialist mental health physiotherapists. J Ment Health. 2014;23(5):256–60. 10.3109/09638237.2014.951481 . Additional Declarations No competing interests reported. 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4","display":"","copyAsset":false,"role":"figure","size":31423,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of participants meeting combinations of the 24-hour movement guidelines for physical activity, screen time, and sleep, stratified by overweight/obesity, mental health status and physical health status.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7521428/v1/f7fd51f5ec846ee7e65733b7.png"},{"id":92261303,"identity":"dda45c48-c37a-4fc6-b38b-6ed6abb50cc2","added_by":"auto","created_at":"2025-09-26 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university stage typically coincides with emerging adulthood (approximately 18\u0026ndash;25 years), a developmental period marked by significant biological, psychological, and social transformations\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Neurodevelopmentally, the prefrontal cortex, responsible for impulse control, planning, and emotion regulation, continues to mature during this stage, increasing vulnerability to external stressors and influencing decision-making processes\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Simultaneously, emerging adults face increased autonomy, academic demands, identity exploration, and changes in social networks, all of which can disrupt established routines and challenge self-regulation\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMaintaining a healthy lifestyle is particularly important during this life stage, as it contributes to both immediate psychological well-being and long-term disease prevention\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Evidence suggests that health-related behaviors formed during emerging adulthood tend to track into later adulthood\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, underscoring the importance of promoting sustainable habits early on. However, the transition to university life is often associated with deteriorating health routines\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, highlighting the need for targeted efforts to foster healthier lifestyle patterns during this vulnerable period.\u003c/p\u003e\u003cp\u003eTraditionally, physical activity, sedentary behavior, and sleep have been studied as independent lifestyle components. However, examining these behaviors separately overlooks how they interact in daily time use. For this reason, research has adopted the concept of \u0026ldquo;24-hour movement behaviors\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. This encompasses all movement-related activities, ranging from physical activity and sleep duration to sedentary behavior (including screen time), on a 24-hour continuum\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. According to these guidelines, a healthy routine for adults aged 18\u0026ndash;64 years should include at least 150 minutes per week of moderate- to vigorous-intensity physical activity (MVPA), ensure 7\u0026ndash;9 hours of restful sleep, and limit time spent in sedentary behaviors to no more than 8 hours per day, also restricting leisure screen time to no more than 3 hours\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. On this basis, studies have established an association between adherence to the 24-hour movement guidelines and various health indicators across the lifespan\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eA meta-analysis encompassing 387,437 participants aged 3 to 18 years across 23 countries revealed that a mere 2.68% adhered to the 24-hour movement guidelines \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Compliance with these guidelines was notably lower among adolescents, particularly females. In Europe, only 9.62% of the sample adhered to all three recommendations, while 13.48% did not adhere to any, underscoring the low compliance with these guidelines. However, there is a paucity of literature concerning adults, particularly university students. A multi-center cross-sectional survey conducted by Pengpid and Peltzer\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e involving 3223 university students from Indonesia, Malaysia, Myanmar, Thailand, and Vietnam reported that 11.7% met all three 24-hour movement guidelines. Another study by Zhang et al.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e conducted among 1,793 Chinese university students, found that 27.8% adhered to the 24-hour movement guidelines, but there is a scarcity of studies in European students.\u003c/p\u003e\u003cp\u003eRegarding correlates of adherence to the 24-hour movement guidelines, the systematic review by Rollo et al.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e reported that, among adults, adherence was more likely among individuals who were younger, male, had a lower body mass index (BMI), higher educational attainment, were employed, had higher income, and did not have children. In more specific samples, Pengpid and Peltzer\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e found greater adherence among males (15.6%), individuals aged 22\u0026ndash;30 years (17.0%), and those from lower-income countries such as Indonesia, Myanmar, and Vietnam (14.6%). Similarly, Bu et al.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e observed that male university students, and those whose mothers held a master\u0026rsquo;s degree or above, were more likely to meet all three movement behavior recommendations, which was associated with lower anxiety symptoms compared with meeting fewer guidelines.\u003c/p\u003e\u003cp\u003e Although studies on adherence to 24-hour movement guidelines have been conducted in countries such as Indonesia, Malaysia, Myanmar, Thailand, Vietnam, China, and Canada, none have specifically targeted the Spanish university population. This group, due to its transitional developmental stage and the physical, psychological, and social changes it undergoes, is particularly vulnerable to symptoms of depression and anxiety, which tend to increase throughout the university years. Moreover, cultural norms, academic pressures, and lifestyle patterns in Spain may influence movement behaviors and mental health outcomes differently compared to other countries, highlighting the need for context-specific research. Therefore, the aim of the present study was two-fold: first, to determine the adherence to the 24-hour movement guidelines in a sample of college students from Spain; second, to identify the correlates associated with that adherence.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePopulation and study design\u003c/h2\u003e\u003cp\u003eThe UNIversity student\u0026rsquo;s LIFEstyle behaviors and Mental health (UNILIFE-M)\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e is a global prospective cohort study aimed at investigating the links between university student\u0026rsquo;s lifestyle choices and mental health symptoms throughout their academic careers. The study's research framework was previously detailed in the UNILIFE-M study\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. UNILIFE-M collects self-reported data through an online survey that assesses mental health symptoms such as depression, anxiety, mania, sleep disturbances, substance abuse, inattention-hyperactivity disorder, and obsessive-compulsive thoughts or behaviors, alongside lifestyle factors like diet, physical activity, substance use, stress management, social support, restorative sleep, the environment, and sedentary behavior over a period of 3.5 years. Participants from 84 universities in 27 countries were assessed upon entry in the 2023 and/or 2024 academic year and will be followed up at 1, 2, and 3.5-year intervals.\u003c/p\u003e\u003cp\u003eIn this study, data was collected from \u003cem\u003eUniversidad Loyola Andalucia\u003c/em\u003e during the 2024 academic year, involving 923 participants, of whom 671 completed all the questionnaires. Participants who did not meet the inclusion criteria (130), those who left the questionnaire entirely blank (114), and those with one or more unanswered questions (8) were excluded. The study's inclusion criteria required participants to be between 18 and 35 years old and to be enrolled as first-year students, specifically in their first semester, during the 2024 academic year. Students from various faculties and disciplines were eligible to participate. Those not meeting these criteria were excluded from the analysis. A team of trained psychologists administered the questionnaires to students during the initial weeks of classes using convenience sampling. Students from different faculties and specializations were recruited through online platforms (such as university websites, virtual classroom messages, and online reminders), mass emails, and visits to classrooms where first-semester courses were held to inform them about the study and seek their participation in completing the questionnaires, all in compliance with relevant data privacy laws and policies.\u003c/p\u003e\u003cp\u003eThis study was reviewed and approved by the Research Ethics Committee of \u003cem\u003eUniversidad Loyola Andaluc\u0026iacute;a\u003c/em\u003e (Approval ID: 240605/CE24544). All procedures involving human participants will be conducted in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe questionnaire used in this study was specifically developed for the UNILIFE-M project. The full protocol is currently under peer review, and a preprint version is already available\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. An English version of the questionnaire has been uploaded as Supplementary File 1.\u003c/p\u003e\n\u003ch3\u003eLifestyle\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eTwenty-four-hour Movement Behaviors\u003c/h2\u003e\u003cp\u003eTwenty-four-hour Movement Behaviors were evaluated using the validated Spanish version of the Physical Activity Scale 2.1 (PAS-2.1S)\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, which measures physical activity across work/school, transportation, and leisure domains. The PAS-2.1S was not originally conceived within the UNILIFE-M protocol. However, in the present study, we included it as an additional instrument in the sample from \u003cem\u003eUniversidad Loyola Andaluc\u0026iacute;a.\u003c/em\u003e This instrument consists of nine items: six focus on daily activities such as sleep duration, sedentary time, leisure activities, and commuting, while three assess weekly physical activity at light (LPA), moderate (MPA), and vigorous (VPA) intensity levels. The total moderate-to-vigorous physical activity (MVPA) was determined by adding the minutes of MPA and VPA per week. Meeting the MVPA guidelines was defined as achieving\u0026thinsp;\u0026ge;\u0026thinsp;150 minutes per week\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Sleep duration was considered adequate when participants reported 7\u0026ndash;8 hours per night (420\u0026ndash;540 minutes/day)\u003csup\u003e12\u003c/sup\u003e. Sedentary behavior was deemed within the recommended limits if participants reported\u0026thinsp;\u0026le;\u0026thinsp;640 minutes/day of total sedentary time and \u0026le;\u0026thinsp;180 minutes/day of recreational screen time\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Participants were categorized based on the number of 24-hour movement guidelines they met, ranging from 0 to 3, and were grouped into four categories: \u0026ldquo;none of the guidelines\u0026rdquo;, \u0026ldquo;one guideline\u0026rdquo;, \u0026ldquo;two guidelines\u0026rdquo;, and \u0026ldquo;all three guidelines\u0026rdquo;.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSociodemographic information\u003c/h3\u003e\n\u003cp\u003eSelf-reported data were collected on age (in years), sex (male/female), sexual orientation (originally including heterosexual, homosexual, bisexual, pansexual, and other), marital status (original categories ranging from single to married, separated, divorced, or widowed), student accommodation (yes/no), employment status (yes/no), race/ethnicity (originally categorized into multiple groups), and university degree (based on academic program enrollment). For analytical purposes, the following dichotomous variables were created: age was grouped as \u0026ldquo;\u0026le;18 years old\u0026rdquo; or \u0026ldquo;\u0026gt;18 years old\u0026rdquo; (based on the sample median); sexual orientation was dichotomized as \u0026ldquo;LGTBQ+\u0026rdquo; (including homosexual, bisexual, pansexual, and other identities) or \u0026ldquo;heterosexual\u0026rdquo;; marital status was recoded into \u0026ldquo;single\u0026rdquo; or \u0026ldquo;non-single\u0026rdquo;; student accommodation and employment status were recoded as \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo;; and ethnic group was categorized as \u0026ldquo;Caucasian\u0026rdquo; or \u0026ldquo;non-Caucasian\u0026rdquo;. Degree programs were grouped into academic areas and further dichotomized as \u0026ldquo;health sciences\u0026rdquo; or \u0026ldquo;non-health sciences\u0026rdquo;.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eAnthropometric information\u003c/h2\u003e\u003cp\u003eAnthropometric data were self-reports and included weight (kg) and height (cm), from which body mass index (BMI, kg/m\u0026sup2;) was calculated. BMI categories followed World Health Organization (WHO) cut-offs: underweight, normal weight, overweight, and obesity\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. For analysis, BMI was dichotomized into \u0026ldquo;no overweight/obesity\u0026rdquo; (underweight or normal weight) or \u0026ldquo;overweight/obesity\u0026rdquo; (overweight or obesity).\u003c/p\u003e\u003cp\u003eMental and physical health information\u003c/p\u003e\u003cp\u003eParticipants were asked whether they had ever been diagnosed with a mental health problem or developmental disorder by a psychiatrist or psychologist. Responses were dichotomized into \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo; to create a binary variable representing mental health diagnosis status. In addition, participants were asked to report whether they had ever been diagnosed with specific mental disorders (e.g., depression, anxiety, eating disorders) and physical conditions (e.g., asthma, diabetes, epilepsy, coeliac disease). These conditions were grouped into two broad categories: a) mental health disorders: defined as having received a diagnosis of any of the following conditions: depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), eating disorders, or other related mental health diagnoses; b) physical health conditions: defined as having received a diagnosis of any chronic somatic disease, including cardiovascular, respiratory, metabolic, neurological, or gastrointestinal disorders\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were computed for all study variables. The distribution of continuous variables (e.g., age, BMI, MVPA, sitting time, and sleep duration) was assessed using the Shapiro\u0026ndash;Wilk test, density plots, and quantile-quantile (Q\u0026ndash;Q) plots. All variables showed non-normal distributions (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and visual deviation from normality). Therefore, continuous variables are presented as medians with interquartile ranges (IQR), while categorical variables are summarized using frequencies and percentages.\u003c/p\u003e\u003cp\u003e To examine the association between sociodemographic characteristics and adherence to all three 24-hour movement guidelines, a robust logistic regression model was fitted. Results are reported as odds ratios (ORs) with 95% confidence intervals (95% CIs). Additionally, Venn diagrams were generated to visually illustrate the overlap between adherence to physical activity, sleep, and screen time recommendations, facilitating the interpretation of behavioral combinations.\u003c/p\u003e\u003cp\u003eAll analyses were conducted using R (version 4.3.2) and RStudio (version 2023.12.1\u0026thinsp;+\u0026thinsp;402), with statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the descriptive characteristics of the participants (N\u0026thinsp;=\u0026thinsp;671). The age sample consisted of adolescents of \u0026le;\u0026thinsp;18 years (n\u0026thinsp;=\u0026thinsp;472; 70.3%). The distribution by sex was nearly equal, with 336 females (50.1%) and 335 males (49.9%). Most participants identified as heterosexual (n\u0026thinsp;=\u0026thinsp;614; 91.5%), and the majority were Caucasian (n\u0026thinsp;=\u0026thinsp;629; 93.7%). A large proportion were single (n\u0026thinsp;=\u0026thinsp;483; 72.0%). Student accommodation was reported by 140 participants (20.9%), and current employment was reported by 93 participants (13.9%). Regarding the academic program, 264 participants (39.3%) were enrolled in health sciences. Overweight or obesity was recorded in 609 participants (91.0%). Mental health problems were reported by 67 participants (10.0%), and physical health problems were reported by 176 participants (26.2%).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive data of the covariates of the study participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;671\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e472 (70.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e199 (29.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e336 (50.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e335 (49.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSexual orientation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLGTBQ+\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57 (8.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e614 (91.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRace/ethnicity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaucasian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e629 (93.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-Caucasian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42 (6.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-single\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e188 (28.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e483 (72.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStudent accommodation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e140 (20.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWork status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e93 (13.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDegree program\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth sciences\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e264 (39.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-health sciences\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e407 (60.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight/obesity status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo overweight/obesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60 (9.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight/obesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e609 (91.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMental health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo mental health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e604 (90.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMental health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67 (10.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhysical health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo physical health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e495 (73.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhysical health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e176 (26.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eData expressed as median (interquartile range) or number (percentage). BMI, body mass index; CI, confidence interval; LGBTQ+, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and other sexual orientations including pansexual and other non-heterosexual identities.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the descriptive data of the 24-hour movement behaviors among the university students examined. The median time spent in moderate-to-vigorous physical activity (MVPA) was 240.0 minutes per week (IQR 120.0 to 660.0). Median screen time was 180.0 minutes per day (IQR 120.0 to 300.0), and median sleep duration was 420.0 minutes per night (IQR 390.0 to 480.0). In terms of adherence to individual recommendations, 68.5% of participants met the physical activity guideline, 49.9% met the screen time guideline, and 66.6% met the sleep duration guideline. When analyzed jointly, only 25.9% of the sample met all three 24-hour movement guidelines. A total of 40.1% met two guidelines, 27.1% met one, and 7.0% did not meet any of the recommendations (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive data of the 24-hour movement behaviors study participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;671\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLPA (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e150.0 (90.0, 300.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMPA (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90.0 (30.0, 240.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVPA (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e120.0 (0.0, 360.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMVPA (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e240.0 (120.0, 660.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePA (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e480.0 (240.0, 907.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePA guideline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMeeting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e447 (68.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-meeting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e206 (31.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSitting time (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e420.0 (300.0, 480.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSitting (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e180.0 (120.0, 300.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSB guideline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMeeting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e326 (49.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-meeting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e327 (50.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSD (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e420.0 (390.0, 480.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSD guideline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMeeting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e441 (66.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-meeting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e221 (33.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwenty-four-hour guidelines\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone of the guidelines\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (7.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOne guideline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e175 (27.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo guidelines\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e259 (40.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAll three guidelines\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e167 (25.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eMedian (interquartile range) or number (percentage). LPA, light physical activity; MPA, moderate physical activity; MVPA, moderate-to-vigorous physical activity; PA, physical activity; SB, sedentary behavior; SD, sleep duration; VPA, vigorous physical activity. Note: The number of information may vary due to lack of data\" and not presenting the number for each variable.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRobust generalized linear model examining the association of several correlates and adherence to the 24-hour movement guidelines among Spanish university students.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePredictor\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026le;\u0026thinsp;18 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;18 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.37 to 0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.21 to 2.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSexual orientation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLGTBQ+\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeterosexual\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.68 to 3.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.380\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRace/ethnicity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaucasian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-Caucasian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.24 to 1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.267\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-single\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.58 to 1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.502\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLiving in a student accommodation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.77 to 1.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.407\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWork status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.59 to 1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.940\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDegree program\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHealth sciences\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-health sciences\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.47 to 1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.050\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight/obesity status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo overweight/obesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOverweight/obesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.65 to 2.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.523\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMental health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo mental health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMental health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.09 to 0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.008\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhysical health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo physical health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePhysical health problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.58 to 1.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.600\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eCI, confidence interval; LGBTQ+, Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and other sexual orientations including pansexual and other non-heterosexual identities; Ref., reference.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the proportion of participants meeting all three 24-hour movement guidelines, disaggregated by sociodemographic. Overall adherence was higher among participants older than 18 years (19.8%) compared with those aged 18 or younger (16.1%). When stratified by sex, females reported greater adherence (20.7%) than males (11.0%). In addition, students who identified as heterosexual showed a higher adherence (26.8%) than LGTBQ\u0026thinsp;+\u0026thinsp;students (5.9%). Regarding marital status, single students showed slightly higher adherence (26.4%) than their non-single counterparts (23.7%). Finally, in terms of race/ethnicity, a higher proportion of non-Caucasian participants (26.3%) met all three recommendations compared with their Caucasian peers (17.1%).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e presents the proportion of participants meeting all three 24-hour movement guidelines, disaggregated by academic and labor characteristics. Adherence was slightly higher among students enrolled in health sciences (28.9%) compared with those in non-health sciences (23.8%). When stratified by type of accommodation, participants living in student accommodation showed a higher adherence (23.7%) than those not living in such arrangements (14.5%). Regarding labor status, students who were not working reported greater adherence (26.4%) than those who were working (5.0%).\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e presents the proportion of participants meeting all three 24-hour movement guidelines, disaggregated by physical and psychological characteristics. Compliance was slightly higher among participants who were overweight/obesity (26.3%) compared to those who were no overweight/obesity (20.3%). When stratified by mental health, participants with no mental health problems showed higher compliance (27.8%) than those with mental health problems (7.8%). In terms of physical health, students with no physical health problems showed slightly higher adherence (26.6%) than those with physical health problems (23.8%).\u003c/p\u003e\n\u003cp\u003eAccording to the GLM (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), male students were significantly more likely to meet all three 24-hour movement guidelines compared to female students (OR\u0026thinsp;=\u0026thinsp;1.77; 95% CI 1.21 to 2.59; p\u0026thinsp;=\u0026thinsp;0.003). In contrast, students older than 18 years showed significantly lower odds of adherence compared to their younger peers (OR\u0026thinsp;=\u0026thinsp;0.54; 95% CI 0.35 to 0.84; p\u0026thinsp;=\u0026thinsp;0.007). Additionally, those enrolled in non-health sciences programs were less likely to meet the guidelines compared to students in health sciences (OR\u0026thinsp;=\u0026thinsp;0.68; 95% CI 0.47 to 1.00; p\u0026thinsp;=\u0026thinsp;0.050). Lasty, students with mental health problems were less likely of adhering to all the three guidelines (OR\u0026thinsp;=\u0026thinsp;0.27; 95% CI 0.09 to 0.65; p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e Our findings suggest that only approximately one in four university students met the 24-hour movement guidelines, highlighting a concerningly low adherence in this population. This prevalence is consistent with previous studies conducted in similar settings. For instance, Bu et al.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e reported a 27.0% adherence rate among 1,846 Chinese university students, while Pengpid and Peltzer\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e found that only 11.7% of students across five countries met all three recommendations. These figures reinforce the idea that integrated movement behaviors remain suboptimal among young adults globally. Conversely, our results contrast sharply with those of Contini et al.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, who found that just 0.2% of a sample of Canadian undergraduate students met the 24-hour movement guidelines. However, their study applied a more stringent set of criteria, incorporating additional components such as muscle-strengthening activities and specific sleep and screen-time subdomains, which may partially explain the stark discrepancy. In fact, had our study used similarly detailed and demanding metrics, the proportion of adherent participants might have been even lower, further underscoring the seriousness of the situation. These findings collectively suggest that, regardless of the country or methodological differences, a substantial proportion of university students are failing to meet integrated recommendations for physical activity, sedentary behavior, and sleep, behaviors that are essential for their overall health and well-being\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e Additionally, our findings indicate that male students are more likely to meet the 24-hour movement guidelines, which aligns with previous research conducted among both adolescent and university populations. Previous literature has consistently shown that males tend to report greater adherence to physical activity, sleep and screen time recommendations\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Although studies in younger populations have not always found sex-based differences in overall adherence\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, such disparities appear to become more pronounced during young adulthood, particularly in relation to physical activity levels\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Theoretically, this association may be explained by sociocultural and gender-related factors. Males are often exposed to encouragement for engaging in vigorous physical activity from early ages, while females may face stronger social norms and greater barriers, such as lower perceived safety, reduced self-efficacy, or time constraints linked to traditional roles \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Moreover, sedentary behaviors patterns tend to differ by sex, with females engaging more frequently in recreational screen time\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, which may negatively affect adherence to the integrated movement guidelines.\u003c/p\u003e\u003cp\u003eYounger students were more likely to meet the 24-hour movement guidelines, a finding consistent with previous research showing age-related declines in movement behaviors\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, even within university populations\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Several studies have highlighted that health-related behaviors tend to deteriorate as students\u0026rsquo; progress through their academic careers\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. One possible explanation is that younger students are more engaged in a campus culture that promotes social interaction, group exercise, and peer support\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, which can facilitate healthier routines, including regular physical activity and reduced sedentary time. In contrast, older students may feel less connected to this environment and, in some cases, experience social disengagement or stigma\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, potentially decreasing their participation in health-promoting group activities. Moreover, they often face additional responsibilities, such as employment, caregiving, or financial stress, that may constrain their time and energy, contributing to more sedentary behavior and irregular sleep patterns\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. This deterioration may also be exacerbated by increased academic stress and a decline in perceived self-efficacy to maintain healthy routines, as students\u0026rsquo; progress through their university careers\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. However, it is important to note that, despite the age difference, all students are at the same stage in their academic careers (first year). Therefore, older students may have other responsibilities in addition to their academic studies, while younger students still have greater support from their parents.\u003c/p\u003e\u003cp\u003e Students enrolled in health sciences programs were more likely to meet the 24-hour movement guidelines compared to their peers from other academic disciplines. However, the literature on this association remains inconclusive and, to some extent, contradictory\u003csup\u003e\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. For instance, studies in Spain and Croatia have shown that health sciences students report higher levels of physical activity, better dietary habits, and less screen time compared to those from other fields\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. In contrast, a large study across 17 low- and middle-income countries found no significant differences in health risk behaviors between Health and non-health science students\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. These discrepancies may reflect contextual variations across countries. Although no consistent trend is observed across income groups, with adherence rates of 16.6% in low- and lower-middle\u0026ndash;income countries, 11.9% in upper-middle\u0026ndash;income countries, and 14.4% in high-income countries (among children under five years)\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, differences between studies suggest that national context plays a role. Supporting this, a meta-regression analysis showed that overall adherence to the 24-hour movement guidelines was positively associated with a country\u0026rsquo;s Human Development Index (HDI). This suggests that students in more developed countries, such as Spain, may be more likely to engage in healthier movement behaviors. Similarly, greater ability to access and understand health information has been linked to healthier lifestyles among health sciences students\u0026sup3;⁰. Moreover, health sciences programs often include practical components (e.g., physical activity or nutrition workshops) and promote higher health literacy\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e, which may encourage healthier behaviors compared to students in non-health disciplines, who may have less exposure to such content and weaker health beliefs\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e Importantly, our findings revealed that students with a diagnosed mental health problem were significantly less likely to adhere to all three 24-hour movement guidelines. While most of the existing literature has traditionally focused on the beneficial impact of meeting these guidelines on mental health, showing that greater adherence is associated with lower levels of depression, anxiety, and psychological distress\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, our results also support the plausibility of the reverse relationship. This inverse association may be explained by several interrelated mechanisms. First, common symptoms of mental disorders, such as anhedonia, low motivation, fatigue, and executive dysfunction, can impair an individual\u0026rsquo;s ability to initiate and sustain health-promoting behaviors, including physical activity\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e and sleep hygiene\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Second, sleep disturbances are highly prevalent across a range of mental health conditions\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e, including depression, anxiety, and ADHD, and can directly interfere with both sleep duration and physical recovery\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Finally, mental health conditions are associated with higher perceived barriers to physical activity (e.g., fear of injury, low self-efficacy, lack of social support), which further reduce the likelihood of meeting activity guidelines\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study has several limitations that must be acknowledged. First, its cross-sectional design prevents the establishment of causal relationships between adherence to movement behaviors and potential determinants. Second, all data were self-reported, which may introduce recall bias and social desirability bias, particularly in behaviors such as screen use, physical activity, or sleep duration. Furthermore, the lack of objective measurements, such as accelerometry for physical activity and sleep, may limit the accuracy of the estimates. Thirdly, the sample was selected for convenience, requiring caution in extrapolating the findings. Despite these limitations, the findings have important practical implications. Rather than promoting these behaviors in isolation, health professionals and public health authorities should advocate for personalized, integrated 24-hour movement behavior interventions, especially targeting high-risk groups identified in this study, such as female students, older students, non-health sciences students and individuals with mental health problems.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Our results indicate that only a small proportion of Spanish university students adhered to all three 24-hour movement guidelines, with significant disparities observed by sex, age, academic discipline and mental health problems. These findings highlight the urgent need to address integrated movement behaviors in this population, particularly among high-risk subgroups. Promoting a holistic approach that combines physical activity, limited screen time, and adequate sleep may offer a promising, nonpharmacological strategy to support overall health and well-being in university students. Future interventions should be personalized and context-specific, targeting those least likely to meet the guidelines. Furthermore, should also consider the possible plausibility of an inverse relationship between 24-hour movement guidelines and diagnosed mental health problems.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eMVPA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emoderate- to vigorous-intensity physical activity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eUNILIFE-M\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUNIversity student\u0026rsquo;s LIFEstyle behaviors and Mental health\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003ePAS-2.1S\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePhysical Activity Scale 2.1 Spanish version\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eLPA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elight physical activity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eMPA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emoderate physical activity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eVPA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003evigorous physical activity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eADHD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eattention-deficit/hyperactivity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eASD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eautism spectrum disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eQ\u0026ndash;Q\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003equantile-quantile plots\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eIQR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003einterquartile ranges\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eORs\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eodds ratios\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003e95% CIs\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e95% confidence intervals\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHDI\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman Development Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThis study was reviewed and approved by the Research Ethics Committee of \u003cem\u003eUniversidad Loyola Andaluc\u0026iacute;a\u003c/em\u003e (Approval ID: 240605/CE24544). All procedures involving human participants will be conducted in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.F.L.-G. and J.A.M.-E. contributed to the conceptualization. J.F.L.-G. contributed to the methodology, formal analysis and data curation. J.F.L.-G. contributed to the writing original draft preparation. F.Q.-C., J.A.M.-E., S.C.-M., M.M.-M., A.L.-B., A.J. W., D.T., A. C. D., R.Y.-S., F.B. S. and P. G.-L. contributed to the writing review and editing. All authors have read and agreed to the published version of the manuscript. J.F.L.-G. is the guarantor of this article, and he accepts full responsibility for the work, had access to the data and controlled the decision to publish.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors wish to extend their gratitude to Universidad Loyola Andaluc\u0026iacute;a and all the students, teachers, and staff members who participated.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArnett JJ. 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The value of social support to encourage people with schizophrenia to engage in physical activity: an international insight from specialist mental health physiotherapists. J Ment Health. 2014;23(5):256\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/09638237.2014.951481\u003c/span\u003e\u003cspan address=\"10.3109/09638237.2014.951481\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"young adults, behavior patterns, university education, public health promotion, lifestyle risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7521428/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7521428/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eUniversity students are at a critical stage for establishing healthy lifestyle habits, yet little is known about their adherence to integrated 24-hour movement guidelines that include physical activity, sedentary behavior, and sleep. The aim of this study was to examine the prevalence of adherence to the 24-hour movement guidelines and identify sociodemographic, anthropometric and mental or physical health conditions correlates among Spanish university students.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis cross-sectional analysis included first-year students \u003cem\u003efrom Universidad Loyola Andalucía\u003c/em\u003e(Spain) participating in the UNIversity student’s LIFEstyle behaviors and Mental health (UNILIFE-M) study. Data were self-reported using validated questionnaires. Adherence was defined according to international recommendations for moderate-to-vigorous physical activity (≥150 min/week), screen time (≤3 h/day), and sleep duration (7–9 hour/night). Descriptive statistics, Venn diagrams, and robust logistic regression models were used to assess prevalence and correlates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 671 students (median age = 18 years; interquartile range [IQR] 18-19); 50.1% females) were included. Only 25.9% of students met all three 24-hour movement guidelines, while 7.0% met none. Adherence was significantly higher among males (odds ratio [OR] = 1.77; 95% confidence interval [95% CI] 1.21 to 2.59), and lower in older students (≥18 years old; OR = 0.58; 95% CI 0.37 to 0.90), those enrolled in non-health sciences programs (OR = 0.68; 95% CI 0.47 to 1.00); and those with mental health problems (OR = 0.27; 95% CI 0.09 to 0.65).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAdherence to 24-hour movement guidelines is low among Spanish university students, particularly among females, older students, non-health sciences academic disciplines and mental health problems. Personalized interventions targeting high-risk groups are warranted to promote healthy lifestyle behaviors in this population.\u003c/p\u003e","manuscriptTitle":"Adherence to the 24-hour movement guidelines and its correlates among Spanish university students: UNILIFE-M study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-26 12:11:23","doi":"10.21203/rs.3.rs-7521428/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-08T16:23:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T06:37:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260565148491407478231412660006774772698","date":"2025-09-19T13:24:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63240836801834743959159359997047944385","date":"2025-09-18T07:06:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159039562756611228229234571109487909790","date":"2025-09-17T18:21:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150683693776485088119669643617730537769","date":"2025-09-17T13:49:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-17T13:14:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T13:11:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T05:25:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T05:21:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-09-08T23:51:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"24162dcc-17e0-4d2b-b206-fb425c373499","owner":[],"postedDate":"September 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-26T12:11:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-26 12:11:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7521428","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7521428","identity":"rs-7521428","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}