The impact of a national exercise intervention on lifestyle habits among individuals with Schizophrenia spectrum disorders - Results from the FitForLife intervention study

The impact of a national exercise intervention on lifestyle habits among individuals with Schizophrenia spectrum disorders - Results from the FitForLife intervention 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 Short Report The impact of a national exercise intervention on lifestyle habits among individuals with Schizophrenia spectrum disorders - Results from the FitForLife intervention study Amanda Cassel Pegelow, Maria Skott, Örjan Ekblom, Catharina Lavebratt, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7585899/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Apr, 2026 Read the published version in BMC Research Notes → Version 1 posted 8 You are reading this latest preprint version Abstract Objectives Individuals with schizophrenia spectrum disorders face challenges in maintaining healthy lifestyle habits and have a significantly reduced life expectancy, partly due to increased risks of somatic illness. While physical activity is known to offer broad health benefits, its influence on other lifestyle behaviours—such as diet, alcohol consumption and nicotine use—remains unclear. This study aimed to investigate whether an exercise intervention could affect these lifestyle habits in individuals with schizophrenia spectrum disorders (F20-29). This sub-study was part of a single-arm intervention conducted across 16 outpatient units in Sweden. Participants completed questionnaires before and after the six-month intervention. Analyses included descriptive comparisons, non-parametric tests and ordinal logistic regressions. Results In total, 149 individuals participated. After the intervention, nicotine use showed minimal change. There were patterns of decreased alcohol use, fruit, vegetable and meat consumption, along with increased candy consumption and binge drinking. Further interventions are needed to promote healthy lifestyle habits among individuals with schizophrenia spectrum disorders. Trial registration The trial is registered as “Fitforlife- Exercise in Care of Psychosis” in the ClinicalTrials.Gov with the ID number: NCT04239612 (2019-10-28). Alcohol Dietary habits Lifestyle habits Physical activity Schizophrenia spectrum disorder Smoking Nicotine Figures Figure 1 Introduction Individuals with schizophrenia spectrum disorders (SSD) experience significantly reduced life expectancy (12–15 years) and elevated risks of somatic illnesses [ 1 ]. The shortened life expectancy is attributed to both medication side effects and unhealthy lifestyle habits, which contribute to partly preventable somatic diseases such as cardiovascular and metabolic diseases [ 2 – 5 ]. Individuals with SSD exhibit significantly lower levels of physical activity and higher levels of sedentary behavior compared to the general population [ 6 – 8 ]. Increased physical activity has numerous benefits, including enhanced cognitive functioning, improved psychosocial functioning, and cardiovascular advantages [ 7 – 10 ]. In this sub-study to the FitForLife project the aim was to investigate whether a six-month long physical exercise intervention impacts lifestyle habits such as nicotine use, alcohol use, or dietary habits in individuals with SSD. Nicotine use is common in individuals with SSD, posing a major risk factor for cardiovascular and respiratory diseases [ 11 – 13 ]. Alcohol use has been associated with increased positive symptoms and worse psychosocial functioning, as well as with risks of multiple non-communicable diseases [ 14 , 15 ]. Poor dietary patterns are common in the studied population [ 16 , 17 ], contributing to a significantly higher prevalence of obesity, metabolic syndrome [ 6 , 9 ] and likely contributing to the different intestinal microbiome [ 18 ]. These lifestyle habits contribute to the shorter life expectancy in this group [ 11 – 14 , 19 ]. Although medication and psychological therapy remain central to the treatment of SSD, current approaches often overlook the role of lifestyle interventions, despite their importance. Building upon the benefits of increased physical activity, a key question is whether physical exercise interventions could also improve other lifestyle habits, offering a comprehensive and cost-effective strategy for individuals with SSD [ 20 , 21 ]. Methods Study design and population This study employed a quantitative sub-study design nested in a single-arm intervention: FitForLife [ 22 , 23 ]. The design was selected to ensure that all eligible patients could access the intervention. It was implemented at 16 psychiatric outpatient units specialized in psychosis care in Sweden. The intervention consisted of at least one group exercise session per week led by patients educated for the task. The interventions took place between 2021 and 2023. Participants were adults (≥ 18 years) with an SSD diagnosis receiving care at one of the 16 units. Exclusion criteria included conditions preventing participation in the exercise sessions, such as acute psychosis or somatic illnesses where physical exercise were contraindicated. For this sub-study, individuals who did not answer the lifestyle-related questions were excluded. This study adheres to STROBE guidelines. Data collection and measures Recruitment was conducted at the outpatient units, with all eligible patients asked to participate. Data were collected at baseline and at six-month follow-up via (i) questionnaires, (ii) examinations (bodily measurements e.g., height, weight), (iii) interviews about general background information (e.g., age, sex, education and living situation), (iv) fitness test and (v) medical records (the first F-diagnosis recorded, duration of the diagnosis and antipsychotic medication), all administered by qualified staff at the outpatient units. Questionnaires were completed either on paper or through a mobile app according to participant preference. Written informed consent was obtained at baseline. The questionnaire questions relevant to this sub-study related to alcohol use, nicotine use, and dietary habits. Illicit drug use was a potential research question. However, no participants reported using illicit drugs. Nicotine use was assessed with a yes/no question. The alcohol-related questions were drawn from the widely used Alcohol Use Disorders Identification Test (AUDIT) [ 24 ]. Dietary habits were measured by asking how often the participants had consumed fruit, vegetables, meat, and candy/soda in the past week, with response categories ranging from “1–2 times/week” to “6 or more times/week”. The questionnaire has been added as a supplementary file. At the six-month follow-up, apart from collecting the same information as at baseline, the number of exercise sessions each participant attended was recorded. Data analysis The statistical analyses were conducted using STATA 18. The proportion of change within each variable between pre- and post-assessments were calculated, and two-sided non-parametric tests (Fisher’s exact test and Wilcoxon signed-rank) were conducted. Further analyses were conducted with lifestyle habit categories being dependent variables in ordinal logistic regression models. The ordinal logistic regression included covariates, including age, sex, education, living situation, and BMI to control for potential confounders. The significance level was set at α = 0.05 in all analyses. The regression results were reported as odds ratios (OR) with 95% confidence intervals (CI). A binary logistic regression was used to examine whether individuals lost before follow-up differed systematically from respondents regarding the covariates. Additionally, an interaction analysis was conducted to assess whether the frequency of physical activity sessions modified the effect of the intervention. This did not show any differential results and was therefore not included in the result presentation. Results Sociodemographics A total of 149 individuals were recruited, of whom 52% were men, 37% had an F20 (schizophrenia) diagnosis, 22% lived together with another adult, and the mean age was 47.5 years, see Table 1 . A total of 44 participants (29.5%) did not complete any follow-up questions. Each analysis specifies the sample size (N) based on valid responses. No significant differences were identified between respondents and non-respondents for the covariates tested. Table 1 Baseline characteristics MeanN (%) Total 149 Sex Male 74 (51.7%) Female 69 (48.3%) Age 47.5 20–29 6 (4.2%) 30–39 32 (22.4%) 40–49 44 (30.8%) 50–59 41 (28.7%) 60–69 17 (11.9%) 70–75 3 (2.1%) F-diagnoses 20 Schizophrenia 51 (37.0%) 22 Persistent delusional disorder 10 (7.2%) 23 Acute and transient psychotic disorder 11 (8.0%) 24 Induced delusional disorder 1 (0.7%) 25 Schizoaffective disorders 21 (15.2%) 28 Other nonorganic psychotic disorders 1 (0.7%) 29 Unspecified nonorganic psychosis 21 (15.2%) 30–39 Mood affective disorders 7 (5.1%) Other 15 (10.9%) Years with diagnosis 13.4 1–5 13 (11.2%) 6–10 39 (33.6%) 11–15 25 (21.6%) 16–20 22 (19.0%) 21–25 7 (6.0%) 26+ 10 (8.6%) Antipsychotics No 15 (11.0%) Yes 121 (89.0%) Education Primary school 28 (23.3%) Highschool 66 (55%) Higher education 26 (21.7%) Cohabitant No 97 (78.2%) Yes 27 (21.8%) BMI (kg/m^2) 30.4 Normal weight 23 (17.0%) Overweight 45 (33.3%) Obese 67 (49.6%) Do you use nicotine products? No 73 (59.8%) Yes 49 (40.2%) Alcohol use: AUDIT result Abstainer 30 (32.6%) Low-risk 58 (63.0%) Harmful/hazardous 4 (4.3%) Dependence 0 (0%) How often do you drink alcohol? Never 30 (29.1%) 1/month 46 (44.7%) 2–4/month 19 (18.4%) 2–3/week 6 (5.8%) 4+/week 2 (1.9%) How often do you have 6 + drinks on one occasion? Never 79 (76.7%) Less than 1/month 16 (15.5%) Every month 7 (6.8%) Every week 1 (1.0%) Fruit times/week 1 to 2 33 (27.3%) 3 to 4 28 (23.1%) 5 to 6 15 (12.4%) 6 or more 45 (37.2%) Vegetables times/week 1 to 2 32 (27.1%) 3 to 4 22 (18.6%) 5 to 6 22 (18.6%) 6 or more 42 (35.6%) Meat times/week 1 to 2 29 (26.1%) 3 to 4 51 (45.9%) 5 to 6 15 (13.5%) 6 or more 16 (14.4%) Candy or soda times/week 1 to 2 73 (62.9%) 3 to 4 24 (20.7%) 5 to 6 9 (7.8%) 6 or more 10 (8.6%) Nicotine At baseline, nicotine use was reported by 40.2% of participants (Table 1 ). There were minimal changes between baseline and follow-up: two participants quit and two initiated use (Table 2 ). Due to lack of variation in responses, no further analysis of nicotine use was conducted. Table 2 Changes between baseline and follow-up data. Showing number of individuals, proportions and p -value. N Decrease N (%) No Change N (%) Increase N (%) p -value Nicotine use 73 2 (2.7) 69 (94.5) 2 (2.7) Fishers exact 1.000 Alcohol use AUDIT category 51 9 (17.6) 41 (80.4) 1 (2.0) Wilcoxon signed-rank 0.011 Alcohol intake frequency 68 14 (20.6) 46 (67.6) 8 (11.8) 0.208 Binge drinking 65 6 (9.2) 51 (78.5) 8 (12.3) 0.600 Dietary habits Fruit times/week 80 26 (32.5) 34 (42.5) 20 (25) 0.376 Vegetables times/week 77 22 (28.6) 41 (53.3) 14 (18.2) 0.188 Meat times/week 72 19 (26.4) 38 (52.8) 15 (20.8) 0.634 Candy or soda times/week 71 10 (14.1) 44 (62.0) 17 (23.9) 0.232 BMI category (kg/m^2) 108 9 (8.33) 97 (89.8) 2 (1.85) 0.034 Bold indicates p < 0.05. Alcohol Harmful/hazardous drinking was observed in 4.3% of participants at baseline (Table 1 ). Non-parametric tests indicated a change in AUDIT classification (3 classes) between baseline and follow-up ( p = 0.011; Table 2 ). Table 3 presents the regression models, unadjusted and adjusted. The results show a decrease in AUDIT categories and alcohol use frequency, as well as an increase in binge drinking. Table 3 Ordinal logistic regression with dependent at baseline and follow-up, showing OR and 95% CI. Variable (reference category) Alcohol use, AUDIT category Alcohol use frequency Binge drinking Fruit times/week Vegetables times/week Meat times/week Candy/soda times/week Unadjusted Time ( Baseline ) Follow-up 0.54 0.79 1.04 0.84 0.77 0.98 1.25 [0.24,1.18] [0.42,1.46] [0.46,2.34] [0.48,1.47] [0.44,1.36] [0.54,1.79] [0.66,2.38] N 102 136 130 160 157 144 142 Adjusted Time (Baseline) Follow-up 0.55 0.80 1.24 0.92 0.83 0.88 1.10 [0.22,1.31] [0.42,1.52] [0.52,2.94] [0.49,1.72] [0.45,1.54] [0.45,1.69] [0.55,2.20] Age (Cont.) 0.98 0.99 0.96 1.08 1.05 1.04 1.00 [0.94,1.03] [0.96,1.03] [0.91,1.01] [1.04,1.12] [1.01,1.09] [1.00,1.08] [0.96,1.04] Sex (Male) Female 2.29 1.74 0.79 0.31 0.81 0.36 0.96 [0.90,5.84] [0.86,3.52] [0.30,2.06] [0.15,0.67] [0.40,1.68] [0.17,0.76] [0.43,2.14] Cohabitant (No) Yes 3.71 2.42 1.05 1.88 1.68 0.94 0.42 [1.05,13.12] [1.08,5.44] [0.33,3.39] [0.84,4.21] [0.75,3.79] [0.42,2.11] [0.16,1.10] Education (Primary school) Highschool 1.50 1.17 1.071 3.30 0.84 1.00 1.30 [0.48,4.70] [0.49,2.81] [0.37,3.11] [1.38,7.87] [0.37,1.91] [0.44,2.31] [0.51,3.35] Higher education 0.32 0.43 0.33 8.59 1.36 1.31 1.75 [0.089,1.12] [0.17,1.13] [0.08,1.29] [2.90,25.46] [0.50,3.68] [0.49,3.50] [0.57,5.33] Body Mass Index (Cont.) 1.02 0.99 1.03 1.05 [0.96,1.08] [0.94,1.05] [0.97,1.09] [0.99,1.13] N 97 128 122 137 135 124 123 Bold indicates p < 0.05. Dietary habits Table 1 presents baseline results for dietary habits. After the intervention, fruit, vegetable, and meat consumption had decreased compared to baseline while candy/soda consumption had increased (Tables 2 & 3 ). BMI had decreased compared to baseline ( p = 0.034). Discussion The aim of this study was to investigate whether a physical exercise intervention influenced nicotine use, alcohol use, and dietary habits in individuals with SSD. Nicotine In this study, 40% of participants reported nicotine use in the past month, aligning with prior findings of high smoking prevalence among individuals with SSD [ 1 , 25 ]. In contrast, 5.4% of the general Swedish population smoke tobacco daily [ 26 ]. The high prevalence of nicotine use may partly reflect nicotine’s role of decreasing side-effects of neuroleptics and potential role of symptom management, where patients fear that quitting could worsen their psychotic symptoms [ 27 ]. Our results suggest that participation in physical exercise sessions alone are insufficient to reduce nicotine use. Programs combining exercise with targeted nicotine cessation support may better address this issue [ 1 , 13 ]. Tailored smoking cessation programs should be considered to address the unique barriers individuals with SSD face in quitting [ 27 ]. Alcohol Only about 4% met the criteria for harmful/hazardous drinking, a low prevalence consistent with prior findings among schizophrenia outpatients [ 28 ]. This contrasts with the general Swedish population, where 15.6% report harmful/hazardous drinking habits [ 29 ], as well as with reports that substance dependence is common in individuals with SSD [ 1 ]. The latter discrepancy may reflect aggregation of alcohol with other substances. Lower prevalence of harmful/hazardous drinking among SSD outpatients may also relate to typically lower physical activity and sedentary lifestyles [ 6 – 8 ], as previous studies link higher physical activity to greater alcohol consumption [ 30 , 31 ]. Social and economic factors may contribute to the low prevalence of drinking in this group, as stigma, exclusion, and social withdrawal reduce opportunities for social drinking, while financial constraints linked to employment challenges and discrimination may limit alcohol use due to its cost [ 32 ]. The results indicate that exercise alone did not alter drinking habits. However, given the decreased AUDIT categories, decreased alcohol use frequency and increased binge drinking, future research with larger samples or longer interventions may be valuable. Dietary habits Although previous research has found poor dietary habits in individuals with SSD [ 33 , 34 ], our sample showed moderate adherence to general guidelines. Specifically, fruit and vegetable intake (37% and 36% ≥ six times/week) approached the 500 g/day recommendation, which is met by only 20% of Swedes [ 35 , 36 ]. Meat consumption—less than four times/week for 72% of participants—aligned with the guideline of less than 500 g/week [ 35 ]. Given the link between meat consumption and higher income [ 37 ], this may reflect the lower socioeconomic status common among individuals with SSD [ 38 ]. Candy/soda were consumed one to two times per week by 63%, aligning with the approximately 60% of Swedes who meet sugar-intake norms [ 36 ]. Overall, these four measures suggest that this SSD cohort’s dietary habits were not markedly poor, although there is room for improvement, particularly in fruit and vegetable consumption. A limitation of our study is the absence of gram-based response categories, which hinders direct comparison with general guidelines. Prior research comparing individuals with schizophrenia to matched controls found no direct differences, apart from lower fruit and vegetable consumption [ 34 , 39 , 40 ]. This study observed increased candy/soda consumption and decreased fruit and vegetable intake after the intervention. This contrasts with general-population studies suggesting that physical activity can improve appetite control and reduce cravings for unhealthy food [ 41 , 42 ]. The intervention may have been too short to influence dietary behaviors. Alternatively, participants may require targeted nutritional support to change dietary habits. The observed BMI decrease deviates from the typical trajectory in this patient group, where obesity is common and antipsychotics often lead to weight gain [ 43 ]. However, the BMI decrease was not associated with any of the studied lifestyle habits. Overall, the intervention did not have a significant effect on the participants’ nicotine use, alcohol consumption, or dietary habits. The conclusion is that additional interventions, on top of exercise programs, are needed to promote healthy lifestyle habits for nicotine, alcohol and food among individuals with SSD. Limitations This study used data from the FitForLife project, a single-arm intervention without a control group. While this design ethically allowed all eligible individuals to participate and avoided withholding a potentially beneficial exercise program [ 44 ], it limits statistical analyses by preventing comparison with a non-exposed group [ 45 ]. The six-month timeframe may have been too short to detect long-term behavioral changes, especially in entrenched habits such as nicotine use. Recruiting 149 participants with SSD—of whom 44 did not complete follow-up—was reasonably robust given the challenges of engaging and retaining individuals with severe mental illnesses [ 46 , 47 ]. Although few results were significant, many showed marginal effects, suggesting that a larger sample might be needed. Notably, 52% of the participants were men, contributing to the representativeness of the sample, as men are generally underrepresented in studies [ 49 ] while often experiencing more severe symptoms [ 48 ]. In terms of potential selection bias, individuals who opted into the intervention may differ from those who declined. Logistic regression showed no significant differences in measured covariates between completers and non-completers, but unmeasured factors may still vary, so selection bias cannot be fully excluded. The dietary questions were chosen from nine questions originally designed for a microbiota study, four were used in the current study. These four were selected in collaboration with public health and nutrition researchers and broadly aligned with dietary recommendations [ 35 ]. The original nine questions were designed to be as few as possible to maximize responses. As these dietary items were not tailored specifically to the current study, future research should consider more precise or extensive dietary measures, including fiber intake and high-fat foods. Response rates varied, with some categories receiving few responses, possibly reflecting discomfort or fear of repercussions, especially regarding sensitive behaviors like nicotine or alcohol use. Although questionnaires were anonymous, administration within treatment settings may have led to under-reporting. Stigma remains a critical barrier in this population, potentially deterring honest reporting or proactive behavior change [ 50 ]. Addressing stigma and fear of repercussions may improve response rates and reporting accuracy in future interventions. Abbreviations AUDIT Alcohol use disorders identification test BMI Body mass index CI Confidence intervals OR Odds ratio SSD Schizophrenia spectrum disorders WHO World Health Organization Declarations Ethics approval and consent to participate The FitForLife project has received ethical approval. It was approved by the Regional Ethics Review Board in Stockholm: 2019–03409 and amendments. The trial is registered in the ClinicalTrials.Gov with the ID number: NCT04239612 (2019-10-28). Written informed consent was obtained from all participants during the initial visit. The study adhered to the ethical principles of the Helsinki Declaration. Consent for publication Not applicable. Funding This study was supported by grants from the Swedish Research Council for Health, Working Life and Welfare (In Swedish: Forskningsrådet för hälsa, arbetsliv och välfärd) (FORTE, 2022 − 01254 YF), the Swedish Research Council (2018–02723 YF; 2022 − 01188 CL). 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Int J Obes. 2019;43(9):1681–90. Agarwal SM, Stogios N, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ, Hahn M. Pharmacological interventions for prevention of weight gain in people with schizophrenia. Cochrane Db Syst Rev. 2022;10(10):CD013337. World Health Organization. Physical activity. https://www.who.int/news-room/fact-sheets/detail/physical-activity (2024). Accessed 15 Mar 2025. Ejlertsson G. Statistik för hälsovetenskaperna. 3rd ed. Lund: Studentlitteratur AB; 2019. Abbott M, Arthur A, Walker L, Doody G. The challenge of recruiting people with schizophrenia to a health promotion trial. Br J Gen Pract. 2005;55(517):634–6. Kanuch SW, Cassidy KA, Dawson NV, Athey M, Fuentes-Casiano E, Sajatovic M. Recruiting and retaining individuals with serious mental illness and diabetes in clinical research: lessons learned from a randomized, controlled trial. J Health Dispar Res Pract. 2016;9(3):115–26. Li R, Ma X, Wang G, Yang J, Wang C. Why sex differences in schizophrenia? J Transl Neurosci. 2016;1(1):37–42. Becker R. Gender and survey participation: an event history analysis of the gender effects of survey participation in a probability-based multi-wave panel study with a sequential mixed-mode design. Methods Data Anal. 2022;16(1):30. The Public Health Agency of Sweden. Stigmatisering kopplad till psykisk ohälsa. https://www.folkhalsomyndigheten.se/publikationer-och-material/publikationsarkiv/s/stigmatisering-kopplad-till-psykisk-ohalsa/ (2020). Accessed 21 Mar 2025. Additional Declarations No competing interests reported. Supplementary Files STROBEchecklistSubmissionIDd11febbed6b2464d9eda4ed9d26a84c4.doc QuestionnaireFitForLifeLifestylehabitsSubmissionIDd11febbed6b2464d9eda4ed9d26a84c4.docx Cite Share Download PDF Status: Published Journal Publication published 15 Apr, 2026 Read the published version in BMC Research Notes → Version 1 posted Editorial decision: Revision requested 12 Jan, 2026 Reviews received at journal 16 Nov, 2025 Reviewers agreed at journal 27 Oct, 2025 Reviewers invited by journal 29 Sep, 2025 Editor assigned by journal 29 Sep, 2025 Editor invited by journal 24 Sep, 2025 Submission checks completed at journal 23 Sep, 2025 First submitted to journal 23 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The shortened life expectancy is attributed to both medication side effects and unhealthy lifestyle habits, which contribute to partly preventable somatic diseases such as cardiovascular and metabolic diseases [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIndividuals with SSD exhibit significantly lower levels of physical activity and higher levels of sedentary behavior compared to the general population [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Increased physical activity has numerous benefits, including enhanced cognitive functioning, improved psychosocial functioning, and cardiovascular advantages [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this sub-study to the FitForLife project the aim was to investigate whether a six-month long physical exercise intervention impacts lifestyle habits such as nicotine use, alcohol use, or dietary habits in individuals with SSD.\u003c/p\u003e\u003cp\u003eNicotine use is common in individuals with SSD, posing a major risk factor for cardiovascular and respiratory diseases [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Alcohol use has been associated with increased positive symptoms and worse psychosocial functioning, as well as with risks of multiple non-communicable diseases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Poor dietary patterns are common in the studied population [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], contributing to a significantly higher prevalence of obesity, metabolic syndrome [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and likely contributing to the different intestinal microbiome [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These lifestyle habits contribute to the shorter life expectancy in this group [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough medication and psychological therapy remain central to the treatment of SSD, current approaches often overlook the role of lifestyle interventions, despite their importance. Building upon the benefits of increased physical activity, a key question is whether physical exercise interventions could also improve other lifestyle habits, offering a comprehensive and cost-effective strategy for individuals with SSD [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design and population\u003c/h2\u003e\u003cp\u003eThis study employed a quantitative sub-study design nested in a single-arm intervention: FitForLife [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The design was selected to ensure that all eligible patients could access the intervention. It was implemented at 16 psychiatric outpatient units specialized in psychosis care in Sweden. The intervention consisted of at least one group exercise session per week led by patients educated for the task. The interventions took place between 2021 and 2023.\u003c/p\u003e\u003cp\u003eParticipants were adults (≥ 18 years) with an SSD diagnosis receiving care at one of the 16 units. Exclusion criteria included conditions preventing participation in the exercise sessions, such as acute psychosis or somatic illnesses where physical exercise were contraindicated. For this sub-study, individuals who did not answer the lifestyle-related questions were excluded. This study adheres to STROBE guidelines.\u003c/p\u003e\u003ch3\u003eData collection and measures\u003c/h3\u003e\u003cp\u003eRecruitment was conducted at the outpatient units, with all eligible patients asked to participate. Data were collected at baseline and at six-month follow-up via (i) questionnaires, (ii) examinations (bodily measurements e.g., height, weight), (iii) interviews about general background information (e.g., age, sex, education and living situation), (iv) fitness test and (v) medical records (the first F-diagnosis recorded, duration of the diagnosis and antipsychotic medication), all administered by qualified staff at the outpatient units. Questionnaires were completed either on paper or through a mobile app according to participant preference. Written informed consent was obtained at baseline.\u003c/p\u003e\u003cp\u003eThe questionnaire questions relevant to this sub-study related to alcohol use, nicotine use, and dietary habits. Illicit drug use was a potential research question. However, no participants reported using illicit drugs. Nicotine use was assessed with a yes/no question. The alcohol-related questions were drawn from the widely used Alcohol Use Disorders Identification Test (AUDIT) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Dietary habits were measured by asking how often the participants had consumed fruit, vegetables, meat, and candy/soda in the past week, with response categories ranging from “1–2 times/week” to “6 or more times/week”. The questionnaire has been added as a supplementary file.\u003c/p\u003e\u003cp\u003eAt the six-month follow-up, apart from collecting the same information as at baseline, the number of exercise sessions each participant attended was recorded.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe statistical analyses were conducted using STATA 18. The proportion of change within each variable between pre- and post-assessments were calculated, and two-sided non-parametric tests (Fisher’s exact test and Wilcoxon signed-rank) were conducted.\u003c/p\u003e\u003cp\u003eFurther analyses were conducted with lifestyle habit categories being dependent variables in ordinal logistic regression models. The ordinal logistic regression included covariates, including age, sex, education, living situation, and BMI to control for potential confounders. The significance level was set at α = 0.05 in all analyses. The regression results were reported as odds ratios (OR) with 95% confidence intervals (CI). A binary logistic regression was used to examine whether individuals lost before follow-up differed systematically from respondents regarding the covariates.\u003c/p\u003e\u003cp\u003eAdditionally, an interaction analysis was conducted to assess whether the frequency of physical activity sessions modified the effect of the intervention. This did not show any differential results and was therefore not included in the result presentation.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographics\u003c/h2\u003e\u003cp\u003eA total of 149 individuals were recruited, of whom 52% were men, 37% had an F20 (schizophrenia) diagnosis, 22% lived together with another adult, and the mean age was 47.5 years, see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 44 participants (29.5%) did not complete any follow-up questions. Each analysis specifies the sample size (N) based on valid responses. No significant differences were identified between respondents and non-respondents for the covariates tested.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMeanN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74 (51.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (48.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (4.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (30.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (28.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (11.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u0026ndash;75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF-diagnoses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20 Schizophrenia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (37.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22 Persistent delusional disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (7.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23 Acute and transient psychotic disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24 Induced delusional disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25 Schizoaffective disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28 Other nonorganic psychotic disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29 Unspecified nonorganic psychosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39 Mood affective disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (5.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (10.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears with diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (11.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (33.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (19.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (8.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntipsychotics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (11.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e121 (89.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (55%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (21.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCohabitant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97 (78.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (21.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m^2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal weight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (17.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (49.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you use nicotine products?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (59.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (40.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol use: AUDIT result\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbstainer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (32.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow-risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58 (63.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHarmful/hazardous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (4.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow often do you drink alcohol?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (29.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1/month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46 (44.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;4/month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (18.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;3/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4+/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow often do you have 6\u0026thinsp;+\u0026thinsp;drinks on one occasion?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (76.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 1/month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (15.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvery month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvery week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFruit times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 to 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 to 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 to 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (12.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 (37.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVegetables times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 to 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (27.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 to 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 to 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (18.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (35.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeat times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 to 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (26.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 to 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (45.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 to 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCandy or soda times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 to 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (62.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 to 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (20.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 to 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (7.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (8.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eNicotine\u003c/h2\u003e\u003cp\u003eAt baseline, nicotine use was reported by 40.2% of participants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There were minimal changes between baseline and follow-up: two participants quit and two initiated use (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Due to lack of variation in responses, no further analysis of nicotine use was conducted.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges between baseline and follow-up data. Showing number of individuals, proportions and \u003cem\u003ep\u003c/em\u003e-value.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDecrease\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo Change N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIncrease\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNicotine use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69 (94.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eFishers exact\u003c/em\u003e\u003c/p\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol use\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAUDIT category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (80.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eWilcoxon signed-rank\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol intake frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (20.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46 (67.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBinge drinking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51 (78.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.600\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDietary habits\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFruit\u003c/p\u003e\u003cp\u003etimes/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26 (32.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.376\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVegetables times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (18.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeat\u003c/p\u003e\u003cp\u003etimes/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCandy or soda times/week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (14.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44 (62.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (23.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.232\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI category (kg/m^2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (8.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e97 (89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eBold indicates \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAlcohol\u003c/h3\u003e\n\u003cp\u003eHarmful/hazardous drinking was observed in 4.3% of participants at baseline (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Non-parametric tests indicated a change in AUDIT classification (3 classes) between baseline and follow-up (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the regression models, unadjusted and adjusted. The results show a decrease in AUDIT categories and alcohol use frequency, as well as an increase in binge drinking.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOrdinal logistic regression with dependent at baseline and follow-up, showing OR and 95% CI.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable \u003cem\u003e(reference category)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlcohol use, AUDIT category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAlcohol use frequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBinge drinking\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFruit times/week\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVegetables times/week\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMeat times/week\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCandy/soda times/week\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eUnadjusted\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime\u003c/b\u003e (\u003cem\u003eBaseline\u003c/em\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[0.24,1.18]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.42,1.46]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.46,2.34]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.48,1.47]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.44,1.36]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.54,1.79]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.66,2.38]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdjusted\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime\u003c/b\u003e \u003cem\u003e(Baseline)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[0.22,1.31]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.42,1.52]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.52,2.94]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.49,1.72]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.45,1.54]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.45,1.69]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.55,2.20]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (Cont.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.08\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.05\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1.04\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[0.94,1.03]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.96,1.03]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.91,1.01]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.04,1.12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[1.01,1.09]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[1.00,1.08]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.96,1.04]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e \u003cem\u003e(Male)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.31\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.36\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[0.90,5.84]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.86,3.52]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.30,2.06]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.15,0.67]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.40,1.68]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.17,0.76]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.43,2.14]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCohabitant\u003c/b\u003e \u003cem\u003e(No)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e3.71\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e2.42\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[1.05,13.12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[1.08,5.44]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.33,3.39]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.84,4.21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.75,3.79]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.42,2.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.16,1.10]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e \u003cem\u003e(Primary school)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighschool\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[0.48,4.70]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.49,2.81]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.37,3.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.38,7.87]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.37,1.91]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.44,2.31]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.51,3.35]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e8.59\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e[0.089,1.12]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e[0.17,1.13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[0.08,1.29]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[2.90,25.46]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.50,3.68]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.49,3.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.57,5.33]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody Mass Index\u003c/b\u003e (Cont.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[0.96,1.08]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[0.94,1.05]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.97,1.09]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e[0.99,1.13]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eBold indicates \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eDietary habits\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents baseline results for dietary habits. After the intervention, fruit, vegetable, and meat consumption had decreased compared to baseline while candy/soda consumption had increased (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). BMI had decreased compared to baseline (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to investigate whether a physical exercise intervention influenced nicotine use, alcohol use, and dietary habits in individuals with SSD.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eNicotine\u003c/h2\u003e\u003cp\u003eIn this study, 40% of participants reported nicotine use in the past month, aligning with prior findings of high smoking prevalence among individuals with SSD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In contrast, 5.4% of the general Swedish population smoke tobacco daily [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The high prevalence of nicotine use may partly reflect nicotine\u0026rsquo;s role of decreasing side-effects of neuroleptics and potential role of symptom management, where patients fear that quitting could worsen their psychotic symptoms [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur results suggest that participation in physical exercise sessions alone are insufficient to reduce nicotine use. Programs combining exercise with targeted nicotine cessation support may better address this issue [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Tailored smoking cessation programs should be considered to address the unique barriers individuals with SSD face in quitting [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAlcohol\u003c/h2\u003e\u003cp\u003eOnly about 4% met the criteria for harmful/hazardous drinking, a low prevalence consistent with prior findings among schizophrenia outpatients [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This contrasts with the general Swedish population, where 15.6% report harmful/hazardous drinking habits [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], as well as with reports that substance dependence is common in individuals with SSD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The latter discrepancy may reflect aggregation of alcohol with other substances.\u003c/p\u003e\u003cp\u003eLower prevalence of harmful/hazardous drinking among SSD outpatients may also relate to typically lower physical activity and sedentary lifestyles [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], as previous studies link higher physical activity to greater alcohol consumption [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial and economic factors may contribute to the low prevalence of drinking in this group, as stigma, exclusion, and social withdrawal reduce opportunities for social drinking, while financial constraints linked to employment challenges and discrimination may limit alcohol use due to its cost [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results indicate that exercise alone did not alter drinking habits. However, given the decreased AUDIT categories, decreased alcohol use frequency and increased binge drinking, future research with larger samples or longer interventions may be valuable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eDietary habits\u003c/h2\u003e\u003cp\u003eAlthough previous research has found poor dietary habits in individuals with SSD [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], our sample showed moderate adherence to general guidelines. Specifically, fruit and vegetable intake (37% and 36% \u0026ge; six times/week) approached the 500 g/day recommendation, which is met by only 20% of Swedes [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Meat consumption\u0026mdash;less than four times/week for 72% of participants\u0026mdash;aligned with the guideline of less than 500 g/week [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Given the link between meat consumption and higher income [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], this may reflect the lower socioeconomic status common among individuals with SSD [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Candy/soda were consumed one to two times per week by 63%, aligning with the approximately 60% of Swedes who meet sugar-intake norms [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Overall, these four measures suggest that this SSD cohort\u0026rsquo;s dietary habits were not markedly poor, although there is room for improvement, particularly in fruit and vegetable consumption.\u003c/p\u003e\u003cp\u003e A limitation of our study is the absence of gram-based response categories, which hinders direct comparison with general guidelines. Prior research comparing individuals with schizophrenia to matched controls found no direct differences, apart from lower fruit and vegetable consumption [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study observed increased candy/soda consumption and decreased fruit and vegetable intake after the intervention. This contrasts with general-population studies suggesting that physical activity can improve appetite control and reduce cravings for unhealthy food [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The intervention may have been too short to influence dietary behaviors. Alternatively, participants may require targeted nutritional support to change dietary habits. The observed BMI decrease deviates from the typical trajectory in this patient group, where obesity is common and antipsychotics often lead to weight gain [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. However, the BMI decrease was not associated with any of the studied lifestyle habits.\u003c/p\u003e\u003cp\u003eOverall, the intervention did not have a significant effect on the participants\u0026rsquo; nicotine use, alcohol consumption, or dietary habits. The conclusion is that additional interventions, on top of exercise programs, are needed to promote healthy lifestyle habits for nicotine, alcohol and food among individuals with SSD.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study used data from the FitForLife project, a single-arm intervention without a control group. While this design ethically allowed all eligible individuals to participate and avoided withholding a potentially beneficial exercise program [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], it limits statistical analyses by preventing comparison with a non-exposed group [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The six-month timeframe may have been too short to detect long-term behavioral changes, especially in entrenched habits such as nicotine use.\u003c/p\u003e\u003cp\u003eRecruiting 149 participants with SSD\u0026mdash;of whom 44 did not complete follow-up\u0026mdash;was reasonably robust given the challenges of engaging and retaining individuals with severe mental illnesses [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Although few results were significant, many showed marginal effects, suggesting that a larger sample might be needed. Notably, 52% of the participants were men, contributing to the representativeness of the sample, as men are generally underrepresented in studies [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] while often experiencing more severe symptoms [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn terms of potential selection bias, individuals who opted into the intervention may differ from those who declined. Logistic regression showed no significant differences in measured covariates between completers and non-completers, but unmeasured factors may still vary, so selection bias cannot be fully excluded.\u003c/p\u003e\u003cp\u003eThe dietary questions were chosen from nine questions originally designed for a microbiota study, four were used in the current study. These four were selected in collaboration with public health and nutrition researchers and broadly aligned with dietary recommendations [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The original nine questions were designed to be as few as possible to maximize responses. As these dietary items were not tailored specifically to the current study, future research should consider more precise or extensive dietary measures, including fiber intake and high-fat foods.\u003c/p\u003e\u003cp\u003eResponse rates varied, with some categories receiving few responses, possibly reflecting discomfort or fear of repercussions, especially regarding sensitive behaviors like nicotine or alcohol use. Although questionnaires were anonymous, administration within treatment settings may have led to under-reporting. Stigma remains a critical barrier in this population, potentially deterring honest reporting or proactive behavior change [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Addressing stigma and fear of repercussions may improve response rates and reporting accuracy in future interventions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAUDIT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlcohol use disorders identification test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\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\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence intervals\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSchizophrenia spectrum disorders\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\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\u003eThe FitForLife project has received ethical approval. It was approved by the Regional Ethics Review Board in Stockholm: 2019\u0026ndash;03409 and amendments. The trial is registered in the ClinicalTrials.Gov with the ID number: NCT04239612 (2019-10-28). Written informed consent was obtained from all participants during the initial visit. The study adhered to the ethical principles of the Helsinki Declaration.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was supported by grants from the Swedish Research Council for Health, Working Life and Welfare (In Swedish: Forskningsr\u0026aring;det f\u0026ouml;r h\u0026auml;lsa, arbetsliv och v\u0026auml;lf\u0026auml;rd) (FORTE, 2022\u0026thinsp;\u0026minus;\u0026thinsp;01254 YF), the Swedish Research Council (2018\u0026ndash;02723 YF; 2022\u0026thinsp;\u0026minus;\u0026thinsp;01188 CL). The funding sources had no role in the design or interpretation of this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYF designed the study. ACP analyzed the data. All authors worked with the manuscript and agreed on the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors wish to acknowledge and thank the staff at the psychiatric care units and all participants in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSwedish Board of Health and Welfare. Nationell utv\u0026auml;rdering av v\u0026aring;rd och st\u0026ouml;d vid schizofreni och schizofreniliknande tillst\u0026aring;nd \u0026ndash; 2022. 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Recruiting and retaining individuals with serious mental illness and diabetes in clinical research: lessons learned from a randomized, controlled trial. J Health Dispar Res Pract. 2016;9(3):115\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi R, Ma X, Wang G, Yang J, Wang C. Why sex differences in schizophrenia? J Transl Neurosci. 2016;1(1):37\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBecker R. Gender and survey participation: an event history analysis of the gender effects of survey participation in a probability-based multi-wave panel study with a sequential mixed-mode design. Methods Data Anal. 2022;16(1):30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Public Health Agency of Sweden. Stigmatisering kopplad till psykisk oh\u0026auml;lsa. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.folkhalsomyndigheten.se/publikationer-och-material/publikationsarkiv/s/stigmatisering-kopplad-till-psykisk-ohalsa/\u003c/span\u003e\u003cspan address=\"https://www.folkhalsomyndigheten.se/publikationer-och-material/publikationsarkiv/s/stigmatisering-kopplad-till-psykisk-ohalsa/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020). Accessed 21 Mar 2025.\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":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Alcohol, Dietary habits, Lifestyle habits, Physical activity, Schizophrenia spectrum disorder, Smoking, Nicotine","lastPublishedDoi":"10.21203/rs.3.rs-7585899/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7585899/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eIndividuals with schizophrenia spectrum disorders face challenges in maintaining healthy lifestyle habits and have a significantly reduced life expectancy, partly due to increased risks of somatic illness. While physical activity is known to offer broad health benefits, its influence on other lifestyle behaviours\u0026mdash;such as diet, alcohol consumption and nicotine use\u0026mdash;remains unclear. This study aimed to investigate whether an exercise intervention could affect these lifestyle habits in individuals with schizophrenia spectrum disorders (F20-29). This sub-study was part of a single-arm intervention conducted across 16 outpatient units in Sweden. Participants completed questionnaires before and after the six-month intervention. Analyses included descriptive comparisons, non-parametric tests and ordinal logistic regressions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn total, 149 individuals participated. After the intervention, nicotine use showed minimal change. There were patterns of decreased alcohol use, fruit, vegetable and meat consumption, along with increased candy consumption and binge drinking. Further interventions are needed to promote healthy lifestyle habits among individuals with schizophrenia spectrum disorders.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eThe trial is registered as \u0026ldquo;Fitforlife- Exercise in Care of Psychosis\u0026rdquo; in the ClinicalTrials.Gov with the ID number: NCT04239612 (2019-10-28).\u003c/p\u003e","manuscriptTitle":"The impact of a national exercise intervention on lifestyle habits among individuals with Schizophrenia spectrum disorders - Results from the FitForLife intervention study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:08:41","doi":"10.21203/rs.3.rs-7585899/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-12T16:09:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-16T09:47:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337018307047635465046048888813593262803","date":"2025-10-27T15:07:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-29T11:07:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-29T11:06:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-24T08:54:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-23T18:58:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2025-09-23T16:05:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b5584c8c-bd6c-4410-9fb6-160488f3bac1","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:00:50+00:00","versionOfRecord":{"articleIdentity":"rs-7585899","link":"https://doi.org/10.1186/s13104-026-07801-x","journal":{"identity":"bmc-research-notes","isVorOnly":false,"title":"BMC Research Notes"},"publishedOn":"2026-04-15 15:57:04","publishedOnDateReadable":"April 15th, 2026"},"versionCreatedAt":"2025-10-12 14:08:41","video":"","vorDoi":"10.1186/s13104-026-07801-x","vorDoiUrl":"https://doi.org/10.1186/s13104-026-07801-x","workflowStages":[]},"version":"v1","identity":"rs-7585899","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7585899","identity":"rs-7585899","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}