Lifestyle Behaviors and their association with self-rated health among university students in Spain: A cross-sectional study

Abstract

Objective To evaluate lifestyle behaviors, gender differences, and factors independently associated with unfavorable self-rated health (SRH) among university students. Methods In this cross-sectional study, 453 university students at a private university in Spain completed a baseline assessment of SRH, physical activity (PA), sedentary behavior, Mediterranean diet adherence, sleep quality, perceived stress, and substance use in September 2025. Associations with unfavorable SRH were analyzed using multivariable logistic regression (n = 426). Results Although 83.44% reported favorable SRH, women reported poorer SRH and higher stress, while men showed higher PA and at-risk drinking (p < 0.05). In multivariable analysis, perceived stress was strongly associated with unfavorable SRH (OR = 1.10, 95% CI: 1.05, 1.16). Being a man (OR = 0.46, 95% CI: 0.23, 0.93) and Mediterranean diet adherence (OR = 0.82, 95% CI: 0.68, 0.97) were associated with lower odds of unfavorable SRH. PA, sleep quality, and substance use showed no independent associations. Conclusions Perceived stress is the primary factor associated with unfavorable SRH. University health promotion strategies should integrate psychological support with lifestyle interventions. However, findings should be interpreted cautiously given the predominance of students from health-related disciplines.