Factors Associated with Substance Use and Physical Activity Among German University Students 20 Months into the COVID-19 Pandemic.

Substance use (SU) and physical activity (PA) among university students changed with the beginning of the COVID-19 pandemic. In this study, we examined factors associated with SU and PA and profiles of these health behaviours in university students in Germany 20 months into the pandemic. A cross-sectional study on student well-being during the COVID 19-pandemic was conducted in October/November 2021 at five German universities. 7203 students completed the web-based survey. Smoking, binge drinking, cannabis use, and moderate and vigorous PA served as outcomes. Twenty months into the pandemic, 17% of students reported smoking, 19% binge drinking and 6% cannabis use at least once during the last week. 13% reported low moderate and 35% low vigorous PA in the last week. Students perceiving studies to be more important than other activities showed lower odds for SU. Depressive symptoms were associated with a higher chance of smoking (OR 1.07; 95%-CI 1.06-1.09 per one unit on the CESD-8-scale) and cannabis use (1.07; 95%-CI 1.04-1.09), low moderate (1.09; 95%-CI 1.07-1.11) and low vigorous (1.06; 95%-CI 1.05-1.07) PA. The 'health protective behaviour'-profile with high overall PA and low SU was the most common one found. Among other factors, perceiving studying to be less important than other activities and reporting depressive symptoms appear to play a role in reporting risky health behaviours. Prevention programmes should therefore be integrated in the university setting and address mental health issues and health behaviours simultaneously.