ArticleFrontiers in public health2026
Lifestyle factors or protective behaviors: which are more strongly associated with upper respiratory tract infections after COVID-19? A cross-sectional study of 1,535 Chinese college students.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Respiratory pathogens have resurged following the COVID-19 pandemic. College students are socially active and often live or study in congregate settings, which may place them at continued risk of upper respiratory tract infection (URTI). Objective: To compare the strength of the associations of lifestyle factors and protective behaviors with the number of URTI episodes among college students in the post-COVID-19 period. Methods: We conducted a cross-sectional survey from June 1 to June 30, 2024, among 2,100 students at six universities in southeastern China. Students were eligible if their first SARS-CoV-2 infection had occurred at least 1 year before the survey. We collected the number of URTI episodes from June 1, 2023, to June 1, 2024, together with demographic, lifestyle, and protective-behavior data. The analysis included 1,535 valid questionnaires. Hierarchical negative binomial regression was used. Demographic variables were entered in the baseline model, after which lifestyle factors and protective behaviors were added sequentially. Their entry order was then reversed to compare the relative contribution of each variable group. Results: When entered first into the baseline model, lifestyle factors produced a greater improvement in model fit than did protective behaviors (Δ Conclusion: Lifestyle factors were more strongly associated with URTI episodes than protective behaviors among college students in the post-COVID-19 period. These findings suggest that modifiable lifestyle factors, including sleep, physical activity, and sedentary behavior, as well as natural ventilation, may be relevant targets for campus health strategies.
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