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. 2025 Dec;57(1):2522974.
doi: 10.1080/07853890.2025.2522974. Epub 2025 Jun 26.

Prevalence of lower back pain and its associations with lifestyle behaviors among university students in the West Bank, Palestine: a cross-sectional study

Mohammad Yaser Hasan Awad  1 , Haya Jebreen Mohammed Warasna  1 , Bashar Yaser Hasan Awad  1 , Mohamed E Shaaban  2 , Tasnim Ibrahim  3 , Iyad Yaser Hasan Awad  4 , Ahmad J Warasna  5 , Tarek A Owais  6 , Saif Khaled Abdalhadi Azzam  1 , Mahmoud Tareq Fadel ALAbed  7 , Reem J Saad  8
Affiliations

Prevalence of lower back pain and its associations with lifestyle behaviors among university students in the West Bank, Palestine: a cross-sectional study

Mohammad Yaser Hasan Awad et al. Ann Med. 2025 Dec.

Abstract

Background: Low back pain (LBP) represents a significant global health burden; however, its prevalence and association with lifestyle behaviors among Palestinian university students remain understudied. This study assessed the prevalence of LBP and its risk factors among university students in the West Bank.

Methods: A descriptive cross-sectional study was conducted among university students in the West Bank, Palestine, between November and December 2024. A total of 1396 students from 10 universities participated. Participants completed an online questionnaire that assessed demographics, LBP prevalence, pain severity, sleep quality (using the Pittsburgh Sleep Quality Index [PSQI]), and lifestyle behaviors (using the Health-Promoting Lifestyle Profile II [HPLP-II]). Descriptive statistics and univariate and multivariate analyses were used to examine the associations between LBP and various factors.

Results: The prevalence of LBP was 52%, with higher rates in females (79% vs. 21%, p < 0.001). Students with LBP had poorer sleep quality (median PSQI: 9.0 vs. 8.0, p < 0.001) and lower HPLP-II scores (131 vs. 137, p < 0.001). Multivariate analysis identified poor sleep as an independent predictor of pain severity (p = 0.0003). Notably, the 1-point PSQI difference fell below the established clinical significance thresholds (MCID=3-5 points).

Conclusions: LBP is highly prevalent among university students in the West Bank, with notable associations with poor sleep quality, unhealthy lifestyle behaviors, and higher BMI. These findings emphasize the need for interventions targeting improved sleep quality, stress management, and the promotion of physical activity. Future research should investigate the causal relationships and explore the long-term outcomes of lifestyle modification in LBP.

Keywords: LBP; lifestyle behaviors; physical activity; prevalence; sleep quality; stress management; university students.

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Conflict of interest statement

The authors declare that they have no competing interests.

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