Associations between modifiable lifestyle choices and academic performance over the first year of university: A longitudinal cohort study

Objective: To examine associations between lifestyle choices and academic performance, considering differences by gender and the potential influence of psychopathology. Participants: 1,447 first-year Canadian undergraduates. Methods: Exposures from the Fall 2021 U-Flourish survey included substance use, exercise, sleep, self-care, and screen time. Multivariable linear regressions estimated associations between exposures and cumulative GPA at year-end. Results: Males more commonly reported weekly binge drinking (17.7 vs. 12.2%, p = 0.01) and ≥7 h/day of leisure screen time (19.1 vs. 14.7%, p = 0.05), while females more commonly reported smoking tobacco/vaping in the past month (29.2 vs. 22.4%, p = 0.01). Poor sleep, daily smoking, and leisure screen time were independently associated with a lower average GPA. Multiple unhealthy lifestyle choices showed a dose-response association with lower GPA, particularly among females; adjustment for depressive symptoms partially attenuated these associations. Conclusion: Clustering of unhealthy lifestyle choices cumulatively undermines academic performance, underscoring the need for proactive, integrated health promotion targeting undergraduates.