Background Lower back pain (LBP) is a common musculoskeletal disorder that may affect students’ daily lives. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior has not been established, and improving knowledge in this area may help develop preventive strategies and optimize college students’ quality of life. Methods A cross-sectional study of 1420 college students in Saudi Arabia was conducted, and participants who attended Saudi Universities were recruited from May 2021 to November 2021. An established validated online survey assessed LBP, sleep quality, time spent sedentary (sedentary duration), health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Generalized Linear Regression was used to assess the associations between LBP severity and lifestyle behaviors after controlling for covariates. Results LBP was prevalent among college students from Saudi Arabia. Most of the sample were young (23.81 ± 6.02), and female (83.7%). There were significant differences between students with and without LBP regarding age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=0.2, p < .001, CI: 16 to 0.24), and sedentary duration (ß=0.03, p = .01, CI:0.009 to 0.06). Conclusions This study helped define the prevalence of LBP in college students in Saudi Arabia and evaluated the association between LBP and lifestyle behaviors. The findings showed that students with higher levels of poor sleep quality or sedentary behavior had higher levels of pain. Promoting sleep quality and reducing sedentary behavior may help establish preventive strategies for LBP in college students.

Research question Lower back pain (LBP) is a common musculoskeletal disorder that may affect the daily living of students. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior was not established yet in which improving the knowledge in this area of research may help in establishing preventive strategies and optimizing the quality of life of college students. Methods A cross-sectional study of 1420 college students in Saudi Arabia was conducted and recruited from May 2021 to November 2021. An established online survey was utilized to assess LBP, sleep quality, sedentary duration, health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Results LBP was prevalent among college students from Saudi Arabia. There were significant differences between students with and without LBP in age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for Age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=.2, p < .001), and sedentary duration (ß=.03, p = .01) Conclusions The study helped in defining the prevalence of LBP in college students in Saudi Arabia, and evaluating the association between LBP and lifestyle behaviors. Promoting sleep quality and sedentary behavior may help in establishing preventive strategies of LBP for college students.