Jasna Lulić Drenjak1, Miran Pehar2, Edin Užičanin3, Dean Kontić4, Natasa Zenic5

1Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
2Faculty of Science and Education, University of Mostar, Mostar, Bosnia and Herzegovina
3Faculty of Physical Education and Sport, University of Tuzla, Tuzla, Bosnia and Herzegovina
4University of Dubrovnik, Dubrovnik, Croatia
5Faculty of Kinesiology, University of Split, Split, Croatia

Physical activity, sport participation, and cigarette smoking in university students after COVID-19 pandemic; Cross sectional analysis of the associations in south-eastern Europe

Monten. J. Sports Sci. Med. 2023, 12(1), 61-68 | DOI: 10.26773/mjssm.230308


Cigarette smoking (CS) and low physical activity levels (PAL) are known to be risk factors for cardiovascular diseases. However, few studies have examined the associations between these factors in population of university students, and, to the best of our knowledge, no study examined this issue in period after the COVID-19 pandemic, despite the detrimental social and health consequences of the pandemic. The aim of this cross-sectional study was to examine associations between sport-participation, PAL and CS among university-level students in the first year after the COVID-19 pandemic. Participants were 761 students (411 females) from three universities in Bosnia and Herzegovina and Croatia, who were tested using semi-structured anonymous questionnaires at the beginning of the 2022/2023 academic year. Questions included queries on sociodemographic characteristics, CS, PAL, and sport-participation. Differences between genders were established by Chi-square test and gender-stratified logistic regressions were calculated to evaluate the associations between sport-participation and PAL, with binomized CS (smoking vs. non-smoking). One third of participants were daily smokers. Logistic regression showed no correlation between PAL and smoking prevalence for total sample (OR = 0.88, 95%CI: 0.75-1.05), males (OR = 0.95, 95%CI: 0.41-1.45), or females (OR = 0.90, 95%CI: 0.54-1.52). In addition, sport participation was not significantly associated with smoking. Results did not prove that sport and physical exercising are a way of reducing the likelihood of smoking; this finding could be a characteristic of the studied sample of participants, but could also be related to the period that was observed (the first year after the COVID-19 pandemic). Further studies examining the associations between PAL/sport participation and other types of substance misuse are warranted.


substance misuse, physical exercising, students, sport participation

View full article
(PDF – 250KB)


Ajman, H., Novak, D., & Mišigoj-Duraković, M. (2019). Social capital and physical activity among Croatian high school students: a school type-based cross-sectional study. Medica Jadertina, 49(2), 75-83.

Bagarić, I., Špehar, N., & Zvonarek, N. (2005). Physical education and sports at Zagreb and other Croatian universities. Paper presented at the 4th International Scientific Conference on Kinesiology: Science and profession-challenge for the future: proceedings book.

Bedford, J., Enria, D., Giesecke, J., Heymann, D. L., Ihekweazu, C., Kobinger, G., . . . Wieler, L. H. (2020). COVID-19: towards controlling of a pandemic. Lancet, 395(10229), 1015-1018. https://doi.org/10.1016/s0140-6736(20)30673-5

Caput-Jogunica¹, R., Neljak, B., & Ćurković¹, S. (2013). The role and challenges of physical education at the Croatian Universities.

Caputo, E. L., & Reichert, F. F. (2020). Studies of Physical Activity and COVID-19 During the Pandemic: A Scoping Review. J Phys Act Health, 1-10. https://doi.org/10.1123/jpah.2020-0406

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep, 100(2), 126-131.

Castañeda-Babarro, A., Arbillaga-Etxarri, A., Gutiérrez-Santamaría, B., & Coca, A. (2020). Physical Activity Change during COVID-19 Confinement. International Journal of Environmental Research and Public Health, 17(18), 6878. https://doi.org/10.3390/ijerph17186878

Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta Biomed, 91 (1), 157-160. https://doi.org/10.23750/abm.v91i1.9397

Daskalopoulou, C., Stubbs, B., Kralj, C., Koukounari, A., Prince, M., & Prina, A. M. (2017). Physical activity and healthy ageing: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev, 38, 6-17. https://doi.org/10.1016/j.arr.2017.06.003

De Martelaer, K., & STRUYVEN, J. D. B. K. (2012). Youth sport ethics: teaching pro-social behaviour. In Ethics in Youth Sport (pp. 69-87): Routledge.

Florić, O. K., & Ninković, S. (2013). The contribution of sport to prosocial behavior in youth. Stanisław Juszczyk, 175.

Fogelholm, M., Malmberg, J., Suni, J., Santtila, M., Kyrolainen, H., Mantysaari, M., & Oja, P. (2006). International Physical Activity Questionnaire: Validity against fitness. Med Sci Sports Exerc, 38(4), 753-760. https://doi.org/10.1249/01.mss.0000194075.16960.20

Geets Kesic, M., Gilic, B., Cerkez Zovko, I., Drid, P., Korovljev, D., & Sekulic, D. (2021). Differential impact of COVID-19 lockdown on physical activity in younger and older adolescents - prospective study. Med Pr, 72(6), 633-643. https://doi.org/10.13075/mp.5893.01180

Gilic, B., Ostojic, L., Corluka, M., Volaric, T., & Sekulic, D. (2020). Contextualizing Parental/Familial Influence on Physical Activity in Adolescents before and during COVID-19 Pandemic: A Prospective Analysis. Children (Basel), 7(9). https://doi.org/10.3390/children7090125

Gilic, B., Zenic, N., Separovic, V., Jurcev Savicevic, A., & Sekulic, D. (2021). Evidencing the influence of pre-pandemic sports participation and substance misuse on physical activity during the COVID‑19 lockdown: a prospective analysis among older adolescents. Int J Occup Med Environ Health, 34(2), 151-163. https://doi.org/10.13075/ijomeh.1896.01733

Giustino, V., Parroco, A. M., Gennaro, A., Musumeci, G., Palma, A., & Battaglia, G. (2020). Physical Activity Levels and Related Energy Expenditure during COVID-19 Quarantine among the Sicilian Active Population: A Cross-Sectional Online Survey Study. Sustainability, 12(11), 4356.

Gonzalez, M., Epperson, A. E., Halpern-Felsher, B., Halliday, D. M., & Song, A. V. (2021). Smokers Are

More Likely to Smoke More after the COVID-19 California Lockdown Order. Int J Environ Res Public Health, 18(5). https://doi.org/10.3390/ijerph18052582

Grogan, S., Walker, L., McChesney, G., Gee, I., Gough, B., & Cordero, M. I. (2022). How has COVID-19 lockdown impacted smoking? A thematic analysis of written accounts from UK smokers. Psychology & Health, 37(1), 17-33.

Guo, H., Reeder, A. I., McGee, R., & Darling, H. (2011). Adolescents' leisure activities, parental monitoring and cigarette smoking--a cross-sectional study. Subst Abuse Treat Prev Policy, 6, 12. https://doi.org/10.1186/1747-597X-6-12

Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2020). Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants. Lancet Child Adolesc Health, 4(1), 23-35. https://doi.org/10.1016/s2352-4642(19)30323-2

Hagstromer, M., Oja, P., & Sjostrom, M. (2006). The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr, 9(6), 755-762. https://doi.org/10.1079/phn2005898

Hallal, P. C., Victora, C. G., Azevedo, M. R., & Wells, J. C. (2006). Adolescent physical activity and health: a systematic review. Sports Med, 36(12), 1019-1030. https://doi.org/10.2165/00007256-200636120-00003

Hecht, S. S. (2002). Cigarette smoking and lung cancer: chemical mechanisms and approaches to prevention. The lancet oncology, 3(8), 461-469.

Idrizovic, K., Zenic, N., Tahirajl, E., Rausavljevic, N., & Sekulic, D. (2015). Cigarette Smoking among 17-18 Year Old Adolescents - Prevalence and Association with Sociodemographic, Familial, Sport, and Scholastic. Factors. Med Pr, 66(2), 153-163. https://doi.org/10.13075/mp.5893.00104

Kaleta, D., Korytkowski, P., & Makowiec-Dabrowska, T. (2013). Cigarette Smoking among Economically Active Population. Medycyna Pracy, 64(3), 359-371. Retrieved from ://WOS:000326993500008

Maric, D., Bianco, A., Kvesic, I., Sekulic, D., & Zenic, N. (2021). Analysis of the Relationship between Tobacco Smoking and Physical Activity in Adolescence: A Gender Specific Study. Medicina (Kaunas), 57(3). https://doi.org/10.3390/medicina57030214

Mayer, D., Simetin, I. P., Rodin, U., Benjak, T., Puntaric, E., & Puntaric, I. (2015). The impacts of media messaging and age and sex variance on adolescent smoking habits in Croatia. J Addict Med, 9(2), 147-154. https://doi.org/10.1097/ADM.0000000000000070

Milosevic Georgiev, A., Kotur-Stevuljevic, J., & Krajnovic, D. (2019). Socio-demographic Factors Associated with Smoking Habits Among University Students in Belgrade, Serbia. Zdr Varst, 58(1), 11-20. https://doi.org/10.2478/sjph-2019-0002

Modric, T., Zenic, N., & Sekulic, D. (2011). Substance use and misuse among 17- to 18-year-old Croatian adolescents: correlation with scholastic variables and sport factors. Subst Use Misuse, 46(10), 1328-1334. https://doi.org/10.3109/10826084.2011.579677

Mundal, R., Kjeldsen, S. E., Sandvik, L., Erikssen, G., Thaulow, E., & Erikssen, J. (1997). Predictors of 7-year changes in exercise blood pressure: effects of smoking, physical fitness and pulmonary function. Journal of hypertension, 15(3), 245-249.

Narici, M., De Vito, G., Franchi, M., Paoli, A., Moro, T., Marcolin, G., . . . Maganaris, C. (2020). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science, 1-22. https://doi.org/10.1080/17461391.2020.1761076

Onofre, M., Marques, A., Moreira, R., Holzweg, M., Repond, R.-M., & Scheuer, C. (2012). Physical education and sport in Europe: From individual reality to collective desirability (Part 2). International Journal of Physical Education, 49(3), 17-31. v

Organization, W. H. (2018). WHO global report on trends in prevalence of tobacco smoking 2000-2025: World Health Organization.

Rodriguez Garcia, P. L., Lopez Villalba, F. J., Lopez Minarro, P. A., & Garcia Canto, E. (2013). [Relationship between tobacco consumption and physical exercise in adolescents. Differences between genders]. Adicciones, 25(1), 29-36. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23487277

Samardzic, S., Marvinac, G. V., & Prlic, A. (2009). Regional pattern of smoking in Croatia. Coll Antropol, 33 Suppl 1, 43-46. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19563146

Saris, W. H. (1986). Habitual physical activity in children: methodology and findings in health and disease. Medicine & Science in Sports & Exercise.

Sekulic, D., Ostojic, D., Decelis, A., Castro-Pinero, J., Jezdimirovic, T., Drid, P., . . . Gilic, B. (2021). The Impact of Scholastic Factors on Physical Activity Levels during the COVID-19 Lockdown: A Prospective Study on Adolescents from Bosnia and Herzegovina. Children (Basel), 8(10). https://doi.org/10.3390/children8100877v

Sekulic, D., Ostojic, M., Ostojic, Z., Hajdarevic, B., & Ostojic, L. (2012). Substance abuse prevalence and its relation to scholastic achievement and sport factors: An analysis among adolescents of the Herzegovina-Neretva Canton in Bosnia and Herzegovina. BMC public health, 12(1), 274. https://doi.org/10.1186/1471-2458-12-274

Sekulic, D., Rodek, J., & Sattler, T. (2020). Factors associated with physical activity levels in late adolescence: a prospective study. Med Pr, 71 (6), 637-647. https://doi.org/10.13075/mp.5893.01012

Sekulic, D., Sisic, N., Terzic, A., Jasarevic, I., Ostojic, L., Pojskic, H., & Zenic, N. (2017). Sport and scholastic factors in relation to smoking and smoking initiation in older adolescents: a prospective cohort study in Bosnia and Herzegovina. BMJ Open, 7(3), e014066. https://doi.org/10.1136/bmjopen-2016-014066

Stefan, L., Kasovic, M., & Zvonar, M. (2020). Association between the levels of physical activity and plantar pressure in 6-14-year-old children. PeerJ, 8, e8551. https://doi.org/10.7717/peerj.8551

Škegro, D., & Čustonja, Z. (2014). The beginnings of education and training for delivering physical education classes in Croatia–140 years of tradition. Kinesiology, 46(Supplement 1.), 127-133.

Telama, R. (2009). Tracking of physical activity from childhood to adulthood: a review. Obes Facts, 2(3), 187-195. https://doi.org/10.1159/000222244

Vink, J. M., & Boomsma, D. I. (2011). Interplay between heritability of smoking and environmental conditions? A comparison of two birth cohorts. BMC Public Health, 11, 316. https://doi.org/1471-2458-11-316 [pii] 10.1186/1471-2458-11-316

Whooten, R., Kerem, L., & Stanley, T. (2019). Physical activity in adolescents and children and relationship to metabolic health. Curr Opin Endocrinol Diabetes Obes, 26(1), 25-31. https://doi.org/10.1097/med.0000000000000455

Wiley, R. C., Oliver, A. C., Snow, M. B., Bunn, J. Y., Barrows, A. J., Tidey, J. W., . . . Heil, S. H. (2023). The impact of the Covid-19 pandemic on smoking among vulnerable populations. Nicotine and Tobacco Research, 25(2), 282-290.

Zenic, N., Ban, D., Jurisic, S., Cubela, M., Rodek, J., Ostojic, L., . . . Sekulic, D. (2017). Prospective Analysis

of the Influence of Sport and Educational Factors on the Prevalence and Initiation of Smoking in Older Adolescents from Croatia. Int J Environ Res Public Health, 14(4). https://doi.org/10.3390/ijerph14040446