An Investigation of COVID-19 Outcomes and College Student Demographics: Results from a National Sample

Abstract

Purpose

To assess the effects of COVID-19 on college students and any differential outcomes across collegiate sub-populations towards the beginning of the pandemic.

Design

Cross-sectional survey.

Setting

Fall 2020 American College Health Association-National College Health Assessment.

Subjects

N = 13 373 undergraduate/graduate/professional students; 22 colleges/universities.

Measures

Six COVID-19 outcomes; 10 demographics.

Analysis

Campus-specific weights for student enrollment/sex distribution. Cross-tabulations/Pearson χ² test; Cramer’s V/effect size; Bonferroni multiple testing correction (P < .0009).

Results

5.6% of students had been diagnosed with COVID-19. Compared to counterparts within each demographic category, rates were significantly higher among many BIPOC student groups (e.g., Native Hawaiian/Other Pacific Islander: 15.0%); cisgender women (5.9%) and men (5.6%); heterosexuals (6.1%); undergraduates (6.3%); and sorority/fraternity members (13.7%). Due to COVID-19, 8.8% of students had lost a loved one; 14.6% had a loved one with long term effects from COVID; 38.6% had increased stress; 61.4% had more financial concerns; and 52.7% had more difficulty accessing mental healthcare. Students identifying as BIPOC; cisgender women and transgender/gender non-conforming (TGNC); queer-spectrum; undergraduate; first-generation; having a disability; and taking courses online were significantly more affected by most of these outcomes (all comparisons P < .0009).

Conclusions

Students were widely impacted by COVID-19 with substantive differences across sub-populations. Future research should examine trends over time and explore ways to reduce health disparities.

Keywords

COVID-19 students outcomes demographics colleges/universities institutions of higher education

Purpose

There have been over 90 million cases of COVID-19 and more than one million deaths in the U.S.¹ Colleges and universities, which enroll 20 million students annually,² are a high-risk environment for COVID-19 transmission³ and contribute to community spread.⁴ COVID-19 can cause major morbidity among young people,^5,6 and college campuses are a critical setting for COVID-19 mitigation efforts.⁷ Research on college students and COVID-19 has primarily focused on the mental health of students enrolled at a single institution or in a small national sample,⁸ with most studies finding that students’ mental health has deteriorated as a result of the pandemic. Nominal information exists utilizing more substantive samples, assessing other issues related to COVID-19, or investigating differential impacts across collegiate sub-populations. The present study fills these gaps by examining numerous COVID-19 outcomes and their relationship with multiple college student demographics within a large national sample towards the beginning of the COVID-19 pandemic.

Methods

This study is secondary data analysis of the Fall 2020 American College Health Association-National College Health Assessment III, an established online comprehensive college health survey administered among self-selected colleges/universities each semester.⁹ Institutions in the national dataset surveyed a census or random sample of students. Variables of interest for the current study, operational definitions, and response options are in Table 1; the full instrument is available for review elsewhere.¹⁰ Each participating institution had Institutional Review Board (IRB) approval.

Table 1.

Weighted Analyses of Student Demographics and COVID-19 Outcomes.

	Weighted Overall Sample (%)	Had COVID-19			Loved One with Long Recovery			Loved One Died Due to COVID-19			Significant Increase in Stress			More Stressful Financial Situation			More Difficult Access to Mental Health Care
		%	Sig (p)	Effect size (ϕc)	%	Sig (p)	Effect size (ϕc)	%	Sig (p)	Effect size (ϕc)	%	Sig (p)	Effect size (ϕc)	%	Sig (p)	Effect size (ϕc)	%	Sig (p)	Effect size (ϕc)
All respondents		5.6			14.6			8.8			38.6			61.4			52.7
Gender			.001	.025		<.0009^a	.067		<.0009^a	.067		<.0009^a	.173		<.0009^a	.096		<.0009^a	.070
Cis Woman	51.3	5.9			16.6^b			10.5^b			45.3^b			65.4^b			49.9^b
Cis man	44.4	5.6			11.9^b			6.7^b			29.5^b			56.4^b			55.9
Transgender/Gender non-conforming	4.30	3.0			17.7^b			10.4			54.8^b			68.6^b			60.0
Sexual orientation^c			<.0009^a	.042		<.0009^a	.041		.001	.022		<.0009^a	.127		<.0009^a	.048		<.0009^a	.109
Straight/Heterosexual	79.0	6.1			13.8			8.4			35.4			60.3			48.5
Queer-spectrum	21.0	3.7			17.4			10.0			50.6			66.1			59.7
Race^d			<.0009^a	.071		<.0009^a	.121		<.0009^a	.146		<.0009^a	.069		<.0009^a	.104		.005	.065
American Indian or Native Alaskan	0.5	8.0			18.9			18.8^e			35.7			63.4			23.1
Asian or Asian American	9.9	2.0^e			10.2^e			9.6			35.1^e			61.3			52.0
Black or African American	6.0	3.9			15.6			14.6^e			35.2			64.4			50.2
Hispanic/Latinx	7.6	9.0^e			26.7^e			19.0^e			47.7^e			77.0^e			54.0
Middle Eastern/North African (MENA)	0.8	9.8			25.5^e			18.6^e			41.6			60.7			55.3
Native Hawaiian/Other Pacific Islander	0.1	15.0			23.8			19.0			38.1			66.7			12.5
White	64.4	5.8			12.8^e			6.2^e			37.7^e			58.6^e			52.1
Biracial/Multiracial	9.5	5.9			18.9^e			12.3^e			43.2^e			65.2^e			57.9
Disability status^f			.645	.003		<.0009^a	.048		<.0009^a	.039		<.0009^a	.091		<.0009^a	.043		<.0009^a	.061
No	80.0	5.6			13.8			8.2			36.2			60.3			50.2
Yes	20.0	5.8			18.1			11.0			47.3			65.6			56.6
Degree level			<.0009^a	.057		.241	.008		.324	.007		<.0009^a	.037		<.0009^a	.091		<.0009^a	.100
Undergraduate	78.4	6.3			14.4			8.7			39.6			63.9			55.2
Graduate/Professional	21.6	3.1			15.1			9.1			35.2			53.1			43.0
First generation college student^g			.093	.012		<.0009^a	.054		<.0009^a	.056		<.0009^a	.061		<.0009^a	.137		.249	.016
No	62.3	5.4			13.2			7.6			36.4			56.4			52.0
Yes	37.7	6.0			17.2			10.9			42.5			70.1			53.8
Parent/Guardian of child under 18^h			.080	.012		.255	.008		.242	.008		.201	.009		.035	.014		.011	.036
No	94.2	5.7			14.6			8.7			38.4			61.3			53.1
Yes	5.8	4.5			15.7			9.7			40.3			64.3			45.7
Sorority/Fraternity			<.0009^a	.114		.030	.015		.243	.008		.359	.006		.003	.020		.046	.028
No	90.6	4.8			14.4			8.8			38.5			61.2			53.1
Yes	9.4	13.7			16.2			8.1			39.5			64.5			48.3
Learning mode			.002	.024		<.0009^a	.070		<.0009^a	.076		<.0009^a	.077		<.0009^a	.052		.219	.024
In-person	3.6	5.2			11.5			6.5			28.6^b			58.7			58.1
Online	39.3	6.3			17.6^b			11.4^b			42.9^b			64.6^b			53.4
Both	57.1	5.1			12.7^b			7.1^b			36.2^b			59.5^b			51.8

^aOverall Chi Square significance based on the Bonferonni adjustment at P < .0009.

^bPost hoc significance based on the Bonferroni adjustment at P < .009.

^cQueer-spectrum included asexual, bisexual, gay, lesbian, pansexual, queer, questioning, and identity not listed.

^dRace/ethnicity was select all that apply. Participants who checked more than one option they were categorized as biracial/multiracial.

^ePost hoc significance based on the Bonferroni adjustment at P < .003.

^fDisability included one or more of the following: ADD/ADHD, Autism Spectrum Disorder, deaf/hearing loss, mobility/dexterity disability, blind/low vision, or speech/language disorder.

^gFirst-generation was defined as not having a parent/guardian who had completed a bachelor's degree.

^hParent/Guardian was defined as having primary responsibility for a child/children under the age of 18.

For analysis, because female students were overrepresented, campus-specific weights were computed based on the sex distribution of each institution’s overall student population and the same aggregate weight was given to each institution to ensure schools with larger student enrollments were not overrepresented. Cross-tabulations with the Pearson χ² test examined differences across demographic groups. The Bonferroni multiple testing correction set significance at P < .0009 (.05/54). Cramer’s V assessed effect size. Post-hoc tests using adjusted residuals were conducted for analyses beyond 2 × 2 tables.

Results

There were 13 373 student respondents from 22 institutions. Student demographic characteristics are in Table 1. Over two-thirds (68.1%) of participating institutions were public and institutions were almost equally divided by enrollment sizes of less than 2500, 2500-9999, 10 000-19 999, and 20 000 or more students. Schools were well represented in the Northeast (32%), Midwest (23%), and South (41%), with fewer in the West (5%). There was a mean 14% response rate across participating schools.

All results are in Table 1. Although students were widely affected by COVID-19, specific sub-populations were disproportionately impacted. Almost 6% of students reported having had COVID-19. Rates were particularly high among Native Hawaiian/Other Pacific Islander (15.0%), Middle Eastern/North African (9.8%), Hispanic/Latinx (9.0%), and American Indian or Native Alaskan (8.0%) students. Compared to their counterparts, infection rates were also significantly higher among students who identified as cisgender women and men, heterosexual, undergraduate, and markedly among sorority/fraternity members.

Almost 15% of students reported having a loved one with long term effects/a long recovery from COVID-19, and almost 9% lost a loved one to COVID-19. Some students’ loss was particularly alarming; for example, almost one-fifth of students who identified as American Indian or Native Alaskan, Hispanic/Latinx, Middle Eastern/North American, and Native American/Other Pacific Islander had a loved one die from COVID-19. Of the latter 3 groups, almost one-quarter had a loved one with lingering symptoms from COVID-19. Students who identified as cisgender women and transgender/gender non-conforming (TGNC), queer-spectrum, having a disability, first generation, and learning wholly online experienced the greatest amount of loss and severe illness among loved ones.

A substantial portion of students reported increased stress due to COVID-19 (38.8%), with students who identified as cisgender women and TGNC, queer-spectrum, Hispanic/Latinx, having a disability, undergraduate, first generation, and learning completely online reporting significantly more stress than their counterparts. There were similar trends among students who reported having a more stressful financial situation due to COVID-19 (61.4% overall).

Among those students who sought mental health services, more than half (52.7%) reported services became more difficult to access, with students identifying as cisgender men and TGNC, queer-spectrum, having a disability, and undergraduates having significantly more difficulty than their peers. There were no significant differences in challenges faced due to COVID-19 based on sorority/fraternity membership or parenting status. Although the differences described were statistically significant at the P < .0009 level, there were weak effect sizes across analyses.

Discussion

This research illuminates several ways COVID-19 impacted college students towards the beginning of the pandemic and is one of the few studies to assess differences in COVID-19 related outcomes based on student demographics. Findings reveal that students have been broadly affected by COVID-19 and that the challenges confronted due to COVID-19 may be a unifying experience for many students. However, some groups have been disproportionately burdened. Results align with recognized disparities related to COVID-19 case and death rates as well as financial stress based on race/ethnicity at the U.S. population level.^11,12 The current study demonstrates that college students and their loved ones are not exempt from these trends. National data also track COVID-19 cases by sex, represented as female and male;¹¹ this study shows the importance of extending this binary to include TGNC individuals. Additionally, similar to other research that investigated the impact of COVID-19 on LGBTQ college students, this study also found that TGNC and queer-spectrum students were disproportionately affected by consequences related to COVID-19; however, the prior study found that LGBTQ students were more likely to have been diagnosed with COVID-19 whereas this study found the opposite.¹³

This research also expands current understandings of how other student groups have been impacted by COVID-19. As with individuals with marginalized identities related to race/ethnicity, gender, and sexual orientation, students with disabilities and first generation college students also faced disproportionate challenges. The reasons behind these disparities are likely multi-faceted and relate to historical and current oppression and social determinants of health. Prior work posited that COVID-19 would exacerbate known health inequities among college students that existed prior to the pandemic¹⁴; the current study provides evidence for this supposition.

This study also assessed COVID-19 outcomes based on students’ learning modality. Students who were solely taking classes online fared worse related to their loved ones, stress, and finances compared to students completing coursework in-person or in a hybrid fashion. It is possible that these challenges may have led students to pursue online learning exclusively; yet there is also the potential that online learning intensified some existing concerns. Although there has been substantial research comparing student learning outcomes between online vs in-person classes, these findings demonstrate that future research should also examine the relationship between students’ learning mode and their well-being, particularly as online education continues to become more widespread.

These results have important implications for higher education professionals during and in the aftermath of the COVID-19 crisis. They provide valuable insight into the COVID-19 related challenges that all students faced while navigating their first full academic term during the pandemic and expose numerous disparities within the collegiate community. Prior to the pandemic, there were already alarming rates of mental health concerns among college students, with campuses struggling to meet students’ needs.¹⁵ The additional sustained challenges that students now face due to COVID-19 make providing expansive and culturally responsive support services even more critical, particularly for collegiate sub-populations most deeply impacted. Using the current findings as a baseline for tracking outcomes as time moves forward will be crucial to support students during the ongoing COVID-19 pandemic and to understand the student experience as academic institutions prepare for potential future public health emergencies.

This study extends and strengthens the literature by having a robust national sample and examining multiple outcomes related to COVID-19 among a key at-risk population and multiple sub-populations therein. Limitations include a convenience sample with a cross-sectional design and a low response rate with predominantly 4-year institutions. Additionally, despite major descriptive and statistically significant differences between demographic groups, effect sizes were weak; more nuanced examination is needed to determine possible contributing factors. Future research should also assess how findings evolve over time and explore underlying reasons behind them, especially through qualitative research on students’ lived experiences. More research is also needed on vaccination and other mitigation strategies on college campuses (e.g., masking, testing) given varying institutional policies,¹⁶ and the most effective approaches to enhance overall student well-being in the era of COVID-19.

So What?

What is already known on this topic?

COVID-19 causes substantial morbidity and college campuses are a high-risk environment for COVID-19 infection and transmission.

What does this article add?

Little is known about COVID-19 infection rates and COVID-19-related hardships among college students. This article contributes vital information about these outcomes and their differential effects across multiple collegiate sub-populations based on a large national sample at the outset of the pandemic.

What are the implications for health promotion practice or research?

College students are widely impacted by COVID-19, with specific sub-populations experiencing health disparities. Colleges and universities are well-situated to provide resources and services to students as the COVID-19 pandemic persists, with prioritization to groups that may be particularly vulnerable. Continued research is needed to track these outcomes over time.

Footnotes

Author Contributions

All authors contributed to the conceptualization of this paper. Mary Hoban and Christine Kukich led the analysis. Alyssa Lederer led the writing.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Alyssa M. Lederer

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