Risk Factors for COVID-19 in College Students Identified Using Physical, Mental, and Social Health Reported During the Fall 2020 Semester: An Observational Mobile Health Technology Study (Preprint)

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic triggered a seismic shift in education, to online learning. With nearly 20 million students enrolled in colleges across the U.S., the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. OBJECTIVE This study leveraged mobile health (mHealth) technology and sought to: i) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; ii) assess physical activity through consumer-grade wearable sensors (Fitbit®); and iii) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. METHODS Detailed methods were previously published in JMIR Res Protocols (Cislo et al). After completing a baseline assessment (i.e., Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, to wear the Fitbit®, and complete subsequent assessments at T1, T2 and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using means (M) and standard deviations (SD), while categorical measures were summarized using frequencies and proportions. Formal comparisons were made based on COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<0.05) in univariable associations at once and then removing one variable at a time by backward selection until the optimal model was obtained. RESULTS During the fall 2020 semester, 1,997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index (STAI), with moderate and severe levels in N=465 (24%) and N=970 (49%) students, respectively. Approximately, one-third of students reported having a mental health disorder (N=656, 33%). The average daily steps recorded in this student population was approximately 6500 (M=6474, SD=3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=0.52). Our analyses revealed significant associations of COVID-positivity with use of marijuana and alcohol (p=0.020 and 0.046, respectively) and lower belief in public health measures (P=0.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=0.009). CONCLUSIONS Mental health problems were common in this student population. Several factors, including substance use, were associated with risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. CLINICALTRIAL ClinicalTrials.gov (NCT04766788) INTERNATIONAL REGISTERED REPORT RR2-10.2196/29561