Health Habits: Emerging From the COVID Crush

The pandemic punch sent campus learning routines into a tailspin but also knocked out many college students’ healthy lifestyle routines. Attending class, getting sleep and eating meals in the same room, or in a crowded house, became the reality for millions of college students who previously got in thousands of daily steps even if they didn’t block off time for exercise.

In a new Student Voice survey, conducted by Inside Higher Ed and College Pulse and presented by Kaplan, 44 percent of students report getting less physical exercise than before the pandemic, with loss of motivation being the primary reason identified for one-third of that group.

Psychologists have been talking a lot in the past year about “motivation paralysis,” says Jody Early, an associate professor in the School of Nursing and Health Studies at the University of Washington at Bothell. The term refers to a desire to act on something but being unable to do so.

COVID-19 caused people to lose the normalcy in their lives, and not being grounded in routines results in “this ongoing sense of uncertainty that can really have a toll on the body,” Early explains. “It’s like having windows open on your computer draining the battery. It’s draining to us, and we don’t know what’s going on.”

The survey, taken by 2,002 college students between April 28 and May 2, reveals new lifestyle routines since the pandemic started that could negatively impact overall health. For example:

• 45 percent have fallen into less structured eating routines, eating whenever they are hungry, and 38 percent have regularly missed meals during the pandemic because they are less hungry or are more stressed.
• One-third are getting less sleep than pre-COVID, and among those reporting that both their mental and physical health are not good, or that their mental health is worse than their physical health, 41 percent are getting less sleep.
• Only about one in four students have not felt the physical effects of increased screen time, while 54 percent have experienced headaches and 46 percent have experienced neck or shoulder pain.
• More than half of students have not had a wellness checkup in the last year, a data point that jumps to nearly two-thirds for students who identify as Latinx.

Student perceptions of their health are generally positive, with two-thirds reporting excellent (18 percent) or good (48 percent) overall physical health. But that still leaves one-third viewing their health as fair or poor. Fewer than one in five (18 percent) students -- but 23 percent of varsity and 26 percent of club athletes -- rate their health as excellent. By political leaning, strong Republicans are most likely to report favorable health, with 33 percent saying it’s excellent (and a total of 83 percent selecting excellent or good).

The survey also reveals how much students agree that their college cares about their physical health. Nearly half agree either somewhat or strongly, while one-third are neutral and about one in five disagree.

“Schools are recognizing the value of working toward a healthier campus environment that supports being physically active and making better choices with food,” says Mary Hoban, chief research officer at the American College Health Association, which surveys students each fall and spring.

What does a college caring look like to students?

To some, it’s about events. Quinnipiac University’s outdoor cycling class this spring, for example, made an impression on Charles Dunn, a rising senior studying biology who says the institution has been planning a lot around student health and wellness.

Campuswide wellness committees with student representation are another signal of officials prioritizing student health. Autumn Spyhalsky, who will be a third-year pharmacy student in the fall at the University at Buffalo, was selected for such a role. As a member of the wellness task force, she has provided input on the planning of a facility on North Campus (the hub for most undergrads) to offer health services, including mental health.

At Boise State University, attention to health is obvious. The BroncoFit program attends to the whole person by focusing on eight dimensions of wellness, including physical. In 2019, newly inaugurated Boise State president Marlene Tromp formed a president’s wellness committee to advise her, and the strategic plan completed this February by a separate group includes a goal about developing a thriving community, which incorporates whole-person wellness. An implementation team will work across the university to ensure everyone is moving toward the metrics using tactics suggested, even down to the curricular level, she says, adding that the phrase “whole student” appears in other strategic plans in higher ed, but “people don’t know how to actualize it.”

Carolina Recchi, cofounder of EdSights, which uses AI-powered chat bots to help higher ed institutions improve retention and hence collects a lot of data on the daily life of more than 200,000 students at its client institutions, says campus leaders had great interest in seeing data this year about areas of student struggle. “There was a lot of talk about mental health and wellness in cabinet and alumni meetings, but there wasn’t as much action. It’s understandable, but I think there’s still the work to do. It’s been more about coming to terms with the magnitude of the problem and getting data to back up future decisions.”

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In their comments, several Student Voice survey respondents connected the level of care to the level of COVID-related caution. Respondents who are currently taking all classes online from home were slightly more likely than those back on campus to strongly agree their college cares about health.

One student criticized his university in the Northeast for shutting down gyms and classrooms, plus decreasing physical activity and healthy food options. “The only thing these restrictions did was make it harder for college students to make good decisions and make it easier for them to be lazy and unhealthy,” the student wrote.

From DJ Pepito’s perspective as chief programs officer at NACAS, the National Association of College Auxiliary Services, administrators are especially cognizant of food insecurity among students and other basic needs. “There’s a heightened awareness now among campus leaders about the severity of basic needs issues across colleges today,” she says. The NACAS Foundation awards up to $25,000 annually for related efforts through its Campus Care Grant.

Here’s more on the choices students are making about their health and challenges they face in maintaining a healthy lifestyle, as well as what higher ed institutions can do to support students now and moving forward.

Moving, Eating, Sleeping and Socializing

As noted, the more than four in 10 students getting less physical exercise now compared to pre-pandemic are most likely to select loss of motivation as the primary reasons they are moving less. “It’s torture being in my room all day,” says Spyhalsky, who has had very limited in-person learning this year. She will still force herself to go running or occasionally rock climbing or to the gym.

Silvia Saccardo, who co-wrote a study titled “Lifestyle and Mental Health Disruptions During COVID-19” and who is still tracking college students’ health habits, says students were averaging about 10,000 steps a day before the pandemic but are only getting 5,000 to 6,000 now. Saccardo, an assistant professor in the Department of Social and Decisions Sciences at Carnegie Mellon University, is focusing her current work on promoting vaccinations.

The next most common reason for a lower physical activity level cited by Student Voice respondents is less free time. One student at a university in the Southeast who used to run three miles a day wrote she barely has time to do anything for her mental or physical health anymore because of academic program stress. “I’m always miserable and sick,” she added.

Gyms and athletic facilities being shut down is the third most common reason given for less exercise. Austin Towle, a U.S. Army veteran who began attending Pennsylvania State University this semester and who lives near campus, was still on active duty last March and working out daily at the gym as well as serving as a personal trainer for his company. “When the gym shut down, it threw a wrench into everything,” he says. Although the initially closed Penn State gym facilities opened partway through this semester, it was with limited capacity and other restrictions. So Towle, whose goal is to compete in a bodybuilding show in the fall, has been continuing workouts at a local family-owned gym.

“One of my main groups of friends is through the gym, the bodybuilding team,” he says. “We meet and talk about diet and exercise and what’s working for us.”

That’s in stark contrast to the current habits of many college students. Nearly half of both those taking some or all in-person classes and those in school fully online right now report less structured meal routines. About three in 10 are eating more during the pandemic, and about one-quarter say the quality of their food has gotten worse.

Pepito says NACAS members involved in food services and dining will continue to make encouraging healthy habits a top priority as students return more widely to campuses this fall. “I don’t think healthy eating has just gone out the door. It’s an increased request from students,” she says. “This generation of students is all about convenience and fast options, but still staying healthy.”

Student reporting on sleep habits since the pandemic shows a somewhat even split between those getting less sleep, those getting more sleep and those getting about the same amount. Women, students struggling with mental health and students at two-year institutions (about 250 people in the survey sample attend community colleges) are most likely to be struggling to get enough sleep.

Dunn, who works as an emergency medical technician both on Quinnipiac’s campus and at home in Old Saybrook, Conn., is getting only three hours or so a night now (but, he adds, he walks about 20,000 steps a day).

According to EdSights data, students who previously rated their wellness as good but who are now struggling report that mental health is the biggest challenge right now. The No. 2 struggle? Sleep.

Sleep may also be impacted by food or housing insecurity, points out Hoban. “It’s hard to be healthy physically or mentally if you don’t know where you’re sleeping tonight.”

Although Saccardo’s research shows students are sleeping more since the pandemic started -- mainly because they’re waking later each morning -- they are generally getting way less than the recommended seven to nine hours. That was the case pre-COVID as well.

The vast majority of Student Voice survey respondents aren’t turning to alcohol or marijuana because of the pandemic. Ten percent report more marijuana use and 17 percent report more drinking than before last March; 75 percent don’t use marijuana at all, and 53 percent don’t drink alcohol at all.

“Our alcohol data measures excessive use, and it seems to be lower than before the pandemic,” says Hoban. “They’re still drinking, but they’re not drinking as much to excess, from what I can see.”

Regarding sexual activity, 6 percent are engaging in more risky sexual behavior than pre-pandemic, while 4 percent report being safer about sex. Responses from men, women and nonbinary students are about the same. Those identifying as lower class for socioeconomic status are by far most likely to be engaging in risky sexual behaviors (35 percent, with a plus or minus 16 percent margin of error).

As noted, few students (27 percent) were immune from the physical impacts of increased screen time. But 32 percent of those getting more physical activity since the pandemic say they have not had screen time impacts. When the data are filtered by those who are learning online only from home, 25 percent report no tech-related health symptoms. In addition, women and nonbinary students are more likely than men to experience headaches, neck/shoulder pain and other symptoms.

Support Steps to Take

Supporting students’ physical health tends to involve mental health as well. But during COVID-19, says Tromp at Boise State, college and university leaders placed most of the emphasis on physical health, with the priority of stopping the spread. “When we saw a physical health crisis, we did not respond to the mental health crisis running parallel.”

Survey respondents are split somewhat evenly on reporting that their physical health is better than their mental health, that neither is great and that both are OK. Only 11 percent say their mental health is better.

Those rating their physical health as excellent are most likely to say both their physical and mental health are pretty good. Political leaning also seems to make a difference, with strong Republicans being by far most likely to say both are fine. Strong Democrats were most likely to report their physical health is better than their mental health, or that both are not great.

When considering actions to take, campus leaders should keep in mind how different individuals are. “I have had students tell me they wouldn’t walk into our new multimillion-dollar exercise facility because they feel they wouldn’t fit in there,” says Early from UW. Maybe helping students to move more isn’t just about offering more intramurals but also an activity like drumming, she adds. “We need to do a better job.”

One survey respondent from a private institution in the Midwest agrees, writing, “My college attempts to encourage ‘healthy’ eating and exercise classes through a required gym class, but only gives advice in a limited scope and caters it to students of less-active backgrounds.”

Following are seven actions to consider.

1. Create a wellness committee (or strengthen an existing one). Tromp says it should focus on both physical and mental health to build a plan for well-being and then act on it. Early from UW notes that it will take a while to get students acclimated this fall. “We’re not going to zip back into a state of everyone feeling better. Focus on more mental health and connections, and then that can feed into physical fitness,” she suggests.

2. Develop tiered peer supports. Just as colleges have worked to train students to be a first step for peers needing mental wellness help, students could support peers with physical health. For example, Boise State’s BroncoFit Peer Health Educators (certified in standards set by the National Association of Student Personnel Administrators) work with fellow students across campus, encouraging them to develop responsible habits and attitudes toward high-risk health and safety issues. A new idea being developed as part of the university’s strategic plan implementation includes connecting individual students. Someone looking to work out more might get paired with a running or racquetball partner, while someone looking to adopt better eating habits might get a lunch buddy.

3. Continue popular new offerings. EdSights helped its client schools with campaigns around physical exercise in the past year, Recchi explains, such as “pick your resource” efforts where the college mascot would offer to share ideas for more physical exercise, better nutrition or more quality sleep. “Most were on campus, but some did it virtual,” she says. “A lot of initiatives were born because of COVID but are working out really well.” And remember, says Hoban, that some students, such as those with physical disabilities or people worried about stigma, had doors opened to them when health services and counseling became virtual and more accessible.

4. Find out what students think they need to adopt healthier habits. “By now, people have new routines,” Saccardo says. When students were asked as part of her study on what they need for fall in terms of support, some identified a desire to build better routines.

5. Incentivize healthy lifestyle choices. When Saccardo’s team gave students $5 for each day they reached 10,000 steps, the incentive helped restore pre-pandemic activity levels (but, she adds, did not have a positive impact on mental health, suggesting the need to intervene on not just physical activity but perhaps eating and sleeping habits as well).

6. Incorporate an understanding of student trauma. Many students have lost not only everyday habits to COVID-19 but also financial security and loved ones. “There’s a lot of loss that has happened,” says Early, adding that these losses are more pronounced for BIPOC students. As Hoban puts it, “Not everybody is returning to ‘normal.’ For some of our students, these impacts are permanent.”

7. Prepare for the long term. “I don’t want people to lose this lesson, to have their wheels slide into the well-worn ruts again and stop thinking about mental health and physical health,” says Tromp. “This crisis showed us that if we don’t care for the whole student, we’re not going to see the success we want to see. It’s that comprehensive approach. It has to be integrated and it has to be ongoing.” As she’s been telling her senior leaders throughout this past year, the charge is this: to become a better university on the other side of COVID.