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Gilley KN, Baroudi L, Yu M, Gainsburg I, Reddy N, Bradley C, Cislo C, Rozwadowski ML, Clingan CA, DeMoss MS, Churay T, Birditt K, Colabianchi N, Chowdhury M, Forger D, Gagnier J, Zernicke RF, Cunningham JL, Cain SM, Tewari M, Choi SW. Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors. JMIR Ment Health 2022; 9:e34645. [PMID: 34992051 PMCID: PMC8834863 DOI: 10.2196/34645] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/14/2021] [Accepted: 01/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, 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 (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. METHODS After completing a baseline assessment (ie, at Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, 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 mean (SD) values, while categorical measures were summarized as n (%) values. Formal comparisons were made on the basis of COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time through backward selection until the optimal model was obtained. RESULTS During the fall 2020 semester, 1997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 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 (mean 6474, SD 3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) and with lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). CONCLUSIONS Mental health problems were common in this student population. Several factors, including substance use, were associated with the 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. TRIAL REGISTRATION ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/29561.
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Affiliation(s)
- Kristen N Gilley
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Loubna Baroudi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Miao Yu
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Izzy Gainsburg
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
| | - Niyanth Reddy
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Christina Bradley
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
| | - Christine Cislo
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | | | - Caroline Ashley Clingan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Matthew Stephen DeMoss
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Tracey Churay
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kira Birditt
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Mosharaf Chowdhury
- Department of Computer Science Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Forger
- Department of Mathematics, University of Michigan, Ann Arbor, MI, United States
| | - Joel Gagnier
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States.,Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Ronald F Zernicke
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States.,Exercise & Sport Science Initiative, University of Michigan, Ann Arbor, MI, United States
| | - Julia Lee Cunningham
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
| | - Stephen M Cain
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
| | - Muneesh Tewari
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States.,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
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Cislo C, Clingan C, Gilley K, Rozwadowski M, Gainsburg I, Bradley C, Barabas J, Sandford E, Olesnavich M, Tyler J, Mayer C, DeMoss M, Flora C, Forger DB, Cunningham JL, Tewari M, Choi SW. Monitoring beliefs and physiological measures in students at risk for COVID-19 using wearable sensors and smartphone technology: Protocol for a mobile health study. JMIR Res Protoc 2021; 10:e29561. [PMID: 34115607 PMCID: PMC8386373 DOI: 10.2196/29561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted lives significantly and greatly affected an already vulnerable population, college students, in relation to mental health and public safety. Social distancing and isolation have brought about challenges to student's mental health. Mobile health apps and wearable sensors may help to monitor students at risk for COVID-19 and support their mental well-being. OBJECTIVE Through the use of a wearable sensor and smartphone-based survey completion, this study aimed to monitor students at risk for COVID-19. METHODS We conducted a prospective study of students, undergraduate and graduate, at a public university in the Midwest. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal mobile devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints - at baseline, 1-month later, 2-months later, 3-months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. RESULTS This study enrolled 2,158 college students between September 2020 and January 2021. Subjects are currently being followed on-study for one academic year. Data collection and analysis are ongoing. CONCLUSIONS This study examined student health and well-being during the COVID-19 pandemic. It also assessed the feasibility of wearable sensor use and survey completion in a college student population, which may inform the role of our mobile health tools on student health and well-being. Finally, using wearable sensor data, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data towards the development of a model for the early prediction and detection of COVID-19. CLINICALTRIAL ClinicalTrials.gov NCT04766788.
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Affiliation(s)
- Christine Cislo
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
| | - Caroline Clingan
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
| | - Kristen Gilley
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
| | - Michelle Rozwadowski
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Izzy Gainsburg
- Management and Organizations Area, Ross School of Business, University of Michigan, Ann Arbor, US
| | - Christina Bradley
- Management and Organizations Area, Ross School of Business, University of Michigan, Ann Arbor, US
| | - Jenny Barabas
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Erin Sandford
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Mary Olesnavich
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Jonathan Tyler
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Department of Mathematics, University of Michigan, Ann Arbor, US
| | - Caleb Mayer
- Department of Mathematics, University of Michigan, Ann Arbor, US
| | - Matthew DeMoss
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Christopher Flora
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Daniel B Forger
- Department of Mathematics, University of Michigan, Ann Arbor, US
| | - Julia Lee Cunningham
- Management and Organizations Area, Ross School of Business, University of Michigan, Ann Arbor, US
| | - Muneesh Tewari
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, US
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, US
| | - Sung Won Choi
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, US
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