Higher Education Strategy Associates

Tag Archives: Student Health

June 05

Student Health (Part 3)

You know how it is when someone tries to make a point about Canadian higher education using data from American universities? It’s annoying.  Makes you want to (verbally) smack them upside the head. Canada and the US are different, you want to yell. Don’t assume the data are the same! But of course the problem is there usually isn’t any Canadian data, which is part of why these generalizations get started in the first place.

Well, one of the neat things about the AHCA-NCHA campus health survey I was talking about last week is that it is one of the few data collection instruments that is in use on both sides of the border. Same questions, administered at the same time to tens of thousands of students on both sides of the border. And, as I started to look at the data for 2016, I realized my “Canada is different” rant is – with respect to students and health at least – almost entirely wrong. Turns out Canadian and American students are about as alike as two peas in a pod. It’s kind of amazing, actually.

Let’s start with basic some basic demographic indicators, like height and weight. I think I would have assumed automatically that American students would be both taller and heavier than Canadian ones, but figure 1 shows you what I know.

Figure 1: Median Height (Inches) and Weight (Pounds), Canadian vs. US students.


Now, let’s move over to issues of mental health, one of the key topics of the survey. Again, we see essentially no difference between results on either side of the 49th parallel.

Figure 2: Within the last 12 months have you been diagnosed with/treated for…


What about that major student complaint, stress? The AHCA-NCHA survey asks students to rate the stress they’ve been under over the past 12 months. Again, the patterns in the two countries are more or less the same.

Figure 3: Within the last 12 months, rate the stress you have been under.


One interesting side-note here: students in both countries were asked about issues causing trauma or being “difficult to handle”. Financial matters were apparently more of an issue in Canada (40.4% saying yes) than in the US (33.7%). I will leave it to the reader to ponder how that result lines up with various claims about the effects of tuition fees.

At the extreme end of mental health issues, we have students who self-harm or attempt suicide. There was a bit of a difference on this one, but not much, with Canadian students slightly more likely to indicate that they had self-harmed or attempted suicide.

Figure 4: Attempts at Self-harm/suicide.


What about use of tobacco, alcohol and illicit substances? Canadian students are marginally more likely to drink and smoke, but apart from that the numbers look pretty much the same. The survey, amazingly, does not ask about use of opioids/painkillers, which if books like Sam Quinones’ Dreamland are to be believed have made major inroads among America’s young – I’d have been interested to see the data on that. It does have a bunch of other minor drugs – heroin, MDMA, etc, and none of them really register in either country.

Figure 5: Use of Cigarettes, Alcohol, Marijuana, Cocaine.


This post is getting a little graph-heavy, so let me just run through a bunch of topics where there’s essentially no difference between Canadians and Americans: frequency of sexual intercourse, number of sexual partners, use of most illegal drugs, use of seat belts, likelihood of being physically or sexually assaulted, rates of volunteering….in fact among the few places where you see significant differences between Canadian and American students is with respect to the kinds of physical ailments they report. Canadian students are significantly more likely to report having back pain, Americans more likely to report allergies and sinus problems.

Actually, the really big differences between the two countries were around housing and social life. In Canada, less than 2% of students reported being in a fraternity/sorority, compared to almost 10% in the United States. And as for housing, as you can see Americans are vastly more likely to live on-campus and vastly less-likely to live at home. On balance, that means they are incurring significantly higher costs to attend post-secondary education. Also, it probably means campus services are under a lot more pressure in the US than up here.

Figure 6: Student Living Arrangements.


A final point here is with respect to perceptions of campus safety. We all know the differences in rates of violent crimes in the two countries, so you’d expect a difference in perceptions of safety, right? Well, only a little bit, only at night and mostly- off-campus. Figure 7 shows perceptions of safety during the day and at night, on campus and in the community surrounding campus.

Figure 7: Perceptions of safety on campus and in surrounding community.


In conclusion: when it comes to students health and lifestyle, apart from housing there do not appear to many cross-border differences. We seem to be living in a genuinely continental student culture.

June 02

Student Health (part 2)

Now you may have seen a headline recently talking about skyrocketing mental health problems among students.  Specifically, this one from the Toronto Star, which says, among other things:

A major survey of 25,164 Ontario university students by the American College Health Association showed that between 2013 and 2016, there was a 50-per-cent increase in anxiety, a 47-per-cent increase in depression and an 86-per-cent increase in substance abuse. Suicide attempts also rose 47 per cent during that period.

That’s a pretty stunning set of numbers.  What to make of them?

Part of what’s going on here is looking at the size of the increase instead of the size of the base.  If the incidence of something goes from 1% to 2% in the population, that can be accurately expressed either as “a one percentage point increase” or “IT DOUBLED!”.   The increase for the numbers on “attempted suicide in the last 12 months”, for instance, rose from 1.3% to 2.1%.  With such a tiny base, double-digit increases aren’t difficult to manufacture.

(in case you’re wondering whether these figures are a function of possible measurement error, the answer is no.  With a 40,000 student sample, the margin of error for an event that happens 1% of the time is 0.1, so a jump from 0.8% is well beyond the margin of error).

Now, the Star is correct, there is a very troubling pattern here – across all mental health issues, the results for 2016 are significantly worse than for 2013 and troublingly so.  But it’s still a mistake to rely on these figures as hard evidence for something major having changed.  As I dug into the change in figures between 2013 and 2016, I was amazed to see that in fact figures were not just worse for mental health issues, but for health and safety issues across the board.  Some examples:

  • In 2013, 53.4% of students said their health was very good or excellent, compared to just 45.3% three years later
  • The percentage of students whose Body Mass Index put them in the category of Class II Obese or higher rose from 3.15 to 4.3%, a roughly 35% increase.
  • The percentage of students with diabetes rose by nearly 40%, migraine headaches by 20%, ADHD by nearly 25%
  • Even things like incidence of using helmets when on a bicycle or motorcycle are down by a couple of percentage points each, while the percent saying they had faced trauma from the death or illness of a family member rose from 21% to 24%.

Now, when I see numbers like this, I start wondering if maybe part of the issue is an inconsistent sample base.   And, as it turns out, this is true.  Between 2013 and 2016, the institutional sample grew from 30 to 41, and the influx of new institutions changed the sample considerably.  The students surveyed in 2016 were far more likely to be urban, and less likely to have been white or straight.  They were also less likely to have been on varsity teams or fraternity/sorority members (and I suspect that last one tells you something about socio-economic background as well, but that’s perhaps an argument for another day).

We can’t tell for certain how much of the change in reported health outcomes have to do with the change in sample.  It would be interesting and helpful if someone could recalculate the 2016 data using only data from institutions which were present in the 2013 sample.  That would provide a much better baseline for looking at change over time.  But what we can say is that this isn’t a fully apples-to-apples comparison and we need to treat with caution claims that certain conditions are spreading in the student population.

To conclude, I don’t want to make this seem like a slam against the AHCA survey.  It’s great.  But it’s a snapshot of a consortium at a particular moment in time, and you have to be careful about using that data to create a time series.  It can be done – here’s an example of how I’ve done it with Canadian Undergraduate Survey Consortium data, which suffers from the same drawback.  Nor do I want to suggest that mental health isn’t an issue to worry about.  It’s clearly something which creates a lot of demand for services and the need to be met somehow (though whether this reflects a change in underlying conditions or a change in willingness to self-identify and seek help is unresolved and to some degree unresolvable).

Just, you know, be careful with the data.  It’s not always as straightforward as it looks.


June 01

Student Health (part 1)

I have been perusing a quite astonishingly detailed survey that was recently released regarding student health.  Run by the American College Health Association-National College Health Assessment, this multi-campus exercise has been run twice now in Canada – once in 2013 and once in 2016.  Today, I’m going to look at what the 2016 results say, which are interesting in and of themselves.  Tomorrow, I’m going to look at how the data has changed since 2013 and why I think some claims about worsening student health outcomes (particularly mental health) need to be viewed with some caution.  If I get really nerdy over the weekend, I might do some Canada-US comparisons, too.


The 2016 study was conducted at 41 public institutions across Canada.  Because it’s an American based survey, it keeps referring to all institutions as “colleges”, which is annoying.  27 of the institutions are described as “4-year” institutions (which I think we can safely say are universities), 4 are described as “2-year” institutions (community colleges) and 10 described as “other” (not sure what to make of this, but my guess would be community colleges/polytechnics that offer mostly three-year programs).  In total, 43,780 surveys were filled out (19% response rate), with a roughly 70-30 female/male split.  That’s pretty common for campus surveys, but there’s no indication that responses have been re-weighted to match actual gender splits, which is a little odd but whatever.


There’s a lot of data here, so I’m mostly going to let the graphs do the talking.  First, the frequency of students with various disabilities.  I was a little bit surprised that psychiatric conditions and chronic illnesses were as high as they were.

Figure 1: Prevalence of Disabilities

Figure 1 Prevalence of Disabilities

Next, issues of physical safety.  Just over 87% of respondents reported feeling safe on campus during the daytime; however, only 37% (61% of women, 27% of men, and right away you can see how the gender re-weighting issue matters) say that they feel safe on campus at night.  To be fair, this is not a specific worry about campuses: when asked about their feelings of personal safety in the surrounding community, the corresponding figures were 62% and 22%.  Students were also asked about their experiences with specific forms of violence over the past 12 months.  As one might imagine, most of the results were fairly highly gendered.


Figure 2: Experience of Specific Forms of Violence Over Past 12 Months, by Gender

Figure 2 Experience of Specific Forms of Violence

Next, alcohol, tobacco, and marijuana.  This was an interesting question as the survey not only asked students about their own use of these substances, but also about their perception of other students’ use of them.  It turns out students vastly over-estimate the number of other students who engage with these substances.  For instance, only 11% of students smoked cigarettes in the past 30 days (plus another 4% using e-cigarettes and 3% using hookahs), but students believed that nearly 80% of students had smoked in the past month.


Figure 3: Real and Perceived Incidence of Smoking, Drinking and Marijuana Use over Past 30 Days

Figure 3 Real and Perceived Incidence of Smoking

Figure 4 shows the most common conditions for which students had been diagnosed with and/or received treatment for in the last twelve months.  Three of the top ten and two of the top three were mental health conditions.

Figure 4: Most Common Conditions Diagnosed/Treated in last 12 Months

Figure 4 Most Common Conditions Diagnosed

Students were also asked separately about the kinds of things that had negatively affected their academics over the previous year (defined as something which had resulted in a lower mark than they would have otherwise received).  Mental health complaints are very high on this list; much higher in fact than actual diagnoses of such conditions.  Also of note here: internet gaming was sixth among factors causing poorer marks; finances only barely snuck into the top 10 reasons, with 10.3% citing it (though elsewhere in the study over 40% said they had experienced stress or anxiety as a result of finances).

Figure 5: Most Common Conditions Cited as Having a Negative Impact on Academics

Figure 5 Most Common Conditions Cited as Having

A final, disturbing point here: 8.7% of respondents said they had intentionally self-harmed over the past twelve months, 13% had seriously contemplated suicide and 2.1% said they had actually attempted suicide.  Sobering stuff.