September 15, 2022

The choice to explore hybrid learning options at UNC-Chapel Hill during the Fall 2020 semester came during a time of heightened uncertainty – before variants and vaccines, when our evolving understanding of the novel coronavirus conflicted with concerns about the impact of an extended lockdown on learning. Carolina students grappled with difficult decisions, including where to live, how to go to class and how much of the college experience they would lose.

A new study led by the UNC Gillings School of Global Public Health sheds light on COVID-19 infection among undergraduate students during this time and suggests strategies for colleges and universities to reduce transmission by creating safe opportunities for students to socialize and retain many of the on-campus experiences they value.

Researchers found that students who lived in fraternity and sorority settings, as well as students who participated in social activities, were most likely to have had a COVID-19 infection, while those who lived off campus were less likely to have been infected.

Dr. Audrey Pettifor

Dr. Audrey Pettifor

“College is an important time for young people to gain independence, test boundaries, make new friendships and try new things,” said study co-author Audrey Pettifor, PhD, professor of epidemiology. “While our study found that students who socialized more were more likely to have had COVID-19 infection, it is also clear that restricting social activities completely, as we did in 2020, was not good for student mental health or development.”

The study, published recently in the Journal of Adolescent Health, examined data from students in the Heelcheck program, which was open to all UNC undergraduates. It measured their levels of SARS-CoV-2 seroprevalence, demographics and views on the pandemic, including how they felt about public health measures, whether they were likely to get vaccinated and whether they thought the virus would prevent them from engaging in social activities.

Doctoral student Karen Diepstra, MPH, is lead author on the study, along with Pettifor and doctoral student Brooke Bullington from the Department of Epidemiology. They collaborated with Prem Lakshmanane, PhD, research associate professor of microbiology and immunology; Bonnie Shook-Sa, DrPH, assistant professor of biostatistics; and Corbin Jones, PhD, professor of biology and genetics.

In total, 7.3% of undergraduates in the Heelcheck program had COVID-19 antibodies by the end of the Fall 2020 semester, indicating they had been infected previously. Compared to students who lived off-campus in Chapel Hill, those who did not live in Chapel Hill had the lowest prevalence of COVID-19 (1.9%). Students who lived on campus but moved to off-campus housing in Chapel Hill had an 18.9% prevalence, and students who spent the semester living in a sorority or fraternity house had a 46.8% prevalence.

Students were overwhelmingly in favor of measures that prevented transmission, and most also expressed support for personal behaviors that lowered the risk of infection, including masking and staying away from large gatherings. However, many had concerns about participating in contact-tracing programs because they were worried about how peers would react, and many reported a willingness to participate in situations that might put them at risk of COVID-19 exposure rather than leave or ask peers to make the situation safer.

Study results showed an association between students who participated in high-risk behaviors – such as living in fraternities and sororities or going to indoor gatherings with 10 or more people – and a higher risk of having had COVID-19. For example, surveyed students who said they would go to an indoor party unmasked were 3.8 times more likely to have had COVID-19 than those who said they would not go. Students who were concerned about friends being upset at them for sharing close contact information were four times more likely to have had COVID-19.

Such results illustrate the complex challenges faced by academic institutions and students who must manage behavioral risks while still pursuing a meaningful on-campus experience. It is important that universities acknowledge students’ need to socialize and openly discuss their concerns about participating in public health behaviors.

To encourage behavior that lowers the risk of transmission, the researchers suggest that universities create activities that allow students to socialize in the lowest-risk settings possible.

“While undergraduate students may strongly support COVID-19 prevention measures, there may be a discrepancy between support of prevention methods and their actual implementation—the desire to experience ‘normal’ social lives and the potential to underestimate risk must be recognized and incorporated into realistic mitigation efforts,” the study team wrote. “As opposed to completely restricting social activities, colleges should create and encourage safe opportunities to socialize and experience ‘college life’ while minimizing COVID-19 transmission.”

“In the future, colleges need to find ways for students to engage with their peers in safer ways rather than not at all,” Pettifor said. “We also need to acknowledge the importance of peer pressure and the impact it may have on students complying with prevention measures, and then work to help students navigate these real challenges in our health promotion efforts.”

This work was supported by the North Carolina Policy Collaboratory through appropriation from the North Carolina General Assembly (NCGA) in support of research on treatment, community testing and prevention of COVID-19.

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