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A cross-sectional analysis of demographic and behavioral risk factors of SARS-CoV-2 antibody positivity among a sample of U.S. college students

Our take —

This study, available as a preprint and thus not yet peer-reviewed, was conducted in September 2020 and assessed demographic and behavioral factors associated with history of SARS-CoV-2 infection among college students from Indiana University Bloomington (UIB). Overall, 1,239 randomly sampled students completed a behavioral survey, and 1,076 students were administered serological testing to assess for historical SARS-CoV-2 infection. Among study participants, 4.6% were confirmed to have a history of SARS-CoV-2 infection and 10.3% self-reported a history of SARS-CoV-2 infection. Among students who tested positive for SARS-CoV-2 antibodies and had complete self-reported testing data, 63% self-reported a history of SARS-CoV-2 infection. Sorority or fraternity membership, multiple romantic partners, knowing someone in one’s immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day per week, and interacting with more than 4 people when drinking alcohol were associated with seropositivity and SARS-CoV-2 infection history. Data should be interpreted with caution however, as they were assessed in September 2020, around the time of return to college, and may largely reflect infection history predating return to college.

Study design

Cross-sectional

Study population and setting

This study assessed demographic and behavioral factors associated with laboratory based and self-reported SARS-CoV-2 infection among college students. A random sample of undergraduate students was recruited from Indiana University Bloomington (UIB). Eligible participants were age 18 years or older, a current IUB undergraduate student, and currently residing in Monroe County, Indiana in September 2020. Overall, 1,397 students consented to participate of whom 1,239 participated in the socio-behavioral questionnaire, and serological testing data were available for 1,076 students. The study included a self-reported socio-behavioral questionnaire covering age, biological sex, engagement in campus and social activities, alcohol use and relationship status, and a SARS-CoV-2 IgM/IgG rapid assay kit to assess the presence of antibodies as a measure for history of infection.

Summary of Main Findings

Among study participants, 4.6% (95% CI: 3.3%, 5.8%) were confirmed to have a history of SARS-CoV-2 infection, and the prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% CI: 8.6%, 12.0%). Among students who tested positive for SARS-CoV-2 antibodies and had complete self-reported testing data (N=46), 63% self-reported a history of SARS-CoV-2 infection (=29). Sorority or fraternity membership, multiple romantic partners, knowing someone in one’s immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day per week, and hanging out with more than 4 people when drinking alcohol were associated with both seropositivity and self-reported SARS-CoV-2 infection history.

Study Strengths

This study included college students who were recruited through random sampling. This study leveraged a socio-behavioral questionnaire and serological testing to assess potential risk factors with history of SARS-CoV-2 infection.

Limitations

Temporality could not be established because the data were collected cross-sectionally, therefore the risk factors assessed could have occurred prior to SARS-CoV-2 infection. This analysis also reported descriptive measures of associations, and therefore, it cannot be assumed that any of these factors are causally associated with infection. Additionally, given that this study was conducted in September (beginning of the school year), infections may have been occurred during social activities unrelated to the college setting. Among 7,499 students recruited and 4,069 presumed eligible, 2,651 did not respond or did not sign the consent form and 21 explicitly refused. Selection bias may be present if enrolled individuals differed from those who refused or did not respond to the study invitation.

Value added

This study leveraged a random sample of college students to assess potential risk factors with history of SARS-CoV-2 infection using both serological testing and self-reported measures.

This review was posted on: 5 March 2021