College Freshmen with Chronic Illness: A Comparison With Healthy First-Year Students

Over the past four decades, advances in medicine have decreased the mortality rates of many previously fatal chronic diseases (American Academy of Pediatrics, 2002). Children who would have died early in life are now living well into adulthood, and many are matriculating as college students (Maslow, Haydon, McRee, Ford, & Halpern, 2011). Each year in the US, more than 500,000 youth with chronic conditions, ranging from diabetes to bipolar disorder, turn 18 years old (Lotstein, McPherson, Strickland, & Newacheck, 2005), and colleges must adapt to face this new challenge. In high school, although children with chronic illness have greater absenteeism than their healthy peers, the vast majority are able to graduate (Maslow et al. 2011; Suris, Michaud, & Viner, 2004). Despite their having similar high school graduation rates, data from the National Longitudinal Study of Adolescent Health indicate that youth with chronic illness are only half as likely to graduate from college as their healthy peers (18% vs. 32%; Maslow et al., 2011; Olson, 2004).

Data regarding the prevalence of chronic illness among college students, the college experience of chronically ill students, and why such students are at greater risk of failing to graduate from college are limited. One study found that one third of college respondents reported some form of long-standing illness (Stewart-Brown et al., 2000). Bishop (2005) examined quality of life and psychosocial adaptation for college students with chronic illness in a sample of 72 students, most with physical disabilities or psychiatric conditions. From these data, Bishop theorized that health-related quality of life is linked to positive adaptation to student life for college students with chronic illness. Non-health-related challenges facing chronically ill students can be extrapolated from studies of chronically ill adolescents, such as one by Shiu (2001) that suggests that disruptions in peer relationships may increase educational drop-out rates. Loneliness is one construct that has been examined for college students in general and has been found to be an important mediator of health behavior correlated with depression (Ponzetti, 1990; Wisemann & Guttfreund, 1995; Yarcheski, Mahone, Yarcheski, & Canella, 2004). Youth with chronic illness may be at particular risk for isolation and loneliness. Taken together, this evidence suggests that important factors that may affect the adaptation to college for youth with chronic illness include lower quality of life and greater isolation as compared to healthy peers, which could persist through their transition to college and negatively influence their student experience and academic success.

More and more youth with chronic illness are entering college each year, yet there is a major gap in our understanding of how the experience of being a first-year student differs for chronically ill students and healthy students. This study was designed to examine the experience of being chronically ill and transitioning to college by addressing the following research questions: (a) Do chronically ill college first-years and their healthy peers differ in health-related quality of life and measures of loneliness? (b) Do college first-years use available health services and other resources?

METHOD

An invitation to participate in an online survey was e-mailed to the first-year class at a private university within 1 month of enrolling.

Measures

Demographic Information collected included questions about age, sex, ethnicity, home state, and living situation (alone or with roommates).

Loneliness was assessed using the UCLA loneliness scale, a widely used 20-item measure with M = 40, SD = 9.5 for healthy U.S. college students (Russell, 1996). The UCLA loneliness scale has demonstrated high construct validity and internal consistency in samples of undergraduate students (Russell, Peplau, & Ferguson, 1978). A higher score indicates increased loneliness. A sample question is: “How often do you feel it is difficult for you to make friends?”

Health Related Quality of Life was assessed with questions about general health including the CDC 4-item Health Related Quality of Life scale (HRQoL; Zullig, 2005). This scale and the related Healthy Days Index have demonstrated good construct validity and reliability in adult populations (Moriarty, Zack, & Kobau, 2003; Zullig, 2005). The Healthy Days Index score...