Associations between e-health questionnaire responses, health checks and graduation: Finnish register-based study of 2011–2012 university entrants

OBJECTIVE: To evaluate the association between health and study-related factors measured by an Electronic Health Questionnaire (eHQ), participation in a health examination process and graduation in a university student population. DESIGN: Nationwide, retrospective, register-based cohort study with a 6-year follow-up. SETTING: Student health care in Finland. Finnish Student Health Service (FSHS) provides statutory student health services to university students in Finland. The health examination process of FSHS includes the eHQ provided annually to university entrants and a subsequent health check when necessary based on students' eHQ response. PARTICIPANTS: A national cohort of university entrants from the 2011-2012 academic year (n=14 329, n (female)=8075, n (male)=6254). OUTCOME MEASURES: The primary outcome measure was graduation, measured based on whether a student had completed a bachelor's, licentiate or master's degree during the 6-year follow-up. RESULTS: Some 72% of the women and 60% of the men had graduated during the follow-up. The predictors in the eHQ associated with non-graduation differed by sex. Among the women's low enthusiasm about studies (OR 2.6, 95% CI 1.9 to 3.6), low engagement with studies (OR 2.5, 95% CI 1.8 to 3.4) and daily smoking (OR 1.9, 95% CI 1.4 to 2.6) were the strongest predictors to non-graduation. Among the men, low engagement with studies (OR 3.7, 95% CI 2.5 to 5.5) and obesity (body mass index≥35) (OR 4.0, 95% CI 1.9 to 8.8) were the strongest predictors to non-graduation. Not attending the health check when referred was associated with non-graduation in both sexes: the OR for not graduating was 1.6 (95% CI 1.3 to 1.9) in women and 1.3 (95% CI 1.0 to 1.6) in men. CONCLUSIONS: Engagement and enthusiasm about studying in the first year are important predictors of graduation and therefore a potential intervention target. Health promotion initiatives conducted early in the studies may have a positive effect on students' academic achievement.