Overall, prevalence estimates of health-risk behaviours across the eight Canadian post-secondary institutions ranged from 3.5% in use of illicit drugs, to 88.5% that are consuming less than 5 servings of fruits and/or vegetables each day. Traditionally, there has been a public health focus to reduce “risky health behaviours”, with particular interest directed towards risk factors associated with non-communicable diseases (i.e., smoking, illicit drug use, and binge drinking)
. Among these, binge drinking had the highest prevalence (59.4%) in our sample. Although assessed differently, results from the Canadian Campus Survey
 reported lower prevalence in binge drinking, with 18.5% of their undergraduate sample consuming 5 or more drinks on a single occasion at least twice a month. The prevalence of smoking (12.7% versus 13.1%), cannabis use (16.7% versus 17.5%), and illicit drug use (2.2% versus 3.5%) however, were comparable to findings of the population-based study by Adlaf and colleagues
. This may suggest that campuses as a whole are doing a good job of dissuading the use of these substances among post-secondary students. Despite the low prevalence of traditional health-risk behaviours, the majority of students were not engaging in healthy behaviours either. The absence of engaging in these positive health risk behaviours poses its own health a risk,
 thus was characterized as health-risk behaviours. Findings show that the vast majority of the student population was considered to be physical inactive (72.2%), lacking of sleep (75.7%), and consuming inadequate servings of fruits and vegetables each day (88.5%). Perhaps a shift from the public health perspective is required for administrators at post-secondary institutions. In addition to prevention of prevailing health-risk behaviours, greater investments should be placed towards the promotion of positive health behaviours.
A secondary purpose of the current study was to examine the institutional variability across health-risk behaviours. Significant between-group differences were found based on the basis of campus size. Specifically, institutions that had fewer students (i.e., < 20,000) exhibited higher rates of inactivity, binge drinking, and marijuana and illicit drug use compared to institutions having a larger student body (i.e., ≥ 20,000). Furthermore, there appears to be variability between individual institutions irrespective of the size of the campus. Speculatively, the disparities in health-risk behaviour may be indicative of discrepancies in health-promoting efforts across each campus to reduce the prevalence of such behaviours across the post-secondary institutions. For example, institutions with a smaller student population may have less funding available to build capacity for delivering effective campus-wide health-promotion initiatives in comparison to institutions with a greater student population. Similarly, there might be institutional differences in health promotion efforts, with each school employing different strategies at targeting the health of students. The development of audit tools would be helpful for assessing school level variation in health promotion efforts to confirm such possibilities.
Having a surveillance system such as the NCHA survey that can regularly monitor health-risk behaviours across institutions might make it possible to determine over time the institutions that are successful in changing health behaviours of interest. In turn, this information might pinpoint promising policies or strategies associated with such change, which can then be disseminated nationally. This is the first study to collectively examine the NCHA data from multiple Canadian post-secondary institutions. As such, our study provides a baseline for the prevalence of health-risk behaviours among Canadian post-secondary students. In the absence of a Canadian surveillance mechanism, the US-based NCHA survey seems to be a promising monitoring tool to collect health-related data on Canadian post-secondary students. However, more institutions should be encouraged to participate in future surveys. By reaching a greater number of institutions, collected data will enable opportunities to examine priority health issues affecting the broader Canadian post-secondary population, explore differences between geographic regions, and provide a basis for making comparisons of prevalence and progress to national and provincial norms.
There are some limitations to the study. First, as there were only eight Canadian post-secondary institutions that participated in the 2009 NCHA survey, the reported prevalence may not be representative of the larger, Canadian post-secondary student population. Second, only 10% of the student body from each of the participating institutions was randomly invited to participate in the survey; thus there is the potential for non-response bias. Third, there were seasonal differences in terms of the administration of the NCHA across the institutions. Two of the institutions administered the survey during the spring of 2009, while the remaining six administered the survey during the fall of 2009. It may therefore be possible for these seasonal differences to influence students' responses to some of the measured health-risk behaviours. Finally, while self-report instruments such as the NCHA are useful tools for gathering public health data,
[26, 27] the nature of such data may be influenced by response bias. Additionally, some measures within the NCHA instrument are less than optimal. In particular, physical activity is not assessed in a way that allows interpretation in terms of ascertaining whether individuals are meeting current physical activity guidelines.
Overall, our study provides preliminary population-level data on the prevalence of common health-risk behaviours among the Canadian post-secondary population. Our findings point to the need for more concentrated health promotion campaigns targeting health promoting behaviours; including obtaining more sleep, consuming more fruit and vegetables, and greater participation in physical activity. Future efforts are warranted in exploring how best to increase post-secondary institutional commitment to collecting surveillance data. Consideration should also be given to the development and validation of a Canadian Postsecondary Health Surveillance System with more rigorous sampling procedures to ensure representativeness.