Background Transitioning to higher education (HE) has been highlighted as a critical time to embed positive health-related behaviours (HRBs). However, there has been a long-standing association between student life and risk-taking. This study aimed to (1) identify the prevalence of HRBs over time in cohorts of HE students in Ireland, (2) establish an overall health index and analyse the health-related status of HE students and associated factors based on this index and (3) explore student perspectives towards public health interventions.

Methods Using an anonymous, repeated measures, cross-sectional study design, 4 years of data were gathered and analysed from a student sample (N (final)=3221). A series of Pearson’s χ2, t-tests and one-way analysis of variance tests followed by linear regression analysis were performed to determine the individual and combined associations between participant characteristics and health scores.

Results There were notable unfavourable patterns over time in all HRBs, except tobacco use, which indicated a declining trend. Factors associated with lower health index scores included identifying as female, living at home, higher socioeconomic status, studying in the arts humanities and social sciences field and having a higher body mass index. Most students reported they would avail of an intervention on drug use (78.1%, 95% CI 0.77% to 0.80%), alcohol consumption (75.7%, 95% CI 0.74% to 0.77%), tobacco use (67.3%, 95% CI 0.66% to 0.69%) and mental health (65.4%, 95% CI 0.64% to 0.67%) if they felt that they needed to.

Conclusions This study demonstrates a clear rationale for providing health-enhancing behavioural interventions for students in HE settings. Outcomes may be of interest to educationalists, policy-makers and health-promotion experts.