Journal of American College Health

Cardiovascular disease is the leading cause of death for men and women in the United States. Risk factors and health behaviors combine over time to contribute to the disease process. College communities provide a unique environment for health promotion, risk reduction, and primary intervention. Heart health should be an integral part of college health.

Segmentation of populations may facilitate development of targeted substance abuse prevention programs. The authors aimed to partition a national sample of university students according to profiles based on substance use. The authors used 2008-2009 data from the National College Health Assessment from the American College Health Association. The sample consisted of 111,245 individuals from 158 institutions. The sample was partitioned using cluster analysis according to current substance use behaviors. The association of cluster membership with individual and institutional characteristics was examined. Cluster analysis yielded 6 distinct clusters. Three individual factors--gender, year in school, and fraternity/sorority membership--were the most strongly associated with cluster membership. In a large sample of university students, the authors were able to identify 6 distinct patterns of substance abuse. It may be valuable to target specific populations of college-aged substance users based on individual factors. However, comprehensive intervention will require a multifaceted approach.

The authors reviewed demographic and clinical characteristics of undergraduates at a Brazilian public university (UNICAMP) who visited the campus mental health service (SAPPE) and compared their demographics with those from all undergraduate students enrolled in the university. The authors looked at data from all undergraduates who sought counseling or mental health care at SAPPE over a 17-year period (N = 2,203; 1987-2004). They obtained this information from clinical charts and a UNICAMP database. Women, students from other Brazilian states, students living in the campus residence hall, and students whose main source of income was a scholarship were overrepresented. Female student-clients complained about family conflicts more frequently than did their male counterparts, and male student-clients reported concern about poor academic performance more frequently than did their female counterparts. Sex, living in a university residential facility, and reliance on a scholarship grant were predictive of undergraduates' mental health-seeking behavior and pattern of complaints.

The authors tested the long-term effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in 92 college women aged 18 to 24 years who ere at risk for clinical depression. The women were randomly assigned to either an experimental or a no-treatment control group. The experimental group participated in a 6-week cognitive-behavioral intervention that targeted identification and reduction of negative thinking, using such techniques as thought stopping and affirmations. Data on depressive symptoms, self-esteem, and negative thinking were collected before the intervention and at intervals of 1, 6, and 18 months postintervention. The women in the intervention group experienced a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem than those in the control group. The beneficial effects continued over an 18-month follow-up period. These findings support the importance of thought stopping and affirmations as prevention interventions with at-risk college women.

Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship between poor mental health and acute infectious illnesses (bronchitis, ear infection, sinusitis, strep throat) among 47,202 US college students. The authors used frequency and cross-tabulation analyses to characterize mental health and determine univariate associations among variables. They used binary logistic regression to determine the association between poor mental health and acute infectious illness, controlling for research-derived covariates. The prevalence of acute infectious illness ranged from 8% to 29%. The prevalence of anxiety and depression ranged from 12% to 20%, respectively. Depression, anxiety, and exhaustion were associated with acute infectious illness across all dependent measures, with odds ratios ranging from .56 to .91. Poor mental health is associated with acute infectious illness among college students.

The number of students accumulating credit card debt--and the amount of debt itself--on college campuses is increasing. If high-risk credit and health behavior are associated, health behavior interventions might apply to high-risk credit behavior. The authors' purpose was to examine these possible associations. They used a retrospective design with existing data from a sample of 45,213 US college students and several ordinal regression models, which corresponded with high priority college health issues. Students with high-risk credit behavior were more likely to have driven after drinking, used amphetamines in the previous 30 days, felt functionally impaired by depression in the previous 12 months, had a higher body mass index (BMI), or had a lower grade-point average (GPA). They were less likely to have participated in vigorous physical activity, used condoms for oral or vaginal sex in the prior 30 days, or used marijuana. The findings support the notion that high-risk health and credit behaviors are associated. Further research could clarify the nature of this relation.

Over the past 70 years a legend has evolved that the first college health program in the United States was established at Amherst College in 1861. Although the program at Amherst was innovative in its day and served as a model for the field of college health, several other institutions prior to 1860 appropriated funds, hired staff, and established on-campus programs to improve the health of their students. The military academies led the way, and the first of these early programs to become operational was located at the US Military Academy at West Point, New York, in 1830.

The word hygiene originally defined a comprehensive plan for preserving individual and community health in all its dimensions. In the latter half of the 19th century, Dr Edward Hitchcock Jr established a system of hygiene at Amherst College that became the model for campus hygiene programs. Dr Thomas A. Storey of Stanford University, an advocate of teaching hygiene to college students, wrote articles and textbooks and was active on national committees that promoted college hygiene programs. Storey was one of the founders of the American Student Health Association, later renamed the American College Health Association, which in its early years chose promotion of hygiene as a major objective. As the 20th century progressed, the profession of health education emerged. With its emergence came the realization that health education, once viewed as primarily a matter of delivering health information to students, required an appreciation of human behavior as well. By 1950, the word hygiene had given way to health in most contexts in recognition of this new paradigm.

Studies of college student suicide can be grouped into the following 4 eras: 1920-1960, 1960-1980, 1980-1990, and 1990-2004. The suicide rate for students has declined monotonically across these 4 eras, from 13.4 to 8.0 to 7.5 and, most recently, to 6.5. The decreasing proportion of men in the student populations studied largely accounts for this decline. Since 1960, the suicide rate for students has consistently been about half the rate of the general US population, matched for age and gender. This highly favorable relative suicide rate is the result of firearms having been effectively banned from campuses. Additional population-oriented approaches warrant implementation to further reduce student-suicide rates. Approaches focused on high-risk groups also hold promise. These findings are based upon and may be most valid for the 70% of all students who attend 4-year colleges and universities full time.

The introduction of the birth control pill in 1960 precipitated 2 decades of intense social change in the United States, particularly in the area of sexuality. Colleges and universities were not immune to these changes. The author examines the struggles at 1 land-grant university to find common ground on this issue among students, faculty, administrators, and trustees between 1970 and 1976.

Recent writings on the narcissistic characteristics of American culture have alluded to ubiquitous attitudes and behaviors best described as entitlement. The authors review some of this work and note its impact on the education and practice of medicine as well its usefulness in better understanding increasing faculty complaints about so-called student irresponsibility. Dysfunctional student-teacher relationships are examined, and strategies of intervention are suggested with particular attention given to faculty role modelling.

This study investigated the gender-specific, self-reported sexual behaviors and attitudes of never-married college students attending a southeastern university in 1973 and 1988. Data were collected by means of a mailed questionnaire that remained essentially unchanged for both years. The authors found that both men and women reported an increase in heterosexual relationships that included sexual intercourse and a decrease in nonsexual relationships with the other gender. The majority of the students perceived themselves as adequately informed about sexuality and satisfied with their relationships, although the proportion of men who reported being satisfied with their relationships declined over the 15 years. The students indicated that sexuality education should focus primarily on information about AIDS and on preparation for marriage.

Data obtained from interviews with nearly 4,700 female students utilizing a university contraceptive clinic over ten consecutive years (1974–1983) indicated that the pill was the most popular contraceptive of three prescription methods (pills, IUD, and diaphragm). Although the pill dominated in each of the ten years examined, the percentage of women using this method substantially declined from 1974 (89%) to 1983 (73%). However, the percentage of pill users slightly increased after 1980 and remained fairly constant. Conversely, a trend of increased diaphragm selection emerged over time, with only 6% of the study population choosing this method in 1974, compared with 25% ten years later. Diaphragm use, however, peaked in 1980 (33%) and then declined during the following three years. Ethnicity was significantly correlated with pill and diaphragm preference. A higher percentage of black (84%) and Hispanic (78%) women selected pills, compared with white women (69%), but a higher percentage of whites (24%) chose diaphragms, compared with blacks (12%) and Hispanics (15%). Pill use was inversely related to age, but diaphragm and IUD preference increased with age. These patterns are consistent with national trends in contraceptive use over the past decade and indicate that the pill may be making a comeback.

In light of widespread concern about alcohol abuse on college campuses, the authors review the empirical literature concerning fraternity drinking published since 1980. The review is structured according to 5 themes that emerge from the literature: (a) the continuity between high school and college drinking, (b) the self-selection of heavy drinkers into environments that support heavy drinking, (c) the central role of alcohol in fraternity socialization, (d) the misperception of drinking norms, and (e) the enabling environment of the fraternity house. The literature is summarized for the benefit of those who wish to better understand the role of alcohol use in the fraternity system.

This paper considers the emerging themes of the current era and reviews data on topics which will affect students during their lives. These include the choice to remain single, to marry, or to be childless. The impact of maternal employment on children, the determinants of sex roles, and emerging lifestyles including dual-career families and single parent families are also considered. The author emphasizes the complexity of the changes in current society and the need for maintaining a perspective which takes account of multiple variables when drawing conclusions, e.g., maternal work is not the same as maternal deprivation. For those who counsel students this paper is an important source of information about the concerns of students now and for the future.

“Acquired Immunodeficiency with Reversed T4/3T8 Ratios in Infants Born to Promiscuous and Drug-Addicted Mothers,” Arye Rubinstein, et al. A new syndrome of acquired immunodeficiency has been identified in seven children who were small for gestational age at birth and subsequently have exhibited failure to thrive, lymphadenopathy, parotitis, hepatosplenomegaly, interstitial pneumonia, and recurrent infections. All have a profound cell-mediated immunodeficiency with reversed T4/3T8 ratios. Six are hypergammaglobulinemic and one has low IgG levels. The mothers of five of the seven children are sexually promiscuous and/3or drug addicts. Three mothers have an immunodeficiency similar to that found in their infants. One of them died at age 33 years with a diagnosis of acquired immunodeficiency syndrome. In five of the children and in three of their mothers, there is evidence of a persistent Epstein-Barr virus (EBV) infection. We speculate that a perinatal or in utero transmission of EBV can induce an “infectious immunodeficiency.” The clinical, histopathologic, and immunologic features resemble those described in adult homosexuals and drug addicts. (Journal of the American Medical Association 1983;249:2350–2356.)

During the fall of 1985, we conducted a survey to evaluate the extent and the scope of pharmacy practice in college health institutions. We mailed self-administering questionnaires to all ACHA member institutions. Responses from 222 institutions (72.3%) showed that 41% of ACHA student health services have pharmacist-supervised drug distribution and control. Thirty-one percent of the institutions have a pharmacy and therapeutics committee. About 34% have an in-house pharmacy with a pharmacist in control.It is clear from this survey that the services of pharmacists are not generally available as part of comprehensive health care delivery in the college health setting. When pharmacists are involved, they are primarily active in the delivery of outpatient dispensing services, with a strong emphasis on the provision of drug information to patients and other health care providers.

Suggestions that there is a growing epidemic of suicide among college students in the United States are false. The National Survey of Counseling Center Directors reports 1,404 student suicides over a 14-year period and an adjusted suicide rate of 6.5, half the rate of the general US population (12.6 for all races) during this period when matched for gender and age. Counseling centers appear effective in treating suicidal students, for although the suicide rate for students who were currently or previously clients at campus counseling centers is 3 times the rate of other students, student clients have 18 times the risk of suicide compared to students in general. Identifying and referring students at elevated risk for suicide could further reduce the crude and relative rate of student suicide. However, even programs that do this only moderately well may require substantial increases in counseling staffing.