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.
In 1999, the Harvard School of Public Health College Alcohol Study resurveyed colleges that participated in the 1993 and 1997 surveys. Responses to mail questionnaires from more than 14,000 students at 119 nationally representative 4-year colleges in 39 states were compared with responses received in 1997 and 1993. Two of 5 students (44%) were binge drinkers in 1999, the same rate as in 1993. However, both abstention and frequent binge-drinking rates increased significantly. In 1999, 19% were abstainers, and 23% were frequent binge drinkers. As before, binge drinkers, and particularly frequent binge drinkers, were more likely than other students to experience alcohol-related problems. At colleges with high binge-drinking rates, students who did not binge drink continued to be at higher risk of encountering the second-hand effects of others' heavy drinking. The continuing high level of binge drinking is discussed in the context of the heightened attention and increased actions at colleges. Although it may take more time for interventions to take effect, the actions college health providers have undertaken thus far may not be a sufficient response.
This article seeks to assist college health nurses in developing appropriate protocols for patient care. In addition, the authors outline factors influencing protocol content, design, and development and describe steps in creating individualized protocols by practice setting. To provide college health nurses with a basic understanding of protocols, the authors offer definitions and examples of appropriate and inappropriate use, and show how protocols can influence the delivery of patient care. Although protocols may provide college health nurses with directives for managing specific health problems, they require a sophisticated level of judgment and skill in their implementation.
Are clients at college counseling centers more disturbed today than they were 5, 10, or 20 years ago? Since the mid-1980s, counseling center personnel have consistently perceived student clients as more distressed or reported acutely distressed clients as more prevalent than they did 1, 3, or 5 years ago. Only 3 studies employing a systematic, data-based methodology have addressed this question. Two researchers used different actuarial measures of the acuity or character of client pathology and concluded that current student clients are not more disturbed than were earlier ones. One researcher used clinical judgments rendered at the end of therapy and concluded that current students were more distressed. Using the Personality Assessment Inventory, the author found the actuarially determined quantitative and qualitative indices of pathology unchanged for 3,400 counseling center clients seen during 10 consecutive years. Over the same period, the use of medications increased fivefold. An actuarial measure of client distress appears crucial to both accurate diagnosis and treatment and to the adequate preparation of future counseling center professionals.
In 1997, the Harvard School of Public Health College Alcohol Study resurveyed colleges that participated in a 1993 study. The findings revealed little change in binge drinking: a slight decrease in percentage of binge drinkers and slight increases in percentages of abstainers and frequent binge drinkers. Two of 5 students were binge drinkers (42.7%); 1 in 5 (19.0%) was an abstainer, and 1 in 5 was a frequent binge drinker (20.7%). As was true in 1993, 4 of 5 residents of fraternities or sororities were binge drinkers (81.1%). Asian students showed a greater increase and White students a greater decrease in binge drinking from 1993 to 1997, compared with all other students. Among students who drank alcohol, increases in frequency of drinking; drunkenness; drinking to get drunk; and alcohol-related problems, including drinking and driving, were reported. Binge drinkers in both 1993 and 1997 were at increased risk of alcohol-related problems, and nonbingers at colleges with high binge drinking rates had increased risks of encountering secondhand effects of binge drinking.
The 2001 Harvard School of Public Health College Alcohol Study surveyed students at 119 4-year colleges that participated in the 1993, 1997, and 1999 studies. Responses in the 4 survey years were compared to determine trends in heavy alcohol use, alcohol-related problems, and encounters with college and community prevention efforts. In 2001, approximately 2 in 5 (44.4%) college students reported binge drinking, a rate almost identical to rates in the previous 3 surveys. Very little change in overall binge drinking occurred at the individual college level. The percentages of abstainers and frequent binge drinkers increased, a polarization of drinking behavior first noted in 1997. A sharp rise in frequent binge drinking was noted among students attending all-women's colleges. Other significant changes included increases in immoderate drinking and harm among drinkers. More students lived in substance-free housing and encountered college educational efforts and sanctions resulting from their alcohol use.
The authors examined changes in college students' illicit drug use, patterns of polydrug use, and the relationship between students' ages of initiation of substance use and later use of marijuana and other illicit drugs between 1993 and 2001. Data from 119 US colleges and universities in the Harvard School of Public Health College Alcohol Study were used in the study. They found significant increases in percentages of students' use of marijuana in the past 30 days (from 13% to 17%), past year (from 23% to 30%), and lifetime (from 41% to 47%) between 1993 and 2001, with most of the increase occurring between 1993 and 1997. Past 30-day use of other illicit drugs increased from 4% to 7% and past year use increased from 11% to 14%. More than 98% of marijuana and other illicit drug users used another substance. They also either smoked, were binge drinkers, and/or were users of another illicit drug. Drug prevention programs should emphasize heavy alcohol use and smoking and should start when students are in high school or earlier.
Results from the 1995 National College Health Risk Behavior Survey, which monitored health risk behaviors among US college and university undergraduates, suggest that many students' behaviors increase their likelihood of adverse health outcomes. During the 30 days preceding the survey, 34% of the participants had consumed five or more alcoholic drinks on at least one occasion, and 27% had drunk alcohol and driven a car. Thirty-one percent had smoked cigarettes regularly during their lifetimes, 49% had ever used marijuana, 30% had used a condom during their last sexual intercourse, 21% were overweight, and 38% had participated in vigorous physical activity on 3 or more of the 7 days preceding the survey. These data were analyzed by gender, age group, race and ethnicity, and institution type. They can be used by those responsible for the health and education of college students to reduce risks associated with the leading causes of mortality and morbidity.
For a study of elevated psychological distress, the authors used data based on a national probability sample of 7,800 Canadian undergraduate students from 16 universities. They used the 12-item General Health Questionnaire to assess mental health. Thirty percent of the students in the sample reported elevated psychological distress, which varied significantly according to sex, region, year of study, and recreational and academic orientation. Rates of elevated distress were significantly higher among the students than among the general population in Canada.
The authors assessed the stability of diet and physical activity and their relationship to weight changes in first-year university women.
They collected anthropometric and body composition data from 101 resident women at the beginning of their first year of college and again at 12 months. The authors obtained physical activity and dietary logs 4 times throughout the year.
Caloric intake decreased over 12 months in all participants (p = .01). There was little change in physical activity in participants who lost weight (p = .73, d = .18). Those who gained weight experienced a trend toward decreased physical activity (p = .13, d = .38). A significant Time X Group interaction on physical activity (p = .04) suggests that physical activity patterns differed substantially between individuals who gained weight and those who lost weight.
Reduction in physical activity appears to be the defining characteristic in freshman weight gain.
First-year college students were surveyed by telephone to determine their current level of tobacco use and find out what advice they had previously received from physicians regarding tobacco products. Current tobacco use reported in this 1st-year population was 19% in men and 17% in women. Although 99.6% of the students reported having had a medical visit within the last 5 years and 89% reported a visit within the past 12 months, only 26% remembered being asked at the last visit about their use of tobacco. Women were significantly more likely than men to have been asked about tobacco (31% compared with 21%), perhaps because of oral contraceptive counseling and the women's medical history. It appeared that healthcare providers are not fully using the opportunities available to them to educate young adults about using tobacco.
The US Centers for Disease Control and Prevention developed the Youth Risk Behavior Survey to measure the health risk behavior of the nation's high school students and to measure progress toward meeting the national health objectives for the year 2000. The survey was adapted for college students and pilot tested in spring 1993 in 18 4-year public and private colleges in New Jersey. In this article, the authors summarize results from this survey regarding unmarried respondents' risk behavior, including sexual behavior, use of alcohol, drugs, and tobacco, and behaviors that may lead to intentional and unintentional injuries. These findings, when compared with the relevant national health objectives, suggest that New Jersey college students will meet the health objectives regarding tobacco and cocaine use but will not meet national targets set for condom and birth control use, alcohol and marijuana use, and seatbelt and bicycle helmet use.
Beginning in 1985, an ACHA task force studied national health objectives to determine how well colleges and universities were achieving nationally defined health goals. The task force found that the college-aged population was not specifically recognized as a concern among health planners and that little consistent data on the health status of students existed. The task force worked closely with federal agencies in identifying relevant issues and focusing on the higher education community's commitment to disease promotion and positive health behaviors.
The Student Health Services at Academic Medical Centers group has been aware since its inception in 1997 of the need for standards for health science schools in dealing with the issue of the student infected with a blood-borne pathogen. In view of the absence of such standards, the group organized a small task force of individuals from several student health services at academic medical centers and from key public and private organizations to develop recommendations for institutional responses to the health science student infected with a blood-bome pathogen. This article reviews the current status of relevant position statements of state medical boards, certain professional organizations, and other English-speaking countries, and reviews current literature. A discussion of ethical considerations of the task force's recommendations precedes the specific recommendations, which are divided into four sections: disclosure issues, testing issues, exposure management, and curriculum modification and prevention.
College and university health centers are facing a dynamic era of change. In fact, change is the constant that permeates the organization. The one essential ingredient to dealing most effectively with change is to have a clearly defined mission. The author outlines a seven-step process that can be used by college and university health center personnel to create, reaffirm, and/or revise their mission statements, which serve as a beacon for decision making, organizational culture, and responsible action.
College and university administrators have expressed concern that adoption of tobacco-free policies may reduce applications and enrollment. This study examines adoption and implementation of 100% tobacco-free campus policies by institutions of higher education on applications and enrollment.
North Carolina private colleges and universities and public community colleges. Analysis was conducted in 2011.
Student enrollment and application data were analyzed by campus type to determine (a) if there was a difference in student applications and enrollment before and after policy implementation, and (b) if there was a difference in student applications and enrollment for campuses with versus without a policy.
No significant differences were found in student enrollment or applications when comparing years prior to and following policy implementation or when comparing with institutions without 100% tobacco-free campus policies.
The authors found no evidence that 100% tobacco-free policy adoption had an impact on student enrollment or applications.
This study examined alcohol consumption patterns and trends at a public university in the Northeast from 2002 to 2008.
Stratified random sampling was used to select undergraduate students enrolled in courses during spring semesters in 2002, 2004, 2006, and 2008.
Data were collected during regularly scheduled classes for 4 measures of alcohol consumption and 5 demographic categories using the Core Alcohol and Drug Survey.
Four groups showed significant increases in both frequency and volume of alcohol consumption-students who were female, over 21 years of age or over, living off-campus, or performing well academically. There were no decreasing trends for any demographic group. These results differ from national college health surveys, which have shown alcohol use remaining steady during this period.
Campus-specific trend data can provide unique perspectives and guide programming efforts. These trends suggest a need for new intervention strategies on this campus.
The United States experienced a shortage of influenza vaccine for the 2004--2005 influenza season. The authors surveyed college health programs to determine whether they had targeted vaccine to priority groups and knew how to reallocate remaining vaccine. They used an electronic message to distribute a Web-based survey to the members of 3 college-affiliated organizations--the Association of American Colleges and Universities, American Association of Community Colleges, American College Health Association--and to subscribers of the Student Health Service Listserv. They received 434 completed surveys. Sixty percent (259) of the respondents stated they had received vaccine and planned to vaccinate their high-risk students, staff, and faculty members; 77% (198) planned to reallocate leftover vaccine. Given the potential for future disruptions of the influenza vaccine supply, the authors recommend that college health programs establish policies to identify members of their high-risk population and also consider providing the live attenuated influenza virus vaccine.
The authors measured factors associated with under-treatment of medical students' depression. They administered a cross-sectional Beck Depression Inventory and sociodemographic questionnaire to students at 1 medical school, defining their outcome measure as the use of counseling services or antidepressant medication. Of an estimated 450 available student participants in the study, 322 (71.6%) completed the questionnaire. Forty-nine students (15.2%) were classified as depressed and 10 (20.4%) reported experiencing suicidal ideation during medical school, but only 13 (26.5%) of the depressed students reported treatment. The researchers observed no difference in treatment by year in school, completion of psychiatric requirement, race, or depression severity. Treatment for depression was significantly associated with older age and personal and family histories of depression. Despite the availability of effective medications and confidential mental health services, medical students with depression are undertreated. The authors' findings support the need for targeted messages to help medical students recognize their depression and refer themselves for appropriate treatment.
The authors describe the cervical cytology and sexually transmitted infection (STI) testing patterns of US college health centers.
A total of 128 self-selected US college health centers-representing more than 2 million college students-completed an online survey during February and March 2007.
Almost 13% of cervical cytology results were abnormal; most of these were atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions. In women, 2.9% of chlamydia tests and 0.4% of gonorrhea tests were positive. Human immunodeficiency virus (HIV) and syphilis tests were positive in 0.1% and 0.3% of students tested, respectively. Herpes simplex virus type 1 (HSV-1) accounted for 59.9% of genital herpes infections.
College health centers are important sources for Pap and STI test data. Pap tests frequently yield low-grade abnormalities, and screening tests for chlamydia and especially gonorrhea are infrequently positive. Rates of HIV and syphilis in this population are low, raising concerns about positive predictive value when screening low-risk students. A majority of genital herpes infections are caused by HSV-1.